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Redesign of a virtual reality basic life support module for medical training – a feasibility study

Healthcare providers, including medical students, should maintain their basic life support (BLS) skills and be able to perform BLS in case of cardiac arrest. Research shows that the use of virtual reality (VR)...

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Assessment of the effectiveness of hospital external disaster functional drills on health care receivers’ performance, using standardized patients and mass cards simulation: a pilot study from Saudi Arabia

Given the increasing frequency of disasters globally, it is critical that healthcare systems are prepared for these mass casualty events. The Saudi health system’s preparedness for mass casualty incidents need...

The impact of ketamine on emergency rapid sequence intubation: a systematic review and meta-analysis

Rapid sequence intubation (RSI) is a crucial step in the resuscitation process for critically ill patients, and the judicious use of sedative drugs during RSI significantly influences the clinical outcomes of ...

Characteristics of trauma patients treated by Helicopter Emergency Medical Service and transported to the hospital by helicopter or ambulance

Trauma patients treated by the Helicopter Emergency Medical Services (HEMS) can be transported to the hospital either by helicopter or by ambulance, in both cases accompanied by the HEMS physician. The objecti...

Behind the scenes: a qualitative study on threats and violence in emergency medical services

The increasing prevalence of threats and violence against ambulance clinicians is a critical issue that has not been adequately studied. These incidents pose significant challenges to the provision of prehospi...

Valued technical and non-technical skills among disaster responders: a cross sectional study of disaster responders involved in the earthquake in Türkiye and Syria January 2023

Disaster responders are an important part of disaster response. However, despite large efforts to train disaster responders, there is a limited scientific knowledge regarding which competences and skills such ...

Length of stay and associated factors among pediatric patients in the pediatric emergency unit of the Tikur Anbessa specialized hospital, Addis Ababa, Ethiopia

Length of stay in the emergency department is used as a quality indicator to gauge the overall efficiency of emergency care. The performance measure was used to evaluate the quality of care provided in the eme...

Hybrid emergency care at the home for patients – A multiple case study

Healthcare systems worldwide are facing numerous challenges, such as an aging population, reduced availability of hospital beds, staff reductions and closure of emergency departments (ED). These issues can exa...

Evaluation of stabbing assault injuries in a tertiary emergency department: a retrospective observational study

Approximately 458,000 victims were deceased from intentional violence in 2021. A stabbing assault causes 25% of homicides. The study aims to evaluate injury patterns, trauma scores, radiological findings, type...

Factors affecting neurological outcomes of patients with sudden cardiac arrest in the emergency department

Little is known about patients with sudden cardiac arrest in the emergency department (ED). This study aimed to identify factors affecting the prognosis of patients with cardiac arrest in the ED.

Redirection of low-acuity emergency department patients to nearby medical clinics using an electronic medical support system: effects on emergency department performance indicators

Overcrowded emergency departments (EDs) are associated with higher morbidity and mortality and suboptimal quality-of-care. Most ED flow management strategies focus on early identification and redirection of lo...

Prevalence, predictors and outcomes of self-reported feedback for EMS professionals: a mixed-methods diary study

Providing feedback to healthcare professionals and organisations on performance or patient outcomes may improve care quality and professional development, particularly in Emergency Medical Services (EMS) where...

Prehospital neurological emergencies– a survey on the state of prehospital neurological assessment by emergency medical professionals

Neurological emergencies are one of the major diagnosis groups in the Emergency Medical Services (EMS) with the highest rate of misdiagnosis. Despite the knowledge of time sensitivity and the importance of pre...

Comparing NEWS2, TRISS, and RTS in predicting mortality rate in trauma patients based on prehospital data set: a diagnostic study

In the recent years, National Early Warning Score2 (NEWS2) is utilized to predict early on, the worsening of clinical status in patients. To this date the predictive accuracy of National Early Warning Score (N...

Violent encounters on the front line: Sequential explanatory mixed-methods investigation of physical violence factors in the prehospital setting

Workplace violence (WPV) is an important issue in prehospital care, especially for emergency medical technicians ( EMTs) who are at increased risk of physical violence due to the nature of their work. This stu...

Comparison of Modified Early Warning Score (MEWS), Simplified Acute Physiology Score II (SAPS II), Sequential Organ Failure Assessment (SOFA), and Acute Physiology and Chronic Health Evaluation II (APACHE II) for early prediction of septic shock in diabetic patients in Emergency Departments

Sepsis is a severe medical condition that can be life-threatening. If sepsis progresses to septic shock, the mortality rate increases to around 40%, much higher than the 10% mortality observed in sepsis. Diabe...

Place of telemedicine in the organization of emergency care: feasibility and benefits

Telemedicine encompasses all medical practices that allow patients to be remotely cared for through new information and communication technologies. This study aims to assess the remote management of patients c...

Exploring the challenges of emergency medical service providers in the initial phase of the COVID-19 pandemic: a qualitative content analysis

As the COVID-19 pandemic continues to unfold, there has been a substantial increase in the demand for prehospital services. Emergency medical service (EMS) providers have encountered a myriad of challenges tha...

Emergency pediatric patients and use of the pediatric assessment triangle tool (PAT): a scoping review

We conducted a scoping review of the evidence for the use of the Pediatric Assessment Triangle (PAT) tool in emergency pediatric patients, in hospital and prehospital settings. We focused on the psychometric p...

Quality and safety in prehospital airway management – retrospective analysis of 18,000 cases from an air rescue database in Germany

Prehospital airway management remains crucial with regard to the quality and safety of emergency medical service (EMS) systems worldwide. In 2007, the benchmark study by Timmermann et al. hit the German EMS co...

The challenges of delivery in pre-hospital emergency medical services ambulances in Iran: a qualitative study

Although unplanned deliveries in ambulances are uncommon, Emergency Medical Services (EMS) providers may encounter this situation before reaching the hospital. This research aims to gather insights from Emerge...

Take-home naloxone administered in emergency settings: feasibility of intervention implementation in a cluster randomized trial

Opioids kill more people than any other class of drug. Naloxone is an opioid antagonist which can be distributed in kits for peer administration. We assessed the feasibility of implementing a Take-home Naloxon...

Negotiating grey areas: an interview-based analysis of paramedic uncertainty and decision-making in cardiac arrest events

Paramedics are responsible for critical resuscitation decisions when attending Out of Hospital Cardiac Arrests (OHCA). Existing research indicates that a range of clinical and non-clinical factors moderate the...

The impact of surge capacity enhancement training for nursing managers on hospital disaster preparedness and response: an action research study

Hospitals as the main providers of healthcare services play an essential role in the management of disasters and emergencies. Nurses are one of the important and influential elements in increasing the surge ca...

Paramedics’ experiences and observations: work-related emotions and well-being resources during the initial months of the COVID-19 pandemic—a qualitative study

As first responders, paramedics are an extremely important part of the care chain. COVID-19 significantly impacted their working circumstances. We examined, according to the experiences and observations of par...

Psychometric properties of the Farsi version of the Disaster Nursing Readiness Evaluation Index (F-DNREI)

Considering the vital role of nurses in responding to disasters, it is essential to measure their readiness with a valid and reliable tool. The present study aimed to assess the psychometric properties of the ...

Severe hyperlactatemia in the emergency department: clinical characteristics, etiology and mortality

Severe hyperlactatemia (lactate level ≥ 10 mmol/L) is associated with high mortality rates in critically ill patients. However, there is limited data on emergency department (ED) patients. We aimed to investig...

Identification of avoidable patients at triage in a Paediatric Emergency Department: a decision support system using predictive analytics

Crowding has been a longstanding issue in emergency departments. To address this, a fast-track system for avoidable patients is being implemented in the Paediatric Emergency Department where our study is condu...

Establishing a common ground: the future of triage systems

Triage systems, crucial for Emergency Departments, face unresolved doubts and issues that have not been addressed, coupled with increasing fragmentation due to a growing body of new evidence. International col...

Abated crowding by fast-tracking the Throughput component of the ED for patients in no need of hospitalization with competency managed personnel

Emergency department (ED) crowding is a major patient safety concern and has a negative impact on healthcare systems and healthcare providers. We hypothesized that it would be feasible to control crowding by e...

Oxygen accumulation and associated dangers in rescue helicopters

At the time of the COVID-19 pandemic, devastating incidents increased due to frequent oxygen administration to patients. The dangers associated with the use of oxygen, especially through local enrichments and ...

Correction: Systemic review of age brackets in pediatric emergency medicine literature and the development of a universal age classification for pediatric emergency patients - the Munich Age Classification System (MACS)

The original article was published in BMC Emergency Medicine 2023 23 :77

Validation of a checklist to facilitate serious illness conversations in adult emergency in China: a single-centre pilot study

Advances in emergency and critical care have improved outcomes, but gaps in communication and decision-making persist, especially in the emergency department (ED), prompting the development of a checklist to a...

A retrospective analysis of the need for on-site emergency physician presence and mission characteristics of a rural ground-based emergency medical service

This study aimed to address the challenges faced by rural emergency medical services in Europe, due to an increasing number of missions and limited human resources. The primary objective was to determine the n...

Emergency department visits as a potential opportunity to promote primary care attachment and modify utilization patterns – results of a pilot study in Berlin, Germany

Utilization by low acuity patients contributes to emergency department (ED) crowding. Both knowledge deficits about adequate care levels and access barriers in primary care are important promoters of such pres...

Blood pressure variability and prognostic significance in traumatic brain injury: analysis of the eICU-CRD database

Preliminary evidence demonstrates that visit-to-visit systolic blood pressure (SBP) variability is a prognostic factor of TBI. However, literature regarding the impact of initial blood pressure management on t...

Out of hospital cardiac arrest - new insights and a call for a worldwide registry and guidelines

Out of hospital cardiac arrest (OHCA) is a major public health problem with substantial mortality rates worldwide. Genetic diseases and primary electrical disorders are the most common etiologies at younger ag...

Unveiling the performance of the prehospital Rapid Emergency Medicine Score (pREMS): How the predictive score impacts in-hospital outcomes in traumatic brain injury (TBI): A retrospective observational cohort study

This study aimed to evaluate the predictive accuracy of the prehospital rapid emergency medicine score (pREMS) for predicting the outcomes of hospitalized patients with traumatic brain injury (TBI) who died, w...

Magnitude and outcome of road traffic accidents among patients admitted in dessie town governmental hospitals, Northeast Amhara, Ethiopia, 2022

Road traffic accidents(RTA) are a major public health problem worldwide, accounting for almost 1.24 million deaths per year and it is the number one cause of death among those aged group 15–29 years. Even thou...

A novel learner driver first aid eLearning program: a mixed-method pre-post pilot test and evaluation

Approximately 1.35 million people worldwide are killed in road accidents every year. Mandatory first aid training for learner drivers has been introduced in some European countries but no such requirements are...

Implementation of major trauma app: usability and data completeness

The current UK standard for major trauma patients is to record notes in a paper trauma booklet. Through an innovative collaboration between a major trauma centre and a digital transformation industry partner, ...

