PRE-HOSPITAL EMERGENCY MEDICINE · UK EDITION
PHEM Evidence Rundown
May 2026 | Issue #5 | Monthly Edition
Jake Turner
Curated with the assistance of AI (Perplexity). All content editorially reviewed.
May 2026 brings the most significant UK prehospital airway update in years: the Association of Anaesthetists has published updated national PHEA guidelines. Alongside that, the SWiFT RCT delivers the definitive answer on whole blood vs component therapy in UK HEMS, the Armstrong Medical APL valve FSN demands immediate pre-use checks, and two major triage studies reshape how we think about TST in mass casualty events. The prehospital REBOA vs resuscitative thoracotomy debate has its strongest comparative data yet.
WHAT'S INSIDE THIS MONTH (25 ITEMS)
UK Guidelines & Safety Alerts (7):
Updated Association of Anaesthetists PHEA guidelines · RCUK ReSPECT 2026 policy briefing · MHRA: Armstrong Medical APL valve FSN · MHRA: Philips Trilogy Evo ventilator FSN · MHRA: Physio-Control paediatric defibrillation electrode FSN · UKHSA Legionnaires' disease London · Royal College of Paramedics rebrand
Key Trials & Articles (13):
SWiFT RCT: whole blood vs component therapy · REBOA vs resuscitative thoracotomy SR/MA · Prehospital time and hypotensive trauma mortality · Automated vs manual i-gel ventilation in HEMS · Prehospital severe agitation SR (ketamine IM) · CCO vs standard CPR meta-analysis · Asystolic OHCA survival trends 2003-2022 · Bystander sex and CPR provision · Paediatric OHCA international SR/MA
- EXECT-CPR: TEE-guided CPR RCT · Ten Second Triage simulation validation · MATTS major trauma triage tool validation · Paramedic prehospital POCUS feasibility
FOAMed & Appraisal (5):
St Emlyn's: SWiFT full appraisal · St Emlyn's: UK HEMS access postcode lottery · The Resus Room: SWiFT + updated PHEA guidelines · EMCrit: Dynamic LVOTO in septic shock · REBEL EM: Queen of Hearts AI ECG for OMI
EVIDENCE TAG LEGEND
THIS MONTH'S CONTENTS
UK Guidelines & Safety Alerts
1. Association of Anaesthetists: Updated PHEA Guidelines (Anaesthesia, March 2026)
2. RCUK: ReSPECT Policy Briefing 2026 Update 3. MHRA FSN: Armstrong Medical APL Valve (Mapleson C) 4. MHRA FSN: Philips Trilogy Evo Ventilator 5. MHRA FSN: Physio-Control Paediatric Defibrillation Electrodes 6. UKHSA: Legionnaires' Disease Outbreak, London 7. College of Paramedics rebranded as Royal College of Paramedics
Key Journal Articles & Trials
8. SWiFT RCT: Whole Blood vs Component Therapy in UK HEMS (NEJM) 9. REBOA vs Resuscitative Thoracotomy: SR/MA (J Trauma) 10. Prehospital Time and Hypotensive Trauma Mortality, Sweden (SJTREM) 11. Automated vs Manual Ventilation with i-gel in HEMS (PEC) 12. Prehospital Severe Agitation SR: Ketamine IM First-Line (EMJ) 13. CCO vs Standard CPR Meta-Analysis: Equivalent Outcomes (Am J Cardiol) 14. Asystolic OHCA Survival Trends 2003-2022 (Resuscitation) 15. Bystander Sex and CPR Provision in OHCA (EMJ) 16. International Paediatric OHCA Incidence: SR/MA (Crit Care Med) 17. EXECT-CPR: TEE-Guided CPR RCT (JAMA Intern Med) 18. Ten Second Triage Simulation Validation: 4x Faster than MITT (SJTREM) 19. MATTS: Major Trauma Triage Tool Validation in England (PLoS ONE) 20. Paramedic Prehospital POCUS: 87.9% Sensitivity, Changes 36% of Transport Decisions (SJTREM)
FOAMed & Critical Appraisal
21. St Emlyn's: SWiFT Full Critical Appraisal 22. St Emlyn's: UK HEMS Access — A National Postcode Lottery 23. The Resus Room April 2026: SWiFT + Updated PHEA Guidelines 24. EMCrit: Dynamic LVOTO in Septic Shock — Up to 22% Incidence 25. REBEL EM: Queen of Hearts AI ECG for OMI Detection
Quick Hits | Action Points
UK GUIDELINES & OFFICIAL UPDATES
ASSOCIATION OF ANAESTHETISTS · ANAESTHESIA · 24 MARCH 2026
1. Updated UK National Guidelines for Prehospital Emergency Anaesthesia
The Association of Anaesthetists, via a multidisciplinary PHEM/anaesthesia/ICM modified Delphi process, has published updated national guidelines for prehospital emergency anaesthesia (PHEA). The update covers: pre-PHEA sedation protocols; minimum personnel and training standards for RSI delivery; equipment and drug requirements; monitoring standards (waveform ETCO2 mandatory); PHEA in children; and transport. The central mandate is that PHEA must be delivered to the same standard as in-hospital RSI — a direct reinforcement against degraded prehospital practice. Competence frameworks are tightened, with implications for HEMS governance and critical care paramedic scope of practice.
