Paramedic Papers Daily — 12 November 2026

Eight new papers today — here are the top four. Paper one — in a mature US prehospital whole-blood program, paediatric transfusions were almost all penetrating trauma, and half the children survived. Paper two — risk scores built from twenty-seven thousand paediatric cardiac arrests sort survival odds from three per cent to forty-eight. Paper three — South African out-of-hospital rapid sequence intubation is mostly trauma, with ketamine in three quarters of cases. Paper four — a meta-analysis finds just over six per cent of first responders show hepatitis B infection.

Paper one — Prehospital Emergency Care. A retrospective cohort from San Antonio's fire department ambulance service, describing seventy-three children who received prehospital whole blood, out of seventeen hundred and three total transfusions between twenty eighteen and twenty twenty-five. Trauma accounted for ninety-six per cent of the paediatric transfusions, and gunshot wounds for seventy-four. Forty-five per cent had an elevated age-adjusted shock index on the first available vitals, and twenty per cent were pulseless before any calculation was possible. Survival to discharge was fifty per cent — thirty-nine per cent died, and eleven per cent are unknown. The detail that jumps out is the age split: toddlers and young children showed the biggest drop in shock index after resuscitation, suggesting younger kids respond physiologically once blood goes in. The caveat — this is a single program's descriptive data with no comparator group, so it tells you who got blood, not whether blood beat the alternatives. Prehospital blood is still limited to a few Australian services, so this informs the debate more than current practice — but paediatric trauma physiology doesn't change at the border.

Paper two — The American Journal of Emergency Medicine. A registry study of twenty-six thousand eight hundred and ninety-five paediatric out-of-hospital cardiac arrests from a US national database, covering twenty thirteen to twenty twenty-three. Overall, twenty-eight per cent survived to hospital admission and twelve per cent to discharge. The researchers built three risk scores — one each for infants, preschool and school-age children, and adolescents — from variables crews already record: arrest location, witness status, cause of arrest, bystander CPR, AED use and first rhythm. The scores sorted children into low, moderate and high survival groups with respectable discrimination, and the spread was wide — average survival ran from three per cent in the lowest group to forty-eight per cent in the highest among adolescents. One caveat — internal validation only. Nobody has tested these prospectively at the bedside, so for now they're research and quality-monitoring tools, not triage rules for crews.

Paper three — BMC Emergency Medicine. A retrospective review of three hundred and fifty-four out-of-hospital rapid sequence intubations performed by advanced emergency care practitioners across three South African provinces, screened from more than half a million patient records. Trauma drove two-thirds of the intubations. Ketamine was documented in seventy-five per cent of cases, rocuronium in just over half. The process measures were mostly solid — pre-oxygenation in ninety-nine per cent, end-tidal carbon dioxide monitoring in eighty-four — but post-intubation sedation or analgesia was only documented in seventy-two per cent. Ketamine is standard kit across Australian services; rocuronium isn't — some carry it, some don't. The caveat is documentation itself: a retrospective record review undercounts whatever wasn't written down, including adverse events.

Paper four — also Prehospital Emergency Care. A systematic review and meta-analysis pooling twenty-two studies and nineteen thousand one hundred and eighty-eight first responders — paramedics and emergency medical technicians, but also police and firefighters. Pooled hepatitis B prevalence was six point two per cent, hepatitis C one point eight, and MRSA colonisation about four per cent. COVID among unvaccinated staff came in at thirteen point six per cent, dropping to seven point three once high-bias studies were excluded. Those numbers carry big caveats — the heterogeneity across studies was very high, and mixing occupations muddies the pooled estimates. But the direction is clear: prehospital work means uncontrolled exposure to blood and body fluids, and this is the evidence base behind the vaccination requirements, PPE and infection-control protocols Australian crews already work under.

Quick recap. One — paediatric whole blood in a US program goes overwhelmingly to penetrating trauma, and half of these children survive. Two — risk scores from twenty-seven thousand paediatric arrests predict survival anywhere from three to forty-eight per cent. Three — South African out-of-hospital RSI is two-thirds trauma, with ketamine the usual induction agent. Four — roughly one in sixteen first responders shows hepatitis B infection.

Four more on the dashboard today, including longer collapse-to-contact times linked with ROSC, and emergency transport in remote Indigenous communities. That's the roundup for Thursday the twelfth of November. Back tomorrow.