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In helicopter search and rescue (SAR), rescue hoists or static underslung lines are frequently used for patient access. Electrostatic charges accumulated by the aircraft can discharge through hoisted health care personnel, a phenomenon known as electrostatic discharge (ESD) or "static." These discharges can potentially cause serious injury, yet there is a surprising scarcity of published data on their incidence and clinical impact. We aimed to determine the incidence and severity of ESD during hoist operations within the Norwegian SAR service. We conducted a nationwide, 1-year prospective observational study including all SAR bases operated by the 330 Squadron in Norway, between February 1, 2025, and January 31, 2026. All SAR hoist missions and training exercises conducted over the 1-year period were included. Data collected included ESD occurrence, hoist mission characteristics, atmospheric conditions, and subjective/objective severity of the discharge. Of the 839 hoist operations performed during the study period, ESD occurred in 28 of these, representing an overall incidence of 3.3%. The risk of ESD was significantly higher during hoists over water compared with land (odds ratio [OR] 2.18, 95% CI 1.01-4.70). There was precipitation within 5 nautical miles in 71% of ESD incidents, and grounding equipment was found inadequate in 64%. Severity was classified as moderate in 29% (n = 8) and severe in 21% (n = 6) of ESD incidents. Two rescue paramedics required hospital admission. ESD caused communication equipment failure in 11% (n = 3) of incidents and led to the termination of the hoist operation in 18% (n = 5) of the incidents. This nationwide study demonstrates that ESD occurs in 3.3% of hoist operations performed by the SAR service in Norway. With half of the ESD incidents rated as moderate or severe and a notable frequency of mission terminations and hospitalizations, ESD represents a significant occupational hazard. These findings highlight an urgent need to re-evaluate safety protocols for SAR personnel, and to further investigate the scope and health implications of ESD for SAR personnel.

Evaluate the impact of an emergency medicine-trained anesthesiology critical care (EM ACC) fellow on the delivery of critical care to patients admitted to the intensive care unit (ICU) and boarding in the emergency department (ED). This is a mixed methods observational study at a single urban tertiary care center. A second year EM ACC fellow was deployed to the ED for 2 months. We performed a 360° analysis of this pilot program using a cross-sectional staff survey, an analysis of fellow productivity, and a secondary retrospective cohort analysis of patient outcomes. Fellows worked a total of 26 shifts and encountered 101 ICU boarding patients. Surveys were completed by 71 medical professionals: 22 emergency medicine (EM) physicians, 44 EM nurses, and 5 critical care (CC) physicians (n = 107, response rate 66.4%). On a 5-point Likert scale, the EM ACC fellow was reported to be invaluable or very helpful by 91.5% of all respondents. Qualitative analysis of open feedback emphasized improved team communication, coordination of care, timely interventions, and enhanced CC education. Fellows generated 3.1 work relative value unit (wRVU) per hour and 4.9 wRVU per patient while facilitating 11 (10.8%) ICU downgrades and 4 (3.9%) ICU upgrades. There were no significant differences in patient outcomes (ICU length of stay [LOS], hospital LOS, and discharge disposition). This model, using an EM ACC fellow, offers an approach to improve the delivery of CC to ICU patients boarding in the ED and may be modified to fit the resources, needs, and models available at different institutions. At the study institution, integrating EM ACC fellows into the ED garnered widespread support and demonstrated billing feasibility, but did not show difference in patient outcomes.

