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 ...

BackgroundTraumatic brain injury (TBI) remains a major cause of morbidity, yet U.S. comparisons of injury mechanisms in diverse urban settings are limited. We examined differences across motorized road injuries, non-motorized road injuries, and falls. MethodsWe performed a retrospective study of consecutive TBI admissions to an ACS-verified trauma center from 2017 to 2022. Mechanisms were categorized as motorized, non-motorized, or falls. Outcomes included mortality, ICU and ventilator use, and...

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...

BackgroundRural emergency departments (EDs) are critical to ensuring equitable access to acute care, yet face persistent systemic challenges. In Quebec, Canada, reforms to healthcare governance, funding and resource allocation, and service delivery have transformed rural ED operations. This study aimed to document characteristics, challenges, and improvement priorities for all rural EDs in the province. MethodsA participatory mixed-methods design was used. 26 rural EDs in Quebec were included. ...

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...

BackgroundManual bag-valve ventilation during cardiopulmonary resuscitation (CPR) is prone to substantial variability in tidal volume and respiratory rate, frequently resulting in hyperventilation. The clinical effectiveness of mechanical ventilation as an alternative strategy remains uncertain. ObjectivesThis systematic review and meta-analysis compared mechanical versus manual ventilation during adult CPR to assess return of spontaneous circulation (ROSC), survival to hospital discharge, and ...

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...

BackgroundCOVID-19 patients seen in an emergency department (ED) are at high risk of complications including post-COVID-19 condition (PCC), commonly known as Long COVID. As evidence is emerging concerning the efficacy of early post-acute rehabilitation and therapeutic interventions, early ED identification supported by a clinical prediction rule, combined with appropriate outreach and health education, could contribute to alleviating the burden of the disease on health systems and positively imp...

ObjectivesTo characterize emergency department (ED) clinician engagement with electronic health record (EHR)-based social drivers of health (SDOH) data; test whether engagement differs in encounters with opioid use disorder (OUD); and, among OUD encounters, assess whether engagement is associated with medications for OUD (MOUD) treatment. Materials and MethodsWe conducted a cross-sectional study of adult ED encounters (January 2023-October 2024). OUD encounters, identified with a structured phe...

OBJECTIVESAlthough several systematic reviews attempted to compare supraglottic airway (SGA) and endotracheal intubation for or adults with out-of-hospital cardiac arrest (OHCA), the optimal airway management strategy remains debated. We conducted a systematic review and meta-analysis comparing supraglottic airway (SGA) devices and endotracheal intubation (ETI) as initial interventions in OHCA to clarify their relative clinical efficacy. DATA SOURCESWe retrieved relevant clinical trials from Pu...

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...

AbstractO_ST_ABSObjectiveC_ST_ABSAlcohol and drug use is an established factor contributing to traumatic injury globally. However, its prevalence and impact within regional and remote populations is poorly characterised. This study examines associations between alcohol and drug use and clinical outcomes among major trauma patients in North Queensland. MethodsA retrospective audit was conducted of all major trauma patients in the Townsville University Hospital Trauma Registry Information System ...

BackgroundOut-of-hospital cardiac arrest accounts for over 350,000 deaths annually in the United States, and survival depends on early bystander cardiopulmonary resuscitation (CPR). Although many cardiac arrests occur on or near school grounds, Massachusetts has no statewide CPR graduation requirement and little current data on school preparedness. MethodsWe conducted a cross-sectional electronic survey of all 413 public high schools in Massachusetts (including charter, vocational, and technica...

BackgroundMotorcycles are a common mode of transport in major Cameroonian cities, contributing to a rising burden of injuries among both users and pedestrians. These groups differ in exposure, mechanisms, and vulnerability, yet both bear a disproportionately high injury burden. However, comparative data on their epidemiological patterns and outcomes remain scarce. To support targeted prevention policies, we analysed trauma registry data to describe demographic, crash, injury, clinical, and outco...

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...

Study ObjectiveTo compare a computable structured opioid use disorder (OUD) phenotype currently used to trigger emergency department (ED) clinical decision support (CDS) with a large language model (LLM) for OUD identification, using expert physician review as the reference standard. MethodsWe conducted a retrospective study of randomly sampled adult ED encounters (January 1, 2023-October 17, 2024) at a single academic health system. Encounters were stratified by structured phenotype status and...