Much has been achieved in European emergency medicine (EM) over the past 30 years since EUSEM was founded in 1994 at a meeting of the International Federation for Emergency Medicine in London.

Before the Society was launched there was no specialty in EM in Europe, let alone a core curriculum in the subject. Now, the Society has grown from a small, multidisciplinary group of individual experts into an organisation that has 38 national European societies, over 1200 individual members and represents over 40,000 EM specialists in Europe.

President of EUSEM, Jim Connolly, a consultant in EM at Great North Trauma and Emergency Care, Newcastle-upon-Tyne, UK, says: “Thirty is a real ‘coming of age’ moment for EUSEM and something we need to celebrate throughout the congress.

“When EUSEM was founded, the existence of EM as a primary specialty across Europe was seen as key to making emergency care the best it could be. This aim is now tangibly close and EUSEM needs to look at the next phase of EM development, including improved harmonisation and advocacy for the specialty and those who work in it.”

Emeritus Professor of Emergency Medicine, Dr Herman Delooz, of KU Leuven, Belgium, was instrumental in setting up EUSEM and became its first president. He says: “Both EUSEM and the European Journal of Emergency Medicine, which started in 1993 and was adopted as its journal by EUSEM at its foundation, have done very well. The specialty of emergency medicine is established in many European countries and the journal has achieved an international reputation.

“At the first European Congress on Emergency Medicine in San Marino, Italy, in 1998, we discussed and finalised a ‘Manifesto for Emergency Medicine in Europe’, which was published in the European Journal of Emergency Medicine that year. This Manifesto was translated in several European languages and was the European ‘coming of age’ of the Society. Following the publication, we were invited to lecture all over Europe by the national societies that represented emergency doctors.”

A significant milestone came in 2011 when, after lobbying from EUSEM, the UEMS (Union Européenne des Médecins Spécialistes), a non-governmental organisation representing national associations of medical specialists in Europe, recognised EM as a specialty.

EUSEM prepared a curriculum for the specialty and the latest version was published in 2019, in association with the UEMS Multidisciplinary joint Committee on Emergency Medicine. So far, 17 European national societies have implemented the curriculum in their countries.

Prof. Delooz says there is still more work to be done. “More research is needed to establish EM as an academic discipline.”

Mr Connolly says: “EUSEM is entering an exciting stage in its ‘coming of age’. Keys to the next stages of growth are developing a strong governance framework and a long-term strategy that engages all of the membership.

END

During the General Assembly on 15 October 2024, Dr Jim Connolly handed over his presidency to Dr Robert Leach. EUSEM would like to thank Dr Connolly for his leadership and support. He has ensured that the society will continue to grow.  We welcome Dr Robert Leach as the new president.

PRESS RELEASE

Embargo: 00.01 hrs CEST on Wednesday 16 October 2024

Seizures caused by children swallowing medications or illegal substances doubled over 15-year period

Copenhagen, Denmark: New data shows that the number of children suffering a seizure after swallowing medications or illegal substances has doubled between 2009 and 2023 in the US. The findings were presented today (Wednesday) at the European Emergency Medicine Congress.

The most common substances involved in these poisonings include over-the-counter antihistamines, prescription antidepressants and painkillers, and illegal synthetic cannabinoids.

Dr Conner McDonald from the University of Virginia School of Medicine told the Congress: “Seizure is one of the most severe symptoms a poisoned patient can experience, and children are particularly vulnerable. Depending on variables such as where a seizure happens, how long it continues and the pre-existing health of the child, seizures can lead to long-term damage or even death.”

Working with Professor Christopher Holstege, Chief of the Division of Medical Toxicology at the University of Virginia School of Medicine, and colleagues, Dr Farah gathered data from the US National Poison Data System on seizures in children and teenagers (under the age of 20 years) that resulted from exposure to any single substance between 1 January 2009 and 31 December 2023.

The National Poison Data System brings together information from the 55 poison centres across the US. These centres are consulted in the most serious cases of poisoning, including poisoning in children that results in seizure.

The researchers analysed the data according to the children’s ages and the substance they had consumed. Overall, they found that cases had increased from 1,418 in 2009 to 2,749 in 2023, corresponding with an average yearly increase of five per cent.

Among children aged between six and 19 years, the number of cases had doubled over the 15-year period. In children under six years, there was a 45% increase in cases over the 15-year period.

The substances responsible for most of this increase include diphenhydramine (an over-the-counter antihistamine commonly used for allergies, hay fever and nasal congestions), tramadol (an opioid prescribed for pain in adults), bupropion (an antidepressant prescribed for adults and children), and synthetic cannabinoids known as K2 or spice (illegal substances that are man-made and chemically similar to substances found in the cannabis plant).

Dr McDonald explained: “Diphenhydramine can be purchased in the United States in bottles containing 500 or 600 tablets. Bupropion is being more frequently prescribed to treat depression in adults and children. Other legal and illegal drugs can be bought online and shipped around the world. Therefore, these drugs are becoming more available in homes and within the reach of children.”

