BMC Emergency Medicine最新文献

{"title":"Head, face, and neck injury patterns across the life course: a 20-year NEISS analysis of 2,345,287 emergency department visits in the U.S.","authors":"Michael Alfertshofer, Cosima C Hoch, Dirk Nolte, Hans-Günther Machens, Leonard Knoedler, Shady Abu-Sirhan, Siti Rahmayanti, Deise Caldas Kühlman, Jeffrey E Janis, Zachary S Peacock, Steffen Koerdt, Sarina Bucher, Max Heiland, Nicholas Moellhoff, Samuel Knoedler","doi":"10.1186/s12873-026-01821-3","DOIUrl":"https://doi.org/10.1186/s12873-026-01821-3","url":null,"abstract":"<p><strong>Background: </strong>Head, face, and neck injuries impose a substantial burden for emergency departments (ED); the mechanisms driving them across the life course however remain poorly understood at the population level. Large-scale, integrated analysis spanning anatomical regions, injury mechanisms, age groups, settings, and associated products or environmental surfaces offers an opportunity to identify the patterns and vulnerable populations that smaller or shorter-term studies cannot resolve.</p><p><strong>Methods: </strong>We queried National Electronic Injury Surveillance System (NEISS) records from 2006 to 2025 for injuries to the head, face, eyes, mouth, neck, or ears. Demographics, anatomical region, injury setting, associated products or environmental surfaces, and ED disposition were extracted, and a rule-based narrative classifier assigned 1 of 17 injury mechanisms from free-text descriptions. Non-routine ED disposition was defined as admission, transfer, observation, or fatality. Analyses were descriptive and based on unweighted NEISS case records.</p><p><strong>Results: </strong>Among 2,345,287 ED presentations, representing 31.8% of all NEISS-coded visits, the head was most often injured (51.2%), followed by the face (28.2%). Annual volume rose 35.2% (105,727 in 2006 to 142,918 in 2025), driven mainly by head injuries (+ 83.4%). Median age was 14 years and 56.4% of patients were male, but among older adults (≥ 65 years), females predominated (60.6%). Falls were the leading mechanism (53.0% across subcategories). Most patients were treated and discharged (89.4%) and admission rate rose roughly 18-fold from toddlers (1.3%) to older adults (23.3%). Non-routine ED disposition increased with age, and syncope- or medical-related falls had the highest non-routine ED disposition rate (33.9%). The home was the most common injury setting (63.1%). Injury exposures varied by age group, with beds most common in infants, tables in toddlers, sports equipment in children and adolescents, and floors in older adults.</p><p><strong>Conclusions: </strong>Head, face, and neck injuries represent a large and growing share of NEISS-coded ED presentations, with distinct patterns by age, sex, injury mechanism, setting, and clinical outcome. These findings may assist in the planning of targeted prevention strategies and future research on risk stratification for vulnerable age groups and injury mechanisms.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"26 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149227135","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of on-site mobile CT imaging on prehospital patient management during the Munich Oktoberfest: a retrospective observational before-after study at a mass gathering.","authors":"Wilhelm Flatz, Dominik Hinzmann, Philip Kampmann, Leonhard Poehlmann, Paul Reidler, Jenny Schlichtiger, Karl-Georg Kanz, Jeffrey Bazarian, Jens Ricke, Viktoria Bogner-Flatz","doi":"10.1186/s12873-026-01785-4","DOIUrl":"10.1186/s12873-026-01785-4","url":null,"abstract":"<p><strong>Background: </strong>Mass gatherings such as the Munich Oktoberfest increase demand on Emergency Medical Services (EMS), particularly for trauma patients requiring imaging. Suspected mild traumatic brain injury (mTBI) often necessitates hospital referral and diagnostic imaging, placing strain on prehospital and hospital resources.</p><p><strong>Methods: </strong>This retrospective observational before-after study evaluated the impact of an on-site mobile computed tomography (CT) scanner deployed during the Oktoberfest in 2022 and 2023. Patients with suspected head, facial, or cervical spine trauma requiring CT imaging were included. EMS hospital transport data during these events (with mobile CT) were compared with a historical reference period from 2015 to 2019 (without mobile CT) and with matched pre- and post-event periods. Standardized prehospital protocols guided patient assessment and imaging decisions.</p><p><strong>Results: </strong>A total of 498 patients underwent on-site CT imaging. Of these, 429 (86%) were treated on-site and discharged after imaging and clinical evaluation, while 52 (10%) required hospital transport based on CT findings. Additional transports occurred for unrelated medical issues. On-site CT availability prevented 429 EMS transports, corresponding to an estimated 22,737 min of EMS deployment time. Trauma-related hospital admissions during Oktoberfest were lower in 2022-2023 than in 2015-2019, and the relative increase in admissions during the event was reduced.