Nurse triage phone lines (NTPLs) are widely used to guide patients to appropriate care levels, often relying on conservative clinical decision support systems (CDSS). This study describes the association of integrating emergency medicine physician consultation (TeleEM) with NTPL recommendations, and subsequent emergency department (ED) utilization. From October 2020 to July 2024, a prospective, observational study was conducted across a multistate health system. TeleEM physicians reviewed NTPL cases for which nurse staff requested consultation and could agree with, upgrade, or downgrade the CDSS recommendation. Seventy-two-hour ED utilization following TeleEM consultation was also assessed. Among 15,196 TeleEM consults, physicians agreed with the CDSS in 56% of cases, downgraded to a less urgent endpoint in 34% of cases (n = 5164), and upgraded to a more urgent endpoint in 10% of cases (n = 1517). Of downgraded patients, 32.1% (n = 1656) presented to the ED within 72 hours, and 92.2% of those were discharged from the ED. Of upgraded patients, 72.7% (n = 1,103) presented to the ED within 72 hours, and 88.5% of those were discharged from the ED. The most common ED chief complaints among downgraded patients who presented within 72 hours were chest pain (12.9%), abdominal pain (7.0%), and dizziness (4.6%). Integrating emergency physician input into NTPL calls was associated with changes in triage disposition in >40% of cases. Among patients whose recommendations were downgraded, lower observed ED utilization was seen relative to patients whose recommendations were upgraded, although nearly one-third of downgraded patients still presented to the ED within 72 hours. These findings should be interpreted as associative rather than causal.

To examine patient-reported non-disease-specific out-of-pocket costs (OOPCs) among emergency department (ED) visitors in a publicly funded health care system, including factors associated with OOPC and to explore patient experiences related to these costs. This convergent parallel mixed-method study used data collected through telephone surveys and semistructured interviews from March 1, 2021, to July 27, 2023. All patients who visited the 4 EDs (2 rural and 2 urban EDs) in Newfoundland and Labrador, Canada, were randomly selected to participate based on when they visited the ED (date and time). OOPC was defined as the total amount patients incurred from food, transportation, missed work hours, and other related expenses. Quantitative analyses included multivariable binomial and multinomial regression models adjusting for age, gender, ED location, and patient self-reported length of stay (LOS). Sensitivity analyses using multiple imputation assessed the impact of missing data. Qualitative data were analyzed using thematic analysis. Among the final sample of 818 patients, 24% (199/818) reported OOPC for an ED visit. An ED length of stay of 4+ hours was associated with higher odds of incurring OOPC (adjusted odds ratio [aOR], 2.26; 95% CI, 1.29-4.15) and OOPC of ≥$200 Canadian dollars (CAD; aOR, 3.68; 95% CI, 1.21-11.19). Patients who visited urban EDs were more likely to report OOPC of ≥$200 CAD (aOR, 2.55; 95% CI, 1.09-5.99). Qualitative analysis showed 4 OOPC themes: (1) ED visits are expensive; (2) missing work hours; (3) being forced to choose between care and necessities; and (4) ongoing costs of care. These findings demonstrate that OOPC persist even within a publicly funded health system and underscore the importance of improving ED efficiency to reduce the financial burden on individuals seeking care.

A minority of people make high use of emergency ambulance services. Some UK ambulance services have deployed multidisciplinary case management for these patients. This approach extends usual (within-service) care provision to include input from other agencies such as social care. We aimed to evaluate the effectiveness of case management compared with usual care. Natural experiment retrospective cohort study with patients from 4 UK ambulance services. We accessed anonymized electronic health records for patient cohorts identified by ambulance services. We compared patient-level outcomes based on mortality and emergency health contacts within 6 months of patient eligibility for case management. Cohorts were compared using logistic regression models, adjusting for ambulance service, patient characteristics, and service use in the 6 months before patients became eligible. We found no differences between case management (intervention; n = 550) and usual care (control; n = 633) cohorts for our primary outcome, defined as death or any emergency health contact within 6 months. Nearly all patients recorded at least 1 such contact: 526 of 550 (95.6%) in the intervention cohort, compared with 601 of 633 (94.9%) in the control (adjusted odds ratio 1.159; 95% CI, 0.595-2.255). Mortality at 6 months was high: 58 of 550 (10.5%) in the intervention cohort and 89 of 633 (14.1%) in the control cohort. We found no evidence for the clinical effectiveness of multidisciplinary case management over within-service usual care. Study patients had a high risk of death within 6 months of eligibility for case management, and almost all made at least 1 recorded emergency health contact in that period.

