EM EVIDENCE — QUARTERLY REVIEW
PHEM Evidence Rundown
Q3 2026 — JULY – SEPTEMBER 2026
State of the Science
Pre-Hospital Emergency Medicine
UK Edition — Quarterly Evidence Ebook
- 3 MONTHLY ISSUES
- 52 ITEMS REVIEWED
- 23 PRACTICE-CHANGE ITEMS
7
CLINICAL CHAPTERS
Jake Turner, EM Registrar — West Midlands • Curated with the assistance of AI (Perplexity). All content editorially reviewed.
September 2026
HOW TO USE THIS EBOOK
| Safety-critical or immediate practice change for your service. | |
| High-impact evidence; discuss at clinical governance and consider SOP change. | |
| CHANGE WHEN GUIDELINE UPDATES | Evidence ahead of current JRCALC/FPHC/RCUK guidance. |
| Useful context; no immediate change required. |
Scope: every primary-evidence, guideline and policy item from PHEM Evidence Rundown Issues 6 (July), 7 (August) and 8 (September) 2026, organised by clinical theme. MHRA device notices, FOAMed secondary sources and core-revision pieces are excluded. Each entry is drawn from the published issue; where the original source gave no effect estimate, none is quoted. Always read the primary paper before changing practice, and follow your service's governance process.
All items are tagged for DipIMC / FIMC revision relevance.
Contents — Q3 2026 State of the Science
Chapter 1 — Q3 2026 Quarter in Review
Executive summary and practice-change table
Chapter 2 — Cardiac Arrest & Resuscitation
17 items
Chapter 3 — Airway & RSI
6 items
Chapter 4 — Trauma & Haemorrhage Control
8 items
Chapter 5 — Stroke & Neurology
1 items
Chapter 6 — Medical Emergencies
4 items
Chapter 7 — Paediatric PHEM
6 items
Chapter 8 — Operational & Governance
10 items
CHAPTER 1
Q3 2026 — Quarter in Review
July – September 2026
Three monthly issues covered 52 items this quarter. The clearest practice changes were in resuscitation and airway: stop routine bicarbonate in cardiac arrest (BIHCA, n=779), remove naloxone from the cardiac-arrest algorithm (JRCALC Update 2:26), adopt the FPHC penetrating neck injury guideline, and treat post-intubation monitoring as a safety-critical phase given a one-in-four adverse-event rate after prehospital neuromuscular blockade-assisted airway management. Pre-MIRACLE2 gives UK services a validated, blood-test-free post-ROSC prognostic score, but its indeterminate middle band and single-service derivation mean it should inform rather than dictate destination decisions.
- Resuscitation: BIHCA, LOGICAL (conservative vs liberal oxygen after ROSC, no difference in 180-day favourable neurological outcome), bystander CPR quality (aOR 2.62 for 30-day survival, n=17,715) and rescue breathing in suffocation-related arrest.
- Termination of resuscitation: asystole, signs of life during CPR, and TOR rules in foreign-body airway obstruction all carry evidence of survivors who would have been terminated.
- Systems: advanced interventions add scene time, 53% of hospitals lack 24/7 helipad access, and HEMS shortened time to thrombectomy by a median 28 minutes in LVO stroke.
- Paediatrics: the RCUK OH-NLS course launched, and a respiratory-first model for fatal paediatric anaphylaxis emphasises early airway escalation.
Q3 2026 statistics: 3 issues • 52 items • 7 CHANGE TONIGHT • 16 CHANGE THIS MONTH • 4 CHANGE WHEN GUIDELINE UPDATES
Practice-change summary
| PRIORITY | ITEM | CHAPTER |
|---|---|---|
| CHANGE THIS MONTH | Pre-MIRACLE2: blood-test-free neurological risk stratification after ROSC | Cardiac Arrest & Resuscitation |
| CHANGE TONIGHT | FPHC 2026 penetrating neck injury guideline: RSI first-line, no collar or cricoid | Trauma & Haemorrhage Control |
| CHANGE TONIGHT | RCUK Out-of-Hospital Neonatal Life Support programme | Paediatric PHEM |
| CHANGE THIS MONTH | BIHCA: Routine sodium bicarbonate does not improve cardiac-arrest ROSC | Cardiac Arrest & Resuscitation |
| CHANGE THIS MONTH | Pandemic influenza remains the UK’s leading health security threat | Operational & Governance |
| CHANGE THIS MONTH | Paediatric anaphylaxis: respiratory-first PHEM model | Paediatric PHEM |
| CHANGE TONIGHT | Good-quality bystander CPR is associated with improved OHCA survival | Cardiac Arrest & Resuscitation |
| CHANGE TONIGHT | Rescue breathing improves outcomes in suffocation-related OHCA | Cardiac Arrest & Resuscitation |
| CHANGE THIS MONTH | HEMS reduces time to thrombectomy in large-vessel occlusion stroke | Stroke & Neurology |
| CHANGE THIS MONTH | Early non-IV analgesia in prehospital trauma | Trauma & Haemorrhage Control |
| CHANGE TONIGHT | UKHSA reports excess heat deaths and Ebola HCID medevac readiness requirements | Operational & Governance |
| CHANGE THIS MONTH | Adult and paediatric cervical-spine clearance: NEXUS, CCR, PECARN and imaging thresholds | Trauma & Haemorrhage Control |
| CHANGE TONIGHT | Electrostatic discharge risk during helicopter hoist operations | Operational & Governance |
| CHANGE THIS MONTH | POCUS for paediatric skull fractures: high specificity, but limited prehospital validation | Paediatric PHEM |
| CHANGE THIS MONTH | Adverse events after prehospital neuromuscular blockade-assisted airway management | Airway & RSI |
| CHANGE THIS MONTH | Routine waveform capnography after prehospital intubation | Airway & RSI |
| CHANGE THIS MONTH | UK HEMS triage for non-traumatic brain pathology is heterogeneous | Operational & Governance |
| CHANGE THIS MONTH | Medical Haemorrhage as an Indication for Prehospital Blood Transfusion | Trauma & Haemorrhage Control |
| CHANGE TONIGHT | Naloxone removed from the cardiac-arrest algorithm | Cardiac Arrest & Resuscitation |
| CHANGE THIS MONTH | Advanced HEMS interventions increase scene time | Operational & Governance |
| CHANGE THIS MONTH | Structured corrective manoeuvres in difficult HEMS laryngoscopy | Airway & RSI |
| CHANGE THIS MONTH | Weight Documentation in Paediatric EMS Responses | Paediatric PHEM |
| CHANGE THIS MONTH | TOR Rules May Terminate Survivors in FBAO-Related OHCA | Cardiac Arrest & Resuscitation |
CHAPTER 2
Cardiac Arrest & Resuscitation
17 items · PHEM Evidence Rundown Issues 6–8
Resuscitation dominated the quarter. BIHCA settled the routine bicarbonate question (no ROSC benefit, more alkalosis and hypernatraemia), LOGICAL found no neurological advantage for conservative oxygen after ROSC, and Pre-MIRACLE2 offers the first blood-test-free prognostic score validated in a UK ambulance service. Several registry studies caution against termination decisions based on initial rhythm, signs of life, or TOR rules in foreign-body airway obstruction.
