PRESS RELEASE

Embargo: 00.01 hrs CEST on Tuesday 15 October 2024

Research explains why some cyclists don’t wear helmets and what might convince them to wear one

Copenhagen, Denmark: Wearing a helmet can prevent brain injury and deaths in cyclists, yet many do not wear a helmet. New research presented at the European Emergency Medicine Congress today (Tuesday) suggests that this is largely due to issues of convenience and comfort. [1]

The study also suggests that more adult cyclists would wear helmets if they were encouraged and incentivised to do so, for example if they were provided with a free helmet, education, and periodic reminders.

The research was presented by Dr Steven Friedman, an emergency doctor at Toronto General Hospital and associate professor at the University of Toronto, Canada. He said: “Towns and cities need to create protected routes and infrastructure for people to get around safely on bikes. However, crashes will still occur, and helmets are important for preventing cycling-related head injuries.

“As an emergency physician, I frequently see injured adult cyclists and many of them were not wearing helmets at the time of the crash. I wanted to understand why some cyclists don’t wear helmets and to empower more cyclists to consistently wear a helmet.”

Dr Friedman carried out a review of previous research looking at non-legislative measures to get more adult cyclists to wear helmets [2]. Although the evidence he found was limited, it suggested that cyclists are more likely to use a helmet, given the right encouragement.

He then tested out a set of incentives to see if they would persuade more cyclists to wear helmets. A group of 72 injured cyclists, who had not been wearing a helmet and were treated at Toronto General Hospital, took part in the research. Their ages ranged from 18 to 68 years and there was an even split of women and men.

All participants were asked about their cycling habits. The majority said they planned to cycle on the day they were injured and that they cycled most days outside of the winter months. However, most said they never or rarely wore a helmet (76%), even though very few thought that helmets were unnecessary or ineffective, and around half believed that cycling in Toronto is dangerous.

Female cyclists were marginally more likely to report wearing a helmet most of the time or always when cycling on their own bike. Women and men gave broadly the same reasons for not wearing a helmet, with the most common being that they did not own a helmet, that it was inconvenient, or that it was uncomfortable.

Approximately one third of the injured cyclists were randomly assigned to a protocol to promote wearing a helmet with the others randomised to be controls. The protocol included: an explanation of the value of wearing a helmet given by the study research coordinator, a voucher to get a free helmet, scheduled email reminders with brief survey regarding helmet use, a social media group, and the opportunity to refer a friend for a free helmet after a year.

All participants were asked to complete questionnaires over the following 12 months to see whether or not they were using bike helmets.

Half of those given a voucher for a free cycle helmet redeemed their voucher. Although many participants were no longer responding to the questionnaires after a year, of those who did (17 out of the 72 people), 75% of cyclists given the incentives said they always wore a helmet, compared to 22% of controls.

Dr Friedman said: “This research helps us better understand who are the cyclists that end up in our emergency department and why they are not wearing helmets, and it enabled us to try a new protocol to promote sustained helmet use.

“The people we treated in this study were frequent commuter cyclists making planned trips, who generally do not regard cycling in the city as safe yet chose not to wear helmets for reasons largely related to convenience and comfort. Initiatives to increase helmet use should address these perceived barriers, and further explore cyclists’ perceptions of the risk of injury and death. The interventions we tested, which are based on principles of adult education and behavioural economics, may be effective for achieving sustained helmet use in adult cyclists. We now need larger studies to confirm our findings and refine our protocol.”

Dr Barbra Backus is chair of the EUSEM abstract selection committee. She is an emergency physician in Rotterdam, The Netherlands, and was not involved with the research. She said: “Cycling is generally very good for our health, and an increased use of bikes instead of cars helps to reduce air pollution and to tackle climate change. Safe cycling is important and depends both on crash prevention – with better cycling infrastructure – and appropriate use of helmets to minimise injuries when crashes do occur.

“This research helps us understand why cyclists don’t wear helmets and what might promote them to choose to do so. When cyclists are seen in the emergency department following a collision, that’s a unique opportunity for doctors to explain why helmets are important, and this study suggests that such an intervention may be effective. I hope that future research will verify and build on this work to help make cycling safer for everyone.”