Isolated cervical transverse process fractures (TPFs) are increasingly identified in trauma. Although generally considered stable and nonoperative, current guidelines provide inconsistent recommendations on when to pursue spine consultation or computed tomography angiography (CTA) to assess for blunt cerebrovascular injury (BCVI). This scoping review aimed to determine which clinical or radiographic features of isolated cervical TPFs have been used or reported in association with spine consultation and/or BCVI screening. A comprehensive search of 5 databases and gray literature was conducted. Eligible studies included outcomes related to spine stability or BCVI. Data extraction focused on spine consultation, imaging, fracture characteristics, management, and BCVI related outcomes. Risk of bias was assessed using the ROBINS-E tool, and certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation methodology. A narrative synthesis was performed due to heterogeneity. Nine studies met inclusion criteria, comprising approximately 129 cases of isolated cervical TPFs. All fractures were managed nonoperatively, with variable collar usage. No studies explicitly reported rates of spinal instability or spine consultation. CTA use was variable, reflecting differences in imaging protocols. BCVI rates ranged from 0% to 23%, with multiple TPFs and fractures involving the transverse foramen (TF) being more frequent in cases positive for BCVI. Certainty of evidence for both outcomes was rated as very low due to methodological limitations and inconsistent reporting. Although there is insufficient evidence to make definitive recommendations on spine consultation or CTA for isolated cervical TPFs, available studies report exclusively nonoperative management without documented instability; however, the certainty of this evidence is very low. Multiple TPFs and fractures involving the TF were more frequently reported among BCVI cases, though findings were inconsistent. These findings suggest that emergency physicians should consider CTA in cases of multiple TPFs or TF involvement, while routine spine consultation for lesser injuries may be unnecessary; however, given the very low certainty of available evidence and medicolegal considerations surrounding spinal fractures, future prospective research is needed to support evidence-based guidelines and impact clinical practice.

Ileocolic intussusception is a major cause of intestinal obstruction in children under 2 years of age. Diagnosis is typically confirmed using ultrasonography, and treatment often involves an air or hydrostatic enema performed by radiologists or surgeons outside of the pediatric emergency department (PED) without the provision of adequate sedation or analgesia. This study aimed to assess the efficacy and safety of a comprehensive bedside approach for the diagnosis and reduction of ileocolic intussusception within the PED of a tertiary care pediatric hospital. A retrospective cohort study conducted between January 2021 and July 2024. Key outcome variables included the reduction success rate, time to reduction, and adverse events. During the study period, 28 children diagnosed with ileocolic intussusception via point-of-care ultrasound were treated bedside with ultrasound-guided hydrostatic reduction performed by a pediatric radiologist under sedation provided by pediatric emergency medicine physicians. There were 20 (86%) successful bedside reductions with an average time from admission to reduction of 126 minutes and an average length of stay of 407 minutes, respectively. No adverse events were recorded, although early recurrence of intussusception within 48 hours occurred in 2 patients (7%). This is the first study that detailed a comprehensive bedside approach for the diagnosis and reduction of ileocolic intussusception in the PED. This approach has a high success rate, minimizes the need for interdepartmental transfers, and facilitates the administration of appropriate sedation and analgesia without significant adverse events. Further prospective studies are needed to confirm the safety and efficacy of this bedside approach.

