PHEM Q1 2026 Quarterly

PHEM Evidence Rundown

Q1 2026 Quarterly Compilation — January to March 2026

For PHEM doctors, critical care paramedics, BASICS responders & HEMS physicians

The first quarter of 2026 has delivered the strongest evidence base for prehospital critical care teams in a generation. From the Lancet Respiratory Medicine study estimating 170 lives saved per year by targeted prehospital RSI, to the ILCOR recommendation formally endorsing prehospital critical care teams for OHCA, to landmark position statements on prehospital TXA timing, blood products, and spinal motion restriction — this quarter demands attention from every PHEM practitioner. This compilation distils the 28 highest-impact items from Q1 into a single thematic reference document.

Quarter in Review: Q1 2026

Airway and RSI dominated the quarter. The Lancet Respiratory Medicine Intub-8 study provided the most powerful evidence yet that prehospital RSI saves lives — but only when targeted to the right patients. The RSI Trial in NEJM challenged ketamine's assumed haemodynamic stability, while a UK study on post-intubation hypotension in TBI placed a new SBP threshold at 100 mmHg. DAS published its most significant airway guideline update in a decade.

Haemorrhage control and blood products saw convergent international guidance. The NAEMSP/ACEP/ACS-COT joint TXA statement, the EAST TXA meta-analysis, and the PATCH-Trauma timing analysis all point in the same direction: TXA must be given fast (within 90 minutes), and it is adjunctive to haemorrhage control. Prehospital whole blood evidence matured, with systematic reviews confirming safety and reduced transfusion burden, while the ARC Bundle (pRBCs + TXA + calcium) emerged as the only bundled strategy with a consistent mortality signal.

Cardiac arrest saw the PRECARE trial demonstrate prehospital ECPR feasibility with 25% neurologically intact survival, and cost-effectiveness analysis confirmed it is economically viable within a multi-capability HEMS model. The ILCOR/ERC 2025 guidelines formally recommended prehospital critical care teams for OHCA for the first time.

Trauma systems were reshaped by KSSAA's HEMS outcomes study (5 extra survivors per 100 patients), the EAST urban penetrating trauma guideline challenging ALS interventions, and the NAEMSP geriatric trauma position statement addressing the growing elderly trauma population. The FPHC crush injury consensus and NAEMSP spinal motion restriction position rounded out a quarter of evidence-driven practice change.

FOAMed delivered exceptional PHEM content: St Emlyn's TBS 2026 reviews, the Damage Control Prehospital Care podcast with Harriet Tucker, The Resus Room's work on pseudo-PEA and intubation location, and REBEL EM's coverage of the HOPE stroke trial.

Key Statistics This Quarter

Total items reviewed

65+

Key to Evidence Tags

RCT Randomised Controlled Trial SR/MA Systematic Review / Meta-Analysis GUIDELINE Official Guideline CONSENSUS Consensus Statement OBSERVATIONAL Observational Study REVIEW Narrative/Scoping

Review

CHANGE PRACTICE Requires immediate practice review DipIMC/FIMC Relevant to DipIMC/FIMC curriculum

Contents

1. Airway & RSI — Intub-8 survival model, RSI Trial, post-intubation hypotension, DAS 2025, intubation location, VL performance errors
2. Resuscitation & Cardiac Arrest — ILCOR/ERC 2025, PRECARE ECPR, pseudo-PEA, resuscitative thoracotomy, bystander CPR, paediatric OHCA
3. Trauma & Haemorrhage Control — TXA timing & position statements, whole blood evidence, AAJT, central venous access, POC lactate, HEMS outcomes
4. Spinal & Triage — Spinal motion restriction, NAEMSP geriatric trauma, field triage performance
5. Oxygen & Respiratory — TRAUMOX2, RENOVATE, PE guidelines
6. FOAMed & Critical Appraisal — TBS 2026, Damage Control PHEM, HOPE stroke trial
7. Operational & System-Level — RCUK 2025, JRCALC update, RCEM/AACE pre-alert, AACE strategy, Air Ambulances UK

1. Airway & RSI

1.1 Prehospital RSI Saves 170 Lives Per Year in the UK (Intub-8) OBSERVATIONAL CHANGE

PRACTICE DipIMC/FIMC

Nelson AP et al. Lancet Respir Med. 2026 Feb 11. | Full text

AI-supported causal modelling study of 6,467 major trauma patients at Southmead Hospital MTC, Bristol. Using the Intub-8 machine learning model (8 prehospital variables), researchers identified patients who genuinely needed prehospital intubation and estimated the causal survival effect.

