PRESS RELEASE: Unplanned, premature, out-of-hospital births pose challenges for emergency teams
First study of these births in Austria highlights how to improve outcomes

Embargo: 00.01 hrs CEST on Monday 29 September 2025

Vienna, Austria: The first detailed analysis of unplanned births that occurred outside the hospital setting in Austria has shown that, although such deliveries are rare, they pose challenges for emergency teams that attend, especially if babies are born prematurely [1].

In a study presented at the European Emergency Medicine Congress today (Monday), the researchers found that between 2017 and 2024 there were 173 unplanned, out-of-hospital births in the Styria region of Austria, of which 16 (9%) were premature (less than 37 weeks’ gestation). The most premature was born at 26 weeks’ gestation, weighing 845g, and four babies (25%) died around the time of birth.

Now, the team plan to identify regional differences in the rest of Austria, evaluating the preparedness of emergency teams, and assessing outcomes for both mothers and newborns.

Ms Helena Leonhartsberger, a medical student and research team member in the neonatology department at the Medical University of Graz, Austria, who also volunteers as a paramedic with the Austrian Red Cross, told the congress: “Our study is the first to document the frequency of out-of-hospital, unplanned, premature deliveries and the associated complications. We concluded that standardised emergency protocols and early involvement of specialised neonatal transport teams are crucial for improving outcomes.

“Most emergency physicians are not specialised in paediatrics or, more specifically, in neonatology. Although these scenarios are rare, emergency teams must be adequately trained and prepared to handle them. Furthermore, appropriate equipment for treating newborns, particularly premature or critically ill neonates, should be available on all emergency vehicles.”

“We also plan to use these findings to improve training for emergency personnel and to recommend what neonatal emergency equipment should be made available and standardised on all Austrian emergency vehicles, ensuring consistent care nationwide.”

Ms Leonhartsberger decided to research this topic after she attended an out-of-hospital birth as a paramedic during her first year of training.

“I was unprepared for the situation, but fortunately, everything went well,” she said. “This led me to study pre-hospital deliveries of premature infants, aiming to explore how emergency teams can be better prepared for such high-risk situations and improve outcomes for these vulnerable patients.”

The study, which was led by Professor Bernhard Schwaberger, deputy head of the clinical department of neonatology at the Medical University of Graz, found that the median age of babies born prematurely out of hospital was 35 weeks’ gestation, with a median birth weight of 2390g.

Among the four babies that died, no resuscitation was attempted in two. One premature baby underwent successful pre-hospital resuscitation and intubation. Of the 12 surviving preterm infants, one required initial bag-mask ventilation and subsequent nasotracheal intubation by a neonatal intensive care team, and another received oxygen via face mask. Ten babies were able to breathe spontaneously.

The researchers found that the temperatures of the babies were recorded in only six of the 13 babies that were admitted to hospital, and the median temperature was 34.8°C; the lowest recorded temperature was 31.5°C.

Ms Leonhartsberger said: “Admission temperature is a key prognostic factor, yet this was not documented for all the babies, and when it was, the babies were often found to be hypothermic.

“Our findings underscore the need for national preparedness, not only through standardised protocols but also through ongoing training and appropriate equipment on all emergency vehicles. They also highlight the importance of public awareness, reinforcing that, while planned home births may be safe under ideal conditions, complications can arise quickly and unpredictably. The research supports the broader goal of improving maternal and neonatal outcomes by ensuring that every birth, regardless of location, receives the highest standard of emergency care.”

A strength of the study is the detailed analysis of premature births outside of hospitals. The main limitation is the small number of cases and the fact that it focuses on one region of Austria so the finding may not reflect the situation in other areas. This is why the researchers now plan to analyse data in other regions.

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: “Premature deliveries always require careful medical supervision in hospital and will be performed by a highly trained and diverse team of experienced professionals to reduce any serious risk to both mother and baby. When these premature births take place out of the hospital setting in the unprepared environment of a household or an ambulance with a smaller team they present an even more significant challenge. Even though they are rare, they require preparation and the training that is part of the so-called HALO procedures: High-Acuity Low Occurrence.

“Helena Leonhartsberger’s study shows, for the first time, the incidence of such births in one region in Austria, and how there were variations in how these births were managed. For instance, temperature management is a very important factor for the efficacy of further treatments. In this highly stressful setting, unfortunately only six out of the 13 babies admitted to hospital had their temperatures recorded, despite the importance of this intervention. It is crucial to identify the incidence and management of premature, unplanned, out-of-hospital deliveries, not just in other areas of Austria but also in other countries. This will enable planning to ensure that all emergency medical services adhere to agreed protocols, and that they have swift access to specialist neonatal equipment for treating and transporting premature babies to hospital.”

