The Cardiac Arrest Registry to Enhance Survival (CARES) was created in 2004 in collaboration with the Centers for Disease Control and Prevention (CDC) and Emory University School of Medicine’s Department of Emergency Medicine. The registry allows local communities to benchmark their performance, enhance the quality of care, and increase survival rates for out-of-hospital cardiac arrest (OHCA). CARES enrolls patients who experience a non-traumatic, EMS-treated OHCA. For each case, data is collected from three sources: 911 call center data, EMS data, and hospital data. CARES data is de-identified and stored in a secured web-based cloud platform and maintains confidentiality throughout the process. CARES data is subjected to an internal auditing system that oversees both local and regional levels. The variables in CARES adhere with the Utstein style reporting system and the National EMS Information System (NEMSIS) standard. As of 2023, CARES captures data from a population base of over 178 million people which accounts for 53% of the total U.S. population. Over the past two decades, CARES has consistently been a part of public health surveillance for OHCA and serves as a quality improvement tool to improve cardiac arrest outcomes. Moreover, CARES commits to facilitate observational research on OHCA, continues to modernize its software platform, and comprehensively expands its coverage for the entire U.S.

Transgender and gender diverse (TGD) people have long faced significant barriers to safely accessing medical care-especially gender-affirming care, which has been shown to strikingly improve health outcomes like suicidality and depression. In the prehospital setting, gender-affirming care amounts to showing respect for the TGD patient's identified gender and maintaining a safe environment that fosters a positive therapeutic relationship throughout the encounter. This represents a challenge for many Emergency Medical Services (EMS) systems due to the lack of TGD-specific training for EMS clinicians, a paucity of TGD-specific research to inform EMS education and clinical care, and in some cases the resistance of EMS clinicians to such training. Transgender and gender diverse people are facing a regression in legal access to essential medical care. With this position statement, NAEMSP joins other professional medical societies in providing recommendations to improve care for TGD patients, thereby affirming TGD individuals' right to exist as their authentic selves, as well as their entitlement to the same high-quality prehospital medical care as their cisgender peers.

Background: Training on how to perform a prehospital extended focused assessment with sonography in trauma (EFAST) has resulted in improved outcomes for trauma patients in several countries. The result of previous studies showed good accuracy despite minimal training. However, data on the diagnostic accuracy among untrained paramedic students and the course length in middle-income countries is scarce. In Thailand, the current paramedic education does not include training on prehospital ultrasounds. In the present study, we aimed to investigate the diagnostic accuracy of EFAST among ultrasound-naïve paramedic students and factors that are associated with successful posttest training. Methods: Final-year paramedic students attending a 4-year university program were included in this study. A 2-h didactic training session and 1-h hands-on workshop were led by experienced emergency physicians. The diagnostic indices for EFAST interpretation were obtained pretraining and posttraining. The participants’ ultrasound image acquisition was also evaluated individually on a mannequin model using a standardized assessment tool. Results: In total, 47 paramedic students were voluntarily enrolled and underwent EFAST training. Of these participants, 31 (66%) reported having > 1 year of experience in the prehospital field. Four were advanced emergency medical technicians before becoming paramedic students. The sensitivity, specificity, positive predictive value, and negative predictive value after training were 85.7% (95% CI, 81.5– 89.3), 81.6% (95% CI, 74.2– 87.6), 91.6% (95% CI, 87.9– 94.4), and 71% (95% CI, 63.3– 77.8), respectively. Previous prehospital experience was not associated with accuracy. Conclusion: This study demonstrated that paramedic students in Thailand were able to achieve a competency comparable with that of other medical professionals in a simulated environment. The total 3 h training course was sufficient for them to acquire EFAST skills.

