Emergency Care and Medicine

Background/Objectives: Glucagon-like Peptide 1 receptor agonists (GLP-1s) have increased in popularity for obesity management and treatment of various metabolic conditions. The medications, however, have significant side effects and carry a risk for adverse events. The objective of this study was to investigate the prevalence of patients taking these medications presenting to the Emergency Department (ED). Methods: We conducted a multi-center retrospective study at two EDs: an urban level 1 trauma center and an academic quaternary medical center (combined annual census approximately 90,000) over a 9-year period (2017–2025). We collected data on all ED encounters involving patients taking GLP-1s, including dual GLP-1/GIP (Glucose-dependent Insulinotropic Polypeptide) agonists, at the time of admission, including demographic information, presenting complaints, comorbidities, and disposition. Descriptive and comparative statistics were used to characterize GLP-1 patient encounters vs. non-GLP-1 patient encounters overall and by diabetes status. The change in encounters over the study period was also assessed. p-values < 0.05 were considered statistically significant. Results: Over the 9-year study period, the proportion of ED encounters involving patients on GLP-1s increased from 0.4% in 2017 to 5.8% in 2025 (p < 0.001). Patients taking GLP-1s were more often female (53.9%), obese (59.4%), and middle-aged, ranging from 35 to 64 years of age (57.3%), and commonly presented with complaints of abdominal or other pain, weakness, or dizziness. Nearly three-quarters of all patients had a Charlson Comorbidity Index (CCI) score of 3 or higher (74.0%). These patients had a higher rate of inpatient admission from the ED (33.5% vs. 23.7%, p < 0.001). Conclusions: The number of patients presenting to the ED who were taking GLP-1s significantly increased over time as these medications became more widely utilized. Patients taking GLP-1s were more often obese with multiple comorbidities and were more likely to be admitted for inpatient care. Further studies are needed to determine whether GLP-1 use independently influences emergency care utilization and the need for hospitalization. Full article

Pediatric trauma accounts for 10–20% of all emergency department visits annually in the United States, and both intentional and unintentional injuries contribute significantly to the overall morbidity and mortality associated with trauma in children. Solid organ injuries are often identified, particularly in relation to blunt injury mechanisms, and can lead to serious adverse events if not diagnosed and treated expeditiously. Advancements in diagnostic tools and intervention strategies have improved outcomes for injured children. This review identifies common mechanisms for pediatric solid organ injuries, discusses advances in triage and diagnostic capabilities, and explores treatment options along with intervention innovations for these types of traumatic injuries in the pediatric population. Full article

Background/Objectives: Nursing home (NH) residents who become acutely unwell may frequently be conveyed to emergency departments (EDs). However, at least half of such low-acuity visits could be avoided. Telehealth-supported acute care programmes may potentially reduce unnecessary ED attendances and subsequent hospital utilization. This study aimed to describe a telehealth-based acute care programme for NH residents and to explore a pragmatic method for estimating potential inpatient bed-day savings using publicly available diagnosis-related group (DRG)-based average-length-of-stay (ALOS) data. Methods: A telehealth-based programme was implemented at Sengkang General Hospital (SKH) to support NH staff in the management of acutely unwell residents. NH residents were prospectively tracked for ED non-attendance within 14 days following teleconsultation. Potential inpatient bed-day savings were estimated by mapping teleconsultation diagnoses to relevant DRGs and referencing Singapore Ministry of Health Hospital Bill Size and Fee Benchmarks. Institution-specific and nationally derived ALOS estimates were compared using exploratory Bland–Altman agreement analysis. Results: Over two financial year periods, seven NHs participated in the programme. A total of 726 teleconsultations were conducted, of which 424 encounters were successfully managed within NHs without ED attendance within 14 days (ED non-attendance rate being 58.4%). Using DRG-based estimation, the projected inpatient bed-day savings for FY2023 were 694.31 days using institution-specific ALOS and 805.42 days using nationally derived ALOS estimates. Exploratory Bland–Altman analysis across 34 mapped diagnostic categories demonstrated a mean bias of 0.098 days (approximately 2.4 h), with 95% limits of agreement ranging from −1.31 to +1.51 days. Conclusions: The acute care programme may reduce ED attendances and hospitalizations among NH residents. Publicly available national DRG-based ALOS data may provide a pragmatic approach for estimating the potential inpatient hospital bed-day savings when institution-specific data are unavailable. Full article