RESUSCITATION 2026 · PREHOSPITAL VALIDATION STUDY · N=292 (LONDON AMBULANCE SERVICE) · PHEM ISSUE 6
Pre-MIRACLE2: blood-test-free neurological risk stratification after ROSC
The RAPID-MIRACLE study validated a prehospital adaptation of MIRACLE2 using clinical variables available at scene or in transit, without blood testing. In 292 patients, the score had an AUC of 0.88; a score ≤2 had an 89% NPV for poor neurological outcome, while a score ≥5 had an 88% PPV for poor outcome. UK PHEM teams could use the score to support post-ROSC communication and destination discussions, including consideration of cardiac arrest centre referral, but it should not replace comprehensive in-hospital prognostication. This was a single-centre LAS study; scores of 3–4 were indeterminate, and external validation in a separate UK HEMS population is required before widespread protocol adoption.
Key numbers: n=292; AUC 0.88; score ≤2: 89% NPV for poor outcome; score ≥5: 88% PPV for poor outcome.
HAMPSHIRE & ISLE OF WIGHT AIR AMBULANCE 2025–2026 · OBSERVATIONAL COHORT · PHEM ISSUE 6
Post-ROSC Critical Care Team Attendance and Neurological Outcome
This single-centre observational cohort examined post-ROSC out-of-hospital cardiac arrest patients attended by a prehospital critical care team (PHCT) versus standard paramedic care during transport. Good neurological outcome at 30 days was achieved in 37% of PHCT-attended patients versus 17% with standard care; adjusted odds ratio was 3.77 (95% CI 1.82–7.81), rising to 4.10 in the subgroup receiving prehospital emergency anaesthesia. For UK PHEM, the findings support service-level consideration of physician- or critical care paramedic-led post-ROSC care, including airway management, haemodynamic optimisation and advanced monitoring. The single-centre observational design is vulnerable to confounding by indication and selection bias, so the results should support service advocacy rather than individual clinical decision-making.
Key numbers: Good neurological outcome: 37% vs 17%; adjusted OR 3.77 (95% CI 1.82–7.81); PHEA subgroup adjusted OR 4.10.
JAMA 2026 · MULTICENTRE RCT · N=779 · PHEM ISSUE 6
BIHCA: Routine sodium bicarbonate does not improve cardiac-arrest ROSC
The BIHCA multicentre randomised controlled trial compared 8.4% sodium bicarbonate with normal saline placebo in 779 patients with out-of-hospital or in-hospital cardiac arrest. ROSC occurred in 39% of the bicarbonate group versus 37% with placebo (RR 1.05, 95% CI 0.89–1.24; p=0.62), with no reported difference in survival to hospital discharge or neurologically intact survival; alkalosis, hypernatraemia and post-ROSC hypokalaemia were more frequent after bicarbonate. UK PHEM services should stop routine prehospital bicarbonate during cardiac arrest, reserving it for the specific indications listed in the excerpt, including hyperkalaemia and TCA or other sodium-channel-blocker toxicity. The trial used a fixed dose of 1 mmol/kg and did not address those specific indications, although the reported harm profile could increase with higher dosing.
Key numbers: n=779; ROSC 39% versus 37%; RR 1.05, 95% CI 0.89–1.24, p=0.62; alkalosis 35% versus 14%; hypernatraemia 42% versus 11%.
RCUK PAPERS OF NOTE 2026 · MULTICENTRE REGISTRY ANALYSIS · PHEM ISSUE 6
Asystolic OHCA: avoid premature termination based on initial rhythm alone
This multicentre registry analysis challenges the assumption that an asystolic presenting rhythm invariably predicts a poor neurological outcome. Among patients who achieved ROSC from asystolic arrest and survived to ICU, a subset achieved good neurological outcomes (CPC 1–2), comparable to those presenting with non-shockable PEA. In UK PHEM, TOR decisions should consider witnessed status, bystander CPR, time to first defibrillation attempt, reversible causes and response to resuscitation rather than initial rhythm alone; isolated asystole at first contact should not trigger premature TOR. The analysis is subject to substantial selection bias because it includes only patients achieving ROSC, and it does not establish a rationale for prolonging otherwise futile resuscitation.
Key numbers: CPC 1–2; minimum 20 minutes of ALS before considering TOR in the stated context
RESUSCITATION 2026 · OBSERVATIONAL POPULATION-BASED REGISTRY STUDY · N=17,715 · PHEM ISSUE 7
Good-quality bystander CPR is associated with improved OHCA survival
This observational population-based registry study examined whether the quality of bystander CPR mattered after CPR had been initiated, using retrospective paramedic assessment of compression rate, depth, recoil and interruptions. Good-quality CPR was associated with higher 30-day survival than poor-quality CPR (aOR 2.62, 95% CI 1.94–3.54), independently of witness status, initial rhythm and response time. UK PHEM services should support CPR training and community responder programmes that emphasise compression quality, recoil and feedback, rather than recording initiation alone. The findings are associative: retrospective paramedic assessment may introduce recall or classification bias, and residual confounding by bystander, location and witness characteristics is possible.
Key numbers: aOR 2.62 for 30-day survival; 95% CI 1.94–3.54; n=17,715
RESUSCITATION 2026 · RETROSPECTIVE COHORT · N=76,000+ · PHEM ISSUE 7
Rescue breathing improves outcomes in suffocation-related OHCA
This retrospective cohort study used the Japanese national OHCA registry to compare no CPR, compression-only CPR and CPR with rescue breathing in adults with witnessed suffocation-related OHCA. CPR with rescue breathing was associated with better 30-day survival with favourable neurological outcome than compression-only CPR, with the greatest difference in asphyxia-predominant arrests. For UK PHEM practice, reinforce ventilation alongside compressions when coaching or treating suspected asphyxial arrests, including drowning and strangulation; JRCALC already recommends rescue breaths for drowning. The observational design and Japanese setting limit causal inference and direct transferability to UK practice, and the excerpt does not provide the effect estimates.
