ETCO2
Level |
Direction |
Primary Outcome |
Patient/Process |
Setting |
Reference |
II
|
Supportive (Green)
|
ETCO2 to predict future care needs
|
Patient
|
PH-Paramedic
|
BR W, Bruno J, Duckwitz M, Akers N, Jeanmonod D, Jeanmonod R. Prehospital end-tidal CO2 as an early marker for transfusion requirement in trauma patients. Am J Emerg Med 2021; 45:254–7. Medline
|
II
|
Supportive (Green)
|
All cause mortality
|
Patient
|
PH-Paramedic
|
Bryant MK, Portelli Tremont JN, Patel Z, Cook N, Udekwu P, Reid T, et al. Low initial pre-hospital end-tidal carbon dioxide predicts inferior clinical outcomes in trauma patients. Injury 2021; 52(9):2502–7. Medline
|
II
|
Supportive (Green)
|
Mortality
|
Patient
|
PH-Paramedic
|
Campion EM, Cralley A, Sauaia A, Buchheit RC, Brown AT, Spalding MC, et al. Prehospital end-tidal carbon dioxide is predictive of death and massive transfusion in injured patients: An Eastern Association for Surgery of Trauma multicenter trial. J Trauma Acute Care Surg 2022; 92(2):355–61. Medline
|
II
|
Supportive (Green)
|
Prognostication of mortality
|
Patient
|
ED-Paramedic & MD
|
Childress K., Arnold K., Hunter C., Ralls G., Papa L., Silvestri S. Prehospital End-tidal Carbon Dioxide Predicts Mortality in Trauma Patients. PEC; 22(2) 170-4. Medline
|
II
|
Supportive (Green)
|
mortality
|
Patient
|
PH-MD & CCT
|
Willis RG, Cunningham KW, Troia PA, Gutierrez AS, Christmas AB, Brintzenhoff R, Sing RF. Prehospital End-Tidal CO(2): A Superior Marker for Mortality Risk in the Acutely Injured Patient. Am Surg 2021; 31348211023401. Medline
|
II
|
Supportive (Green)
|
Need for transfusion
|
Patient
|
PH-Paramedic & MD
|
Wilson BR, Bruno J, Duckwitz M, Akers N, Jeanmonod D, Jeanmonod R. Prehospital end-tidal CO2 as an early marker for transfusion requirement in trauma patients. Am J Emerg Med 2020. Medline
|
Fentanyl
Level |
Direction |
Primary Outcome |
Patient/Process |
Setting |
Reference |
I
|
Supportive (Green)
|
Reduction in pain
|
Patient
|
ED-MD
|
Farahmand S., Shiralizadeh S., Talebian MT., et al. Nebulized fentanyl vs intravenous morphine for ED patients with acute limb pain: A randomized clinical trial. Am J Emerg Med 2014; 32(9):1011-5. Medline
|
I
|
Supportive (Green)
|
Pain relief using the visual analog scale score
|
Patient
|
PH-Paramedic
|
Galinski M., et al. A randomized double-blind study comparing morphine with fentanyl in prehospital analgesia. Am J Emerg Med 2005; 23:114-9. Medline
|
I
|
Supportive (Green)
|
Pain relief
|
Patient
|
|
Niemi-Murola L., Unkuri J., Hamunen K. Parenteral opioids in emergency medicine - A systematic review of efficacy and safety. Scandinavian journal of pain 2017; 2(4):187-94. Medline
|
I
|
Supportive (Green)
|
Pain score reduction
|
Patient
|
ED-MD
|
Shear ML., Adler JN., Shewakramani S., et al. Transbuccal fentanyl for rapid relief of orthopedic pain in the ED. Am J Emerg Med 2010; 28(8):847-852. Medline
|
II
|
Supportive (Green)
|
Change in pain score
|
Patient
|
|
Bronsky E.S., Koola C., Orlando A., Redmond D., D'Huyvetter C., Sieracki H., Tanner II A., Fowler R., Mains C., Bar-Or D., Intravenous Low-Dose Ketamine Provides Greater Pain Control Compared to Fentanyl in a Civilian Prehospital Trauma System: A Propensity Matched Analysis, 2019; Prehospital Emergency Care, 23:1, 1-8, DOI: 10.1080/10903127.2018.1469704 Medline
|
II
|
Neutral (Yellow)
|
Adverse events
|
Patient
|
ED-MD
|
Bible L, Obaid O, Khurrum M, Goh M, Hammad A, Kitts DJ, et al. Pre-Hospital Administration of Opioids in Trauma Patients: Is Dose Associated With Outcomes? J Surg Res 2021; 268:634–42. Medline
|
III
|
Supportive (Green)
|
Pain relief (NRS or VAS)
|
Patient
|
PH-Paramedic
|
Dijkstra BM., Berben SA., van Dongen RT., Schoonhoven L. Review on pharmacological pain management in trauma patients in (pre-hospital) emergency medicine in the Netherlands. Eur J Pain 2013; 18(1):3-19. Medline
|
III
|
Supportive (Green)
|
Pain rating using NRS
|
Patient
|
|
Frakes MA., Lord WR., Kociszewski C., Wedel SK. Efficacy of fentanyl analgesia for trauma in critical care transport. Am J Emerg Med 2006; 24(3):286-9. Medline
|
III
|
Supportive (Green)
|
Pain Relief
|
Patient
|
PH-Paramedic
|
Park CL., Roberts DE., Aldington DJ., Moore RA. Prehospital analgesia: systematic review of evidence. J R Army Med Corps 2010; 156(4 S1):295-300. Medline
|
III
|
Supportive (Green)
|
Analgesia
|
Patient
|
PH-Paramedic
|
Rickard C., et al. A RCT of intranasal fentanyl vs intravenous morphine for analgesia in the prehospital setting. Am J Emerg Med 2007; 25:911-7. Medline
|
X
|
Not Yet Graded (White)
|
-
|
Patient
|
|
Soriya GC., McVaney KE., Liao MM., et al. Safety of prehospital intravenous fentanyl for adult trauma patients. J Trauma Acute Care Surg 2012; 72(3):755-759. Medline
|
HEMS
Level |
Direction |
Primary Outcome |
Patient/Process |
Setting |
Reference |
I
|
Supportive (Green)
|
Mortality
|