Background/Objectives: Erythroderma is a rare but potentially life-threatening dermatological emergency characterised by generalised erythema and scaling involving more than 80% of the total body surface area. Erythroderma is associated with significant morbidity and mortality due to systemic complications and diverse underlying aetiologies. Methods: In this narrative review, PubMed was searched up to February 2026. Studies were screened for relevance to emergency physicians, with emphasis on epidemiology, diagnostic approach, and acute management. Non-English publications and conference abstracts were excluded. A total of 122 sources were included in the final synthesis. Results: Erythroderma most commonly results from exacerbation of pre-existing inflammatory dermatoses, drug reactions, infections, or cutaneous T-cell lymphoma. Clinical presentation includes diffuse erythema and scaling affecting ≥80–90% of body surface area, often accompanied by pruritus, systemic symptoms, and signs of organ dysfunction. Systemic complications arise from cutaneous barrier failure and include fluid imbalance, thermoregulatory dysfunction, cardiovascular strain, protein loss, and secondary infection. Initial emergency department management prioritises supportive care, fluid and nutritional optimisation, restoration of skin barrier function, and assessment for organ dysfunction. While a definitive aetiological diagnosis is not always immediately required, certain conditions—particularly severe drug reactions and infectious causes such as staphylococcal scalded skin syndrome—necessitate urgent targeted intervention. Conclusions: Erythroderma represents a syndromic emergency requiring systematic evaluation and early supportive management. Prompt recognition of high-risk aetiologies and timely dermatology referral are essential to optimise outcomes and reduce morbidity and mortality. Full article

Background: Non-invasive, real-time hemoglobin monitoring (SpHb) may reduce blood-draw costs and accelerate clinical decision-making. This study evaluated agreement between SpHb (Masimo^®) and laboratory hemoglobin (LabHb) in patients with and without dehydration. Methods/Approach: This single-center exploratory cross-sectional study included male veterans. SpHb and LabHb were measured simultaneously. Demographic data, fasting status, and laboratory markers of dehydration were extracted from the electronic health record. Descriptive statistics, correlation analyses, and Bland–Altman analyses were performed. Results: Fifty-three male veterans were included. LabHb ranged from 9.20–17.00 g·dL⁻¹ and SpHb ranged from 9.90–15.90 g·dL⁻¹. Patients with dehydration had higher LabHb (M = 14.54, SD = 1.60) than those without dehydration (M = 13.01, SD = 1.68; p < 0.001). SpHb and LabHb were strongly correlated in non-dehydrated patients (r = 0.82, p < 0.001) but not in dehydrated patients (r = 0.23, p = 0.275). Among non-dehydrated patients, limits of agreement were −1.67 to 2.18 g·dL⁻¹ (~69% within threshold). In dehydrated patients, limits widened to −1.97 to 5.27 g·dL⁻¹ (~25% within threshold), with 70.83% overestimating LabHb (>1 g·dL⁻¹). Conclusion: This exploratory study found a strong correlation and acceptable agreement between SpHb and LabHb in non-dehydrated patients, with substantially reduced agreement in dehydrated patients. Only approximately 25% of measurements in dehydrated patients met predefined agreement limits, indicating clinically meaningful variability. These findings suggest that hydration status may significantly affect SpHb performance. While SpHb may be useful in appropriately selected, hydrated populations, caution is warranted in dehydrated states. Larger, adequately powered studies are needed to further evaluate the impact of hydration and define the optimal patient populations and clinical applications. Full article

