Paramedic Papers Daily — 6 November 2026

Nine new papers today — here are the top four. Paper one — the twenty twenty-six ILCOR resuscitation consensus is out, the international evidence review behind resuscitation guidelines worldwide. Paper two — a large US dataset finds bystander naloxone before ambulance arrival linked to fewer repeat doses and fewer transports. Paper three — an Australian trauma centre rolled out a physiology-based pathway for traumatic shock, and staff rate it highly. Paper four — long-term follow-up of cardiac arrest survivors treated with ECPR shows survival mostly confined to good neurological recovery, but quality of life holding up.

Paper one — Resuscitation. The twenty twenty-six ILCOR Consensus on Science with Treatment Recommendations, from one hundred and ninety-one authors across six task forces, covering basic, advanced, paediatric and neonatal life support, education and teams, and first aid. This is the international evidence review that Australian and New Zealand resuscitation guidelines are built on — so whatever changes land here flow into the guidelines crews work under over the coming cycle. The catch: the abstract isn't available yet, so the detail of what actually changed still needs assessing. Worth watching rather than actioning today.

Paper two — Drug and Alcohol Dependence. A cross-sectional analysis of just over twenty-six thousand ambulance activations for opioid overdose in the United States. In about thirty per cent of cases, naloxone had been given by a layperson — a family member or bystander — before crews arrived. Those cases needed less ambulance naloxone afterwards, twenty-four per cent versus thirty-five, and were less likely to end in transport, seventy-nine versus eighty-four per cent. Cardiac arrest and advanced airway attempts were uncommon in both groups. Naloxone is standard kit across Australian services and take-home naloxone programs run here too, so the pattern is directly relevant. The caveat — it's registry data, and we can't tell whether the lower transport rate reflects genuine recovery or people declining transport after reversal. That second possibility is exactly what crews worry about.

Paper three — Emergency Medicine Australasia. A single-centre quality-improvement project at an Australian Level One trauma centre, covering three thousand six hundred and sixty-seven major trauma patients. About nine per cent met criteria for traumatic shock using simple physiology — a systolic pressure of ninety or below, a shock index above one, prehospital blood, or senior clinician concern. Those patients were younger, more severely injured, and died in the department far more often — nearly seven per cent versus under half a per cent. The pathway standardised activation, pre-arrival preparation, equipment and team roles, and favourable staff ratings of trauma bay equipment jumped from about a quarter to eighty-seven per cent. But the evaluation was staff experience only — no clinical outcomes were assessed. One activation trigger worth noting: prehospital blood is still limited to a few Australian services — most don't carry it.

Paper four — Resuscitation Plus. A single-centre cohort from Italy following adults given extracorporeal CPR — ECPR — for refractory out-of-hospital cardiac arrest. Of four hundred and six treated patients, sixty-three — sixteen per cent — survived to discharge. At a median follow-up around three years, sixty-one per cent of those were still alive, and eighty-two per cent of survivors had favourable neurological outcome. Only about two per cent of all treated patients were alive with poor neurology — long-term survival was largely confined to good recovery. Quality of life was preserved, but mild cognitive impairment showed up in a third of the survivors assessed, poor sleep in more than half, and anxiety symptoms were more common in caregivers than in survivors. ECPR is a hospital-initiated therapy, not something Australian ambulances deliver — but these are the outcomes behind the recovery conversations crews have with families. Only seventeen survivors were formally assessed, so treat it as hypothesis-generating.

Quick recap. One — the twenty twenty-six ILCOR consensus is published; the detail of what changed is still to be assessed. Two — layperson naloxone before crews arrive meant less ambulance naloxone and fewer transports across twenty-six thousand US overdoses. Three — an Australian physiology-based shock pathway lifted staff ratings dramatically, though clinical outcomes weren't measured. Four — ECPR survivors mostly had good neurological recovery, with cognition and sleep the lingering problems.

That's the roundup for Friday the sixth of November. Five more on the dashboard today, including a first consensus on TBI in first responders and FAST done in a moving ambulance. Back tomorrow.