Key findings: Among 229 high-risk patients, prehospital intubation reduced 30-day mortality by 10.3%. Nationally, this translates to an estimated 170 lives per year — comparable to the impact of major trauma centre designation. AUC for intubation prediction: 0.943. Cost-effectiveness: just 89 GBP per QALY for the prehospital component. Crucially, indiscriminate intubation of all trauma patients showed only a 1.56% effect — the benefit is concentrated in identifiable high-risk patients.

Why it matters: This is the most policy-significant prehospital research paper of 2026. It provides the strongest evidence yet that targeted prehospital RSI by physician-paramedic teams saves lives and is cost-effective. It strengthens the case for HEMS and CCPAS funding and supports risk-stratified intubation protocols over a blanket approach.

Tell your department: "The Lancet Resp Med Intub-8 study shows prehospital RSI in the right patient saves 170 UK lives per year — but only when targeted. Blanket RSI for all comers does not work."

1.2 RSI Trial: Ketamine vs Etomidate RCT DipIMC/FIMC

Casey JD et al. N Engl J Med. 2025;393. | Full text

The largest RCT ever comparing ketamine (1–2 mg/kg) vs etomidate (0.2–0.3 mg/kg) for emergency intubation. 2,365 critically ill adults across 14 US EDs/ICUs.

Key findings: No mortality difference (ketamine 28.1% vs etomidate 29.1%; p=0.65). However, cardiovascular collapse was significantly more common with ketamine (22.1% vs 17.0%; NNH=20).

Etomidate's adrenal suppression did not translate to increased mortality. Trauma patients were excluded.

Caution: Ketamine's perceived haemodynamic stability does not hold at standard doses in this population. In catecholamine-depleted prehospital patients, the cardiovascular collapse risk may be amplified. However, trauma patients were excluded — extrapolation to HEMS RSI requires caution.

Tell your department: "The RSI Trial shows no mortality difference between ketamine and etomidate, but ketamine causes more cardiovascular collapse. Vasopressor readiness is essential regardless of agent choice."

1.3 Post-Intubation Hypotension in TBI: SBP Threshold at 100 mmHg OBSERVATIONAL CHANGE

PRACTICE DipIMC/FIMC

Price J et al. JAMA Netw Open. 2025;8(11):e2544057. | Full text

Multicentre retrospective cohort from East of England HEMS (HEMSbase linked to TARN). Over 500 patients undergoing prehospital RSI for severe TBI. Post-intubation hypotension (PIH, SBP <90 within 10 minutes) occurred in 19% and was associated with 43% vs 27% 30-day mortality. The mortality inflection point was at approximately 100 mmHg — not the traditional 90 mmHg.

Why it matters: This shifts the SBP target from 90 to 100 mmHg in isolated TBI. Meticulous haemodynamic management during prehospital RSI — arterial line pre-induction, judicious fentanyl titration, vasopressor readiness — should be standard HEMS practice.

Tell your department: "Post-intubation hypotension kills TBI patients. Aim for SBP above 100, not 90. Consider arterial line before induction."

1.4 DAS 2025 Difficult Airway Guidelines GUIDELINE DipIMC/FIMC

DAS Working Group. Br J Anaesth. 2026;136(1):283–307. | DAS Guidelines | PubMed

The most significant UK intubation guideline update since 2015. 65 recommendations from systematic review of 1,241 papers and three-round Delphi consensus. Plan A–D maintained. Video laryngoscopy now the preferred primary device. Maximum 3+1 intubation attempts. Physiologically difficult airway module directly applicable to HEMS RSI. FONA: scalpel–bougie–tube technique definitively recommended. Waveform capnography mandatory.

Why it matters: The definitive reference for airway management. HEMS SOPs should be reviewed against these recommendations, particularly on VL-first approach, 3+1 attempts, physiologically difficult airway, and FONA technique.