Background: Basic emergency care is an important component of health system strengthening in resource-limited settings in sub-Saharan Africa. Objectives: This scoping review mapped and synthesised evidence on the implementation, capacity-building approaches, and policy implications of the WHO/ICRC Basic Emergency Care (BEC) course in the region. Methods: Twenty studies from 13 countries were included. Reported facilitators of BEC implementation included perceived relevance to frontline practice, practical and structured course content, contextual adaptation, mentorship, and training-of-trainers or cascade approaches. Reported barriers included time constraints, staffing shortages, limited infrastructure and emergency care resources, and technological challenges affecting digital reinforcement strategies. Across studies, BEC was generally associated with short-term improvements in provider knowledge, confidence, and perceived competence. However, implementation outcomes were reported inconsistently and were largely limited to acceptability, feasibility, and appropriateness, with less evidence on adoption, cost, penetration, and sustainability. Evidence on longer-term retention, practice change, patient outcomes, and broader system-level impact remained limited. Conclusions: Overall, BEC appears to be a potentially useful and context-appropriate approach to strengthening frontline emergency care training, but stronger longitudinal and implementation-focused evaluations are needed. Full article

Background/Objectives: Febrile illness in returning travelers presents a diagnostic and operational challenge for emergency medicine clinicians as early symptoms of high-consequence tropical infections often overlap with common viral syndromes. This review synthesizes current evidence to guide frontline clinicians in the systematic evaluation, diagnosis, and management of internally acquired febrile illnesses with a focus on pathogen of greatest relevance to United States (US) emergency departments (ED). Methods: We conducted a narrative review of the literature addressing epidemiology, clinical presentation, diagnostic testing, and management strategies for key travel-associated infections. Special consideration was given to rapid diagnostic modalities, pediatric risk factors, and infections most frequently implicated in returning travelers, including chikungunya (CHIK), dengue virus (DENV) disease, Ebola virus (EBV) disease, malaria, Mpox, typhoid fever (TF), yellow fever (YF), and Zika virus (ZIKV) disease. Results: Effective evaluation begins with a detailed travel and exposure history, recognition of epidemiologic and clinical red flags, and targeted use of rapid diagnostic tests. Malaria remains the most common life-threatening cause of post-travel fever and the only pathogen with reliable Food and Drug Administration (FDA)-cleared rapid testing available in the ED. Arboviral infections such as DENV, CHIK, ZIKV, and YFrequire region-specific consideration and phase-appropriate molecular or serologic evaluation. Emerging and high-consequence pathogens, including Mpox and EBV, necessitate strict infection control measures and coordination with public health authorities. Pediatric travelers, particularly those visiting friends and relatives, face disproportionate risk for severe systemic infections and often require broader diagnostic testing. Conclusions: A structured approach integrating travel history, focused examination, rapid diagnostics, and early recognition of high-risk features is essential to improving outcomes for febrile returning travelers. Strengthened vector control, enhanced vaccination uptake, and global surveillance are critical to reducing future disease burden. Full article

Background: Isolated gallbladder injuries are rare, especially when initial imaging is normal. Advanced imaging is required to detect delayed complications. Moreover, it is necessary to make an appropriate diagnosis while selecting the most suitable treatment option. Case Presentation: A 49-year-old man fell while cycling and developed worsening abdominal pain. Initial contrast-enhanced computed tomography (CT) scans showed no abnormalities. However, the patient later developed cholangitis and cholecystitis caused by biliary obstruction from a delayed gallbladder hematoma. Magnetic resonance imaging (MRI) and magnetic resonance cholangiopancreatography (MRCP) were used to diagnose this condition. The patient was initially managed conservatively with antibiotics, which led to temporary symptomatic improvement. Notably, the patient developed a delayed recurrence of suspected acute cholangitis (Grade I) on Day 12 due to hematoma migration. After recurrence, endoscopic nasobiliary drainage was performed as a step-up approach, in accordance with the Tokyo Guidelines 2018 management bundle, to achieve biliary decompression, followed by elective laparoscopic cholecystectomy. Pathological examination revealed chronic cholecystitis with hematoma. Conclusions: Isolated gallbladder injuries should be considered in patients with blunt abdominal trauma. Delayed hematoma formation can lead to biliary obstruction, even without initial CT findings. In such cases, early implementation of MRI and MRCP, along with close clinical monitoring for delayed recurrence, is essential. A strategic “step-up approach” incorporating endoscopic drainage is a safe and effective management option prior to definitive surgery. Full article

