Early Bird Registration for EUSEM 2024 is NOW OPEN!

We are thrilled to announce that early bird registration for the upcoming EUSEM Congress 2024 is now open! This is your gateway to the latest advancements and insights in Emergency Medicine! You can now secure your space at a special rate and enjoy the exclusive benefits of your EUSEM membership. Don't miss out on this limited-time offer until 12 June!

Event Details:

Dates: From 12 to 13 October, Pre-courses  - From 13 to 16 October EUSEM congress sessions 

Location: Bella Center, Center Boulevard 9 - Indgang 7, 2300 Copenhagen, Denmark.

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Breaking news: Emergency Medicine Takes a New Turn in the Netherlands

On the 26 October 2023, we received the incredible news that the Dutch Society for Emergency Medicine (NVSHA) had received confirmation from the Ministry of Health that Emergency Medicine has been officially recognised as a primary specialty in the Netherlands.

This achievement has come about as a result of the hard work of NVSHA and its leadership over a sustained period of some 25 years.

EUSEM warmly congratulates the NVSHA on this remarkable achievement, which will undoubtedly bring tremendous benefits to the entire healthcare system and emergency medicine doctors in the Netherlands. 

As a society whose aim is to achieve the recognition of Emergency Medicine as a specialty across Europe we feel honoured to have the NVSHA as a member and thank NVSHA for their work. We look forward to continued collaborative work to make Emergency Medicine in Europe the best it can be.

Click HERE to read the full article in Dutch 

 

 

 

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New publication: Status of the specialty Emergency Medicine in Europe

By Wilhelm Behringer (a) and Ruth Brown (b)

aDepartment of Emergency Medicine, Medical University of Vienna, Austria and and bImperial College Healthcare NHS trust, UK
Correspondence to Wilhelm Behringer, MD, MBA, MSc, Department of Emergency Medicine, Medical University Vienna, Vienna General Hospital

Received 28 July 2023 Accepted 29 July 2023.

Extract

Emergency Medicine is a relatively young specialty in Europe [1,2]. It started in Europe 1972, when the first 30 consultant posts were established in the UK, at that time under the name Accident & Emergency medicine, which was changed to Emergency Medicine in 2004 [3]. The European Union of Medical Specialists (Union Européenne des Médecins Spécialistes, UEMS) represents hospital medical specialists within the member states of the EU, and includes 43 specialist sections representing independently recognized specialties. Continue reading....

 

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PRESS RELEASE Identifying sepsis: only two out of four recommended screening tools are useful Paramedics and emergency doctors almost never suspect sepsis

Embargo: 00.01 hrs CEST on Wednesday 20 September 2023

Barcelona, Spain: Two out of the four internationally-recommended screening tools used by emergency medical services are inadequate for recognising sepsis, according to new research presented at the European Emergency Medicine Congress today (Wednesday).

Mrs Silke Piedmont, a health scientist at the Department of Emergency Medicine Campus Benjamin Franklin Charité – Universitätsmedizin Berlin (Germany), and her colleagues from the University of Magdeburg and Jena (Germany), analysed data on 221,429 patients who were seen by emergency medical services (EMS) in Germany in 2016 outside of the hospital setting. They found that only one out of four screening tools had a reasonably accurate prediction rate for sepsis – NEWS-2 (National Early Warning Score). It was able to correctly predict 72.2% of all sepsis cases and correctly identified 81.4% of negative, non-septic, cases.

A second screening tool, qSOFA (quick Sequential Organ Failure Assessment), correctly predicted 96.6% of patients who did not have sepsis.

Mrs Piedmont said: “We found that paramedics never documented a suspicion of sepsis, and emergency services physicians rarely did so, only documenting a suspicion in 0.1% of cases. The screening tools recommended in the Surviving Sepsis Campaign guidelines differed greatly in terms of which and how many patients were identified as possibly having sepsis.”  

Sepsis, often referred to as blood poisoning, is a life-threatening condition that arises when the body’s immune system goes into overdrive in response to an infection and injures the body’s tissues and organs. It is vital to recognise it early, otherwise it can lead to shock, multiple organ failure and even death.

