One of the largest international surveys into job satisfaction among emergency department workers has revealed that while the majority found their work satisfying and rewarding, there are still many areas where improvements are needed, according to research presented at the EUSEM 2025- European Emergency Medicine Congress on 28 September 2025. The paper, “Global Job Satisfaction Among Emergency Medicine Professionals: Results from the 2025 Emergency Medicine Day Survey”, is published in the European Journal of Emergency Medicine.
We can officially announce that Dr. Michela Cascio has been elected Chair of the YEMD section with 41 votes and Dr. Alessandra Iorfida has been elected Co-chair with 24 votes.
Many congratulations to both of them and to all the other candidates for standing in the election.
Press Release: Neurological outcomes after patients suffer cardiac arrest at home are similar between low-and high-income areas in Vienna
Embargo: 00.01 hrs CEST on Wednesday 1 October 2025
Vienna, Austria: People who have a cardiac arrest in their own homes have similar neurological outcomes regardless of socioeconomic background, according to research presented at the European Emergency Medicine Congress today (Wednesday) [1].
However, the study of 676 patients who received treatment in the Department of Emergency Medicine at the Medical University of Vienna suggested that those who lived in lower-income areas may be less likely to receive cardiopulmonary resuscitation (CPR) from bystanders compared to people suffering a cardiac arrest (when the heart stops pumping blood around the body) in higher-income areas – a finding that the researchers say requires further studies to see whether it is a real effect.
The study was carried out by researchers led by Drs Jürgen Grafeneder and Christoph Schriefl at the Medical University of Vienna. They looked at outcomes for patients who experienced an out-of-hospital cardiac arrest (OHCA) and were treated in their emergency department between January 2020 and December 2022. They took data from the department’s CPR records, and looked at patients’ addresses, which they linked to electoral districts. These districts were then matched with the average household income for each area using data from Austria’s National Statistical System.
The researchers assessed neurological outcomes, such as brain damage and thinking ability, one, six and twelve months after the OHCA. They also investigated the association between these outcomes and household incomes, taking into account factors specific to each patient’s condition and any interventions or other treatments before they arrived at the hospital.
Ms Hannah Voith, a medical student at the Medical University of Vienna, presented the findings to the Congress. She said: “We found no significant association between patients’ income and neurological outcomes after an out-of-hospital cardiac arrest. For cases that happened at the patient’s home address, we divided patients’ incomes into quartiles and examined basic life support rates from bystanders across the four groups. We observed a trend towards lower rates for patients in the bottom quartile with the lowest incomes – 64% – compared to 78% for patients from the top quartile with the highest incomes, but this trend was not statistically significant.
“Even though this trend is not significant, it does suggest disparities in pre-hospital care in lower income areas, and underscores the importance of targeted public health interventions, such as expanding first aid training, to reduce inequities and improve survival after out-of-hospital cardiac arrest. Our analysis emphasises the complex relationship between social factors and emergency care outcomes, highlighting the importance of further research in this field.
“Multiple studies have established that early bystander-performed cardiopulmonary resuscitation significantly enhances both survival rates and favourable neurologic outcomes following out-of-hospital cardiac arrest.
“In addition, it is important to note that the group of patients we studied was pre-selected, as we only included patients who were admitted to the hospital. There is a high likelihood that patients who never received bystander basic life support did not enter our registry, because they died before reaching the hospital. Therefore, much of the effect of basic life support, or lack of it, would be ‘filtered out’ before our population was assembled and would not notably impact the neurologic outcomes we report.
“The results suggest that further research is needed to investigate bystander basic life support rates between varying income levels. This could help to promote basic life support training and awareness. Public health strategies that boost bystander readiness across all societal groups may help reduce disparities and improve outcomes. For policymakers, this involves investing in accessible, low-threshold education and training programmes.
She concluded: “To our knowledge, this is the first Austrian study to systematically examine the link between patients’ income and neurological outcomes after out-of-hospital cardiac arrest. It is also unique in combining detailed registry data with geosocial analysis, providing new insights into regional variations in emergency response.”
While recognising that Vienna’s infrastructure and professional preclinical emergency care network are unique, the researchers say it would be helpful to see what happens in other large cities in Austria, such as Graz. In addition, they plan to evaluate bystander basic life support rates across Vienna, investigate long-term outcomes for patients, and for patients who have received extracorporeal cardiopulmonary resuscitation – a procedure that passes a patient’s blood supply through a machine to oxygenate the blood.
