Triage in emergency departments (EDs) prioritizes patient care when demand exceeds resources. In Canada, the Canadian Triage and Acuity Scale (CTAS) is the nationally endorsed system used to guide triage decisions. Despite longstanding advocacy for standardized practices, implementation and training requirements vary across hospitals, and electronic decision-support tools have been increasingly integrated to support triage. This study aimed to describe current triage practices, staffing, and training across Canadian EDs. We conducted a national, bilingual cross-sectional survey of ED staff across 10 provinces and three territories. A 21-item electronic questionnaire, developed by a multidisciplinary team, captured data on triage roles, training, tools, and protocols. Surveys were distributed via provincial and local ED leads, with follow-up reminders to maximize participation. Responses were summarized using descriptive statistics and reported as counts and percentages. The survey was conducted in accordance with the Kelley checklist. A total of 1169 surveys were completed, mostly in English, from ten provinces and two territories with Ontario and Alberta being overrepresented. Respondents were predominantly registered nurses (79.1
Cancers diagnosed through the emergency department (ED) were identified, and their characteristics, and diagnostic and treatment intervals were compared to community-diagnosed cases. A medical records review was conducted for new cancer cases seen by medical oncology at The Ottawa Hospital from January 1 to March 31, 2024. Enrolled cases were assessed for ED visits in the preceding 3 months and classified as ED diagnosed if the cancer was diagnosed as a result of the ED visit. An equal number of cases without a preceding ED visit were randomly selected as community-diagnosed comparators. Patient characteristics, Ontario Marginalization Index scores, cancer type and stage, screen detection, diagnostic assessment pathway eligibility and referral, diagnostic timelines, treatment, and mortality were abstracted. Among 1011 new cancer cases, 241 (23.8
Sudden cardiac arrest is a leading cause of mortality in Canada (40,000 treatable deaths annually). Despite the benefits of 9-1-1 telecommunicator-assisted CPR, agonal (reflexive/ineffective) breathing often leads to misdiagnosis and delayed intervention. Artificial intelligence (AI), particularly large language models, may improve cardiac arrest recognition during 9-1-1 calls. This study aimed to identify community-informed requirements for integrating AI models into 9-1-1 ambulance communications centers to enhance rapid cardiac arrest recognition and timely response. We hosted a CIHR-funded planning and dissemination meeting at the Ottawa Paramedic Service. The qualitatively driven study involved diverse community members including emergency physicians, telecommunicators, paramedics, cardiac arrest survivors, AI model developers, and policymakers. We used a structured Miro board exercise before, during, and after the meeting to facilitate participant input. Five pre-identified themes guided the exercise: (1) essential must-haves in a useful AI application, (2) considerations for integration with 9-1-1 system, (3) policy/ethical considerations, (4) burning questions, and (5) missing community members. Participants emphasized the need for high cardiac arrest interpretation accuracy, low false activation rates, multilingual capabilities, and explainable AI model outputs. Integration concerns included compatibility with computer-assisted dispatch systems, platform independence, and redundancy during outages. Ethical considerations focused on privacy, data sovereignty, liability, and bias mitigation. Participants raised questions about AI model’s ability to interpret voice cues, background audio, and caller distress. Gaps in community representation were identified, including accessibility experts and Ministry information technology specialists. This planning exercise identified critical technical, ethical, and operational requirements for AI model integration into 9-1-1 ambulance communications centers. Community member insights will inform future development and validation of an AI-driven decision support architecture aimed at improving cardiac arrest recognition, reducing time to CPR initiation, and enhancing equity in emergency response. The findings support a patient/telecommunicator-centered, responsible approach to AI model deployment in prehospital care.
