Sebastian Schnaubelt
Enrico Baldi
Mario Krammel
Patrick Sulzgruber- 1Emergency Medical Service, Vienna, Austria
- 2Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria
- 3PULS – Austrian Cardiac Arrest Awareness Association, Vienna, Austria
- 4Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- 5Cardiac Arrest and Resuscitation Science Research Team, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- 6Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
Editorial on the Research Topic
Prehospital emergency medicine: challenges and opportunities
Emergency medical care provided before hospital arrival depends on functioning emergency medical services (EMS) and covers a wide range of medical and organizational topics (1). No matter whether a system is physician-, nurse-, or purely paramedic-based or whether it more follows an Anglo-American or Franco-German style (2), the ultimate goal of a system that saves lives is to strive for excellency. A skill transfer including (non-)invasive techniques and novel technologies from the in- to the pre-hospital setting has in recent years been increasingly shown to improve the quality of care and, subsequently, outcomes. Successful examples include blood gas analysis, point-of-care ultrasound, and video laryngoscopy (3–5). To further advance these endeavors, research is not only a factor of pre-hospital medicine that is “nice to have” but a definitive necessity (1, 6). Concepts such as research units have in the past been shown to be productive solutions, but research can also be integrated into the everyday EMS work routine. However, several challenges have emerged in this context, for instance adapting clinical research methodology to the pre-hospital setting. Limited resources and EMS organizations not being a traditional part of academia pose further barriers (6, 7).
The Research Topic we hereby present aims at showcasing the progress made across the wide variability of prehospital emergency medicine.
Education
Armijo-Rivera et al. present a study on the Team Emergency Assessment Measurement (TEAM) and its novel Spanish version's applicability in Chile. TEAM assesses non-technical performance as a self-reporting tool. This was found to be feasible and highlights the possibility to apply scoring systems in different populations. Izquierdo-Condoy et al. took one step further and assessed the preparedness and proficiency of life support. Included nursing staff showed a relevant deficiency in theoretical basic and advanced life support knowledge. Even though performed with nursing staff, the assessment process via questionnaires is well-described and could also be conducted with pre-hospital personnel.
Trauma
Teuben et al. assess the impact of pre-hospital trauma life support (PHTLS®) course participation on altered self-confidence, communication, and routines in the treatment of severe trauma and included a mix of paramedics and emergency physicians. PHTLS® training was associated with improved self-confidence and enhanced communication, implying that pre-hospital personnel, and ultimately also patients, profit from standardized course involvement. Lin et al., on the other hand, investigate the more specific pathology of traumatic lung injury (TLI). In more than 100 TLI patients, the international standardized ratio (INR) was identified as a marker for poor prognosis and was suggested as an early warning indicator—a factor that could be taken into account in future thoughts about point-of-care testing in the pre-hospital setting.
Cardiopulmonary resuscitation
Skrisovska et al. conduct a simulation study to assess the efficacy of ventilation during pediatric cardiopulmonary resuscitation (CPR). Both healthcare professionals (using bag-valve-mask ventilation) and lay rescuers (using mouth-to-mouth ventilation) were included. Assisted by dispatchers, participants could deliver effective ventilation to pediatric manikins, underscoring the feasibility of current respective guidelines.
Ethics
Lemoyne et al. tackle a part of pre-hospital emergency medicine that has always been and increasingly will be of the utmost importance: nursing homes and their hospitalization approaches, in which a proportion of nursing home interventions and hospital transfers might be preventable. While this topic can be approached from an economic perspective, the EMS personnel's perceptions of the adequacy of emergency calls from nursing homes is potentially even more relevant. EMS staff reported that nursing home interventions were rarely necessary or indicated, and various key issues and potential solving strategies were identified.
Forecasting emergencies
Yang et al. took an unusual look at a part of pre-hospital care that is often underrepresented in literature: maritime emergency medicine. Due to the extremely limited resources in this setting, emergency forecasting models could potentially help organize underlying systems. Managed maritime emergency cases were analyzed, and various models were assessed to forecast emergencies. According to the authors, this could be a steppingstone in facilitating the development of effective prevention and control strategies.
