Lung ultrasound (LUS) is accurate for diagnosing pneumonia in the emergency department (ED), but standard training is time-intensive, limiting its widespread implementation. We evaluated LUS proficiency for pneumonia diagnosis and perceived adoption barriers after a short training programme.

This study was conducted in the frame of the PLUS-IS-LESS trial (Procalcitonin and Lung UltraSonography-based antibiotherapy in patients with Lower rESpiratory tract infection in Swiss Emergency Departments) (NCT05463406), a pragmatic stepped-wedge cluster-randomised clinical trial evaluating a clinical management algorithm combining LUS and procalcitonin to guide antibiotic use for lower respiratory tract infections (LRTIs) in 10 Swiss EDs.

All medical supervisors (senior registrars and senior physicians) from the participating EDs were invited to go through the PLUS-IS-LESS LUS training programme and all those who completed the training programme were included in this study.

The training programme included an e-learning course, followed by a half-day on-site training session with theory and hands-on practice. For proficiency evaluation, a validated structured assessment of LUS skills (LUS-OSAUS) was adapted into a 32-question online quiz and five bedside LUS examinations. Success was defined as achieving a score ≥80% on both the online quiz and supervised practical assessment. Success rates were compared between physicians according to their characteristics (age, sex, medical experience, previous use of ultrasound or LUS, linguistic region of work and type of hospital) using a ² test. A 6-month follow-up survey identified factors associated with non-certification and barriers to the clinical use of LUS for managing LRTIs.

Of 122 trained physicians, 83 (68 %) completed both quiz and supervised LUS and 61 (50%) achieved certification. The most challenging items were pleural line assessment (83% success), recognition of consolidations (83%) and decision-making based on LUS findings (72%). Physicians <40 years had a higher success rate (p=0.009). Among those without complete certification, limited access to an ultrasound machine and low perceived added value of LUS were the main identified reasons. Lack of time was the most frequently reported barrier overall to LUS integration into ED workflows (77%).

After receiving short training and focused proficiency testing, only half of physicians achieved certification, underscoring the challenges of broad LUS implementation. Limited time, equipment access and low perceived clinical value were key barriers, and integrating LUS findings into decision-making remained difficult. Ongoing support, supervision and protected time may be needed to enhance LUS adoption in EDs.

NCT05463406.

Emergency care departments often navigate the dual imperatives of providing timely medical care and cooperating with police as law enforcement officers (LEOs) involved in injury-related cases. Using Strauss’ negotiated order theory, we examined the engagements between clinicians and the police at the Upper West Regional Hospital in Ghana, analysing the structural and negotiation contexts shaping their interactions.

We used a qualitative case study design.

The study was conducted at the Upper West Regional Hospital in Ghana.

Participants included clinicians (n=11; 7 nurses and 4 doctors) and police officers (n=10; 6 Criminal Investigation Department and 4 Motor Traffic and Transport Department) with experience engaging with each other during patients’ visits at the emergency department of the Upper West Regional Hospital.

Participants were recruited through snowball sampling. We first conducted semi-structured interviews (April 2024 and February 2025) with the 21 participants. We then conducted a validation workshop with clinicians, healthcare managers and police in April 2025, incorporating key insights from the workshop into the thematic analysis to strengthen the study’s credibility and contextual relevance.

We found that interactions between clinicians and police were shaped by three key structural factors: (1) organisational structures like role boundaries and decision-making authority; (2) the policy environment, particularly legal and ethical obligations; and (3) wider cultural contexts, such as societal norms. Within these contexts, negotiations centred on how clinicians and police balanced autonomy with collaboration, shared information, resolved disputes and built interprofessional trust. Informal networks and feedback were particularly important mechanisms for building smoother engagements.

Clinician–LEO interactions are dynamic and require continuous negotiation to align healthcare priorities with law enforcement mandates. Clear policies on engagements, interprofessional training programmes and culturally responsive frameworks are needed to enhance emergency care.

Fracture misdiagnosis is a common diagnostic error in emergency departments (EDs) and minor injury units (MIUs), leading to poor patient outcomes, unnecessary treatments and significant healthcare costs. Artificial intelligence (AI)-assisted fracture detection tools are now available for use in radiology workflows; however, the impact of these technologies on patient outcomes, experiences and overall care pathways in the real-world clinical setting is limited.