Speaking before the Congress, Professor Holstege said: “The increase in seizures in children exposed to these drugs is extremely worrying and must be addressed. It’s a stark reminder to parents and carers to store medications safely so that children cannot get hold of them.

“In the US, we also need to have a serious discussion on whether products like diphenhydramine should be sold in containers with such large quantities of pills and whether these products should be contained within blister packs to make it more difficult for children and suicidal individuals to gain access to such a large quantity.”

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: “The increase in drug poisoning among children is worrysome. Although these data are for the US, we know that drugs are the most common sources of poisoning in children around the world. It is important that we keep looking for safer distribution and storage of medication. Blister packs and child-resistant pill bottles can help, but all drugs, whether they are over the counter, prescribed, or illegal should be kept out of reach or locked away where children cannot access them.

“No parent or carer ever wants to see their child suffer a drug-induced seizure, especially when it could have been prevented.”

(ends)

[1] Abstract no: OA098, “Seizures in Single Substance Pediatric Exposures: Analysis from the United States National Poison Data System” by Conner McDonald, in the Oral Abstracts: Neurology session, 11.00-12.30 hrs CEST, Room 19.

Funding: No external funding.

About European Society of Emergency Medicine (EUSEM)

PRESS RELEASE

Embargo: 00.01 hrs CEST on Wednesday 16 October 2024

Increase in air pollution corresponds with more patients at the hospital emergency department

Copenhagen, Denmark: Increases in levels of particulate matter in the air, even within World Health Organization guidelines, correspond with an increase in the number of patients going to the hospital emergency department, according to research presented at the European Emergency Medicine Congress today (Wednesday).

The study found links particularly between air pollution and cases of trauma, breathing difficulties and skin conditions.

The research was presented by Dr Andrea Rossetto an emergency medicine resident at University of Florence and Careggi University Hospital, Florence, Italy, and a PhD Student at Queen Mary University of London, UK.

Dr Rossetto said: “We know that air pollution is damaging for health, especially in terms of breathing and lung diseases, and this is likely to have an impact on our health services. However, there is limited evidence on the impact of fluctuations in air pollution on the overall workload in the emergency department.”

Working with Dr Alessio Gnerucci from the Department of Physics and Astronomy, University of Florence, Italy, Dr Rossetto gathered data on patients admitted to the emergency department at Careggi University Hospital in Florence between 2019 and 2022. This included a total of 307,279 patient visits to the emergency department.

They compared this with data on the daily levels of particulate matter of less than 2.5 micrometres in size (PM2.5) and particulate matter of less than 10 micrometres (PM10) near patients’ home addresses for up to 30 days before they went to hospital.

The researchers found an increase in daily patients in the emergency department of 10-15% in the few days following an increase in levels of PM2.5 and PM10. In particular, cases of trauma, breathing difficulties and skin conditions increased in the days following rises in air pollution. Cases of trauma linked to air pollution were generally in younger patients, while in older patients (over 65) breathing difficulties linked to pollution were more common.

Dr Rossetto said: “In this study, we were able to estimate pollution in the air where patients live, and this revealed a strong connection between higher levels of particulate matter and visits to the emergency department.

“At our hospital most trauma patients have been involved in road traffic collisions. Traffic is also a primary driver of increased air pollution in urban areas. It is likely that heavy traffic is directly responsible for the increase in trauma cases and indirectly for more patients presenting with breathing difficulties linked to air pollution.

“This means we’re seeing more patients with breathing difficulties at a time when the emergency department is already under stress with more trauma cases, with potentially worse outcomes for such patients.”

The researchers say that more research is needed to see if a similar relationship between air pollution and emergency department admissions exists in other hospitals, for example, this study does not include children, who can be more susceptible to the effects of air pollution.

The researchers hope to carry out similar studies looking at the impact of levels of other pollutants in the air and weather patterns on visits to the emergency department, not only in terms of overall workload but also in relation to specific diseases.

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: “This study adds to existing evidence that air pollution, even at concentrations within WHO guidelines, is harmful to our health and our health services. Understanding this link could allow hospitals to prepare for surges in patient numbers and take action to reduce overcrowding in the emergency department. Hopefully further research will provide even more information on this topic.

“However, if we want to protect our health and reduce the burden on hospitals, we need to do all we can to minimise emissions and reduce exposure to air pollution.”

(ends)

[1] Abstract no: POS0812, “Particulate matter and emergency department visits in the Florence urban area between 2019 and 2022: a time-series study” by Andrea Rossetto, poster presentation session, Wednesday 18 October, 11:00-12:30 hrs CEST, Room 18.

Funding: No external funding.

About European Society of Emergency Medicine (EUSEM)

PRESS RELEASE

Embargo: 00.01 hrs CEST on Tuesday 15 October 2024

Half of all patients with sepsis die within two years

Copenhagen, Denmark: Half of all patients with sepsis admitted to an emergency medical department died within two years, according to Danish researchers investigating factors that could predict outcomes for these patients.