Identifying the key characteristics, trends, and seasonality of pedestrian traffic injury at a major trauma center in Saudi Arabia: a registry-based retrospective cohort study, 2017–2022

Pedestrian traffic injuries are a rising public health concern worldwide. In rapidly urbanizing countries like Saudi Arabia, these injuries account for a considerable proportion of trauma cases and represent a...

Emergency department utilization before and during the COVID-19 pandemic among individuals with sickle cell disease

The emergency department (ED) is a vital source of healthcare for individuals living with sickle cell disease (SCD). Prior research indicates that during the COVID-19 pandemic some individuals with SCD avoided...

Emergency preparedness in the central sterile supply department: a multicenter cross-sectional survey

To investigate the current situation of emergency preparation and emergency drill in the CSSD, and analyze its influence on the nurses’ emergency attitude and ability.

Fracture pain in children in the emergency department: the impact of a new pain management procedure

To compare compliance with the French national guidelines before and after the implementation (in 2018) of a new protocol on acute fracture pain management in the pediatric emergency department of a French uni...

Development and psychometric testing of a scale to measure effective rural emergency transfer (RET)

The process of transferring patients from small rural primary care facilities to referral facilities impacts the quality of care and effectiveness of the referral healthcare system. The study aimed to develop ...

New Trauma Score versus Kampala Trauma Score II in predicting mortality following road traffic crash: a prospective multi-center cohort study

Mortality due to injuries disproportionately impact low income countries. Knowledge of who is at risk of poor outcomes is critical to guide resource allocation and prioritization of severely injured. Kampala T...

The prevalence of physical and verbal violence among emergency medicine physicians in military hospitals vs non-military hospitals, Jeddah, Saudi Arabia: multi-center cross-sectional study

In healthcare settings, physical and verbal attacks are commonly encountered in the workplace among healthcare providers. Patients and patients’ relatives and friends have been reported to be the perpetrators ...

Comparison of prognosis between extracorporeal CPR and conventional CPR for patients in cardiac arrest: a systematic review and meta-analysis

Compared to the conventional cardiopulmonary resuscitation (CCPR), potential benefits of extracorporeal cardiopulmonary resuscitation (ECPR) for patients with cardiac arrest (CA) are still controversial. We ai...

Designing a model of emergency medical services preparedness in response to mass casualty incidents: a mixed-method study

Emergency medical services preparedness in mass casualty incidents is one of the most important concerns in emergency systems. A mass casualty incident is a sudden event with several injured individuals that o...

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Citation Impact 2023 Journal Impact Factor: 2.3 5-year Journal Impact Factor: 2.5 Source Normalized Impact per Paper (SNIP): 0.936 SCImago Journal Rank (SJR): 0.745 Speed 2023 Submission to first editorial decision (median days): 14 Submission to acceptance (median days): 164 Usage 2023 Downloads: 1,251,999 Altmetric mentions: 586

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BMC Emergency Medicine

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Page 1 of 23

Red blood cell transfusion in a tertiary Haitian hospital’s emergency department: patient characteristics and availability challenges

Red blood cell (RBC) transfusions are essential for many patients admitted to emergency departments (ED). However, accessibility to red cell transfusions is often limited, especially in low-income countries su...

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Predictors of nursing home conveyances to emergency department

With increasing rates of patient conveyances from nursing homes to emergency departments worldwide, we aim to examine factors causing high rates of conveyances from nursing homes to the emergency department (E...

Development of decision tree classification algorithms in predicting mortality of COVID-19 patients

The accurate prediction of COVID-19 mortality risk, considering influencing factors, is crucial in guiding effective public policies to alleviate the strain on the healthcare system. As such, this study aimed ...

Virtual reality for assessing emergency medical competencies in junior doctors – a pilot study

The teaching and assessment of clinical-practical skills in medical education face challenges in adequately preparing students for professional practice, especially in handling emergency situations. This study...

A 26 years old primigravida woman presented with abdominal cutaneous entrapment syndrome: a case report

Abdominal cutaneous nerve entrapment syndrome (ACNES) is characterized by severe, mostly refractory, chronic pain due to the entrapment of the cutaneous branches of the lower torso intercostal nerves at the la...

Characteristics and outcomes of emergency department patients across health care systems: an international multicenter cohort study

A wide variation of emergency medical system configurations across countries has limited the value of comparison of quality and performance measures in the past. Furthermore, lack of quantitative data on EDs p...

Case series: star anise toxicity presenting to the emergency department in Eastern Regional Referral Hospital in Bhutan

Star anise fruit has been used in spice in Asian cuisine, ingredient for traditional medicines, component for antiviral drugs and as parts of tea and beverage across the globe. Toxicity from these plants has b...

Provider perception of presentations with nonspecific back pain in the emergency department and primary care practices: a semi-structured interview study

Increasing numbers of patients treated in the emergency departments pose challenges to delivering timely and high-quality care. Particularly, the presentation of patients with low-urgency complaints consumes r...

Surviving a classic heat stroke/hyperthermia > 42 °C – a case report

Classic heat stroke is a severe trauma which can lead to multi-organ dysfunctions and is associated with a high mortality.

Emergency department service utilisation of older patients with urgent conditions: a cross-sectional observational study

As with many countries worldwide, Singapore is experiencing a rapidly ageing population. Presentation of older persons for urgent but non-emergent conditions to the Emergency Department (ED) represents a growi...

Posterior reversible encephalopathy syndrome (PRES) on the second postpartum day: learning experience from a case report and literature review

Posterior reversible encephalopathy syndrome (PRES) is an uncommon neurological disorder which is characterised by variable symptoms. The transient clinical condition may be underestimated and misdiagnosed as ...

Aortoesophageal fistula with hemorrhagic shock successfully treated with resuscitative endovascular balloon occlusion of the aorta

Aortoesophageal fistula (AEF) is a rare cause of upper gastrointestinal hemorrhage. Despite diagnostic and therapeutic advances, the mortality rate in AEF patients remains high because of its fulminant course,...

Evaluation of advanced multi-purpose trauma moulage-based training on clinical skills for dealing with trauma-affected individuals in undergraduate nursing students

Simulation-based training courses have been developed and widely accepted.The use of simulators can prevent bitter consequences that may sometimes put human lives in danger. Increasing the skill of nursing stu...

Cervical epidural hematoma: a case series highlighting uncommon causes

Cervical epidural hematoma (CEH) is a rare but potentially devastating condition, characterized by the accumulation of blood within the epidural space of the cervical spine, leading to spinal cord compression ...

Decrease of haemoconcentration reliably detects hydrostatic pulmonary oedema in dyspnoeic patients in the emergency department – a machine learning approach

Haemoglobin variation (ΔHb) induced by fluid transfer through the intestitium has been proposed as a useful tool for detecting hydrostatic pulmonary oedema (HPO). However, its use in the emergency department (...

Management of gunshot injury to the abdominal aorta and inferior vena cava: a case report of a combat patient wounded in the Russo-Ukrainian war

Russo-Ukrainian war is associated with severe traumas, including injuries to the major vessels. Penetrating aortic injury remains one of the most difficult injuries; the mortality rate is 90–100% in case of gu...

Entrustable professional activities, emergency medicine and medical education: a systematic review

Entrustable professional activities (EPAs) are one way to assess competencies, and are designed to bridge the gap between theoretical competencies and real world clinical practice.

Unexpected Grave’s-induced acute myocardial infarction in a young female, a literature review based on a case report

Myocardial ischemia can occur due to several causes, which result in an imbalance between the supply and demand of oxygen to cardiac muscles. One potential reason for this condition is the overwork of the hear...

Utility of pelvic examination in assessing women with bleeding in early pregnancy: a multicenter Canadian emergency department study

Bleeding in early pregnancy is a common emergency department (ED) presentation. Although variability in approaches has been demonstrated, research is relatively uncommon on practices and outcomes. This study i...

Emergency care via video consultation: interviews on patient experiences from rural community hospitals in northern Sweden

Delivering emergency care in rural areas can be challenging, but video consultation (VC) offers opportunities to make healthcare more accessible. The communication and relationship between professionals and pa...

An unsuspected extracranial internal carotid pseudoaneurysm following dog bites: a case report and review of literature

Extracranial internal carotid artery (ICA) pseudoaneurysm is a rare condition that can be caused either by penetrating or blunt trauma, including dog bites, which is an uncommon occurrence. Together with the p...

Vaping-associated illness: a reassessment

In 2019, there was widespread presentation of respiratory distress as well as other organ system involvement in patients with a history of vaping. There continue to be reports of vaping-associated illness (VAI...

Cytokine release syndrome following COVID-19 infection during treatment with nivolumab for cancer of esophagogastric junction carcinoma: a case report and review

Cytokine release syndrome (CRS) is an acute systemic inflammatory syndrome characterized by fever and multiple organ failure, which is triggered by immunotherapy or certain infections. Immune checkpoint inhibi...

Incidence, characteristics, and prehospital outcomes of out-of-hospital cardiac arrest in Qatar: a nationwide gender-based investigation

Research on incidence and characteristics of Out-of-Hospital Cardiac Arrest (OHCA) in the Middle East is limited. We assessed the incidence, prehospital characteristics, and outcomes of OHCA in Qatar, a Middle...

Neuraxial anesthesia for non-neurological emergency surgery in a patient with acute ischemic stroke: a case report

The recent guidelines recommend delaying elective non-neurological surgery after an index stroke, but there is a lack of consensus regarding emergency surgery in patients with a recent stroke. Impaired cerebra...

Safety of adenosine for pediatric tachyarrhythmia treatment in the emergency department: a multi-hospital 10-year cross-sectional study

Supraventricular tachycardia is the most common dysrhythmia in children. Initial vagal maneuvers are successful less than half of the time. Adenosine, a potent AV nodal blocker with a short half-life, is recom...

Rupture of a calcified right ventricle to pulmonary artery homograft by balloon dilation– emergency rescue by venus P-Valve

Percutaneous pulmonary valve implantation (PPVI) is a recognized alternative treatment to surgery for patients with dysfunctional right ventricular outflow tracts. Patient selection is essential to avoid serio...

U-shaped correlation of lymphocyte count with all-cause hospital mortality in sepsis and septic shock patients: a MIMIC-IV and eICU-CRD database study

In sepsis, the relationship between lymphocyte counts and patient outcomes is complex. Lymphocytopenia and lymphocytosis significantly influence survival, illustrating the dual functionality of lymphocytes in ...

Diagnostic laparoscopy with indocyanine green fluorescence test for the evaluation of intestinal perfusion in abdominal blunt injury: a case report

The indocyanine green (ICG) fluorescence test has become a standard test in surgical procedures, facilitating the assessment of blood perfusion in real-time. While its utility in emergency surgeries for evalua...

Extended reality training for mass casualty incidents: a systematic review on effectiveness and experience of medical first responders

Mass casualty incidents (MCI) are unforeseeable and complex events that occur worldwide, therefore enhancing the training that medical first responders (MFRs) receive is fundamental to strengthening disaster p...

