BMC Emergency Medicine最新文献

{"title":"Emergency medical services providers' perspectives on the use of artificial intelligence in prehospital identification of stroke- a qualitative study in Norway and Sweden.","authors":"Ann-Chatrin Linqvist Leonardsen, Camilla Hardeland, Andreas Dehre, Glenn Larsson","doi":"10.1186/s12873-025-01300-1","DOIUrl":"10.1186/s12873-025-01300-1","url":null,"abstract":"<p><strong>Background: </strong>Stroke is a large and increasing health challenge, leading to acquired physical disability and mortality. A rapid diagnostic assessment in the acute phase of a stroke is crucial and highly time dependent. Studies suggest that artificial intelligence (AI) could contribute for prognostication, prediction and resource optimization in suspected stroke cases in prehospital emergency care. The objective of the current study was to explore Emergency Medical Services providers' perspectives on using AI in the prehospital assessment of patients with a suspected stroke diagnosis.</p><p><strong>Methods: </strong>A qualitative study design following stroke case simulation with an AI-based diagnostic tool was used. One focus group and ten dyadic interviews were conducted comprising 24 participants from three ambulance stations in Norway and Sweden respectively. Data were analyzed following Braun and Clarke's steps for thematic analysis.</p><p><strong>Results: </strong>Three themes were identified, namely (1) Another tool in the toolkit, (2) Trust is essential, and (3) The devil is in the details. The participants underlined that the AI-based tool was just an addition to their usual assessment, including symptoms, anamnesis, and vital parameters, as well as their own 'clinical eye'. Moreover, trust was needed from various stakeholders for the tool to have a function in the patient pathway. Finally, size and weight, as well as the ability to differentiate between hemorrhagic and thrombotic stroke were central aspects for the tool to be feasible.</p><p><strong>Conclusion: </strong>Emergency Medical Services providers mainly rely on their own clinical eye, combining symptoms, anamnesis and measurement of vital parameters when assessing suspected stroke patients. AI-based tools may be used as support in the decision-making process, however this depends on the establishment of trust in the tool across EMS providers, neurologists and other health professionals.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"25 1","pages":"136"},"PeriodicalIF":2.3,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12306024/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144727676","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":"The second victim phenomenon among German emergency medical technicians: a cross-sectional study based on the SeViD questionnaire (SeViD-VIII).","authors":"Hartwig Marung, Victoria Klemm, Reinhard Strametz, Thomas Neusius, Matthias Raspe, Hannah Roesner, Harald Karutz, Klaus Runggaldier, Rainer Petzina, Luis Teichmann, Stefan Bushuven","doi":"10.1186/s12873-025-01298-6","DOIUrl":"10.1186/s12873-025-01298-6","url":null,"abstract":"<p><strong>Background: </strong>Emergency medical technicians (EMTs) frequently encounter high-stress, traumatic events, making them vulnerable to the second victim phenomenon (SVP), a state of emotional distress following adverse patient-related incidents. While SVP is well documented among physicians and nurses, research on EMTs remains limited. This study examines the prevalence, risk factors, symptom burden, and preferred support strategies for SVP among German EMTs.</p><p><strong>Methods: </strong>A cross-sectional survey was conducted using the validated SeViD questionnaire (Second Victims in German-speaking countries). The survey assessed SVP prevalence, symptom severity, and preferred support measures. Binary logistic regression was performed to identify predictors of SVP and symptom burden. Descriptive statistics were used to summarize demographic and occupational characteristics.</p><p><strong>Results: </strong>Among the 699 respondents, 528 (75.5%) completed the survey. The prevalence of SVP was 65.3%, with 53.3% reporting SVP within the past 12 months. The most common triggering events were unexpected patient deaths (37.1%) and aggressive behavior from patients or relatives (19.1%). Logistic regression revealed that professional experience (OR = 1.055, p < 0.001) and employment in ground-based intensive care transport (OR = 2.444, p = 0.004) were risk factors for SVP, whereas male gender (OR = 0.392, p < 0.001) and conscientiousness (OR = 0.765, p = 0.033) were factors associated with lower risk. Higher extraversion was associated with lower symptom burden (OR = 0.754, p = 0.013). The most valued support measures were legal consultation and professional counseling.