1.5 Intubation Location: In-Ambulance Saves Scene Time OBSERVATIONAL

Garner AA et al. Emerg Med J. 2025. | Reviewed: Resus Room Feb 2026

Single-centre retrospective (413 patients, 96 months). In-ambulance intubation was not associated with increased complications vs stretcher-outside, but reduced total scene time by a median 4 minutes (95% CI -6.5 to -1.5; p=0.002). First-pass success 96.9% overall. Ground intubations had 2x the complication risk.

Why it matters: Challenges the dogma of mandatory 360-degree access for prehospital RSI. In-ambulance intubation saves time and is safe, with direct implications for non-compressible haemorrhage where every minute counts.

1.6 Videolaryngoscopy Performance Errors: A New Taxonomy OBSERVATIONAL

Reviewed: Resus Room Mar 2026

Classification of microskill errors specific to hyperangulated videolaryngoscopy. Hyperangulated VL differs from standard geometry in technique requirements, yet training rarely distinguishes between them. Practical training and feedback implications for all HEMS airway providers using devices like the C-MAC D-blade or McGrath MAC.

2. Resuscitation & Cardiac Arrest

2.1 ILCOR/ERC 2025: Prehospital Critical Care Teams Recommended for OHCA GUIDELINE

CHANGE PRACTICE DipIMC/FIMC

ILCOR CoSTR 2025 / ERC Guidelines 2025. Circulation supplement, Oct 2025. | ILCOR CoSTR | ERC Guidelines

For the first time, ILCOR formally recommends prehospital critical care teams attend adult non-traumatic OHCA (weak recommendation, low certainty) and suggests attendance for paediatric OHCA. Additional key recommendations: suggest against routine mechanical CPR devices (may be reasonable where high-quality manual CPR is impractical); EMS systems may implement TOR rules with local validation; suggest against TOR rules in paediatric OHCA.

Why it matters: This is the highest-level international endorsement of HEMS/critical care team dispatch to cardiac arrest. Combined with the Intub-8 study, the evidence base for advanced prehospital teams is now stronger than at any previous point. Directly supports HEMS tasking to OHCA and funding justification.

2.2 PRECARE: Prehospital ECPR Feasibility and Cost-Effectiveness OBSERVATIONAL DipIMC/

FIMC

Kruit N et al. Resuscitation. 2025;212:110631. Cost analysis: Zmudzki F et al. Resusc Plus. 2026;28:101242. | PRECARE trial | Cost analysis

Prospective single-arm feasibility study (Sydney). 12 patients received prehospital ECPR on scene with 100% successful cannulation. Mean arrest-to-ECMO flow: 39 minutes. One-third weaned from ECMO; one-quarter survived to discharge with good neurological outcome. Cost-effectiveness: AUD $34,000/QALY (base case, 15% team time) — well below accepted thresholds. If team exclusively dedicated to ECPR: AUD $95,000/QALY. ON-SCENE trial (Netherlands) results expected Q2/Q3 2026.

Why it matters: Prehospital ECPR is technically feasible, produces 25% neurologically intact survival from refractory arrest, and is cost-effective within a multi-capability HEMS model. A hybrid team is the economically optimal design — directly relevant to UK HEMS services developing ECPR programmes.

2.3 Prehospital Resuscitative Thoracotomy: A Decision Framework CONSENSUS DipIMC/FIMC

ter Avest E et al. Crit Care. 2025;29:485. | Full text

A data-informed decision framework: injury location predicts tamponade vs exsanguination; organised ECG rhythm suggests residual viability. When tamponade is likely (penetrating thoracic), immediate RT is prioritised. When exsanguination is likely (junctional/abdominal), haemorrhage control and transfusion take precedence. Provides a structured graphic decision aid.

Why it matters: The most operationally useful RT decision framework to date. Print the graphic and add it to your service's clinical reference materials.

2.4 Pseudo-PEA: Reframing Arrest as Profound Shock SR/MA DipIMC/FIMC

Reviewed: Resus Room Mar 2026

Systematic review challenging the binary arrest/not-arrest model. Pseudo-PEA = organised electrical activity with cardiac contraction insufficient to generate a palpable pulse or audible BP. POCUS identifies myocardial motion and diagnoses reversible causes. Management reframe: treat as profound shock, not cardiac arrest. Decision-making implications for HEMS/BASICS teams with echo capability.