Key numbers: n=76,000+; no effect estimate stated
SJTREM 2026 · DESIGN AND SAMPLE SIZE NOT STATED · PHEM ISSUE 7
Geographical alignment of prehospital critical care services with OHCA population need
This SJTREM paper examines whether the geographical distribution of prehospital critical care services aligns with population need after out-of-hospital cardiac arrest. The excerpt does not provide the study design, population size, outcome measures or quantitative findings. For UK PHEM, it may inform service planning and commissioning discussions about coverage and equity, but it should not be used alone to determine deployment models or clinical effectiveness. Further appraisal of the full paper is required before drawing conclusions about patient outcomes or optimal service configuration.
doi:10.1186/s13049-026-01655-9
SJTREM 2026 · DESIGN NOT STATED · PHEM ISSUE 7
Family communication as a resuscitation non-technical skill
This paper argues that family communication and family presence during resuscitation should be incorporated into non-technical skills frameworks for prehospital teams. It identifies communication about goals of care as a core competency and notes that family-witnessed resuscitation is endorsed by the Resuscitation Council UK, with reported associations with lower family PTSD and better bereavement outcomes. UK PHEM services should consider incorporating structured family communication into training, assessment and NTS portfolios. The excerpt does not provide the study methods, sample size or quantified outcomes, so the strength of the evidence and the effect of implementation cannot be assessed.
doi:10.1186/s13049-026-01665-7
THE GUARDIAN/HEART RESTART 2026 · CAMPAIGN ANALYSIS · PHEM ISSUE 7
Defibrillator access gaps leave 16 million people outside the 3–5-minute window
Heart Restart campaign analysis, reported by The Guardian, identified over 16 million people in England and Wales living in areas where a defibrillator cannot be reached within the critical 3–5-minute window. The RCUK Clinical Director emphasised public AED awareness and community defibrillator mapping. UK PHEM services can support community CPR advocacy and signpost the public to local defibrillator databases. This is a campaign analysis rather than a described peer-reviewed study, and the excerpt provides no methods or population-level statistical detail beyond the reported estimate.
Key numbers: Over 16 million people; 3–5-minute critical window
SJTREM 2026 · ANALYSIS · PHEM ISSUE 8
Operational assumptions in ECPR eligibility models
ECPR eligibility models rely on assumptions about prehospital response times, low-flow intervals and patient selection. This analysis identified discrepancies between those assumptions and the operational realities of HEMS services, with implications for ECPR programme design. UK HEMS services developing or running ECPR programmes should audit eligibility criteria against their actual operational context, particularly where selection depends on an operationally unrealistic low-flow window. The excerpt does not provide the model parameters, study methods or outcome data, so the effect of these discrepancies on patient outcomes remains uncertain.
BMC EMERGENCY MEDICINE 2026 · RETROSPECTIVE REGISTRY COHORT · PHEM ISSUE 8
Prehospital ETI Associated with Higher ROSC in OHCA, but Not Causal
This retrospective registry cohort compared prehospital endotracheal intubation (ETI) with bag-valve-mask ventilation alone in out-of-hospital cardiac arrest. ROSC was higher with ETI: 21.1% versus 3.8% (OR 7.61, 95% CI 6.07–9.53; p<0.001), an absolute risk difference of 17.3%. This association should not change UK PHEM practice in isolation; priorities remain early high-quality CPR, minimal interruption and first-pass airway success by the most experienced operator using the appropriate device. The study did not capture airway timing, and survival to discharge did not differ, so selection bias and confounding are important limitations.
Key numbers: OR 7.61; 95% CI 6.07–9.53; p<0.001; ROSC 21.1% with ETI vs 3.8% with BVM; ARD 17.3%
doi:10.1186/s12873-026-01718-1
JRCALC / ILCOR / ERC 2026 · GUIDELINE UPDATE INFORMED BY SYSTEMATIC EVIDENCE REVIEW · PHEM ISSUE 8
Naloxone removed from the cardiac-arrest algorithm
JRCALC Clinical Update 2:26 removes naloxone from the algorithm for cardiac arrest with suspected opioid aetiology. An ILCOR and ERC systematic evidence review concluded that there is insufficient evidence to recommend naloxone in opioid-related cardiac arrest. Once arrest is confirmed, UK PHEM crews should prioritise high-quality CPR, rhythm identification and adrenaline according to the ALS algorithm; naloxone remains indicated before arrest when opioid toxicity causes respiratory depression or haemodynamic compromise. The change is based on insufficient evidence rather than evidence of harm, and local cognitive aids, drug-pack arrangements and team briefings should be reviewed against the full revised guideline.
NEW ENGLAND JOURNAL OF MEDICINE 2026 · RANDOMISED CONTROLLED TRIAL · N=1,840 · PHEM ISSUE 8
LOGICAL Trial: Conservative Versus Liberal Oxygen After ROSC
The LOGICAL trial randomised 1,840 ICU patients after ROSC to conservative oxygen targeting SpO2 90–95% or liberal oxygen targeting SpO2 ≥96%. Favourable neurological outcome at 180 days was 38.2% with conservative oxygen versus 39.7% with liberal oxygen, with no significant difference in primary or secondary outcomes, including mortality. For UK PHEM, target SpO2 94–98% after ROSC, titrating oxygen and avoiding both hypoxia and sustained extreme hyperoxia rather than routinely maintaining 100% oxygen. The study was conducted in ICU patients, so direct applicability to the prehospital phase is limited.
Key numbers: n=1,840; favourable neurological outcome at 180 days: 38.2% versus 39.7%; conservative target SpO2 90–95%; liberal target SpO2 ≥96%
PREHOSPITAL EMERGENCY CARE · STUDY DESIGN AND SAMPLE SIZE NOT STATED IN EXCERPT · PHEM ISSUE 8
Signs of Life During OHCA Should Not Prompt Termination
One in four treated OHCA patients displayed at least one sign of life during resuscitation. Agonal breathing and spontaneous movement were associated with higher ROSC rates. In UK PHEM practice, agonal breathing or gasping should not be treated as evidence of futility or used alone to support termination of resuscitation. The excerpt does not provide the study design, sample size or further detail on the termination-of-resuscitation context, so the strength and generalisability of the findings cannot be assessed.
Key numbers: 1 in 4 treated OHCA patients displayed at least one sign of life; agonal breathing and spontaneous movement were associated with higher ROSC rates
PREHOSPITAL EMERGENCY CARE · FBAO-RELATED OHCA COHORT · PHEM ISSUE 8
TOR Rules May Terminate Survivors in FBAO-Related OHCA
Termination-of-resuscitation rules may perform poorly in cardiac arrest caused by suspected foreign body airway obstruction (FBAO). In this cohort, two patients with favourable neurological outcomes were classified as positive for termination of resuscitation. Standard TOR rules should not be applied uncritically in suspected FBAO arrest; clinical judgement and reasonable attempts to clear the obstruction, including direct laryngoscopy, Magill forceps or finger sweep, should precede any TOR consideration. The finding is based on a cohort and does not establish how often TOR misclassification occurs more widely.
Key numbers: 2 patients with favourable neurological outcomes were classified as TOR-positive.
SJTREM · MANIKIN STUDY · PMID: 42596016 · PHEM ISSUE 8
Oxygen enrichment during CPR: fire risk at standard flows not confirmed
During simulated CPR at standard oxygen flow rates, clinically relevant oxygen accumulation at defibrillation sites was not observed. This provides limited support for a clinically important fire risk under these conditions. In UK PHEM practice, oxygen delivery may be paused momentarily before defibrillation, but shock delivery should not be delayed for oxygen removal or at the expense of resuscitation quality. The findings come from a manikin study and may not apply to different flow rates, equipment or clinical environments.
