Emergency Medicine Journal

BackgroundAdvanced Practice Providers (APPs), including physician assistants and nurse practitioners, represent a growing proportion of the emergency medicine workforce, including in high-acuity community emergency departments (EDs). Despite this growth, many sites lack formal onboarding structures, particularly for new graduate or inexperienced APPs transitioning to practice. Unlike postgraduate residencies and fellowships, limited literature exists on structured onboarding models outside acade...

ObjectivesEmergency Medical Services (EMS) demand is increasing, with a growing proportion of low-acuity encounters. Prior studies are limited by regional sampling, inconsistent definitions, narrow observation periods, and limited theoretical grounding. The objective of this study was to identify predisposing, enabling, and need-based factors associated with EMS transport among low-acuity emergency department (ED) patients, guided by Andersens Behavioral Model of Health Services Use. MethodsWe ...

BackgroundIn the United States, emergency clinicians are often the first to care for injured patients in the hospital setting. To better understand end-user needs, we evaluated emergency clinician priorities and preferences in accessing, interpreting, and applying trauma clinical guidance. MethodsEmergency clinicians were recruited via email for semi-structured video conference interviews. Rapid directed qualitative analysis of interview notes and audio recordings yielded initial insights about...

ObjectiveTo explore emergency medical dispatchers (EMD) experiences of prioritising patients and stewarding ambulance resources when system capacity is constrained. DesignQualitative interview study using inductive qualitative content analysis. SettingEmergency medical communication centres (EMCCs) in Sweden operated by the national emergency call provider, responsible for receiving 112 calls and dispatching ambulances. ParticipantsThirteen purposively sampled EMDs with at least one year of p...

ObjectiveTo compare the efficacy and safety of etomidate versus ketamine as induction agents for rapid sequence intubation in critically ill adults, focusing on 28-day mortality and post-intubation hypotension. Data SourcesPubMed, Embase, and the Cochrane Library were systematically searched from inception to January 2026. Reference lists of included studies were also manually screened. Study SelectionWe included randomized controlled trials (RCTs) comparing single-dose intravenous ketamine ve...

BackgroundStandardized training and competency testing is needed for appropriate point-of-care ultrasound (POCUS) clinical use. Our study objective assesses a low-fidelity simulation pig model workshop and tests the knowledge and technical skills of emergency medicine (EM) clinicians when performing simulated ultrasound-guided serratus anterior nerve block (UG-SANB). MethodsEM residents, attendings, and advanced practice providers (APP) participated in a prospective cohort study, completing a o...

ObjectiveWe aimed to prospectively validate and compare published prediction models and clinician-assigned triage categories for early trauma care. DesignProspective multicentre cohort study. SettingThree public hospitals in urban India: one secondary care hospital in Mumbai and one tertiary care teaching hospitals in Delhi and Kolkata each. ParticipantsAdult patients aged over 18 years presenting to the emergency department with a history of trauma between 2016 and 2022. A total of 13,041 pa...

IntroductionRecent evidence has shown that vitamin C has analgesic properties in immediate postoperative context. However, while a clinical trial is currently underway to evaluate vitamin C for reducing opioid consumption in acute musculoskeletal (MSK) injuries emergency department (ED) patients, its direct analgesic effect in this population has not yet been established. This pilot study evaluated the feasibility of conducting a randomized placebo-controlled trial to determine the analgesic eff...

RationaleCardiopulmonary resuscitation (CPR) aims to provide oxygen to vital organs through chest compressions and ventilations, until return of spontaneous circulation (ROSC) is achieved. A major barrier to effective oxygenation during CPR is atelectasis, which impairs gas exchange and results in hypoxemia--a condition strongly associated with decreased rates of ROSC and worsened neurological outcomes. Positive end-expiratory pressure (PEEP) is routinely used in critical care to prevent atelec...

BackgroundSalbutamol is the most commonly prescribed inhaler for adults discharged from the Emergency Department (ED) with uncontrolled asthma. However newer options, e.g. Maintenance and Reliever Therapy (MART), are now recommended due to growing concerns over risks linked to salbutamol over-prescription. Transitioning to new inhalers requires support for both patients and healthcare professionals (HCP). This paper outlines how we developed an implementation package based on evidence, theory an...