2.5 Bystander CPR: Definitive Meta-Analysis (72 Studies) SR/MA

Leng Z et al. Shock. 2026 Feb 3. | PubMed

The largest meta-analysis of bystander CPR to date (72 studies, 2.9 million OHCA events). Bystander CPR was associated with a 50% increase in odds of 30-day survival (OR 1.50, 95% CI 1.34–1.67). Benefit attenuated in older patients and women. Moderate evidence certainty.

2.6 Paediatric OHCA: Survival Drops Below 1% at 15 Minutes OBSERVATIONAL DipIMC/FIMC

Okubo M et al. Resuscitation. 2026 Feb 25. | Full text

Retrospective cohort (ROC Registry, 1,313 paediatric OHCA). Survival probability drops below 1% at approximately 14.8 minutes of EMS-initiated prehospital CPR. Of 1,313 children, 18% achieved prehospital ROSC; 10.4% survived to discharge. Provides objective data for the hardest termination-of-resuscitation decisions in prehospital practice.

2.7 Mechanical vs Manual CPR During Intra-Arrest Transport: No Difference OBSERVATIONAL

Resuscitation. 2026 Feb 19. | PubMed

Among OHCA patients undergoing intra-arrest transport, no significant difference between mechanical and manual CPR in neurological outcome (AOR 0.93). Survival to discharge: MCC 7.0% vs manual 7.8%. Consistent with PARAMEDIC, LINC, and CIRC. Mechanical CPR supports operator safety and consistency during complex manoeuvres, but is not a survival intervention.

3. Trauma & Haemorrhage Control

3.1 TXA Timing: 90-Minute Window (PATCH-Trauma Analysis) RCT CHANGE PRACTICE DipIMC/

FIMC

PATCH-Trauma investigators. Ann Emerg Med. 2026;87(1):83–89. | PubMed

Exploratory analysis of the PATCH-Trauma RCT (1,287 adults). TXA within 90 minutes: 28-day mortality 17% vs 25% placebo (ARR ~8%). TXA beyond 90 minutes: no mortality benefit (RR 1.04). The 3-hour window from CRASH-2 may be too permissive. Median prehospital administration time: 79 minutes.

Why it matters: The window opens and closes while many patients are still in the prehospital phase. This is the strongest argument yet for giving TXA as early as possible — ideally within 30–60 minutes, not just within 3 hours.

Tell your department: "The PATCH-Trauma analysis shows TXA works within 90 minutes and stops working after that. Give it early — the 3-hour window is too generous."

3.2 NAEMSP/ACEP/ACS-COT Joint TXA Position Statement CONSENSUS DipIMC/FIMC

Barrett WJ et al. | Full text | NAEMSP

The highest-level tripartite consensus on prehospital TXA. TXA may reduce mortality in adult trauma with haemorrhagic shock when administered within 3 hours. Two dosing regimens explicitly endorsed: 1g bolus + 1g hospital infusion, or 2g single IV/IO push (field-friendly). TXA is adjunctive, not a substitute for direct haemorrhage control. Not recommended for isolated TBI or SCI. Multidisciplinary QI programme required.

3.3 Prehospital Whole Blood: Converging Evidence SR/MA DipIMC/FIMC

Dion P-M et al. Transfusion. 2026 Mar 7. | Full text Raetz E et al. Prehospital Emergency Care. 2025;30:169–173. (SAFD safety data) Burns B et al. SJTREM. 2026 Jan 22. (Narrative review) | PubMed NAEMSP Blood Transfusion Position Statement. | PubMed

Q1 2026 saw convergent evidence on prehospital whole blood. The systematic review (7 studies, 6,954 patients) confirms consistent safety (no TRALI, no haemolysis, rare reactions at <1%) and reduced transfusion requirements, though mortality is neutral vs component therapy. The SAFD study (572 prehospital transfusions, <1% reaction rate) provides the largest safety dataset. The NAEMSP position endorses LTOWB as first-choice, with composite triggers including lactate >4 mmol/L. A separate study showed whole blood specifically benefits blunt trauma (survival 94.1% vs 79.5% for pRBCs).

