Emergency Medicine Australasia最新文献

{"title":"Effect of Optimised Single Role Versus Multirole Physician Response Model on Time to Contact in Patients Requiring Advanced Interventions in Greater Sydney, Australia","authors":"Alan A. Garner,&nbsp;Russell Hoore,&nbsp;Sviatlana Kamarova","doi":"10.1111/1742-6723.70151","DOIUrl":"10.1111/1742-6723.70151","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>This study aimed to compare the timeliness of single role versus multirole physician-staffed prehospital models and construct an optimised capability-based case allocation map for Sydney, Australia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We retrospectively compared response, scene, and total prehospital intervals over an 11-year period. Generalized linear regression models with log function were used to control for confounders. An optimized case allocation map was derived from response time data.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>For the single role service 672 helicopter responses were compared with 289 road and 208 helicopter multirole responses. Multirole patients were typically closer to their base (median 18.2 km vs. 23.4 km, <i>p</i> = 0.004). Response interval was shorter for the single role service (median 18 min vs. 24 min, <i>p</i> &lt; 0.001). Scene and total prehospital intervals were shorter for the single role service (24 min vs. 32 min, <i>p</i> &lt; 0.001 and 70 min vs. 80 min, <i>p</i> &lt; 0.001, respectively). On multivariate analysis, multirole allocation was significantly associated with longer scene intervals (IRR = 1.176, [95% CI 1.133, 1.221], <i>p</i> &lt; 0.001) and longer total prehospital intervals (IRR = 1.402 [95% CI 1.315, 1.495], <i>p</i> &lt; 0.001). The optimised case allocation map indicates multirole road response is faster for a 9 km radius circle eccentrically centred on their base. All other locations are more rapidly served by the single role helicopter model.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>A single role model is associated with a shorter response, scene, and total prehospital intervals compared with a multirole model. Real-world response time data rather than distance can be used to optimise case allocation when response capabilities are not equivalent.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"37 5","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145279180","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Outcomes and Management of Body Stuffing: A Retrospective Review","authors":"Angela L. Chiew,&nbsp;Abbey Tan,&nbsp;Bash Jagarlamudi,&nbsp;Dinuka Dadallage,&nbsp;Betty S. H. Chan,&nbsp;Katherine Z. Isoardi","doi":"10.1111/1742-6723.70146","DOIUrl":"10.1111/1742-6723.70146","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Body stuffing involves hastily ingesting poorly sealed drug packets for concealment. Management varies from no imaging to CT scans and observation for 6–24 h or until packet passage. This study describes the characteristics, management, and outcomes of body stuffers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>A retrospective review was conducted on body stuffers reported to the NSW Poisons Information Centre and South-East Area Toxicology Service (2014–2023). Patients who ingested drugs for concealment were included. Body packers, body pushers, and cases without medical records were excluded. Data were collected from databases and medical records.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 192 patients, 126 met inclusion criteria (85% male, median age 30 years). Median time to presentation was 3.2 h (IQR: 1.7–6.6, <i>n</i> = 84). The median number of packages was one (IQR: 1–3), with balloons being the most common (56%). Concealed substances included opioids (39%) and amphetamines (29%). Thirty-two ingested multiple substances, while 26 denied or had unknown ingestion. Symptoms were present in 61 (48%), commonly sedation (19) or agitation (13). Symptomatic patients mostly concealed sedatives (29) or stimulants (28), while those ingesting tobacco or denying ingestion were usually asymptomatic. Imaging included abdominal X-ray (63) and CT (50). Sensitivity for X-ray and CT was 25% and 52% respectively. No asymptomatic patients developed symptoms during their stay. Twelve re-presented with new symptoms following discharge.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study found that body stuffers concealed various drugs, with opioids and stimulants more likely to cause symptoms. Asymptomatic patients typically had a benign course. Imaging has limited sensitivity; reserving it for those with more high-risk features of exposure seems reasonable.