Press Release: Study shows how risk of death rises with rate of overcrowding and corridor care in hospital emergency department

Embargo: 00.01 hrs CEST on Friday 25 September 2026

Paris, France: The risk of death for patients treated in the emergency department increases by one per cent for every ten per cent increase in occupancy, according to research that will be presented at the European Emergency Medicine Congress. [1]

The researchers say their findings show how overcrowding brings a very real risk for patients and provides evidence for policy makers and hospital managers on prioritising emergency care. Although the study was based on UK hospitals, the researchers say that given the levels of overcrowding in hospitals around the world their findings may apply in many other countries.

The research was presented by Dr Ryan McHenry from the University of Glasgow, UK, and an emergency medicine doctor in the West of Scotland. He said: “Emergency department overcrowding is an increasing public health concern internationally, with evidence that long delays increase patient mortality. Crowding is also associated with poor patient and staff experiences.

“There is less evidence around how crowding itself might be associated with mortality. Our traditional measures of emergency department crowding were developed in a time where crowding was less of an issue, and these simply aren’t sufficient to describe the crisis that currently exists in emergency care.”

The study included 19,034 patients being treated at 134 hospital emergency departments in Wales, Northern Ireland and England over five different time periods in 2025.

Researchers compared data on patient deaths within 28 days of being treated in the emergency department with information on occupancy on the day they were seen in the department.

Occupancy is calculated by how many spaces, such as cubicles, the department has compared with how many patients were being treated. For example, a hospital with 50 cubicles and 50 patients is at 100% occupancy, with 40 patients it is at 80% occupancy, and with 60 patients it is at 120% occupancy. The study showed that, on average, emergency departments were operating at 175% occupancy.

Analysis of the data showed that for every ten per cent increase in occupancy, the risk of dying from any cause within 28 days increased by one per cent. At the levels of crowding experienced by departments in this study, this equates to hundreds of deaths a week.

Dr McHenry and his colleagues also looked at the impact of ‘corridor care’ where patients receive treatment in non-standard clinical spaces such as corridors. This was also linked to an increase in the risk of deaths, in line with the risk associated with the occupancy rate. However, researchers say occupancy rate is much easier to measure and record.

Dr McHenry said: “We found that increased crowding in emergency departments is associated with increased mortality for patients admitted to hospital. This is important because we know that emergency departments are now often very crowded, and reducing that crowding has the real potential to save lives. Overcrowding is a problem in many countries and, although there will be regional differences, this link between overcrowding and patient deaths is likely to hold true around the world.

“A major strength of this study is its size and geographic reach, with participation from 139 emergency departments from across the UK. We’ve worked with hundreds of collaborators, collecting data that otherwise would be impossible to bring together. This gives us a detailed and accurate view of how crowding and corridor care impact patients.

“Extrapolating the results of this study across the UK means that emergency department crowding could have contributed to 554 deaths a week during the study period, as compared to a situation where departments had one space for every patient. Although we cover the majority of the emergency departments in the UK, this was still a relatively small study, and the possible range of expected deaths is therefore large; we estimate anywhere between 33 and 1,083 excess deaths are plausible. Regardless, these numbers track similar estimates of harm from long waits and crowding, and demonstrate the harms associated with the crisis in emergency care. Further studies are needed to confirm these findings and find a more precise estimate of the harms from crowding.

“We are already engaging with governments to ensure this research feeds into health service policy. We now need to find solutions that work in tackling emergency department crowding.”

The researchers have used their results to create a risk calculator (www.uncorkedcalculator.com) where emergency department staff can understand the risks for patients when their department is overcrowded.

Dr Felix Lorang is a member of the EUSEM abstract selection committee. He is head of the emergency department at Klinikum Lippe, North Rhine-Westphalia, Germany, and was not involved in the research. He said: “Around the world, the need for emergency care is growing, while infrastructure is failing to keep pace. Many emergency departments are operating far beyond capacity, and the ‘exit block’ — when patients are stuck in the emergency department because no inpatient ward beds are available — places an even greater burden on these emergency departments. This makes it harder for doctors and nurses to deliver the treatment patients need, or even the minimum treatment required to prevent further harm.