We will conduct a prospective cluster randomised cross-over trial over a 6-month period, assessing the impact of an AI-assisted fracture detection tool in EDs and MIUs across 4 healthcare Trusts in the UK. Patients aged over 2 years old undergoing a plain film radiography for a suspected fracture as part of routine clinical care will be eligible for study enrolment. The trial will deploy Radiobotics’ RBfracture, a CE-approved AI-assisted medical device software for fracture detection at each site for 6 months. Randomisation will be at a cluster-level; a site will be randomised to begin with ‘AI on’ or ‘AI off’ for a month, followed by alternating active status each month for the remaining 5 months. The primary outcome will evaluate the incidence of ‘inappropriate healthcare contacts’ among patients receiving imaging for suspected fractures. This composite metric encompasses inappropriate referrals to fracture clinics, repeated hospital attendances and subsequent follow-up communications regarding missed fractures. The rates of these measures will be compared in the ‘AI on’ versus ‘AI off’ stages. Secondary outcomes will include patient-reported outcomes, clinician surveys, a predefined health economic evaluation assessing cost-effectiveness and budget impact and the diagnostic performance of the algorithm.

The study has received ethical approval from the South Central—Oxford Research Ethics Committee (Reference: 25/SC/0252, approval date: 23 October 2025), and subsequently from the Health Research Authority (IRAS 3 57 391-A). The results of this study will be presented at relevant scientific conferences and peer-reviewed publications will be disseminated on wider public forums such as traditional and social media.

This is an ongoing, actively recruiting trial (ISRCTN23087950). Recruitment began in January 2026 and will run for 6 months at each site, with per-patient follow-up of 30 days and subsequent data analysis. This manuscript describes protocol version 1.1. The full protocol and statistical analysis plan are available from the corresponding author on request and will be deposited on the study’s public repository (https://github.com/Jason-L-Oke/SAMURAI) prior to publication of results.

ISRCTN23087950.

Dissemination of evidence-based burn first-aid is critical for improving clinical outcomes for patients with acute burn injuries. The overarching goal of this research is the successful and sustainable translation of 20 min of cool running water (20CRW), administered within 3 hours of a burn, as a first-aid treatment for acute thermal injuries within emergency departments (EDs) and emergency medical services (EMSs). Despite the well-established benefits of 20CRW, this treatment is not included in relevant USA burn first-aid guidelines and has not been adopted in clinical settings as a standard first-aid treatment.

This protocol outlines an investigation using an effectiveness-implementation hybrid type III design to evaluate the effectiveness of 20CRW implementation into ED and EMS settings in Sacramento, California. The principal aim of this research is to implement 20CRW as a first-aid treatment for acute thermal burn injuries within participating ED and EMS settings. We will assess adherence to 20CRW guidelines and provision following implementation into routine clinical practice. In addition, we will evaluate the clinical effectiveness of 20CRW in improving patient outcomes, and the acceptability of 20CRW as a burn first-aid treatment, considering both clinician and burn survivor perspectives. This research will generate critical evidence on the implementation and clinical impact of 20CRW in US emergency care settings. It will also evaluate whether the co-designed implementation strategies effectively support adoption of 20CRW within the US ED and EMS settings.

Institutional Review Board (IRB) approval has been awarded for this research (IRB ID: 18834-5) from the University of California Davis Office of Research Ethics Committee. Results of this investigation will be disseminated across participating hospital and EMS organisations, presented at national and international conferences and published in open access peer-reviewed journals.

To clarify the epidemiology and risk factors for sepsis among trauma patients admitted to the intensive care unit (ICU) using the Japan Trauma Data Bank (JTDB).

Retrospective cohort study.

Analysis of nationwide JTDB data collected between 2004 and 2019 in Japan.

A total of 126 433 adult trauma patients with an Abbreviated Injury Scale score ≥3 who survived for at least 72 hours after ICU admission were included.

The primary outcome was in-hospital mortality among patients who developed sepsis after trauma. The secondary outcome was identification of risk factors associated with post-traumatic sepsis using multivariable logistic regression analysis.

Sepsis developed in 972 patients (0.77%) and was associated with significantly higher in-hospital mortality compared with patients without sepsis (42.4% vs 4.6%, p

Although post-traumatic sepsis was uncommon, it was associated with markedly increased mortality. Older age, male sex, severe injury, early blood transfusion and abdominal/pelvic or lower extremity trauma were identified as major risk factors for sepsis after trauma.