(ends)

[1] Abstract no: OA122, “Pre-hospital emergency care for preterm infants after unplanned out-of-hospital deliveries: a retrospective case series from Styria, Austria (2017–2024)” by Helena Leonhartsberger, Pre-hospital session, Monday 29 September, 11:00-12:30 hrs CEST, Schubert 4 room.

Funding: The study received no funding.

PRESS RELEASE: EM workers report job satisfaction, though burnout and staff retention remain major problems

Embargo: 00.01 hrs CEST Sunday 28 September 2025

Vienna, Austria: 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 European Emergency Medicine Congress today (Sunday) [1]. The paper, “Global Job Satisfaction Among Emergency Medicine Professionals: Results from the 2025 Emergency Medicine Day Survey”, is published today in the European Journal of Emergency Medicine. [2]

The survey, conducted by the EUSEM Emergency Medicine Day Working Group, received responses from 1,112 healthcare providers in 79 countries, and represents one of the largest and most comprehensive global assessments of emergency medicine (EM) workforce well-being to date. EM professionals face persistent challenges including excessive workloads, high pressure, shift/night work and emotional stress. While job satisfaction is essential for workforce sustainability, quality of patient care and staff retention, international data on this topic remain limited.

The average satisfaction score among participants was 25.37 out of 36 and reflected a generally positive sentiment, but Professor Luis Garcia-Castrillo from the Marquès de Valdecilla University Hospital, University of Cantabira, Santander, Spain, says career development opportunities, work organisation, and workload received relatively low scores.

“These are areas where action is needed urgently if specialist staff are to be retained and new team members recruited,” he says.

EM professionals working in high-volume emergency departments that received more than 100,000 visits a year reported significantly lower job satisfaction, as did those in mid-career with between five- and 20-years’ experience. While satisfaction did not vary significantly by gender, academic role, or hospital type, the survey highlights that nurses and paramedics reported higher satisfaction levels than physicians, particularly in workload and organisational aspects.

“Co-worker support, organisational commitment, and professional fulfilment were the most positively-rated factors. We also found that respondents intending to stay in their current role over the next year had significantly higher satisfaction scores, and this emphasises the important link between well-being and staff retention,” says Prof Castrillo.

“The very nature of EM means that it places high demands on staff, but we have shown that with professional support, good team work and a sense of purpose, such demands do not inhibit their enthusiasm for their work. But we cannot emphasise enough that strategies are needed to strengthen leadership, support mid-career staff, improve work-life balance and create clear professional growth opportunities. There are urgent red flags around the incidence of burnout, especially in departments with a very high patient demands,” says the paper’s first author, Professor Roberta Petrino, from the Ente Ospedaliere Cantonale, Lugano, Switzerland.

The team plans to publish additional findings and to conduct further analyses of the data, including differences between countries and systems.

Emergency Medicine Working Group Chair, Dr Basak Yilmaz, from the Emergency Medical Services of Burdur Provincial Health Directorate, Burdur, Turkiye, says: “Our data are already sufficient to be useful to local and national EM bodies as a benchmark for improving staff retention and care quality. One of our most striking findings is the strong correlation between job satisfaction and professional retention. This is important, not just for individual staff members, but also for the sustainability of the EM system as a whole.”

(ends)

[1] “Emergency Medicine is a happy journey: the results of a global survey”, Emergency Medicine Day session, Sunday 28 September, 16:30 - 18:00 hrs CEST, Strauss rooms 2+3.

[2] DOI: 10.1097/MEJ.0000000000001272

Click Here to access the Journal

How ready is Europe for the next crisis? From pandemics to mass casualties, and even the realities of wartime medicine, the Presidential Sessions bring together global experts to share hard lessons, bold strategies, and a vision for a safer, more resilient Europe.

EUSEM2025: Exclusive Presidential Sessions 

Presidential Session #1

Sunday, 28 September | 16:30 – 18:00 | Schubert 4

Moderators:

• Robert Leach (Tournai, Belgium)

• Judith Tintinalli (Pittsboro, North Carolina, U.S.A.)

This first presidential session brings together international leaders to explore how Europe can strengthen emergency care and crisis response in the face of future challenges. Topics will include the World Health Organization’s vision for emergency care in Europe, lessons learned from managing mass casualties during the COVID-19 pandemic, and the European Union’s preparedness strategy for major health and security crises.

Speakers:

• Lee Wallis (Switzerland) – The WHO’s vision on Emergency Care for a future Europe

• François Braun (France) – Future mass casualty events: Lessons learned from the management of COVID-19 – France’s strategy

• Hans Das (Belgium) – The EU’s Preparedness Strategy: How Prepared is Europe?

Presidential Session #2

Monday, 29 September | 14:45 – 16:15 | Schubert 4

Moderators:

• Judith Tintinalli (Pittsboro, North Carolina, U.S.A.)