“This research makes it unmistakably clear to all of us — patients, medical professionals, and hospital managers alike — that overcrowding and corridor care mean many emergency patients will not survive.

“These findings can help hospitals understand the true impact of overcrowding in emergency departments. Understaffed and inadequately resourced emergency departments are, in themselves, an independent and dangerous health risk. But these results are especially critical for governments, politicians, and health services, because saving lives in emergency care is achievable — by preventing overcrowding, through sufficient staffing and through emergency departments that are adequately planned and equipped.”(ends)

[1] Abstract no: OA068, “The association between emergency department occupancy and mortality: a multi-centre prospective cohort study” by Ryan McHenry, Best abstracts session, Saturday 26 September, 11-12:30 hrs CEST, room 142.Funding: The UK Royal College of Emergency Medicine. The researchers also acknowledge all the time given voluntarily by collaborators across the UK to make this study possible.

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PRESS RELEASE: Over a third of patients with chest pains could avoid going to emergency departments if ambulance crews use new blood test

Embargo: 00.01 hrs CEST on Friday 25 September 2026

Paris, France: Researchers in The Netherlands have found that about 30% of presentations to emergency departments of patients with chest pain could be avoided if a highly sensitive troponin test is used in combination with other parameters by ambulance crews during pre-hospital triaging.

At present, about 95% of people with chest pains are transported by ambulance to emergency departments for further analysis, but only a minority have a serious cardiac condition. The study presented today (Friday) at the European Emergency Medicine Congress is the first to investigate the effect of combining the high-sensitive point-of-care troponin test and the HEART-score on hospital referrals for these patients.

Troponin tests measure the level of troponin proteins in the blood; these are raised when the heart muscle is damaged. Normally, these tests are carried out in the hospital laboratory when patients reach the emergency department. New, high-sensitive point-of-care troponin tests, such as the one developed by QuidelOrtho, that was used in this study, can provide on-the-spot results, often in less than 20 minutes, and have been shown to have the same accuracy as those analysed in a central laboratory. They are starting to be used to make faster decisions about patients in the emergency department with chest pain.

The HEART-score is a scoring system that takes account of factors such as the patient’s medical history, age, electrocardiogram (ECG) abnormalities, and risk factors like smoking, and categorises them into being at low, medium or high risk of experiencing a heart problem. The HEART-score also incorporates a troponin test result. Since the better, high-sensitivity point-of-care troponin tests have become available, it is possible to calculate a HEART-score in the pre-hospital setting, allowing earlier risk stratification of patients with chest pain.

The study presented today was performed by the Rotterdam-Rijnmond ambulance service in The Netherlands and enrolled 1022 patients with chest pains between 2022 and 2025. In the ‘before’ phase of the study, 539 patients with acute chest pain were given the usual care before any decision about going to hospital was made. This consisted of an ambulance being dispatched to a patient with acute chest pain, the crew examining and assessing the patient and then deciding whether or not to transport the patient to the nearest emergency department or to a hospital where the patient was already known. If there were no indications of acute heart problems or another serious condition that required immediate treatment, the patient was left at home or referred to their general practitioner.

In the ‘after’ phase of the study, 483 patients were given the interventional treatment, which included the ambulance crew taking a blood sample when they reached the patient. This was analysed by the high-sensitive point-of-care troponin test while the crew carried out all the other usual examinations and assessments. After evaluating and recording the findings, the first four elements of the HEART-score (medical history, age, ECG and risk factors) were calculated. Once the troponin test was completed, the findings were added to the HEART-score to establish the patient’s risk of experiencing a major adverse cardiovascular event (MACE), such as stroke, heart attack (myocardial infarction) or death as a result of problems with the heart or blood vessels.