(ends)

[1] Abstract no: POS0545, “HEADSTRONG: Twelve month follow-up of a program to characterize and promote sustained bicycle helmet use” by Steven Friedman, poster presentation session.

[2] Abstract no: POS0546, “Promoting helmet use in adult cyclists: a scoping review of non-legislative interventions” by Steven Friedman, poster presentation session.

Funding: This project received an unrestricted research grant from the Dr Tom Pashby Sports Safety Fund.

Dr Brenda Varriano received funding as a summer research student from the University Health Network STAR-EM Program.

About European Society of Emergency Medicine (EUSEM)

Embargo: 00.01 hrs CEST on Monday 14 October 2024

Three key signs of major trauma could speed up treatment of severely injured children brought to emergency departments by carers not ambulances

Copenhagen, Denmark: Severely injured children who are brought to an emergency medical department by their parents or carers are often not seen as quickly as those who arrive at hospital via ambulance, according to findings presented at the European Emergency Medicine Congress today (Monday). [1]

The study’s researchers identified three key trauma features that should prompt doctors to review these patients immediately and potentially prioritise their treatment: boggy swelling to the head, abdominal bruising, and thigh swelling or deformity.

The study was carried out in an inner-city level 1 major trauma centre, the Bristol Royal Hospital for Children, Bristol, UK, and show that children brought in by carers were seen by emergency doctors within an average time of 58.5 minutes, ranging from 3 to 168 minutes [2].

Dr Robert Hirst, who led the study, believes the findings could be applicable to other centres that have similar pre-hospital and urgent and emergency care systems, especially as little is known generally about this group of patients.

Dr Hirst, who is an emergency medicine registrar at the hospital, told the Congress: “We see many injured children brought to the paediatric emergency department each year. Most are transported by ambulance which results in pre-hospital emergency services pre-alerting the emergency department to their arrival. This leads to early trauma team activation, resulting in specialist services and resources being ready and prepared to see these patients as soon as they arrive. This has been shown to be associated with better outcomes for children with significant injuries.

“However, we know there is a group of children who are brought by their carers who do not receive this rapid activation of resources. This can lead to delays in the appropriate level of care being provided. We wanted to find out more about these patients, their ages, the types of injuries they present with, and what happens to them. At present, little is known about this particular group of patients.”

A level 1 major trauma centre is an emergency medical centre that treats injuries that are so severe they are life-altering with a risk of death or disability, and which need immediate medical attention. Injuries can include fractures and head injuries.

Dr Hirst and colleagues looked at children aged younger than 16 years who were brought to the emergency department between 5 August 2020 and 6 May 2022 by carers, without activation of pre-hospital emergency services. During this time, 153 children with major traumas arrived; 24 of them had injuries significant enough to be added to the national Trauma Audit and Research Network (TARN) database and were included in the study. None of them received trauma team activation. All the patients still received appropriate care for their injuries, and none suffered any detrimental effects from being brought to the children’s emergency department by their parents or carers, rather than by ambulance.

The average age of the children was just over six years, and 18 (75%) were boys. Nearly all of them (23, 95.8%) had injuries to one part of their bodies, and most (22, 92%) had obvious external evidence of injury. The majority (13, 54%) had head injuries, eight (33%) had injuries to their arms or legs, and three (12.5%) had intra-abdominal injuries.

The median Injury Severity Score (a scale that measures and categorises injuries to different areas of the body) was 9, and six patients (25%) scored over 15, meaning these were injuries significant enough to be classified as major trauma. Ten (42%) of children required surgery, with seven requiring surgery for a broken thigh bone, and three needing neurosurgery to evacuate blood from swellings around the brain or to correct skull fractures. No children died.

The injuries resulted from falls (12, 50%), sporting injuries (6, 25%), bicycle injuries (2, 8%), being dropped (1, 4%), or were unexplained (3, 12.5%).

Dr Hirst said: “As always with all paediatric injuries, it is important to be aware of the possibility of non-accidental injury. Concerns for non-accidental injury were confirmed in three of our patients, all under the age of one. Consideration of non-accidental injury, robust safeguarding processes, and regular multidisciplinary governance review is vital to safeguard children attending the emergency department.”