Dr Finn E. Nielsen, a senior scientist in the Department of Clinical Epidemiology at Aarhus University Hospital, Denmark, told the European Emergency Medicine Congress today (Tuesday) [1] that he and his colleagues examined deaths over a long follow-up period in a prospective study of 714 adult patients admitted to the emergency department with sepsis. Their findings revealed several risk factors associated with sepsis-related deaths.

“We found that certain factors increased the risk of death after sepsis, including, not surprisingly, advanced age. Additionally, conditions such as dementia, heart disease, cancer and previous hospitalisation with sepsis within the last six months before admission also elevated the risk of dying during a median follow-up period of two years,” he said. [2]

In a report in 2020, the World Health Organization (WHO) highlighted limitations and gaps in knowledge about sepsis outcomes, with existing studies having a mixture of designs, differences in data sources, and different definitions of sepsis, all of which produced considerable variations in estimates of incidence and deaths from the condition. The WHO called for prospective studies to investigate long-term outcomes for sepsis patients.

Dr Nielsen, who is a specialist in emergency medicine, cardiology and internal medicine, established the sepsis research group in his emergency department in 2017. The current study examined outcomes among patients admitted with sepsis between October 2017 and the end of March 2018.

“Our study relied on a sepsis database, which provided valuable information based on prospectively collected patient data. Unlike frequently used routine registry data, this approach minimised errors, and allowed for more accurate and detailed insights into sepsis effects.”

A total of 2,110 patients with suspected infections were included in the study, of whom 714 developed sepsis. The researchers obtained data on deaths from the Danish registry systems, which provide up-to-date information on all Danish citizens. They found that after a median of two years, 361 (50.6%) of the patients with sepsis had died from any cause, including sepsis. Older age increased the risk of death by 4% for every additional year of age.

Furthermore, a history of cancer more than doubled the risk (121%), ischaemic heart disease (a condition in which the arteries supplying blood to the heart narrow or become blocked by a build-up of fat) increased the risk by 39%, dementia increased the risk by 90%, and previous admission with sepsis within the last six months increased the risk by 48%.

“Our study identifies several risk factors that should be prioritised by medical staff for information, care and follow-up checks. We believe this knowledge is useful for both clinicians and researchers in the field of acute medicine,” said Dr Nielsen. “Recognising that sepsis is a serious illness with high mortality is crucial.”

As the study was carried out in a single centre, further research in larger, prospective studies is needed.

“In this study, we have attempted to address some of the gaps in our understanding of sepsis epidemiology. We have contributed with an investigation that, unlike many other studies, is based on prospective electronic health record-based research. Similar but larger studies of sepsis-related outcomes need to be repeated across departments, regions and countries to obtain a comprehensive epidemiological picture of sepsis, including the long-term prognostic aspects of physical, mental and cognitive disorders, and the potential impact of these factors on the risk of death,” he said.

Dr Nielsen and his colleagues tried to develop a model that could predict the risk of death over the longer term but found that its predictive power was not good enough.

“Although we identified several risk factors that clearly increased the risk of death and should provide a focus for clinicians and researchers during the discharge planning process, as well as for developing future prediction studies, we were unable to construct an overall model suitable for predicting mortality in clinical practice,” he said. “There is a need for prospective studies of the effect of other factors that are not examined in our study, including various complications that may arise following hospitalisation and after discharge.”

Dr Nielsen added: “We will be presenting supplementary data to the conference. Including a score for organ failure in a more complex model has improved the ability to predict the risk of long-term death after hospitalisation. This has potential applications in clinical practice and future research.”

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: “Sepsis is a serious and potentially fatal medical condition. The incidence of sepsis is increasing in several countries, yet so far, there has been limited, reliable information about long-term outcomes for patients who develop sepsis. This study has shown certain risk factors that should alert clinicians to the risk of patients with sepsis at an increased risk of dying, so that they can monitor them and follow them up more closely. More research is needed to help us better understand the risk factors for an increased risk of dying from sepsis, which can help to improve treatment.”

(ends)

[1] Abstract no: OA058, “Long-term mortality among sepsis patients: A prospective single-center study”, by Finn E. Nielsen, in the Infectious Diseases oral abstracts session, Tuesday 15 October at 11:00 hrs CEST, Room 18.

[2] A “median” average is the middle number when a set of numbers are placed in order. In this study, some patients will have died before two years and some after. The range was one to 896 days.

Funding: This study was funded by the Regional Zealand Research Foundation.

About European Society of Emergency Medicine (EUSEM)

The European Society for Emergency Medicine (EUSEM) is an academic, medical, non-profit society representing the interests of all healthcare professionals involved in Emergency Medicine across Europe. It has members consisting of 38 National European societies and over 1200 individual members. In total, through the different forms of membership, the society represents over 40000 Emergency Medicine Specialists. The scope of EUSEM is from prehospital to the clinical setting, encompassing the whole pathway for emergency medicine. Since 1994, EUSEM has organised a meeting for its members. The congress now attracts over 3000 participants from 76 countries. Its main objective is to share best practices, and to present the latest research and developments in the field in order to provide the best treatment and care for patients.

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)