Background: Few studies have assessed the safety and efficacy of discharging emergency department patients with alcohol withdrawal after receiving parenteral phenobarbital. This study aimed to validate this practice and delineate the role of intramuscular phenobarbital for this indication. Methods: This single-center retrospective chart review included adult patients with non-severe alcohol withdrawal, as diagnosed by treating providers based on clinical judgment, who were managed in the emergency department’s low-acuity provider at triage zone, received parenteral phenobarbital, and were discharged within 12 h of arrival. The primary safety and efficacy endpoints were the percentages of patients who expired or re-presented to the emergency department for an alcohol-related diagnosis within seven days of the initial presentation, respectively. A subgroup analysis was performed to compare outcomes between those who only received intramuscular or intravenous phenobarbital. Results: Of the 192 patient encounters included, no deaths were reported. Twenty-one (10.9%) patients re-presented after the initial visit, received treatment, and were discharged home. One (0.52%) patient was admitted following re-presentation. The percentages of patients who re-presented in the intramuscular-only and intravenous-only groups were 8% and 13.5%, respectively (p = 0.25). The total and weight-based doses received were not significantly different between those who did and did not re-present in both the intramuscular-only and intravenous-only groups. The median length of stay in the intramuscular-only and intravenous-only groups was 3.97 h and 5.87 h, respectively (p < 0.001). Conclusions: Our findings suggest that patients presenting with non-severe alcohol withdrawal symptoms may be discharged from the emergency department following receipt of parenteral phenobarbital, without requiring additional outpatient alcohol withdrawal medications. Intramuscular phenobarbital appears to be a viable alternative route of administration and warrants further investigation. Full article

Background/Objectives: Comprehensive epidemiological studies of bicycle crashes involving all ages in Japan are limited, particularly regarding multiple-rider incidents. This study investigated the epidemiology of single- and multiple-rider bicycle crashes in a Japanese core regional city. Methods: Ambulance transport data from Takatsuki City (1 January 2014 to 31 July 2024) were retrospectively analyzed, including demographics, crash characteristics, and severity of injury for bicycle crash patients. The primary outcome was examination of the epidemiology of bicycle crashes with moderate and severe severity or severe and fatal severity, encompassing both single- and multiple-rider incidents. Statistical tests and logistic regression analysis were used. Results: For 6683 transported patients, 6377 (95.4%) involved single-rider crashes and 306 (4.6%) involved multiple riders. Single-rider crash patients were older and more often male. Moderate or greater injuries occurred in 625 single-rider and 11 multiple-rider crash patients. No severe or fatal injuries occurred in multiple-rider crashes. General roadways and intersections were common crash locations. Male sex and older age predicted greater injury severity in single-rider crashes. Fifty single-rider bicycle crashes resulted in severe or greater severity injuries, and four fatal crashes were recorded. Conclusions: This study uniquely details multiple-rider bicycle crashes in Japan, revealing a lower severity of injuries compared to single-rider crashes. Full article