Japan’s physician-staffed helicopter emergency medical services (HEMS) are widely deployed but published evidence is heterogeneous across indications, outcomes and study designs. We aimed to map the internationally reported, English-language literature evaluating physician-staffed HEMS in Japan and to identify evidence gaps requiring further research.

Scoping review was conducted using established methodological frameworks and reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR).

MEDLINE, Web of Science, CINAHL and the Cochrane Library, supplemented by backward and forward citation tracking.

Original studies evaluating physician-staffed HEMS in Japan and reporting patient outcomes for any emergency condition published in English-language journals.

We conducted a systematic database search using terms related to physician-staffed HEMS in Japan. The original search (28 May 2024) was updated on 25 February 2026 using the same eligibility criteria. Two reviewers independently performed title/abstract screening followed by full-text screening to determine eligibility. We additionally performed backward and forward citation tracking of the included studies. We summarised characteristics of eligible studies descriptively using counts and proportions.

The updated search identified 341 records, and citation tracking identified 16 further studies, yielding 76 included studies. Publications increased over time (2016–2020: 32.9%; 2021–2026: 52.6%). Most studies were single-centre observational (55.3%) or registry-based (39.5%), with few multi-centre studies (5.3%). Trauma was the most frequent study population (25.0%), and mortality the most common primary outcome (35.5%). First authors were university-affiliated in 88.2% of studies, 39.5% appeared in a single aeromedical journal, and no study compared physician-staffed with non-physician HEMS.

The internationally reported, English-language literature on physician-staffed HEMS in Japan has expanded over time, but remains dominated by retrospective observational designs, is produced largely by university-affiliated authors, and is concentrated in a small number of journals. Prospective multi-centre evaluation, comparison with non-physician HEMS, functional and longer-term outcomes, and economic evaluation were absent from the identified literature.

Older adults with multiple long-term conditions account for a large share of emergency department (ED) visits and up to 25% may be avoidable. Efforts to reduce such visits show mixed results, likely due to multiple caregivers and limited adaptation to local contexts. We explored factors contributing to avoidable ED visits as reported by multiple care providers, focusing on modifiable factors of importance in the design of a sustainable primary care (PC) intervention.

Web-based survey conducted across six in- and outpatient healthcare providers in Stockholm, Sweden: ED, geriatrics, ambulance services, advanced home-based healthcare, PC and home healthcare (both within and outside regular working hours). Closed-ended questions were analysed descriptively and open-ended questions using qualitative content analysis.

A total of 100 healthcare professionals (nurse assistants, registered nurses and physicians) with at least 6 months of working experience.

All providers considered potentially avoidable ED visits a major concern, with home care workers seen as the main initiators of ED referrals. One overarching theme was generated—medical and psychosocial complexities in the assessment of older patients with multiple long-term conditions—and four categories of contributing factors: (1) insufficient access to health and social care, (2) poor communication and cooperation, (3) deficient professional competence and geriatric knowledge and (4) unclear responsibility and fragmented care. Five providers highlighted limited access to care as the most demanding concern while PC noted poor communication.

An intervention should combine enhanced home-based care, better collaboration across providers, direct geriatric admissions and targeted training for home care workers. Accounting for differences in provider perspectives in intervention design may enhance feasibility and acceptability.

Cardiac arrest (CA) remains a major health burden with poor survival and poor neurological outcomes despite decades of advances in resuscitation science. Although high-quality cardiopulmonary resuscitation is essential, it provides only limited cerebral and coronary perfusion, and current strategies relying on high-dose epinephrine may adversely affect cerebral microcirculation. Resuscitative endovascular balloon occlusion of the aorta (REBOA) has emerged as a potential adjunct to improve coronary and cerebral perfusion without compromising microvascular blood flow. Although animal studies and small human case series suggest physiological and clinical benefits of REBOA in CA, randomised clinical trials are lacking.