Patient
|
PH-MD & CCT
|
Schoenfeld D, Thomas CE, McCartin MP, Blumen IJ, Galvagno SM Jr, Thomas SH. Natural Experiment Outcomes Studies in Rotor Wing Air Medical Transport: Systematic Review and Meta-Analysis of Before-and-After and Helicopter-Unavailable Publications From 1970 to 2022. Air Med J. March 2024; 43(2):124-32. Medline
|
II
|
Supportive (Green)
|
Survival
|
Patient
|
PH-Paramedic
|
Brown JB., Gestring ML., Guyette FX., et al. Helicopter transport improves survival following injury in the absence of a time-saving advantage. Surgery. 2016;159(3):947-59. Medline
|
II
|
Supportive (Green)
|
Survival
|
Patient
|
PH-Paramedic
|
Brown JB., Gestring ML., Stassen NA., et al. Geographic variation in outcome benefits of helicopter transport for trauma in the united states: A retrospective cohort study. Ann Surg. 2016;263(2):406-12. Medline
|
II
|
Supportive (Green)
|
Survival
|
Process
|
ED-Paramedic & CCP
|
Deeb AP, Teng CY, Peitzman AB, Billiar TR, et al. Direct Trauma Center Access by Helicopter Emergency Medical Services is Associated With Improved Survival After Severe Injury. Ann Surg October 2023; 278(4):e840-7. Medline
|
II
|
Supportive (Green)
|
Survival
|
Patient
|
PH-MD & CCT
|
Frankema SP, Ringburg AN, Steyerberg EW, Edwards MJ, Schipper IB, van Vugt AB. Beneficial effect of helicopter emergency medical services on survival of severely injured patients. Br J Surg. 2004 Nov;91(11):1520-6. doi: 10.1002/bjs.4756. PMID: 15455361. Medline
|
II
|
Supportive (Green)
|
Survival
|
Patient
|
PH-Paramedic & CCT
|
Fritz CL, Thomas SA, Galvagno SM Jr, Thomas SH. Survival Benefit of Helicopter Scene Response for Patients with an Injury Severity Score of at Least Nine: A Systematic Review and Meta-Analysis. Prehosp Emerg Care July 2023; 1-10. Medline
|
II
|
Supportive (Green)
|
Survival
|
Patient
|
|
Giannakopoulos GF., Kolodzinskyi MN., Christiaans HM., et al. Helicopter emergency medical services save lives: Outcome in a cohort of 1073 polytraumatized patients. Eur J Emerg Med 2013; 20(2):79-85. Medline
|
II
|
Supportive (Green)
|
Mortality
|
Patient
|
Other
|
Haas B, Stukel TA, Gomez D, Zagorski B, De Mestral C, Sharma SV, Rubenfeld GD, Nathens AB. The mortality benefit of direct trauma center transport in a regional trauma system: a population-based analysis. J Trauma Acute Care Surg. 2012 Jun;72(6):1510-5; discussion 1515-7. doi: 10.1097/TA.0b013e318252510a. PMID: 22695414. Medline
|
II
|
Supportive (Green)
|
Time saved
|
Process
|
Other
|
JY J, WK K, Roh H, JH M, JS H, YJ K, et al. Time-saving effects using helicopter transportation: comparison to a ground transportation time predicted using a social navigation software. Med 2021; 100(27):e26569. Medline
|
II
|
Supportive (Green)
|
Survival
|
Patient
|
PH-Paramedic & MD
|
Kushida Y, Jitsuiki K, KI M, Ikegami S, Nagasawa H, Takeuchi I, et al. A comparison of physician-staffed helicopters and ground ambulances transport for the outcome of severe thoracic trauma patients. Am J Emerg Med 2021; 45:358–60. Medline
|
II
|
Supportive (Green)
|
Mortality
|
Process
|
Other
|
Maddry JK., Mora AG., Savell S., Reeves LK., Perez CA., Bebarta VS. Combat MEDEVAC: A comparison of care by provider type for en route trauma care in theater and 30-day patient outcomes. The journal of trauma and acute care surgery. 2016;81(5):S104-S110. Medline
|
II
|
Supportive (Green)
|
Time to care
|
Process
|
PH-Paramedic
|
MR B, Iora P, AC D, RDL F, CER F, MDB C, et al. Helicopter Transportation of Brazilian Trauma Patients: A Comparison of Times to Care. Air Med J 2021; 40(4):259–63. Medline
|
II
|
Supportive (Green)
|
Survival to discharge
|
Patient
|
PH-MD & CCT
|
Oppe S, De Charro FT. The effect of medical care by a helicopter trauma team on the probability of survival and the quality of life of hospitalised victims. Accid Anal Prev. 2001 Jan;33(1):129-38. doi: 10.1016/s0001-4575(00)00023-3. PMID: 11189116. Medline
|
II
|
Supportive (Green)
|
6 month neurological outcome
|
Patient
|
PH-Paramedic & MD
|
Pakkanen T., Kamarainen A., Huhtala H., Silfvast T., Nurmi J., Virkkunen I., et al. Physician-staffed helicopter emergency medical service has a beneficial impact on the incidence of prehospital hypoxia and secured airways on patients with severe traumatic brain injury. Scandinavian journal of trauma, resuscitation and emergency medicine 2017; 25(1) 94. Medline
|
II
|
Supportive (Green)
|
mortality
|
Patient
|
PH-Paramedic
|
Pham H., Puckett Y., Dissanaike S. Faster on-scene times associated with decreased mortality in Helicopter Emergency Medical Services (HEMS) transported trauma patients. Trauma surgery & acute care open 2017; 2(1) e000122. Medline
|
II
|
Supportive (Green)
|
Survival
|
Patient
|
Other
|
Schneider AM, Ewing JA, Cull JD. Helicopter Transport of Trauma Patients Improves Survival Irrespective of Transport Time. Am Surg 2021; 87(4):538. Medline
|
II
|