IFEM model curriculum: emergency medicine learning outcomes for undergraduate medical education

The International Federation for Emergency Medicine (IFEM) published its model curriculum for medical student education in emergency medicine in 2009. Because of the evolving principles of emergency medicine a...

Mortality and morbidity associated with new onset acute kidney injury in critically ill COVID-19 infection patients

The recent global pandemic due to severe acute respiratory syndrome coronavirus-2 resulted in a high rate of multi-organ failure and mortality in a large patient population across the world. As such, a possibl...

The MINUTES bundle for the initial 30 min management of undifferentiated circulatory shock: an expert opinion

Acute circulatory shock is a life-threatening emergency requiring an efficient and timely management plan, which varies according to shock etiology and pathophysiology. Specific guidelines have been developed ...

Catecholamine concentration as a predictor of mortality in emergency surgical patients

Trauma and emergency surgery are major causes of morbidity and mortality. The objective of this study was to determine whether serum levels of epinephrine and norepinephrine are associated with aging and morta...

A diagnostic dilemma: distinguishing a sulfasalazine induced DRESS hypersensitivity syndrome from a CD30 + lymphoma in a young patient

Drug reaction with eosinophilia and systemic symptoms (DRESS) is a severe hypersensitivity reaction characterized by cutaneous rash, lymphadenopathy, fever, eosinophilia, leukocytosis, and life-threatening org...

Comparing online and onsite simulation modules for improving knowledge and confidence in disaster preparedness among undergraduate medical students

Disaster preparedness is one of the critical strategies for effectively managing disasters and has been an area of high focus in the healthcare sector over the past few decades. The current Indian medical unde...

“Iliacus muscle abscess as an unexpected cause of posterior hip pain in a healthy young adult female”: a case report

Iliacus muscle abscess is an uncommon but potentially life-threatening condition that can present with nonspecific symptoms, posing diagnostic challenges. This case report highlights the importance of consider...

Dabigatran accumulation in acute kidney injury: is more better than less to prevent bleeding? A case report

Dabigatran is an oral anticoagulant that is mainly renally excreted. Despite its efficacy in preventing thromboembolic events, concerns arise regarding bleeding complications in patients with acute kidney inju...

Airway breathing circulation dengue: a case of multifactorial shock due to major trauma and severe dengue infection

Dengue is the most common arboviral illness reported globally, endemic to most tropical and sub-tropical regions of the world. Dengue Shock Syndrome is a rare complication of severe Dengue infection resulting ...

Treatment strategy for compartment syndrome at multiple regions due to injuries caused by a tree fall: a case report

Compartment syndrome commonly occurs in patients with forearm and lower leg fractures. Compartment syndromes of the gluteal and thigh muscles are less common. It is imperative that compartment syndrome be diag...

Early colonic-preparation and salvage laparoscopic appendectomy (ECSLA)- innovative protocol for the management of magnets ingestion

Ingestion of magnets carries risks for significant morbidity. We propose a new protocol designed to reduce the need for surgery, shorten length of stay, and decrease morbidity.

Successful management of a delayed presentation of traumatic descending thoracic aorta pseudoaneurysm: a literature review based on a case report

Blunt traumatic aortic injury (BTAI) is the second leading cause of death due to traumas in young patients. The primary presentation might be chest or interscapular pain, difficulty in breathing, and, in sever...

Do-not-attempt-resuscitation decision making: physicians’ recommendations differ from the GO-FAR score predictions

In-hospital cardiac arrest (IHCA) is a major cause of mortality globally, and over 50% of the survivors will require institutional care as a result of poor neurological outcome. It is important that physicians...

Severe COVID-19 multisystem inflammatory syndrome versus severe dengue in children from Indonesia: a cross-sectional study

Severe multisystem inflammatory syndrome in children (MIS-C) and severe dengue are challenging to identify during the COVID-19 pandemic in dengue-endemic areas. Fever, multiorgan involvement, and shock charact...

Creating a master training rotation schedule for emergency medicine residents and challenges in using artificial intelligence

The allocation of resident physicians to clinical rotations presents a complex challenge that requires balancing multiple objectives with the goals of providing optimal patient care, maintaining adequate depar...

Violence in the emergency department: a quantitative survey study of healthcare providers in India

Workplace violence (WPV) in Emergency Departments (EDs) is an increasingly recognized challenge healthcare providers face in low-resource settings. While studies have highlighted the increased prevalence of WP...

Low-dose tenecteplase during cardiopulmonary resuscitation in massive pulmonary embolism

We report the case of an 18-year-old male who presented to the Emergency Department with sudden onset dyspnea. The patient was intubated on arrival, but suffered a cardiac arrest soon after. Point-of-care echo...

Paracetamol overdose causing acute kidney injury without hepatotoxicity: a case report

Paracetamol is a widely used analgesic and antipyretic. Paracetamol-induced hepatotoxicity is well known, but nephrotoxicity without hepatotoxicity is rarely seen.

The wolf in sheep’s clothing: vasovagal syncope in acute aortic dissection

The presentation of acute aortic dissection can pose a challenge for emergency physicians, as it may occur without pain. Atypical presentations can lead to significant delays in diagnosis and increased mortali...

A potentially lifesaving error: unintentional high-dose adrenaline administration in anaphylaxis-induced cardiac arrest; a case report

Cardiopulmonary resuscitation is a crucial skill for emergency medical services. As high-risk-low-frequency events pose an immense mental load to providers, concepts of crew resource management, non-technical ...

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Citation Impact 2023 Journal Impact Factor: 2.0 5-year Journal Impact Factor: 2.3 Source Normalized Impact per Paper (SNIP): 1.157 SCImago Journal Rank (SJR): 0.700 Speed 2023 Submission to first editorial decision (median days): 27 Submission to acceptance (median days): 134 Usage 2023 Downloads: 985,950 Altmetric mentions: 682

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International Journal of Emergency Medicine

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Recent Advances in Emergency Medicine

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Since the start of basic and advanced life support seminars, medicine has evolved throughout the centuries and especially in the recent years, providing not only new insights regarding pathophysiology of medical emergencies but also new treatment strategies. All medical specialties and departments, from ...

Keywords : Emergency Medicine, Emergency, Medical Emergency, Surgical Emergency, recent advances, cardiopulmonary resuscitation, acute medicine

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Greatest Hits in Emergency Medicine Research: 2023

Keeping abreast of all the high-impact papers in em is no easy feat..

EMRA’s Research Committee, in partnership with other EMRA committees, has compiled a quick review of some of the most practice-affirming or practice-changing papers recently published. This is by no means a definitive list, but our summaries of these noteworthy papers will be good to know for your next shift!

Effect of Intravenous or Intraosseous Calcium vs Saline on Return of Spontaneous Circulation in Adults With Out-of-Hospital Cardiac Arrest: A Randomized Clinical Trial.

Review by Sierra F. Williams, MS, OMS-IV

This double-blind, randomized clinical trial sought to determine whether administration of calcium during out-of-hospital cardiac arrest (OHCA) improves return of spontaneous circulation (ROSC) in adults. In this trial, 397 adult patients were randomized to receive up to 2 intravenous or intraosseous doses of 5 mmol of calcium chloride (n = 197) or saline (n = 200). A dose of calcium chloride or saline was administered immediately following a dose of epinephrine. The primary outcome of the study was sustained ROSC (defined as ROSC without need for further CPR for 20 minutes), while the secondary outcome included survival and a favorable neurological outcome at 30 and 90 days, with a modified Rankin Scale score of 0-3. The trial was stopped early due to concerns of harm in the calcium group. Sustained ROSC was achieved in 19% of patients in the calcium group and 27% in the saline group (risk ratio, 0.72 [95% CI, 0.49 to 1.03]; risk difference, −7.6% [95% CI, −16% to 0.8%]; p=0.09). At 30 days, 5.2% of patients in the calcium group survived compared to 9.1% of patients in the saline group (risk ratio, 0.57 [95% CI, 0.27 to 1.18]; risk difference, −3.9% [95% CI, −9.4% to 1.3%]; p=0.17). 3.6% of patients in the calcium group reached a favorable neurological outcome compared to 7.6% of patients in the saline group (risk ratio, 0.48 [95% CI, 0.20 to 1.12]; risk difference, −4.0% [95% CI, −8.9% to 0.7%]; p=0.12). The study showed that administration of calcium during OHCA in adults did not improve sustained ROSC and can potentially cause harm.

Critique and Implications for Practice Prior to the COCA trial, evidence regarding the use of calcium in OHCA has been conflicting and lacking. However, guidelines often continue to recommend its use. There is sufficient evidence to support the use of calcium in select patient populations that were not included in this study, such as hyperkalemia, hypocalcemia, and CCB toxicity. Although the results were not statistically significant due to the low power of the study, the use of calcium in OHCA appears to be correlated with patient harm that cannot be ignored. This indicates that calcium in OHCA is not suitable for all patients and should not be used routinely. It is also important to keep in mind that there has been no study to date to demonstrate that a single medication administered during cardiac arrest made a difference in survival with a favorable neurological outcome. Early, high-quality CPR in addition to early defibrillation in the appropriate patients are the only 2 treatments that have shown improvement in these outcomes.*

*Referenced First10EM and Salim Rezaie EBM review during ResusX 2022 conference

Prehospital & Disaster Medicine, Health Systems

Using the Centers for Disease Control and Prevention’s National Syndromic Surveillance Program Data to Monitor Trends in U.S. Emergency Department Visits for Firearm Injuries, 2018 to 2019

Review by Muhammad Waseem, MD, MS & David Gordon, MS3

The authors utilized a retrospective analysis of the CDC National Syndromic Surveillance Program dataset to analyze near-real time data between January 2018 and December 2019, capturing 215 million ED visits. The study used a set of ICD-9 and ICD-10 diagnosis codes and chief complaint keywords to filter for firearm injury records. Of those visits, 132,767 were firearm related (61.6 per 100,000 ED visits). This study revealed that males aged 15-24 had higher firearm injury-related ED visit rates relative to other demographic age groups. Overall, the rate of fire-arm related injury increased for all age groups between 15 and 64 years over the interval studied. Analyzed by region, the rate of ED visits for firearm injury significantly increased in the northeast, southeast, and southwest regions. These results are consistent with other studies but were able to be reported with less lag due to the study’s near real time surveillance methods.

Critique and Implications for Practice Firearm-related injury is a major public health issue, but there is lag between when ED visits relating to firearm injury occur and when traditional reports for firearm injury are captured. This study highlights the epidemiology of firearm-related visits to the emergency department, raising awareness of the problem and noting the need for prevention strategies. The rate of firearm-related injury and presentation to the ED is only increasing. Awareness of the epidemiology of firearm injury can help target community-based public health violence prevention, facilitate training, and guide rapid response strategies. On a systems level, this method analysis can also inform resource allocation, particularly identifying where firearm visits make up a substantial portion of ED visits. In contrast to a typical 2-year data lag from traditional ED surveillance systems used to monitor firearm injury ED visits, this study utilized near-real time electronic medical record national surveillance data. Where data is available, incorporating methods that leverage real-time surveillance could provide further insight into other clinical applications as well.