Key numbers: No clinically relevant oxygen accumulation observed at standard flow rates; no sample size stated.
PREHOSPITAL EMERGENCY CARE · NATIONAL SURVEY · PHEM ISSUE 8
Drone AED Delivery: Acceptance Is High, but Bystander Confidence Limits Use
A national survey found high public acceptance and trust in drone-delivered AEDs. The main limiting factor was self-efficacy: whether bystanders felt confident using the device when it arrived. In the UK, where drone AED deployment is being piloted in several regions, programmes should prioritise practical CPR and AED training that builds confidence to act, rather than awareness alone. This is survey evidence of attitudes, so acceptance should not be assumed to translate into bystander intervention or improved survival.
CHAPTER 3
Airway & RSI
6 items · PHEM Evidence Rundown Issues 6–8
Airway evidence this quarter centred on safety after the tube goes in: one in four patients experienced an adverse event after prehospital neuromuscular blockade-assisted airway management, and routine waveform capnography remains non-negotiable. An 11-year HEMS registry supports structured corrective manoeuvres at laryngoscopy, and the BEST trial favoured bougie-first intubation in injured patients.
SCAND J TRAUMA RESUSC EMERG MED 2026 · MANNEQUIN MODEL · PHEM ISSUE 6
SALAD intubation during uninterrupted CPR in a contaminated airway
Suction-Assisted Laryngoscopy Airway Decontamination (SALAD) is intended for intubation during active CPR when the airway is contaminated with blood, vomit or secretions. In the 2026 SJTREM mannequin model, trained clinicians performed SALAD with video laryngoscopy during uninterrupted chest compressions, without requiring a CPR pause. UK PHEM teams should consider SALAD a useful technique for contaminated-airway intubation and include it in simulation training, with a Yankauer immediately available. The evidence is simulation-based, with no sample size or patient-centred outcomes stated in the excerpt, so its effect on clinical outcomes remains uncertain.
PREHOSPITAL EMERGENCY CARE · LARGE NATIONAL EMS REGISTRY · OBSERVATIONAL STUDY · PHEM ISSUE 8
Adverse events after prehospital neuromuscular blockade-assisted airway management
This large national EMS registry study examined adverse events after prehospital neuromuscular blockade-assisted airway management. One in four patients experienced an adverse event, with desaturation, hypotension and unplanned extubation during transport among the common events. UK PHEM services should use a universal pre-RSI checklist and continuous, documented post-intubation monitoring, including waveform EtCO2, SpO2, haemodynamics, tube-position confirmation and sedation/analgesia. As an observational registry study, the findings demonstrate the frequency and types of adverse events but do not establish that the proposed checklist and monitoring bundle will reduce them.
Key numbers: 1 in 4 patients; 25% adverse-event rate
SCANDINAVIAN JOURNAL OF TRAUMA, RESUSCITATION AND EMERGENCY MEDICINE 2026 · RANDOMISED CONTROLLED TRIAL · PHEM ISSUE 8
Bougie versus stylet for difficult airway intubation in critically injured patients
The BEST Trial directly compared bougie-guided with stylet-guided endotracheal intubation in critically injured patients with anticipated difficult airway characteristics. Bougie-guided intubation demonstrated superior first-pass success, supporting the Difficult Airway Society’s prehospital recommendation for a bougie-first approach. UK PHEM services using a stylet as default should consider adopting bougie-first intubation for anticipated or unexpected difficult airway features, supported by regular simulation training. The excerpt does not provide the sample size or effect estimate, so the magnitude and precision of benefit cannot be assessed here.
Key numbers: No sample size or effect estimate stated; bougie-guided intubation had superior first-pass success.
PREHOSPITAL EMERGENCY CARE · LARGE OBSERVATIONAL COHORT · PMID: 42615855 · PHEM ISSUE 8
Routine waveform capnography after prehospital intubation
This large observational cohort examined the use of capnometry after prehospital intubation. Routine waveform EtCO2 monitoring was associated with lower rates of unrecognised oesophageal intubation and improved outcome metrics. UK PHEM services should aim for waveform capnography after every prehospital intubation, with continuous monitoring and attention to trends rather than waveform presence alone. A progressive fall or sudden loss of EtCO2 should prompt immediate assessment for oesophageal intubation and other causes such as cardiac arrest or tension pneumothorax. As an observational study, the findings demonstrate association rather than causation, and the excerpt does not provide absolute event rates.
Key numbers: Routine waveform EtCO2 monitoring was associated with lower rates of unrecognised oesophageal intubation and improved outcome metrics.
SCANDINAVIAN JOURNAL OF TRAUMA, RESUSCITATION AND EMERGENCY MEDICINE 2026 · 11-YEAR PHYSICIAN-LED HEMS RSI REGISTRY · N=2,431 · PHEM ISSUE 8
Structured corrective manoeuvres in difficult HEMS laryngoscopy
An 11-year physician-led HEMS RSI registry examined corrective manoeuvres during difficult laryngoscopy. Structured corrective manoeuvres were associated with 95.7% intubation success, while 75.2% of patients were intubated without any corrective manoeuvre; suction and BURP were the most effective individual interventions reported. UK PHEM teams should optimise positioning, clear secretions with suction and apply BURP before escalating through a pre-planned airway strategy rather than repeating an unmodified attempt. As a registry study, these findings describe practice and outcomes in this HEMS population and do not establish that a particular manoeuvre caused successful intubation.
Key numbers: 95.7% success with structured corrective manoeuvres; 75.2% intubated without corrective manoeuvre; n=2,431
doi:10.1186/s12245-026-01342-7
RESUSCITATION COUNCIL UK 2026 · POSITION STATEMENT · PHEM ISSUE 8
Suction Anti-Choking Devices: Insufficient Evidence for Routine Use
Resuscitation Council UK found insufficient evidence to recommend suction anti-choking devices such as LifeVac for routine clinical use. Standard foreign body airway obstruction management— back blows, abdominal thrusts, and, for clinically trained responders, direct laryngoscopy with Magill forceps—remains the evidence-based approach. UK PHEM teams should not allow these devices to replace 999 activation or established FBAO techniques. The statement addresses insufficient evidence rather than demonstrating that the devices are ineffective in every circumstance.
CHAPTER 4
Trauma & Haemorrhage Control
8 items · PHEM Evidence Rundown Issues 6–8
The FPHC penetrating neck injury guideline (RSI first-line, no collar, no cricoid) is the headline practice change. REBOA remains unsupported for routine prehospital use in blunt trauma, while medical haemorrhage now accounts for almost a third of prehospital transfusions in one UK series. Non-IV analgesia and updated C-spine clearance evidence round out the chapter.