Speaking before the Congress, her colleague Dr Wolfgang Bauer, senior physician at the Charité, said: “In emergency care, there are good and long-established standards for the detection and treatment of heart attacks and stroke that have improved patients’ chances of survival. Unfortunately, a lot less attention is paid to sepsis and standards to improve early sepsis recognition and survival. Our study found there was a similar incidence for sepsis, 1.6%, as for heart attacks, 2.6%, and stroke, 2.7%, in cases seen by emergency medical services. However, in terms of both percentages and absolute numbers, more patients died from sepsis than from heart attacks or stroke. Out of all cases with sepsis, 31.4% died within 30 days after being seen by emergency services, versus 13.4% and 11.8% respectively for heart attacks and stroke. These findings emphasise the need for better sepsis awareness and more frequent use of effective screening tools.”

Mrs Piedmont and colleagues say the Surviving Sepsis Campaign guidelines about which sepsis screening tool is the most reliable for use by EMS are not specific enough and are based on little, useful evidence. The aim of the current study was to assess which of four screening tools was best for EMS to predict sepsis – NEWS-2, MEWS (Modified Early Warning Score), SIRS (Systemic Inflammatory Response Syndrome) or qSOFA.

The study linked data on 221,429 cases with follow-up between 2016 and 2017 from ten health insurance companies with information from documentation by paramedics and emergency doctors on 110,419 cases in 2016. This enabled the researchers to calculate the four screening tools’ ability to predict that a patient had sepsis. The predictions were confirmed or rejected during subsequent hospital investigations after contact with EMS. The researchers also looked at incidence and death rates for sepsis compared to heart attack and stroke, how much was recorded about any suspicions of sepsis, and how often EMS staff would have documented sepsis if they had used screening tools.

When they compared the performance of the four screening tools, the researchers found that NEWS-2 was the best for identifying patients with sepsis as it had a sensitivity (correctly predicted sepsis) of 72.2%, followed by MEWS, which had a sensitivity of 46.8% and a specificity (correctly predicted no sepsis) of 88.4%, SIRS (30.4% sensitivity, 93.8% specificity), and qSOFA (24% sensitivity, 96.6% specificity). Out of all EMS cases, 24.3% of cases were predicted to have sepsis by at least one of the screening tools, but only 0.9% were predicted to have sepsis by all four tools simultaneously.

“The incidence and death rates for sepsis and the low recognition of it, emphasise the need for better awareness and more frequent use of screening tools,” said Mrs Piedmont. “No screening tool provides ideal performance. NEWS-2 best supports emergency medical services in identifying most patients with sepsis. EMS patients that are NEWS-2 positive should be flagged up as potentially having sepsis and referred for special attention and assessment by emergency doctors who are expert in sepsis. If EMS insist on using the qSOFA, they should be aware that a positive qSOFA makes sepsis likely, but also, that a negative qSOFA cannot rule out sepsis conclusively.

“A rule of thumb for EMS staff could be that NEWS-2 negative patients are the most likely not to have sepsis, and qSOFA positive patients are the most likely to have sepsis – and also that qSOFA misses many patients with sepsis. Further clinical patient assessment and evaluation will always be needed for both tools. Future sepsis guidelines should be more precise and omit recommendations for MEWS and SIRS for emergency medical services since they were inferior in all the measures for accuracy.”

The researchers say these findings could also apply to other countries, especially as studies in Canada and the UK support aspects of their results [2,3]. “Ours is the first study comparing all four screening tools and showing the predictive usefulness of applying the screening tools to all adult patients independently of any presumptions or preliminary diagnoses by emergency medical services,” said Mrs Piedmont.

There were two things that could be improved, say the researchers: better and complete assessments of vital signs, such as body temperature and breathing rate; and “translating” alarming vital signs into a suspicion of sepsis, which could be helped by using a good sepsis screening tool.