Critical Care, Airway Management

Effect of Use of a Bougie vs Endotracheal Tube with Stylet on Successful Intubation on the First Attempt Among Critically Ill Patients Undergoing Tracheal Intubation: A Randomized Clinical Trial

Review by Elisa Quince DO, MS

This multicenter, randomized clinical trial assessed if utilizing a bougie or an endotracheal tube with stylet would increase the likelihood of success on the first attempt. In this study, referred to as the “BOUGIE” trial, 1,102 critically ill adults who required tracheal intubation were randomly assigned the utilization of a bougie or endotracheal tube with a stylet. The study found an 80% success rate with the utilization of the bougie versus 83% with a stylet. Overall, the study found that using a bougie did not significantly increase the incidence of successful intubation on the first attempt compared to using an endotracheal tube with a stylet.

Critique and Implications for Practice This study challenges the perception that a provider should primarily use a bougie during difficult intubations. This perception was shaped by previous observational studies and 1 RCT concluding that using a bougie was associated with increased incidence of first-attempt intubation. It encourages providers to focus more on utilizing the method the operator is most comfortable with at that time. When comparing the BEAM trial to this study, one difference is that the BEAM trial was limited to one single emergency department in Hennepin County Medical Center, while the BOUGIE trial received data from 7 different emergency departments and 8 ICUs in the United States. Differences in training styles and experiences can lead to the differences seen in the results of these studies but can lead to the implication that for difficult intubations, how one is trained can dictate comfort level, and comfort level can lead to successful intubation on the first attempt.

Pediatric EM

Effect of Amoxicillin Dose and Treatment Duration on the Need for Antibiotic Re-treatment in Children with Community-Acquired Pneumonia: The CAP-IT Randomized Clinical Trial

Review by David Leon, MD

This study is a multi-center 2x2 RCT with children who required amoxicillin for community-acquired pneumonia (CAP), randomized to receive either 35-50 mg/kg/d or 70-90 mg/kg/d of amoxicillin for a treatment duration of 3 or 7 days. The primary outcome was if it was clinically indicated to re-treat with antibiotics for respiratory infection within 28 days after randomization. There was no significant difference between the high- and low-dose groups, nor the 3-day vs 7-day groups. The secondary outcomes addressed CAP-related symptom severity. Cough duration was slightly prolonged in the 3-day course group. No significant interaction was noted between dose and duration groups. Outpatient treatment of CAP in children with a lower dose of amoxicillin was noninferior to traditional high-dose amoxicillin, and 3-days of antibiotics was noninferior to 7-days, with respect to the need for antibiotic retreatment within a month.

Critique and Implications for Practice For children with mild to moderate CAP who are not in need of significant support, such as those appropriate for discharge or only requiring overnight observation, it seems adequate to treat with both lower dose and shorter course of antibiotics. However, this data may not be applicable to children with severe CAP. Local antibiogram and resistance must be considered given that the study only included amoxicillin. This is of particular interest as there was a nationwide shortage of amoxicillin this year.

CT or Invasive Coronary Angiography in Stable Chest Pain

Review by Sandra Gad, MSc

Randomly assigned 3,561 patients (56.2% female), follow-up was complete for 3523 (98.9%). Major adverse cardiovascular events occurred in 2.1% in the CT group and in 3% of the ICA group (hazard ratio, 0.70; 95% confidence interval [CI], 0.46 to 1.07; P=0.10). Major procedure-related complications occurred in 0.5% of the CT group and in 1.9% of the ICA group (hazard ratio, 0.26; 95% CI, 0.13 to 0.55). Angina during the final four weeks of follow-up was reported in 8.8% of the patients in the CT group and 7.5% of those in the ICA group (odds ratio, 1.17; 95% CI, 0.92 to 1.48). The DISCHARGE trial group found that the incidence of major adverse cardiovascular events did not differ between the CT group and the invasive coronary angiography group in patients with stable chest pain.

Critique and Implications for Practice CT can be a reliable option with similar diagnostic abilities to ICA when diagnosing CAD in patients with stable chest pain. Using CT can significantly reduce patients’ concerns regarding the invasive nature of ICA, as well as alleviate the financial burden associated with ICA. Further, CT can speed up diagnosis and ensure timely treatment.

Sodium Bicarbonate Use During Pediatric Cardiopulmonary Resuscitation: A Secondary Analysis of the ICU-RESUScitation Project Trial

Review by Nathan Dreyfus, MD

This multi-center, retrospective cohort analysis compared the outcomes of pediatric in-hospital cardiac arrest cases (p-IHCA) between patients who received intra-resuscitation sodium bicarbonate and those who did not. Children analyzed were those who received chest compressions between ages =>37 weeks post-conceptual age and <= 18 years between October 2016 to March 2021. Various child characteristics including their Pediatric Risk of Mortality score (PRISM) and Vasoactive Inotropic Score (VIS) were collected across 10 clinical sites. The main outcome of investigation was the duration of survival to hospital discharge. Other outcomes included ROSC, neurological outcomes, and presence of new morbidity. It was shown that sodium bicarbonate was used more in children with cardiac diagnoses, increased severity of illness and longer CPR duration. Of 1,100 CPR events, use of sodium bicarbonate was associated with lower rates of survival to hospital discharge and discharge with favorable neurologic outcomes.

Critique and Implications for Practice While the propensity-weighted model in this study omits several potential confounders, the results echo similar recent papers in adult populations providing evidence against the routine or indiscriminate use of sodium bicarbonate for cardiac arrest. One limitation is that sodium bicarbonate use was more common in medical and surgical cardiac patients than non-cardiac patients, as well as with children with higher PRISM and VIS scores which could contribute to the poorer outcomes seen. Intra-arrest lab values such as pH were not analyzed so it is unknown how sodium bicarbonate would play a role for severe intra-arrest metabolic acidosis. Also, the time to first sodium bicarbonate administration was not analyzed which could pose limitations. Although sodium bicarbonate remains a part of the ACLS and PALS guidelines for cardiac arrest, its utility is not evidence-based per this study as well as per other studies. I will be thoughtful about when I choose to administer sodium bicarbonate during code situations, as this study suggests there might even be harm in doing so.

Prehospital & Disaster Medicine, Critical Care

One and Done Epinephrine in Out-of-Hospital Cardiac Arrest? Outcomes in a Multiagency United States Study

Review by Luke Wohlford, MD, MPH

A pre- and post-intervention study investigating patient outcomes when comparing the existing protocol of epinephrine every 3-5 minutes in non-traumatic cardiac arrest to a 1-time epinephrine dosing protocol. Adults included in this study among 5 North Carolina EMS agencies were assessed for survival to hospital discharge and ROSC pre- and post-implementation. After controlling for patient factors, the single-dose approach demonstrated comparable survival to discharge rates (adjusted odds ratio 0.88, 95% confidence interval 0.77–1.29), but with lower rates of ROSC (adjusted odds ratio 0.58, 95% confidence interval 0.47–0.72). With neurological outcomes as the more patient-centered outcome, an argument can be made about the validity of a 1-time epinephrine dosing protocol.

Critique and Implications for Practice Further work and additional studies may need to be done to further elucidate neurological outcomes among those with survival to hospital discharge, this study demonstrates equipoise with a 1-time epinephrine dosing protocol that may allow higher proportions of time spent on CPR during resuscitations and free up more resources for high-quality cardiac arrest care.

Performance of the Paracetamol-Aminotransferase Multiplication Product in Risk Stratification After Paracetamol (Acetaminophen) Poisoning: A Systematic Review and Meta-Analysis

Review by Mason Jackson, MD

This systematic review and meta-analysis evaluated the acetaminophen cross-product as a marker of hepatotoxicity. The cross product is calculated by multiplying the higher of the aminotransferases (AST or ALT) by the acetaminophen concentration and can be used to determine hepatotoxicity risk in scenarios excluded by the original acetaminophen overdose studies, which primarily looked at single dose, acute and timed overdoses. Target measurements were a lower threshold of 1,500 and upper threshold of 10,000. When used as a diagnostic predictor of hepatotoxicity, and hepatotoxicity in staggered ingestions, and ingestions older than 8 hours, the cross product produced a lower limit OR of 31 to 85 and a higher limit OR of 99 to 367. This demonstrates that the acetaminophen cross product is a strong diagnostic tool that can aid the emergency physician in acute acetaminophen overdose alongside the Rumack-Mathew nomogram, generating profound changes in diagnostic certainty.

Critique and Implications for Practice In patients presenting with staggered overdoses or delayed presentation of an acetaminophen overdose, utilization of the cross product will help decide the need for N-acetyl cysteine in the ED. It serves as a useful marker for intensivists and toxicologists caring for these patients on inpatient services as well.

Medical Education

Communicating Diagnostic Uncertainty at Emergency Department Discharge: A Simulation-Based Mastery Learning Randomized Trial

Review by Hannah Seyller, MD , and Kay Nicole Tipton, DO, MS

This multi-center randomized control trial examined the ability of resident physicians to communicate diagnostic uncertainty through simulated patient encounters. Though many patients leave the ED without a formal diagnosis, residents have little training communicating diagnostic uncertainty to their patients.

In this trial, 109 residents participated in a simulation-based learning curriculum that included online modules, a mobile learning application, and 3 simulated telehealth practice sessions with a standardized patient. Participants were divided into immediate and delayed intervention groups, which did not receive the intervention curriculum until after the second patient encounter. The primary outcome was each physician’s “mastery” of communicating diagnostic uncertainty after the second encounter based on the Uncertainty Communication Checklist.

Regardless of training site or stage of training, residents in the immediate access group showed an increased mastery compared to the delayed group, who had not yet received the intervention. Two-thirds of participants felt the curriculum increased their communication skills, and 60-65% said they applied skills they learned to their clinical practice. Limitations include unblinded participants and internal development of the objective scoring tool used to determine mastery.

Critique and Implications for Practice Residents are often not properly trained on how to communicate diagnostic uncertainty with patients. This article provides a framework that can be implemented in current or future practice within residencies to improve communication at discharge when the exact cause of patients’ symptoms remains unknown. Although the article did demonstrate a difference between early and late intervention groups within the measurement of the study, it did not show a difference when translated to clinical practice. Further studies will need to be performed to evaluate how this framework and others can affect clinical practice in emergency departments.

Effect of Moderate vs. Mild Therapeutic Hypothermia on Mortality and Neurologic Outcomes in Comatose Survivors of Out-of-Hospital Cardiac Arrest. The CAPITAL CHILL Randomized Clinical Trial

Review by Charles Sanky, MD, MPH

This single-center, double-blinded, stratified, randomized-controlled, clinical superiority trial was the first study to compare hypothermia at 31°C with 34°C in survivors of out-of-hospital cardiac arrest. It sought to determine whether this difference in moderate versus mild hypothermia improved clinical outcomes in comatose survivors of out-of-hospital cardiac arrest. Patients were randomly assigned to temperature management with a target body temperature of 31 °C (n = 193) or 34 °C (n = 196) for a period of 24 hours. Outcomes included all-cause mortality, ICU length of stay, neurological outcome, and adverse effects. This study found no significant difference in the composite of mortality and poor neurological outcome, occurring in 48.4% (31°C group) and 45.4% (34°C group), 95% CI, −7.2% to 13.2%; P = 0.56. However, the 31°C group had a 3-day longer median length of stay in the ICU (10 vs. 7 days; 95% CI -1.2 to 4.1; P=0.004).