This prospective, randomised controlled, single-centre clinical trial investigates the effect of REBOA during the treatment of CA. The planned study duration is 36 months, with a total of 98 patients to be randomised to either standard advanced life support (ALS) or ALS plus REBOA. Adult patients with an in-hospital CA, successful placement of a femoral artery introducer sheath and any electrical cardiac activity in the initial rhythm analysis are eligible for inclusion. Exclusion criteria comprise traumatic CA, asystole as the initial rhythm, pregnancy and CA occurring on intensive care units, in the operating room or in cardiac catheter laboratory. The primary outcome is sustained return of spontaneous circulation lasting for at least 20 min. Secondary and exploratory outcomes include survival, neurological outcome, changes in aortic blood pressure, end-tidal CO₂ and near-infrared spectroscopy values as well as causes of death and vascular complications related to the intervention. Statistical analyses will be performed on a modified intention-to-treat basis.

The study protocol (Version 2.1, 11.02.2026) was approved by the Cantonal Ethics Committee of Cantone Bern (2025-D0108). Study results will be disseminated through peer-reviewed journals.

NCT07434726.

To apply the Haddon Matrix framework (HM) to examine factors associated with the severity of paediatric road traffic injuries (RTIs) in Ghana.

Prospective hospital-based cross-sectional study. Variables were organised according to the three domains of the HM framework. Three negative binomial regression models were developed to identify the best-fitting model for predicting paediatric RTI severity

Three teaching hospitals in the Northern, Ashanti and Central Regions of Ghana.

A total of 484 consecutive children and adolescents aged 0–18 years presenting to the emergency department with RTIs between 18 September 2023 and 30 September 2024 were included. Data were collected using interviewer-administered questionnaires and medical record reviews.

The primary outcome was injury severity measured using the Injury Severity Score, an anatomical measure based on the sum of the squared Abbreviated Injury Scale scores for the three most severely injured body regions.

The third model (variable selection threshold p≤0.1) demonstrated the best predictive model for paediatric RTI severity, with the lowest Akaike Information Criterion and the highest log-likelihood. Increased injury severity was independently associated with self-reported frequent alcohol use (β=1.54, p=0.016), Harmattan weather conditions (β=0.21, p=0.024), afternoon crashes (β=0.17, p=0.041) and referral cases (β=0.28, p=0.003). Whereas single bicycle crashes (β=–1.58, p=0.011) and walk-in hospital visits (β=–1.09, p=0.026) were associated with lower injury severity.

The HM identified modifiable environmental, behavioural and health system factors associated with paediatric RTI severity. Interventions targeting alcohol use, Harmattan-related road safety, timely referral and prehospital care may reduce injury severity among children in Ghana.

Emergency medical services (EMS) staff worldwide have long been at risk of encountering violence and aggression (V&A) at work, including threats, verbal, physical and sexual assault, and on rare occasions, fatalities occur. Exposure to V&A can result in stress, fear and burnout. This is an international problem and EMS employers, trade unions and others are working towards tackling it. The aim of this research was to conduct an exploratory qualitative interview study of EMS staff focusing on experiences, perceptions and interpretations of V&A directed towards them.

This study took place in 2022 in one UK ambulance service covering a population of three million people. Individual, one-to-one semi-structured interviews were conducted with EMS staff via a Voice over Internet Protocol. Data were thematically analysed drawing on evolved grounded theory methodology concepts.

10 EMS staff were interviewed, and the following categories emerged: Rusted, busted and inevitability of V&A in EMS environment, Tolerable or intolerable V&A in EMS, Gendered V&A and genderisation in EMS, Modifiable factors and harm reduction of V&A in EMS, Professional, ethical and clinical judgments of V&A in EMS and Sociocultural and system frustrations of V&A in EMS. The basic social process that emerged was one of Systemic frustration and gender-based V&A in EMS.

Protecting EMS staff from V&A is complex and multifaceted, and we have conducted a thematic analysis drawing on evolved grounded theory concepts that proposes V&A in EMS may be borne out of, and sustained, by systemic frustration and gender-based issues. We draw on Dollard’s et al (1939) frustration–aggression hypothesis and Kelly’s ‘Continuum of Violence’ (1988). Experiences of sexual V&A revealed in our study, supported by a wider body of knowledge, lay bare a caring context of rampant gender-based V&A directed towards EMS staff by members of society, colleagues and within the context of a patriarchal EMS. Our study revealed how EMS has not effectively tackled V&A and the many sociocultural constructs within EMS. We advocate for purposeful efforts, further research and systemic interventions beyond punitive measures to tackle this issue.