Why it matters: This is the UK national standard for PHEA. Every HEMS service and physician-paramedic critical care team is governed by this document. Expect training programmes, drug protocols, and governance frameworks to be updated to align. DipIMC/FIMC candidates must be familiar with these guidelines as the reference standard for PHEA practice questions.
Tell your department: "The PHEA guidelines have been updated. Check our RSI protocol, drug kit, ETCO2 monitoring, and personnel standards against the new document before the next clinical governance review."
Source: Anaesthesia 2026 — PMID 41873247
RESUSCITATION COUNCIL UK · 24 MARCH 2026
2. ReSPECT Policy Briefing: 2026 Update — Digital Patient Access Expanding
RCUK's updated policy briefing on ReSPECT (Recommended Summary Plan for Emergency Care and Treatment) documents significant progress toward UK-wide standardisation. England has adopted ReSPECT as the single nationally standardised Emergency Care and Treatment Plan with digital, patient-accessible records; Scotland has embedded it across 8 of 14 Health Boards via the National Digital Platform; Northern Ireland is committing to national implementation in 2026; Wales is in discussion. For prehospital providers, the key operational change is that ReSPECT plans are increasingly accessible digitally at the point of care — prehospital teams must understand how to retrieve and act on a patient's ReSPECT document as a clinical standard, not an exception.
Why it matters: Prehospital teams are increasingly expected to retrieve and honour ReSPECT decisions in the field. Digital accessibility means "I couldn't find the form" is no longer acceptable. Understand your local system's access pathway before the next complex resuscitation call.
Source: resus.org.uk — ReSPECT Policy Briefing 2026
MHRA · FIELD SAFETY NOTICE · 5 MARCH 2026
3. MHRA FSN: Armstrong Medical APL Valve Defect — Immediate Pre-Use Checks Required
Armstrong Medical Limited has issued an urgent Field Safety Notice (CAPA-100) for Resuscitation Sets with APL valves (Mapleson C circuits) following a confirmed manufacturing defect. The APL valve may stick during opening or closing, preventing adequate pressure relief during manual ventilation. This results in sustained elevated airway pressures, excessive PEEP, haemodynamic compromise, and respiratory injury. One case of transient patient harm has been confirmed. Mandatory pre-use checks are required before every use: inflate the reservoir bag, confirm the valve closes and opens correctly at each PEEP setting. Affected devices are widely used in UK HEMS kits and resuscitation sets.
Immediate action required: Check all Armstrong Medical Mapleson C resuscitation sets in your service before next clinical use. Perform the mandatory valve function check as per IFU. Return the FSN response form to Armstrong Medical. Complete the check even if the kit appears unused.
Tell your department: "Check every Armstrong Medical Mapleson C circuit before your next shift. The APL valve can stick, causing pressure build-up without alarm. This is an immediate safety check, not a scheduled recall."
Source: MHRA FSN 9-13 March 2026 — CAPA-100
MHRA · FIELD SAFETY NOTICE · UPDATED MARCH 2026
4. MHRA FSN: Philips Trilogy Evo Ventilator — Non-Pneumatic Nebulisers Prohibited
Philips Respironics has issued an urgent updated FSN (2026-CC-SRC-002) prohibiting the use of non-pneumatic (vibrating mesh) nebulisers with Trilogy Evo Platform ventilators. Use of these nebulisers causes incorrect leak estimation, leading to under-delivery of tidal volume without any visible alarm on the user interface. This is an entirely silent failure mode. Required actions: immediately cease use of non-pneumatic nebulisers with all Trilogy Evo devices; update device software to version 1.06.15.00; communicate to all users including paramedics and retrieval teams. This directly affects any HEMS or critical care transport service using Trilogy Evo for prehospital ventilation.