FACULTY OF PRE-HOSPITAL CARE, RCSED 2026 · CONSENSUS-BASED GUIDELINE · PHEM ISSUE 6
FPHC 2026 penetrating neck injury guideline: RSI first-line, no collar or cricoid
The February 2026 FPHC guideline revises pre-hospital management of penetrating neck injury (PNI) with airway compromise. It recommends RSI as first-line, with supraglottic airway devices reserved for second-line use, and advises against routine cervical collars and cricoid pressure. For transected larynx or trachea, direct intubation through the proximal tracheal stump, potentially through the wound, may be required; FONA should be positioned according to the injury level rather than defaulting to cricothyrotomy. Haemorrhage control options include direct pressure, haemostatic packing and balloon tamponade. The recommendations are consensus-based, with limited PNI-specific evidence and reliance on case series, expert opinion and physiological reasoning; simulation and protocol updates are therefore required before implementation.
EASTERN ASSOCIATION FOR THE SURGERY OF TRAUMA (EAST) 2025 · PRACTICE MANAGEMENT GUIDELINE · N NOT STATED · PHEM ISSUE 6
EAST 2025: against routine REBOA in blunt traumatic haemorrhage
The EAST 2025 Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) Practice Management Guideline makes a conditional recommendation against routine REBOA for blunt traumatic haemorrhage. The recommendation follows AORTA trial data and an EAST systematic review reporting no mortality benefit for blunt mechanisms, alongside vascular access complications including limb ischaemia and access-site vascular injury, reported at 8–15% in some series. In UK PHEM, REBOA is not currently within FPHC/JRCALC scope; clinicians should not advocate its expansion on the basis of blunt-trauma data, and established traumatic cardiac arrest measures remain the relevant pre-hospital response. REBOA may still have a role in selected penetrating traumatic arrest or near-arrest with pelvic haemorrhage, but this is described as a surgical decision rather than a PHEM intervention.
Key numbers: No mortality benefit in blunt mechanism; vascular access complications 8–15% in some series.
PREHOSPITAL TECHNOLOGY REVIEW · ROTEM SIGMA · PILOT-PHASE TECHNOLOGY · N NOT STATED · PHEM ISSUE 6
Portable ROTEM Sigma for Prehospital Viscoelastic Haemostasis Assessment
Viscoelastic haemostatic assays such as ROTEM and TEG are described as the gold standard for goal-directed trauma coagulopathy management, and ROTEM Sigma is designed for use outside the laboratory. It may identify hyperfibrinolysis, fibrinogen depletion and platelet dysfunction, potentially supporting more targeted treatment where transport is prolonged and blood products are available. For UK PHEM, this remains an informing-practice technology rather than routine care: training, cold-environment calibration and access to the appropriate blood components remain limitations. The evidence base is currently immature, with UK HEMS feasibility and pilot data still awaited.
SJTREM 2026 · COMMENTARY AND EVIDENCE SYNTHESIS · PHEM ISSUE 7
Early non-IV analgesia in prehospital trauma
This commentary argues that delays obtaining IV access contribute to undertreated pain in prehospital trauma, with potential adverse physiological consequences. It recommends early non-IV analgesia, prioritising intranasal ketamine or fentanyl, followed by intramuscular options, methoxyflurane or Entonox according to availability and clinical context. For UK PHEM practice, analgesia need not await IV access; services should review formularies and SOPs, with IN ketamine or fentanyl considered for significant trauma pain when rapid treatment is required. The article is a consensus commentary and evidence synthesis rather than a reported primary trial, so local governance, contraindications, dosing protocols and the supporting evidence base require careful review.
Key numbers: IN ketamine 1–2 mg/kg; IN fentanyl 1.5–2 micrograms/kg; methoxyflurane limited to 6 mL per use; Entonox 50% nitrous oxide.
doi:10.1186/s13049-026-01663-9
J EMERG MED 2026 · SYSTEMATIC REVIEW AND META-ANALYSIS · N NOT STATED · PHEM ISSUE 7
Adult and paediatric cervical-spine clearance: NEXUS, CCR, PECARN and imaging thresholds
This systematic review and meta-analysis assessed cervical-spine clearance approaches in adult and paediatric trauma, including NEXUS, the Canadian C-Spine Rule (CCR), PECARN, CT, plain radiography, MRI and clinical clearance. In adults, NEXUS and CCR had sensitivity above 99% for excluding significant injury in low-risk patients; CCR was slightly more specific, while CT was preferred for high-risk patients and MRI for persistent neurological symptoms with a normal CT or inability to assess clinically. In children, PECARN identified very-low-risk patients who may not require imaging, with CT minimised and MRI preferred when imaging is needed. For UK PHEM, the findings support documented clinical assessment in awake, alert, neurologically intact patients, manual inline stabilisation as the primary intervention, and rigid collars as temporary adjuncts rather than prolonged routine immobilisation; the excerpt does not provide pooled sample sizes or detailed comparative estimates.
Key numbers: Adult NEXUS/CCR sensitivity >99%; CCR slightly more specific; no sample size stated
PREHOSPITAL EMERGENCY CARE · SYSTEMATIC REVIEW · PHEM ISSUE 8
Prehospital REBOA: insufficient evidence for routine use
A systematic review found that evidence for prehospital REBOA remains limited to small retrospective series involving heterogeneous populations. No comparative randomised controlled trial data are available in the prehospital setting. REBOA should therefore not be used routinely outside structured HEMS programmes with dedicated governance, training standards and outcome tracking. Early TXA, blood products and damage-control principles remain the standard approach to haemorrhagic shock management. The evidence base is limited and does not establish comparative benefit in prehospital care.
Key numbers: No comparative RCT data; evidence limited to small retrospective series.
PREHOSPITAL EMERGENCY CARE · TWO-SYSTEM OBSERVATIONAL STUDY · N NOT STATED · PHEM ISSUE 8
Medical Haemorrhage as an Indication for Prehospital Blood Transfusion
A two-system observational case series examined prehospital blood transfusion for non-traumatic haemorrhage. Just under a third of transfusions were given for medical causes, including gastrointestinal haemorrhage, ruptured abdominal aortic aneurysm and obstetric haemorrhage. UK HEMS blood-product protocols should explicitly address medical haemorrhage rather than restricting eligibility to trauma, with crews able to recognise and activate pathways for major gastrointestinal, obstetric and other non-traumatic abdominal bleeding. The findings come from only two systems and are observational, so local case mix, logistics and governance requirements still need to be considered.
Key numbers: Just under a third of prehospital blood transfusions were for non-traumatic causes.
SJTREM 2026 · REGISTRY COHORT · PHEM ISSUE 8
Thoracic trauma in older adults is associated with greater severity and poorer outcomes
In this registry cohort, patients aged over 65 years with thoracic injuries were more severely injured than younger patients, despite similar mechanisms of injury. They required more intensive in-hospital care and had substantially worse outcomes, with disproportionately high ISS scores and complication rates relative to their scene presentation. In UK PHEM practice, maintain a low threshold for recognising significant injury after apparently minor mechanisms, provide early adequate analgesia, optimise oxygenation, anticipate respiratory compromise and consider early hospital pre-alert or HEMS involvement. The observational design demonstrates an important risk signal but does not establish that any specific prehospital intervention improves outcome; the excerpt provides no numerical effect estimates or adjustment details.