Dr Barbra Backus told the congress: “If the HEART-score was low and the troponin test value was less than four nanograms per litre and there was no suspicion of another serious condition, such as a pulmonary embolism, pneumothorax or pancreatitis, then the patient was left at home or referred to their general practitioner. Clear instructions were provided to the patient to call emergency services again if the complaints didn’t resolve, or deteriorated or recurred. When these criteria were not met, the patient was transported to an emergency department

“We followed the patients for a minimum of one month, but for most patients we have over six months follow-up. During the ‘before’ phase, when the high-sensitive point-of-care troponin test was not used by the ambulance crews, 19 patients (3.5%) were left at home, whereas during the ‘after’ phase when the test was used, 165 patients (34.2%) were left at home. In other words, over a third of patients avoided going to an emergency department when they were assessed by the ambulance crews using the high-sensitive troponin test and HEART-score.

“Hospital referrals were reduced significantly, avoiding hospital overcrowding and unnecessary use of medical resources, while enabling more patients to avoid the stresses of the hospital environment. This is good for patients and good for hospitals.”

With 86% of follow-up complete, the researchers found that 109 patients (12.4%) developed a MACE within 30 days: 15.0% before and 9.8% after implementation of the high-sensitive point-of-care troponin test. Of those left at home after implementation, only one out of 165 patients (0.6%) experienced a MACE within 30 days, compared to none out of 19 patients (0%) before the test’s implementation.

Dr Backus said that this advanced, pre-hospital triage will be made mandatory in The Netherlands in 2027. “I think it is applicable to healthcare systems in many other countries too,” she said.

This study reflects the first real-world implementation of a high-sensitive point-of-care troponin test in a large urban ambulance service and enhances the generalisability of the findings for routine clinical practice. Limitations include the fact that not all patients were included in the study and there were more low-risk patients in the ‘after’ group; however, adjusting for this difference did not alter the results of the study in a meaningful way.

Dr Maša Sorić is a member of the EUSEM abstract selection committee. She is head of the emergency department at University Hospital Merkur, Zagreb, Croatia, and was not involved with the research. She said: “This study has the potential to refine the allocation of patients to emergency department while improving the quality and efficiency of pre-hospital emergency care. By enabling earlier rule-out of acute myocardial infarction in the pre-hospital setting, high-sensitivity point-of-care troponin testing may reduce unnecessary hospital transports and emergency department evaluations. Beyond emergency medical services, this approach could, with further validation, eventually be extended to other primary care settings, facilitating more efficient patient triage and resource utilisation across the healthcare system.”(ends)

1] Abstract no: OA007, “Implementation of high-sensitive point-of-care troponin in the prehospital setting, a before-after trial, preliminary results” by Barbra Backus et al., Prehospital oral abstracts session, Friday 25 September, 09:00-10:30 hrs CEST, room 142.

Funding: This study was self-funded by Rotterdam-Rijnmond’s ambulance service, with a small investment from QuidelOrtho.

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PRESS RELEASE: Violence against emergency workers is increasing: hospital overcrowding is a major contributor Emergency medical services are better prepared for a mass casualty incident than for everyday violence

Embargo: 00.01 hrs CEST on Friday 25 September 2026

Paris, France: Seventy-five percent of workers in emergency medical departments and services have witnessed violence in the past year, according to a survey of over 1,300 health professionals in 81 countries worldwide.

In a special session at the European Emergency Medicine Congress today (Friday), Luis Garcia Castrillo, a professor in emergency medicine, now retired, at the Hospital Marqués de Valdecilla, Santander, Spain, said that while patients and their friends or relatives were the main perpetrators, often because of alcohol or drug consumption, overcrowding in emergency medical departments was an equally important contributor to the violence.

Prof. Castrillo said: “Workplace violence not only jeopardises the physical and mental health of healthcare professionals but also negatively impacts the quality of care they provide. The survey reveals that 45.8% of respondents thought that the quality of care was diminished as a result of the violence they encountered.”