Supportive (Green)
|
Mortality
|
Process
|
Other
|
Stewart K, Garwe T, Oluborode B, Sarwar Z, Albrecht RM. Association of Interfacility Helicopter versus Ground Ambulance Transport and in-Hospital Mortality among Trauma Patients. PEC 2020:1-9. Medline
|
II
|
Supportive (Green)
|
Mortality
|
Patient
|
In-Patient
|
Stewart K, Garwe T, Oluborode B, Sarwar Z, Albrecht RM. Association of Interfacility Helicopter versus Ground Ambulance Transport and in-Hospital Mortality among Trauma Patients. PEC 2020:1-9. Medline
|
II
|
Supportive (Green)
|
out of hospital time
|
Process
|
ED-Paramedic & MD
|
Stowell A, Bobbia X, Cheret J, Genre Grandpierre R, Moreau A, Pommet S, et al. Out-of-hospital Times Using Helicopters Versus Ground Services for Emergency Patients. Air Med J 2019; 38(2):100-5. Medline
|
II
|
Supportive (Green)
|
Inhospital Mortality
|
Patient
|
PH-Paramedic & CCT
|
Werman HA., Darbha S., Cudnik M., Caterino J. Do Trauma Patients Aged 55 and Older Benefit from Air Medical Transport? PEC; 21(4) 461-5. Medline
|
II
|
Neutral (Yellow)
|
Survival
|
Patient
|
|
Ahmed N. Survival of Trauma Victims Transported by Helicopter Who Required Cardiopulmonary Resuscitation Within the First Hour of Hospital Arrival. South Med J; 109(4):213-9. Medline
|
II
|
Neutral (Yellow)
|
1-year mortality
|
Patient
|
Other
|
Alstrup K, Rognås L, Sollid S, Johnsen SP, Valentin JB, Petersen JAK. Association of Helicopter vs Ground Emergency Medical Transportation With 1-Year Mortality in Denmark. JAMA Netw Open 2021; 4(1):e2033318. Medline
|
II
|
Neutral (Yellow)
|
In-hospital mortality.
|
Patient
|
|
Al-Thani H., El-Menyar A., Pillay Y., Mollazehi M., Mekkodathil A., Consunji R. Hospital Mortality Based on the Mode of Emergency Medical Services Transportation. Air Med J 2017; 36(4):188-92. Medline
|
II
|
Neutral (Yellow)
|
Survival
|
Patient
|
|
Buntman AJ., Yeomans KA. The effect of air medical transport on survival after trauma in johannesburg, south africa. S Afr Med J 2002; 92(10):807-11. Medline
|
II
|
Neutral (Yellow)
|
Patients requiring a procedure from a trauma surgeon or specialist within 1 hour of arrival
|
Patient
|
PH-Paramedic
|
Horwood CR, Ricci K, Sobol CG, Evans D, Eiferman D. Stop Flying the Patients! Evaluation of the Overutilization of Helicopter Transport of Trauma Patients. J Surg Res 2020; 256:290-4. Medline
|
II
|
Neutral (Yellow)
|
Mortality
|
Patient
|
PH-Paramedic & MD
|
Lapidus O, Rubenson Wahlin R, Bäckström D. Trauma patient transport to hospital using helicopter emergency medical services or road ambulance in Sweden: a comparison of survival and prehospital time intervals. Scand J Trauma Resusc Emerg Med 2023; 31(1):101. Medline
|
II
|
Neutral (Yellow)
|
Mortality
|
Patient
|
Other
|
Sborov KD, Gallagher KC, Medvecz AJ, Brywczynski J, Gunter OL, Guillamondegui OD, et al. Impact of a New Helicopter Base on Transport Time and Survival in a Rural Adult Trauma Population. J Surg Res 2020; 254:135-41. Medline
|
II
|
Neutral (Yellow)
|
Mortality
|
Patient
|
PH-Paramedic & MD
|
Tsuchiya A., Tsutsumi Y., Yasunaga H. Outcomes after helicopter versus ground emergency medical services for major trauma--propensity score and instrumental variable analyses: A retrospective nationwide cohort study. Scandinavian journal of trauma, resuscitation and emergency medicine. 2016;24(1):140. Medline
|
III
|
Supportive (Green)
|
Hospital resource utilization, ICU admission, mortality
|
Patient
|
PH-MD & CCT
|
Sebastian C., Collopy K., Clancy TV., Acquista E. Analysis of Helicopter-Transported Trauma Patients at a Regional Trauma Center. Am Surg 2018; 84(6) 952-8. Medline
|
III
|
Neutral (Yellow)
|
Mortality
|
Patient
|
PH-Paramedic & CCT
|
Björkman J, Laukkanen-Nevala P, Olkinuora A, Pulkkinen I, Nurmi J. Short-term and long-term survival in critical patients treated by helicopter emergency medical services in Finland: a registry study of 36 715 patients. BMJ Open 2021; 11(2):e045642. Medline
|
III
|
Neutral (Yellow)
|
Description of interventions performed
|
Process
|
PH-Paramedic & MD
|
Boyd LR, Borawski J, Lairet J, Limkakeng AT Jr. Critical Care Air Transport Team severe traumatic brain injury short-term outcomes during flight for Operation Iraqi Freedom/Operation Enduring Freedom. J R Army Med Corps. 2017;163(5):342–346. Medline
|
III
|
Neutral (Yellow)
|
Percentage of patients requiring intervention
|
Patient
|
PH-MD & CCT
|
Gavrilovski M, Griggs JE, Ter Avest E, Lyon RM. The contribution of helicopter emergency medical services in the pre-hospital care of penetrating torso injuries in a semi-rural setting. Scand J Trauma Resusc Emerg Med 2021; 29(1):112. Medline
|
X
|
Not Yet Graded (White)
|
-
|
|
|
Galvagno SM Jr., Haut ER., Zafar SN., et al. Association between helicopter vs ground emergency medical services and survival for adults with major trauma. JAMA 2012; 307(15):1602-10. Medline
|
X
|
