In this June issue

Clinical practice guidelines (CPGs) are important for management of children with sepsis. An excellent audit of childhood sepsis CPGs for Australia and Aotearoa NZ concludes that they are of variable quality and lack consistency with key treatment recommendations. CPGs are concordant with the Australian Commission for Safety and Quality in Healthcare care standard, but not with international sepsis guidelines. A bi-national sepsis CPG will reduce un-necessary variation in care.

A cross-sectional study of patients presenting to Whangarei Hospital ED, using the Hunger Vital Sign screening tool, concludes that food insecurity was prevalent among patients presenting there. Associated factors were Māori ethnicity, household crowding and lower socioeconomic status. There was no statistically significant association between food insecurity and number of comorbidities or the primary reason for ED attendance.

Low acuity presentations (LAPs) contribute to large numbers of ED presentations and carry numerous consequences. A retrospective observational study from Melbourne reports ED presentations among children less than 12 months old (infants) to the Royal Prince Alfred Hospital between 2017–2019. The authors conclude that a substantial number of infant ED presentations are LAPs. Targeted interventions may benefit from focusing on families with a background of socioeconomic disadvantage, social isolation, cultural and linguistic diversity, and perinatal complications.

Patients leave EDs for many reasons and at all stages of care. In Australian law, clinicians and health services owe a duty of care to people presenting to the ED for care, even if they have not yet in a treatment space. There is also a duty to warn patients of material risks associated with their condition, proposed treatment(s), reasonable alternative treatment options and the likely effect of their healthcare decisions, including refusing treatment. This extends to a decision to leave the ED before care is completed.

A single centre retrospective study from Victoria describes the effects of different induction agents on the incidence of post induction hypotension (PIH) and its associated interventions during rapid sequence intubation (RSI) in the ED using propofol, ketamine or fentanyl. The authors report that both propofol and ketamine are significantly associated with PIH after RSI, alongside age and shock index. The PIH is likely multifactorial in nature.

We publish a paper reporting naloxone use in a nationwide sample of Aotearoa New Zealand road EMS patients. It establishes a baseline for future surveillance. There were between 8.0 (in 2018) and 9.0 (in 2020) naloxone administrations per 100 000 population-years, or approximately one administration per day for the whole country of 5 million people.

Initial experience by an Australian neonatal prehospital and retrieval service using videolaryngoscopy concludes that the procedure allows neonatal tracheal intubation with a comparable success rate to direct laryngoscopy in a prehospital and retrieval setting.

The focus in this issue is Disaster Medicine.