Immediate action required: If your service uses Trilogy Evo ventilators, stop using vibrating mesh nebulisers immediately. Check your software version. Contact your clinical engineering team for the update pathway.
Source: MHRA FSN 9-13 March 2026 — FSN 2026-CC-SRC-002
MHRA · FIELD SAFETY NOTICE · FEBRUARY/MARCH 2026
5. MHRA FSN: Physio-Control Paediatric Defibrillation Electrodes Safety Notice
Physio-Control Inc. has issued a Field Safety Notice (MHRA ref: 38761418) for the ELECTASSY-AED INFANTCHILD REDUCED ENERGY-WW paediatric defibrillation electrodes. Full details of the specific defect are in the FSN. These electrodes are used in paediatric AED and defibrillator applications and are directly relevant to prehospital resuscitation of children. Prehospital services using this product should consult the full FSN document for required actions and check compatibility with their current AED and defibrillator stock. Do not delay checking if these electrodes are in active use.
Source: MHRA FSN 9-13 March 2026 — Physio-Control INFANTCHILD electrodes
UKHSA HEALTH PROTECTION REPORT · 24 MARCH 2026
6. Legionnaires' Disease Outbreak: North West and South West London
UKHSA, London Local Authorities, and the Health and Safety Executive are investigating a Legionnaires' disease cluster in NW and SW London. As of 23 March 2026, 8 confirmed cases share the same Legionella sequence type with 13 further under investigation. No common environmental source has been identified; environmental sampling and precautionary shock-dosing of cooling towers is ongoing. Clinicians nationally have been alerted for active case-finding. Prehospital relevance: Legionellosis can cause rapid-onset severe pneumonia requiring prehospital airway intervention. HEMS and LAS crews responding to severe atypical pneumonia in NW/SW London should consider Legionella as a differential and pre-alert for appropriate antibiotics (levofloxacin or azithromycin — not beta-lactam alone).
Source: UKHSA HPR Vol 20 Issue 3, 24 March 2026
COLLEGE OF PARAMEDICS · JANUARY 2026
7. College of Paramedics Rebranded as Royal College of Paramedics
From January 2026, the College of Paramedics has officially rebranded as the Royal College of Paramedics, with HRH The Prince of Wales appointed as Patron. The new title reflects formal recognition of paramedics as a regulated healthcare profession and signals a step-change in the profession's standing alongside other royal colleges. For PHEM practitioners, the rebrand is relevant in the context of critical care paramedic scope of practice discussions, DipIMC/FIMC career pathways, and how the paramedic profession is represented in national guidelines and policy forums.
Source: Royal College of Paramedics — collegeofparamedics.co.uk
KEY JOURNAL ARTICLES & TRIALS
NEW ENGLAND JOURNAL OF MEDICINE · 17 MARCH 2026
8. SWiFT RCT: Prehospital Whole Blood Does Not Outperform Component Therapy in UK HEMS
The SWiFT trial is the definitive UK evidence base for prehospital blood product strategy. In 616 patients with life-threatening traumatic haemorrhage across 10 English air ambulance services, transfusion of up to 2 units of whole blood was not superior to standard component therapy (packed red cells + plasma) for the composite outcome of death or massive transfusion at 24 hours (48.7% vs 47.7%; RR 1.02, 95% CI 0.80–1.31; P=0.84). Coagulation impairment (raised prothrombin time) was paradoxically more common in the whole-blood group, raising questions about the haemostatic quality of the tested whole blood product. Secondary outcomes were also equivalent.
Why it matters: This directly governs UK HEMS blood product carriage decisions. The current component-based standard (RBC + plasma) is confirmed as equivalent to whole blood at 2-unit doses. This does not rule out whole blood at higher doses or with different formulations — but it does not support replacing existing UK HEMS protocols with whole blood for now.
Paired Controversy: See Item 21 (St Emlyn's critical appraisal) for detailed discussion of why the coagulation signal matters and what should happen next with whole blood research in UK HEMS.
Tell your department: "SWiFT is published. Whole blood is not superior to our current component protocol at 2 units. Our existing RBC + plasma standard is confirmed as appropriate. No protocol change required at this stage."