Not Yet Graded (White)
|
-
|
|
|
Hannay RS., Wyrzykowski AD., Ball CG., Laupland K., Feliciano DV. Retrospective review of injury severity, interventions and outcomes among helicopter and nonhelicopter transport patients at a level 1 urban trauma centre. Can J Surg 2014;.57(1):49-54. Medline
|
X
|
Not Yet Graded (White)
|
-
|
|
|
Sterner RC, Brooks NP. Interfacility Ambulance Versus Helicopter Transport of Traumatic Spinal Cord Injury Patients: Outcomes, Observations, and Utilization. WMJ May 2024; 123(2):88-94. Medline
|
Intubation
Level |
Direction |
Primary Outcome |
Patient/Process |
Setting |
Reference |
II
|
Supportive (Green)
|
30-day mortality
|
Patient
|
PH-MD & CCT
|
Renberg M, Dahlberg M, Gellerfors M, Rostami E, Günther M. Prehospital and emergency department airway management of severe penetrating trauma in Sweden during the past decade. Scand J Trauma Resusc Emerg Med Nov 2023; 31(1):85. Medline
|
II
|
Neutral (Yellow)
|
7-day survival
|
Patient
|
Other
|
April MD, Bridwell RE, Davis WT, et al. Interventions associated with survival after prehospital intubation in the deployed combat setting. Am J Emerg Med February 2024; 79:79-84. Medline
|
II
|
Neutral (Yellow)
|
Mortality
|
Patient
|
Other
|
Schauer SG, Hudson IL, Fisher AD, Dion G, et al. Improving Outcomes Associated with Prehospital Combat Airway Interventions: An Unrealized Opportunity. J Spec Oper Med 2023. Medline
|
II
|
Neutral (Yellow)
|
ED and in-hospital mortality
|
Process
|
ED-Paramedic & MD
|
Thomas MB, Urban S, Carmichael H, Banker J, et al. Tick-tock: Prehospital intubation is associated with longer field time without any survival benefit. Surgery July 2023. Medline
|
II
|
Neutral (Yellow)
|
Mortality
|
Patient
|
PH-MD & CCT
|
Weigeldt M, Schulz-Drost S, Stengel D, Lefering R, Treskatsch S, Berger C. In-hospital mortality after prehospital endotracheal intubation versus alternative methods of airway management in trauma patients. A cohort study from the TraumaRegister DGU®. Eur J Trauma Emerg Surg. March 2024. Medline
|
II
|
Opposes (Red)
|
Mortality
|
Patient
|
PH-Paramedic
|
Chou D., Harada MY., Barmparas G., et al. Field intubation in civilian patients with hemorrhagic shock is associated with higher mortality. The journal of trauma and acute care surgery. 2016;80(2):278-82. Medline
|
II
|
Opposes (Red)
|
Mortality
|
Patient
|
ED-Paramedic & MD
|
Hatchimonji JS, Dumas RP, Kaufman EJ, Scantling D, Stoecker JB, Holena DN. Questioning dogma: does a GCS of 8 require intubation? Eur J Trauma Emerg Surg 2021; 47(6):2073–9. Medline
|
II
|
Opposes (Red)
|
First pass success
|
Patient
|
PH-Paramedic & MD
|
Kolaparambil Varghese LJ, Völlering JJ, De Robertis E, Hinkelbein J, Schmitz J, Warnecke T. Efficacy of endotracheal intubation in helicopter cabin vs. ground: a systematic review and meta-analysis. Scand J Trauma Resusc Emerg Med May 2024; 32(1):40. Medline
|
II
|
Opposes (Red)
|
Mortality
|
Patient
|
PH-MD & CCT
|
Stausberg T, Ahnert T, Thouet B, Lefering R, Böhmer A, Brockamp T, Fröhlich M. Endotracheal intubation in trauma patients with isolated shock: universally recommended but rarely performed. Eur J Trauma Emerg Surg 2022. Medline
|
III
|
Neutral (Yellow)
|
Success rate of the intervention
|
Patient
|
PH-Paramedic & MD
|
Smith S, Liu M, Ball I, Meunier B, Hilsden R. A Systematic Review of Prehospital Combat Airway Management. J Spec Oper Med 2023. Medline
|
Ketamine
Level |
Direction |
Primary Outcome |
Patient/Process |
Setting |
Reference |
I
|
Supportive (Green)
|
Change in pain scale at 30 min.
|
Patient
|
PH-Paramedic & MD
|
Le Cornec C, Le Pottier M, Broch H, et al. Ketamine Compared With Morphine for Out-of-Hospital Analgesia for Patients With Traumatic Pain: A Randomized Clinical Trial. JAMA Netw Open January 2024; 7(1):e2352844. Medline
|
I
|
Neutral (Yellow)
|
Adverse events
|
Patient
|
ED-MD
|
Cevik E., Bilgic S., Kilic E., Cinar O., Hasman H., Acar AY., et al. Comparison of ketamine-low-dose midozolam with midazolam-fentanyl for orthopedic emergencies: a double-blind randomized trial. Am J Emerg Med 2013; 31(1):108-13. Medline
|
I
|
Neutral (Yellow)
|
Measurable pain relief
|
Patient
|
PH-Paramedic
|
McMullan JT, Droege CA, Chard KM, et al. Out-of-Hospital Intranasal Ketamine as an Adjunct to Fentanyl for the Treatment of Acute Traumatic Pain: A Randomized Clinical Trial. Ann Emerg Med June 2024. Medline
|
II
|
Supportive (Green)
|
Change in pain score
|
Patient
|
|
Bronsky E.S., Koola C., Orlando A., Redmond D., D'Huyvetter C., Sieracki H., Tanner II A., Fowler R., Mains C., Bar-Or D., Intravenous Low-Dose Ketamine Provides Greater Pain Control Compared to Fentanyl in a Civilian Prehospital Trauma System: A Propensity Matched Analysis, 2019; Prehospital Emergency Care, 23:1, 1-8, DOI: 10.1080/10903127.2018.1469704 Medline
|
II
|
Supportive (Green)
|
Change in pain and dosage of morphine equivalents.