Emergency medical service (EMS) clinician-level turnover is high and varies dramatically by agency type. There is a need to evaluate mean turnover rates, adjusted by agency characteristics, to provide standardized and comparable measures across workplace settings. Our objective was to leverage recent methods to evaluate agency-level mean turnover and describe the agency-level characteristics of those leaving the agency of record. A 2-year retrospective evaluation of EMS clinicians from 2020 to 2022 was conducted to evaluate agency-level turnover. EMS clinicians and agencies from 9 states that required National EMS Certification to obtain/maintain EMS licensure were used. Demographic and EMS-related characteristics were collected, including agency-specific attributes (agency type, service type, majority full-time employees) and state-level identifiers. The percentage of those leaving each EMS agency was calculated, and multivariable linear regression was used to calculate adjusted agency-level mean turnover rates. A total of 1137 EMS agencies with 20,881 EMS clinicians met the inclusion criteria. The adjusted agency-level mean turnover rate was 17.4% and varied dramatically based on agency type (14.3% to 23.7%), with the lowest being fire agencies and the highest being private. When we examined the EMS demographics and work-related characteristics, we discovered significant variability, which is consistent with the theory that each agency type may have different characteristics of clinicians leaving. Adjusted agency-level mean turnover rates varied dramatically by agency type with associated variability in EMS clinician demographics and workplace characteristics. This suggests that the characteristics of agency turnover potentially vary by specific organizational culture, and identifying these variations may assist in developing interventions to enhance retention.

The emergency medical services (EMS) educational infrastructure plays a critical role in maintaining a resilient and stable EMS workforce. Clear disaster preparedness strategies/initiatives are needed to maintain this pipeline during emergencies. Our objective was to build a basis for the EMS educational program's disaster preparedness planning by identifying educational barriers and adaptations experienced through the COVID-19 pandemic. We held focus groups with EMS educational program directors (PDs) to identify educational barriers and the adaptations they used during the COVID-19 pandemic. PD participants discussed topics in small online groups of 3-6 PDs and 2 facilitators. Thematic analysis was performed to identify emerging themes. Initial coding of the transcribed conversations was performed with themes aggregated and categorized as barriers or adaptations. A total of 35 PDs were enrolled across 8 focus groups. Barriers and adaptations were grouped into 6 domains: regulatory, primary institution/program, faculty/educators, technology use, curriculum, and students. PDs and faculty noted increased workload, increased feelings of stress, and uncertainty in situations where online learning was not in place. New or enhanced technology implementation was essential to program continuation. Program, lab, and clinical structures changed substantially with a rapid increase in the use of simulation, scenarios, and distance learning to adapt to the lack of clinical and field sites. As EMS initial educational programs addressed the pandemic, significant barriers resulting in unique real-time adaptation were noted. To prepare for future educational interruptions, lessons learned from previous widespread system interruptions can be leveraged for informed educational system disaster planning.

Geriatric emergency department (GED) programs face challenges in risk-stratifying older adults. Existing tools, like the identification of seniors at risk (ISAR) score model, have modest predictive accuracy and are difficult to implement sustainably. We undertook a quality improvement initiative to develop, evaluate, and validate a screening score (SS) within a large, integrated health care system. This score, which can be deployed and automated at emergency department (ED) triage, identifies older adults at risk of subsequent ED or hospital use and short-term mortality. The GED-SS score model was developed from a multicenter cohort of ED patients aged ≥70 years with an Emergency Severity Index > 1 from January 1, 2018, until December 31, 2019. The composite outcome was ≥3 days of acute care (ED, observation, or inpatient) or death within 90 days. The GED-SS score model was prospectively validated in 1313 ED patients and then compared with the nurse-performed ISAR score screenings. The GED-SS score model showed better discrimination with an area under the curve (AUC) value of 0.73 vs 0.66 for the ISAR score model identification. At a 43% sensitivity threshold (based on an ISAR score model cutoff value of ≥ 3), the GED-SS score model had higher specificity (86% vs 78%) and positive predictive value (59% vs 47%), while also flagging fewer patients (23.3% vs 29.1%). We developed and validated a GED-SS score model to identify older adult ED patients at increased risk of short-term mortality and acute care utilization. The model, which uses structured data facilitating automatic calculation, was prospectively validated and performed comparably to or better than the ISAR score model.

