Table 1 Characteristics of the included studies

Garner et al., 2015¹⁰

Australia

Randomized controlled trial

Physician-based pre-hospital care

Patients with a GCS score of 3–8 due to blunt trauma as measured in the 1st prehospital tea to arrive at the accident scene

178

43 (26–55)*

124:54

NR

30-day mortality, Persistent vegetative state, or disability

Standard care

197

40 (27–60)*

153:44

NR

Hepple et al., 2019¹¹

England

Retrospectives analysis

Enhanced critical care team

All injured patients who came to 2 trauma centers. The patients must have either been admitted to critical care, transferred to specialized care within 72 h, or died

281

44.7 (0–97)

206:75

17 (9–29)*

Mortality at hospital discharge

Non-enhanced care team

281

56.9 (0–105)

195:86

9 (9–19)*

Lyons et al., 2021⁷

Wales

Retrospective observational study

EMRTS

Patients with traumatic blunt injuries

412

NR

302:110

NR

30-day mortality

Standard care

3623

NR

1826:1797

NR

Maddock et al., 2020¹²

Scotland

Retrospective cohort study

Prehospital critical care team (PRCCT)

Adult trauma patients

776

45 (16–95)

565:211

17 (4–75)

30-day mortality

Non-PRCCT

13,504

56 (16–103)

7641:58:63

9 (1–75)

Yeguiayan et al., 2011¹³

France

Prospective cohort study

Pre-hospital management by Service Mobile d'Urgences et de Réanimation (SMUR)

Adult patients with severe blunt trauma

2513

41.1 ± 18.0

1910:603

NR

30-day mortality

Management by non-SMUR (Fire brigade)

193

153:37

NR

Fukuda et al., 2018¹⁴

Japan

Retrospective analysis

ALS by a physician

Patients with OHCA

814

58.5 ± 22.2

546:268

NR

1-month survival

ALS by EMS personnel

814

58.4 ± 22.2

567:247

NR

Goto et al., 2019¹⁵

Japan

Prospective observational study

Physician CPR

Patients with out-of-hospital cardiac arrest

16,612

68.2 ± 20.1

10,370:6242

NR

1-month neurologically intact survival

Paramedic CPR

16,612

68.8 ± 20.1

10,397:6215

NR

Den Hartog et al., 2015¹⁶

The Netherlands

Retrospective cohort study

HEMS

Severely injured patients with ISS > 15

681

43 (27–59)*

528:153

26 (22–25)*

Odds of survival at 30-days (adjusted for injury severity)

EMS

1495

44 (27–62)*

1082:413

22 (17–29)*

Moors et al., 2019 ¹⁷

Netherlands

Retrospective observational study

Physician based HEMS

Injured pediatric patients

196

12 (7–16)*

125:71

25 (18–34)*

Odds of survival at 30-days (adjusted for injury severity)

EMS

112

13 (8–16)*

82:30

19 (17–26)*

Tsuboi et al., 2024 ¹⁸

Japan

Retrospective cohort study

Physician staffed GEMS

Patients aged 15–85 years, with an ISS ≥ 16, a clear injury and transport history, and those transported to the hospital from the accident scene

2361

52.7 ± 20.5

1694:667

27.2 ± 10.4

Survival to hospital discharge

Non-physician staffed GEMS

46,783

56.5 ± 19.7

33,485:13,298

23.5 ± 8.4

de Jongh et al., 2012 ¹⁹

Netherlands

Retrospective cohort study

EMS

All patients with an ISS score of between 1 and 75

186

39.9 ± 22.5—with TBI@@36.2 ± 18.2 -without TBI

NR

30.8 ± 11.6—with TBI@@15.5 ± 11.3—without TBI

Mortality at hospital discharge

EMS/HEMS

186

39.6 ± 22.2 with TBI 36.2 ± 18.8 – with out TBI

NR

33.5 ± 11.0- with TBI 16.0 ± 12.6- without TBI

Hesselfeldt et l., 2013 ²⁰

Denmark

Prospective controlled observational study

Before P-HEMS

Trauma patients with suspected injury. Trauma with reduced level of consciousness.@@Age below 2 years suffering trauma. Mass casualty victims and Horseback riding accidents

