ABSTRACTS
Prehospital Antibiotic Use: A National Retrospective Cohort StudyAuthor: Aimee Fleming EMT-P, EMS-Instructor | Clinical Captain | Williamson County EMS Associate Authors: May, Robby, Ed.D., NRP, CCP-C Muneer, Aqib, D.O. Jarvis, Jeffrey L, MD, MS, EMT-P Fernandez, Antonio, Ph.D., NRP
Background: Early antibiotic use has been associated with decreased ICU length of stay and mortality. In patients with open fractures, EMS antibiotic use has decreased time to treatment and lowered infection rates. A recent position statement recommends early prehospital antibiotics. Little is known, however, of the national practice of prehospital antibiotic use. Objective: We sought to determine the prevalence of prehospital antibiotic use while describing the characteristics of patients receiving antibiotics. Methods: We conducted a cohort analysis of the de-identified 2024 ESO Data Collaborative research dataset. We included all 911 responses with linked hospital outcome data in which patients received an antibiotic in the prehospital setting. We excluded interfacility transfers, topical antibiotic administration, and records with missing data on route or time of administration. We describe characteristics of patients receiving antibiotics - age, gender, race/ethnicity, and urbanicity; clinical characteristics - clinician's field impression, the emergency department diagnosis/disposition, the Social Vulnerability (SVI) of the patient’s geographic location; and intervention details - specific antibiotic(s) used and route of administration. Results: Of the 12,568,565 911 responses in the dataset, 4,607 (0.04%) cases involved the administration of prehospital antibiotics. The median age was 65 [IQR: 40-78] with 4% pediatric (<18), 45.1% adult (18-64), and 51% Geriatric (>65). 59.6% were female and 69.2% were White. 37.6% of responses were by third-service agencies (61.2%) and 25.5% by fire-based agencies. 70.2% were by agencies using paid staff. 55% of field clinical impressions were medical. The most frequently used antibiotics were cefazolin (39.9%) and ceftriaxone (38.3%). Antibiotics were administered via an intravenous route in 83.1%. Conclusion: Prehospital antibiotic administration is a rare intervention in this dataset with cefazolin and ceftriaxone being the most common. These findings provide a broad characterization of current EMS antibiotic use, offering insight into patterns of care and potential areas for further investigation.
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