In this December issue

Abstract

Although Point of care Ultrasound (POCUS) use is widespread in EDs, there are no standardised training standards. A group of Australasian enthusiasts have produced a statement that encompasses current published and unpublished guidance for creating and maintaining robust POCUS programs in EDs. We publish two papers from the group that describe the processes they followed and the outcomes achieved. Their recommendations have five pillars of Infrastructure, Governance, Administration, Education and Quality. The guidelines are comprehensive and consideration should be given to adopting them as the benchmark for our specialty.

Joana Manton provides us with a fascinating literature review of the phenomenon of ED autoresuscitation. A systematic search of five databases with the keywords ‘autoresuscitation’, ‘cardiac arrest’ and ‘emergency department’ produced 240 papers and 26 cases. These then provided 26 cases of interest. The majority of people who auto-resuscitated did so within ten minutes of being pronounced dead. Eleven survivors were discharged neurologically intact. Only five patients had a bedside echocardiogram before resuscitation was stopped. Underreporting of autoresuscitation is suspected due to fears of blame. Passive monitoring for 10 min after resuscitation stops is recommended. There is need for more data on this phenomenon.

In recent years, the landscape of disasters, conflicts, and terror events has become more frequent and complex. Climate change, armed conflicts, terrorism, disinformation, cyber-attacks, inequality, and pandemics now present significant challenges to humanity. Emergency physicians today are likely to encounter ideologically motivated violent extremism or terrorist actions by radicalized lone actors. Terror medicine, distinct from disaster medicine, addresses the unique and severe injuries caused by terrorist incidents, including explosions, gunshots, and chemical agents. Understanding the broader public health implications of these attacks is crucial for emergency physicians to enhance community safety and resilience. We publish an excellent review that offers a comprehensive approach to understanding terror medicine, defining the concept of “terror,” its significance for emergency physicians, and the known health impacts on patients, healthcare workers, and responders.

Equitable access means that timely, sensitive, and respectful treatment is offered to all people. Adults with disability access ED care more frequently than the general population. However, in Australia and internationally, people with disability experience poorer healthcare access and outcomes than the general population. A team from Macquarie University offers us a systematic review of evaluated strategies implemented to improve care for people with disability in the ED.

Emergency physicians are often required to manage a diverse set of complex challenges; navigating direct patient care, systemic issues and inter-professional interactions. Leadership is well recognised as crucial in optimising both the delivery and the quality of patient care. There is a clear need to gain greater understanding of the reality of EM leadership through exploring doctors' experience and perception of leadership in EM, yet there is a paucity of research focusing on this area. Key areas for future leadership development include situational awareness, emotional intelligence and a fluid approach to leadership styles.

A paper from New South Wales reports on the long term trends in population-based incidence and outcomes of rib fracture hospitalisations. A total of 70 609 cases were analysed. The number of rib fracture hospitalisations increased by 25% between 2015 and 2022. The highest proportion of cases was in the 45–65 years and 65–85 years age groups. On a per population basis, the incidence rate increased by 2 % per annum. After adjusting for age, comorbidity and injury severity, there was no significant trend in 30-day mortality observed between 2015 and 2022.

The focus for discussion in this issue is the future of our specialty in Australasia.

As reported in October, this is the final print issue of the journal. From next year we will publish in a digital format only. In doing so, we will adopt a production and publication practice called Continuous Publication. In simple terms this means that papers are published online as soon as production is finished and allocated automatically to the issue that is open, rather than current practise which is to allocate to a specific future issue. The Early View section will thus become redundant and will vanish from your screen. There are some other technical matters that accompany Continuous Publication but they are of minimal significance to the way the journal is read and accessed online. Readers will also see a new style and format of published manuscripts as well as a new font. Farewell and thank you to the print issue.