Methamphetamine use has risen dramatically in North America, contributing to increased emergency department (ED) visits marked by agitation and complex psychosocial needs. While clinical consequences of methamphetamine use are well-documented, there is a paucity of research capturing the perspectives of people who use methamphetamines (PWUM) when accessing emergency care. This study aimed to explore the lived experiences of PWUM in ED settings to identify service gaps and inform patient-centered care strategies.

A qualitative exploratory study was conducted using semi-structured interviews with PWUM who accessed ED services in Calgary, Alberta within the past five years. Participants were recruited through community-based organizations and professional networks. Interviews were audio-recorded, transcribed, and analyzed using Braun and Clarke’s six-phase thematic analysis approach. A member-checking session was conducted with individuals with lived/living experience to validate findings.

Five interviews were included in the final analysis. Three major themes emerged including: first, experiences of stigma in which participants described feeling judged, dehumanised and often received differential treatment following disclosure of methamphetamine use. This led to avoidance behaviours including leaving against medical advice and withholding substance use histories. Second, many highlighted the need for care beyond acute needs. While acute medical concerns were addressed, participants perceived a lack of attention to underlying psychosocial and addiction-related issues. Opportunities for deeper engagement and referral to supportive services were frequently missed. Lastly, participants provided recommendations for care delivery, namely enhanced integration of acute, mental health and community services; inclusion of peer support workers with lived experience; and creation of alternative care settings tailored to the needs of PWUM.

PWUM experience significant stigma and perceive ED care as focused solely on acute stabilisation rather than holistic, person-centred support. Their recommendations call for systemic changes that address both clinical and psychosocial dimensions of care. Integrating peer navigators, expanding service linkages and establishing alternate care environments may improve patient trust, engagement and health outcomes. Future work should incorporate these perspectives to develop more compassionate and effective emergency healthcare responses for PWUM.

Itching is a common and distressing clinical manifestation following burns, which severely impairs patient quality of life. Current pharmacotherapy for post-burn pruritus is limited by low efficacy and frequent side effects. Transcutaneous electrical nerve stimulation (TENS), a non-invasive neuromodulation technique, is widely used for analgesia and exhibits a favourable safety and tolerability profile. Although itch and pain are both nociceptive sensations, they constitute distinct sensory modalities. This clinical trial aims to evaluate the efficacy and safety of TENS for treating moderate to severe post-burn itching.

This multicentre, randomised, placebo-controlled clinical trial intends to recruit 382 patients with moderate-to-severe itching (the Worst Itch Numeric Rating Scale (WINRS) score of ≥4) after burns from multiple burn centres across China for TENS treatment. The recruitment process began in April 2025 and is expected to be concluded in October 2027. Eligible patients will be randomly assigned in a 1:1 ratio to receive either TENS stimulation (experimental group) or placebo stimulation (control group). The intervention will be administered once daily for 30 min across seven consecutive days. The primary outcome is the 7-day itch improvement rate, defined as the proportion of patients who achieved a reduction of at least 50% in the WINRS score on day 7 of the intervention, assessed on day 8, compared with their prerandomisation baseline. Secondary outcomes include the severity of itching, neuropathic symptoms and signs, sleep disturbance, quality of life, scar severity and safety. Exploratory endpoints consist of neuroimaging markers and scar function parameters. A physician and the patient will complete all assessments during the intervention phase and at the follow-up visit on day 14.

Ethical approval for this multicentre study was granted by the leading ethics committee, the Ethics Committee of the First Affiliated Hospital of Army Medical University (KY2024217). All authors are affiliated with the First Affiliated Hospital of Army Medical University.

ChiCTR2500099822.

To identify the latent profiles of vicarious trauma among emergency trauma nurses in China and examine the factors associated with these profiles.

A cross-sectional study.

195 hospitals at Level 2 and above across 22 provincial-level administrative regions in China.

From January to March 2025, 930 emergency trauma nurses were recruited using a convenience sampling method (valid questionnaire response rate: 96.37%). All participants held a valid nursing practice certificate and had at least 1 year of trauma care experience.

Vicarious trauma, work engagement, stressor and coping style were measured using the Vicarious Traumatization Questionnaire, the Utrecht Work Engagement Scale, the Stressor Scale for Emergency Nurses and the Trait Coping Style Questionnaire, respectively.

