Paramedic-Led Prehospital Emergency Care Interventions and Their Impact on Patient Outcomes: A Systematic Review

Authors

  • Abdulaziz Dhafer Alqahtani Paramedic, Department of Emergency Medicine, King Saud University Medical City (KSUMC), Riyadh, Saudi Arabia Author
  • Abdulrahman Saeed Aljandabi Paramedic, Department of Emergency Medicine, King Saud University Medical City (KSUMC), Riyadh, Saudi Arabia. Author
  • Abduulah Ali Altuwaijri Paramedic, Department of Emergency Medicine, King Saud University Medical City (KSUMC), Riyadh, Saudi Arabia. Author
  • Nawaf Mohammed Alanazi Paramedic, Department of Emergency Medicine, King Saud University Medical City (KSUMC), Riyadh, Saudi Arabia. Author
  • Fares Abdullah Alshahrani Paramedic, Department of Emergency Medicine, King Saud University Medical City (KSUMC), Riyadh, Saudi Arabia. Author
  • Naif Ali Alshmrani Paramedic, Department of Emergency Medicine, King Saud University Medical City (KSUMC), Riyadh, Saudi Arabia. Author
  • Turki Athab Alrwaili Paramedic, Department of Emergency Medicine, King Saud University Medical City (KSUMC), Riyadh, Saudi Arabia. Author
  • Mohammed Mari E Alnami Paramedic, Department of Emergency Medicine, King Saud University Medical City (KSUMC), Riyadh, Saudi Arabia. Author

DOI:

https://doi.org/10.65759/8vp70102

Keywords:

Paramedics, prehospital care, emergency medical services, advanced life support, out-of-hospital cardiac arrest

Abstract

Background: Paramedic-led prehospital emergency care is a central component of time-sensitive emergency systems, and the clinical value of advanced procedures and drug treatment varies by condition, training model, and endpoint. Objective: This systematic review evaluated the impact of paramedic-led prehospital interventions on survival, neurological recovery, physiological improvement, hospital use, and safety. Methods: A PRISMA-aligned systematic search plan covered PubMed/MEDLINE, Scopus, Web of Science Core Collection, and Cochrane CENTRAL. Eligible studies enrolled emergency patients managed before hospital arrival by paramedics or ambulance clinicians and reported patient-level outcomes after a defined intervention. Randomized trials, cluster trials, controlled before–after studies, and large prospective clinical studies were prioritized. Results: Ten studies were selected for synthesis. Evidence showed context-specific benefit rather than universal benefit from prehospital care. Advanced life support improved outcomes in respiratory distress, while systemwide advanced life support did not improve survival after cardiac arrest or major trauma. Epinephrine improved 30-day survival after out-of-hospital cardiac arrest without an increase in favorable neurological recovery. Supraglottic airway approaches achieved easier ventilation, with mixed survival findings. Plasma improved 30-day survival in air-medical trauma patients, whereas tranexamic acid and combined red-cell/plasma resuscitation produced neutral primary results. Prehospital antibiotics for suspected sepsis shortened treatment time without mortality reduction. Conclusion: Paramedic-led interventions improve outcomes when matched to precise clinical phenotype, rapid protocol execution, and outcome-focused quality systems.

References

1. Stiell IG, Wells GA, Field B, Spaite DW, Nesbitt LP, De Maio VJ, et al. Advanced cardiac life support in out-of-hospital cardiac arrest. N Engl J Med. 2004;351(7):647-656. doi:10.1056/NEJMoa040325.

2. Stiell IG, Spaite DW, Field B, Nesbitt LP, Munkley D, Maloney J, et al. Advanced life support for out-of-hospital respiratory distress. N Engl J Med. 2007;356(21):2156-2164. doi:10.1056/NEJMoa060334.

3. Stiell IG, Nesbitt LP, Pickett W, Munkley D, Spaite DW, Banek J, et al. The OPALS Major Trauma Study: impact of advanced life-support on survival and morbidity. CMAJ. 2008;178(9):1141-1152. doi:10.1503/cmaj.071154.

4. Perkins GD, Ji C, Deakin CD, Quinn T, Nolan JP, Scomparin C, et al. A randomized trial of epinephrine in out-of-hospital cardiac arrest. N Engl J Med. 2018;379(8):711-721. doi:10.1056/NEJMoa1806842.

