This Week in Emergency Medicine — Jun 4, 2026

Welcome to This Week in Emergency Medicine. This week we're covering 9 notable papers spanning prehospital care, psychiatric emergencies, and broader health systems topics. Let's dive in.

We start in the prehospital environment, with four papers looking at everything from dispatch to treatment and even the cleanliness of the rig. Three of these come from Prehospital Emergency Care.

First, let's look at the initial call for chest pain. How can we better risk-stratify these patients at the dispatch level? A study in Prehospital Emergency Care sought to externally validate the SCARE score for predicting acute myocardial infarction in adults calling a French emergency medical communication center [7].

The Study This was a prospective, multicenter observational study across four physician-staffed dispatch centers. They included over 2,000 adults who were hospitalized after calling for non-traumatic chest pain. The SCARE score was calculated retrospectively, so it didn't influence real-time decisions.

Results The SCARE score showed good discrimination for hospital-diagnosed AMI, with an Area Under the Curve of 0.85. Interestingly, performance was even better in women than in men. Using a pre-specified high-risk cutoff, the score had a sensitivity of about 74% and a negative predictive value of 95%. This means that in this hospitalized cohort, a low-risk score made AMI much less likely, but not impossible. The rate of AMI rose from about 2% in the low-risk group to 31% in the high-risk group.

Conclusions The SCARE score appears to be a useful tool to help dispatchers prioritize resources for potential AMI, but the authors caution it should not be used as a standalone rule-out tool, as it still misses a quarter of AMIs and doesn't address other life-threatening causes of chest pain.

Staying with cardiac care, another paper in Prehospital Emergency Care looked at the adoption of double sequential external defibrillation, or DSED, for refractory ventricular fibrillation since the publication of the DOSE VF trial [10].

The Study Investigators used a large, nationwide United States dataset from 2018 to 2024, analyzing over 16,000 out-of-hospital cardiac arrests with an initial shockable rhythm who received at least four defibrillation attempts. They compared DSED use before and after the DOSE VF trial was published in late 2022.

Results The use of DSED did increase after the trial's publication. However, the overall proportion of eligible patients receiving it remains quite low, at just over 8% in the post-trial period. An interrupted time-series analysis confirmed a statistically significant increase in the rate of DSED use quarter by quarter after the trial. The takeaway is that while awareness and use are growing, DSED is far from standard practice even in eligible patients.

Next, also from Prehospital Emergency Care, a nationwide cohort study compared intranasal versus intramuscular naloxone for opioid overdose [9]. Previous studies suggested intranasal naloxone might be less effective but cause less precipitated withdrawal. This study looked at real-world outcomes in over 16,000 patients treated by EMS.

Results About 20% of patients received their first dose via the intramuscular route. Compared to patients who first received intranasal naloxone, the intramuscular group had significantly lower odds of needing additional naloxone doses—a more than 60% reduction. They also had higher odds of returning to a Glasgow Coma Scale score greater than 12. Critically, there was no associated increase in the odds of needing treatment for nausea, vomiting, or agitation, which the authors used as a proxy for precipitated withdrawal. The IM group also had slightly lower odds of being transported to the hospital.

Conclusions In this large, real-world cohort, an initial strategy of intramuscular naloxone was associated with more favorable physiologic outcomes without evidence of increased precipitated withdrawal in the prehospital setting.

Finally, for our prehospital section, a study in Prehospital Emergency Care looked at something more fundamental: how clean are our ambulances and our uniforms? [5]. The results are sobering. Investigators prospectively sampled 20 ambulances and 27 EMS clinicians before and after their shifts. They found that even when deemed 'service ready', 60% of ambulances and over 63% of clinicians were already contaminated with at least one clinically important pathogen, like MRSA, MSSA, or VRE. Contamination persisted or accumulated during the shift. The finding of pre-shift uniform contamination suggests clinicians themselves may be a source of contamination within the ambulance. This underscores the need for better uniform hygiene and more rigorous cleaning protocols.

Next, we turn to the challenging interface of emergency medicine and mental health.

A scoping review in the Annals of Emergency Medicine mapped the current literature on the medical screening of adult psychiatric patients in the ED, often called 'medical clearance' [2]. The authors sifted through over 9,000 records to find 145 relevant publications. The key finding is the overall low quality of evidence guiding this common practice. The vast majority of original research was retrospective. The most studied topics were lab testing, history taking, and vital signs. The authors identified a major theme across society recommendations: most discourage routine, shotgun laboratory testing and instead call for a targeted workup based on a proper history and physical exam. This paper doesn't give us a new screening tool, but it confirms that our current 'clearance' processes are built on a weak evidence base and highlights the need for high-quality prospective studies.