</p><p><strong>Conclusions: </strong>SVP is highly prevalent among EMTs and has significant psychological and emotional consequences. Greater work experience and intensive care transport roles increase SVP risk, whereas conscientiousness and extraversion appear protective. The implementation of structured peer support programs may help mitigate the impact of SVP.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"25 1","pages":"137"},"PeriodicalIF":2.3,"publicationDate":"2025-07-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12306064/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144727677","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":"Performance of dispatcher-assisted cardiopulmonary resuscitation integrating with mouth-and-nose covering instructions during the COVID-19 pandemic: a population-based retrospective study.","authors":"Hideki Asai, Hidetada Fukushima, Yasuyuki Kawai, Keita Miyazaki, Kouji Yamamoto, Arisa Kinoshita, Hirozumi Okuda","doi":"10.1186/s12873-025-01296-8","DOIUrl":"10.1186/s12873-025-01296-8","url":null,"abstract":"<p><strong>Background: </strong>The coronavirus disease 2019 (COVID-19) pandemic, which emerged in late 2019, compelled people to change their behavior globally. Due to concerns about potential aerosol transmission during chest compressions, a modified dispatcher-assisted cardiopulmonary resuscitation (DACPR) protocol incorporating mouth-and-nose covering instructions was introduced in Nara, Japan. This study examined its impact on DACPR performance during the COVID-19 pandemic.</p><p><strong>Methods: </strong>This is a retrospective before-after study. DACPR performance data from the Nara Wide Area Fire Department were analyzed, comparing the non-pandemic period (March 2019 to February 2020) with the pandemic period (November 2020 to October 2021). The primary outcome was the time from emergency call acceptance to the first chest compression (T3). Secondary outcomes included the time to cardiac arrest recognition (T1), the time to start of DACPR instructions (T2), DACPR implementation rate, and adherence to infection prevention instructions.</p><p><strong>Results: </strong>The implementation of the modified protocol did not significantly alter the overall DACPR rate (406, 50.3% in the non-pandemic vs. 390, 47.2% in the pandemic; p =.214). Although the difference was relatively small, a statistically significant prolongation of T3 was observed during the pandemic period (246.0 s vs. 261.5 s, p <.05). Compliance with mouth-and-nose covering instructions among dispatchers was relatively low (43.1%). Among cases where such instructions were provided, only 21.4% of bystanders fully adhered to the protocol (both the bystander and the patient covering their mouth and nose). However, dispatcher-provided instructions significantly increased the likelihood of bystanders wearing masks and covering the patient's mouth and nose. Multivariable analysis did not identify the protocol implementation as a significant factor influencing T3.</p><p><strong>Conclusions: </strong>This study demonstrated that the modified DACPR protocol incorporating infection prevention measures was associated with a statistically significant delay of approximately 15.0 s in CPR initiation. However, given the low adherence rate, the overall impact of these measures on DACPR performance was limited. These findings highlight the need to increase adherence to infection prevention measures while minimizing delays in life-saving interventions, particularly during pandemics caused by airborne pathogens.