2026 Systematic Review of Evidence-Based Guidelines for Prehospital Care.

OBJECTIVES

Evidence-based guidelines (EBGs) are widely regarded as a valuable means of translating scientific evidence to clinical practice. Efforts continue to promote the development and implementation of new EBGs across all aspects of emergency medical services (EMS), but with variable quality and gaps in the content addressed by existing EBGs. We performed a biennial systematic review of prehospital EBGs to identify and assess the quality of EBGs published between 2023 and 2025 that can inform prehospital clinical care and operations.

METHODS

We used a systematic review study design and searched Ovid Medline, EMBASE, and CINAHL from January 1, 2023, to May 21, 2025, for prehospital EBGs providing recommendations following an organized review of relevant literature. We appraised the quality of published EBGs with adapted criteria of the National Academy of Medicine (NAM) and the Appraisal of Guidelines for Research and Evaluation (AGREE) II Tool.

RESULTS

In total, 71 new EBGs were identified. These addressed a variety of EMS clinical and operational topics. Most EBGs (n = 67, 94.4%) addressed clinical topics of EMS medicine, with a focus on time-life critical conditions (n = 45, 63.4%), along with injury and special clinical considerations (n = 37, 52.1% each). About half (n = 37, 52.1%) met all adapted NAM criteria for high-quality EBGs, of which 32 (86.5%) represented compilations of guidelines related to cardiopulmonary resuscitation, emergency cardiovascular care, and trauma. The mean AGREE II overall domain score was 70.9% (SD 11.4%), and 30 (42.3%) EBGs had an average domain score above 75%. These 71 new EBGs demonstrated incremental improvement in the NAM criteria and AGREE II scoring compared to the 178 EBGs identified in previous reviews.

CONCLUSIONS

This updated systematic review identified many published EBGs intended for EMS. These EBGs were overall of higher quality than those previously published, and their appraisal continues to yield important findings that can serve to inform guideline developers on how to continually improve the quality of prehospital EBGs. The high-quality EBGs identified in this review should serve as targets to promote the dissemination and implementation of evidence-based recommendations, inform prehospital protocol development, and guide the initial certification and continuing education of EMS personnel.