The physical fitness of health care workers also influences the quality of cardiopulmonary resuscitation (CPR). With the recent conceptualization of "pit-crew" in hospitals to ensure sustained, seamless, high-quality CPR, the physical fitness parameters of CPR health care workers that affect CPR quality must be systematically studied. This systematic review aimed to synthesize findings from the current literature on the physical health parameters of CPR health care workers that are essential to ensuring high-quality CPR. PubMed, Scopus, and the Cochrane databases were reviewed to identify relevant articles published in English from inception to February 2025. Studies were included if they reported any physical health parameter of CPR health care workers and their association with high-quality CPR, including chest compression rate, depth, timing, or overall CPR quality. The risk of bias was assessed using the Joanna Briggs Institute critical appraisal tool by 2 independent reviewers. After screening of 11,895 articles, 22 studies published between 2002 and 2024 were included, with 2492 CPR participants in manikin studies. Age, gender, height, weight, body mass index, physical exercise frequency, handgrip or upper-body strength, anaerobic power, maximum heart rate during CPR, muscle strength, fatigue or endurance, body composition, and ventilation threshold were various parameters that were found to be significantly associated with high-quality CPR. Due to differences in the presentation of physical fitness parameters across the studies, a meta-analysis could not be carried out as planned. Physical health and fitness parameters of CPR health care workers are crucial to ensure high-quality CPR. Achieving adequate depth and sustained frequency of chest compressions requires both strength and endurance among CPR health care workers.

Emergency department (ED) visits are a common experience that most individuals will have across their lifetime. ED-based evaluation for acute complaints can be fraught with anxiety and stress due to diagnostic uncertainty, long waiting and boarding times, and the harsh, stimulating environment of the ED. Modulating the physical ED environment can be time consuming, expensive and given regulations, at times nearly impossible. Increased patient stress and anxiety is associated with persistent hypertension, inflammation, and worsening patient experience. Mind-body interventions (MBIs) are nonpharmacologic interventions that leverage the bidirectional relationship between physiological and psychological processes to address universal distress, pain and other commonalities among the ED experience. Many of these interventions like music, mindfulness and acupuncture have been successfully deployed in other clinical settings to mitigate components of stress and improve the patient experience. These interventions have the potential to address the commonalities surrounding ED distress. In this concepts piece we describe MBIs, their potential application in the ED and future directions for research on MBIs in the emergency department.

Delirium is prevalent yet underrecognized in the emergency department (ED). Timely identification of delirium is a priority, but results from systematic implementation of targeted delirium screening in the ED are limited. This study analyzes delirium screening rates, positivity rates, and distribution of screening scores before and after implementation of an electronic medical record (EMR)-based risk stratification at ED triage. In the baseline period, delirium screening was based on age (65+ years) and clinical concern for altered mental status (AMS). In the intervention period, eligibility for delirium screening was based on an automated EMR-based risk stratification. The 4AT was used as a delirium screening tool in both periods. In the baseline period, only 3267 (3.0%) of patient encounters were noted to have AMS and were eligible for delirium screening; 2241 patients received the screening; 1901 screenings resulted in a positive 4AT. In the intervention period using EMR-based targeted screening, 39,065 encounters were eligible for delirium screening; 14,125 patients received the screening, resulting in 2016 positive 4AT. This multicenter study demonstrates the feasibility of EMR-based risk stratification to target encounters for delirium screening at ED triage. The clinical judgment approach resulted in lower screening rates and a greater percentage of high-positive 4AT scores. The risk-stratified approach resulted in a 6-fold increase in number of screenings and identification of low-positive 4AT scores, detecting more patients with subtle delirium. An approach that leverages risk-stratified screening, complemented by screening based on clinical judgment, could capture a wider range of patients with delirium.