He continued: “The most important issue highlighted in our study is a group of severely injured children facing delays to be seen by expert emergency doctors. If emergency departments adopted triage alerts for the three major signs identified by this study – boggy swelling of the head, abdominal bruising, and thigh swelling or deformity – this could prompt an urgent senior clinician review. This could improve management of this particular group of children by triggering trauma teams and appropriate allocation of resources for this high-risk population.”

Dr Hirst and his colleagues are improving processes in their department so that injured children with external evidence of injury are reviewed promptly by a senior clinical decision-maker.

“We will reassess the impact of these changes on our key performance indicators and outcomes for these children,” he concluded.

Dr Barbra Backus is chair of the EUSEM abstract selection committee. She is an emergency physician in Rotterdam, The Netherlands, and was not involved with the research. She said: “If pre-hospital emergency services have not been activated for a severely injured child, then it’s possible that the carer or emergency department medical staff may not recognise the severity of the injury immediately. This is why adoption of triage alerts for the three key features identified in this study could make a significant difference to how quickly these patients are reviewed by a senior clinician and, potentially, to their outcomes.

“Although health systems and procedures for dealing with paediatric patients who arrive at emergency medical departments by means other than an ambulance may vary from centre to centre and country to country, the findings from this study deserve close attention by emergency departments everywhere.”

(ends)

[1] Abstract no: OA004, “Identifying the walk-in wounded: a case series of paediatric major trauma patients self-presenting to a paediatric major trauma centre” by Robert Hirst et al., in the Best Abstracts oral session, 09:00-10:30 hrs CEST, Room 19.

[2] Children arriving by ambulance, or where the emergency department has been alerted before their arrival, are usually seen immediately.

Funding: This study received no funding.

About European Society of Emergency Medicine (EUSEM)

PRESS RELEASE

Embargo: 16:30 hrs CEST on Sunday 13 October 2024

Climate change is a health emergency too

International experts warn of impact on emergency medical services worldwide

Copenhagen, Denmark: International experts in emergency medicine have warned that climate change is likely to have a severe impact on emergency services around the world. Despite this, few countries have assessed the scale of the impact or have a plan to deal with it.

In a special session at the European Emergency Medicine Congress today (Sunday), Luis Garcia Castrillo, a professor in emergency medicine, now retired, at the Hospital Marqués de Valdecilla, Santander, Spain, described how he and colleagues from EUSEM’s Emergency Medicine Day working group had asked 42 focus groups, consisting of experts in emergency medicine, prehospital care and disaster medicine, in 36 countries in 13 UN regions of the world to complete a survey on climate change awareness and preparedness [1]. The research is due to be published in the European Journal of Emergency Medicine [2].

“On a scale of 0 to 9, they rated the severity of the impact of climate change on health systems and specifically on emergency care, both now and in the future, at an average of 7,” he said. “This is a high figure, especially as some regions, such as northern Europe, consider it to be less of a problem than do other countries, such as Australia.

“The focus groups considered that the impact of climate change on emergency medical services would be similar or even higher than on global health systems. However, only 21% of the focus group members reported that assessments of the effect of climate change on emergency medical services had been carried out, and only 38% reported any measures had been taken to prepare for the impact of climate change .

“Out of all the focus group respondents, 62% said their governments or policy makers had made no assessment of the impact of climate change on emergency services, 9% said they didn’t know, 55% said nothing had been done to prepare for the impact of climate change, and 10% didn’t know.

“It is surprising how awareness is lacking in so many countries, as well as among emergency medicine societies. Some countries do not seem to be concerned at all. Yet this is going to affect rich and poor countries alike.”

Dr Roberta Petrino, director of the Emergency Department at Ente Ospedaliero Cantonale, Lugano, Switzerland, co-chaired the session “Climate change is a health emergency too”, and is a co-author of the report.

She said: “One interesting finding is that the need to implement actions to mitigate climate change is considered important everywhere. In particular, our survey showed the need to strengthen emergency medicine services and education programmes for medical students and emergency medicine doctors, as well as research.

“Emergency medical professionals are very worried about the effects of climate change on the care they provide. Our report shows that colleagues feel it’s an important problem around the world, although specific issues vary from one region to another and these relate to geographical position, the economic situation and the types of risks.”