</p><p><strong>Conclusion: </strong>This retrospective analysis of the use of a mobile CT scanner in a prehospital setting during a mass gathering found that its implementation was associated with improved patient triage, fewer hospital transports, and more efficient EMS resource utilization. While the retrospective before-after study design does not permit direct causal inference, on-site imaging may have contributed to more targeted patient management and reduced demand on hospital resources. These findings suggest that mobile CT could represent a useful model for supporting medical services at large-scale public events and warrant further prospective evaluation.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"26 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13644297/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149126812","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early hemodynamic changes after the use of push-dose noradrenaline in patients presenting to the emergency department with septic shock: a descriptive study.","authors":"Atsushi Yamamoto, Tomoyuki Akita, Aya Sugiyama, Sayaka Nakahara, Yuhei Urakami, Soichiro Mae, Tetsunori Ikegami, Junko Tanaka","doi":"10.1186/s12873-026-01773-8","DOIUrl":"https://doi.org/10.1186/s12873-026-01773-8","url":null,"abstract":"<p><strong>Background: </strong>Although continuous noradrenaline infusion (CNI) is standard vasopressor therapy during the initial resuscitation of patients with septic shock, hemodynamic stabilization may not be immediate. Push-dose noradrenaline (PDNA) has been proposed as a temporary measure while CNI is being established. However, its clinical use, dosing, early hemodynamic response, and short-term safety in the emergency department (ED) are not well described.</p><p><strong>Methods: </strong>To address this gap, we conducted a single-center retrospective descriptive study at a tertiary care hospital in Japan in 2019. Adults with Sepsis-3 septic shock who received PDNA in the ED and were admitted to the intensive care unit were included. We assessed the context and dosing of PDNA administration, CNI use, mean arterial pressure (MAP) within 15 min after PDNA administration, and adverse events.</p><p><strong>Results: </strong>Of 91 patients with septic shock, 50 (55%) received PDNA. PDNA was administered at CNI initiation in 25 patients, during CNI dose escalation in 6, and as rescue administration before CNI initiation in 19. The median (interquartile range [IQR]) initial PDNA dose was 20 (20-30) µg. During the 15-minute observation window, 32 (64%) patients received one bolus, 14 (28%) received two, 3 (6%) received three, and 1 (2%) received four. The directly observed median (IQR) MAP was 52 (44-61) mmHg at initial PDNA administration (n = 30) and 62 (50-68) mmHg 1 min later (n = 25). One of 36 patients evaluable for prespecified physiological adverse events experienced an adverse event; however, no serious adverse events were documented.</p><p><strong>Conclusions: </strong>In this single-center retrospective descriptive study, PDNA was most commonly administered at CNI initiation, and administration was followed by an early increase in median MAP. However, the noncomparative design and concurrent resuscitative interventions preclude attribution of this change solely to PDNA administration. No serious adverse events were documented; however, safety assessment was limited owing to missing data and retrospective ascertainment. These findings do not establish the effectiveness or safety of PDNA. Prospective comparative studies with standardized monitoring are required.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"26 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149227061","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ECPR readiness without perfusionist support: a cross-sectional national survey on circuit preparation, team structure, and training.","authors":"Eva Mishuris, Alexander Wallraff, Rüdger Kopp, Jan Larmann, Lasse J Strudthoff, Christian Bleilevens, Patrick Winnersbach","doi":"10.1186/s12873-026-01766-7","DOIUrl":"10.1186/s12873-026-01766-7","url":null,"abstract":"<p><strong>Background: </strong>Extracorporeal cardiopulmonary resuscitation (ECPR) is a time-critical intervention for selected patients with refractory cardiac arrest. Survival depends on minimizing low-flow duration before ECPR initiation. Timely deployment requires organizational preparedness, trained personnel, and rapid extracorporeal membrane oxygenation (ECMO) circuit readiness. However, data on ECPR organization in centers operating without dedicated perfusionist support are limited.</p><p><strong>Methods: </strong>A nationwide cross-sectional online survey was conducted among German ECMO centers operating without perfusionist support. The questionnaire assessed circuit readiness, responsible personnel, training frequency, and the availability of standard operating procedures (SOPs).