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"37 5","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145279132","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reconsidering Evidence Gaps in Antibiotic Therapy for Acute Pyelonephritis","authors":"Ying Han","doi":"10.1111/1742-6723.70154","DOIUrl":"10.1111/1742-6723.70154","url":null,"abstract":"","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"37 5","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145257611","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editorial—Research in Emergency Medicine: Barriers, Opportunities, and the Road Ahead","authors":"A. Hilbig,&nbsp;E. Andreotti","doi":"10.1111/1742-6723.70149","DOIUrl":"10.1111/1742-6723.70149","url":null,"abstract":"<div>\u0000 \u0000 <p>Research, one of the many non-clinical portfolios available to FACEMs, forms a critical foundation of emergency medicine (EM). Yet the challenges inherent in research can create barriers that limit trainee engagement in a domain with the potential to open diverse and complementary career pathways. This issue of <i>Trainee Focus</i> examines the evolving roles of the departmental research lead and the journal editor, alongside the growing influence of AI in the research process. It also reflects on the ACEM Research Requirement and its role in shaping trainees' critical thinking and application of evidence-based medicine.</p>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"37 5","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145250332","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Measurement of Serum Ammonia in the ED: Lost Opportunities","authors":"Ciselle Meier,&nbsp;Catherine Manolikos,&nbsp;Kharis Burns,&nbsp;Damon A. Bell","doi":"10.1111/1742-6723.70153","DOIUrl":"10.1111/1742-6723.70153","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Serum ammonia concentration is useful to identify adult onset inherited metabolic disorders in patients with encephalopathy, which are currently under-recognised. We investigated the current ammonia requesting practises in an Australian Tertiary Hospital Emergency Department (ED) to determine if hyperammonemia is being considered in adults presenting with non-hepatic encephalopathy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective chart review was performed on all adult patients with a serum ammonia requested from a single tertiary ED over a 12 month period. The indications for ammonia testing, site of collection (ward vs. emergency department) and aetiology of hyperammonemia were recorded. An elevated serum ammonia level was defined as &gt; 60μmol/L.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 597 serum ammonia tests were drawn from 439 patients, of which 177 (29.6%) tests were from patients with known inherited metabolic disorders. Ammonia ordering was higher on the ward (77.5%) than in the ED (22.5%); however, the ED had a higher proportion of orders with a hepatic indication for testing (89.8% vs. 63.4%). There were 666 emergency department presentations for confusion/coma or encephalopathy. Of these patients, 52 (7.8%) had an ammonia measured, 25 (3.8%) from ED. Other indications for ammonia measurement included valproate toxicity, altered mental status, seizures, and atypical neurological symptoms. No new cases of suspected metabolic disease were identified.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Ammonia testing from the ED remains predominantly in the assessment of patients with hepatic disease, which is not a guideline-recommended indication. Serum ammonia concentration is underutilised in cases of encephalopathy of unclear aetiology, potentially leading to missed diagnoses of metabolic disease.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"37 5","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145250364","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ACEM Research Requirement—Is It Worth the Effort or the Money?","authors":"Eva Andreotti","doi":"10.1111/1742-6723.70152","DOIUrl":"10.1111/1742-6723.70152","url":null,"abstract":"<div>\u0000 \u0000 <p>To sit for the Fellowship Clinical Examination, ACEM trainees must complete a research requirement (RR). The RR can be met through coursework modules, original research, or a thesis, though in practice, the coursework pathway dominates. Intended to embed habits of inquiry and critical appraisal, the RR is often experienced as a bureaucratic task, with limited evidence that current approaches translate into lasting changes in clinical behaviour. Structural barriers make original research largely inaccessible, while coursework offers modest impact at significant cost. With AI reshaping both research processes and learning, the College faces important choices: refine or relax authorship rules, develop optional critical appraisal modules, or embed evidence-based medicine skills more directly into workplace practice. Ultimately, the RR must evolve to ensure that trainees not only meet curriculum requirements but also develop the curiosity and capability to apply evidence meaningfully in clinical care.