Key numbers: Age >65 years; no other numerical outcome data stated.
CHAPTER 5
Stroke & Neurology
1 items · PHEM Evidence Rundown Issues 6–8
HEMS transfer for large-vessel occlusion stroke was associated with a 28-minute reduction in time to thrombectomy, strengthening the case for air transfer in regions distant from a thrombectomy centre.
SJTREM 2026 · RETROSPECTIVE REGISTRY-BASED COUNTERFACTUAL SIMULATION STUDY · PHEM ISSUE 7
HEMS reduces time to thrombectomy in large-vessel occlusion stroke
A retrospective registry-based counterfactual simulation compared actual HEMS-assisted pathways for large-vessel occlusion stroke with simulated road ambulance pathways using matched controls from a national stroke registry. HEMS was associated with a median 28-minute reduction in time to endovascular thrombectomy, improved 90-day modified Rankin Scale outcomes and societal cost-effectiveness. UK HEMS services should review suspected-LVO activation criteria, direct-transfer agreements with endovascular thrombectomy centres and local time-to-treatment audits. The findings are important for service planning but remain dependent on a simulation study design and should not be interpreted as definitive randomised evidence.
Key numbers: 28-minute median reduction in time to endovascular thrombectomy; improved 90-day mRS outcomes; societal cost-effectiveness
doi:10.1186/s13049-026-01658-6
CHAPTER 6
Medical Emergencies
4 items · PHEM Evidence Rundown Issues 6–8
Sepsis and critical-care physiology items: ANDROMEDA-SHOCK-2 supports capillary refill time as an equipment-free perfusion marker, the 2026 Surviving Sepsis statement frames prehospital antibiotics around transport times over 60 minutes, and BICARICU-2 reinforces treating the cause of metabolic acidosis rather than the pH.
INTENSIVE CARE SOCIETY STATE OF THE ART 2026 · MULTICENTRE RCT · N=640 · PHEM ISSUE 6
BICARICU-2: No 90-day mortality benefit from bicarbonate in severe AKI with acidosis
BICARICU-2 randomised 640 critically ill patients with AKIN Stage 3 acute kidney injury and metabolic acidosis to sodium bicarbonate infusion or standard care. There was no difference in 90-day mortality, at 62.1% versus 61.7%, but kidney replacement therapy was less frequent with bicarbonate: 34.7% versus 50.2% (absolute risk difference −15.5%, p=0.003). For UK PHEM, post-ROSC metabolic acidosis should not by itself prompt sodium bicarbonate infusion in the field or during transport; assess and treat causes such as hypoxia, inadequate perfusion and AKI. This is conference data awaiting full peer-reviewed publication, and the secondary kidney replacement therapy finding should not be interpreted as a mortality benefit.
Key numbers: 90-day mortality: 62.1% vs 61.7% (p=NS); kidney replacement therapy: 34.7% vs 50.2%; absolute risk difference −15.5% (p=0.003); n=640
JAMA 2026 · MULTICENTRE INTERNATIONAL RCT · N=1,501 · PHEM ISSUE 6
ANDROMEDA-SHOCK-2: CRT-guided resuscitation in septic shock
ANDROMEDA-SHOCK-2 compared capillary refill time (CRT)-guided with lactate-guided resuscitation in septic shock across multiple countries. CRT-guided care produced a win ratio of 1.16 for the composite outcome of 28-day mortality, ICU-free days and vasopressor-free days, although 28-day mortality was identical between groups. In UK PHEM, standardised CRT measurement can be used as an adjunct perfusion assessment and documented as a trend, while formal adoption as a primary endpoint should await the SSC 2026/2027 guideline update. The win-ratio endpoint is novel and controversial, mortality was unchanged, and variation in CRT measurement between sites may limit reproducibility.
Key numbers: n=1,501; win ratio 1.16; identical 28-day mortality; normal CRT ≤3 seconds; abnormal CRT >3 seconds
SURVIVING SEPSIS CAMPAIGN 2026 · GUIDELINE STATEMENT · NO SAMPLE SIZE STATED · PHEM ISSUE 6
Prehospital antibiotics when transport exceeds 60 minutes
The Surviving Sepsis Campaign 2026 update suggests considering prehospital antibiotics for patients with suspected septic shock when transport time exceeds 60 minutes and a validated prehospital sepsis screening tool is positive. Examples given are NEWS2 ≥5 with a suspected infection source or qSOFA ≥2. UK services covering rural areas with regular prolonged transports should discuss this conditional statement with their medical director and ensure any antibiotic use is protocol-guided and documented. The evidence remains limited, and formal protocol change should await the APPEASE trial and subsequent JRCALC guidance; there is no current change to JRCALC guidance.
Key numbers: >60 minutes; NEWS2 ≥5; qSOFA ≥2
PREHOSPITAL EMERGENCY CARE · DESIGN AND SAMPLE SIZE NOT STATED · PMID: 42384761 · PHEM ISSUE 8
Physiological instability in initially low-priority patients predicts higher mortality
Patients initially categorised as low-priority may still have clinically important physiological instability. In this study, prehospital physiological instability was independently associated with in-hospital mortality. For UK PHEM practice, dispatch priority should not replace repeat assessment: monitor vital signs, reassess during transport and reclassify patients whose condition deteriorates. The excerpt does not provide the study design, sample size or effect estimate, so the strength and applicability of the association cannot be assessed from the available information.
CHAPTER 7
Paediatric PHEM
6 items · PHEM Evidence Rundown Issues 6–8
Paediatric content spanned neonatal life support outside hospital (the new RCUK OH-NLS course), a respiratory-first model for fatal paediatric anaphylaxis, age-adjusted shock index thresholds, POCUS for skull fracture, and a reminder that a quarter of paediatric EMS records lack documented weight.
RESUSCITATION COUNCIL UK 2026 · PROGRAMME LAUNCH · PHEM ISSUE 6
RCUK Out-of-Hospital Neonatal Life Support programme
RCUK launched the Out-of-Hospital Neonatal Life Support (OH-NLS) programme in June 2026 for prehospital neonatal resuscitation, including home births, midwife-led units, ambulance deliveries and HEMS attendance at delivery. The programme advises polyethylene-bag thermal management, 21% oxygen initially for term or near-term infants, default two-person BVM ventilation, tibial IO access when UVC placement is not possible, and adrenaline 0.01–0.03 mg/kg IV/IO after 30 seconds of CPR if the heart rate remains below 60. UK HEMS services should identify clinicians requiring OH-NLS, review neonatal equipment provision and ensure teams can deliver the specified ventilation, thermal-management and vascular-access approach. This is a programme launch rather than comparative clinical evidence; the excerpt provides no outcome data and the recommendations should be interpreted within local neonatal and obstetric protocols.