Source: NEJM 2026 — PMID 41841706 (SWiFT)
JOURNAL OF TRAUMA AND ACUTE CARE SURGERY · 26 MARCH 2026
9. REBOA vs Resuscitative Thoracotomy in Haemorrhagic Shock: SR/MA Favours REBOA
The largest comparative evidence synthesis to date on REBOA versus resuscitative thoracotomy (RT) for noncompressible torso haemorrhage: 14 studies, 9,028 patients. REBOA was associated with significantly lower in-hospital mortality than RT (OR 0.17, 95% CI 0.10–0.28; moderate-certainty evidence), with the greatest benefit in haemorrhagic shock (OR 0.18) compared with cardiac arrest (OR 0.32). Early 24-hour mortality showed the strongest effect (OR 0.12). REBOA was associated with increased complication rates (OR 7.81) but improved neurological outcomes. The comparison is imperfect due to case-mix differences, but this is the strongest comparative data yet.
Why it matters: For UK HEMS services that deploy REBOA, this is the most compelling comparative data to date supporting its use over RT in haemorrhagic shock — particularly in the pre-arrest phase. The cardiac arrest comparison is less favourable, reinforcing that REBOA should be deployed early, before arrest. Directly relevant to REBOA training and patient selection criteria.
Source: J Trauma Acute Care Surg 2026 — PMID 41885281
SCANDINAVIAN JOURNAL OF TRAUMA, RESUSCITATION AND EMERGENCY MEDICINE · 24 MARCH 2026
10. Every 10 Extra Minutes of Prehospital Time Increases 30-Day Mortality by 5.1% in Hypotensive Trauma
Nationwide Swedish SweTrau registry data (n=3,740 hypotensive trauma patients, 2013–2022). Each additional 10 minutes of prehospital time was associated with a 5.1% increase in odds of 30-day mortality after full adjustment for injury severity, mechanism, age, and sex (AOR 1.005 per minute, 95% CI 1.000–1.009; P=0.046). The association was strongest in penetrating trauma and in patients with the lowest blood pressure (SBP <70 mmHg). Transport modality, HEMS use, and scene time components were all analysed.
Why it matters: Provides quantified, registry-level data for a principle PHEM practitioners know instinctively: time is haemorrhage. This data is directly applicable to scene time management decisions, tasking debates, and justification for limiting on-scene interventions in hypotensive trauma. The 5.1% per 10-minute figure is a useful, quotable benchmark.
Tell your department: "The data is there: in hypotensive trauma, every 10 extra minutes on scene costs 5% mortality. Get in, get the critical interventions, move."
Source: SJTREM 2026 — PMID 41872945
PREHOSPITAL EMERGENCY CARE · 1 APRIL 2026
11. Automated Ventilation with i-gel Achieves Target MV in 100% vs 33% with Manual BVM in HEMS
Prospective simulation-based crossover study evaluating automated vs manual bag-valve-mask ventilation via i-gel during short-haul helicopter rescue. Automated ventilation achieved target minute ventilation (5–7.2 L/min) in 100% of static and live helicopter scenarios vs only 67% (static) and 33% (live) for manual BVM ventilation. Manual ventilation caused 4 i-gel disconnections and greater airway dislodgement events; attendants strongly preferred automated ventilation for in-flight use.
Why it matters: Manual BVM ventilation in a moving helicopter with a supraglottic airway is unreliable. This study provides level-1 simulation evidence for a clinical principle that experienced HEMS practitioners already apply — use a transport ventilator, not manual BVM, during helicopter transport after SGA placement. Directly relevant to airway governance in winch-capable and standard rotary-wing HEMS services.
Source: Prehospital Emergency Care 2026 — PMID 41919775
EMERGENCY MEDICINE JOURNAL · 18 MARCH 2026
12. Prehospital Severe Agitation SR: Ketamine IM 5 mg/kg Most Effective for ABD
Systematic review of prehospital pharmacological management of severe agitation and acute behavioural disturbance (ABD): 42 studies from 6,091 screened, PROSPERO-registered. Ketamine IM at 5 mg/kg achieved adequate sedation in 79–98% of cases across studies and was the most effective single agent. Midazolam was associated with higher adverse event rates, particularly respiratory depression. Droperidol showed a favourable safety profile with no increase in mortality or QT prolongation. No studies were high quality; 6 were moderate quality. This represents the most comprehensive synthesis available for this high-risk clinical scenario.
Why it matters: ABD and excited delirium are among the highest-risk prehospital scenarios for patient and provider harm. This SR provides the clearest evidence to date to support ketamine IM as first-line, challenges routine midazolam use, and supports droperidol where available. Relevant to JRCALC protocol development, critical care paramedic drug authority, and HEMS standard operating procedures.