The AHRQ systematic review (119 studies) found the Advanced Resuscitative Care Bundle (pRBCs + TXA + calcium) is the only bundled strategy with a consistent mortality signal. Each minute of field delay increases mortality by 11%.

Why it matters: Prehospital whole blood is safe and feasible. Bundle your interventions (blood + TXA + calcium). Blunt trauma may benefit most from whole blood. Minimise field time in haemorrhagic shock.

3.4 Prehospital Central Venous Access in Haemorrhagic Shock (London HEMS)

OBSERVATIONAL

Pallavicini P et al. Anaesthesia. 2026;81:83–91. | Full text

London's Air Ambulance, 4-year retrospective cohort. Large-bore trauma line insertion in exsanguinating haemorrhage: 80% success rate. Successful placement enabled significantly greater prehospital transfusion volumes. Survival to ED arrival higher with successful central line. Complications uncommon and minor.

3.5 AAJT: Civilian Pelvic Haemorrhage Control Without Vascular Access REVIEW

Honnef G et al. Scand J Trauma Resusc Emerg Med. 2026;34:2. | Full text

First civilian case report of the Abdominal Aortic and Junctional Tourniquet (AAJT) for blunt pelvic haemorrhage. No vascular access required. SBP improved from 70 to 90 mmHg within minutes. Maintained for 40 minutes during imaging and OR transfer. No lower limb ischaemia. Potential prehospital alternative to REBOA for non-compressible junctional haemorrhage, especially given the UK REBOA trial's early termination.

3.6 Prehospital POC Lactate Outperforms SBP and Shock Index SR/MA

Alabas MA et al. Cureus. 2026 Jan. | Full text

Systematic review: prehospital POC lactate (AUC 0.716–0.882) outperforms shock index (AUC 0.631) and SBP alone (AUC 0.59) for predicting early operative intervention. Clinically relevant threshold: lactate greater than or equal to 2.5 mmol/L. Particularly valuable in normotensive patients with occult hypoperfusion. Consistent across blunt and penetrating mechanisms.

3.7 HEMS Attendance: 5 Extra Survivors Per 100 Patients (KSSAA) OBSERVATIONAL

DipIMC/FIMC

Griggs J et al. Emerg Med J. 2026 Jan 22. | Full text

Kent, Surrey and Sussex Air Ambulance, 9-year Ws analysis of 3,225 major trauma patients. Actual 30-day survival was 85% vs predicted 81% — 5 extra survivors per 100 patients (~115 additional lives per year). Prehospital emergency anaesthesia independently associated with unexpected survival. Traumatic cardiac arrest ROSC rate improved 6% per year between 2013 and 2022.

3.8 Traumatic OHCA: Scene Time Over 10 Minutes Kills OBSERVATIONAL

Choi Y. Injury. 2026;57(1):112821.

South Korean registry (6,106 traumatic OHCA patients). Overall survival 3.7%. Scene time over 10 minutes associated with significantly reduced survival, with a sharp cutoff at the 10-minute mark. Reinforces "scoop and run" for traumatic cardiac arrest.

4. Spinal Management & Triage

4.1 Spinal Motion Restriction: 81% of Studies Favour Selective Approach SR/MA CHANGE

PRACTICE DipIMC/FIMC

Cucci F et al. Injury. 2026;57:113024. | PubMed

Scoping review (27 studies). 22/27 studies (81%) favoured selective spinal motion restriction over routine full immobilisation. No evidence that selective SMR increases missed injuries. Paediatric admissions reduced 25% with SMR. Full immobilisation associated with pain, reduced perfusion, and increased imaging workload.

Why it matters: Routine full immobilisation for all mechanism-based trauma is not evidence-supported. Selective assessment-based SMR is the evidence-aligned approach. EMS systems still mandating routine immobilisation should review their protocols.

4.2 NAEMSP Geriatric Trauma: Age-Adjusted Triage and SMR CONSENSUS

Haussner WK et al. Prehospital Emergency Care. 2025. | PubMed

NAEMSP position statement on the growing geriatric trauma population. Four core recommendations: (1) age-adjusted physiologic criteria for triage — standard parameters underestimate injury severity in the elderly; (2) prompt weight-based analgesia with pharmacokinetic adjustments; (3) consult advance care planning/POLST documents for resuscitation decisions; (4) selective SMR — full immobilisation often unsuitable for kyphotic elderly patients.