Background/Objectives: Optimization of the frequency and depth of chest compressions is considered essential for effective cardiopulmonary resuscitation in patients with cardiac arrest. Structured debriefing performed after actual or simulated cardiac arrest may help resuscitators maintain chest compression parameters within guideline-recommended ranges. The objective of the present study was to analyze whether Plus/Delta structured debriefing after clinical simulation of cardiac arrest on the duration of chest compressions performed within guideline-recommended frequency and depth ranges. Methods: A quasi-experimental study without a control group was carried out with nursing students. Compression frequency and depth parameters were analyzed in two manikin-based tests separated by the performance of a Plus/Delta structured debriefing. Results: After the intervention, the frequency and depth of chest compressions showed a slight decrease, accompanied by a statistically significant increase in the duration of cardiopulmonary resuscitation within the ranges recommended by the guidelines, although with limited clinical relevance. Conclusions: In this simulated setting, Plus/Delta structured debriefing was associated with a modest increase in the duration during which chest compressions were maintained within guideline-recommended frequency and depth ranges. Given the absence of a control group, these findings should be interpreted as exploratory but suggest a potential educational value of structured reflective debriefing in CPR training. Full article

Background/Objectives: Retrospective projects including audits and observational research advance the practice of emergency medicine but face methodological challenges affecting data quality. This guideline presents an 11-step framework to guide the conduct of high-quality retrospective projects, minimizing bias and enhancing reproducibility for clinicians. Methods: The stepped approach mirrors the standard sections of a study protocol but reframes them as guiding questions to make each section’s content and purpose more practical, intuitive, and clear for users. Conclusions: This framework equips clinicians with a practical entry point to retrospective study design, distilling methodological nuances and strategies to bridge theory and application. Systematic adherence promotes rigor, reduces bias, and elevates retrospective chart review from a convenient tool to a robust method for evaluating practice patterns, interventions, and quality improvement in emergency care. Implementation also fosters a culture of evidence-based inquiry essential to advancing emergency medicine. Full article

Background: Lemierre’s syndrome (LS), previously termed the “forgotten disease” after the introduction of modern antibiotics, is a rare and potentially fatal infection of the neck resulting in septic thrombophlebitis of the internal jugular and other neck veins. In recent years, there has been an increased resurgence of this disease, or at least in its detection, and it remains an important diagnosis with life-threatening potential to consider when presenting with multifocal cavitary pneumonia. Fusobacterium necrophorum, an obligate anaerobic Gram-negative bacterium, is the most isolated culprit organism involved in this condition; however, it is often fastidious and difficult to culture. The use of 16s rRNA gene sequencing can aid in this diagnosis when uncertainty exists. Methods: This case report describes an otherwise healthy 17-year-old male with a history of regular vaping presenting with upper respiratory infectious symptoms who was ultimately diagnosed with multifocal necrotizing pneumonia. In this case, there was initial diagnostic uncertainty as traditional microbiologic culture mechanisms failed to identify a causative organism for tailored antimicrobial treatment. This was despite direct empyema fluid analysis and pulmonary-bronchial biopsy. Novel gene sequencing was performed using 16s rRNA typing, a promising new way to identify a catalog of host organisms, detecting F. necrophorum. This diagnosis prompted further diagnostic imaging of the neck, confirming a small internal jugular clot and diagnosis of LS. Results: This case highlights the need for suspicion of LS in patients presenting with multifocal pneumonia. Furthermore, it re-iterates the idea of culture-negative infections, whereby fastidious organisms or tissue samples do not readily provide a diagnosis. Lastly, it further introduces hypotheses regarding the use of vaping as a possible associated factor for significant infection and lung injury. Conclusions: The use of 16s rRNA sequencing for the detection of fastidious, opportunistic organisms is another tool for physicians to ensure additional diagnostic clarity and appropriate treatment. Full article