BackgroundThere is uncertainty among physicians regarding the optimal clinical application of the novel high-sensitivity cardiac troponin I (hs-cTnI)-VITROS assay within the widely implemented upper reference limit (URL)-based ESC 0/3h-algorithm. MethodsThis prospective, international, multicenter study aimed to validate and compare different modifications of the URL-based ESC 0/3h-algorithm among adult patients presenting with suspected acute myocardial infarction (AMI) to the emergency depart...

Sepsis is a complex condition with a time-dependent evolution. Longitudinal biomarker dynamics could help us to better characterise sepsis. We hypothesised that the kinetics of biomarkers are associated with sepsis and with the intensity of organ dysfunction, and may have predictive capacity for patient survival. This single-centre, prospective, observational study included adult patients presenting to the Emergency Department (ED) with suspected infection. Patients were included in the study i...

Rapid prediction of the severity of acute coronary syndrome (ACS) is crucial for appropriate intervention in emergency department. Neutrophils (Neu), lymphocytes (Lym) and monocytes (Mon) and their ratios (Neu/Lym, NLR; Mon/Lym, MLR NeuxMon/Lym, SIRI) are acknowledged to be associated with the prediction of the severity and adverse outcome of ACS patients. Here, we analysed retrospectively eosinophils (Eos) and Eos-derived novel ratios (Neu/Eos, NER; Mon/Eos, MER; Neu x Mon/Eos, SIII; Neu/Eos x ...

The red cell distribution width (RDW) is a recognized prognostic marker in sepsis, yet its dynamic changes over time and their relationship with outcomes remain unexplored. This study aimed to identify distinct RDW trajectories during the early phase of sepsis and evaluate their association with mortality. We conducted a retrospective cohort study using data from the MIMIC-IV database (n=3,813) as the derivation cohort and from the First Affiliated Hospital of Kunming Medical University (n=467) ...

Overcrowding of emergency departments (ED) is now a problem of global health care concern due to the increase in patients. Triage systems have been established for a considerable period. However, their reliability in choosing the appropriate patient and the level of service has undergone much scrutiny. In this paper, we describe a comprehensive machine learning framework aimed at predicting critical emergency department outcomes and enabling dynamic routing decisions. Through the MIMIC-IV-ED dat...

Distributed manufacturing of open-source hardware shows potential to offer accessible, affordable, and customizable solutions for users in low-resource contexts. Their real-world adoption, however, depends not only on the availability of openly shared designs but also on their replicability when fabricated in different local contexts. This work investigates the replicability of open-source hardware through a practical design-driven approach, using the development and experimental evaluation of a...

This study explores the influence of social determinants of health (SDOH) on follow-up behavior among patients referred to community-based organizations (CBOs) in the Emergency Department (ED) of Long Island Jewish (LIJ) Medical Center. A retrospective analysis was conducted on data collected from 342 patients who were screened for SDOH between February and July 2023. Descriptive statistics and Chi-squared tests were used to identify potential associations between demographic and social factors ...

Rapid risk stratification is essential in the clinic, yet vital signs, laboratory tests, and triage scores may not fully capture risk at presentation. We investigated whether facial photographs taken after emergency admission provide an additional mortality signal. Using 27,660 smartphone facial photographs, we trained deep neural networks to identify mortality risk with a Cox proportional hazards framework. Face-derived risk scores strongly stratified short- and long-term mortality, outperformi...

BackgroundHip fracture remains a leading cause of morbidity and mortality among older adults in the United States. The aim of this systematic and meta-analytical review is to synthesize available evidence on predictors of one-year mortality following hip fracture among older adults, guided by a socio-ecological framework. MethodsWe searched PubMed, Embase, Web of Science, CINAHL, and Scopus for U.S.-based studies published between 2010 and 2025 reporting one-year mortality after hip fracture. S...

BackgroundPostoperative delirium (POD) is a common complication of surgery. It is associated with a number of detrimental effects, including mortality and healthcare costs. We sought to determine whether common comorbidity indices are predictors of POD. MethodsUsing the Medical Information Mart for Intensive Care (MIMIC)-IV database, we identified 8022 abdominal surgery procedures across 7212 adult patients. We calculated both the Charlson comorbidity index (CCI) and the Elixhauser comorbidity ...