Critique and Implications for Practice Numerous studies have suggested that going beyond the targeted temperature management of 32 to 36 degrees, the updated post-cardiac arrest TTM guidelines. Studies have consequently attempted to determine what the optimal temperature might be, including the much larger TTM trial in 2021, which did not find a difference in normothermia versus hypothermia. Still, the impact on ICU length of stay is concerning, possibly reflecting that moderate hypothermia could mask fevers that otherwise would have received treatment. This study may not change my practice yet but is worth considering in the wake of new ACLS guidelines regarding TTM.

Wilderness Medicine

A New Multi-Disciplinary Approach Supported by Accident and Field Test Data to Optimize Survival Chances in Rescue and First Aid of Avalanche Patients

Review by Chelsea McAuslan, MS4

This retrospective analysis of 1070 full avalanche burials from accident databases and large prospective field test datasets were used to develop evidence-based algorithms exclusively for the avalanche rescue environment. AvaLife provides a holistic and tailor-made tool for avalanche first aid with its consideration of adapted sequence of actions, inclusion of rescue tactical considerations, advice for cases with multiple burials where there is a shortage of resources, considerations of using recovered subjects as a resource in the ongoing rescue, the adapted definition of “injuries incompatible with life,” reasoning behind the importance of rescue breaths, and the updated BLS iCPR algorithm.

Critique and Implications for Practice This study highlights the method AvaLife in the rescue and treatment of patients trapped from the effects of an avalanche. It provides ALS and BLS providers with the methods of triage to allow for the best chances of survival for patients who undergo entrapment. The principle of the “greatest good for the greatest number” is shown crucial in these cases of situational resource shortage. Rescuers must analyze the environment, take into consideration the forces that could prolong excavation, and proceed with appropriate survival techniques according to AvaLife Protocol in patients with injuries resulting from avalanche and burial.

Admin & Operations

The use of the word "quiet" in the emergency department is not associated with patient volume: A randomized controlled trial

Review by David Gordon, MS3

This randomized control trial evaluates if hearing the word “quiet” bears any change in patient volume and perception of the business of an ED shift. In this trial, 506 staff surveys were collected over a sample of 47 shifts. For each, a researcher approached staff members with a greeting. If the day were randomized to the intervention, the researcher asked, “Has it been quiet in here?” Three hours later, the researcher returned to the staff member to administer the survey, which assessed crowdedness of ED, feelings toward patient volume entering ED, and the belief that the word quiet affects business of the day. There was no association between the word “quiet” and increased patient volumes. However, staff members who perceived that the word “quiet” influenced patient volumes reported a perception of a more crowded ED with more patients after hearing the word “quiet.” Some staff members provided qualitative responses that shifts had “worsened” following hearing the word “quiet,” citing acutely ill patient cases they were managing.

Critique and Implications for Practice Throughout an ED shift, someone might approach an ED staff member and ask if the day is a “quiet” day. ED providers care for patients as they enter the department, but the word “quiet” does not influence patient volume. Though this study was conducted at a single site, the methodology of the study provides a robust analysis to address a common concern among emergency department staff. Staff members who feel as though there is an increase in ED volume and business following hearing the word “quiet” likely have a preconceived belief that this is true. A staff member’s initial preconceived notions of factors that trigger business within the ED may contribute to their perceptions of the ED shift. Generalizing on the study’s results, if staff adopts a mindset that the word “quiet” does not affect patient volumes, they may perceive decreased business over the course of the shift.

Any papers we missed? Let the EMRA Research Committee know a nd we can discuss it at an upcoming journal club!

This list was compiled and edited by EMRA Research Committee members Charles Sanky, MD, MPH; David Gordon, MS3; Kristina Pagano, MS3; and Nathan Roberts, MD, PhD.

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Emergency medicine: past, present, and future challenges

Wei, Shujian a,b,c,d,e,∗

a Department of Emergency Medicine and Chest Pain Center, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China

b Clinical Research Center for Emergency and Critical Care Medicine of Shandong Province, Institute of Emergency and Critical Care Medicine of Shandong University, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China

c Key Laboratory of Emergency and Critical Care Medicine of Shandong Province, Key Laboratory of Cardiopulmonary-Cerebral Resuscitation Research of Shandong Province, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China

d Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese Ministry of Health and Chinese Academy of Medical Sciences, State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China

e Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China.

∗Corresponding author. Address: Department of Emergency Medicine and Chest Pain Center, Qilu Hospital, Cheeloo College of Medicine, Shandong University, No. 107, Wenhuaxi Road, Jinan, Shandong, 250012, China. E-mail address: [email protected] (S. Wei).

How to cite this article: Wei S. Emergency medicine: past, present, and future challenges. Emerg Crit Care Med. 2021;1:49–52. doi: 10.1097/EC9.0000000000000017

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0

Origin and history of emergency medicine

The term “emergency,” first used in the 1630s, is derived from the Latin word emergere , meaning unforeseen events that require immediate attention. The term “emergency medicine” can be traced to the French Revolution (1789–1799). In 1792, Dominique Jean Larrey, a military medical surgeon, gained a position in the Army of the Rhine and left for Strasbourg, where he witnessed great mobility of the horse artillery and then suggested that General Adam Philippe de Custine have the medical staff use this method to speed up transport of the wounded. The general approved Larrey's proposal. Larrey's “ambulance” was a simple carriage, despite the exposure to enemy fire. In 1797, during the first Italian campaign, Larrey created a complete rescue system with an active medical team in the battlefield. In contrast to previous rescue methods, Larrey transported critically wounded patients to the rescue station and operated on them as soon as possible, instead of delaying the operation after the battle. The timely rescue system created by him enabled every wounded soldier to be treated within 24 hours, which significantly reduced the mortality rate. Therefore, Larrey has often been referred to as “the father of emergency medical services.” [1]

Medicine, as a professional field, dates back to the early 19th century, while emergency medicine can only be traced back to 50 years ago, making it the most recently developed major field in medicine. Before the 1960s, staff in hospital emergency departments usually worked in rotation with family doctors, general surgeons, physicians, and other specialists. In many small emergency departments, nurses conducted the triage of patients, and specialty doctors were called in based on the type of injury or disease. Many pioneers of emergency medicine were family doctors and other specialists, who believed that extra training in first aid was necessary. A group of doctors left their professional positions and devoted themselves to education. In 1952, Maurice Ellis was appointed as the first “first aid consultant” at Leeds General Infirmary in England. In 1967, the Casualty Surgeons Association was founded, with Maurice Ellis as its president. [2,3] In 1961, in the United States, Dr James DeWitt Mills, along with 4 assistant physicians, established 24/7 emergency care at Alexandria Hospital in Alexandria, Virginia; it was later known as the Alexandria Plan. [4] In 1970, the University of Cincinnati launched the first emergency resident physician program in the world. In 1971, the University of Southern California became the first American medical school to establish a department of emergency medicine. [5] History was made in 1979, when the American Board of Medical Specialties voted to make emergency medicine a recognized medical specialty in the United States. [5]

In China, emergency medicine started relatively late. The Ministry of Health issued “Suggestions on Strengthening First Aid Work in the City” and “On the Release of the Construction Plan of Hospital Emergency Departments (Trial)” on October 30, 1980 and June 11, 1984, respectively. These 2 documents stipulated the work direction, scope, and tasks of the emergency department; thereby, laying the foundation for the construction of emergency departments in China. In 1985, Peking Union Medical College Hospital established the first postgraduate program in emergency medicine. [6–8]

Current state of emergency medicine

Emergency medicine mainly involves the rapid assessment, treatment, and triage of critically ill patients, and has transformed from the emergency room to the emergency department or emergency center. Hospitals typically set up a relatively complete emergency medical system of “out-of-hospital emergency medical services, in-hospital emergency medical services, and critical care.” Numerous emergency diagnostic and treatment technologies, such as cardiopulmonary resuscitation, emergency percutaneous coronary intervention, continuous renal replacement therapy, left ventricular assistive devices, and extracorporeal membrane oxygenation, are applied in emergency medicine. Moreover, a growing number of qualified physicians have devoted themselves to emergency medicine, and several academic platforms have been established, which facilitate knowledge exchange.

With the continuous reform of the medical system and the comprehensive implementation and promotion of hierarchical diagnostic and treatment systems from medical reform, the development of emergency medicine is confronted with rare opportunities and more challenges. For example, the construction of emergency systems varies across nations and regions. Practitioners in emergency services have the vital task of establishing a complete emergency diagnosis and treatment system to maintain the daily health of the public and to satisfy the emergency demands of major public health events. It is necessary to move the front of first aid forward, carry out multidisciplinary cooperation, treat all types of critically ill patients, deal with public health emergencies, and boost hierarchical diagnosis and treatment work. Amid the rapid growth of modern medicine, advanced technology and innovative drugs continue to emerge. In many cases of emergency work, it is the timely, orderly, and efficient application of these technologies and drugs to the early treatment of critically ill patients that matters. Therefore, “process optimization and early treatment” is an important direction in emergency medicine research.

With the development of a medical discipline, each medical specialty is more characterized, and even some single diseases tend to form specialties. [9] Following the law of medical development, emergency medicine also gives full play to specialty characteristics and the development of subspecialties. [10] For example, in areas with a high incidence of cardiovascular diseases, emergency centers have subspecialty focus areas for cardiovascular diseases, and in rural areas with a common occurrence of acute poisoning, emergency departments of primary hospitals establish a subspecialty for the treatment of acute poisoning. In developing subspecialties, emergency medicine focuses on the advancement of diagnostic and treatment technologies for life-threatening diseases and integration with other subspecialties. The construction of high-quality subspecialties in emergency medicine is conducive to the development of new diagnostic and treatment equipment and technology.

Future of emergency medicine

The coronavirus disease pandemic has brought huge challenges to medical systems, especially emergency medicine. [11] Elevating the capability of early identification, appropriate treatment, and life support for severe or critical patients will always be the core topics of emergency medicine.

Emergency medicine in the future will be characterized by continuous advances in practices, research, technologies, and so forth. In terms of clinical practices, problems such as inefficiency and crowding may arise and cause tension in emergency departments. The development of emergency medicine is still in its primary stage and is extremely uneven between rural and urban areas. The resolution of such issues and optimization of processes in emergency medicine can be realized by implementing an increasing number of equipment configurations, improving the structure of emergency medical personnel, and establishing a closer linkage between out-of-hospital and in-hospital emergency services. In essence, “process optimization and early treatment” manifests as an influential component in the development of emergency medicine. In the optimization of the emergency process, the stability of emergency medical professionals is a valuable resource. Upgrading clinical emergency care competence, including rapid response, effectiveness, and service attitude, and improving the skills of medical professionals in the emergency department are of great importance.