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"25 1","pages":"134"},"PeriodicalIF":2.3,"publicationDate":"2025-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12296633/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144717385","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":"Decision-making and acute behavioural disturbance (ABD): a qualitative thematic analysis of perspectives on decision-making by UK ambulance paramedics.","authors":"Jaqualine Lindridge, Timothy Edwards, Leda Blackwood","doi":"10.1186/s12873-025-01297-7","DOIUrl":"10.1186/s12873-025-01297-7","url":null,"abstract":"","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"25 1","pages":"135"},"PeriodicalIF":2.3,"publicationDate":"2025-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12297720/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144717384","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":"Metallophosphide poisoning, a rising public health problem in Ethiopia: a systematic review and meta-analysis.","authors":"Kassaye Demeke Altaye, Bethelhem Yenenew Assefa, Adina Worku Teka, Saron Mulugeta Worku, Geta Bayu Genet, Bikis Liyew, Nahom Worku Teshager","doi":"10.1186/s12873-025-01294-w","DOIUrl":"https://doi.org/10.1186/s12873-025-01294-w","url":null,"abstract":"<p><strong>Introduction: </strong>Metallophosphide poisoning, mainly due to aluminum phosphide and zinc phosphide, is a growing public health problem in developing countries associated with a high mortality rate, including in Ethiopia, where it is used a fumigant for stored grains and agricultural commodities. Ethiopia lacks a well-organized poison control center, making it difficult to obtain primary data on metallophosphide poisoning cases and outcomes. This systematic review and meta-analysis aim to determine the pooled prevalence and mortality rate from metallophosphide poisoning in Ethiopia.</p><p><strong>Methods: </strong>As of August 2024, PUBMED, EMBASE, SCOPUS, and GOOGLE SCHOLAR were inclusively searched. Two independent reviewers extracted the data. Quality was assessed using the Modified Newcastle-Ottawa Scale adapted for cross-sectional studies. A random effects model was used to obtain the pooled estimate of the prevalence of and mortality rate from metallophosphide poisoning.</p><p><strong>Results: </strong>Fourteen studies with a sample size of 3218 were included in the final estimate. The pooled prevalence of metallophosphide poisoning in this systematic review and meta-analysis was 38% (95% CI: 0.14-0.71, I² = 96.6%, p < 0.0001). In the teen-included studies for the pooled mortality analysis, the sample size was 677 and the pooled mortality rate was 37% (95 % CI: 0.22, 0.55, I2 = 87.8%, P < 0.0001).</p><p><strong>Conclusion: </strong>We found a high pooled prevalence of metallophosphide poisoning in Ethiopia. This highlights the urgent need for regulatory actions to restrict the sales and distribution of these substances. This is supported by international experiences from similar low-resource settings. We recommend safer alternatives to control insects and rodents, such as mechanical rodent controls and integrated pest management. Public awareness creation and enhancing local management protocols to reduce the burden and improve the outcome of metallophosphide poisoning.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"25 1","pages":"133"},"PeriodicalIF":2.3,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144697584","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":"Assessing health risks and preparedness strategies in mass-gathering religious events: a retrospective observational study.","authors":"Huan-Ting Chi, Wei-Kai Liao, Ming-Tai Cheng, Wei-Kuo Chou, Chien-Hao Lin","doi":"10.1186/s12873-025-01293-x","DOIUrl":"10.1186/s12873-025-01293-x","url":null,"abstract":"<p><strong>Background: </strong>Mazu pilgrimages are among the largest moving religious events worldwide, involving ceremonies and processions spanning over 300 km in 8-10 days. The massive crowds pose unique public health challenges. This study aimed to assess the health risks and contributing factors of these events to help authorities and local healthcare services better anticipate, prepare for, and mitigate potential health issues during the pilgrimage.</p><p><strong>Methods: </strong>We conducted a retrospective observational study using patient data from the Emergency Medical Resources Management System of Taiwan's Ministry of Health and Welfare from 1 January 2018 to 31 October 2024. Records included demographics, means of transport, Taiwan Triage and Acuity Scale (TTAS) level, diagnosis, and disposition for each emergency department (ED) visit related to the two Mazu pilgrimages. Individual ED visits were aggregated into daily counts to estimate daily health impacts. The primary outcome was the daily total number of pilgrimage-related ED visits; secondary outcomes were daily counts for specific diagnoses. Multivariable linear regression was used to examine associations between environmental and event-related factors-including whether the day was the start or end day of the pilgrimage (S-or-E-day), daily walking distance, highest temperature, and relative humidity-and the log-transformed daily ED visit and diagnosis-specific counts.