“Sepsis causes approximately 20% of all global deaths,” said Mrs Piedmont [4]. “There is great potential to save lives and maintain patients’ quality of life if sepsis is recognised and treated earlier. As most sepsis cases start outside of hospital, emergency medical services play a vital role. They can shorten the length of time until sepsis treatments can be provided quickly in hospitals and reduce the risk of dying if they suspect sepsis.

“In addition, it’s crucial that the public’s awareness of sepsis is increased, by integrating it into education systems and through media campaigns. Patients ought to know the variety of sepsis symptoms, how urgent it is to call for prompt help and to ask the question ‘Could it be sepsis?’. As sepsis prevention is even better than early detection, they should also be aware of preventive measures such as hygiene and vaccination.”

The researchers hope their findings will inform new guidelines on sepsis that are being drawn up in some countries so as to give more specific recommendations for sepsis screening. More research is also needed to improve screening tools and to assess the real-world effects of screening tools on patients with and without sepsis.

Professor Youri Yordanov from the St Antoine Hospital emergency department (APHP Paris), France, is Chair of the EUSEM 2023 abstract committee and was not involved in the research. He said: “Sadly, we too often see patients being brought into hospital emergency departments with advanced sepsis. Some of them we can save, but unfortunately some will die who could have been saved if they had received treatment at an earlier stage. Emergency services need tools that can help them quickly and accurately predict that a patient may have sepsis and should be investigated further in hospital. This study shows that more needs to be done to develop such tools and improve the existing ones. Only then will we be able to bring down the death rates from sepsis.”

(ends)

[1] Abstract no: OA97, “Sepsis screening by Emergency Medical Services - Why recommendations of the Surviving Sepsis Campaign are too unspecific. Results from a cohort study,” by Silke Piedmont, in the oral abstract session “Pre-hospital and EMS”, 10.35-12.00 hrs CEST, Wednesday 20 September in the VIP room.  https://shorturl.at/guwJR

[2] Lane DJ, Wunsch H, Saskin R, Cheskes S, Lin S, Morrison LJ, Scales DC. Screening strategies to identify sepsis in the prehospital setting: a validation study. CMAJ. 2020a;192:E230-E239. doi:10.1503/cmaj.190966.

[3] Scott LJ, Redmond NM, Garrett J, Whiting P, Northstone K, Pullyblank A. Distributions of the National Early Warning Score (NEWS) across a healthcare system following a large-scale roll-out. Emerg Med J. 2019;36:287–92. doi:10.1136/emermed-2018-208140.

[4] Rudd KE et al. Global, regional, and national sepsis incidence and mortality, 1990-2017: analysis for the Global Burden of Disease. Lancet 2020; 395: 200-11. doi: https://doi.org/10.1016/ S0140-6736(19)32989-7.

Note: When obtaining outside comment, journalists are requested to ensure that their contacts are aware of the embargo on this release.

 

Funding: The data were acquired as part of the project “Integrated emergency care: A focus on emergency medical services” (http://rettungsdienst-im-fokus.ovgu.de) which was funded by the German Innovation Fund of the Joint Federal Committee (G-BA) (funding identifier: 01VSF17032). The funder had no influence on the published results. All authors have no conflict of interest to declare.

 

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PRESS RELEASE Patients visiting emergency departments because of alcohol abuse are more likely to make return visits and to die in the following decades

Embargo: 00.01 hrs CEST on Tuesday 19 September 2023

Barcelona, Spain: People who come to emergency departments with alcohol-related diseases or conditions are more likely to make return visits and to die in the following 20 years, than people who come to emergency departments for other reasons, according to new research. For many, this means they may die in their 40s or 50s.

Professor Drew Richardson told the European Emergency Medicine Congress that he and his colleagues had followed 194 patients who had alcohol-related diagnoses when they arrived in the emergency department of The Canberra Hospital in 2002. They compared them with a control group of 194 patients who had diagnoses unrelated to alcohol, and they followed both groups until 2022.