5. Benger JR, Kirby K, Black S, Brett SJ, Clout M, Lazaroo MJ, et al. Effect of a strategy of a supraglottic airway device vs tracheal intubation during out-of-hospital cardiac arrest on functional outcome: the AIRWAYS-2 randomized clinical trial. JAMA. 2018;320(8):779-791. doi:10.1001/jama.2018.11597.

6. Sperry JL, Guyette FX, Brown JB, Yazer MH, Triulzi DJ, Early-Young BJ, et al. Prehospital plasma during air medical transport in trauma patients at risk for hemorrhagic shock. N Engl J Med. 2018;379(4):315-326. doi:10.1056/NEJMoa1802345.

7. Alam N, Oskam E, Stassen PM, van Exter P, van de Ven PM, Haak HR, et al. Prehospital antibiotics in the ambulance for sepsis: a multicentre, open label, randomised trial. Lancet Respir Med. 2018;6(1):40-50. doi:10.1016/S2213-2600(17)30469-1.

8. Wang HE, Schmicker RH, Daya MR, Stephens SW, Idris AH, Carlson JN, et al. Effect of a strategy of initial laryngeal tube insertion vs endotracheal intubation on 72-hour survival in adults with out-of-hospital cardiac arrest: a randomized clinical trial. JAMA. 2018;320(8):769-778. doi:10.1001/jama.2018.7044.

9. Guyette FX, Brown JB, Zenati MS, Early-Young BJ, Adams PW, Eastridge BJ, et al. Tranexamic acid during prehospital transport in patients at risk for hemorrhage after injury: a double-blind, placebo-controlled, randomized clinical trial. JAMA Surg. 2021;156(1):11-20. doi:10.1001/jamasurg.2020.4350.

10. Crombie N, Doughty HA, Bishop JRB, Desai A, Dixon EF, Hancox JM, et al. Resuscitation with blood products in patients with trauma-related haemorrhagic shock receiving prehospital care: the RePHILL randomized controlled phase 3 trial. Lancet Haematol. 2022;9(4):e250-e261. doi:10.1016/S2352-3026(22)00040-0.

11. Kim F, Nichol G, Maynard C, Hallstrom A, Kudenchuk PJ, Rea T, et al. Effect of prehospital induction of mild hypothermia on survival and neurological status among adults with cardiac arrest: a randomized clinical trial. JAMA. 2014;311(1):45-52. doi:10.1001/jama.2013.282173.

12. RIGHT-2 Investigators. Prehospital transdermal glyceryl trinitrate in patients with ultra-acute presumed stroke: an ambulance-based, randomised, sham-controlled, blinded-endpoint, phase 3 trial. Lancet. 2019;393(10175):1009-1020. doi:10.1016/S0140-6736(19)30194-1.

13. Jayaraman S, Sethi D, Wong R. Advanced training in trauma life support for ambulance crews. Cochrane Database Syst Rev. 2014;2014(8):CD003109. doi:10.1002/14651858.CD003109.pub3.

14. Finn J, Jacobs I, Williams TA, Gates S, Perkins GD. Adrenaline and vasopressin for cardiac arrest. Cochrane Database Syst Rev. 2019;1(1):CD003179. doi:10.1002/14651858.CD003179.pub2.

15. Carney N, Totten AM, Cheney TP, Jungbauer RM, Neth MR, Weeks C, et al. Prehospital airway management: a systematic review. Prehosp Emerg Care. 2022;26(5):716-727. doi:10.1080/10903127.2021.1940400.

16. Lindsay PJ, Buell D, Scales DC. The efficacy and safety of pre-hospital cooling after out-of-hospital cardiac arrest: a systematic review and meta-analysis. Crit Care. 2018;22(1):66. doi:10.1186/s13054-018-1984-2.

17. Acharya P, Sinha R, Jena R, Sharma N, Vats A, Kumar S. Prehospital tranexamic acid in trauma patients: a systematic review and meta-analysis. Front Med. 2023;10:1284016. doi:10.3389/fmed.2023.1284016.

18. Varney J, Tillyard A, Kirtley S, Daei A, Wang X, Knight T. Prehospital administration of broad-spectrum antibiotics for sepsis: a systematic review and meta-analysis. J Clin Med. 2022;11(7):1922. doi:10.3390/jcm11071922.

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Published

2026-06-29

Issue

Vol. 2 No. 3 (2025): Journal of Tazeez for Public Health

Section

Articles