Source: Emerg Med J 2026 — PMID 41760406
AMERICAN JOURNAL OF CARDIOLOGY · 28 MARCH 2026
13. CCO vs Standard CPR: Equivalent Survival in Meta-Analysis of 232,655 OHCA Cases
18 studies (5 RCTs + 13 observational cohorts), 232,655 OHCA cases. Compression-only CPR (CCO) and standard CPR with ventilation (sCPR) produced equivalent survival to hospital discharge (OR 0.85, 95% CI 0.61–1.19) and equivalent favourable neurological outcomes (OR 0.87, 95% CI 0.64–1.20). Sensitivity analyses suggested a marginal, inconsistent disadvantage with CCO in some subgroups but results were not statistically significant across the primary outcomes.
Why it matters: Strengthens the evidence base for dispatcher-assisted CPR (DA-CPR) instructions that default to compression-only. Reinforces that compression-only is an equivalent option for the untrained bystander. Does not challenge the RCUK standard of sCPR for trained rescuers, but is directly relevant to 999 DA-CPR protocol design and public CPR education campaigns.
Source: Am J Cardiol 2026 — PMID 41912003
RESUSCITATION · 25 MARCH 2026
14. Asystolic OHCA Survival Is Falling Despite Rising Bystander CPR Rates
Population-based registry; 75,262 asystolic OHCA cases in Victoria, Australia, 2003–2022. Despite bystander CPR rates nearly doubling (37.1% to 71.1%), survival to hospital discharge fell significantly from 1.2% to 0.3% (P<0.001). Prehospital ROSC also declined (17.8% to 15.4%). The 2018–2022 period was independently associated with lower odds of survival compared to 2003–2007 (AOR 0.42, 95% CI 0.23–0.75). Arrests in aged care facilities and traumatic aetiology increased over the study period, partly explaining the trend.
Why it matters: Challenges the assumption that system-level improvements in bystander CPR automatically translate to survival gains. In asystolic arrest, the rhythm itself predicts a near-zero survival floor regardless of CPR quality. This has direct implications for DNACPR/ReSPECT decision-making, ECPR patient selection, and resuscitation futility discussions with families in the prehospital setting.
Source: Resuscitation 2026 — PMID 41895637
EMERGENCY MEDICINE JOURNAL · 31 MARCH 2026
15. Female Bystanders Less Likely to Perform CPR on Male Patients — DA-CPR Reduces the Gap
Prospective cohort; 6,487 OHCA cases; Korean national registry, 2019–2023. Female bystanders were significantly less likely to perform CPR (aOR 0.83, 95% CI 0.73–0.95). The disparity was greatest when a female bystander attended a male patient (aOR 0.684, 95% CI 0.578–0.810 — a 32% reduction in CPR likelihood). Dispatcher-assisted CPR substantially narrowed this sex-based gap (without DA-CPR aOR 0.673 vs with DA-CPR aOR 0.822), demonstrating that active 999 guidance is a key equity intervention.
Why it matters: Strongly supports 999 dispatcher-assisted CPR as both a clinical and equity intervention. The sex disparity in bystander CPR is modifiable, and the dispatcher is the lever. Relevant to UK ambulance service DA-CPR protocol design, dispatcher training, and community CPR campaign targeting.
Source: Emerg Med J 2026 — PMID 41916680
CRITICAL CARE MEDICINE · 26 MARCH 2026
16. International Paediatric OHCA Incidence: 5.56 per 100,000 Person-Years (SR/MA, 50 Studies)
First comprehensive global meta-analysis of paediatric OHCA incidence: 50 studies, 37,681 cardiac arrest incidents, 18 countries, 547 million person-years. Pooled incidence in high-income countries: 5.56 per 100,000 person-years (95% CI 4.54–6.58; I²=100%). Substantial heterogeneity across age subgroups, aetiology, and presenting rhythm. Data from low-middle-income countries were sparse. Inconsistent definitions were identified as a major limitation across studies.
Why it matters: This is the reference denominator for paediatric OHCA service planning and training volume requirements. The rarity of the event — 5.56 per 100,000 — directly underpins the case for structured simulation-based training to maintain competency for a scenario that all PHEM practitioners must be prepared for but rarely encounter.
Source: Crit Care Med 2026 — PMID 41885565
JAMA INTERNAL MEDICINE · 23 MARCH 2026
17. EXECT-CPR RCT: TEE-Guided CPR Compression Adjustment Does Not Improve ROSC
Cluster-randomised; n=132; single tertiary centre in Taiwan. Transesophageal echocardiography (TEE)-guided CPR with adjusted compression placement (targeting left ventricle, avoiding aortic valve impingement) did not significantly improve sustained ROSC ≥20 minutes vs conventional guideline-directed CPR (44% vs 39%; cluster-adjusted OR 1.21, 95% CI 0.64–2.29; P=0.54). TEE-guided patients had higher end-tidal CO2 at 11–20 minutes, suggesting a potential haemodynamic benefit signal. The trial was substantially underpowered.
