Standardized algorithm for the primary assessment of patients during the prehospital phase of emergency medical care

The quality of emergency medical care provided in the prehospital setting is directly dependent on the standardization of the algorithms used during the initial assessment. In situations of acute time constraints and significant clinical uncertainty, the use of standardized protocols helps reduce subjectivity in the diagnostic process and streamline patient management strategies. The aim of this study was to develop and scientifically substantiate a standardized algorithm for the initial patient examination. The study involved an analysis of legislative and regulatory documents, domestic and international scientific sources, as well as expert opinions on the quality of medical care. It was found that neglecting the biomechanical characteristics of the injury and the absence of a strict sequence during the initial examination contribute to the development of “diagnostic blindness” and an “obfuscated” clinical picture, in which the proportion of undetected hidden injuries in cases of multiple trauma ranges from 20 to 30 %. It has been established that errors made during the collection of medical history and objective data lead to an incorrect initial diagnosis and the selection of a suboptimal treatment strategy, which subsequently results in a break in continuity between the various stages of care. A standardized algorithm has been developed that combines an analysis of the biomechanics of the injury with the sequential application of the DRSABCDE protocol. This algorithm is based on the principles of obtaining the most comprehensive information possible in the shortest possible time and prioritizing the exclusion of pathological conditions that pose an immediate threat to life. The practical implementation of the proposed approach will reduce the influence of subjective factors, ensure consistency in tactical decisions when treating critically ill patients, shorten the decision-making phase, and strengthen the legal protection of first responders and healthcare professionals.

1. Entwistle V., Firnigl D., Ryan M., Francis J., Kinghorn P. Which experiences of health care delivery matter to service users and why? A critical interpretive synthesis and conceptual map. Journal of Health Services Research and Policy, 2012, vol. 17, no. 2, pp. 70–78. https://doi.org/10.1258/jhsrp.2011.011029

2. Sharabchiev Yu. T., Dudina T. V. Availability and quality of medical care: components of success. Mezhdunarodnye obzory: klinicheskaya praktika i zdorov’e [International reviews: clinical practice and health], 2013, no. 4, pp. 16–34 (in Russian).

3. Shkarupa V. V., Kuzin A. A., Zobov A. E., Ryzhikov A. A. Methods for assessing the quality of medical care in Russia and abroad: formation and modern aspects. Vestnik Rossiiskoi Voenno-meditsinskoi akademii [Bulletin of the Russian Military Medical Academy], 2024, vol. 26, no. 1, pp. 101–112 (in Russian).

4. Karailanov M. G., Panfilov M. S., Cherkasov S. N. Ways to optimise the emergency medical service in the conditions of a large city district. Mezhdunarodnyi nauchno-issledovatel’skii zhurnal [International Research Journal], 2023, no. 8, art. 117 (in Russian).

5. Mikhailova Yu. V., Plavunov N. F., Vvedenskii G. A., Mikhailov A. Yu. Directions for improving the management of the ambulance and emergency service, including specialized care, in a megalopolis, based on the results of a sociological survey. Sotsial’nye aspekty zdorov’ya naseleniya [Social Aspects of Population Health], 2025, vol. 71, no. 3, art. 2 (in Russian).

6. Böbel S., Verhoeven J., Scholz M., Penders B., Frisina Doetter L., Collatz Christensen H., Krafft T. Strengthening the WHO emergency care systems framework: insights from an integrated, patient-centered approach in the copenhagen emergency medical services system-a qualitative system analysis. BMC Health Services Research, 2025, vol. 25, no. 1, art. 401. https://doi.org/10.1186/s12913-025-12465-7

7. Gerlach G. M., Jerjen S. M. E., Gemperli A. Integrating emergency medical services into health systems for continuous and resilient care. Public Health Reviews, 2026, vol. 47, art. 1609282. https://doi.org/10.3389/phrs.2026.1609282

8. Voskanyan Yu. E. Epidemiology of medical errors and incidents in emergency medicine. Zhurnal imeni N. V. Sklifo­ sovskogo “Neotlozhnaya meditsinskaya pomoshch′” = Russian Sklifosovsky Journal of Emergency Medical Care, 2022, vol. 11, no. 2, pp. 301–316 (in Russian).

9. Murav’eva A. A., Farsiyants A. V., Kovrizhkin A. V. The main problems and defects of the medical care on prehospital stage for patients with acute cerebrovascular accident in Stavropol. Skoraya meditsinskaya pomoshch’ [Emergency Medical Care], 2023, vol. 24, no. 2, pp. 84–90 (in Russian).