Introduction: Large language models (LLMs) have proven effective in many different fields, including the allocation of scarce resources. Triage within emergency departments (ED) is a core process that ensures the sickest patients are seen in a timely manner. Relatively little research has examined the use of existing LLMs in the triage process. Methods: 12 widely available LLMs were provided with real-world patient triage vital sign data from an academic trauma center in a major metropolitan area. The LLMs were asked to assign a triage score to each patient based on this information alone. The deviation between each LLM triage score and the real-world triage score for each patient was calculated, and the absolute value of the deviation was calculated and then averaged across the entire dataset per LLM. The average absolute value of deviation (AAVD) could then be used to compare LLMs against each other. All LLMs were blinded to the real-world triage score and received no additional training or instruction. Results: The models with the highest concordance with real-world triage scores were Claude Sonnet 4.5 (AAVD: 0.37; 62.37% concordance), ChatGPT-5 Instant (AAVD: 0.39; 62.89% concordance), and Claude Opus 4.1 (AAVD: 0.40; 62.37% concordance). The least accurate models were Gemini 2.5 Flash (AAVD: 0.42; 43.81% concordance), ChatGPT-4o Mini (AAVD: 0.49; 45.36% concordance), and ChatGPT-o3 (AAVD: 0.48; 48.45% concordance). Conclusions: This study analyzes the ability of LLMs to triage emergency department patients based primarily on vital sign data. Certain LLMs demonstrated moderate concordance with real-world triage scores. LLMs may be able to synthesize objective vital sign data and provide a triage recommendation. Further study could involve clinical validation against patient outcomes. Full article

Background: One in four U.S. adults aged ≥65 years experiences a fall annually, leading to substantial injury and morbidity. Functional limitations may serve as early markers of vulnerability to fall injury. We aimed to estimate temporal trends and the association between functional limitation and fall injuries among community-dwelling older adults. Methods: For this retrospective cohort study, we pooled 2006–2017 National Health Interview Survey data and identified older adult survey respondents. Functional limitation, defined as any reported difficulty performing daily activities, and fall injury, defined as occurring within three months prior to the interview, were measured as binary variables. We controlled for sociodemographic, self-rated health, healthcare access, and physical activity factors. We reported the yearly trend in fall injury and functional limitations and performed survey-weighted univariable and multivariable logistic regression analyses, accounting for potential confounders. Results: Our sample comprised 79,891 older adults, of whom 66% reported functional limitations and 2.3% reported a fall injury within 3 months of their interview. The prevalence of functional limitation increased from 61.8% in 2007 to 68.4% in 2017 (p < 0.001). Also, the fall injury rates ranged from 1.8% to 2.6% during the same period. Older adults with functional limitations were more likely to report fall injuries (3.2% vs. 1.1%, p < 0.001). After adjustment, functional limitation was associated with a two-fold higher odds of fall injury (OR = 2.03, 95% CI 1.71–2.40). Conclusions: Functional limitations are highly prevalent and increasing among older U.S. adults, doubling the likelihood of fall injury occurrence. Full article

Foreign body ingestion (FBI) is a common pediatric emergency, particularly among children aged 3–6 years and those with developmental delays. While most ingestions are benign, certain high-risk objects, including button batteries, rare earth magnets, water beads, and sharp objects, require prompt identification and intervention to prevent significant morbidity and mortality. This narrative review synthesizes current epidemiology, injury mechanisms, diagnostic strategies, and evolving management guidelines for these high-risk ingestions, emphasizing the importance of timely intervention, standardized protocols, and ongoing advocacy for product safety and public education. Full article

Introduction: Stroke remains the second leading cause of death worldwide and a major cause of long-term disability. Approximately 87% of strokes are ischemic, and 30% of these are large vessel occlusions (LVOs). Early recognition of LVOs and rapid transport to a comprehensive stroke center (CSC) capable of MT are critical to improving outcomes. Accurately predicting LVOs in prehospital settings remains chall29enging. Several triage scales have been developed to aid early detection, but their diagnostic accuracy varies across studies. This study compares the performance of commonly used prehospital LVO scales by pooling published data to identify which tools best support emergency medical services (EMS) in optimizing triage and improving outcomes. Methods: A systematic search, following the Cochrane Library, of PubMed, Scopus, and Web of Science identified studies evaluating prehospital LVO triage scales using standardized search terms. Diagnostic accuracy measurements were extracted, and a pooled analysis was completed to compare scores. Results: From 743 unique articles, 15 studies evaluating prehospital large vessel occlusion (LVO) triage scales were included. Pooled log diagnostic odds ratios (DORs) indicated that RACE demonstrated the highest discriminative performance (2.367 [1.943–2.792]), followed by LAMS (2.228 [1.987–2.470]). The lowest scores were from the PASS (1.992 [1.758–2.227]) and C-STAT (1.886 [1.652–2.119]) scales. Conclusions: Among prehospital triage scales, RACE demonstrated the highest accuracy for LVO detection, followed by LAMS and G-FAST. Variation in scores may indicate inconsistency in performing the tests or the complexity of the questions. These findings support a personalized approach to choosing an LVO identification scale based on the resources available. Full article

