Prehospital Emergency Medical Services

The goal of this clinical trial is to evaluate whether rapid blood tests performed in the ambulance can be implemented in routine prehospital assessment of adults who are initially considered for transport to hospital. Ambulance clinicians frequently assess adults who are transported to hospital but discharged shortly after arrival without requiring advanced diagnostic testing or treatment. In this study, researchers will examine whether adding rapid point-of-care blood testing (POCT) at the scene supports ambulance clinicians and Emergency Medical Dispatch Centre (EMDC) physicians in making more informed decisions about hospital conveyance. POCT provides rapid measurements of biomarkers including infection markers, electrolytes, kidney function, blood counts, and total carbon dioxide, a proxy measure related to acid-base status. Ten ambulance clusters will participate in a matched, cluster-randomized design. Half will provide standard care, and half will have access to POCT following consultation with an EMDC physician in patients who would otherwise be considered for hospital transport. The main question is whether prehospital POCT can be performed, documented, and made available before the final conveyance decision in routine ambulance-based assessment. The study will also examine whether access to POCT is associated with a higher proportion of patients remaining at home rather than being transported to hospital. Safety outcomes will include hospital admission within 24 hours among non-conveyed patients, short-stay hospitalization, intensive care unit (ICU) admission, and 30-day mortality. This study will evaluate the implementation of POCT-supported decision-making in prehospital care and explore whether it may increase non-conveyance without compromising patient safety.

The goal of this prospective observational study is to develop and assess the core ultrasound applications for emergency medical technicians (EMTs) in Taiwan. The study focuses on advanced emergency medical technicians (EMT-Ps) and their ability to perform point-of-care ultrasound (POCUS) in prehospital settings. The main questions it aims to answer are: Can a standardized POCUS training program improve EMT-Ps' competency in ultrasound applications? What is the reliability and validity of the newly established POCUS assessment modules for EMT-Ps? Researchers will compare trained EMT-Ps' ultrasound proficiency and clinical decision-making before and after training to see if structured POCUS education enhances diagnostic accuracy and patient care in prehospital settings. Participants will: Attend a structured POCUS training program, including lectures and hands-on practice with standardized patients and simulation models. Undergo competency assessments, including written exams, objective structured clinical examinations (OSCEs), and image interpretation tests. Perform ultrasound scans on actual patients in prehospital settings, focusing on trauma, respiratory distress, stroke, and cardiac arrest cases. Receive feedback and participate in follow-up assessments to evaluate knowledge retention and clinical application.