Caution: This is a small, underpowered trial from a single centre with a specific TEE protocol. TEE in cardiac arrest is increasingly discussed in ECPR contexts. The neutral primary outcome with a biological signal (ETCO2 trend) means this is not the final word. Larger trials are needed before TEE-guided CPR becomes standard in HEMS or ED resuscitation.
Source: JAMA Intern Med 2026 — PMID 41870444
SCANDINAVIAN JOURNAL OF TRAUMA, RESUSCITATION AND EMERGENCY MEDICINE · 23 MARCH 2026
18. Ten Second Triage Validated: 4x Faster than MITT with Comparable Accuracy Across All Emergency Services
Prospective multi-service simulation study; police, fire, ambulance responders. The Ten Second Triage Tool (TST) reduced mean overall triage time from 1,500 seconds using MITT (40.5 s/casualty) to 377 seconds (10.2 s/casualty) — a 4-fold speed advantage. Time to delivery of life-saving interventions was markedly reduced (491 s TST vs 1,377 s MITT). Triage accuracy was comparable (TST 80.3% vs MITT 79.3%) and performance was equal between healthcare and non-healthcare responders, validating cross-service use.
Why it matters: The TST is NHS England-endorsed for major incident response. This validation study confirms it delivers equivalent accuracy to MITT in a fraction of the time, across all three emergency services. The 4x speed advantage translates directly to earlier life-saving interventions in mass-casualty events. PHEM practitioners should ensure familiarity with TST ahead of JOPs and exercises.
Tell your department: "TST is now evidence-validated across all three services. Make sure your team can run it — 10 seconds per casualty, equivalent accuracy to MITT, and the time you save goes straight into life-saving interventions."
Source: SJTREM 2026 — PMID 41866521
PLOS ONE · 27 MARCH 2026
19. MATTS: Major Trauma Triage Tool Validated in England — Real-World Prevalence Only 3.1%
22 prehospital major trauma triage tools were evaluated in English datasets; 4 MATTS tools were identified as optimal performers. A key finding: real-world major trauma prevalence in the study cohort was only 3.1%, highlighting the challenge of over-triage vs under-triage. No single tool achieved both high sensitivity and high specificity. The MATTS tools offer a pragmatic English-validated framework for guiding trauma triage decisions in a population where the event is rarer than often assumed.
Caution: A 3.1% major trauma prevalence means most patients triaged as "major trauma" by any tool will not have major trauma. The clinical consequence is over-triage with MTC bypass. Under-triage is the patient safety concern. Use triage tools in combination with clinical gestalt, not as binary decision-makers.
Source: PLoS ONE 2026 — PMID 41894536
SCANDINAVIAN JOURNAL OF TRAUMA, RESUSCITATION AND EMERGENCY MEDICINE · 28 MARCH 2026
20. Paramedic Prehospital POCUS: 87.9% Sensitivity, Changes Transport Urgency in 36.1% of Cases
Feasibility study of paramedic-performed prehospital POCUS in a Scandinavian EMS system. Overall sensitivity 87.9%, specificity 92.7% for identifying pathology. POCUS changed transport urgency classification in 36.1% of cases — a clinically and operationally significant proportion. The most common indications were suspected pneumothorax, cardiac dysfunction, and free fluid. Image quality and interpretation were judged acceptable by reviewing physicians.
Why it matters: The 36.1% transport urgency change rate is the headline figure — POCUS in paramedic hands is not just diagnostic, it alters triage and conveyance decisions. Adds to the UK HEMS POCUS evidence base and supports expanding critical care paramedic POCUS curricula. Relevant to DipIMC/FIMC scope-of-practice and training programme design.
Source: SJTREM 2026 — PMID 41904499
FOAMED & CRITICAL APPRAISAL HIGHLIGHTS
ST EMLYN'S · 22 MARCH 2026
21. St Emlyn's: SWiFT Full Critical Appraisal — Why the Coagulation Signal Matters
St Emlyn's provide a thorough PHEM-specific critical appraisal of the SWiFT trial (Item 8), interrogating its design, the whole blood product specification, and crucially — why the unexpected rise in coagulation impairment in the whole-blood arm matters. The appraisal highlights that the tested product was a 2-unit dose of leucodepleted whole blood, and questions whether higher doses, different processing, or fresh whole blood might produce different results. The appraisal argues that SWiFT is not the end of the whole blood conversation but a pivotal evidence marker that should inform the next generation of trials.
