In this October issue

Over ten million ED visits occur annually in Australia and Aotearoa New Zealand. Outside basic administrative data focused on time-based targets, there is minimal information about clinical performance, quality of care, patient outcomes, or equity in emergency care. The lack of a timely, accurate or clinically useful data collection is a missed opportunity to improve care. An experienced and senior group of clinicians outline a proposal for a National Acute Care Secure Health Data Environment. In a linked editorial, Anne-Maree Kelly says that such an initiative is welcome but warns big data offer big promises and bring big issues.

A prospective observational study included children aged >2 and < 18 years presenting to any of three EDs in Victoria over an 18 month period who had their height and weight measured. Almost one-third of children were overweight or obese. Obesity was particularly high in those aged 8–14 years and those from lower SES postcodes. The high proportion of children presenting above a healthy weight is an opportunity for EDs to identify and refer children for bodyweight and lifestyle management.

A prospective descriptive study of domestic and family violence presentations to the Royal Darwin Hospital ED in November 2021 highlights the overwhelming need for a 24-h trauma informed, culturally safe, and integrated service to support people experiencing domestic and family violence. This could be achieved by a specialist unit designed and staffed by First Nations health practitioners.

Extracorporeal cardiopulmonary resuscitation (E-CPR) is primarily limited to hospitals. Some centres in the world have implemented prehospital mobile E-CPR in the form of a dedicated cardiac vehicle fitted with specialised equipment and clinicians for the performance of E-CPR on-scene. Evidence of the outcomes and cost-effectiveness of mobile E-CPR is not established. A team from Queensland evaluated the cost-effectiveness of a hypothetical mobile E-CPR vehicle operated by Queensland Ambulance Service. The conclusion is that prehospital E-CPR may be cost-effective. Successful implementation of a prehospital ECPR program needs substantial planning, training, logistics, and operational adjustments.

A survey of the current structure, capability and operational scope of prehospital and retrieval aeromedical teams across Australia concludes that aeromedicine in Australia has many consistent elements, but there is a diversity of operational models.

A team from Queensland assessed the impact of a Virtual Toxicology Service on the average length of stay of poisoned patients. The team concludes that such a service appears to be associated with a decreased average length of stay.

Antivenoms are important medications to be held within Australia, particularly in regional and remote locations. An audit of current antivenom holdings in hospitals and health services in South Australia revealed significant disparity between recommended and actual antivenom holdings across most sites and that ‘real-time’ remote monitoring of State antivenom holdings is not currently feasible. Correction of stock levels to recommended levels may result in financial benefit for State Health whilst also addressing inequity in regional and remote healthcare provision.

The focus in this issue is on FNDs or functional neurological disorders.

We will stop publishing the print edition of the journal after the December 2024 issue, becoming digital only from 2025. The decision has not been taken lightly. Some readers will be disappointed but on balance it is the right thing to do and is consistent with practice elsewhere in the world of academic publishing. It will also reduce the journal's carbon footprint, as mail distribution from our printing base in Singapore will stop, as will the need to transport paper and ink. There will be another benefit, in that the time from acceptance to publication will be reduced. We will also see some changes to the journal's digital appearance, issue content compilation and issue indexing. Farewell to the print edition.