</p>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"37 5","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145250299","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Role of Artificial Intelligence in Enabling Medical Research","authors":"Ryan P. Radecki","doi":"10.1111/1742-6723.70148","DOIUrl":"10.1111/1742-6723.70148","url":null,"abstract":"<div>\u0000 \u0000 <p>Artificial intelligence (AI), specifically technology based on large language models (LLMs), is rapidly emerging as a versatile adjunct in medical research. Applications of LLMs include preparation for research, literature review and citation screening. There is evidence LLMs are capable of performing significant portions of meta-research, such as systematic reviews and meta-analyses. Other applications could include identification of clinical trial participants, aiding in the collection of informed consent, and extraction of information from unstructured clinical text. Rapid improvement in the reliability and capability of LLMs will only increase potential utility.</p>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"37 5","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145231857","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Inhale Relief, Exhale Risk: Breathing Easier With BATURA","authors":"Sierra Beck,&nbsp;Tahnee Dunlop,&nbsp;Bridget Honan,&nbsp;Abhishek Mitra,&nbsp;Muhuntha Sri-Ganeshan,&nbsp;Joseph Ting","doi":"10.1111/1742-6723.70150","DOIUrl":"10.1111/1742-6723.70150","url":null,"abstract":"","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"37 5","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145231914","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring Senior Emergency Physicians' Perspectives on the Inclusion of Clinical Biomarkers in Clinical Decision Rules for CT Head Use in Patients With Suspected Traumatic Brain Injury","authors":"Alice Rogan,&nbsp;Peter Larsen","doi":"10.1111/1742-6723.70144","DOIUrl":"10.1111/1742-6723.70144","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Clinical biomarkers are an objective test with the potential to improve CT head decision pathways by better risk stratifying patients and supporting Emergency department (ED) physician gestalt. Understanding variations in diagnostic approach, risk tolerance and the perceived need to upgrade guidelines and where will help inform further development of novel TBI pathways.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>This study explored senior emergency physician perspectives regarding current clinical pathways and the potential use of clinical biomarkers as a rule-out test for intracranial pathology in head-injured patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>This descriptive qualitative design study uses data from 11 individual senior ED clinician interviews. Thematic analysis was then performed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The three main themes identified were safe practice and clinical decision-making, resources and logistics and challenges of changing practice. While most clinicians reported easy access to CT head scans, most also reported that waiting for CTs was associated with delays. The majority believed that at least some patient groups were over-investigated in this context. Potential benefits of a rule-out biomarker were viewed positively. However, risk tolerance for missed findings was low, ranging from 0.2% to 1%–2%. A strong evidence base demonstrating a biomarker performed with this precision was viewed by most as essential prior to its use.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Senior ED physicians viewed the potential inclusion of biomarkers in CT head guidelines favorably, particularly concerning decision support in low-risk head injuries. However, the lack of expert consensus or strong evidence demonstrating high diagnostic precision in comparable emergency care models limits their introduction.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"37 5","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/1742-6723.70144","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145212003","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What Does a Research Lead Actually Do? Reflections From the Emergency Department Frontline","authors":"Faye Jordan","doi":"10.1111/1742-6723.70143","DOIUrl":"10.1111/1742-6723.70143","url":null,"abstract":"<div>\u0000 \u0000 <p>An active and thriving research programme is critical to the sustainability of an emergency department. It contributes to maintaining a healthy curiosity amongst clinicians and ensures that clinical practices are challenged and calibrated against evidence-based practices. The role of a research lead in emergency medicine extends beyond the research program alone. Recognising the importance of shaping the research culture, mentoring novice researchers across all streams and building research capacity are paramount to the success of a research programme. The research lead must pursue a strategic vision for research which includes strengthening systems and structures that enable researchers, both novice and experienced, across all disciplines to participate in high leverage practice changing research activities, with a view to embedding a research culture into day-to-day clinical practice.</p>\u0000 </div>","PeriodicalId":11604,"journal":{"name":"Emergency Medicine Australasia","volume":"37 5","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145198914","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}