</p><p><strong>Results: </strong>A total of 1,637 patients visited the ED during Mazu pilgrimages in the study period. Half arrived by ambulance, and 10.8% were triaged as TTAS I/II. Most patients (89.7%) were discharged without admission; only 8.1% were admitted to general wards. Trauma-related diagnoses were the most common (53.7%), with soft tissue injuries (28.1%) and heat emergencies (16.1%) being the most frequent trauma and non-trauma conditions, respectively. The S-or-E-day variable was significantly associated with the daily number of ED visits, trauma, head injuries, orthopaedic injuries, and heat emergencies. Walking distance was linked to ED visits and trauma cases, while highest temperature was linked to heat emergencies.</p><p><strong>Conclusions: </strong>During Mazu pilgrimages in Taiwan, most patients visiting the ED presented with mild conditions, predominantly minor trauma-related injuries. By monitoring walking distance and temperature, healthcare providers can better anticipate and prepare for cases related to trauma and heat emergencies.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"25 1","pages":"132"},"PeriodicalIF":2.3,"publicationDate":"2025-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12281752/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144681921","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":"Comparison of the new risk score (ABL) with the Glasgow Blatchford Score, AIMS65, and pre-endoscopic Rockall Score in patients with upper gastrointestinal bleeding admitted to the emergency department.","authors":"Necip Gökhan Güner, Fatih Çatal, Yusuf Yürümez, Fatih Güneysu, Furkan Bostancı","doi":"10.1186/s12873-025-01291-z","DOIUrl":"10.1186/s12873-025-01291-z","url":null,"abstract":"<p><strong>Background: </strong>Upper gastrointestinal bleeding (UGIB) continues to be a major global health concern, contributing substantially to both morbidity and mortality. This highlights the need for efficient and reliable risk assessment methods, particularly in emergency care settings. The primary objective of this study was to create a new risk scoring system that is easier to apply, more practical in clinical workflows, and highly effective for evaluating patients presenting to the emergency department with UGIB.</p><p><strong>Methods: </strong>This retrospective observational study was conducted at a single center by analyzing records of patients aged 18 years and older who presented to the Emergency Medicine Department of Sakarya Training and Research Hospital with clinical signs and symptoms suggestive of upper gastrointestinal bleeding (UGIB) between January 2022 and June 2023. For analytical purposes, patients were categorized into six distinct subgroups. Those assigned to transfusion, intervention, intensive care unit (ICU), readmission, or mortality groups were collectively defined as high-risk patients. Based on the collected clinical data, a novel scoring system-referred to as the ABL score-was developed. The diagnostic performance of this new score in identifying high-risk patients and each outcome subgroup was then evaluated and compared to existing scoring tools: the Glasgow Blatchford Score (GBS), AIMS65, and the pre-endoscopic Rockall Score (Pre-RS).</p><p><strong>Results: </strong>A total of 589 patients were included, with a median age of 67 years, with a male ratio of 66.2%. ABL score, which includes Age, systolic Blood pressure, Laboratory parameters (hemoglobin, BUN/creatinine ratio, and international normalized ratio/albümin) was found to be more effective in predicting high-risk groups compared to the GBS, AIMS65, and Pre-RS scores ([AUROC]: 0.86, 0.806, 0.71, and 0.704, respectively; p < 0.05). The ABL score also performed better in predicting transfusion and readmission subgroups. (AUROC: 0.886 and 0.719, respectively).</p><p><strong>Conclusion: </strong>The ABL scoring system demonstrated higher predictive performance than GBS, AIMS65, and Pre-RS, particularly in identifying high-risk patients, transfusion requirements, and the likelihood of readmission. However, confirmation of these findings requires validation through larger, prospective studies.