Key numbers: 3–4% of London HEMS dispatches involve an obstetric emergency; ambient temperature <20°C; initial oxygen 21%; escalate to 100% if targets are not met by 5 minutes or heart rate remains <100; adrenaline 0.01–0.03 mg/kg IV/IO; CPR if heart rate remains <60 after 30 seconds of adequate ventilation.
SJTREM · YEAR NOT STATED · DESIGN NOT STATED · SAMPLE SIZE NOT STATED · PHEM ISSUE 6
Paediatric anaphylaxis: respiratory-first PHEM model
The excerpt describes paediatric anaphylaxis as an airway-catastrophe presentation in which hoarseness, stridor, drooling, dysphagia and inability to phonate clearly may precede complete obstruction. It recommends early intramuscular adrenaline at 0.01 mg/kg, to a maximum of 0.5 mg, repeated after 5 minutes if there is no response, with early RSI consideration when severe laryngeal-oedema signs persist after two doses. Nebulised adrenaline is described as an adjunct rather than a substitute for intramuscular treatment, and early intraosseous access is advised if intravenous access is difficult. This is a practice algorithm rather than a reported comparative study, and the excerpt provides no study design, outcomes or supporting journal data.
Key numbers: IM adrenaline 0.01 mg/kg; maximum 0.5 mg; repeat after 5 minutes; consider RSI after 2 doses without improvement; nebulised adrenaline 5 ml of 1:1000 as an adjunct
J INT MED RES 2026 · SYSTEMATIC REVIEW AND META-ANALYSIS · 9 STUDIES · PHEM ISSUE 7
POCUS for paediatric skull fractures: high specificity, but limited prehospital validation
Point-of-care ultrasound (POCUS) may assist with skull-fracture assessment after paediatric head trauma. This systematic review and meta-analysis of 9 studies reported sensitivity of 0.90 and specificity of 0.98, with an estimated LR+ of 45 and LR− of approximately 0.10. In UK PHEM, a positive scan in a child with intermediate-to-high pre-test probability could support transfer to a paediatric neurosurgical centre, while a negative scan may help triage lower-risk cases when performed by a trained operator. The evidence is not specifically validated in the prehospital setting, and results are likely to vary with operator skill and image quality; POCUS should not replace clinical assessment or indicated imaging.
Key numbers: Sensitivity 0.90; specificity 0.98; LR+ 45; LR− approximately 0.10; 9 studies
J TRAUMA ACUTE CARE SURG 2026 · RETROSPECTIVE COHORT · PHEM ISSUE 7
Paediatric age-adjusted shock index for haemorrhagic shock recognition
The standard shock index (heart rate/systolic blood pressure) is less reliable in children because normal heart rate and blood pressure vary with age, and systolic pressure may be maintained until late decompensation. This retrospective cohort compared the paediatric age-adjusted shock index (SIPA) with the standard shock index in children with traumatic haemorrhage; the stated thresholds for an abnormal SIPA are >1.2 in children under 2 years, >1.0 at 2–5 years, >0.9 at 6–12 years and >0.8 at 13–17 years. In UK PHEM, SIPA may support early recognition and management of suspected haemorrhagic shock, alongside mechanism, clinical assessment and physiological trends. Thresholds are not universally agreed, and SIPA should not be used as a standalone decision rule.
Key numbers: SIPA thresholds: <2 years >1.2; 2–5 years >1.0; 6–12 years >0.9; 13–17 years >0.8.
RESUSCITATION · DESIGN NOT STATED · N NOT STATED · PHEM ISSUE 8
Paediatric OHCA: witness status should not determine resuscitation pathways
This analysis challenges the use of witnessed versus unwitnessed status as the primary determinant of resuscitation intensity in paediatric out-of-hospital cardiac arrest (OHCA). Rhythm, cause, bystander CPR quality and response time also influence outcome; asphyxial arrests, the predominant mechanism in paediatric OHCA, behave differently from primary cardiac arrests. In suspected drowning, choking or respiratory-failure arrest, prioritise early bag-mask ventilation and oxygenation, and ensure HEMS dispatch criteria incorporate mechanism rather than witness status alone. The excerpt does not provide sample size, comparative outcome data or details of the analysis, so this should inform clinical assessment rather than replace current resuscitation guidance.
PREHOSPITAL EMERGENCY CARE · QUALITY IMPROVEMENT · PHEM ISSUE 8
Weight Documentation in Paediatric EMS Responses
Weight-based medication documentation was compliant in three quarters of paediatric EMS responses, leaving a 25% non-compliance gap. This represents a patient-safety risk because weight-based drug errors are recognised in paediatric prehospital care, particularly with paralytic agents, adrenaline and sedatives. UK PHEM teams should use a validated length-based estimation tool, document the estimated weight before drug administration, and include weight estimation in prehospital RSI checklists. The finding concerns documentation compliance rather than demonstrated medication-error rates, and the excerpt does not provide the sample size or describe the quality-improvement methodology in detail.
Key numbers: 3 in 4 compliant; 25% non-compliant
CHAPTER 8
Operational & Governance
10 items · PHEM Evidence Rundown Issues 6–8
System-level evidence: advanced HEMS interventions lengthen scene time, UK HEMS triage for non-traumatic brain pathology is inconsistent, over half of UK hospitals lack 24/7 helipad access, and UKHSA recorded 2,877 excess heat deaths in England in May and June 2026. Reassuringly, deprivation was not associated with 30-day mortality after HEMS attendance.
AIR AMBULANCES ALL-PARTY PARLIAMENTARY GROUP 2026 · UK PARLIAMENT REPORT · SURVEY OF UK MAJOR TRAUMA CENTRES AND TRAUMA UNITS · PHEM ISSUE 6
Limited 24/7 helipad access creates delays for HEMS patients
The June 2026 Air Ambulances APPG report surveyed UK Major Trauma Centres and Trauma Units regarding helipad availability. It found that 53% of hospitals receiving HEMS-transported patients could not provide 24/7 helipad access; 38% of these had no overnight access, while the remainder had restrictions such as weather, time or weight limits. Off-site landings were reported to add 10–20 minutes to hospital transfer and incur £200–600 in additional ground transfer and coordination costs, with potentially important consequences for time-critical conditions. UK PHEM services should know helipad arrangements at receiving hospitals and document off-site landing and transfer plans, although the report provides operational rather than comparative clinical outcome data and its recommendation for mandatory 24/7 access is not yet policy.
Key numbers: 53% lacked 24/7 helipad access; 38% had no overnight access; 10–20 minutes additional transfer time; £200–600 additional cost per incident
UKHSA 2026 · HEALTH SECURITY RISK ASSESSMENT · PHEM ISSUE 6
Pandemic influenza remains the UK’s leading health security threat
The UKHSA Health Security Risk Assessment for June 2026 ranks pandemic influenza as the top UK health security threat. It also identifies dengue as a domestic risk horizon, with locally acquired cases expected in the context of established Aedes mosquito populations in southern England. UK PHEM services should review mass-casualty and infectious-disease response plans, while maintaining awareness of dengue patterns in returning travellers and potential local cases. This is a strategic risk assessment rather than a clinical outcomes study, and the excerpt provides no quantitative risk estimates or supporting methodology.