|
Patient
|
PH-Paramedic & MD
|
Cohen B, Talmy T, Gelikas S, Radomislensky I, Kontorovich-Chen D, Benov A, Avital G. Opioid Sparing Effect of Ketamine in Military Pre-Hospital Pain Management - A Retrospective Study. J Trauma Acute Care Surg 2022. Medline
|
II
|
Supportive (Green)
|
Need for IV analgesia after IN ketamine
|
Patient
|
Other
|
Dubecq C, Montagnon R, Morand G, et al. Combat Casualties Treated With Intranasal Ketamine for Prehospital Analgesia: A Case Series. J Spec Oper Med 2023. Medline
|
II
|
Neutral (Yellow)
|
Chronic Pain
|
Patient
|
PH-Paramedic
|
Jennings PA., Cameron P., Bernard S., et al. Long-term pain prevalence and health-related quality of life outcomes for patients enrolled in a ketamine versus morphine for prehospital traumatic pain randomised controlled trial. Emerg Med J 2014; 31(10):840-3. Medline
|
III
|
Supportive (Green)
|
Reduction in pain
|
Patient
|
ED-MD
|
Goltser A., Soleyman-Zomalan E., Kresch F., Motov S. Short (low-dose) ketamine infusion for managing acute pain in the ED: Case-report series. Am J Emerg Med 2015; 33(4):e5-7. Medline
|
III
|
Neutral (Yellow)
|
Pain Relief
|
Patient
|
PH-Paramedic
|
Jennings PA., Cameron P., Bernard S. Ketamine as an analgesic in the pre-hospital setting: a systematic review. Acta Anaesthesiol Scand 2011; 55(6):638-43. Medline
|
Mechanical Intraosseous Insertion
Level |
Direction |
Primary Outcome |
Patient/Process |
Setting |
Reference |
II
|
Supportive (Green)
|
Successful placement
|
Process
|
|
Dolister M., Miller S., Borron S., et al. Intraosseous vascular access is safe, effective and cost less than central venous catheters for patients in the hospital setting. J Vasc Access 2013; 14(3):216-24. Medline
|
II
|
Supportive (Green)
|
First attempt success
|
Patient
|
|
Sunde G., Heradstveit B., Vikenes B., HeltneJ. Emergency intraosseous access in a helicopter
emergency medical service: a retrospective study. Scan J Trauma, Resus and Emerg Med 2010; 18:52. Medline
|
II
|
Supportive (Green)
|
Success
|
Process
|
PH-Paramedic
|
Wang D, Deng L, Zhang R, Zhou Y, Zeng J, Jiang H. Efficacy of intraosseous access for trauma resuscitation: a systematic review and meta-analysis. World J Emerg Surg March 2023; 18(1):17. Medline
|
II
|
Neutral (Yellow)
|
First pass success
|
Process
|
ED-MD
|
Drumheller BC, Edgar MD, Tape MK, Vongviphut D, Herres JP. Comparison of the NIO and EZIO for Resuscitative Vascular Access in the Emergency Department: A Quasi-Experimental, Before-and-After Study. Mil Med 2022. Medline
|
II
|
Neutral (Yellow)
|
30-day in-hospital mortality
|
Patient
|
ED-MD
|
Tan BK., Chong S., Koh ZX., Ong ME. EZ-IO in the ED: An observational, prospective study comparing flow rates with proximal and distal tibia intraosseous access in adults. Am J Emerg Med 2012; 30(8):1602-1606. Medline
|
III
|
Supportive (Green)
|
Cervical-spine movement
|
Process
|
OR
|
Brenner T., Bernhard M., Helm M., Doll S., Völkl A., Ganion N., Friedmann C., Sikinger M., Knapp J., Martin E., Gries A. Comparison of two intraosseous infusion systems for adult emergency medical use. Resuscitation 2008; 78:314-9. Medline
|
III
|
Supportive (Green)
|
Success of EZ-IO insertion
|
Process
|
|
Davidoff J., Fowler R., Gordon D., et al. Clinical evaluation of a novel intraosseous device for adults: Prospective, 250-patient, multi-center trial. JEMS 2005; 30(10):s20-30. Medline
|
III
|
Supportive (Green)
|
Success rate on first attempt
|
Process
|
|
Gazin N., Auger H., Jabre P., et al. Efficacy and safety of the EZ-IO intraosseous device: Out-of-hospital implementation of a management algorithm for difficult vascular access. Resuscitation 2011; 82(1):126-9. Medline
|
III
|
Supportive (Green)
|
Insertion time
|
Process
|
|
Hartholt KA., van Lieshout EM., Thies WC., Patka P., Schipper IB. Intraosseous devices: A randomized controlled trial comparing three intraosseous devices. Prehosp Emerg Care 2010; 14(1):6-13. Medline
|
III
|
Supportive (Green)
|
Time (seconds) for successful access
|
Process
|
|
Lamhaut L., Dagron C., Apriotesei R., et al. Comparison of intravenous and intraosseous access by pre-hospital medical emergency personnel with and without CBRN protective equipment. Resuscitation 2010; 81(1):65-68. Medline
|
III
|
Supportive (Green)
|
Successful insertion
|
Process
|
|
Levitan RM., Bortle CD., Snyder TA., Nitsch DA., Pisaturo JT., Butler KH. Use of a battery-operated needle driver for intraosseous access by novice users: Skill acquisition with cadavers. Ann Emerg Med 2009; 54(5):692-4. Medline
|
III
|
Supportive (Green)
|
Validity
|
Process
|
ICU
|
Olaussen A., Williams B. Intraosseous access in the prehospital setting: Literature review. Prehosp Disaster Med 2012; 27(5):468-72. Medline
|
III
|
Supportive (Green)
|
First attempt success
|
Process
|
SIM
|
Ong ME., Ngo AS., Wijaya R. An observational, prospective study to determine the ease of vascular access in adults using a novel intraosseous access device. Ann Acad Med Singapore 2009; 38:121-4. Medline
|
III
|
Supportive (Green)
|
Success rate
|
Process
|
PH-Paramedic
|
Santos D., Carron PN., Yersin B., Pasquier M. EZ-IO(®) intraosseous device implementation in a pre-hospital emergency service: A prospective study and review of the literature. Resuscitation 2013; 84(4):440-5. Medline