</p><p><strong>Results: </strong>Responses from 42 centers were evaluated, of which 64% reported performing ECPR (n = 27). Most centers (90%, n = 38) had low annual ECMO volumes (< 50 cases). ECMO use was largely limited to the Cardiohelp and iLA activve/Xenios Console systems. Setup times were significantly shorter for ECPR than for non-ECPR ECMO: median 15 min (IQR 12-18; range 5-30) versus 30 min (IQR 20-40; range 15-105) (Mann-Whitney U = 46, p < 0.0001; Cliff's delta = 0.77; 95% CI 0.54-0.94). Nurses were more frequently involved in ECMO deployment in ECPR than in non-ECPR settings (59% (16/27 centers) vs. 20% (3/15 centers)). Within ECPR programs, regular training was reported more frequently for nurses than for physicians (87.5% (14/16 centers) vs. 60% (6/10 centers)). Overall, 76% (n = 32) of centers reported regular training (at least annually) for responsible personnel, 86% (n = 36) had internal SOPs in place, and 69% (n = 29) expressed the need for a universally applicable evidence-based SOP. All centers that reported a pre-defined maximum storage duration (n = 28) adhered to the Extracorporeal Life Support Organization guidelines regarding maximum storage duration of pre-assembled ECMO systems (30 days).</p><p><strong>Conclusions: </strong>German ECMO centers without perfusionist support reported substantial heterogeneity in ECPR readiness and operational workflows. ECPR-performing centers were associated with shorter setup times and more frequently reported interdisciplinary team structures and recurrent team training. These findings describe current organizational practices and perceived needs and support the value of interdisciplinary teamwork, structured training, and standardized protocols as organizational components that may facilitate timely, standardized ECPR deployment.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"26 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13587460/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148988012","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early serial changes in FIB-4 after out-of-hospital cardiac arrest and short-term clinical outcomes: a retrospective cohort study.","authors":"Muhammed Emin Zora, Ömer Sert","doi":"10.1186/s12873-026-01764-9","DOIUrl":"10.1186/s12873-026-01764-9","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The Fibrosis-4 (FIB-4) index combines age, aminotransferase levels, and platelet count. Although developed for chronic liver fibrosis, its components may reflect acute hepatic and systemic injury after cardiac arrest. The primary aim of this study was to characterize early changes in FIB-4 from admission to an approximately 72-hour repeat assessment after out-of-hospital cardiac arrest (OHCA). Secondarily, we evaluated the association of FIB-4 values with 28-day mortality and whether repeat measurement provided additional prognostic information.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This single-center retrospective cohort study included adults admitted to the intensive care unit after sustained return of spontaneous circulation between May 1, 2023, and May 1, 2026. After a record-level eligibility audit, 188 patients were included; 28-day vital status was available for 182. FIB-4 was calculated from the first laboratory set obtained at intensive care unit admission and from the complete laboratory set closest to 72 h after the admission laboratory sample within a 48-96-hour window. The primary analysis assessed paired change in FIB-4. Secondary analyses examined the association of admission FIB-4 with 28-day mortality and, using a 72-hour landmark approach, the association of repeat FIB-4 with subsequent mortality through day 28 and its incremental contribution beyond the admission value.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A valid repeat FIB-4 measurement was available in 122 patients. In paired analysis, median FIB-4 decreased from 5.21 at admission to 3.16 at approximately 72 h (p &lt; 0.001). Of the 182 patients with known 28-day vital status, 82 died (45.1%). Admission FIB-4 was higher in patients who died than in survivors (6.84 [3.25-10.75] vs. 4.14 [2.32-8.16]; p = 0.019). Each doubling of admission FIB-4 was associated with higher odds of mortality in the unadjusted analysis (OR, 1.26; 95% CI, 1.02-1.55; p = 0.029); however, in the OHCA-specific complete-case model, the adjusted association was not statistically significant (OR, 1.16; 95% CI, 0.91-1.46; p = 0.227), and adding FIB-4 to the clinical model increased the AUC only from 0.647 to 0.648 (difference, 0.001). In the 72-hour landmark cohort, 56 patients had an available pre-landmark repeat measurement and known 28-day vital status; 29 died after the landmark. Repeat FIB-4 showed weak discrimination for subsequent mortality (AUC, 0.585), and the OR per doubling was 1.23 (95% CI, 0.86-1.76; p = 0.255). Adding repeat FIB-4 to the admission value increased the AUC from 0.575 to 0.581 (difference, 0.006; 95% CI, - 0.053 to 0.205; likelihood-ratio p = 0.294).