Emergency Medicine Journal最新文献

Background: Recent global events have highlighted an increasing risk of chemical, biological, radiological and nuclear (CBRN) incidents, emphasising the urgent need for enhanced preparedness in the health sector worldwide, especially in low-income countries where burden of exposure is high and limited resources pose significant challenges to effective response. This study aims to develop an assessment tool to evaluate hospital preparedness for CBRN incidents in Lebanon, a low-resource country at high risk for CBRN incidents.

Methods: A two-round modified Delphi method was conducted on 21 January 2025 at the American University of Beirut Medical Center (AUB-MC) involving 11 subject matter experts with various expertise in the CBRN medical and public health fields. The experts used a weblink to vote on the inclusion of tool items, with a predefined consensus at 70% or higher.

Results: Consensus was established for 88 items with the completion of the Delphi study representing 92% of the total number of items. The items were classified into nine essential categories for CBRN preparedness planning that included: facility information, policies and planning, governance, communication (internal/external), training, safety and security, decontamination, pharmaceutical countermeasures, recovery phase and post event management planning. Access to CBRN experts as part of response team, pharmaceutical inventory, gender-related cultural factors particularly in decontamination protocols and preparedness drills emerged as distinctive features within this assessment tool. Parameters concerning special populations and emergency medical services were excluded from the assessment tool.

Conclusion: A comprehensive expert-developed hospital assessment tool for CBRN preparedness was created to enhance CBRN preparedness in resource-limited settings like Lebanon. The standarised tool facilitates the evaluation of Lebanese hospitals' readiness. It also guides policymakers and health authorities in developing targeted policies and strategic interventions to strengthen the health sector's CBRN incidents response capabilities.

Background: Nightclubs, often perceived as safe spaces for entertainment, can nevertheless harbour hidden dangers. Despite their popularity among young adults, the prevalence and characteristics of fatalities associated with nightclub attendance remain unknown. This research aimed to characterise the nature and frequency of nightclub-related deaths in the UK.

Methods: We conducted a retrospective observational study using media reports and coroner verification to identify and characterise nightclub-related deaths in the UK between 2009 and 2024. Nightclub-related deaths encompassed those found deceased inside the venue and those who died within a few hours of attendance, typically on the same night. Articles were screened by hand, and included articles underwent standardised data extraction. Data were corroborated by searching open-source legal proceedings and communicating with the responsible coroner.

Results: There were 89 deaths associated with 75 nightclubs, with a median victim age of 22 years (range 16-54 years) and a rate of 5.9 per annum. Trauma-related injuries 45/89 (51%) and drug-related toxicity 36/89 (40%) were the primary causes. Blunt head injuries 19/45, mostly related to altercations 13/19, and penetrating trauma from knife injuries 17/45 accounted for most trauma deaths. MDMA was named as a cause in almost all drug-related deaths, 34/36 (94%), occurring at a rate of 2.4 per annum. Of the 89 victims, seven were under 18-years-old. Only 25/75 (33%) of the nightclubs with a fatal incident remained open under the same name.

Conclusion: Using open-source media and coroners, this study identified nearly six deaths per year associated with UK nightclubs. Victims are predominantly young adults, with trauma and drug toxicity the leading causes. These findings underscore the need for targeted interventions, including enhanced safety measures and harm reduction strategies, to prevent future tragedies.

Emergency departments (EDs) and NHS ambulance services often serve as the first and only point of contact with healthcare for individuals from deprived communities, marginalised populations and other groups that face inequalities in both access to, and quality of healthcare. These include ethnic minorities, people experiencing homelessness, asylum seekers, sex workers, individuals transitioning from criminal justice settings as well as older adults, children and pregnant women. These populations face disproportionate burdens of disease and systemic barriers to care. Integration of Public Health into Urgent and Emergency Care (UEC) services presents an opportunity to address these challenges.These issues cannot be solved by UEC services alone. EDs and ambulance services, however, are uniquely positioned to identify and address health inequalities by building close relationships with local authorities, primary care, social care and voluntary, community and social enterprises to support preventive efforts, help people before they need to come to ED, reduce repeat attendances and improve patients' experiences and outcomes.Health inequalities cost the NHS billions of pounds each year. Embedding public health in EDs is not just a clinical improvement-it is an economically sound, ethically responsible, equity intervention that addresses the social determinants of health and ensures the most vulnerable receive timely, tailored support.EDs and NHS ambulance services are more than services for time of crisis-they are places of opportunity. By embedding public health principles into emergency care, we can transform emergency care into engines of equity, resilience and prevention. Investing in public health within these settings is not only the right thing to do for patient outcomes and health equity-it is ultimately cost-effective, reducing demand on UEC and improving population health in the long term.