|
III
|
Supportive (Green)
|
Overall placement success
|
Process
|
PH-Paramedic
|
Schalk R., Schweigkofler U., Lotz G., Zacharowski K., Latasch L., Byhahn C. Efficacy of the EZ-IO needle driver for out-of-hospital intraosseous access--a preliminary, observational, multicenter study. Scand J Trauma Resusc Emerg Med 2011; 19:65-7241-19-65. Medline
|
III
|
Neutral (Yellow)
|
First attempt success
|
Process
|
ED-MD
|
Leidel BA., Kirchhoff C., Bogner V., Braunstein V., Biberthaler P., Kanz KG. Comparison of intraosseous versus central venous vascular access in adults under resuscitation in the emergency department with inaccessible peripheral veins. Resuscitation 2012; 83(1):40-5. Medline
|
X
|
Not Yet Graded (White)
|
-
|
|
|
Rittblat M, Tsur N, Karas A, et al. When to choose intraosseous access in prehospital trauma care: A registry-based study from the Israel Defense Forces. Chin J Traumatol 2024. Medline
|
Morphine
Level |
Direction |
Primary Outcome |
Patient/Process |
Setting |
Reference |
I
|
Supportive (Green)
|
Pain Scale
|
Patient
|
ED-MD
|
Birnbaum A., Esses D., Bijur PE., Holden L., Gallagher EJ. Randomized double-blind placebo-controlled trial of two intravenous morphine dosages (0.10 mg/kg and 0.15 mg/kg) in emergency department patients with moderate to severe acute pain. Ann Emerg Med 2007; 49(4):445-53. Medline
|
I
|
Supportive (Green)
|
Pain score measured on a visual analogue scale
|
Patient
|
ED-MD
|
Craig M., Jeavons R., Probert J., Benger J. Randomised comparison of intravenous paracetamol and intravenous morphine for acute traumatic limb pain in the emergency department. Emerg Med J 2012; 29(1):37-9. Medline
|
I
|
Supportive (Green)
|
Reduction in pain
|
Patient
|
ED-MD
|
Farahmand S., Shiralizadeh S., Talebian MT., et al. Nebulized fentanyl vs intravenous morphine for ED patients with acute limb pain: A randomized clinical trial. Am J Emerg Med 2014; 32(9):1011-5. Medline
|
I
|
Supportive (Green)
|
Reduction in pain
|
Patient
|
ED-MD
|
Furyk JS., Grabowski WJ., Black LH. Nebulized fentanyl versus intravenous morphine in children with suspected limb fractures in the emergency department: A randomized controlled trial. Emerg Med Australas 2009; 21(3):203-9. Medline
|
I
|
Supportive (Green)
|
Pain relief using the visual analog scale score
|
Patient
|
PH-Paramedic
|
Galinski M., et al. A randomized double-blind study comparing morphine with fentanyl in prehospital analgesia. Am J Emerg Med 2005; 23:114-9. Medline
|
I
|
Supportive (Green)
|
analgesia
|
Patient
|
ED-MD
|
Kampan S, Thong-On K, Sri-On J. A non-inferiority randomized controlled trial comparing nebulized ketamine to intravenous morphine for older adults in the emergency department with acute musculoskeletal pain. Age Ageing January 2024; 53(1). Medline
|
I
|
Supportive (Green)
|
Mean change in verbal pain score
|
Patient
|
ED-Paramedic & MD
|
Le Cornec C, Le Pottier M, Broch H, et al. Ketamine Compared With Morphine for Out-of-Hospital Analgesia for Patients With Traumatic Pain: A Randomized Clinical Trial. JAMA Netw Open January 2024; 7(1):e2352844. Medline
|
I
|
Supportive (Green)
|
Pain relief
|
Patient
|
ED-MD
|
Miller JP., Schauer SG., Ganem VJ., Bebarta VS. Low-dose ketamine vs morphine for acute pain in the ED: A randomized controlled trial. Am J Emerg Med 2015; 33(3):402-8. Medline
|
I
|
Supportive (Green)
|
VAS scores
|
Patient
|
ED-MD
|
Miner JR., Moore J., Gray RO., Skinner L., Biros MH. Oral versus intravenous opioid dosing for the initial treatment of acute musculoskeletal pain in the emergency department. Acad Emerg Med 2008; 15(12):1234-40. Medline
|
I
|
Supportive (Green)
|
Pain relief
|
Patient
|
|
Niemi-Murola L., Unkuri J., Hamunen K. Parenteral opioids in emergency medicine - A systematic review of efficacy and safety. Scandinavian journal of pain 2017; 2(4):187-94. Medline
|
I
|
Supportive (Green)
|
Efficacy
|
Patient
|
PH-Paramedic
|
Vergnion M., Degesves S., Garcet L., Magotteaux V. Tramadol, an alternative to morphine for treating posttraumatic pain in the prehospital situation. Anesth Analg 2001; 92(6):1543-1546. Medline
|
II
|
Supportive (Green)
|
adequate analgesia final NRS <4
|
Patient
|
PH-Paramedic
|
Deslandes M, Deicke M, Grannemann JJ, et al. Effectiveness and safety of prehospital analgesia with nalbuphine and paracetamol versus morphine by paramedics - an observational study. Scand J Trauma Resusc Emerg Med May 2024; 32(1):41. Medline
|
II
|
Supportive (Green)
|
Analgesia
|
Patient
|
PH-Paramedic
|
Ricard-Hibon A., et al. Compliance with a morphine protocol and effect on pain relief in out-of-hospital patients. J Emerg Med 2008; 34:305-10. Medline
|
II
|
Neutral (Yellow)
|
Adverse events
|
Patient
|
ED-Paramedic & MD
|
Bible L, Obaid O, Khurrum M, Goh M, Hammad A, Kitts DJ, et al. Pre-Hospital Administration of Opioids in Trauma Patients: Is Dose Associated With Outcomes? J Surg Res 2021; 268:634–42. Medline
|
II
|
Neutral (Yellow)
|
Chronic Pain
|
Patient
|
PH-Paramedic
|
Jennings PA., Cameron P., Bernard S., et al. Long-term pain prevalence and health-related quality of life outcomes for patients enrolled in a ketamine versus morphine for prehospital traumatic pain randomised controlled trial. Emerg Med J 2014; 31(10):840-3. Medline