Background/Objectives: Accurate telephone triage of emergency medical cases plays a crucial role in improving outcomes for critically ill patients. Effective triage enables emergency medical dispatchers to provide appropriate pre-arrival instructions and to deploy operational units according to the patient’s severity level. This study aimed to develop and assess the content validity of the Emergency Medical Triage Protocol and Criteria-Based Dispatch Code (EMTP-CBDC) for Thailand. The objective was to ensure the tool’s content accuracy and applicability in prioritizing emergency responses in line with medical urgency, considering global changes and universal standards. Methods: A cross-sectional descriptive study was conducted from 15–30 April 2024. The content validity of the newly developed EMTP-CBDC, comprising 30 symptom groups, was evaluated by five emergency physician experts with at least 1 year of experience in emergency medical oversight. The assessment focused on four aspects: relevance, clarity, simplicity, and ambiguity. The Content Validity Index (CVI) was calculated at both the item level (I-CVI) and the scale level using the average index (S-CVI/Ave). To adjust for chance agreement, the probability of chance agreement (Pc) and the modified kappa coefficient (k*) were calculated for each item. Results: The content validation revealed I-CVI values ranging from 0.80 to 1.00 across all items. The S-CVI/Ave scores were 0.97 for relevance, 0.93 for clarity, 0.98 for simplicity, and 0.94 for ambiguity. These values surpassed the accepted thresholds for content validity. Conclusions: The EMTP-CBDC developed for Thailand demonstrated good content validity across relevance, clarity, simplicity, and ambiguity. Further studies are needed to establish its reliability and field performance before routine implementation.

Introduction: Water-related emergencies are a major urban public health concern, particularly along Bangkok’s heavily trafficked Chao Phraya River. Between 2019 and 2023, Bangkok reported the third-highest drowning mortality rate in Thailand. Although advanced water-based emergency medical service (EMS) units have operated for more than three decades, their operational characteristics have not been systematically evaluated. Objective: To describe the operational characteristics and system structure of advanced water-based EMS units operating along the Chao Phraya River in Bangkok. Methods: A retrospective descriptive study analyzed operational data from January 1, 2021, to December 31, 2023, using mission report databases from the Bangkok Metropolitan Administration EMS Center and three designated advanced water-based EMS units. Key variables included annual incident notifications, mission characteristics, operational outcomes, and system structure. Results: Descriptive evaluation identified several system limitations across all units, including inadequate docking infrastructure, shortages of specialized medical equipment, and the absence of standardized clinical protocols and performance monitoring. Comprehensive quantitative analysis was not possible for Units 2 and 3 because of incomplete operational records. Unit 1 recorded 28, 71, and 52 incident notifications in 2021, 2022, and 2023, respectively, resulting in 11, 50, and 18 EMS missions. Medical assistance was provided in 1, 11, and 9 cases, respectively. These findings are presented descriptively and should not be interpreted as comparisons between units because comparable operational data were unavailable for Units 2 and 3. Conclusion: Available data indicate important gaps in infrastructure, documentation, standardized reporting, and performance monitoring within Bangkok’s water-based EMS system. Strengthening the system will require improved docking infrastructure, standardized medical equipment, digitized reporting systems, and the implementation of continuous quality improvement processes.

Introduction: Criteria-Based Dispatch (CBD) is Thailand’s national telephone-based prehospital triage system used to prioritize emergency response and allocate resources. However, long-term national trends in CBD utilization and their implications for healthcare leadership remain limited. Purpose: This study aimed to analyze 10-year trends in CBD utilization in Thailand (2012– 2022), focusing on overall patterns, age groups, and geographic variations to inform policy and EMS planning. Methods: This retrospective descriptive study analyzed 14,763,882 emergency calls recorded in the national EMS database. Trend analyses were conducted to assess temporal changes across CBD categories, demographic subgroups, and regions. Results: Of 14,758,415 eligible calls, CBD 25 (motor vehicle accident) was the most common category (23.6%) and showed a significant increasing trend with seasonal peaks during the New Year period (p < 0.001). Adults aged 18– 59 years accounted for the largest proportion of calls (52.4%), with CBD 25 predominating (31.5%). Among older adults (≥ 60 years), CBD 17 (sick [unknown]/other) was most frequent (33.3%). Regionally, the Northeast had the highest call volume (46.7%), where CBD 17 predominated, while CBD 25 was most common in other regions. Conclusion: These findings describe important variations in EMS demand across population groups and regions and may inform workforce planning, resource allocation, and targeted prevention strategies.