The demands for technology are certain to direct the course of emergency services, as the need for timely diagnosis and treatment of patients continues to grow. Information technology can be used to tap available resources and collect information on patients and disease management to aid emergency staff in real time via telemedicine. Specifically, in the absence of specialists or general practitioners on site, the vital signs of patients and critical information can be wirelessly transmitted to experts who can provide remote guidance that may be critical to saving lives. [12] In addition, remote monitoring also enables hospitals to grasp the condition of patients at the earliest time, formulate emergency plans in advance, and ensure a seamless connection between out-of-hospital emergency and in-hospital treatment. By virtue of networks, the real-time transmission of medical devices that monitor information, ambulances’ positioning information, and video footage from inside and outside ambulances can facilitate remote consultation and guidance. Moreover, the collection, processing, storage, transmission, and sharing of out-of-hospital emergency information can fully enhance treatment efficiency and service quality, thereby optimizing the process and mode of service.

Big data technology can fully explore medical information to aid in the management and decision-making of emergency care. [13] One of the applications of big data in the medical field is the establishment of a cloud platform for emergency and critical care information management. Such a platform would collect the diagnosis-, examination-, and treatment-related information of patients from databases, such as an emergency logbook, a hospital information system, a picture archiving and communication system, a microbial detection and management system, and a pathology information system. Next, the data were classified, cleaned, extracted, and explored in depth using the platform. Based on this information, a teaching management system can be obtained, including a multidisciplinary triage management system, a critical care score and grading management system, and an early warning system for serious emergencies. The application of big data technology in emergency medicine provides medical practitioners with access to various information databases for each individual and possible treatment options, which will greatly improve teaching efficiency and the ability to diagnose and treat related diseases.

Precision medicine is a medical model that fully considers individual differences in the genes, environment, and lifestyle of patients to achieve the most effective treatment and prevention of diseases. The emergency department is the first critical link in the clinical diagnosis and treatment of critical illnesses and infectious diseases, and individualized accurate assessment and prevention of disease susceptibility is a valuable research direction for precision emergency medicine. [14] Acute infectious diseases are among the most common diseases in the emergency department. However, given the complexity of diseases, lag in detection technology, and lack of multidimensional clinical information integration technology, the diagnosis and treatment of common diseases such as community-acquired pneumonia remain stagnant. In addition, the emergence of drug-resistant pathogens and emerging microorganisms poses a challenge to empirical therapy protocols. Identifying pathogenic microorganisms quickly and accurately is critical for initiating individualized treatment plans and is also the core component of precision emergency medicine systems. The ideal method of monitoring the outbreak of drug-resistant pathogenic microorganisms in communities or hospitals is to analyze the genetic ancestry of pathogenic microorganisms through genome technology. One of the essential tasks of emergency medicine is to use clinical information to provide individualized diagnosis and treatment for cases without a clear etiology. To some extent, it is necessary to establish etiological diagnoses through emergency treatment processes. In addition to molecular etiology diagnoses based on pathogenic specimens (eg, throat swabs, sputum, and body fluids), diagnostic techniques based on omics information have also seen rapid advances, which will improve precision emergency treatment services. For the differential diagnosis of emergency and critical care illnesses, precision emergency medicine can enhance diagnostic effectiveness significantly with the help of multidimensional and omics data, thus creating the ideal conditions for individualized diagnosis and treatment.

With the combination of big data and precision medicine, information technology can promote the growth of scientific research and clinical work in emergency medicine, such as sequencing, information construction, data integration, and analysis, and improve the use of big data in emergency medicine. Under these circumstances, it is possible to achieve breakthroughs in the development of targeted drugs for precision therapy, complete the closed-loop service of precision emergency medicine, and establish a disciplinary system for precision emergency medicine in China.

Artificial intelligence can promote the growth of emergency medicine. [15] Equipped with capabilities in prediction, analysis, and response, artificial intelligence systems can aid emergency staff in diagnosis and treatment. When artificial intelligence tools execute instructions, they can learn from big data through image recognition, speech recognition, human–computer interaction, physical sensing, and other means. After finishing examinations quickly, artificial intelligence tools can formulate a relatively accurate diagnosis and individualized medicine. In addition, artificial intelligence can assist in locating potential risks and threats in advance. In some emergency events, artificial intelligence can assess the situation and predict the required medical services. Another example of artificial intelligence is the use of medical robots. Apart from their application during complex surgeries, medical robots can deliver objects to patients in quarantine and help avoid human contact during virus epidemics. In short, the use of artificial intelligence will undoubtedly benefit emergency medicine in the future.

As more countries are improving their emergency medical systems, the global scale of information exchange is empowering international emergency medicine. Promoting the quality of academic exchange among countries is a priority in the development of international emergency medicine. Moreover, the variety and complexity of emergency diseases pose challenges to timely and accurate emergency medical treatment, and require emergency medical staff to possess rich medical knowledge and accurate judgment.

Although the development of emergency medicine is confronted with quite a few challenges, it has entered the era of communication among various schools of thought. This journey provides opportunities to the field of emergency medicine. With the joint efforts and hard work of stakeholders worldwide, emergency medicine will accomplish more historic advancements.

Conflict of interest statement

Shujian Wei is the Executive Editor of Emergency and Critical Care Medicine . The author declares no conflicts of interest.

Author contributions

Shujian Wei wrote the article.

Ethical approval of studies and informed consent

Acknowledgements.

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Resident Research in Emergency Medicine: An Introduction and Primer

James h. paxton.

* Wayne State University, Department of Emergency Medicine, Detroit, Michigan

Anne M. Messman

Nicholas e. harrison, adrienne n. malik.

† Kansas University Medical Center, Department of Emergency Medicine, Kansas City, Kansas

Raina J. Burke

‡ Wheeling Hospital, Department of Emergency Medicine, Wheeling, West Virginia

Phillip D. Levy

Training in research methodology represents an important aspect of emergency medicine (EM) resident education, but best methods for design, implementation, and dissemination of resident research remain elusive. Here we describe recommendations and best practices from the existing literature on EM resident research, including helpful tips on how to best implement a resident research program.

INTRODUCTION

When René Laënnec, a French physician in 1816, failed to adequately percuss the thorax of a young woman with heart disease, he improvised. Laënnec wrote, “I rolled a quire of paper into a sort of cylinder and applied one end of it to the region of the heart and the other to my ear.” 1 After numerous revisions, his invention was revealed to the medical community, and quickly caught on. Within a few years, primitive stethoscopes could be found in medical shops throughout Paris. Had Laënnec stopped with that rolled-up piece of paper, his one-time improvisation would have been lost to the annals of history. Fortunately, he chose to build upon his initial discovery and, crucially, to share his breakthrough with the world. Laënnec’s journey charts an enduring and fundamental trajectory of medical innovation: from observation, through inspiration, refinement and testing, to dissemination.

Development of a research project can be especially daunting to physicians already engaged in an emergency medicine (EM) residency training program. But execution of a research project during residency remains a worthwhile experience, allowing participants to meaningfully contribute to medical knowledge and develop an investigative spirit. 2 Residents participating in research appear to attain greater job satisfaction, 3 and can objectively frame everyday questions and methodically seek answers 3 to problems including (among others) staffing issues, wait times, and communication barriers. 4 – 5

The Accreditation Council for Graduate Medical Education Residency Review Committee for EM recognizes the importance of these efforts, mandating resident completion of a “scholarly project” prior to graduation. Their requirement cites the following as examples of qualifying activities: “…the preparation of a scholarly paper such as a collective review or case report, active participation in a research project or formulation and implementation of an original research project.” 6 These activities should include problem identification, data collection, analysis, and conclusion. 7 Performance and documentation of these projects are vital to the acceptance of a scholarly project, whether a case report, community project, development of medical software, or traditional research project. 7 Recent reports from within the EM community have emphasized the importance of scholarly activity to EM resident education. 8 – 9

Advancing the state of scientific knowledge is not a requirement for success in resident research, but it is a potential benefit of this exercise. It is the responsibility and privilege of those involved in residency administration to facilitate the training of EM resident researchers in the development and execution of research projects that support not only the professional careers of residents but also the advancement of our specialty. 8 – 9

What is Resident Research?

It has been suggested that “resident research” is, “research where a resident has a principal role in the implementation and completion of the project.” 10 We suggest that the resident research experience be defined by the engagement of the resident learner in the research process, focusing upon the educational value of the project rather than the resident’s official role or involvement in the design and execution of the project. Research studies are intended to create new generalizable knowledge that can be applied to other populations and settings. 11 Consequently, we propose that “resident research” be defined as any systematic investigation designed to yield new information that actively engages the resident-learner and facilitates the acquisition of a greater understanding of the scientific method. This is in distinction to quality improvement projects, which seek to apply existing knowledge to improve healthcare outcomes within a local healthcare institution or setting. 12

Setting Realistic Expectations

One purpose of resident research is to expose residents to the methods by which research is conducted, creating “educated consumers” of the medical literature. However, residencies hoping to establish a resident research program de novo must recognize the additional workload that resident research projects impose upon faculty. Mentors should be primarily responsible for guiding and supervising resident research, but should be adequately vetted to ensure that the research experience yields a positive result for all involved. Research directors should provide guidance relating to funding opportunities, deadlines for abstract submission to key research conferences, important institutional and federal regulations, and departmental resources. 13 Departmental leadership should create an environment in which research is actively promoted, providing appropriate funding and protected time for mentors and other research faculty. 13

Getting Started

Clinical experiences, journal club articles, or experiences with different teaching modalities may generate an appropriate resident research topic including relevant clinical or educational questions. 2 , 14 – 15 Additional ideas may come from the resident’s personal interests or experiences.

Learning Research Methodology

Most programs will offer training through didactic presentations, journal clubs or evidence-based literature discussions. However, a focused educational effort specifically targeting research methodologies has been shown to correlate with improved resident skills, knowledge, and research productivity. 16 Nearly one in four EM training programs offers a fixed rotation in research. 5 , 17 A more feasible format for the busy trainee might be the Advanced Research Methodology Evaluation and Design video series available from the Society of Academic Emergency Medicine (SAEM), including “how-to” webinars and podcasts produced by senior researchers. 18

The Research Question

A general research question must be formulated, which will generate a testable hypothesis. 3 , 19 All possible outcomes should be considered, and at least one of them must be worthwhile. 20 The FINER criteria may be used to assess the relative merits of the proposal: 14 – 15 , 21

Can the project be completed within the time allotted using the given resources? Can the proposed investigation enroll enough patients to demonstrate a difference in the proposed outcome measures?

Is the topic engaging enough to be worth the effort?

Is the proposed investigation different enough from what has been done before to add knowledge on the subject?

Does the proposed investigation respect the morals of the community, the patient, and the profession?