|
II
|
Neutral (Yellow)
|
Likelihood of receiving analgesic
|
Patient
|
PH-Paramedic
|
Michael GE., Sporer KA., Youngblood GM. Women are less likely than men to receive prehospital analgesia for isolated extremity injuries. Am J Emerg Med 2007; 25:901-6. Medline
|
III
|
Supportive (Green)
|
Pain relief (NRS or VAS)
|
Patient
|
PH-Paramedic
|
Dijkstra BM., Berben SA., van Dongen RT., Schoonhoven L. Review on pharmacological pain management in trauma patients in (pre-hospital) emergency medicine in the Netherlands. Eur J Pain 2013; 18(1):3-19. Medline
|
III
|
Supportive (Green)
|
Time to morphine administration
|
Process
|
PH-Paramedic
|
Fullerton-Gleason L., Crandall C., Sklar D. Prehospital Administration of Morphine for Isolated Extremity Injuries: A Change in Protocol Reduces Time to Medication. Prehospital Emergency Care 2002; 6(4):411-6. Medline
|
III
|
Supportive (Green)
|
Pain Relief
|
Patient
|
PH-Paramedic
|
Park CL., Roberts DE., Aldington DJ., Moore RA. Prehospital analgesia: systematic review of evidence. J R Army Med Corps 2010; 156(4 S1):295-300. Medline
|
III
|
Supportive (Green)
|
Analgesia
|
Patient
|
PH-Paramedic
|
Rickard C., et al. A RCT of intranasal fentanyl vs intravenous morphine for analgesia in the prehospital setting. Am J Emerg Med 2007; 25:911-7. Medline
|
III
|
Neutral (Yellow)
|
Administration of analgesics
|
Patient
|
PH-Paramedic
|
White LJ., Cooper JD., Chambers RM., Gradisek RE. Prehospital use of analgesia for suspected extremity fractures. PEC 2000; 4:205-08. Medline
|
Optimal Trip Destination
Level |
Direction |
Primary Outcome |
Patient/Process |
Setting |
Reference |
II
|
Supportive (Green)
|
Survival
|
Patient
|
ED-MD
|
Ashley DW., Pracht EE., Medeiros RS., et al. An analysis of the effectiveness of a state trauma system: Treatment at designated trauma centers is associated with an increased probability of survival. J Trauma Acute Care Surg 2015; 78(4):706-14. Medline
|
II
|
Supportive (Green)
|
In-hospital mortality
|
Process
|
In-Patient
|
CA S, BY G, Nieboer D, Steyerberg EW, Den Hartog D, D Van Klaveren. Identifying trauma patients with benefit from direct transportation to Level-1 trauma centers. BMC Emerg Med 2021; 21(1):93. Medline
|
II
|
Supportive (Green)
|
Survival
|
Patient
|
PH-Paramedic
|
Garwe T., Cowan LD., Neas BR., Sacra JC., Albrecht RM. Directness of transport of major trauma patients to a level I trauma center: A propensity-adjusted survival analysis of the impact on short-term mortality. J Trauma 2011; 70(5):1118-27. Medline
|
II
|
Supportive (Green)
|
30 Day mortality and function
|
Patient
|
PH-Paramedic
|
Kelly ML., Roach MJ., Banerjee A., Steinmetz MP., Claridge JA. Functional and long-term outcomes in severe traumatic brain injury following regionalization of a trauma system. J Trauma Acute Care Surg 2015; 79(3):372-7. Medline
|
II
|
Supportive (Green)
|
In-hospital mortality.
|
Patient
|
|
Mans S., Reinders FE., de Jongh MA., Lansink KW. Direct transport versus inter hospital transfer of severely injured trauma patients. Injury 2016; 47(1):26-31. Medline
|
II
|
Supportive (Green)
|
Mortality
|
Patient
|
ED-MD
|
Mehta VV, Grigorian A, Nahmias JT, Dolich M, Barrios C, Chin TL, Schubl SD, Lekawa M. Blunt Trauma Mortality: Does Trauma Center Level Matter? J Surg Res 2022;276:76–82. Medline
|
II
|
Supportive (Green)
|
Mortality
|
Patient
|
ED-MD
|
Morshed S., Knops S., Jurkovich GJ., Wang J., MacKenzie E., Rivara FP. The impact of trauma-center care on mortality and function following pelvic ring and acetabular injuries. J Bone Joint Surg Am 2015; 97(4):265-72. Medline
|
II
|
Supportive (Green)
|
In-hospital mortality
|
Patient
|
PH-Paramedic
|
Tiruneh A, Bodas M, Radomislensky I, Goldman S, Bala M. Do direct admissions to trauma centers have a survival benefit compared to inter-hospital transfers in severe trauma? Eur J Trauma Emerg Surg April 2023; 49(2):1145-56. Medline
|
II
|
Supportive (Green)
|
In-hospital mortality
|
Patient
|
PH-Paramedic
|
Tiruneh A, Bodas M, Radomislensky I, Goldman S, Bala M. Do direct admissions to trauma centers have a survival benefit compared to inter-hospital transfers in severe trauma? Eur J Trauma Emerg Surg Dec 2022. Medline
|
II
|
Supportive (Green)
|
Mortality
|
Patient
|
In-Patient
|
Trivedi DJ, Bass GA, Forssten MP, Scheufler KM, Olivecrona M, et al. The significance of direct transportation to a trauma center on survival for severe traumatic brain injury. Eur J Trauma Emerg Surg 2022;48(4):2803–11. Medline
|
II
|
Neutral (Yellow)
|
Overall Mortality
|
Process
|
ED-MD
|
Billeter AT., Miller FB., Harbrecht BG., et al. Interhospital transfer of blunt multiply injured patients to a level 1 trauma center does not adversely affect outcome. Am J Surg 2014; 207(4):459-66. Medline
|
II
|
Neutral (Yellow)
|
In-hospital mortality
|
Patient
|
PH-Paramedic
|
Hill AD., Fowler RA., Nathens AB. Impact of interhospital transfer on outcomes for trauma patients: A systematic review. J Trauma 2011; 71(6):1885-900. Medline
|
II
|
Neutral (Yellow)
|
Percentage of patients diagnosed with TBI on CT scan
|
Patient
|
PH-Paramedic