Three latent profiles of vicarious trauma were identified: low vicarious trauma group (35.38%), moderate vicarious trauma group (52.37%) and high vicarious trauma group (12.25%). The entropy value was 0.897, indicating good classification accuracy. Multinomial logistic regression analysis revealed that gender, psychological trauma training, stressors, work engagement, positive coping and negative coping were significantly associated with the latent profiles of vicarious trauma (all p

Emergency trauma nurses exhibit heterogeneous patterns of vicarious trauma. Male nurses, those with high stressor exposure, low work engagement, negative coping styles and no prior psychological trauma training may be at greater risk. Nursing managers should develop targeted interventions for these high-risk groups to mitigate vicarious trauma.

Ambulance staff have the highest sickness absence, burnout and turnover intentions in the National Health Service, with work-related stress and anxiety identified as key drivers. Although multiple occupational stressors have been reported, it remains unclear which have the greatest impact. This study examined which work stressors are most strongly associated with mental health, well-being and intention to leave; whether these associations are explained by stress appraisals and mental rest; and which staff are most vulnerable to adverse outcomes.

A mixed-methods, explanatory, sequential design, stress audit was conducted in one ambulance service in England. An online survey with ambulance staff (n=420) assessed key stress elements (work stressors, stress appraisals, mental rest) and key outcomes (depression, well-being, intention to leave). Semistructured interviews with staff (n=8) explored the findings of the survey in more depth. Linear regression analyses examined relationships between predictors (eg, stressors) and outcomes (eg, well-being) and analysis of variances and t-tests explored differences between groups (eg, gender). A thematic analysis of qualitative data was conducted.

Quantitative and qualitative findings suggest that stress related to manager support (ie, upper management prioritising efficiency over staff needs), workplace demands (ie, organisational demands creating extra burden), poor relationships (eg, with non-peer staff) and constant change had the most negative impact on staff. Low mental rest and threat appraisals (ie, feeling ‘overwhelmed’ by work demands) were strong predictors of all negative outcomes, alongside cumulative stress exposure and negative emotional responses. Longer tenure, supervisory roles, mixed urban–rural working and male gender were associated with greater risk of poorer outcomes.

This study offers a comprehensive and novel insight into the stress experiences of ambulance staff. Findings underscore the need for theoretically-informed, evidence-based interventions that integrate organisational reform and individual support strategies to mitigate sickness absence, safeguard well-being and prevent attrition.

Wounds are one of the most common causes of emergency department visits. Their care often involves stitches, a potentially painful and stressful procedure. Pain and stress management is usually based on local anaesthesia, which is not always optimal. Medical hypnosis may offer a non-pharmacological alternative. Heart rate variability is a pain-free, easy-to-use and objective biomarker of stress. This study aims to assess the benefit of hypnosis on stress and pain during stitching using a randomised controlled trial.

This is a single-centre, randomised controlled trial in an emergency department in Clermont-Ferrand. Patients consulting for suturable wounds will be randomised into two groups: with or without medical hypnosis. Measurements will include questionnaires, heart rate variability, physical activity levels and blood biomarkers. The primary outcome is heart rate variability during the procedure. Data will be analysed with intention-to-treat and per-protocol approaches, with p

The study has received approval from the Ethics Committee Sud-Méditerranée III, France, and is registered on ClinicalTrials.gov. Written informed consent will be obtained from all participants. Results will be published in a peer-reviewed journal.

NCT06497712.

The objectives were to evaluate if a novel self-triaging and self-scheduling emergency department (ED) service, the Minor Ailment Patient Pathway (MAPP), can safely reduce ED wait times for low-acuity patients presenting with either cold and influenza or musculoskeletal ailments.

Prospective cohort study including all consecutive ED patients from 1 June 2023 to 31 March 2024. Outcomes for MAPP patients were compared with contemporaneous, matched ED patients who followed the usual care (UC) ED intake and evaluation process.

Single acute care hospital, Royal Victoria Regional Health Centre, located in Ontario, Canada.

Of 73 132 ED visits during the study period, 2766 (3.8%) used the MAPP. Low-acuity patients, defined by the Canadian Triage and Acuity Scale (CTAS) 3 or 4–5, comprised 59.4% and 34.1%, respectively, of all ED patients.