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"25 1","pages":"131"},"PeriodicalIF":2.3,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12275245/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144667017","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":"Prehospital survival of patients with ST-elevation myocardial infarction requiring out-of-hospital cardiopulmonary resuscitation - a nationwide, real-world observational study.","authors":"Dominika Szabó, András Szabó, Andrea Székely","doi":"10.1186/s12873-025-01292-y","DOIUrl":"10.1186/s12873-025-01292-y","url":null,"abstract":"<p><strong>Background: </strong>The mortality risk of patients presenting with ST-elevation myocardial infarction (STEMI) has been extensively researched. Even though STEMI can be diagnosed before hospital admission, prehospital mortality has been less frequently studied. We aimed to analyze the outcomes of patients with STEMI requiring out-of-hospital cardiopulmonary resuscitation (CPR).</p><p><strong>Methods: </strong>From a large, nationwide prehospital case report database, we collected data from 668 patients requiring CPR because of ambulance-witnessed OHCA (out-of-hospital cardiac arrest) who were diagnosed with STEMI by ECG before cardiac arrest. Utstein-style consensus reporting guidelines were followed. The endpoint was hospital admission with spontaneous circulation. In addition to descriptive statistics, we also aimed to identify predictors of the outcome using multivariable logistic regression. Model performance was characterized by c-statistics and multiple fitting methods. Internal validation was performed using calibration intercept and slope.</p><p><strong>Results: </strong>Using CPR initial rhythm, age, initial heart rate, initial systolic blood pressure, and ECG localization of STEMI as predictors, we found that the constructed logistic regression model showed good discriminative ability, with a c-statistic of 0.844 (95% CI = 0.8105-0.8787). The overall model fit was good, with Hosmer & Lemeshow p = 0.979. The value of Nagelkerke R² test of 0.445 indicated a strong relationship between predictors and outcome. The Z-value of calibration slope was relative to slope = 1 (95% CI = 0.85-1.16).</p><p><strong>Conclusions: </strong>This model can be used to estimate the probability of hospital admission following resuscitation due to ambulance-witnessed OHCA in patients with STEMI. Further studies are needed to improve the possibility of definitive in-hospital treatment for a better survival rate.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"25 1","pages":"130"},"PeriodicalIF":2.3,"publicationDate":"2025-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12275280/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144666935","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":"The diagnostic accuracy of the ESC 0/1-hour algorithm in non-ST-segment elevation myocardial infarction in a crowded emergency department: a real-world experience from a single-center in Türkiye.","authors":"Emre Kudu, Ahmet Enes Kucukardali, Mustafa Altun, Ümit Öztürk, Erhan Altunbaş, Sinan Karacabey, Erkman Sanri, Arzu Denizbasi","doi":"10.1186/s12873-025-01289-7","DOIUrl":"10.1186/s12873-025-01289-7","url":null,"abstract":"<p><strong>Background: </strong>The rapid and accurate diagnosis of non-ST-segment elevation myocardial infarction (NSTEMI) is critical to improving patient outcomes and reducing emergency department (ED) overcrowding. The European Society of Cardiology (ESC) 0/1-hour algorithm, utilizing high-sensitivity cardiac troponin T (hs-cTnT) levels, has demonstrated high diagnostic performance internationally. This study aimed to evaluate its diagnostic accuracy in a high-volume ED setting in Türkiye.</p><p><strong>Methods: </strong>This single-center retrospective cohort study was conducted at Marmara University Pendik Training and Research Hospital, Türkiye, from September 1 to December 31, 2022. Adults presenting with acute chest discomfort and undergoing hs-cTnT testing per the ESC 0/1-hour algorithm were included. Patients with ST-segment elevation, missing data, pregnancy, or those discharged against medical advice were excluded. The primary outcome was NSTEMI diagnosis; the secondary outcome was major adverse cardiac events (MACE) within 30 days.