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Table 2 The EBS

From: The development of emergency medical services benefit score: a European Delphi study

EBS Description Exemplar interventions*
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
  1. COPD chronic obstructive pulmonary disease, ECMO extracorporeal membrane oxygenation, ECPR extracorporeal cardiopulmonary resuscitation, CPR cardiopulmonary resuscitation, STEMI ST-elevation myocardial infarction
  2. *Interventions are listed as examples for each category; determination of the correct EBS is made by the prehospital clinician in charge of patient care