Are the results likely to be applicable to many patients? Will the results be useful and contribute to the greater good?

Formulating a Hypothesis

A suitably refined and meaningful research question will help in generating a hypothesis, providing a clear delineation of what the investigation will attempt to prove. Investigation of a well-designed hypothesis will be interesting even if a negative result is found.

A mentor experienced in the resident’s area of research interest can be an invaluable resource by offering hints at project scope, helping with setbacks, and tailoring the learning experience to the resident’s needs. 22 Most often, the mentor is an established researcher within the department but could include a specialist in another field, or even a non-physician investigator. 5 , 23 – 24 Goals and expectations should be discussed early on, to avoid frustration for both parties. 5 Terregino has shown that, in general, EM residents are relatively unfamiliar with what resources are available to them, which can lead to significant amounts of time wasted. 25 Most hospitals provide research support that is invisible to the outside observer, including project coordinators, departmental research directors, and biostatisticians. 25 The mentor should be aware of all available institutional resources.

The Literature Search

A valid research project must be informed by past work. Most literature reviews will begin with a search of PubMed.gov , the database of the National Library of Medicine, or OVID.org , which includes textbooks as well as journals. 26 Search terms used must be carefully selected, and the proper Boolean operators assigned. One study has shown physicians to be especially inept at crafting effective search strings. 27 Any doubts about the literature search process or its results should be referred to a librarian.

Each paper identified from the literature review should be thoroughly read. Investigators should avoid citing abstracts alone, as they are often incomplete in their data presentation. This process is labor-intensive but necessary to form a strong foundation for the research project. All references cited within each article should be assessed for relevance. The selected literature should be reviewed to better understand the subject matter and to develop context for the proposed work. If adequate data from existing sources are uncovered, one may consider a retrospective evaluation of prior results including a meta-analysis. 2 , 28 – 29

Research Design

The novice researcher should look to the existing medical literature for guidance in how to properly design a new study. Selection of the proper research methodology will depend upon multiple factors, including the research question, hypothesis, and predetermined outcome measures. A timeline should be implemented to ensure that all tasks are achievable within the allotted time. Resident physicians should develop a team approach, incorporating input from the faulty mentor as well as a staff epidemiologist or biostatistician. The required sample size will depend upon a variety of factors, including the acceptable level of significance, power of the study, expected effect size, underlying event rate in the population, and standard deviation in the population. 30 – 31 Efforts should be made to collect an inclusive and truly random sampling, to avoid convenience selection bias. 32 Early consultation with the biostatistician will also inform the researcher’s decisions on the most appropriate methods for the statistical analysis of data derived from the study. For further information about study design specifics, the reader is referred to several existing publications. 2 , 4 , 13 , 33 – 34

The Institutional Review Board

Any research project that involves human participants or their data requires submission to the local institutional review board (IRB). Research protocols submitted to the IRB can fall into one of three categories: full submission; expedited; or exempt. Research involving greater than minimal risk to human subjects will require a thorough review by the IRB and development of an informed consent document. Prospective projects involving only minimal risk may be approved via the expedited process, where a single reviewer may approve the work in lieu of the convened board. Studies that include only retrospective data from the electronic health record may be exempt from IRB review, but this determination should be made by the IRB, rather than by the investigator. Investigators should confer with their local IRB to confirm what level of IRB review is required before beginning data collection.

Conducting the Study

After the research protocol has been IRB-approved or exempted, data collection can commence. Prior development of a data collection tool will greatly enhance the efficiency of this process, facilitating both IRB approval and the subsequent data analysis. Subject enrollment can also be improved with use of a trained research assistant. This problem may be circumvented through creation of an “academic associate program,” which integrates EM research with undergraduate education. 35

Research Funding

Resident research projects usually require little external funding. On occasion, additional costs may be incurred to help pay for statistical analysis, or the purchase of required equipment. 36 Internal sources, as well as the Emergency Medicine Foundation 37 and the SAEM Foundation 38 represent potential sources for funding.

Presentation and Publication

Once the data have been collected and analyzed, the researcher should consider how the results will be disseminated. The annual meeting of SAEM, the Research Forum at the American College of Emergency Physicians’ annual scientific assembly, and the Annual Assembly of the Council of Residency Directors in Emergency Medicine (CORD) represent the premier locales for presentation of EM research. 39

Ideally, the resident research experience should lead to a manuscript, although the lack of immediate publication must not be interpreted as failure. Only 40% of EM abstracts go on to become full article publications. 15 , 40 Most manuscripts are published 1–2 years after initial presentation. 17 Appropriate journal selection for submission enhances the likelihood of success, as does a thorough understanding of manuscript preparation techniques and review criteria. 41 – 43

While any research resultant from a resident’s scholarly project is unlikely to have the impact of Laënnec’s stethoscope, EM residents may still gain much from engaging in clinical research. For some, it will light an investigative fire that will burn for an entire career. At the least, resident research projects can provide an opportunity to explore issues central to the practice of EM, helping the resident to become a more well-rounded physician.

Section Editor: Whitney Johnson, MS, MD

Full text available through open access at http://escholarship.org/uc/uciem_westjem

Conflicts of Interest : By the West JEM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias. No author has professional or financial relationships with any companies that are relevant to this study. There are no conflicts of interest or sources of funding to declare.

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• Volume 19, Issue 3
• Clinical research in emergency medicine: putting it together
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• A M T Good 1 ,
• P Driscoll 2
• 1 Accident and Emergency Department, Royal Liverpool University Hospital, Liverpool, UK
• 2 Accident and Emergency Department, Hope Hospital, Salford, UK
• Correspondence to:
 Dr A M T Good, Accident and Emergency Department, Royal Liverpool University Hospital, Prescot Street, Liverpool L7 8XP, UK;
 Anthony.Good{at}rlbuh-tr.nwest.nhs.uk

The difficulties in conducting good clinical research in emergency medicine can be overcome. This article will begin by identifying the main difficulties faced by the emergency medicine researcher. It will then discuss some solutions through the development and application of the research protocol. Finally, recommendations will be made with regard to writing for publication.

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The top 100 cited articles published in emergency medicine journals

Affiliations.

• 1 Division of Emergency Radiology, Department of Radiology and Imaging Sciences, Emory University Hospital, Atlanta, GA; Department of Emergency Medicine, Hospital General de la Plaza de Salud, Santo Domingo, Dominican Republic. Electronic address: [email protected].
• 2 Department of Clinical Epidemiology and Public Health, Universidad Autónoma de Santo Domingo, Santo Domingo, Dominican Republic.
• 3 Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan.
• 4 Department of Emergency Medicine, Hospital General de la Plaza de Salud, Santo Domingo, Dominican Republic.
• 5 Department of Emergency Medicine, New York Methodist Hospital, Brooklyn, NY.
• PMID: 25979301
• DOI: 10.1016/j.ajem.2015.04.047

Introduction: Our objective was to identify trends and examine the characteristics of the top 100 cited articles in emergency medicine (EM) journals.

Methods: Scopus Library database was queried to determine the citations of the top 100 EM articles. A second database (Google Scholar) was used to gather the following information: number of authors, publication year, journal name, impact factor, country of origin, and article type (original article, review article, conference paper, or editorial). The top 100 cited articles were selected and analyzed by 2 independent investigators.

Results: We identified 100 top-cited articles published in 6 EM journals, led by Annals of Emergency Medicine (65) and American Journal of Emergency Medicine (15). All top-cited articles were published between 1980 and 2009. The common areas of study were categorized as cardiovascular medicine, emergency department administration, toxicology, pain medicine, pediatrics, traumatology, and resuscitation. A statistically significant association was found between the journal impact factor and the number of top 100 cited articles (P < .005).

Conclusion: The top-cited articles published in EM journals help us recognize the quality of the works, discoveries, and trends steering EM. Our analysis provides an insight to the prevalent areas of study being cited within our field of practice.

Copyright © 2015 Elsevier Inc. All rights reserved.

PubMed Disclaimer

• Am J Emerg Med. 2015 Dec;33(12):1837-8
• Top cited articles and journal impact factors. Lee CH. Lee CH. Am J Emerg Med. 2015 Dec;33(12):1837. doi: 10.1016/j.ajem.2015.09.023. Epub 2015 Sep 21. Am J Emerg Med. 2015. PMID: 26458535 No abstract available.
• The author replies. Shuaib W. Shuaib W. Am J Emerg Med. 2015 Dec;33(12):1837-8. Am J Emerg Med. 2015. PMID: 27010044 No abstract available.

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• A Bibliometric Analysis of the Top 100 Cited Papers in Retinal Detachment. Asahi MG, Pakhchanian H, Doepker C, Raiker R, Gallemore RP. Asahi MG, et al. J Vitreoretin Dis. 2021 May 18;5(6):467-478. doi: 10.1177/24741264211007378. eCollection 2021 Nov-Dec. J Vitreoretin Dis. 2021. PMID: 37007181 Free PMC article.
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• Global trends of dalbavancin: A bibliometric analysis. Monteagudo-Martínez N, Solís García Del Pozo J, Ikuta I, Galindo MF, Jordán J. Monteagudo-Martínez N, et al. J Clin Pharm Ther. 2022 Sep;47(9):1299-1311. doi: 10.1111/jcpt.13719. Epub 2022 Jun 23. J Clin Pharm Ther. 2022. PMID: 35735062 Free PMC article. Review.
• The latest research trends in primary biliary cholangitis: a bibliometric analysis. Zhao Y, Yin Z, Du H, Huang K, Zhang F, Chen H. Zhao Y, et al. Clin Exp Med. 2023 Jun;23(2):347-355. doi: 10.1007/s10238-022-00825-0. Epub 2022 Apr 7. Clin Exp Med. 2023. PMID: 35389157
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Research Priorities

• Research Strategy
• James Lind Alliance

RCEM Research Strategy 2020

Top research priorities in emergency medicine.

RCEM, in partnership with the James Lind Alliance (JLA), has conducted a Research Priority Setting Partnership with the aim of including patients, carers and clinicians in a process to establish the top research priorities in emergency medicine.

James Lind Alliance Emergency Medicine Priority Setting Partnership Refresh 2022

We’re excited to share that after the success of the original PSP, the Royal College of Emergency Medicine have recently completed a refresh of the Emergency Medicine research priorities for the next five years. This will ensure that priorities are current and representative of today’s patients, carers, and clinicians. The new top 10 research priorities in Emergency Medicine can be found below.

In January 2017 the  JLA Emergency Medicine Priority Setting Partnership  (EM PSP) published its first list of research priorities, providing guidance on the research, learning and development in the field of emergency medicine. Since then, our world and the landscape of emergency medicine have changed significantly, and some of the original priorities have been addressed through  funded research studies .

Emergency Medicine is a broad, dynamic subject area and includes a variety of different medical areas such as acute medical emergencies, minor illness and injury, major trauma, acute mental health problems and the management of elderly patients with complex co-morbidities and social problems (not to mention the current challenges posed by COVID-19). Defining research priorities for such a diverse speciality and large potential patient base is a significant but rewarding challenge, driving innovation in the field. What’s more the EM PSP refresh will help to connect researchers and funders with real world experience.