Strengths of the study include its use of a large, validated registry of OHCAs in Vienna, detailed socioeconomic information, and the focus on a clinically meaningful outcome: neurological survival. Limitations include the fact that the study was observational, socioeconomic data were based on geographic area rather than on information for individual patients, and infrastructural factors, such as proximity to specialised care centres such as Vienna General Hospital, may have influenced outcomes but were not fully accounted for in the analysis.
Dr Felix Lorang is a member of the EUSEM abstract selection committee. He is head of the emergency department at SRH Zentralklinikum Suhl, Thuringia, Germany, and was not involved with the research. He said: “These findings suggest that if someone survives an out-of-hospital cardiac arrest and can be discharged from hospital, then their neurological outcomes are not affected by their socioeconomic background. We already know that the most important intervention on the way to a favourable neurological outcome is bystander CPR. However, the trend the researchers observed towards lower CPR rates in lower-income areas of Vienna definitely deserves further investigation. More education and training of people everywhere, not just in Vienna, is needed to try to improve the numbers who can offer CPR in an emergency.”
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[1] Abstract no: OA023, “The impact of socioeconomic factors on the outcome in adult out-of-hospital cardiac arrest patients – a retrospective data analysis”, by Hannah Voith. Cardio-respiratory session, Wednesday 1 October, 09:00-10:30 hrs CEST, Schubert 4.
Funding: The study was funded by the Medial Scientific Fund of the Mayor of the City of Vienna.
PRESS RELEASE: Doctors and nurses are better than AI at triaging patients
Embargo: 18.00 hrs CEST on Tuesday 30 September 2025
Vienna, Austria: Doctors and nurses are better at triaging patients in emergency departments than artificial intelligence (AI), according to research presented at the European Emergency Medicine Congress today (Tuesday) [1].
However, Dr Renata Jukneviciene, a postdoctoral researcher at Vilnius University, Lithuania, who presented the study, said that AI could be useful when used in conjunction with clinical staff, but should not be used as a stand-alone triage tool.
“We conducted this study to address the growing issue of overcrowding in the emergency department and the escalating workload of nurses,” said Dr Jukneviciene. “Given the rapid development of AI tools like ChatGPT, we aimed to explore whether AI could support triage decision-making, improve efficiency and reduce the burden on staff in emergency settings.”
The researchers distributed a paper and digital questionnaire to six emergency medicine doctors and 51 nurses working in the emergency department of Vilnius University Hospital Santaros Klinikos. They asked them to triage clinical cases selected randomly from 110 reports cited in the PubMed database on the internet. The clinical staff were required to classify the patients according to urgency, placing them in one of five categories from most to least urgent, using the Manchester Triage System. The same cases were analysed by ChatGPT (version 3.5).
A total of 44 nurses (86.3%) and six doctors (100%) completed the questionnaire.
“Overall, AI underperformed compared to both nurses and doctors across most of the metrics we measured,” said Dr Jukneviciene. “For example, AI’s overall accuracy was 50.4%, compared to 65.5% for nurses and 70.6% for doctors. Sensitivity – how well it identified true urgent cases – for AI was also lower at 58.3% compared to nurses, who scored 73.8%, and doctors, who scored 83.0%.”
Doctors had the highest scores in all the areas and categories of urgency that the researchers analysed.
“However, AI did outperform nurses in the first triage category, which are the most urgent cases; it showed better accuracy and specificity, meaning that it identified the truly life-threatening cases. For accuracy, AI scored 27.3% compared to 9.3% for nurses, and for the specificity AI scored 27.8% versus 8.3%.”
The distribution of cases across the five categories of urgency was as follows:
1 Most urgent
2
3
4
5 Least urgent
Doctors
9%
21%
29%
23%
18%
Nurses
9%
15%
35%
35%
6%
AI
29%
24%
43%
3%
1%
“These results suggest that while AI generally tends to over-triage, it may be somewhat more cautious in flagging critical cases, which can be both a strength and a drawback,” said Dr Jukneviciene.