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Among patients with available paired measurements, FIB-4 decreased from admission to the approximately 72-hour repeat assessment; however, the magnitude of change showed little discriminatory ability for subsequent mortality in the landmark cohort. Higher admission FIB-4 was ass","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"26 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13673793/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149191317","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical characteristics and prognostic differences among acute heart failure phenotypes in the emergency department: a real-world study.","authors":"Hanyang Liang, Yimeng Wang, Yijing Xin, Yulong Li, Chujie Zhang, Yanmin Yang","doi":"10.1186/s12873-026-01628-2","DOIUrl":"10.1186/s12873-026-01628-2","url":null,"abstract":"<p><strong>Background: </strong>The 2021 European Society of Cardiology (ESC) guidelines classify acute heart failure (AHF) into four phenotypes: acute decompensated heart failure (ADHF), acute pulmonary oedema (APO), isolated right ventricular failure (IRVF), and cardiogenic shock (CS). However, differences in clinical characteristics and long-term outcomes among these phenotypes in the emergency department (ED) remain unclear. This study aimed to evaluate their characteristics and prognostic implications in the ED setting.</p><p><strong>Methods: </strong>In this prospective-retrospective observational real-world study, adults presenting with AHF in the ED were consecutively enrolled and categorized according to ESC-defined phenotypes. The study endpoints were 1-year all-cause and cardiovascular mortality. Associations between phenotypes and mortality were assessed using Cox regression models with progressive adjustment.</p><p><strong>Results: </strong>A total of 2,960 patients were included. Clinical characteristics and treatment patterns differed substantially across phenotypes. The 1-year all-cause mortality rates were 10.3% in ADHF, 11.0% in APO, 24.5% in IRVF, and 58.7% in CS (P < 0.001). In multivariable Cox analyses adjusting for clinical variables and treatments, IRVF remained independently associated with increased risks of all-cause mortality (HR 1.92, 95% CI 1.02-3.63; P = 0.044) and cardiovascular mortality (HR 2.22, 95% CI 1.10-4.48; P = 0.027). CS was also independently associated with higher risks of all-cause mortality (HR 2.22, 95% CI 1.34-3.67; P = 0.002) and cardiovascular mortality (HR 2.71, 95% CI 1.57-4.66; P < 0.001).</p><p><strong>Conclusions: </strong>In this ED-based AHF cohort, IRVF and CS were independently associated with worse 1-year outcomes, supporting phenotype-based risk stratification in the ED.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"26 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13536624/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148872951","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Aligning training with clinical reality: linking case-mix and self-reported confidence to entrustable professional activities in physician-staffed EMS.","authors":"Christian Engelen, Tobias Bexten, Kai Schmid, Jens Christian Kubitz, Anne Kamphausen","doi":"10.1186/s12873-026-01753-y","DOIUrl":"10.1186/s12873-026-01753-y","url":null,"abstract":"<p><strong>Background: </strong>Emergency medical services (EMS) physicians must manage a broad spectrum of high-acuity prehospital emergencies. However, current training pathways in Germany are not explicitly competency-based and provide limited structured exposure to low-frequency, high-stakes scenarios. Entrustable professional activities (EPAs) offer a framework to align training with real-world clinical demands. This study aimed to identify key prehospital tasks suitable for an EPA-based curriculum.</p><p><strong>Methods: </strong>We conducted a multi-method descriptive study combining (1) a retrospective analysis of 4,078 prehospital EMS physician records (Nuremberg, 2017-2021) to assess case-mix and procedural frequencies and (2) an online survey of 134 bavarian EMS physicians assessing self-reported confidence across emergency domains. Tasks were categorized on the basis of frequency and confidence levels and mapped to candidate EPAs.</p><p><strong>Results: </strong>Nontraumatic emergencies were dominated by cardiovascular and neurological conditions, whereas traumatic cases involved primarily extremity injuries. The most frequent interventions were intravenous access, oxygen administration, and ECG acquisition; invasive procedures were rare. Physicians self-reported high perceived confidence in resuscitation, airway management, and analgesia and lower perceived confidence in paediatric, neonatal, obstetric, and mass-casualty scenarios. Physicians with an anaesthesiology background descriptively reported higher perceived confidence across several domains; no inferential testing was performed. Tasks characterized by either high frequency with low confidence or low frequency with high stakes were identified as key targets for EPA development.