Introduction: While point-of-care (POC) high-sensitivity cardiac troponin (hs-cTn) testing has the potential to reduce emergency department (ED) length of stay (LOS), evidence of real world effectiveness is lacking. Our objective was to examine factors that influence the real world effectiveness of POC hs-cTn-based accelerated diagnostic protocols (ADPs) in reducing ED LOS.

Methods: This is a post hoc analysis from the "Aiming towards evidence-based interpretation of cardiac biomarkers in patients presenting with chest pain using POC testing" (WESTCOR-POC) study which included 1494 consecutive patients with suspected acute coronary syndrome presenting to the ED at a moderately sized hospital in Norway. Patients were randomised to receive hs-cTn measurements at admission and after 1 hour either by POC or central laboratory testing. This post hoc analysis examines factors affecting the effectiveness of a POC-based ADP and predictors of non-ADP-concordant disposition. Both outcomes were assessed using regression models, with significance level set at p<0.05.

Results: Overall, 36.1% of patients met the ADPs' early discharge criteria, of which 66% were discharged. In effect-modification analyses, the effect of POC testing on ED LOS differed by concordance with ADP recommendations (interaction p=0.011), with a reduction among patients with ADP-concordant disposition (-14 min 95% CI -26 to -3), but no corresponding reduction among patients with discordant disposition (13.5 min, 95% CI -4.5 to 31.4). Factors predicting hospital admission despite ADP-recommended discharge were: age >60 years (OR 2.3, 95% CI 1.4 to 3.7, p=0.001), high triage category (OR 1.9, 95% CI 1.2 to 3.0, p=0.003) and suspected serious differential diagnosis (OR 5.9, 95% 3.5 to 9.9, p<0.001).

Conclusion: Our findings highlight the need for implementation strategies that support ADP concordant disposition decisions and ensure appropriate patient selection to realise the efficiency potential of POC hs-cTn testing in the ED.

Background: Despite the frequent use of both advanced airway management (AAM) and epinephrine during resuscitation, no studies have evaluated the optimal sequencing of these interventions in paediatric out-of-hospital cardiac arrest (OHCA). We therefore aimed to investigate the association between the sequence of AAM and epinephrine administration and outcomes in paediatric patients with OHCA with non-shockable rhythms.

Methods: This retrospective observational study analysed data from a multicentre OHCA registry in Japan from 2014 to 2022. We included paediatric patients (aged <18 years) with non-shockable OHCA who received AAM (endotracheal intubation or supraglottic airway device placement) and/or epinephrine administration. The primary outcome was 1-month survival, and the secondary outcomes were 1-month favourable neurological outcome (defined as a paediatric cerebral performance category of 1-3) and the return of spontaneous circulation (ROSC). Inverse probability of treatment weighting (IPTW) was applied based on propensity scores to address imbalances in patient characteristics.

Results: Of the 952 paediatric patients with non-shockable OHCA (median age (IQR) 2 (0-14) years), 577 (61%) were male. Of these, 455 and 497 belonged to the AAM-first and epinephrine-first groups, respectively. After IPTW, all covariates were well balanced between the AAM-first and epinephrine-first groups (standardised mean difference ≤0.10). Compared with the epinephrine-first group, the AAM-first group showed similar 1-month survival (adjusted OR (aOR), 1.09; 95% CI 0.61 to 1.86), favourable neurological outcome at 1 month (aOR, 0.79; 95% CI 0.12 to 5.07) and ROSC (aOR, 0.98; 95% CI 0.72 to 1.35).

Conclusions: The sequence of AAM and epinephrine administration was not associated with 1-month survival, favourable neurological outcome at 1 month or ROSC in paediatric patients with non-shockable OHCA.