Table 2 The EBS

0

The patient was not seen

1

Prehospital care was not deemed necessary

2

Prehospital care apparently had no significance from the patient’s standpoint (e.g., cannulation, no medication or fluid therapy) or, despite prehospital care, the patient died before reaching the hospital

3

Prehospital care apparently had no significance from the standpoint of the prognosis, but the patient’s symptoms or pain was alleviated (e.g., injured patient’s analgesia)

Administration of analgesics

Administration of antihistamines to treat an allergic reaction

Antiemetic medication

4

Prehospital care was administered; its significance from the patient’s standpoint is unknown, difficult to assess or only assessable retrospectively (e.g., treatment of ischaemic chest pain, brief convulsions and mild breathing difficulty)

Trauma patient immobilisation (cervical collar, back board, etc.)

Administration of inhaled bronchodilators for COPD or pneumonia

Administration of oxygen in moderate breathing difficulty

5

Without prehospital care (administered by the first response unit or the physician-staffed unit), the patient would have died before reaching the hospital, but he/she was assessed as having a poor prognosis (e.g., serious brain damage, coma caused by spontaneous cerebral haemorrhage, primary survival from cardiac arrest after lengthy response times and terminal phase of a malignant disease)

Patient treated but due to severe symptoms and/or underlying diseases has a poor prognosis (e.g., severe trauma or traumatic cardiac arrest, severe hypoxic insult, prolonged resuscitation and cardiac arrest due to severe traumatic brain injury or subarachnoid haemorrhage)

6

The patient was given prehospital care that can be assessed to reduce mortality or otherwise improve the prognosis

Administration of physician-staffed EMS-level medication (medication not allowed in other units) followed by relief of signs and symptoms

Administration of tranexamic acid

Medication for circulatory support (i.v. ephedrine, i.v. noradrenaline or norepinephrine, etc.)

Treatment of prolonged seizures by first- or second-line i.v. medication (bentsodiazepines, phosphenytoin, etc.)

Treatment of hypoglycaemia-induced coma or seizures by i.v. glucose or s.c./i.m. glucagon

Treatment of hypoglycaemia by i.v. glucose or s.c./i.m. glucagon when patient is disoriented but not in coma

Reduction and stabilisation of fractures or luxations

Triage and patient selection to dedicated centre and rapid transportation (major trauma, TBI, need of thrombectomy, need for re-implantation in traumatic amputation, etc.)

Treatment of opioid or benzodiazepine poisoning by antidotes

Maternal positioning in case of prolapsed umbilical cord

Thrombolysis for STEMI in cases with long transportation times

Rapid transportation to PCI

7

Without prehospital care (administered by the first response unit or the physician-staffed unit), the patient would have died before reaching the hospital, and he/she cannot be assessed as having a poor prognosis

Mass casualty incident leadership and triage

Treatment and stabilising of a multi-trauma patient in shock by i.v. fluid administration and/or vasoactive medication

Isolated severe trauma managed with simple manoeuvres (e.g., direct compression and tourniquet)

Needle thoracocentesis followed by a relief of signs and symptoms

Cardioversion or cardiac pacing

Medication (adrenalin/epinephrine) in anaphylactic shock and relief of signs and symptoms

Successful resuscitation with reasonable prognosis

Transfer to ECMO, bypass or angiography during CPR

Manual opening of an obstructed airway and bag-mask ventilation

Use of a supraglottic device and bag-mask ventilation

8

Category 7 in situations where other emergency medical staff on site would not have been capable of administering the aforementioned life-saving treatment (use of physician-staffed EMS unit or advanced trained paramedic unit in systems where licenced to perform)

Thoracotomy or tamponade release with other manoeuvres

Thoracostomy or pleural drainage followed by relief of signs and symptoms

ECMO initiation in prehospital phase (ECPR)

Management of complicated childbirth (shoulder dystocia, malposition, etc.)

Prehospital Caesarean section (resuscitative hysterectomy)

Resuscitation of a newborn by bag-mask ventilation or by more advanced procedures

Rapid sequence intubation or surgical airway management and mechanical ventilation

Blood product transfusions