</p><p><strong>Conclusion: </strong>These findings identify patterns of clinical exposure and self-perceived confidence in the studied EMS context and suggest domains that may warrant further investigation in broader settings. They may inform the preliminary development of candidate EPA-based training frameworks in physician-staffed EMS systems. However, the findings do not demonstrate actual competence deficits, unsafe practices, patient safety effects, or the effectiveness of EPA-based curricula.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"26 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13531932/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148873000","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Drones providing live video to dispatch centers during time-critical incidents.","authors":"M Kristiansson, M Andersson Hagiwara, L Svensson, S Schierbeck, Y Khalid, P Lundgren, C Magnusson, P Nordberg, J Hollenberg, M Ringh, S Forsberg, A Claesson","doi":"10.1186/s12873-026-01752-z","DOIUrl":"10.1186/s12873-026-01752-z","url":null,"abstract":"<p><strong>Background: </strong>Early triage of emergency calls at dispatch centres relies mainly on verbal information, which may not reflect the complexity and severity of a situation, limiting dispatchers situational awareness and early decision-making. Real-time live-video could potentially be provided by drones before the arrival of emergency medical services and fire department. The aim was to evaluate feasibility and operational value of automated beyond visual line of sight (BVLOS) drones delivering early live-video to emergency dispatch centres during time-critical incidents.</p><p><strong>Methods: </strong>This prospective interventional feasibility study was conducted in the region of western Sweden between 7th May-7th November 2025. One drone system with automated external defibrillator and a high-resolution camera was integrated into regional medical/fire dispatch centers, covering a 141 km² suburban area (population approx 63 000) enabling real-time videofeed during emergency 112-calls. The drone was dispatched to consecutive alerts meeting predefined criteria (out-of-hospital cardiac arrest, traffic accidents, fires). Outcomes included time delays, characteristics of drone- and video transmission together with dispatcher-perceived value assessed through surveys.</p><p><strong>Results: </strong>Of 169 alerts, the drone system was operational in 120 (71%). Within this operational population, the drone was deployed in 56/120 alerts (47%). Eleven alerts were subsequently cancelled following updated dispatch information, leaving 45 completed alerts in which the drone arrived on scene and delivered live video to the dispatch centres. The drone arrived first or was the only resource on scene in 44/45 completed alerts (98%), with a median dispatch-to-arrival time of 4:24 min compared with 8:50 min for responding ground units (p < 0.001). Video was transferred to dispatch centres in all (100%) completed alerts and was uninterrupted in 91%. Emergency medical dispatchers reported low/moderate value in 79% of incidents, and high value in 21% (n = 33), with a median score of 3.0 (IQR 1.0-5.0) on a 0-10 scale. Fire dispatchers reported low/moderate value in 33% and high value in 66% (n = 6), median 7.0 (IQR 5.5-9.3) on the same scale. No adverse events were reported.</p><p><strong>Conclusion: </strong>Deployment of a BVLOS drone to diverse time-critical emergencies is operationally feasible and demonstrates a clear arrival time advantage over ground responders. Perceived operational utility varies between dispatcher groups, with fire and rescue services deriving the greatest tactical benefit from early aerial situational awareness. These findings indicate potential for future drone-integration into emergency response systems.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"26 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13531748/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148872998","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reality matters: in-field validation of fresh frozen cadaver-based airway training in HEMS - the BOAH Initiative: a prospective observational cohort study.","authors":"Sebastian Imach, Tobias Ahnert, Sarah Krueger, Mai Bui, Bernd A Leidel, Jenny Patricia Kehrberger, Michael Kemper, Benny Kölbel","doi":"10.1186/s12873-026-01729-y","DOIUrl":"10.1186/s12873-026-01729-y","url":null,"abstract":"<p><strong>Background: </strong>Endotracheal intubation (ETI) remains the gold standard for emergency airway management. The performance indicator is the first-pass success rate (FPSR). Providers without routine practice in elective airway management need adapted training to gain proficiency and maintain a high level of competence. Fresh frozen cadavers (FFCs) have been shown to be effective in training and can be modified to recreate difficult airway features seen in helicopter emergency service (HEMS).