To conclude, it is of the utmost importance to further promote pre-hospital research in various resource settings and environments. Especially against a background of emerging pre-hospital care in low-resource settings and the adjacent challenges (8, 9), novel strategies of evidence gathering, evidence synthesis, and the implementation of evidence-based approaches in pre-hospital emergency medicine will remain a “hot topic” for quite some time.
Author contributions
SS: Conceptualization, Project administration, Supervision, Writing – original draft, Writing – review & editing. EB: Conceptualization, Writing – original draft, Writing – review & editing. MK: Conceptualization, Writing – original draft, Writing – review & editing. PS: Conceptualization, Writing – original draft, Writing – review & editing.
Conflict of interest
SS is associated with the International Liaison Committee on Resuscitation (ILCOR), the European Resuscitation Council (ERC), and the Austrian Resuscitation Council (ARC). EB is associated with ILCOR, the ERC, and the European Society of Cardiology (ESC). PS is associated with the ESC.
The remaining author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision.
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References
1. Wilson MH, Habig K, Wright C, Hughes A, Davies G, Imray CHE. Pre-hospital emergency medicine. Lancet. (2015) 386:2526–34. doi: 10.1016/S0140-6736(15)00985-X
2. Dick WF. Anglo-American vs. Franco-German emergency medical services system. Prehosp Disaster Med. (2003) 18:29–35; discussion 35–7. doi: 10.1017/S1049023X00000650
3. Rief M, Eichinger M, Eichlseder M, Pichler A, Prause G, Bornemann-Cimenti H, et al. Utilization of multi-parameter blood gas analysis in prehospital emergency medicine-a scoping review. J Emerg Med. (2024) 67:e277–87. doi: 10.1016/j.jemermed.2024.04.014
4. Michels G, Greim CA, Krohn A, Ott M, Feuerstein D, Möckel M, et al. Recommendations for Education in Sonography in Prehospital Emergency Medicine (pPOCUS): Consensus paper of DGINA, DGAI, BAND, BV-ÄLRD, DGU, DIVI and DGIIN. Med Klin Intensivmed Notfmed. (2023) 118:39–46. doi: 10.1007/s00063-023-01054-3
5. Steel A, Haldane C, Cody D. Impact of videolaryngoscopy introduction into prehospital emergency medicine practice: a quality improvement project. Emerg Med J. (2021) 38:549–55. doi: 10.1136/emermed-2020-209944
6. Cimino J, Braun C. Clinical research in prehospital care: current and future challenges. Clin Pract. (2023) 13:1266–85. doi: 10.3390/clinpract13050114
7. Mueller M, Losert H, Sterz F, Gelbenegger G, Girsa M, Gatterbauer M, et al. Prehospital emergency medicine research by additional teams on scene – Concepts and lessons learned. Resusc Plus. (2023) 16:100494. doi: 10.1016/j.resplu.2023.100494
8. Burkholder TW, Osei-Ampofo M, Bonney J. Governance and legal considerations supporting prehospital emergency care in low and middle-income countries-For the Special Series on Prehospital Care in LMICs. Surgery. (2024) 176:968–71. doi: 10.1016/j.surg.2024.05.029
Keywords: emergency medicine, emergency medical service (EMS), ambulance, prehospital/EMS, emergency care
Citation: Schnaubelt S, Baldi E, Krammel M and Sulzgruber P (2024) Editorial: Prehospital emergency medicine: challenges and opportunities. Front. Med. 11:1518523. doi: 10.3389/fmed.2024.1518523
Received: 28 October 2024; Accepted: 05 November 2024;
Published: 14 November 2024.
Edited and reviewed by: Lynn Valerie Monrouxe, The University of Sydney, Australia
Copyright © 2024 Schnaubelt, Baldi, Krammel and Sulzgruber. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Sebastian Schnaubelt, sebastian.schnaubelt@muv.ac.at