Background: Behavioural cues observed during emergency department (ED) triage may provide additional information on patient acuity. We conducted an exploratory pilot study to investigate whether mobile phone use observed during ED triage was associated with hospital admission. Methods: We performed a retrospective, single-centre study including all adult ED attendances between 1 January 2019 and 30 June 2025. Demographics, triage category, mobile phone use documented by nursing staff during waiting time, and hospital admission were extracted from the electronic health record. The primary outcome was hospital admission, with a secondary analysis restricted to low-priority triage categories. Results: Among 423,267 ED visits, the overall admission rate was 20.9%. Mobile phone use was documented in 171 patients (0.04%), of whom 4.7% were admitted (p < 0.001). In low-priority patients (n = 336,160), admission was 4.5% among those using a phone compared with 13.2% overall (p = 0.001). Conclusions: Mobile phone use observed during ED triage was associated with lower hospital admission rates and may represent a simple behavioural adjunct to conventional triage assessment. Full article

Background/Objectives: Emergency department short-stay units (ED SSUs) manage patients requiring short-term observation and treatment. For a small number of patients, a longer hospital admission is required. Care for these patients is provided by an inpatient team and the responsibility for managing acute clinical deterioration falls to a rapid response team, activated by an emergency call. While emergency calls have primarily been a feature of the inpatient setting, admitted patients are increasingly boarding within ED SSUs and the occurrence and impact of emergency calls in this setting remains largely unreported. This study aimed to determine the incidence and characteristics of emergency calls within an ED SSU, describing patient demographics, clinical triggers, and outcomes. Methods: This retrospective cohort study utilised the Tasmanian Emergency Care Outcomes Registry (TECOR) to analyse emergency calls in the ED SSU of a tertiary emergency department between 1 February 2024 and 28 February 2025. Inclusion criteria were defined as adult patients (≥14 years) admitted to an inpatient service who had emergency calls whilst in the ED SSU. Descriptive statistics were used to characterise this cohort. Results: Of 83,238 ED presentations, 11,775 adult patients were transferred to the ED SSU. 1464 (12.4%) of these patients were subsequently admitted under an inpatient service but remained boarding in the ED SSU, with 54 emergency calls occurring in 38 unique patients (2.6%). The median age was 81.5 years (IQR 65–86), older than both the main ED cohort with a median age of 71 years, and median ages of 65 to 69.5 years reported in ward-based cohorts. Most calls were medical emergency team (MET) activations (52, 96.30%) with only 2 (3.7%) code blues. The most common triggers were hypotension (20, 37.04%), reduced level of consciousness (7, 12.96%) and serious concern (7, 12.96%). Delays occurred in 18.52% of calls (mean 82 min). The median ED SSU length of stay for patients having an emergency call was 40.15 h, substantially exceeding the intended ED SSU admission criteria threshold of 24 h. Goals of care remained incomplete in 33.33% of calls, even after emergency team review. Conclusions: ED SSU emergency calls are infrequent but clinically significant, involving an elderly, vulnerable population with late sign triggers and prolonged boarding. These findings highlight fundamental mismatches between patient acuity and ED SSU environment capabilities, emphasising the need for improved monitoring, more selective admission criteria, and enhanced systems for recognising deterioration for patients boarding in ED SSUs. Full article