4.3 Field Triage Still Under-Triages 21% (ACS 2021 Criteria) OBSERVATIONAL

Johnston TF et al. Am J Surg. 2026;252:116729.

Even the 2021 updated ACS field triage guidelines fail to meet accuracy targets. Under-triage rate: 21.3% (target less than 5%). Normotensive patients with significant injury are being missed. This is exactly the population where prehospital lactate (item 3.6) adds value — physiological parameters alone are insufficient.

5. Oxygen & Respiratory

5.1 TRAUMOX2: Restrictive Oxygen Is Safe in Trauma RCT DipIMC/FIMC

Arleth T et al. JAMA. 2025;333(6):479–489. | Full text

Large Scandinavian RCT (1,500+ trauma patients). SpO2 94% target vs high-flow liberal oxygen for 8 hours. No difference in the primary composite outcome (death or major respiratory complications at 30 days). Atelectasis less frequent in the restrictive group. Indiscriminate hyperoxia offers no benefit.

Caution: Should not be extrapolated to intubated TBI patients. Conservative oxygen targeting is safe in the general trauma population but further data are needed for specific subgroups.

5.2 RENOVATE: HFNO Non-Inferior to NIV in Acute Respiratory Failure RCT

RENOVATE Investigators. JAMA. Mar 2025. Reviewed: SGEM #505

Multicentre adaptive non-inferiority RCT (1,800 adults, 33 hospitals). HFNO met non-inferiority criteria in 4 of 5 patient groups. Exception: immunocompromised patients (stopped for futility). HEMS and critical care paramedics carrying HFNO capability can use it confidently in most acute respiratory failure presentations.

6. FOAMed & Critical Appraisal

6.1 Damage Control Pre-Hospital Care (Harriet Tucker, St Emlyn's) EXPERT OPINION

St Emlyn's Podcast Ep 287 | 24 Feb 2026

Recorded at Trauma 2030 at the Royal College of Surgeons. Harriet Tucker (London's Air Ambulance / AAKSS) articulates a paradigm shift: moving away from maximal on-scene intervention towards rapid identification of the patient who cannot be fixed prehospital and ruthless prioritisation of time. Using time as treatment, not an adversary. One IV line may be enough. Move interventions into the ambulance. Prime the hospital with pre-alert. The "pit stop" resus model. Taking patients straight to theatre. Cultural resistance to doing less.

Why it matters: The most operationally important PHEM podcast episode this quarter. The damage control philosophy challenges existing practice for paramedics, HEMS, and BASICS responders. Essential listening.

6.2 HOPE Trial: Stroke Thrombolysis Extended to 4.5–24 Hours RCT DipIMC/FIMC

Zhou Y et al. JAMA. Aug 2025. Reviewed: REBEL EM

RCT, 372 perfusion-selected AIS patients. IV alteplase 4.5–24 hours post-stroke onset. mRS 0–1 at 90 days: 40.3% alteplase vs 26.3% standard care (NNT ~8). sICH: 3.8% vs 0.5% (NNH ~31). Mortality identical. Supports a "tissue over time" paradigm. If this becomes standard, PHEM clinicians must document last-known-well and facilitate CT perfusion imaging on primary transfer — not default to "outside window."

7. Operational & System-Level

Brief summaries of key operational developments from Q1 2026.