Doctors also performed better than AI when considering cases that required or involved surgery, and in cases that required treatment with medication or other non-invasive therapies. For surgical cases, doctors scored 68.4%, nurses scored 63.% and AI scored 39.5% for reliability. For therapeutic cases, doctors scored 65.9%, nurses scored 44.5% and AI did better than nurses, scoring 51.9% for reliability.
“While we anticipated that AI might not outperform experienced clinicians and nurses, we were surprised that in some areas AI performed quite well. In fact,in the most urgent triage category, it demonstrated higher accuracy than nurses. This indicates that AI should not replace clinical judgement, but could serve as a decision-support tool in specific clinical contexts and in overwhelmed emergency departments.
“AI may assist in prioritising the most urgent cases more consistently and in supporting new or less experienced staff. However, excessive triaging could lead to inefficiencies, so careful integration and human oversight are crucial. Hospitals should approach AI implementation with caution and focus on training staff to critically interpret AI suggestions,” concluded Dr Jukneviciene.
The researchers are planning follow-up studies using newer versions of AI and AI models that are fine-tuned for medical purposes. They want to test them in larger groups of participants, include ECG interpretation, and explore how AI can be integrated into nurse training, specifically for triage and incidents involving mass casualties.
Limitations of the study include its small numbers, that it took place in a single centre, and that the AI analysis took place outside a real-time hospital setting, so it was not possible to assess how it could be used in the daily workflow; nor was it possible to interact with patients, assess vital signs and have follow-up data. In addition, ChatGPT 3.5 was not trained specifically for medical use.
Strengths of the study were that it used real clinical cases for comparison by a multidisciplinary group of doctors and nurses, as well as AI; its accessibility and flexibility was increased by distributing the questionnaire digitally and on paper; it was clinically relevant to current healthcare challenges such as overcrowding and staff shortages in the emergency department; and the study identified that AI over-triages many patients, assigning higher urgency to them, which is crucial knowledge for the safe implementation of AI in emergency departments.
Dr Barbra Backus is chair of the EUSEM abstract selection committee. She is an emergency physician in Amsterdam, The Netherlands, and was not involved in the study. She said: “AI has the potential to be a useful tool for many aspects of medical care and it is already proving its worth in areas such as interpreting x-rays. However, it has its limitations, and this study shows very clearly that it cannot replace trained medical staff for triaging patients coming in to emergency departments. This does not mean it should not be used, as it could aid in speeding up decision-making. However, it needs to be applied with caution and with oversight from doctors and nurses. I expect AI will improve in the future, but should be tested at every stage of development.”
On Monday 29 September, a colleague of Dr Jukneviciene’s, assistant professor Rakesh Jalali, from the University of Warmia and Mazury (Olsztyn, Poland), gave a presentation at the congress on the use of virtual reality to train clinical staff how to treat patients who have been subject to multiple traumatic injuries [2].
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[1] Abstract no: OA008, “Patient triaging in the ED: can artificial intelligence become the gold standard?” by Renata Jukneviciene, AI/Innovations session, Tuesday 30 September, 16:45-18:15 hrs CEST, Schubert 5 room.
[2] ‘Enhancing medical simulation training: multicenter MedEd polytrauma VR project’, by Rakesh Jalali, Multinational-multicentric research projects in 2025 session, Monday 29 September, 16:45-18:15 hrs CEST, Strauss 1 room.
PRESS RELEASE: Could nasal sprays replace needles for delivering adrenaline to anaphylactic patients?
Embargo: 00.01 hrs CEST on Tuesday 30 September 2025
Vienna, Austria: Instead of stabbing yourself, or someone else, in the thigh with a needle to deliver a dose of adrenaline to counter anaphylactic shock, would it not be easier to use a nasal spray instead?
A study presented at the European Emergency Medicine Congress today (Tuesday) shows that liquid or powder nasal sprays are as effective and sometimes even better than injection devices such as EpiPens® for delivering adrenaline [1].
Anaphylaxis is an acute allergic reaction to substances, such as nuts or insect bites or stings, and is a life-threatening emergency. A patient who goes into anaphylactic shock will often develop some or all of the following symptoms: itchy skin or a red rash, swollen eyes, hands, feet, mouth, tongue and throat, difficulty breathing, wheeze, abdominal pain, nausea and vomiting. They can collapse and become unconscious very quickly. It needs to be treated urgently with adrenaline (also known as epinephrine), usually via an injection or a drip in the patient’s vein.