The international, online survey, conducted by the EUSEM Emergency Medicine Day Working Group, received responses from 1,306 healthcare providers in 81 countries between May and June 2026. A paper is published in the European Journal of Emergency Medicine (EJEM) at the same time as its presentation to the Congress [2].

It found that 75.5% of respondents had witnessed violence in their workplaces in the previous year, 68.8% had experienced psychological harm and 40.3% had experienced physical harm.

Verbal aggression was the most common form of violence (87.8%), followed by physical assault (42.3%), property damage (26.4%), sexual harassment (14.6%), race-related violence (14.5%), armed conflict (4.5%), weapon-related incidents (4.1%), sexual assault (3.5%), cyber harassment (3.1%), and firearms incidents (2.9%). Patients were the principal perpetrators (67.6%), followed by relatives or friends (44.1%). Intoxicated patients or visitors accounted for 44% and psychiatric patients for 35.2%.

Nearly half of the respondents (48.3%) thought workplace violence had worsened over the previous five years, and they perceived violent patients as one of the greatest occupational threats, second only to the risk of infection. Only half (51.1%) had received formal violence prevention training, 38.6% reported no formal training, 57.3% had access to psychosocial support after violent incidents, whereas 27.1% had no access. Women were more likely to report psychological victimisation than men: 72.2% versus 40.4%.

Dr Roberta Petrino, director of the Emergency Department at Ente Ospedaliero Cantonale, Lugano, Switzerland, co-chaired the EUSEM Congress session and is the first author of the EJEM paper. She said: “I would like to underline that the major problem for women working in emergency medicine is the verbal violence; this could be insults, sexual references, gender-related harassment and discrimination. Women emergency workers are subjected to this far more than men, and it has mainly psychological consequences. Respondents to the survey wanted psychological support, and the problem of violence to be addressed through prevention and better safety processes.

“Another important point is the perception of scarce preparation to tackle the problem of violence; respondents thought the emergency services were more prepared for a mass casualty event than for everyday violence.”

Prof. Castrillo, Dr Petrino and the other authors of the report issued a call to all providers of emergency services – pre-hospital services and emergency medical departments – to consider ways to reduce the possible triggers for violence.

Dr Petrino said: “Prolonged waiting times, limited resources and high emotional stress all escalate tensions among patients, relatives and healthcare professionals. This needs to be tackled through organisational interventions. Hospital managers should improve the internal organisation of the hospital so as to reduce overcrowding, for instance, by providing good, well-designed spaces that are well-staffed, and setting up policies in the wards to facilitate patients transferring to them quickly from emergency departments. This would allow emergency departments to improve patient flow. Managers should consider specific education about how to de-escalate situations and how to communicate well, and they should provide safety systems such as video cameras and security personnel.

“Finally, the question should be addressed about violence against healthcare providers in war zones: a large number of Ukrainian doctors, 258, responded to our survey.”

A strength of the study is the large number of responses from so many countries, although there was more participation from some countries than others, which could have introduced bias in the responses. Other limitations include the voluntary and self-reported nature of the survey, which could have introduced bias in the selection and responses of the participants; and the sample size was reduced as about 40% of questionnaires were excluded due to missing or incomplete data.(ends)

[1] “How our colleagues feel about: results from the survey“, presented in the ‘No safe space for emergency medicine teams? End violence everywhere’ session by Luis Garcia-Castrillo, Friday 25 September, 15.45-17.15 hrs CEST, Amphitheatre. https://eusem.floq.live/event/eusem-2026/search?objectClass=timeslot&objectId=69aab6a8fc86e8dca2720cda&type=detail

[2] “Workplace violence and safety perception in emergency medicine system: the Emergency Medicine Day International survey across 81 countries” by Roberta Petrino et al., European Journal of Emergency Medicine doi: 10.1097/MEJ.0000000000001375

Contact Emma Mason if you would like an embargoed copy of the paper before publication.

Funding: The study received no external funding.

