Advances and Challenges in Prehospital Emergency Care

A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Intensive Care/ Anesthesiology".

Deadline for manuscript submissions: 31 October 2025 | Viewed by 441

Special Issue Editor


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Guest Editor
College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia
Interests: trauma; hemorrhage; prehospital care; coagulopathy; traumatic brain injury; burns; resuscitation; ethics

Special Issue Information

Dear Colleagues,

Prehospital emergency care is the first step in the continuum of care for critically ill patients and is a key determinant of patient outcomes. Early intervention in the prehospital environment is essential to reduce preventable deaths and downstream complications for patients with time-critical medical emergencies, including polytrauma, haemorrhagic shock, traumatic brain injury, cardiac arrest, burns, and stroke. Providing effective prehospital emergency care is particularly challenging for the 3.45 billion residents of rural and remote environments globally who are disadvantaged by prolonged prehospital times and delays to definitive hospital care. This is evidenced by the significant and continual discrepancies in outcomes for these patients, including higher morbidity and mortality rates. Despite advances, even in urban areas, it has been estimated that >20% of trauma deaths had potentially survivable injuries, while survival rates for out-of-hospital cardiac arrest remain persistently low at <10%. Recent decades have seen the development and evolution of integrated and coordinated Emergency Medical Services (EMS) systems around the world with a view to improve the efficiency and quality of prehospital emergency care. Nonetheless, challenges remain, and it is imperative we continue to assess, learn, and update. Advances from military systems and casualty care will likely remain a key resource for evidence-based interventions, procedures, and guidelines applicable for prehospital civilian critical care. Optimising prehospital emergency care is key for ensuring good patient outcomes and will not be achieved without innovation and continual improvement.
We will solicit original research articles, systematic reviews, meta-analyses, and reviews pertaining to these topics. 

Dr. Hayley L. Letson
Guest Editor

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Keywords

  • prehospital
  • trauma
  • injury
  • traumatic brain injury
  • burns
  • cardiac arrest
  • stroke
  • rural/remote
  • emergency
  • resuscitation

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Published Papers (1 paper)

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Research

12 pages, 299 KiB  
Article
Prospective Evaluation of Clinical and Laboratory Profiles of Febrile and Afebrile Immunosuppressed Patients Presenting to the Emergency Department
by Tuğrul Topal, Esra Pamukçu, Muhammet Gökhan Turtay, Gülşen Yalçın, Harun Kürşat Şahingil and Mehmet Sezer
Medicina 2025, 61(5), 889; https://doi.org/10.3390/medicina61050889 - 14 May 2025
Viewed by 300
Abstract
Background and Objectives: Immunosuppressed patients are at higher risk of delayed diagnosis and atypical presentations in the emergency department (ED), requiring prompt management. This study compares febrile (≥37.5 °C) and afebrile (<37.5 °C) immunosuppressed patients admitted to the ED regarding clinical and [...] Read more.
Background and Objectives: Immunosuppressed patients are at higher risk of delayed diagnosis and atypical presentations in the emergency department (ED), requiring prompt management. This study compares febrile (≥37.5 °C) and afebrile (<37.5 °C) immunosuppressed patients admitted to the ED regarding clinical and laboratory parameters, including blood and urine tests, vital signs, final diagnoses, outcomes, and mortality. Materials and Methods: Eighty immunosuppressed patients aged 18–82 were prospectively evaluated from May 2019 to May 2020. Data on blood and urine tests, final diagnoses, outcomes, and mortality were recorded using a standardized form. Results: Among the 80 patients, 44 (55%) were female and 36 (45%) were male, with a mean age of 58.5 ± 14.72 years. The febrile patients showed higher admission levels of lactate dehydrogenase (LDH), interleukin-6 (IL-6), procalcitonin (PCT), and longer hospital stays than the afebrile patients. Mortality correlated with low albumin, oxygen saturation, platelet count, and total protein levels and elevated PCT and lipase levels. ICU admissions were linked to low albumin, total protein, and systolic blood pressure levels and elevated LDH, blood urea nitrogen, neutrophil count, and PCT levels. The fever status (febrile versus afebrile) had no significant relationship with the immunosuppression type, complaints, diagnoses, outcomes, or mortality. Final diagnoses varied by immunosuppression type: cholangitis in liver transplant recipients, respiratory infections in cancer patients, and urinary tract infections in kidney transplant recipients. Conclusions: Immunosuppressed patients can present with severe conditions, even without fever. Based on our findings, our study emphasizes that measuring PCT in immunosuppressed patients presenting to the emergency department with various complaints but without fever may help reduce the risk of delayed diagnosis. Full article
(This article belongs to the Special Issue Advances and Challenges in Prehospital Emergency Care)
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