“The group of patients with alcohol-related diagnoses made 44% more visits over the next decade and had a 138% higher death rate over the following 20 years, than the control group,” said Prof. Richardson, who is Professor of Emergency Medicine at Australian National University, Canberra, Australia. “The true death rate may be higher because we lost some patients during the follow-up period. After nearly 14 years, the percentage of patients lost to follow-up was similar for both groups: 40.2% for the alcohol-related cases and 39.2% for the controls.

“There was a wide variety of reasons these patients came to our emergency department, including alcohol withdrawal symptoms, trauma-related injuries, and acute alcohol intoxication.

“If these patients could be targeted by trained professionals while they are in the emergency department to educate them about the consequences of alcohol use, and to offer them assistance in moderating their alcohol consumption, it might be possible to reduce this significant health burden. Presentations related to alcohol consumption are a major burden in emergency departments.”

The study was initiated by one of Prof. Richardson’s medical students, Ms Regan Lim, who had personal family experience of the effects of alcohol and wanted to investigate further.

“Chronic and excessive consumption of alcohol has been a long-standing problem in our society. Emergency departments are the first point of contact for the many consequences of alcohol-related harm. Alcohol-related cases make up 9.5%-15.2% of presentations to emergency departments, and 8.3%-17.9% of emergency department occupancy in Australasia,” said Prof. Richardson.

The researchers analysed the number of patients who came to the emergency department between 1998-2002 (the period before the study started), 2003-2012 (the decade after) and 2013-2022 (the second decade after). The patients with alcohol-related diagnoses had made 522 presentations to the emergency department before the start of the study, compared to 389 for the patients in the control group. In 2002, the numbers were 437 compared to 399, respectively. In the first decade after, they were 1226 compared to 846 respectively. In the second decade, there was a smaller difference due to the numbers lost to follow-up: 820 compared to 673 presentations respectively.

Just over half (56%) of the patients in the alcohol group were male, the median (average) age was 28, and they were usually put into Triage Category 3, which meant they had potentially life-threatening conditions and needed treatment within 30 minutes. The majority (64%) presented in the emergency department in the late evening and over night, between 20:00 hours and 06:00 hours.

During the follow-up period, 44 patients died, of which 31 were patients with alcohol-related diagnoses who died a median of eight years after 2002, and 13 were from the control group, who died a median of 13 years after 2002.

Prof. Richardson said: “Society and policy-makers should recognise the major role that alcohol plays in illnesses and death in our community, and the need for preventative measures. Alcohol consumption is a significant part of Australasian society, but this study shows that consumption that leads to a visit to a hospital’s emergency department is extremely risky in the long term.

“We have been studying the effects of alcohol presentations in emergency departments for over a decade. The next logical step is a long-term trial of an alcohol intervention programme in the emergency department to see if this really does reduce burden of drink-related effects on patients and hard-pressed emergency staff.”

Professor Youri Yordanov from the St Antoine Hospital emergency department (APHP Paris), France, is Chair of the EUSEM 2023 abstract committee and was not involved in the research. He said: “This study shows a pattern that is familiar to many of us working in emergency departments around the world: alcohol abuse is responsible for a large proportion of patients vising emergency departments. Not only does this place significant burdens on emergency departments that are already over-stretched for a variety of reasons, including ageing populations and under-funding, but it shortens people’s lives too. Initiatives to intervene at an early stage to help prevent repeat visits to emergency departments and the problems associated with alcohol abuse would be very welcome and we look forward to seeing the results of further studies into this.”

(ends)

[1] Abstract no: OA110, “Long term outcomes after alcohol-related presentation to ED” by Drew Richardson, in the “Education, training and toxicology” oral session, Tuesday 19 September at 11.05-12.30 hrs CEST, Room 131. https://cm.eusem.org/cmPortal/Searchable/EXA/config/normal/redirectconfig/normal/redirectconference/EUSEM23#!sessiondetails/0000014290_0

Note: When obtaining outside comment, journalists are requested to ensure that their contacts are aware of the embargo on this release.

 

Funding: The research was supported by the Australian National University which provides time for all first-year medical students to undertake a research project. 

 

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