Emergency Medicine Journal最新文献

Mental health presentations represent a significant proportion of attendances to UK emergency departments, but the experiences of patients presenting with mental health issues are reportedly poor. A new model called EmPATH (Emergency Psychiatric Assessment, Treatment and Healing) has been developed in the USA as a means of providing more patient-centred care to this vulnerable group, to the benefit of both service users and healthcare systems. It has been shown to provide a safe space for those most in need, shorten emergency department stays and reduce inpatient admissions. This paper introduces the EmPATH model, discusses potential challenges to its implementation in the UK setting and proposes that the principles of EmPATH could be combined with novel research to develop UK-specific solutions.

The 'tea trolley training' model is well described and established in hospital medical education, but, to the authors' knowledge, has not previously been used for training in the prehospital environment. We sought to adapt this workplace-based teaching approach to improve intraosseous (IO) knowledge, confidence and morale among ambulance clinicians, without adversely affecting operational performance.A mobile 'tea trolley' containing IO equipment, task trainers and refreshments was taken to two emergency department ambulance bays on separate days. Short teaching sessions were delivered opportunistically to prehospital clinicians by a critical care team. An anonymised QR-code survey captured role, self-reported impact on knowledge, confidence, morale and inter-professional working.62 clinicians responded (including paramedics, emergency care assistants and technicians). Most reported improved IO skills and knowledge (94%, n=58), with the remainder neutral. All respondents felt the format worked well and would attend future sessions. Almost all (98%, 61/62) reported improved morale, and all felt that regular tea trolley training would enhance collaborative working between the ambulance service and local air ambulance. No adverse impact on turnaround times was reported.Adapting tea trolley training to the prehospital setting is feasible, well received and perceived to improve IO competence, morale and collaborative working, without compromising operational resilience.

Background: Hospitals responding to mass casualty incidents (MCIs) must rapidly scale up operations to accommodate high casualty counts, with little lead time. On 17 September 2024, 4000 pager devices were detonated across Lebanon, injuring 2323 individuals. This paper reports on a single-centre MCI response to this unprecedented hybrid warfare tactic, describing success features and identifying areas for improvement.

Methods: A qualitative analysis of 10 debrief meeting minutes held within 2 weeks of the incident, as part of the standard quality improvement process post-MCI response that included an after-action review conducted in accordance with the 2019 WHO guidelines. Group-based debriefs, facilitated by the emergency department (ED) chairperson, addressed different response elements and engaged relevant stakeholders. Conclusions were derived from the qualitative analysis of the meeting minutes.

Results: Our hospital received 182 casualties, 66% of whom were triaged to urgent-level care (yellow), 21% to delayed-level care (green) and 13% to immediate-level care (red), with 35 requiring emergent surgery within the first 12 hours. The MCI response was activated 34 min postincident, initiating security lockdown protocols, expedited patient registration, MCI triage protocol implementation, opening of surge areas and command centre activation. Key success features included: shifting from ED-based response to a whole-hospital mobilisation to accommodate the influx; early secondary triage of urgent-level (yellow) patients for immediate transfer to inpatient wards, resulting in 22.5% being managed in the inpatient setting; and optimised information system workflows for admission and order entry. Recommended improvements include simplifying operating theatre transfer workflows, shifting to paper-based documentation of assessments/interventions, optimising surgical and diagnostic prioritisation processes and developing minimal diagnostic imaging standards of care.

Conclusion: This study highlights key successes and challenges of a hospital response to a large hybrid-warfare MCI. Future research on reliability of key success features, specifically use of ED secondary triage protocols, is needed to support wider adoption. In addition, developing minimal imaging standards in MCIs is needed to reduce bottlenecks in this area.

Acute hyperkalaemia is a potentially life-threatening electrolyte disturbance frequently encountered in emergency departments. Timely recognition and appropriate treatment are critical to prevent serious complications such as cardiac arrhythmias and death. This narrative review summarises current evidence-based and guideline-based recommendations for the emergency management of hyperkalaemia, with a focus on practical challenges and frequently encountered clinical uncertainties. A selective literature search was conducted using PubMed, EMBASE and major international guidelines, emphasising clinical studies performed in emergency departments or acute care settings.Key treatment principles include therapy with intravenous calcium salts, primarily indicated in patients with ECG changes or serum potassium levels ≥6.5 mmol/L. Insulin-glucose therapy remains a cornerstone of transcellular potassium shifting but carries a considerable risk of subsequent hypoglycaemia, particularly in non-diabetic patients with low baseline glucose levels. Inhaled beta-agonists such as salbutamol provide an effective and synergistic potassium-lowering effect and are recommended in combination with insulin. The use of sodium bicarbonate remains uncertain and its indication appears limited to patients with severe comorbid conditions and metabolic acidosis. Diuretics may support potassium elimination in patients with volume overload, although prospective evidence in ED populations is lacking. Sodium polystyrene sulfonate is no longer recommended due to questionable efficacy and risk of gastrointestinal adverse events. Newer potassium binders, including sodium zirconium cyclosilicate and patiromer, show promise in recent studies but require further validation in acute care settings. Haemodialysis remains the definitive option in refractory cases or patients with end-stage renal disease.