The process involved research questions being collected, screened and added to a long list in survey format so that individuals that wished to take part in the survey were able to rank each of the research questions. The survey was open over summer of 2022 and closed in early September. The results of the survey allowed us to develop a short-list of the top 26 ranked research questions which were brought to the final workshop at the end of September.

The aim of the workshop was to review and agree the top 10 questions for research into Emergency Medicine. This will help researchers focus on finding answers to questions which will make the most difference to people who need to use an Emergency Medicine Department, and to those who work there. Workshop participants included individuals with lived experience, and health and care professionals who work within this area. Participants discussed in small and larger groups the short-list of 26 questions and decided together about which 10 research questions that they believed should be prioritised.

The James Lind Alliance (JLA) is a not-for-profit organisation, working to bring patients, carers and clinicians together in Priority Setting Partnerships (PSP) to identify and prioritise the  Top 10 unanswered questions  or evidence uncertainties that they agree are the most important.

This was our second time around collaborating with the JLA, and we were delighted to be partnering with them again.

You can find out more about the JLA  here , and you can find the EM PSP  here .

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The Glass Ceiling—Racial Disparities Among Emergency Medicine Chief Residents

• 1 Harvard Medical School, Boston, Massachusetts
• 2 Stanford University School of Medicine, Stanford, California
• Original Investigation Race and Sex Disparities Among Emergency Medicine Chief Residents Jennifer W. Tsai, MD, MEd; Mytien Nguyen, MS; Sarah N. Dudgeon, MPH; William McDade, MD, PhD; Jung G. Kim, PhD, MPH; Pooja Agrawal, MD, MPH; Dowin Boatright, MD, MBA, MHS JAMA Network Open

The role of a chief resident extends beyond a mere title; it is a gateway to opportunities and a stepping stone to leadership roles in both academic and community emergency medicine (EM) settings. Within the department, a chief resident signals to faculty and trainees that the title-bearer is clinically excellent, organized, thorough, and well-respected. It is often considered an unspoken metric for fellowship trainee positions, medical directorships, and other leadership-oriented roles. Although this title denotes increased academic responsibilities, it is also tethered to social capital capable of launching a successful career in EM.

However, this coveted position may not be equally accessible to all. Data from Tsai et al 1 suggest that women underrepresented in medicine (URIM; a category that included residents identified as Black, Hispanic, American Indian or Alaskan Native, and Native Hawaiian or Other Pacific Islander) were least likely to be selected for chief promotion, and 50% as likely to be selected for chief resident compared with White men. This is corroborated by other studies demonstrating that URIM physicians, particularly Black women, are less likely to occupy executive leadership roles (commonly referred to as the “c-suite”) or departmental leadership roles (ie, department chair, vice chair, program director). 2 , 3 This disparity systematically distances URIM physicians from career trajectories that could lead to significant social and economic capital.

Some consider facets such as individual popularity, likability, and on-shift performance to be driving forces in the selection process for chief residents. Although the selection criteria are thought to be objective, there is an inherent subjectivity to nomination, ranking, and voting. This perception may provide insight into the true state of department and residency culture in the US. Furthermore, it raises the question: Are the requirements for becoming a chief intrinsically and structurally biased? If so, this could suggest that the standards and requirements for these roles may need to be reevaluated to ensure fairness and inclusivity.

Chief residents have line of sight to both residency and departmental operations. As a function of proximity and open communication, chiefs can build close relationships with faculty and administration during this formative year. Under their tutelage, significant growth occurs and produces enduring mentorship and sponsorship threads; this serves as an inflection point in career trajectory. The overlay of mentorship and sponsorship, or the lack thereof, can widen the opportunity gap in professional development.

The downstream implications of this disparity in representation are profound. Some programs select their fellows from the pool of chief residents, and some groups and departments only hire chief residents. The skill set development that chief residents undergo is attractive to employers and directly translates into administrative and leadership roles in EM. Thus, the lack of URIM physicians in these roles can limit their career advancement opportunities.

One counterargument has been the floor effect; in other words, the selection pool of URIM residents is inherently low, which contributes to the scarcity of URIM chief residents. However, the recruitment of URIM physicians partly hinges on representation at leadership levels; among those ranks are chief residents. Fewer URIM chiefs can translate to fewer persons with voting privileges advocating on behalf of URIM applicants. For active URIM residents, it reinforces the notion of a glass ceiling—that is, a systemic barrier of access to leadership roles within medicine and health care.

As health care has pivoted toward precision medicine, monitoring outcomes, and cost-savings models, value has been placed on leadership that can influence these factors. And although not explicitly stated, chief residents are in this leadership pipeline—which makes the selection process even more critical. To date, there are no studies that link the presence (or absence) of URIM chiefs to health outcomes. However, for the most vulnerable populations concordance literature does reflect improved clinical outcomes, greater adherence, reduced utilization, and lower health care expenditures (all metrics of interest) when clinicians come from URIM backgrounds. 4 Despite the seemingly natural alignment in goals, a dearth of URIM chiefs exists, as evidenced by this study.

Tsai et al 1 underscores the value of continued implicit bias and microaggression training. It also highlights a significant area of ignorance in the recruitment, advancement, and sponsorship of URIM physicians in leadership roles within the EM workforce. Furthermore, it indirectly elevates a dialogue about the connection between leadership and equitable health outcomes. These dynamics impact health outcomes for diverse patients and represent a branching point where intervention can be targeted. 5

Association of American Medical Colleges and American Medical Association both support diversity, equity, and inclusion (DEI) in medicine; American College of Emergency Physicians, American Academy of Emergency Medicine, Society for Academic Emergency Medicine, and Emergency Medicine Residents’ Association all support DEI within emergency medicine. 5 , 6 Unfortunately, there is also an overarching, concerted effort to dismantle DEI initiatives. Some irony lies in the fact that many of the targets have been Black women newly hired in leadership roles, despite its benefit being skewed toward White women. 7 This article provides additional evidence for why these efforts are both necessary and urgent.

The underrepresentation of URIM physicians in leadership roles, such as chief residents, is a pressing issue that needs to be addressed. It is crucial for the medical community to recognize this disparity and take proactive steps to ensure equal opportunities for all, regardless of their race, ethnicity, and gender. This will not only enrich the diversity of leadership in emergency medicine but also enhance the quality of patient care and health outcomes.

Published: September 24, 2024. doi:10.1001/jamanetworkopen.2024.32606

Open Access: This is an open access article distributed under the terms of the CC-BY License . © 2024 Landry AM et al. JAMA Network Open .

Corresponding Author: Alden M. Landry, MD, MPH, DICP, 164 Longwood Ave, 2nd Floor, Boston, MA 02215 ( [email protected] ).

Conflict of Interest Disclosures: Dr Brown reported receiving consulting fees from GSK outside the submitted work. No other disclosures were reported.

See More About

Landry AM , Brown I. The Glass Ceiling—Racial Disparities Among Emergency Medicine Chief Residents. JAMA Netw Open. 2024;7(9):e2432606. doi:10.1001/jamanetworkopen.2024.32606

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Department of Emergency Medicine’s Annual Research Showcase 2024 Recap

On Thursday, September 12, 2024, the Department of Emergency Medicine held its annual Research Showcase in the Trent Semans Center for Health Equity’s Great Hall. Given the new accommodations for the event, this year the planners wanted to show a broad perspective on how the faculty and students participate in the department’s research mission. And it did not disappoint. 

The attendees were welcomed with coffee and a continental breakfast before Dr. Alexander Limkakeng , Vice Chair of Research, took the stage at 8 a.m. His introduction to this year’s event encapsulated both Duke’s Centennial through a generational look at academia and research in the field of Emergency Medicine and the future of the field through inspiration.

Dr. Limkakeng also introduced our hosts for the event, the current Chief Residents: Amna Nawaz, Carmen Estrada Huerta, and Sekar Novika. Dr. Novika, in turn, introduced this year’s Keynote Speaker, Theodore “Ted” Corbin, MD .

Dr. Corbin, Professor and Chairperson of the Department of Emergency Medicine at Rush University Medical Center in Chicago, presented our audience an overview of his work in solving violence in under-served youth through trauma-informed, hospital-based interventions. In his presentation, "Viewing Violence through the Lens of Trauma and Healing," Dr. Corbin touched on topics ranging from the applied tools he has found beneficial in helping young victims of interpersonal injury, to discussing his behavioral health services program. He also touched on how research, in using different methodologies, can inform new research approaches which, in turn, can inform policy change too. 

Dr. Corbin set the stage for the wide-ranging, community-focused and emergency medicine field-focused research presented throughout the rest of the event.

Throughout the program of interlaced podium research and abstract presentations, those assembled learned of studies ranging from underwater hyperbaric research to medicines in space, and everything in between. One special video highlighted a GEMINI Center collaborator, Dr. Abiola Fasina , and her research entitled "Three Delays Model in Sepsis Care in Lagos, Nigeria."

Two breaks in our program schedule, centered around abstract posters on bulletin boards displayed around the Great Hall, gave attendees a chance to talk directly to project investigators (PIs) and their research. 

The event closed with comments from Dr. Charles Gerardo , Professor and Chair of Duke University Department of Emergency Medicine. He reviewed the far-reaching research our faculty and students engage in and how this research touches communities far beyond Durham, North Carolina. The event adjourned with prepared lunches for the participants.

We invite you to view the 2024 Research Showcase with our on-demand stream .

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Period poverty research finds 1 in 3 teens lack access to menstruation products

by American Academy of Pediatrics

One in three adolescents who have visited a pediatric emergency department report difficulties in accessing menstruation products, according to research presented during the American Academy of Pediatrics 2024 National Conference & Exhibition at the Orange County Convention Center from Sept. 27–Oct. 1.

Staff Scientist Meleah Boyle, Ph.D. MPH, co-senior author of the study, said addressing period poverty, as the issue has been called, is a growing area of research in the United States

"Our study highlights the widespread nature of period poverty and the need for broad actions—both locally and nationally—to increase the affordability and accessibility of these products for youth," Boyle said.

Menstrual equity means that every person who menstruates should have equal access to affordable and quality menstrual products. Unfortunately, many people do not have access to these necessary products. In the study, researchers found that 30% of adolescents do not have the products they need with no differences based on measures of socioeconomic status, such as insurance and community opportunity, or individual differences , such as race and ethnicity.

Prior research estimates that of those who menstruate, 11.9 million struggle to find access to menstrual products. This lack of access can lead to absences from school and/or work as well as negative health outcomes such as urinary tract infections and bacterial vaginosis.

Boyle said the research highlights the need for public health programs and policy changes to ensure youth have access to the products they need to avoid negative impacts on their health and engagement.

"Ensuring access to healthy and appropriate menstrual health products should be a public health priority," Boyle said.

Study co-author Riya Metha is scheduled to present the research from 5:15–6:15 pm ET on Saturday, Sept. 28.

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