In this December issue.

Abstract

Internationally, Indigenous and minoritised ethnic groups experience longer wait times, differential pain management and less evaluation and treatment for acute conditions within emergency medicine care. Examining Emergency Department Inequities (EEDI) investigates whether inequities between Māori and non-Māori exist within EDs in Aotearoa New Zealand (NZ). A team from Auckland present the descriptive findings for their study. Using secondary data from ED admissions into 18/20 District Health Boards in NZ between 2006 and 2012, there were a total of 5 972 102 ED events (1 168 944 Māori, 4 803 158 non-Māori). The researchers found an increasing proportion of ED events per year, with a higher proportion of Māori from younger age groups and areas of high deprivation compared to non-Māori events. Māori also had a higher proportion of self-referral and were to be seen within a longer timeframe compared to non-Māori. There are different patterns of ED usage when comparing Māori and non-Māori events. The next level of analysis of the EEDI dataset will be to examine whether there are any associations between ethnicity and ED outcomes for Māori and non-Māori patients. Kim Yates, also from Auckland, offers her perspective in an accompanying editorial. ECPR is a promising adjunct to routine advanced cardiac life support. Growing worldwide interest in ECPR-use has seen more tertiary centres offering ECPR programmes. A team from Auckland City Hospital report on the extracorporeal membranous oxygenation service provided there. Despite the potential benefits of ECPR, it is currently only offered on an ad hoc basis. It remains unknown whether the hospital will manage sufficient numbers of patients to warrant an ECPR programme. An accompanying editorial concludes that ‘establishing an ECPR programme is resource intensive and requires robust procedures and integration among various stakeholders, including hospital administration, local ambulance services, emergency physicians, critical care specialists, cardiology/cardiac surgery and nursing and multidisciplinary care providers’. Intubation of children in the emergency setting is a high-risk, low incidence event. Standardisation of clinical practice has been hampered by a lack of high-quality evidence to support one technique over another. In a voluntary questionnaire undertaken by medical staff at registrar level or above in EDs and ICU associated with the Paediatric Research in Emergency Departments International Collaborative and Australian and New Zealand Intensive Care Society Paediatric Study Group, respondents reported on their individual intubation practices, with a focus on pre-oxygenation and apnoeic oxygenation techniques, and the use of video laryngoscopy. The conclusion is that within Australia and NZ, there is considerable variation in paediatric emergency airway clinical practice, in particular with respect to pre-oxygenation, apnoeic oxygenation and use of video laryngoscopy. Definitive clinical trials are required to best inform clinical practice in this. Despite ultrasound-guided peripheral intravenous catheter insertion being a well-established method for patients with difficult intravenous access, currently there are limited hospital-based training programmes. A team from the Gold Coast University Hospital describe the training programme they established in their hospital and health service over 5 years ago and how it can be replicated in other centres. NOF fractures are common and serious injuries in the elderly persons. When a NOF fracture is suspected but is not clearly visible on radiographs, guidelines recommend magnetic resonance imaging (MRI), or computed tomography (CT) if MRI is not available/contraindicated. A team of radiologists from Austin Health in Melbourne reviewed the use of CT and subsequent MRI for suspected NOF fractures in patients with negative or equivocal radiographs. They conclude that access to CT for evaluation of suspected occult NOF fractures is much quicker compared to MRI. When CT results are negative with ongoing clinical suspicion of an occult fracture, MRI should be performed in a time-efficient manner. We publish several papers about this deadly virus, including one from Hong Kong that examines the impact it had on ED attendances there in 6 months and one that reports an innovative way to hold routine departmental mortality and morbidity meetings. This section of the journal has a new team of editors. After several years of consistently excellent, reliable and professional work, Colin Banks and Jeremy Furyk are hanging up their FOJ pens. Thank you both. I'm delighted to welcome the new team of Sierra Beck, Bridget Honan, James Mallows and Joseph Ting. Decision fatigue in the ED is the focus in this issue, something we can all relate to.