Between 15 February and 15 March 2024, the researchers asked national and international emergency medicine associations around the world to set up focus groups of between four to six members to answer a series of questions. The 42 focus groups reported on general awareness and concern about climate change, and then ranked in terms of severity the different threats, the possible impacts on emergency medical departments, and, finally, the measures needed to mitigate the problems.

Across all the focus group responses, the top three major risks were pollution, flooding and heatwaves. Three minor risks were cold spells, wildfires and vector-borne diseases, such as malaria. The greatest impact was expected to be an increase in demands on the emergency medical services. The focus groups ranked preparation of strategic plans and education as the two strategic actions that were most important.

Focus groups from high income countries were most concerned about the risks of heatwaves, cold spells and wildfires. They considered the greatest impact would be increased numbers of patients, and they thought education and preparation of strategic plans were the most important actions necessary to mitigate the risks. Countries in northern Europe and the eastern Mediterranean were very concerned about displacement of populations and disruption to basic services.

Focus groups from low and middle-income countries ranked the impact of climate change on food production and disruption to health services as being the most significant risks.

Analysis of the data by region showed that climate change was expected to have a greater impact in Australasia, and countries in Eastern Europe, South Asia, South Saharan Africa and Central America. Countries such as Egypt and Nigeria expected the lowest impact, while South Saharan African regions expected the highest. There were significant differences between regions for the risks of vector-borne disease, climate-related diseases, wildfires, extreme weather events and food shortages. Australasia, Central America and South Saharan Africa had the greatest concerns about these compared to European regions.

The focus group concerns were also analysed through the WorldRiskIndex, a statistical model that assesses the risk of 193 countries falling victim to humanitarian disasters caused by extreme natural events and climate change. It ranks countries from very low risk through to very high risk. The fear of increased demand for emergency medical services, and disruption to the chain of supplies and health services was directly related to WorldRiskIndex, with concerns growing with increasing risk.

“It is clear from our findings that climate change is expected to have a significant impact on emergency medical services,” said Dr Petrino. “Much greater awareness of this is needed at national and international level among policymakers, healthcare providers, healthcare professionals and the general public.

“The European Society of Emergency Medicine calls for nations to put in place plans to mitigate the impact on our services from climate change. In addition to publishing our findings, the Society will be setting up a permanent working group to support, help and monitor actions for mitigating the effects of climate change on the emergency medical services. We will also be talking to key people and institutions to raise awareness.

“As we head towards the end of a year that has seen records broken for the planet’s hottest days, action cannot come quickly enough. Climate change is having an impact on all countries, rich and poor, regardless of geographical region. The world faces a climate change emergency, and our medical services face an emergency too.”

Prof. Garcia-Castrillo and Dr Petrino thanked the emergency medicine community and societies worldwide, who had made it possible to conduct the survey.

(ends)

[1] “The results of the survey on awareness and preparedness for climate change” presented by Luis Garcia-Castrillo, in the session “EM Day Campaign 2024: climate change is a health emergency too!”, 16:30 hrs CEST, Room D4-D5.

[2] “Awareness and preparedness of health systems and emergency medicine systems to the climate change challenges and threats: an international survey”, by Roberta Petrino, Luis Garcia-Castrillo, Graziano Uccheddu, Letizia Meucci, Roberta Codecà. To be published soon in the European Journal of Emergency Medicine.

The study received no funding.

About European Society of Emergency Medicine (EUSEM)

Voting opens today for the new chair of EUSEP,  the European Society for Emergency Paediatrics, a branch of EUSEM.  A voting link will be sent to Paediatric members, the deadline to vote is Monday 14 October 18:00.

The nomination for the chair is:

Professsor Patrick Van de Voorde

Dear Members,

I have been involved in the paediatric section of EUSEM for many years now. I’ve seen it grow and thrive, developing into a proper society under the umbrella of EUSEM and a strong research branch via REPEM. This is the work of many highly committed people over the years and I find myself lucky to have been among them.

EUSEP is now at a crucial point in its young trajectory as we need to further enlarge our story and find a second generation of enthusiast colleagues to take over. I want to contribute to this as coming chair and pave the way for this future generation.