• RCUK 2025 Resuscitation Guidelines GUIDELINE — Full implementation required from 1 April 2026. Jaw thrust now mandated for suspected spinal injury. Drowning: 5 rescue breaths before compressions. Second adrenaline dose at 5 minutes in anaphylaxis. (RCUK)
• JRCALC December 2025 Update GUIDELINE — New intranasal/oromucosal fentanyl monographs. Paediatric End of Life Care section added. ACS, safeguarding, and medication updates. (JRCALC)
• RCEM/AACE Pre-Alert Guideline GUIDELINE — ATMIST format, 60-second maximum. "Heads up" calls explicitly prohibited. Embedding across trusts through Q1 2026. (PDF)
• AACE Five-Year Strategy 2026–2030 CONSENSUS — Paramedics as trusted assessors. Hospital handover delay eradication as 2030 success measure. Return to constitutional response times. (PDF)
• Air Ambulances UK 2026 Policy Position CONSENSUS — Four national priorities: hospital helipad access, patient data access, EGNOS satellite navigation, public awareness of charitable funding. (AAUK)
• NMTR (National Major Trauma Registry) CONSENSUS — Replacing TARN under NHS England. Phase 1 (MTCs) live; Phases 2–4 (trauma units) rolling out. Prehospital data linkage increasingly important. (NHS England)
• Cook Medical Field Safety Notice SAFETY ALERT — Blue Rhino percutaneous tracheostomy sets and Wayne pneumothorax kits affected by expiration date labelling error. HEMS/advanced teams: check lot numbers against Attachment 1. (NHS Supply Chain)

Looking Ahead: Q2 2026

• ON-SCENE Trial Results — The largest prehospital ECPR trial (Netherlands, ~220 patients) is expected to report in Q2/Q3 2026. This will be pivotal for UK HEMS ECPR programme development.
• RCUK 2025 Implementation Deadline — 1 April 2026. All UK first aid training must be compliant. Expect updated bystander CPR quality at handover.
• ECLS-OHCA Trial — Protocol published (SJTREM 2026) for RCT comparing total ECMO vs standard ACLS with rescue ECMO for refractory OHCA. Recruitment to begin.
• BASICS Pre-Hospital Care Conference 2026 — Watch for educational resources and emerging research presentations.
• DFTB26 Conference — Glasgow. Paediatric emergency and critical care education — relevant for PHEM teams attending paediatric emergencies.
• NMTR Phase 2–4 Rollout — Trauma units coming online. Prehospital data linkage quality will be scrutinised.

Action Points This Quarter

1. Review your service's RSI induction agent protocol in light of the RSI Trial — ensure vasopressor readiness regardless of ketamine vs etomidate.
2. Adopt SBP 100 mmHg (not 90) as the post-intubation target in isolated TBI.
3. Audit your TXA protocol: ensure administration is targeted within 90 minutes of injury. The 2g single-push option simplifies field logistics.
4. Review airway SOPs against DAS 2025 recommendations — VL-first, 3+1 attempts, scalpel-bougie-tube FONA.
5. Check Cook Medical tracheostomy and pneumothorax kit lot numbers (FSN 2026FA0001).
6. Update spinal management protocols: selective SMR, not routine full immobilisation.
7. Ensure RCUK 2025 implementation is complete before 1 April 2026 deadline.
8. Listen to St Emlyn's Ep 287 (Damage Control PHEM) and discuss at your next governance meeting.

Sources Checked for Q1 2026 Compilation

UK Guidelines: FPHC/RCSEd, RCUK, RCEM, DAS, NICE, MHRA, NHS England, AACE/JRCALC, College of Paramedics, Air Ambulances UK, BASICS, TARN/NMTR. International: NAEMSP, ILCOR, ERC, EAST, ACS-COT, AHA/ACC, ITACCS, ICAR MedCom. Journals: SJTREM, Prehospital Emergency Care, EMJ, Air Medical Journal, British Paramedic Journal, NEJM, Lancet (+Lancet Resp Med), JAMA (+JAMA Network Open, JAMA Surgery), Resuscitation (+Resusc Plus), Injury, J Trauma Acute Care Surg, Crit Care Med, Anaesthesia, Critical Care (BMC), Annals of EM, Pediatric Emergency Care, Shock, Transfusion, Am J Hematol, Cureus, Am J Surg. FOAMed: St Emlyn's, The Resus Room, REBEL EM, The Bottom Line, EMCrit/PulmCrit, SGEM, DFTB, LITFL, EM Cases.

Next quarterly compilation: Q2 2026 (June 2026). Weekly briefings continue every Monday.

This briefing summarises recent publications and guidelines for educational purposes. Clinical decisions should be made by qualified practitioners guided by local protocols, patient assessment, and professional judgement. Not a substitute for reading the original publications.

Jake Turner

Curated with the assistance of AI (Perplexity). All content editorially reviewed.