While the last paper looked at screening, a pilot study in the Canadian Journal of Emergency Medicine explored a potential treatment for pediatric patients with acute suicidal ideation [1]. Given the rise in adolescent ED visits for suicidality, there's a pressing need for rapid-acting treatments. This was a three-arm, triple-blinded pilot randomized trial comparing intravenous ketamine, midazolam, and saline in adolescents requiring hospitalization for suicidal ideation.

The Study The primary goal was not to prove efficacy, but to assess feasibility. Could a trial like this even be done in a busy ED? The answer appears to be yes. They had a high participation rate, with over 70% of eligible patients and guardians consenting. Retention in follow-up was also good, and no serious adverse events occurred. Blinding seemed effective.

Conclusions While the study was too small to draw conclusions about which treatment worked best, it successfully demonstrated that a rigorous trial of ketamine for this vulnerable population is feasible and safe. It paves the way for a larger, definitive trial to see if ketamine could become the first rapid-acting pharmacological treatment for acute pediatric suicidal ideation in the ED.

Finally, we zoom out to look at systems-level interventions and the future of our research.

A landmark paper in Nature Medicine provides a powerful demonstration of 'food is medicine' [3]. Investigators evaluated a large-scale medically tailored meals program within Massachusetts' Medicaid system. They compared healthcare utilization and costs for over 1,800 recipients of these meals against a matched comparison group. Both groups had diet-related health conditions and food insecurity.

Results After an average of about 7 months, receipt of medically tailored meals was associated with 31% fewer hospitalizations and 20% fewer ED visits. The associated reduction in total healthcare costs was over $3,400 per person. This almost entirely offset the cost of the meal program itself. The findings were robust across multiple analyses, and the program was found to be net cost-saving for patients with conditions like cardiovascular disease, diabetes, and depression.

Moving from patient care to the research that informs it, a paper in the Emergency Medicine Journal details the process of refreshing the pediatric emergency medicine research priorities for the UK and Ireland [4]. The original priorities from 2015 were outdated. This new effort used the James Lind Alliance methodology, which is notable because it gives equal weight to patients, carers, and healthcare professionals. Through surveys and workshops, they generated a new top 10 list of research questions that reflects the shared priorities of all stakeholders, ensuring that future research addresses what truly matters to families.

And on a final note about research, a commentary in PLoS Medicine discusses the upcoming NIH 2025 Public Access Policy [6]. This policy will eliminate the embargo period for federally funded research, making science immediately free for anyone to read. However, the authors raise a critical concern. Without addressing the high article processing charges levied by many journals, this policy could shift the barrier from reading science to publishing it. It risks creating a system where only well-funded institutions can afford to perform and publish research, potentially worsening inequities in science.

If you only have time for one paper this week, make it the study on medically tailored meals in Nature Medicine [3]. It provides large-scale, real-world evidence that a 'food is medicine' intervention can dramatically reduce hospitalizations and ED visits for high-risk patients, all while being nearly cost-neutral. This has profound implications for health policy and how we address social determinants of health.

Here are the key takeaways from this week in Emergency Medicine...

First: For opioid overdose, consider an initial strategy of intramuscular naloxone. A large nationwide United States study found it was associated with less need for redosing and better GCS recovery, without an observed increase in prehospital withdrawal symptoms compared to intranasal administration [9].

Second: For refractory ventricular fibrillation, the use of double sequential external defibrillation is slowly increasing since the DOSE VF trial, but overall adoption remains low. Be aware of this evidence-based option for your toughest cardiac arrests [10].

Third: 'Medical clearance' for psychiatric patients remains an evidence-light zone. A major scoping review confirms that most guidelines recommend a targeted approach based on history and physical, not routine, shotgun lab testing [2].

Fourth: On a systems level, medically tailored meals for high-risk patients with diet-related conditions can significantly reduce hospitalizations and ED visits, with cost savings that nearly offset the program's expense. This is a powerful, evidence-based social determinants of health intervention [3].

Fifth: Your ambulance and uniform are likely contaminated with clinically important pathogens before your shift even begins. This finding underscores the need for improved personal and vehicle hygiene protocols to reduce infection risk [5].

That's your roundup for This Week in Emergency Medicine. The full transcript and references are available on the episode page in your AudioScholar library. This is an AI-curated summary — for clinical decisions, always consult primary sources and current guidelines. See you next week.

This is an automated summary generated by artificial intelligence, which can make mistakes. Always review the original source materials.