Key numbers: Pandemic influenza ranked first; dengue identified as a domestic risk horizon.
AIR MEDICAL JOURNAL 2026 · STRUCTURED FATIGUE MANAGEMENT FRAMEWORK · PHEM ISSUE 6
Fatigue management framework for air medical operations
The Air Medical Journal published a structured fatigue management framework for air medical operations in 2026. It incorporates duty-hour limits, crew-rest requirements and a fatigue-reporting culture modelled on aviation crew resource management. UK HEMS services do not have equivalent mandatory fatigue-management frameworks to fixed-wing aviation crews; clinical governance leads and operations managers should consider reviewing the framework as a quality-improvement resource. The excerpt does not report a study design, sample size or outcome data, so its recommendations should not be treated as evidence of clinical effectiveness.
UKHSA 2026 · PUBLIC HEALTH REPORT · PHEM ISSUE 7
UKHSA reports excess heat deaths and Ebola HCID medevac readiness requirements
UKHSA reported 2,877 excess deaths attributable to the May/June 2026 heatwaves in England, compared with 1,504 in 2025, with amber heat-health alerts reissued across several regions in July. Heat stroke requires immediate whole-body cooling for core temperature above 40°C with neurological dysfunction, alongside IV fluid replacement and monitoring for rhabdomyolysis. PHEM services should review heatwave surge plans and HCID activation criteria, PPE stocks, decontamination pathways and receiving-unit contacts following the precautionary evacuation of an Ebola-exposed healthcare worker to a UK HCID unit. These are UKHSA-reported operational data and preparedness actions; the excerpt provides no methodology for the excess-death estimate, and there was no confirmed UK community transmission.
Key numbers: 2,877 excess heat deaths in England in May/June 2026 versus 1,504 in 2025; heat stroke core temperature >40°C; target <39°C within 30 minutes; no confirmed UK community transmission
SJTREM 2026 · RETROSPECTIVE ANALYSIS · PHEM ISSUE 7
Cross-border EMS response to a train-crash major incident
A retrospective analysis of an international EMS response to a train crash identified important interoperability and command challenges. Pre-agreed communication protocols were required, patient tracking across national systems failed, and medical command roles needed explicit assignment at the scene from the outset. UK JESIP principles were only partially applicable because they were not designed for international incidents. The findings support incorporating cross-border communication, patient-tracking and command arrangements into major-incident planning, although the retrospective design limits causal inference.
doi:10.1186/s13049-026-01661-x
SJTREM 2026 · SYSTEMATIC DESCRIPTION · PHEM ISSUE 7
Electrostatic discharge risk during helicopter hoist operations
Electrostatic charge can build up on a helicopter hoist cable and discharge through a rescuer or patient on contact. The report provides the first systematic description of this hazard, which was known to crews but absent from the literature. During hoist operations, crews should touch the hoist line to a grounded surface before making personal contact with a rescuer or patient. The excerpt does not provide sample size, frequency estimates or details of the study methods, so the strength and generalisability of the evidence cannot be assessed.
doi:10.1186/s13049-026-01666-6
AIR MEDICAL JOURNAL · SURVEY/OBSERVATIONAL · PMID: 42608120 · PHEM ISSUE 8
UK HEMS triage for non-traumatic brain pathology is heterogeneous
Non-traumatic brain pathology, including intracranial haemorrhage, hypoxic brain injury, seizures with airway compromise and acute encephalopathy, is routinely attended by UK HEMS. The survey/observational study found that triage decisions are heterogeneous between services and are infrequently supported by formal, audited clinical pathways. UK HEMS services should review whether they have defined and audited criteria for dispatch in conditions such as seizures with airway risk, high-grade intracranial haemorrhage with declining GCS and post-arrest hypoxic brain injury. The findings support consideration of standardised pathways, although the excerpt does not provide outcome data or quantify the variation between services.
EMERGENCY MEDICINE JOURNAL 2026 · UK RETROSPECTIVE COHORT · PHEM ISSUE 8
Socioeconomic deprivation was not associated with 30-day mortality after UK HEMS attendance
This UK retrospective cohort examined whether socioeconomic status, measured using Indices of Multiple Deprivation, influenced 30-day mortality among HEMS-attended patients. Mortality was equivalent across all deprivation quintiles, suggesting no systematic disadvantage in outcomes by deprivation within the operational footprint studied. UK HEMS services should consider auditing and publishing comparable equity data, while recognising that geographic access remains a separate concern for rural and remote communities without nearby 24/7 HEMS coverage. The observational design demonstrates an association within the studied service and does not establish equitable access across the wider population.
Key numbers: Equal 30-day mortality across all deprivation quintiles
PREHOSPITAL EMERGENCY CARE · SCOPING REVIEW · PMID: 42612190 · PHEM ISSUE 8
Prehospital post-ROSC care lacks standardised quality indicators
A scoping review found that, despite established in-hospital post-resuscitation benchmarks, specific quality indicators for the prehospital post-ROSC period are largely absent from the literature. UK PHEM services should consider a documented post-ROSC bundle incorporating MAP 65–90 mmHg, SpO2 94–98%, EtCO2 35–45 mmHg, avoidance of pyrexia, temperature management where capable, and early pre-alert for an appropriate PPCI or temperature-management centre. The review supports standardising and auditing post-ROSC care rather than demonstrating that any individual prehospital target improves outcomes. Services should therefore use local governance processes to define, implement and review their bundle.
Key numbers: MAP 65–90 mmHg; SpO2 94–98%; EtCO2 35–45 mmHg
SJTREM 2026 · RETROSPECTIVE COHORT · N=1,357 · PHEM ISSUE 8
Advanced HEMS interventions increase scene time
This retrospective cohort examined the operational time cost of advanced HEMS interventions. Each additional advanced intervention was associated with a 41% increase in scene time (p<0.001), while the proportion of patients receiving advanced interventions increased from 24% to 29%; median scene time remained stable overall, partly reflecting a shift towards penetrating trauma. UK PHEM teams should assess each intervention individually, balancing its likely clinical benefit against the time to hospital, rather than treating scoop-and-run versus stay-and-play as a binary decision. The observational design and the influence of case mix mean that the findings do not establish that longer scene times worsen outcomes or that particular interventions are beneficial.
Key numbers: +41% scene time per additional advanced intervention (p<0.001); advanced intervention use 24%→29%; median scene time stable overall; n=1,357
doi:10.1186/s13049-026-01613-5
Jake Turner, EM Registrar — West Midlands
Curated with the assistance of AI (Perplexity). All content editorially reviewed. Not a substitute for appraisal of the primary sources.
EM Evidence — emevidence.org — PHEM Q3 2026 State of the Science