Source: stemlynsblog.org — SWiFT appraisal, 22 March 2026
ST EMLYN'S · 22 MARCH 2026
22. UK HEMS Access — A National Postcode Lottery: 30 Physician-HEMS Teams, Major Regional Gaps
St Emlyn's report on a national survey identifying 30 physician-staffed HEMS teams across the UK, with significant gaps in rural coverage, particularly in parts of the Midlands, North East England, and rural Wales. The piece frames HEMS access as a healthcare equity issue — a patient's probability of receiving physician-level prehospital critical care is determined largely by postcode. The data aligns with the Air Ambulances UK 2026 APPG priorities around 24/7 MTC helipad access and charitable funding transparency (see Item 7 context above).
Counterpoint: Ground-based critical care paramedic programmes are increasingly bridging HEMS gaps in some regions. The equity argument applies most strongly to advanced physician-only interventions (REBOA, PHEA in complex scenarios) rather than all critical care.
Source: stemlynsblog.org — UK HEMS Access, 22 March 2026
THE RESUS ROOM · APRIL 2026 PODCAST
23. The Resus Room April 2026: SWiFT Trial Appraisal and Updated PHEA Guidelines
The Resus Room's April 2026 episode covers the two headline papers this month: the SWiFT RCT and the updated Association of Anaesthetists PHEA guidelines. The podcast provides a PHEM-specific lens on both — discussing SWiFT in the context of what changes (nothing operationally right now) and what it means for research (next steps for whole blood dosing and formulation), and walking through the key changes in the PHEA guidelines compared to the previous version. Strongly recommended as a 30-minute primer for both topics before clinical governance discussions.
Source: theresusroom.co.uk — April 2026 episode
EMCRIT / PULMCRIT · 8 MARCH 2026
24. EMCrit: Dynamic LVOTO in Septic Shock — Incidence Up to 22%, Inotropes Make It Worse
Josh Farkas reviews the evidence for dynamic left ventricular outflow tract obstruction (LVOTO) occurring in septic shock — a diagnosis missed in most prehospital and early ED settings because it mimics cardiogenic shock but responds paradoxically to treatment. Dynamic LVOTO occurs in up to 22% of septic shock patients with low blood pressure and can cause a low-output state that worsens with fluid and deteriorates catastrophically with inotropes (dobutamine, adrenaline). POCUS diagnosis (systolic anterior motion of the mitral valve on parasternal long axis) is essential. Treatment: stop inotropes, give phenylephrine or high-dose noradrenaline, and consider beta-blockade.
Safety point: If a septic patient is deteriorating despite vasopressors and has received dobutamine or adrenaline infusion, dynamic LVOTO is on the differential. POCUS is essential. Adding more inotrope will worsen the obstruction. This is a POCUS diagnosis.
Source: emcrit.org — Dynamic LVOTO, EMCrit 420, 8 March 2026
REBEL EM · 23 MARCH 2026
25. REBEL EM: Queen of Hearts AI ECG for OMI — 89% Accuracy vs 66% for Physicians, CE-Marked in Europe
REBEL EM reviews the latest evidence on the Queen of Hearts AI ECG interpretation tool for occlusion myocardial infarction (OMI) detection, now CE-marked in Europe. AI interpretation achieved 89% overall accuracy vs 66% for physicians alone, and critically — physicians missed 41% of OMIs in the study cohort. The CE mark enables clinical use across EU and EEA territories. UK regulatory pathway is under active review. For PHEM: prehospital 12-lead ECG interpretation for STEMI/OMI is a key decision point for direct cath lab activation — an AI decision-support tool at this point in the pathway could directly reduce door-to-balloon times.
Caution: Not yet MHRA-approved for clinical use in the UK. CE marking does not equal UK regulatory approval post-Brexit. Watch for UKCA marking or specific MHRA guidance. Monitor for deployment in UK ambulance services.