10. Cimino J., Braun C. Clinical research in prehospital care: current and future challenges. Clinics and Practice, 2023, vol. 13, no. 5, pp. 1266–1285. https://doi.org/10.3390/clinpract13050114

11. Martin-Gill C., Patterson P. D., Richards C. T., Misra A. J., Potts B. T., Cash R. E. 2024 systematic review of evidencebased guidelines for prehospital care. Prehospital Emergency Care, 2025, vol. 29, no. 6, pp. 703–712. https://doi.org/10.1080/10903127.2024.2412299

12. Ehlers P., Seidel M., Schacher S., Pin M., Fimmers R., Kogej M., Gräff I. Prospective observational multisite study of handover in the emergency department: theory versus practice. Western Journal of Emergency Medicine, 2021, vol. 22, no. 2, pp. 401–409. https://doi.org/10.5811/westjem.2020.9.47836

13. Barsukova I. M., Makhnovskii A. I., Miroshnichenko A. G., Gudz’ Yu. V., Khominets V. V., Ergashev O. N. “Acute abdomen”: comparison of diagnoses of emergency medical teams and emergency hospital. Skoraya meditsinskaya pomoshch’ [Emergency Medical Care], 2023, vol. 24, no. 4, pp. 11–16 (in Russian).

14. Mangus C. W., James T. G., Parker S. J., Duffy E., Chandanabhumma P. P., Cassady C. M., Bellolio F., Pasupathy K. S., Manojlovich M., Singh H., Mahajan P. Frontline providers’ and patients’ perspectives on improving diagnostic safety in the emergency department: a qualitative study. Joint Commission Journal on Quality and Patient Safety, 2024, vol. 50, no. 7, pp. 480–491. https://doi.org/10.1016/j.jcjq.2024.03.003

15. Kingswell C. J., Calleja P., Sahay A. The impact of emergency triage practices on patient safety: a scoping review protocol. Journal of Emergency Nursing, 2025, vol. 51, no. 3, pp. 498–503. https://doi.org/10.1016/j.jen.2024.12.002

16. McGarvey K., Scott K., O’Leary F. Round-the-table teaching: a novel approach to resuscitation education. The Clinical Teacher, 2014, vol. 11, no. 6, pp. 444–448. https://doi.org/10.1111/tct.12175

17. Schoeber N. H. C., Linders M., Binkhorst M., De Boode W. P., Draaisma J. M. T., Morsink M., Nusmeier A., Pas M., van Riessen C., Turner N. M., Verhage R., Fluit C. R. M. G., Hogeveen M. Healthcare professionals’ knowledge of the systematic ABCDE approach: a cross-sectional study. BMC Emergency Medicine, 2022, vol. 22, no. 1, art. 202. https://doi.org/10.1186/s12873-022-00753-y

18. Bruinink L. J., Linders M., de Boode W. P., Fluit C. R. M. G., Hogeveen M. The ABCDE approach in critically ill patients: a scoping review of assessment tools, adherence and reported outcomes. Resuscitation Plus, 2024, vol. 20, art. 100763. https://doi.org/10.1016/j.resplu.2024.100763

19. Lenjani I., Lenjani F., Mustafa M., Dogjani A., Lenjani B. Basic medical emergency treatment for maxillofacial injuries. Albanian Journal of Trauma and Emergency Surgery, 2025, vol. 9, no. 1, pp. 1676–1681. https://doi.org/10.32391/ajtes.v9i1.435

20. Reznek M. A., Kotkowski K. A., Arce M. W., Jepson Z. K., Bird S. B., Darling C. E. Patient safety incident capture resulting from incident reports: a comparative observational analysis. BMC Emergency Medicine, 2015, vol. 15, art. 6. https://doi.org/10.1186/s12873-015-0032-7

21. Omri M., Bouaouina H., Kraiem H., Chebili N., Methamem M., Jaouadi M. A., Naija M., Naija W., Karoui M. N. Missed injuries in pre-hospital trauma patients. La Tunisie Médicale, 2017, vol. 95, no. 5, pp. 336–340.