Dr Danielle Furness carried out a systematic review of five, international studies comparing intramuscular-injected adrenaline devices, such as EpiPens®, with nasal sprays while she was finishing her medical degree at the University of Buckingham, UK. The studies took place in Israel, Canada, Thailand, the USA and Japan [2].
She told the Congress: “My review found that intranasal adrenaline, a needle-free alternative delivered as a liquid or dry powder spray, can be as effective as the EpiPen, with some forms reaching the bloodstream even faster.”
Dr Furness, who is now a Foundation Year 1 doctor at the Royal Derby Hospital, UK, chose to compare emerging options for anaphylaxis, such as nasal sprays, with current guidelines and the gold standard recommendations while she was studying acute care for her degree. She focused on needle-free alternatives for patients with needle phobia or other barriers to using EpiPens®.
She evaluated the safety and efficacy of the different adrenaline delivery systems, and also the pharmacokinetics – the process of how the drug moves into, through and out of the body, focusing on absorption, distribution and metabolism.
She found that absorption of the nasal sprays was comparable or even faster than injections, taking a maximum of 2.5 to 20 minutes, compared to 9 to 45 minutes for the injected adrenaline. Similar or higher levels of adrenaline were seen in blood plasma for the nasal sprays, while heart rate and blood pressure were similar between patients who received adrenaline via a nasal spray or an injection. Side effects of the nasal spray were mild and passed quickly.
Importantly, nasal sprays last longer and are more portable than injection devices. The shelf life of nasal sprays is two years, while injection devices have to be replaced every 12-18 months. The nasal sprays tend to be smaller and more portable than injection devices, such as the EpiPen®. The neffy® nasal spray is just over six centimetres long, while an EpiPen® is just over 15 cm long.
Dr Furness said: “If approved for use, nasal sprays could become a suitable and equally effective needle-free alternative to the EpiPen, which is the current treatment for anaphylaxis. Patients would still need clear instructions on how and when to use a nasal spray, but it could improve timely administration of adrenaline, especially for people who are afraid of needles, or in public, out-of-hospital settings, which could reduce the rates of hospitalisations. For doctors, it is another tool that could help prevent delays in treatment.
“I believe that once strong, real-world evidence supports the safety and effectiveness of nasal sprays, they could be incorporated into national anaphylaxis guidelines. An initial rollout should include close and strict monitoring, encouraging doctors to report any cases where it may not have worked as expected, to ensure patient safety and maintain confidence in the treatment.”
Neffy® is the first nasal spray to be approved and prescribed in the USA and Europe, including Norway and Iceland. In the UK, the Medicines and Healthcare products Regulatory Agency (MHRA) has approved it as the first needle-free emergency treatment for anaphylaxis. It is expected to become available in the UK towards the end of 2025. Licensing applications have been filed in China, Japan, and Australia, and it is under review in Canada.
Strengths of the review include that it looked at both liquid and dry powder based nasal spray, comparing them directly to the current gold standard of injected adrenaline; it investigated the effects of the different delivery systems on blood pressure and heart rate, and not just how quickly the drug entered the bloodstream; and the trials were carried out in several different countries.
Limitations include that all the studies were early, phase I trials, in which the different delivery systems are tested in healthy adults who were not experiencing anaphylaxis; some of the studies reviewed had small numbers of patients and there were differences in the doses and delivery devices tested; there are no long-term safety data yet; and it is uncertain how the nasal sprays will perform in everyday use outside of controlled trial conditions.
Dr Felix Lorang is a member of the EUSEM abstract selection committee. He is head of the emergency department at SRH Zentralklinikum Suhl, Thuringia, Germany, and was not involved with the research. He said: “Injection devices, such as EpiPens, have been in use for decades to deliver adrenaline to patients with anaphylaxis. However, some patients experience barriers to using them for reasons such as needle phobia, or how easy they are to carry around all the time. From my experience, many people also hesitate when using a needle on a relative or friend for fear of hurting or injuring the person. Nasal sprays appear to overcome these barriers and, if further studies confirm their safety and efficacy, they will be a useful alternative for patients as well as an extra tool for medical staff to use.”