Most MAPP visits were for cold and influenza symptoms (63.6%) or musculoskeletal ailments (18.4%). Compared with CTAS-matched UC patients, MAPP users had a shorter mean length of stay (LOS) and faster mean physician initial assessment (PIA) time (adjusted LOS: –0.44 hours, 95% CI –0.84 to –0.05 and adjusted PIA: –1.22 hours, 95% CI –1.42 to –1.01). 7-day return visits occurred in 3.2% of MAPP patients compared with 4.4% of UC patients (p=0.002), with fewer admissions on return (1.8% vs 13.2%; p

MAPP was associated with shorter LOS, faster PIA, lower rates of return visits and hospital admissions, and high patient satisfaction, all suggestive of a safe, efficient and patient-centred ED service. Despite these benefits, MAPP was underused with only 9.3% of all cold and influenza and musculoskeletal ED patients self-triaging and self-scheduling an ED MAPP visit during this cohort period.

This study aimed to explore emergency medical dispatchers’ (EMDs’) experiences of prioritising patients and stewarding ambulance resources when system capacity was constrained.

Qualitative interview study using inductive qualitative content analysis.

Emergency medical communication centres (EMCCs) in Sweden, operated by the national emergency call provider and responsible for receiving 112 calls and dispatching ambulances.

13 purposively sampled EMDs with at least 1 year of professional experience.

Interviews were analysed inductively using qualitative content analysis (Elo and Kyngäs) through open coding, grouping into subcategories and abstraction into generic categories and one main category.

Dispatchers described prioritisation under scarcity as system work that simultaneously addressed individual patient acuity and population-level readiness. One main category captured this work: stewarding scarce response capacity. Three inter-related generic categories characterised stewardship: (1) prioritising by clinical urgency within geographic and operational constraints; (2) producing availability through anticipation, reassessment and queue governance in a ‘virtual waiting room’; and (3) coordinating response through information infrastructures and interprofessional collaboration. Across categories, dispatchers described redistributing risk across patients and time, managing moral strain when delays could harm patients and using experience, reassessment and teamwork to avoid both under-response to urgent need and over-allocation that would leave areas without coverage.

Dispatch under scarcity is best understood as active stewardship of a safety-critical dispatch queue. Strengthening patient safety therefore requires organisational support for reassessment and escalation during prolonged waits, explicit governance of queue dynamics and geographic coverage trade-offs, safeguards for contextual judgement when automation is used and support for dispatchers exposed to morally difficult scarcity decisions.

Same-day emergency care (SDEC) has been rolled out as a model of care in England with a limited evidence base. This study examined conversion to inpatient admission, 30-day reattendance and 30-day mortality, among adults managed through SDEC compared with those admitted for ≤48 hours, as a proxy for low acuity, over a 4-year period, to assess safety and effectiveness in a real-world operational setting across two acute hospital sites.

Retrospective cohort study.

Two acute hospital sites within one National Health Service (NHS) trust in England, UK.

Adults aged ≥18 years attending acute medical services between April 2021 and March 2025, managed via SDEC or admitted for ≤48 hours (n=43 970).

Conversion to inpatient admission, 30-day reattendance and 30-day mortality.

The crude conversion rate from SDEC to inpatient admission was 5.8%. In the multivariable model, increasing age (OR1.02, 95%CI 1.01 to 1.02), male sex (OR1.42, 95%CI 1.29 to 1.57) and attendance at the Boston site (OR1.71, 95%CI 1.55 to 1.90) were associated with higher odds of admission.

30-day prefix-concordant reattendance occurred in around 10% of patients in both pathways. After adjustment, SDEC patients had substantially lower odds of reattendance than those admitted for ≤48 hours (OR0.26, 95% CI 0.19 to 0.36). The effect of SDEC varied by age (interaction OR1.02, 95% CI 1.01 to 1.02) and site, with a weaker protective effect at Lincoln compared with Boston (interaction OR2.12, 95% CI 1.74 to 2.60). Age was associated with a reduction in reattendance (OR 0.99 per year increase, 95% CI 0.98 to 0.99).

30-day mortality was lower in SDEC than in short-stay admission (0.6% vs 8.2%), with pathway remaining a strong predictor after adjustment (OR0.05, 95%CI0.04 to 0.07). Younger age was protective, while male sex was associated with higher mortality. Pathway by sex interaction indicated a less pronounced protective effect of SDEC in men.

