Emergency Medicine

EMS naloxone in suspected opioid-associated OHCA linked to higher survival and better neurologic outcomes

In a retrospective cohort of 3,811 suspected OA-OHCA patients meeting NACARDI criteria, 32.8% received EMS naloxone. Unadjusted survival to discharge was 8.1% with naloxone versus 4.4% without naloxone. After inverse-probability weighting, naloxone was associated with an absolute survival increase of 2.75 percentage points (95% CI, 1.25–4.26 pp). Sensitivity analyses restricted to patients who received epinephrine attenuated the association to non-significance, so confounding by concomitant therapies is possible. 1

Triage nurses perform extensive assessment, interventions, diagnostics, and communication beyond rapid categorization

Observations of 15 triage nurses over 33 hours captured 303 interactions and 1,183 coded tasks using the HIRAID framework. Most common activities included history-taking (n=475), post-triage communication (n=288), focused assessments (n=165), and interventions (n=134). Triage practice extended into waiting-area and post-triage care, blurring the line between initial categorization and ongoing management. Departments should co-design triage and waiting-area workflows with triage nurses to reflect actual clinical tasks and capacity. 2

EHMRG retains good discrimination across sociodemographic groups but mildly overestimates high risk

In 7,537 Ontario ED AHF patients, EHMRG-7P had a c-statistic of 0.794 and EHMRG30-ST 0.777 for mortality prediction. Both scores showed good calibration overall but mildly overestimated risk in the highest deciles, especially at 30 days. Discrimination was robust across sex, income, marital status, and ON-Marg indices, but slightly lower in long-term-care residents. Using EHMRG will likely bias toward conservative decisions (more admissions) for patients in the top risk deciles. 3