22. Brandler E. S., Sharma M., McCullough F., Ben-Eli D., Kaufman B., Khandelwal P., Helzner E., Sinert R. H., Levine S. R. Prehospital stroke identification: factors associated with diagnostic accuracy. Journal of Stroke and Cerebrovascular Diseases, 2015, vol. 24, no. 9, pp. 2161–2166. https://doi.org/10.1016/j.jstrokecerebrovasdis.2015.06.004

23. Vieira L. F., Grover A., Parreira J. G., Scalea T., Ribeiro M. A. F. (Jr.). Missed injuries in trauma care: an analysis of mechanisms and prevention of one of the surgeon’s worst nightmares. Injury, 2025, vol. 56, no. 8, art. 112600. https://doi.org/10.1016/j.injury.2025.112600

24. Kunitomo K., Harada T., Watari T. Cognitive biases encountered by physicians in the emergency room. BMC Emergency Medicine, 2022, vol. 22, no. 1, art. 148. https://doi.org/10.1186/s12873-022-00708-3

25. Awanzo A., Thompson J. Cognitive biases in clinical decision-making in prehospital critical care; a scoping review. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 2025, vol. 33, no. 1, art. 101. https://doi.org/10.1186/s13049-025-01415-1

26. Pelaccia T., Sherbino J., Wyer P., Norman G. Diagnostic reasoning and cognitive error in emergency medicine: implica­ tions for teaching and learning. Academic Emergency Medicine, 2025, vol. 32, no. 3, pp. 320–326. https://doi.org/10.1111/acem.14968

27. Varma D., Brown P., Clements W. Importance of the mechanism of injury in trauma radiology decision-making. Korean Journal of Radiology, 2023, vol. 24, no. 6, pp. 522–528. https://doi.org/10.3348/kjr.2022.0966

28. Jesslyn M., Satrio R. The association of mechanism of injury with predictable injury patterns: a systematic review. The International Journal of Medical Science and Health Research, 2025, vol. 19, no. 2, pp. 1–59. https://doi.org/10.70070/chcqha71

29. Järvenpää V., Korpela S.-P., Mäki P., Huhtala H., Setälä P., Hoppu S. Prompt dispatcher-initiated tele-CPR and facilitation of bystander’s CPR to improve out-of-hospital cardiac arrest outcomes: A prospective cohort study from Finland. Resuscitation, 2025, vol. 215, art. 110755. https://doi.org/10.1016/j.resuscitation.2025.110755

30. Martino A. M., Giron A., Schomberg J., Ferguson M., Nahmias J., Burruss S., Guner Y., Goodman L. F. Pre-hospital tourniquet use in adolescent and pediatric traumatic hemorrhage: a national study. Journal of Pediatric Surgery, 2025, vol. 60, no. 1, art. 161955. https://doi.org/10.1016/j.jpedsurg.2024.161955

31. Semeraro F., Schnaubelt S., Olasveengen T. M., Bignami E. G., Böttiger B. W., Fijačko N. [et al.]. European resuscitation council guidelines 2025 system saving lives. Resuscitation, 2025, vol. 215, suppl. 1, art. 110821. https://doi.org/10.1016/j.resusci­tation.2025.110821

32. Greif R., Cheng A., Abelairas-Gómez C., Allan K. S., Breckwoldt J., Cortegiani A. [et al.]. Education, implementation, and teams: 2025 International liaison committee on resuscitation consensus on science with treatment recommendations. Circulation, 2025, vol. 152, no. 16, suppl. 1, pp. S205–S249. https://doi.org/10.1161/CIR.0000000000001359

33. Del Rios M., Bartos J. A., Panchal A. R., Atkins D. L., Cabañas J. G., Cao D. [et al.]. Part 1: executive summary: 2025 American heart association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation, 2025, vol. 152, no. 16, suppl. 2, pp. S284–S312. https://doi.org/10.1161/CIR.0000000000001372

34. Stanishevskii A. L., Sokolov Yu. A., Matveichik T. V. Basic cardiopulmonary resuscitation: analysis of the knowledge of the megalopolis population. Meditsinskaya sestra [The Nurse], 2025, vol. 27, no. 4, pp. 33–37 (in Russian).

35. Stanishevskii A. L. Analysis of population’s knowledge of first aid procedures for victims. Meditsina katastrof [Disaster Medicine], 2026, no. 1, pp. 56–60 (in Russian).

36. Stanishevskii A. L. Population Readiness for Cardiopulmonary Resuscitation: Initiation Factors, Barriers and their Predictors. Meditsina katastrof [Disaster Medicine], 2024, no. 3, pp. 17–21 (in Russian).

37. Stanishevskii A. L. Some Aspects of Population Willingness to Provide First Aid. Zhurnal imeni N. V. Sklifosovskogo “Neotlozhnaya meditsinskaya pomoshch′” = Russian Sklifosovsky Journal of Emergency Medical Care, 2025, vol. 14, no. 2, pp. 416–422 (in Russian).

38. Stanishevskii A. L., Sokolov Yu. A., Timoshuk A. L., Novikova N. P. First Aid: Issues of Informing, Motivating and Training the Population. Meditsinskie novosti [Medical News], 2024, no. 12, pp. 19–23 (in Russian).