56

26 (21–88)^ψ

39:17

25 (17–45)^ψ

Odds of survival at 30-days (adjusted for injury severity)

After P-HEMS

146

47 (15–81)^ψ

104:44

25 (16–43)^ψ

GEMS

22,203

 ≥ 15 years

15,694:6504

15–44

Hagihara et al., 2014 ²¹

Japan

Prospective observational study

Physician staffed ambulances

All OHCA patients without dependent cyanosis, rigor mortis, incineration, or decapitation

9231

69.41 ± 16.93

5894:3337

NR

1-month survival

Non-physician staffed ambulance

9231

69.44 ± 17.70

5405:3826

NR

ACLS by ELSTs

91,559

71.6 ± 17.8

56,507:35,052

NR

Bujak et al., 2022 ²²

Poland

Prospective observational study

Physician staffed EMS

All patients aged 18 years and above with OHCA were witnessed by EMS personnel

351

66 (58–77)*

244:107

NR

Survival to hospital discharge

Paramedic staffed EMS

351

67 (57–77)*

239:112

NR

Endo et al., 2021 ²³

Japan

Retrospective cohort study

Physician-led pre-hospital management

Patients aged ≥ 15 years suffering from blunt trauma with an ISS of ≥ 16. Patients are transferred directly from the accident scene. Patients with full data on their transportation to the hospital

2690

62 (41–74)*

1930:760

24 (17–30)

Mortality at hospital discharge

Paramedic-led pre-hospital management

10,760

62 (43–5)*

7593:3167

24 (17–29)

Hamilton et al., 2016 ²⁴

Denmark

Prospective observational study

Physician-involved prehospital care

All OHCA patients

13,234

70 (59–80)*

8252:4709

NR

1-month survival

Non-physician-involved pre-hospital care

7931

72 (61–81)*

5052:2879

NR

Hatakeyama et al., 2023 ²⁵

Japan

Retrospective analysis

With a pre-hospital physician

All OHCA patients aged 18 years and above

1173

75.0 (64.0–83.0)*

729:113

NR

1-month survival

Without a pre-hospital physician

1173

75.0 (63.0–84.0)*

713:460

NR

Kato et al., 2019 ²⁶

Japan

Retrospective cohort study

Physician based EMS

All patients aged ≥ 18 years with OHCA that was not caused by trauma

164

81 (69.8–88)*

82:82

NR

1-month survival

Paramedic based EMS

718

80 (69–70)*

397:418

NR

Sato et al., 2019 ²⁷

Japan

Retrospective observational study

Physician based care

All adult patients with OHCA of whom CPR had been attempted

135

66 (57–78)*

87:48

NR

1-month survival

Non-physician-based care

757

78 (66–86)*

519:240

NR

Obara et al., 2023 ²⁸

Japan

Retrospective observational study

Physician present in prehospital care

Patients with OHCA and less than 17 years

276

0–17 years

129:276

NR

1-month survival

Physician absent in pre-hospital care

911

0–17 years

112:276

NR

Endo et al., 2020²⁹

Japan

Retrospective cohort study

Physician-led pre-hospital management

Patients aged ≥ 15 years suffering from blunt trauma with an ISS of ≥ 16. Patients are transferred directly from the accident scene. Patients with full data on their transportation to the hospital

3032

62 (42–74)*

2156:876

25 (18–32)*

Mortality at hospital discharge

Paramedic-led pre-hospital management

27,936

63 (43–75)*

19,742:8194

21 (17–27)*

Hatakeyama et al., 2021³⁰

Japan

Retrospective cohort study

Physician present in prehospital care

Patients aged ≥ 18 with OHCA

2186

70 ± 15.3

1438:748

NR

1-month survival

Physician absent in pre-hospital care

17,061

73.8 ± 14.9

10,513:6548

NR

Pakkanen et al., 2019³¹

Finland

Retrospective observational study

Physician staffed EMS

Isolated severe TBI presenting with unconsciousness (GCS score ≤ 8)

468

50 (30–64)*

482:169

NR

1-year mortality

Paramedic staffed EMS

183