SDEC was associated with very low conversion to inpatient admission and substantially better short-term outcomes than short-stay admission, including markedly reduced diagnosis-concordant reattendance and lower 30-day mortality. These findings indicate that SDEC is a safe and effective model for managing selected acute medical patients. The consistently favourable outcomes among SDEC attenders suggest that patient selection and operational factors within the emergency pathway may be directing lower-risk patients towards SDEC, highlighting the need to review how SDEC capacity is targeted to ensure alignment with its intended clinical role.

Rising demand for emergency care in England is a continuing challenge driven by population ageing and increasing multimorbidity. Ambulatory emergency care (AEC) refers to the provision of same-day acute care for patients who might otherwise require admission. However, the contribution of AEC conditions to demand remains unclear. This study aimed to examine the proportion and nature of patients attending emergency departments (ED) with AEC-related conditions and to describe variation between hospitals in attendances and emergency admissions for AEC conditions.

A retrospective study of routine data from 21 acute hospitals in England, including adult ED attendances and emergency admissions between 1 November 2021 and 31 October 2022. We used a federated approach to ensure data security, applying established AEC definitions to explore variation by age, socioeconomic status and length of stay.

Primary: Proportion of (i) ED attendances and (ii) emergency admissions for AEC conditions. Secondary: (i) Proportion of patients presenting at ED with an AEC condition who were admitted; (ii) proportion of emergency admissions with an AEC condition with a length of stay

We analysed 1 513 480 attendances (median per hospital: 73 125) and 660 105 admissions (median per hospital: 30 425). AEC accounted for 29.6% of attendances and 40.8% of admissions, with substantial inter-hospital variability. Patients aged ≥65 were more likely to present with an AEC, while patients from deprived areas had lower rates. Among AEC-related admissions, 49.3% had a stay of less than 2 days.

Nearly one-third of attendances and two-fifths of admissions were for conditions potentially manageable in AEC or community settings. Variation between hospitals suggests local factors, including service configuration and primary care access, may influence avoidable acute care use. These findings suggest a need for a more nuanced understanding of the drivers behind AEC, or SDEC Services, to better understand their impact on reducing hospital admissions. Analysing these patterns may inform interventions to reduce avoidable hospital utilisation. Further research is needed to identify drivers of variation and to develop scalable strategies for prevention.

Emergency EEG (emEEG) is increasingly used in the emergency department (ED), but its diagnostic yield remains uncertain. This protocol describes a multicentre observational study aiming to evaluate emEEG findings and their relationship with diagnostic pathways and therapeutic management of patients admitted to the ED.

This multicentre retrospective study will analyse emEEGs performed on patients admitted to the ED of some Italian teaching and community hospitals over a 1-year period with a target sample size of 3850 patients. The diagnostic yield of emEEG will be evaluated by assessing abnormal and epileptiform findings and the relationship between emEEG findings and subsequent clinical decisions, including confirmation or revision of the initial diagnostic suspicion, decisions regarding home discharge or hospitalisation and medication changes. EEG will be classified according to the terminology of the American Clinical Neurophysiology Society. Clinical and instrumental data will be respectively reviewed by emergency physicians and neurologists/neurophysiologists. In particular, via traditional biostatistics and interpretable machine learning models, the study will evaluate the diagnostic yield of emEEG and its association with subsequent clinical management across defined clinical scenarios in the ED.

This first large-scale multicentre protocol will provide valuable insights for emergency department (ED) clinicians in selecting appropriate candidates for an emergency EEG (emEEG), supporting ethically sound, proportionate use of this resource in a time- and risk-critical setting. By clarifying diagnostic yield and its relationship with subsequent clinical decisions, the study is expected to generate robust evidence to guide emEEG ordering, reduce unnecessary testing and delays, and promote safer, more equitable decision-making (including appropriate home discharge) while minimising potential harms from misdiagnosis or overtreatment. The study has been approved by the Ethics Committee Regione Toscana - Area Vasta Centro (n. 27241). Findings will be disseminated through peer-reviewed publications, conference presentations and engagement with relevant clinical societies to inform international recommendations and facilitate translation into ED practice. Furthermore, developed models will be made openly available for external and public validation.