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North Macedonia Strengthens Emergency Medicine Reform with Support from EUSEM

Skopje, North Macedonia – The Minister of Health of North Macedonia, Sasho Klekovski, has reaffirmed the government's commitment to strengthening emergency medical services following a high-level meeting with representatives of the European and Macedonian emergency medicine communities.

The meeting brought together leaders from the European Society for Emergency Medicine (EUSEM) and the newly established Macedonian Association for Emergency Medicine (MZUM). Delegations were led by EUSEM President Dr Robert Leach and MZUM President Dr Vesna Krstevska.

During the discussions, Minister Klekovski outlined a series of ambitious reforms aimed at modernising North Macedonia's emergency care system and improving access to timely, high-quality emergency medical services across the country.

Among the key initiatives presented were plans to establish the Skopje Emergency Medical Service as a separate organisational unit, distinct from the existing Skopje Health Centre structure. The reform programme also envisages the introduction of a modern emergency medical services model incorporating paramedics, bringing North Macedonia closer to internationally recognised standards of emergency care.

The Ministry further announced plans for a major investment in emergency medical transport infrastructure, including the procurement of 100 new emergency vehicles, followed by an additional 50 vehicles in a second phase. These investments are intended to strengthen response capacity and improve patient access to emergency services throughout the country.

Another priority highlighted during the meeting was the reorganisation of the Emergency Centre at the Mother Teresa Clinical Centre in Skopje. The proposed changes aim to enhance patient flow, improve coordination of emergency services and support more effective delivery of acute care.

Minister Klekovski also noted that the Ministry is examining international best practices as part of the reform process. This includes studying the Slovenian model, which features a national dispatch centre, and the Romanian model, known for its specialised emergency medical services. Consideration is also being given to the development of services that currently remain outside the formal emergency care system, including mountain rescue capabilities.

Representatives of EUSEM expressed their willingness to support the ongoing reform efforts and welcomed the establishment of the Macedonian Association for Emergency Medicine. The meeting highlighted opportunities for future cooperation in areas such as professional development, standards of care, training and system development.

Commenting on the discussions, Minister Klekovski thanked both organisations for their engagement and commitment to advancing emergency medicine in North Macedonia.

"Emergency medicine is the front line of the health system, and these reforms are measured in saved lives," he said.

The meeting marks an important step in strengthening collaboration between national and European emergency medicine leaders and demonstrates a shared commitment to improving emergency care for patients across North Macedonia.

 

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Become an EBEEM Examiner! Registration is now open for the next online EBEEM Examiners Workshop

Your expertise can help shape the future of Emergency Medicine.

Registration is now open for the next online Examiners Workshop, occurring on 15 October 2026. 

Apply by: 25 Septmeber 2026

Online Workshop: 15 October 2026

Develop your expertise in:

  • Assessment and adult learning
  • MCQ development
  • Structured Oral Examination (SOE)
  • Competency-based assessment
  • Examiner collaboration and networking

As an EBEEM Examiner, you will have the opportunity to contribute to European standards in Emergency Medicine while developing your own professional and educational experience

Learn More & Apply for the Workshop Here - https://eusem.org/ebeem/ebeem-examiners

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Late & Onsite Registration for EUSEM 2026 is now available

Late & Onsite Registration for EUSEM 2026 is now available

Did you know - EUSEM 2026 is easy and convenient to get to via train:

This September, travel directly to Paris from across Europe: Brussels in around 1h20, London in 2h15, Luxembourg in just over 2hrs, Rotterdam in 2h40, Amsterdam and Cologne in around 3h20, Geneva in just over 3 hours, Basel in around 3 hours, Zürich in 4 hours, Turin in 5h30, Barcelona in around 6h50 and Milan in around 7 hours.

With direct high-speed rail connections bringing major European cities closer to Paris, getting to EUSEM 2026 is simple, comfortable and convenient. Join EUSEM 2026 for one day or more and join the Premier EM Congress in the heart of Europe this September.

Register now - https://eusemcongress.org/register/

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