A society has an important tasks towards its members – and I tend to bring everyone involved into our ‘membership’- in terms of education, research, representation and advocacy. We again need to build capacity for all of this tasks and this is what I intend to do during my presidency so that we have a strong basis to then build on.

EM for children across Europe is provided in many different ways, a reality I understand and respect. Bringing all relevant actors together, and thus liaise with partner societies, is of the utmost importance and one of the clear tasks for the next board.

Finally, from its start EUSEP has been a special one within EUSEM: diverse, out of the box and young at heart. Let’s stay that way…

Truly yours

Patrick

Prof. Van de Voorde CV

The European Society for Emergency Medicine would like to congratulate the Sociedade Portuguesa de Medicina de Urgência e Emergência on obtaining approval for Emergency Medicine to become a specialty in Portugal.

On 23^rd  September 2024, the Assembly of Representatives of the Order of Physicians (OM) approved the new specialty of  Emergency and Urgent Care Medicine. This follows tremendous work by the Portuguese Society in lobbying for the specialty.

The objective now is to start training Emergency Medicine Specialists in early 2025.  A Commission will be setup to see which hospitals can accommodate trainees and the Ministry of Health will be informed so that vacancies can be published as soon as November.

“This is a great day for Emergency Medicine in Europe. Following the recent successes of Spain and the Netherlands, Portugal has continued the drive to have the specialty accepted across the whole of Europe,” said Dr Jim Connolly, President of the European Society for Emergency Medicine. “We are very proud to support the Portuguese Society. We congratulate them on a fantastic outcome, recognising it has been the result of incredible work by the society.”

END

The number of abstracts submitted for presentation at EUSEM 2024 is back to pre-COVID levels according to chair of the congress abstract selection committee, Dr Barbra Backus.

A total of 1228 abstracts were submitted by the main submission deadline on 7 May, and the committee chose 166 for oral presentation, 49 for eposters with five-minute oral presentations (moderated posters) and 839 for presentation as eposters.

Barbra, who has been a member of the abstract selection committee for five years and is also an associate editor of the European Journal of Emergency Medicine, says: “We had a very good number of submissions, and the quality of the research is certainly good.”

This year, the committee is trying a different approach for the abstract presentations in order to mitigate the problem of having large numbers of moderated posters during the breaks between scientific sessions when the attention of participants is often divided between posters, socialising, networking and visiting the exhibition.

“We decided to increase the number of orals and have fewer moderated posters in the hope of improving well-deserved attention for the presenters,” she said. “We have a ‘Best Abstracts’ session on Monday 14 October between 09:00 and 10:30 that is really important. This is for abstracts of high-quality, which have been highly rated during the abstract selection process because of their good methodology, a good sample size, or because they are interesting and very relevant for a broad spectrum of emergency physicians. But of course, all the abstract sessions will be important and interesting for different reasons.

“This year we’ve seen a few more abstracts submitted on artificial intelligence, environmental topics, ‘green’ emergency departments and pollution, which are all important topics. Then there are abstracts on recurring themes such as biomarkers, cardiovascular emergency medicine, geriatrics, neurology and paediatrics that, together with things like trauma care, resuscitation, risk stratification and ultrasound, are all part of our core business. Almost all of these important topics fill at least one full session with abstracts.”

Barbra, who is an emergency physician in Rotterdam, The Netherlands, is now encouraging researchers to submit late breaking abstracts (LBAs) to the congress between 16 and 23 September. She expects approximately 100 to be submitted and about six will be selected for oral presentation.

“Late breaking abstracts need to be innovative, not just an abstract that, for instance, is mainstream, that could have been submitted three months ago but the researchers were too late with their analysis so are submitting as late-breaking. Late-breaking should be ground-breaking. We are keen to see multi-centre abstracts on innovative medicine that is applicable to emergency medicine and physicians, and that can make an impact on the quality of health care provided in emergency departments.”

Barbra concludes: “We have a really good and interesting programme for EUSEM 2024. Although the bigger sessions, with keynote speakers, tend to attract larger audiences, people may be surprised that the oral abstract sessions are just as important in terms of the research quality, innovation and newsworthiness. These studies are our knowledge and practice of the future.”

View the programme here