The aim of this study was to assess 24-month functional outcomes of patients randomly assigned to prehospital tranexamic acid (TXA) compared with those assigned to placebo. The PATCH-Trauma trial assessed administration of TXA by prehospital clinicians and demonstrated greater survival at 28 days from injury among patients allocated to receive TXA, but no difference in favorable functional outcomes at 6 months.This was a subgroup analysis of patients enrolled in the PATCH-Trauma trial. The primary outcome measure was the 8-point Glasgow Outcome Scale-Extended (GOS-E) at 24 months after injury, dichotomized to favorable functional outcomes (GOS-E 5-8) and dead or unfavorable functional outcomes (GOS-E 1-4). We also assessed mortality at 24 hours, 28 days, 6 months, and 24 months after injury. There were 584 patients eligible for inclusion, and 516 patients had data on 24-month outcomes available. Baseline characteristics were comparable. At 24 months, a favorable outcome was reported in 167 (64.0%; 95% CI: 57.8-69.8) patients in the TXA group and 149 (58.4%; 95% CI: 52.1-64.5) in the placebo group (P = .20). There was no difference in the change in GOS-E profile from 6 to 24 months (coeff -0.06; 95% CI: -0.30 to 0.19; P = .64). There was no difference in mortality at any timepoint. Prehospital treatment and ongoing hospital infusion of TXA did not result in improved survival or statistically significant functional outcomes at 24 months compared to placebo. Consideration of longer-term outcomes after trauma is recommended for evidence to practice decisions.

Many emergency physicians start families. Consensus recommendations to support physician pregnancy, parental leave, and lactation for emergency medicine (EM) programs were recently developed. This study aimed to determine how well EM programs' existing parental policies align with these recommendations for resident and attending physicians across US emergency departments. A 53-item REDCap survey evaluated policies for pregnancy, parental leave, and lactation in university- and community-based EM programs with residencies. The survey was emailed to faculty chairs and residency program directors at the 282 programs listed in the Fellowship and Residency Electronic Interactive Database Access database, with at least 4 contact attempts (one by phone) from September 2024 to February 2025. A total of 102 (36%) residency program surveys and 83 (29%) attending group surveys were completed. Most respondents limited overnight shifts in the third trimester for resident and attending physicians (69% and 76%), though fewer, did so in the first trimester (39% and 34%). In the postnatal period, nonbirthing parents received compensated leave in 68% and 57% of resident and attending programs, respectively. Access to compensated leave for adoptive parents and parents by surrogate ranged from 43% to 52% for resident programs and 28% to 42% for attending programs, respectively. Most programs had written lactation policies supporting breastfeeding indefinitely, though access to adequate lactation space and the ability to step away from patient care varied. A minority covered assisted reproductive therapies. EM programs' existing parental policies do not consistently align with recently published consensus-driven parental policy recommendations. More work is needed to increase the adoption of recommendations and understand the impact of adherence on parental and fetal outcomes.

As there is no published review of video review use in cardiac arrest (CA) research, we set out to perform a scoping review to describe the demographics, settings, interventions, and outcomes in the literature. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses framework for scoping reviews, we queried PubMed, Scopus, EMBASE, and Cochrane Library from inception through April 22, 2024, and then updated the query to cover publications through March 7, 2025, including adult CA studies using video-derived data from prehospital, emergency department, or intensive care settings, excluding pediatric and simulation studies. Independent screening and data extraction were both performed by 2 of the reviewers, with a third reviewer and principal investigator resolving discrepancies, respectively. Extracted data encompassed study aims, setting, patient demographics, video review reliability, and detailed information on outcomes, metrics (eg, chest compression fraction), and interventions (eg, intubation). From 3081 identified publications, 76 were included, with 64.5% being manuscripts. They originated from the USA (48.7%), Asia (31.6%), and Europe (19.7%). Studies were predominantly single center (98.7%), from urban settings (82.9%), with retrospective (47.4%) or prospective (31.6%) observational designs. There was marked heterogeneity in reporting methodologies. The median number of patients enrolled was 71. Interrater reliability was reported in only 12 studies. Common reported patient outcomes included return of spontaneous circulation (39.5%), key metrics such as duration of interruptions (52.6%), and time-to-events (51.3%). Frequently reported interventions included mechanical compression device use (36.8%), defibrillation (34.2%), and intubation (28.9%). Publication volume significantly increased over the last 2 decades. Video review enables a precise, multidomain assessment of resuscitation performance of CA that conventional data sources cannot provide. Future work should prioritize consensus definitions and establishing minimum reporting standards.