</p><p><strong>Methods: </strong>In this prospective before-and-after study, the BASELINE phase consisted of recording both the performance of 16 HEMS physicians during 60 consecutive ETIs at Cologne HEMS and the corresponding airway characteristics of the patients. FPSR-raising measures for emergency airway management were identified through a structured literature review process and compiled into a bundle-the Best Of Airway management in HEMS (BOAH) bundle. The bundle was trained on five modified FFCs representing airway characteristics of the BASELINE phase. All the HEMS physicians and eight HEMS technical crew (HEMS-TC) members who were part of the BASELINE phase completed the training with videolaryngoscopy (VL) and a bougie-first strategy. Subsequently, another continuous 60 ETIs by the same teams were evaluated (BOAH phase). The primary outcome measure was the FPSR before and after the implementation of FFC training. Second, we evaluated the duration of ETIs and the oxygen saturation (SpO2) after ETIs.</p><p><strong>Results: </strong>In the BOAH phase, 61 of 63 ETIs were recorded with a complete dataset by sixteen HEMS physicians. The FPSR significantly improved from the BASELINE (76.7%, 95% CI ±10.7) to the BOAH phase (95.1%, 95% CI ± 5.4, p=.004). Lowest postintubation oxygen saturation was 83.8% ± 16.1 SD (BASELINE) vs. 88.4% ± 13.5 SD (BOAH, p=0.014), and the duration of successful ETI attempts was 34 s ± 24.1 SD in the BASELINE phase and 32 s ± 14.9 SD in the BOAH phase (p=0.41).</p><p><strong>Conclusion: </strong>The combination of the BOAH airway bundle and FFC-based training was associated with a higher observed FPSR and improved oxygenation outcomes when it was used on real emergency patients by non-anaesthetist-staffed HEMS crews. These results suggest that skills acquired during cadaver-based training, which included practice of a comprehensive airway bundle, can be reliably transferred to real-life missions.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"26 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13520462/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148825168","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correlations between monitor alarm workload and overall workload in Swedish emergency departments: a prospective multicenter cross-sectional study.","authors":"Sebastian Johansson, Erika Johannesson, Daniel B Wilhelms, Jens Wretborn","doi":"10.1186/s12873-026-01733-2","DOIUrl":"10.1186/s12873-026-01733-2","url":null,"abstract":"<p><strong>Background: </strong>Emergency department staff work under substantial and variable demands. Physiologic monitoring is an integral part of the ED working environment and supports the observation of several patients at the same time, but the alarms generated by monitoring equipment may also add to staff workload. We examined the relation between perceived alarm workload and overall workload and assessed whether operational factors were associated with alarm workload after adjustment for overall workload.</p><p><strong>Methods: </strong>We conducted a prospective, multicenter, cross sectional study at three Swedish emergency departments. During clinical shifts, staff rated their overall workload and alarm workload during the preceding hour on a scale from 0 to 6. Survey responses were matched by emergency department team and hour with patient data from electronic health records and alarm data from monitoring systems. Pearson correlation was used to assess the relation between the two workload measures. Multivariable linear regression was used to examine associations between alarm workload and prespecified operational variables.</p><p><strong>Results: </strong>A total of 184 surveys covering 81 h were collected. Alarm workload was moderately correlated with overall workload r = 0.53, with P < 0.001. After observations without patients were excluded, 68 h were included in the regression analysis. Overall workload, the proportion of patients arriving by ambulance, and the frequency of technical alarms were associated with greater alarm workload in the adjusted analysis. Monitoring equipment was considered helpful in 68% of assessments and disruptive in 18%.</p><p><strong>Conclusions: </strong>Perceived alarm workload was moderately correlated with overall workload. A higher proportion of patients arriving by ambulance and a higher frequency of technical alarms were associated with greater alarm workload after adjustment for overall workload. These findings may help guide efforts to reduce the workload associated with monitor alarms in emergency departments.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"26 1","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13488255/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148787952","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}