• Robert Leach (Tournai, Belgium)

The second presidential session shifts the focus to Europe’s readiness for conflict and large-scale crises. Experts will address the capacity of European healthcare systems to provide medical support during wartime, examine the role of NATO’s Joint Health Group, and discuss the European Union’s mechanisms for handling health crises at the supranational level.

Speakers:

• Gen Petter Iversen (Denmark) – Are European healthcare systems prepared to support large-scale combat operations and give medical care in wartime?

• Raed Arafat (Bucharest, Romania) – What is the role of the Joint Health Group at NATO?

• Lorena Boix Alonso (Canary Islands) – Dealing with health crises at EU level

Stay Safe – Don’t Get Scammed! 

We’ve been made aware of fraudulent websites and agencies claiming to handle registration and hotel bookings for the EUSEM Congress.

The ONLY official website for registration and accommodation is:
www.eusemcongress.org

To protect yourself:

• Always double-check the URL
• Do not share payment details with unofficial providers
• Contact us directly if you have any doubts

Help us spread the word so our community stays safe! 

Sepsis remains a significant health concern across Europe, affecting an estimated 3.4 million individuals annually. The incidence rates are on the rise, with in-hospital mortality reaching approximately 24%, making sepsis one of the leading causes of death in European hospitals. Most patients diagnosed with sepsis are identified upon hospital admission, with over 80% receiving initial assessment and treatment in emergency departments (EDs). This highlights the critical yet challenging role of EDs in managing sepsis effectively.

In response, the Surviving Sepsis Campaign (SSC) introduced sepsis bundles in 2004 to streamline treatment protocols. These bundles, designed to prioritize key resuscitation measures, have evolved over time—from a 6-hour completion window to a 3-hour window, and most recently, a 1-hour bundle in 2018. While emphasizing timely intervention, these changes have increased pressure on emergency medicine physicians, especially since many patients are not transferred immediately to intensive care units (ICUs). Consequently, ED staff often need to implement all elements of the sepsis bundle, including fluid administration, blood culture collection, antibiotic therapy, lactate measurement, and vasopressor use, sometimes extending to complex ICU-level care when transfers are delayed.

The European Society for Emergency Medicine (EUSEM) has expressed concerns about the feasibility of the 1-hour bundle, warning that strict time constraints could disrupt ED workflows. They advocate for focusing on evidence-based practices rather than rigid timing. Achieving timely treatment remains a challenge, particularly in elderly patients or those with nonspecific symptoms, and is compounded by overcrowded EDs with stretched resources. These factors contribute to variability in sepsis management across Europe.

Understanding how EDs implement sepsis protocols is crucial for identifying gaps and barriers. Such insights can support targeted training, resource allocation, and improved monitoring, ultimately enhancing sepsis care across European hospitals.

A recent survey ⁽¹⁾ conducted by EUSEM involved 402 EDs from 28 countries. Results showed that while most EDs (72.5%) had a sepsis protocol, fewer implemented regular monitoring or structured training. The majority found the 1-hour bundle challenging to execute, with only 55% completing all elements within the timeframe. Major barriers included high patient volumes, staffing shortages, and inconsistent sepsis definitions, which delayed recognition and treatment. Concerns about increased broad-spectrum antibiotic use following the bundle's implementation also emerged, underscoring the need for balanced antimicrobial stewardship.

Overall, the survey provides a benchmark for current practices and highlights areas for improvement, such as enhanced training, better monitoring systems, and adherence to evidence-based guidelines. Addressing these issues is essential for improving sepsis outcomes in European emergency departments.

(1) Current sepsis management practices in European emergency departments: the ISG-emergency department European Survey

Bolanaki, Myrto; Kurland, Lisa; Brabrand, Mikkel; Daniels, Ron; Govender, Kiren; Hanses, Frank; Innocenti, Francesca; Lassen, Annmarie; Martin-Loeches, Ignacio; Möckel, Martin;

European Journal of Emergency Medicine ():10.1097/MEJ.0000000000001255, July 11, 2025. | DOI: 10.1097/MEJ.0000000000001255 (https://journals.lww.com/euro-emergencymed/fulltext/9900/current_sepsis_management_practices_in_european.187.aspx)

Sharpen your clinical decision-making with Better Thinking in EM Practice, an accredited short eCourse from EUSEM.

Watch the engaging webinar which explores the role of cognition in diagnosis—how it works, where it fails, and how we can improve it.

Ideal for all healthcare professionals involved in patient care, the course provides practical insights into:

• The causes and impact of diagnostic error in Emergency Medicine

• A clear theoretical model of clinical cognition

• Strategies to enhance thinking and reduce diagnostic mistakes

• Steps to positively change clinical practice

After viewing the webinar, test your knowledge with MCQs and earn your certificate of completion. Gain valuable tools to think better, diagnose smarter, and improve patient outcomes.

Click Here to check it out now on our EUSEM Academy Page.