</p><p><strong>Results: </strong>Of 3,529 eligible patients, 3,216 were included. The mean age of the patients was 53.9 ± 16.4 years, and 58.3% were male. NSTEMI was diagnosed in 319 patients (9.9%). According to the ESC algorithm, 54.4% of patients were classified as \"rule-out,\" 31.3% as \"observe,\" and 12.3% as \"rule-in.\" The sensitivity and negative predictive value (NPV) for NSTEMI in the \"rule-out\" group were both 100%. In the \"rule-in\" group, the specificity was 91.16%, and the positive predictive value (PPV) was 59.14%. MACE occurred in 13.6% (436 patients) within 30 days: 0.7% in the \"rule-out\" group, 13.9% in the \"observe\" group, and 67.0% in the \"rule-in\" group.</p><p><strong>Conclusions: </strong>The ESC 0/1-hour algorithm is highly effective for ruling out NSTEMI in Türkiye, demonstrating excellent sensitivity and NPV. While it facilitates early discharge of low-risk patients, enhancements are needed for risk stratification in intermediate-risk groups. Its implementation could optimize ED resource utilization and improve clinical outcomes.</p><p><strong>Clinical trial number: </strong>Not applicable.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"25 1","pages":"129"},"PeriodicalIF":2.3,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12269136/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144648444","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":"Enhancing military airway suction devices with a focus on performance and portability.","authors":"Maria J Londono, Saketh R Peri, Rakib Hasan, Connor J Evans, David Restrepo, Robert A De Lorenzo, R Lyle Hood","doi":"10.1186/s12873-025-01262-4","DOIUrl":"10.1186/s12873-025-01262-4","url":null,"abstract":"<p><strong>Background: </strong>Airway management is critical in combat casualty care, with airway compromise being the second leading cause of preventable battlefield deaths. Suction devices are essential for clearing obstructions during airway management; however, many medics choose not to carry them due to their excessive weight. Current standards for suction devices mention a minimum liquid flow rate of 1.2 L/min and a maximum device weight of 6 kg, but these standards fail to meet the practical needs of military end-users. The team conducted an I-Corps funded end-user assessment study with over 100 participants, in which a minimum flow rate of 1 L/min and a maximum weight of 4.5 kg were indicated as preferred among respondents. This gap between the standards and user preferences results in exclusion of existing devices from military kits due to weight concerns despite meeting performance criteria.</p><p><strong>Methods: </strong>To address this gap, the Suction Combat Ready Advanced Multifunctional Machine (SCRAMM) was developed with input from U.S. Military clinical stakeholders to emphasize both performance and portability. SCRAMM is designed to handle diverse medical scenarios simultaneously and was characterized against the market leaders Zoll 330 and Impact 326M. Liquid flow rates and device weights were measured and analyzed according to ISO standards and end-user requirements.</p><p><strong>Results: </strong>Zoll 330 and Impact 326M exceeded the ISO-required liquid flow rate by 145%, with weights of 4.8 kg and 5.1 kg, respectively. Additionally, both devices were heavier than the user-preferred weight limit of 4.5 kg. SCRAMM, with three suction lines for simultaneous diverse medical tasks, exceeded the ISO flow rate by 23%. It remained within the preferred weight range at 3.4 kg, demonstrating greater performance-to-weight balance in consideration of actual user needs.</p><p><strong>Conclusion: </strong>This study demonstrates the successful development and characterization of SCRAMM. It met ISO flow rate standards and remained under the 4.5 kg weight threshold preferred by end-users-outperforming current market leaders in portability while maintaining effective suction. These results highlight the importance of incorporating a performance-to-weight metric in evaluating portable suction devices. We recommend that future standards balance performance with portability to better suit military and emergency medical needs.</p><p><strong>Clinical trial number: </strong>not applicable.</p>","PeriodicalId":9002,"journal":{"name":"BMC Emergency Medicine","volume":"25 1","pages":"128"},"PeriodicalIF":2.3,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12269139/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144648443","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}