|
Lecky FE., Russell W., McClelland G., Pennington E., Fuller G., Goodacre S., et al. Bypassing nearest hospital for more distant neuroscience care in head-injured adults with suspected traumatic brain injury findings of the head injury transportation straight to neurosurgery (HITS-NS) pilot cluster randomised trial. BMJ open 2017; 7(10) e016355. Medline
|
II
|
Neutral (Yellow)
|
Duration of hospital stay
|
Patient
|
ED-MD
|
Metcalfe D., Bouamra O., Parsons NR., Aletrari MO., Lecky FE., Costa ML. Effect of regional trauma centralization on volume, injury severity and outcomes of injured patients admitted to trauma centres. Br J Surg 2014; 101(8):959-64. Medline
|
II
|
Neutral (Yellow)
|
Mortality
|
Process
|
ED-MD
|
Rogers FB, Morgan ME, Brown CT, Vernon TM, Bresz KE, Cook AD, et al. Geriatric Trauma Mortality: Does Trauma Center Level Matter? Am Surg 2021; 87(12):1965–71. Medline
|
II
|
Neutral (Yellow)
|
Mortality
|
Patient
|
ED-MD
|
Tallon JM., Fell DB., Ackroyd-Stolarz S., Petrie D. Influence of a new province-wide trauma system on motor vehicle trauma care and mortality. J Trauma 2006; 60:1-5. Medline
|
II
|
Neutral (Yellow)
|
Mortality (at 24 hours and 30 days)
|
Patient
|
|
van der Wilden GM., Janjua S., Wedel SK., et al. Multi-institutional comparison of helicopter transfers directly to the operating room versus the pit stop in the emergency department. Am Surg 2013; 79(9):939-943. Medline
|
III
|
Supportive (Green)
|
Mortality
|
Patient
|
PH-Paramedic
|
Sanson G., Di Bartolomeo S., Nardi G., et al. Road traffic accident with vehicular entrapment: incidence of major injuries and need for advanced life support. Eur J Emerg Med 1999; 6(4):285-91. Medline
|
X
|
Not Yet Graded (White)
|
-
|
|
|
Candefjord S, Asker L, Caragounis EC. Mortality of trauma patients treated at trauma centers compared to non-trauma centers in Sweden: a retrospective study. Eur J Trauma Emerg Surg 2022; 48(1):525–36. Medline
|
X
|
Not Yet Graded (White)
|
-
|
|
|
Wong TH., Lumsdaine W., Hardy BM., Lee K., Balogh ZJ. The impact of specialist trauma service on major trauma mortality. J Trauma Acute Care Surg 2013; 74(3):780-784. Medline
|
Point of Care Lactate
Level |
Direction |
Primary Outcome |
Patient/Process |
Setting |
Reference |
II
|
Supportive (Green)
|
Trauma centre need
|
Patient
|
|
Brown JB., Lerner EB., Sperry JL., Billiar TR., Peitzman AB., Guyette FX. Prehospital lactate improves accuracy of prehospital criteria for designating trauma activation level. The journal of trauma and acute care surgery 2016; 81(3):445-52. Medline
|
II
|
Supportive (Green)
|
Prediction of need for resuscitative care
|
Process
|
PH-Paramedic
|
Guyette FX., Meier EN., Newgard C., et al. A comparison of prehospital lactate and systolic blood pressure for predicting the need for resuscitative care in trauma transported by ground. J Trauma Acute Care Surg 2015; 78(3):600-6. Medline
|
II
|
Supportive (Green)
|
Utility
|
Process
|
|
Lewis CT., Naumann DN., Crombie N., Midwinter MJ. Prehospital point-of-care lactate following trauma: A systematic review. The Journal of Trauma and Acute Care Surgery 2016; 81(4):748-55. Medline
|
II
|
Supportive (Green)
|
Blood admin. in the first 24 hours.
|
Process
|
PH-Paramedic
|
Zadorozny EV, Weigel T, Stone A, Gruen DS, Galvagno SM Jr, et al. Prehospital Lactate is Associated with the Need for Blood in Trauma. Prehosp Emerg Care 2022; 26(4):590–9. Medline
|
II
|
Neutral (Yellow)
|
Prediction of need for transfusion
|
Process
|
PH-Paramedic & MD
|
Gaessler H, Helm M, Kulla M, Hossfeld B, Riedel J, Kerschowski J, et al. Prehospital predictors of the need for transfusion in patients with major trauma. Eur J Trauma Emerg Surg 2022. Medline
|
II
|
Neutral (Yellow)
|
Detection of early hemorrhagic shock
|
Process
|
PH-Paramedic & MD
|
Galvagno S Jr, Sikorski RA, Floccare DJ, Rock P, Mazzeffi MA, DuBose JJ, et al. Prehospital Point of Care Testing for the Early Detection of Shock and Prediction of Lifesaving Interventions. Shock 2020; 54(6):710-6. Medline
|
II
|
Neutral (Yellow)
|
Prediction of need for resuscitative care
|
Process
|
PH-Paramedic
|
St JA, McCoy AM, Moyes AG, Guyette FX, Bulger EM, Sayre MR. Prehospital Lactate Predicts Need for Resuscitative Care in Non-hypotensive Trauma Patients. The western journal of emergency medicine 2018; 19(2):224-31. Medline
|
III
|
Supportive (Green)
|
Correlation between POC lactate and base excess.
|
Process
|
PH-Paramedic
|
Eichinger M, Shah K, Palt N, et al. Association of prehospital lactate levels with base excess in various emergencies - a retrospective study. Clin Chem Lab Med February 2024. Medline
|
III
|
Supportive (Green)
|
Prediction of need for early transfusion
|
Patient
|
ED-MD
|
Gaessler H, Helm M, Kulla M, et al. Prehospital predictors of the need for transfusion in patients with major trauma. Eur J Trauma Emerg Surg April 2023; 49(2):803-12. Medline
|
III
|
Supportive (Green)
|
Need for resuscitative care
|
Patient
|
PH-Paramedic
|
St JA, McCoy AM, Moyes AG, Guyette FX, Bulger EM, Sayre MR. Prehospital Lactate Predicts Need for Resuscitative Care in Non-hypotensive Trauma Patients. The western journal of emergency medicine 2018; 19(2):224-31. Medline
|