COVID-19 vaccination status varies widely among first responders. We sought to understand whether similar vaccination rates exist for first responders and healthcare providers (nurses/physicians) and if this rate changed over time. This is a secondary analysis of a prospective longitudinal study of first responders and healthcare providers recruited starting in January 2021 and followed until April 2024. Following enrollment, participants completed surveys concerning personal demographics (age, sex, race, professional role [first responder, healthcare worker], use of personal protective equipment (PPE), and number of household members under age 18), and medical history (COVID-19 vaccination status, previous COVID-19 infection, and history of comorbidities). Participant vaccination status was confirmed at least every 6 months. Descriptive statistics were calculated, followed by logistic regression models (OR, 95% CI) to describe the associations between vaccination, demographics, and work characteristics. The cumulative incidence was visually described using a Kaplan-Meier plot. Across 190 study participants, 61.1% were first responders, and 38.9% were healthcare providers. First responders were older, predominantly male, and reported more prior exposure to COVID-19. Although the odds of vaccination varied greatly within healthcare providers (OR 8.26, 95% CI 2.42-28.18), their odds of vaccination were higher than those of first responders (referent). Kaplan-Meier plots demonstrated that vaccination rates for both groups plateaued after 1 year. This study noted differential rates of vaccination between first responders and healthcare professionals and that these rates plateaued, demonstrating fixed perspectives on vaccination. Focused efforts to understand diverse perspectives on vaccination concerns may enhance the protection and maintenance of these workforces.

The use of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) has expanded rapidly worldwide for the treatment of obesity, accompanied by a parallel increase in medication errors and accidental overdoses. Gastrointestinal symptoms are the most commonly reported adverse effects in cases of supratherapeutic exposure, whereas neurologic manifestations remain poorly characterized. We report a case of a 50-year-old man with obesity receiving weekly semaglutide 2.4 mg who accidentally administered a total dose of 9.6 mg due to a pen-device handling error. Two days after the injection, he developed generalized burning dysesthesia and marked asthenia in the absence of nausea, vomiting, or abdominal pain. Laboratory tests performed 4 days after exposure were unremarkable. Symptoms gradually improved and resolved completely within 7 days without specific treatment. Clinical trial data suggest a possible dose-related signal for dysesthesia with high-dose oral semaglutide; however, reports of acute parenteral supratherapeutic exposure presenting with isolated neurologic symptoms are scarce. This case suggests that isolated dysesthesia may occur following semaglutide overdose and may follow a benign, self-limited course, a presentation relevant to emergency physicians given the increasing use of GLP-1 RAs.

Opioid-related overdoses remain the leading cause of accidental death in the US. Many jurisdictions are exploring emergency medical services (EMS)-initiated prehospital buprenorphine induction at overdose scenes to reduce subsequent risk. This study evaluated a training strategy preparing EMS agencies to implement these protocols by examining barriers and facilitators affecting their readiness to integrate buprenorphine into standard care. Leadership from 6 Missouri EMS agencies participated in a 6-month training program to support prehospital buprenorphine implementation. We described this evidence-informed frame-and-foster training approach and present findings from a readiness checklist and interviews with 8 trainees. Analysis followed a deductive, exploration, preparation, implementation, sustainment (EPIS)-guided framework approach to assess trainees' perceptions of the training and inner and outer barriers and facilitators to agency-wide implementation. All agencies reported readiness, with (1) frontline staff training and (2) partnering with peer-linkage programs as areas for further preparation. Training increased confidence and clarified workflows. Remaining inner barriers within EMS agencies included stigma among paramedics toward people who use drugs, staff resistance, and burnout, while facilitators included clear protocols and integration into community paramedicine programs. Outer barriers included inconsistent community buprenorphine availability, while facilitators included continued training and state support. This evaluation provides early insights into how a structured training strategy can prepare EMS agencies to implement prehospital buprenorphine. Findings can inform future policy and practice to ensure EMS can effectively incorporate buprenorphine induction into overdose response and improve patient outcomes.