Source: rebelem.com — Queen of Hearts AI ECG, 23 March 2026
QUICK HITS / ALSO NOTABLE
ILCOR Updated CoSTR: IV First Over IO in Adult Cardiac Arrest CONSENSUS — Following the retraction of the VICTOR trial (BMJ, Dec 2025), ILCOR reconfirmed a weak recommendation for IV-first over IO in adult cardiac arrest. IO remains reasonable after two failed IV attempts. Key update: the VICTOR retraction means IO evidence base is weaker than previously thought. (ILCOR CoSTR ALS-2046, updated Jan 2026)
ICAR MEDCOM: Helicopter Rescue at Very High Altitude — First International Guidelines
GUIDELINE — Published February 2026 in High Altitude Medicine & Biology. First guidelines on
helicopter rescue at >3,500 m, covering 19 key operational and medical factors. Relevant to UK mountain rescue HEMS in Scotland and Wales. (High Altitude Med Biol 2026)
NICE HTG774/775: Impella LV Microaxial Flow Pump Approved for Cardiogenic Shock
GUIDELINE — NICE guidance (reviewed 25 March 2026) on percutaneous and surgical insertion
of LV microaxial flow pump (Impella) for cardiogenic shock. Relevant to HEMS destination decisions and post-ROSC care pathways — know which receiving centres in your area have Impella capability. (NICE HTG774 | HTG775)
MHRA-NICE Aligned Pathway Live from 1 April 2026 REVIEW — Simultaneous licensing and NICE value decisions now launched. Reduces typical 90-day gap between marketing authorisation and NICE guidance. First outputs expected June 2026. May accelerate access to new emergency/critical care medicines by 3-6 months. (gov.uk, 17 March 2026)
Digital Major Incident Coordination: Munich Vehicle-Ramming Attack Experience
OBSERVATIONAL — All critical patients distributed across hospitals within 19 minutes; no hospital overload using digital coordination platform. Relevant to UK NHS England digital MCI coordination
ambitions. (PMID 41894438)
ACTION POINTS / THIS MONTH
| 1. | Check all Armstrong Medical Mapleson C circuits now. The APL valve defect is confirmed and a patient has been harmed. Perform the mandatory pre-use valve function check per IFU before every clinical use. If unsure, check with your clinical lead before the next shift. |
| 2. | If your service uses Philips Trilogy Evo ventilators, stop using vibrating mesh nebulisers immediately. Update to software version 1.06.15.00. Contact clinical engineering. This is a silent failure — no alarm fires. |
| 3. | Read the updated PHEA guidelines. Check your service's RSI drug protocol, personnel standards, ETCO2 requirements, and documentation standards against the new Association of Anaesthetists guidance. Raise any gaps at your next clinical governance meeting. |
| 4. | Communicate SWiFT to your HEMS blood product leads. The current component-based protocol (RBC + plasma) is confirmed as equivalent to 2-unit whole blood. No protocol change is indicated, but if your service has been considering whole blood, understand this is not a green light. |
| 5. | Confirm your team can run TST in a mass casualty scenario. The simulation validation confirms it is 4x faster than MITT with equivalent accuracy across all three services. Embed it in your next major incident exercise or simulation day. |
| 6. | Know your local ReSPECT digital access pathway. Plans are increasingly accessible digitally in the field. Before your next complex resuscitation call, know how to retrieve a ReSPECT document in your area. "I couldn't find it" is not an acceptable rationale anymore. |
| 7. | For REBOA-capable services: review your patient selection criteria against the new SR/MA data. REBOA shows a mortality benefit over resuscitative thoracotomy that is strongest in haemorrhagic shock before cardiac arrest — reinforce the principle that REBOA must be deployed before arrest, not as a last resort. |
SOURCES CHECKED THIS ISSUE UK Bodies: FPHC/RCSEd · Resuscitation Council UK · RCEM · DAS · NICE · MHRA · NHS England · UKHSA HPR
- DHSC · NPIS/TOXBASE · Royal College of Paramedics · Air Ambulances UK · BASICS · TARN/NMTR International: NAEMSP · ILCOR · ERC · EAST · ACS-COT · AHA/ACC · ICAR MEDCOM Journals (PubMed date-ranged): Prehosp Emerg Care · SJTREM · Emerg Med J · Air Med J · Br Paramed J · Resuscitation · J Trauma Acute Care Surg · Injury · Crit Care Med · NEJM · Lancet · JAMA · JAMA Intern Med · Am J Cardiol · Anaesthesia · PLoS ONE FOAMed: The Resus Room · St Emlyn's · EMCrit/PulmCrit · REBEL EM · The Bottom Line · DFTB · First10EM · LITFL
Next briefing: First week of June 2026
This newsletter is an educational summary for qualified prehospital and critical care practitioners. It does not constitute clinical guidance or replace local service protocols, drug formularies, or scope-of-practice frameworks. All clinical decisions should be made in the context of individual patient assessment and applicable service operating procedures. Evidence is appraised to the best of the editor's ability; limitations of original studies apply.
Jake Turner
Curated with the assistance of AI (Perplexity). All content editorially reviewed.