Early cardiopulmonary resuscitation and defibrillation increase survival after out-of-hospital cardiac arrest. In Denmark, a national community first responder system dispatches nearby volunteers to initiate cardiopulmonary resuscitation and, when available, retrieve and use an automated external defibrillator before emergency medical services arrive. The system includes more than 60,000 volunteers, approximately 70
In acute stroke, prehospital decisions determine whether symptom recognition leads to timely prioritisation, specialist assessment, and transfer to definitive care. East Suffolk and North Essex include coastal and rural communities where deprivation, distance, workforce configuration, and hospital-interface pressures may combine to produce unequal access to time-sensitive stroke care. This study examined how emergency-system arrangements shape inequities in the recognition, prioritisation, assessment, conveyance, pre-alerting, and transfer of suspected stroke before definitive hospital care. We undertook a qualitative study between May 2024 and July 2025 using semi-structured interviews with 11 purposively selected stakeholders in East Suffolk and North Essex, including paramedics, stroke nurses, general practitioners, managers, a neurologist, and an academic stroke researcher. The work was classified as a service evaluation. Data were analysed thematically in NVivo 14 and mapped to the World Health Organization Health System Performance Assessment (WHO-HSPA) framework and Tanahashi’s coverage model. Intersectionality was used to examine how organisational processes interacted with social and geographical circumstances to shape exposure to delay, misrecognition, and reduced access to stroke-capable care. Patients and carers were not interviewed; findings therefore reflect provider and system-stakeholder accounts. Participants identified inequity where recognition had to be converted rapidly into dispatch priority, on-scene capability, pre-alerting, and transfer. Rural and coastal distance became more consequential when combined with limited mobility, complex extrication, Category 2 ambulance queueing, or secondary transfer. Limited English, communication difficulty, and atypical symptoms became more consequential when crews lacked consistent access to translation, digital tools, or specialist support. Effective coverage was further constrained where Face, Arm, Speech, Time (FAST)-oriented recognition intersected with living alone, multimorbidity, or subtle presentations. Across these domains, participants described compounded disadvantage when social and geographical circumstances interacted with uneven organisational capability and pathway design. Inequities in prehospital stroke care were described as arising from interactions between patients’ circumstances and emergency-system design. Organisational arrangements governing recognition, prioritisation, workforce capability, digital support, and transfer could make particular social, clinical, and geographical circumstances more consequential. The findings identify potential areas for local service review, including workforce development, digital and specialist support, transfer processes, and equity-sensitive feedback; their feasibility and effectiveness require further evaluation.
Older adults with sepsis have a high risk of mortality, and early prognostic biomarkers may facilitate risk stratification in the emergency department (ED). To compare the prognostic performance of lactate, lactate clearance and lactate-to-albumin ratio (LAR) for predicting 28-day mortality in older patients with sepsis. We conducted a retrospective cohort study of older patients (≥ 65 years) presenting with sepsis to the ED at Ramathibodi Hospital between June and December 2023. Initial serum lactate, serum albumin, and follow-up lactate levels at 6 h and 24 h were measured. The primary outcome was 28-day all-cause mortality. The predictive performance of the LAR and lactate clearance was compared using area under receiver operating characteristic (AUROC) curve analysis. Pairwise AUROC comparisons using the DeLong test were performed using complete-case analysis, and decision curve analysis (DCA) to assess clinical benefit. Of 272 older adults screened, 223 met the eligibility criteria. In the complete-case analysis (n = 176), 6-hour lactate clearance showed the highest discriminative performance (AUROC 0.77, 95
Ventilation during cardiopulmonary resuscitation (CPR) must avoid excessive rates and volumes that impair hemodynamics. Mechanical ventilation (MV) may provide more consistent ventilation than manual bag-valve-mask (BVM) ventilation, but its use during CPR reflects broader resuscitation system factors rather than an isolated intervention. We performed a systematic review and meta-analysis according to PRISMA guidelines (PROSPERO CRD420251147964). PubMed, Embase, Scopus, and Web of Science were searched through July 20, 2026, for randomized and observational studies comparing mechanical ventilation with manual bag-valve ventilation during adult cardiac arrest. Ventilation strategies varied across studies with respect to airway type and timing of intubation. The primary outcome was return of spontaneous circulation (ROSC). Secondary outcomes included sustained ROSC, survival to hospital discharge, and survival with favorable neurological outcome. Random-effects models were used. Risk of bias was assessed with RoB 2 and ROBINS-I, and certainty of evidence with GRADE. Nine studies, including 7,384 patients (three randomized controlled trials and six observational studies), were analyzed. MV during CPR was associated with higher odds of ROSC (odds ratio [OR] 1.26, 95
Respiratory failure is a major complication of neurotrauma, including traumatic brain injury and cervical spinal cord injury, but national mortality patterns involving co-reported head or neck injury and acute respiratory failure remain insufficiently described. This study evaluated temporal trends and demographic, geographic, and place-of-death disparities in U.S. mortality involving head or neck injuries with acute respiratory failure from 1999 to 2025. We conducted a population-based descriptive analysis using the CDC WONDER Multiple Cause-of-Death database. Deaths were included when ICD-10 codes for head injury or neck injury (S00–S09 or S10–S19) and acute respiratory failure (J96.0) were reported anywhere on the death certificate. Age-adjusted mortality rates (AAMRs) per 100,000 population were calculated and stratified by sex, age group, race/ethnicity, census region, state, metropolitan status, and place of death. Temporal trends were assessed using Joinpoint regression and reported as annual percent changes (APCs) with 95