Pediatric readiness, measured using the weighted pediatric readiness score (WPRS; 0–100), is associated with improved outcomes and lower mortality. A baseline assessment identified gaps across domains, with the lowest scores in coordination, staffing and training, and quality improvement, highlighting the need for targeted intervention. We evaluated the effectiveness of a multi-component, context-informed intervention on improving pediatric readiness in general EDs. We conducted a single-blinded, matched pair randomized controlled trial in 17 general EDs (October 2022–May 2025). Sites were paired based on baseline WPRS, annual general ED volume, and distance from the provincial tertiary pediatric center and then randomized to a multi-component intervention or control. The intervention included a customized readiness report with discussion, pediatric resource toolkits, educational outreach, and ongoing support; control sites received the report only. Pediatric readiness was reassessed beginning six-month post-intervention using the Canadian adaptation of the National Pediatric Readiness Survey, from which WPRS is derived. The primary outcome was change in overall WPRS compared using Welch’s t tests. Mixed-effects linear regression, with Bayesian analyses was conducted to strengthen confidence in the estimated intervention effects. Sixteen general EDs (8 intervention, 8 control) completed follow-up. Median (IQR) post-intervention WPRS was 44.2 (14.7) for intervention sites and 53.9 (17.6) for control sites. Mean (SD) change in WPRS was − 1.2 (15.1) overall (intervention − 4.8 (16.7); control + 2.4 (13.4); p = 0.4). Post-intervention WPRS ranged from 38.2 to 79.3. Three sites achieved clinically meaningful improvement (> 10 points), nine remained stable, and four declined. No statistically significant intervention effects or covariate associations were identified. Performance was highest in the domains of patient safety and equipment and supplies, while quality improvement remained consistently lowest. A low-intensity multi-component intervention showed varied change in mean WPRS between the randomized sites. Substantial site-level variation suggests that context-responsive and more intensive strategies may be required.
Helicopter Emergency Medical Services (EMS) can expedite transport for patients with acute ischemic stroke, yet many cases do not ultimately receive neuro-intervention (i.e., endovascular thrombectomy or neurosurgical procedure). Expanded stroke treatment time windows have increased the number of potential thrombectomy-eligible patients, adding urgency to appropriate resource utilization. The purpose of this study was to describe characteristics and clinical outcomes of patients with known or suspected ischemic stroke transported via helicopter EMS and identify pre-transport factors associated with receiving neuro-intervention. This four-year population study evaluated adults with confirmed or suspected ischemic stroke transported via helicopter EMS to a comprehensive stroke center in Alberta (Jan 1, 2019 to Dec 31, 2022). The primary outcome was the proportion of patients who received neuro-intervention. Secondary outcomes included neuro-intervention rates comparing early (i.e., < 6 h from ‘last seen normal’) and late (≥ 6 h) presenters, proportion of ‘low-yield’ transfers (i.e., died/palliated or discharged/repatriated within 24 h without neuro-intervention), and a comparison of pre- and intra-transport characteristics of patients who received neuro-intervention to those who did not. Exploratory multivariable regression was used to identify pre-transport predictors of neuro-intervention. Of 226 patients included in this study, 35
Burnout rates are alarmingly high among healthcare workers, particularly emergency staff, where rates reach 60
Emergency departments (EDs) face severe capacity challenges exacerbated by shelter bed shortages, delaying discharges for people experiencing homelessness during the winter months. In response, a Toronto-based hospital-affiliated warming centre was launched to enable EDs to discharge people experiencing homelessness to a supportive location. This exploratory study examined the relationship between ED visits by people experiencing homelessness and hospital-affiliated warming centre operation. Administrative data on ED and hospital-affiliated warming centre utilization were obtained for the winter seasons between Nov 2022 and April 2025. Publicly available data on shelter system volumes and temperature were also obtained. Multiple regression models were fitted to predict how hospital-affiliated warming centre operation affected ED volume and flow. The hospital-affiliated warming centre supported 1,196 visits during its first year and 638 visits during the second year. There was a nonsignificant association between ED visits by people experiencing homelessness and operation of the hospital-affiliated warming centre in both years. Operation in year one was associated with significantly longer daily mean ED visits (44.6 min longer) among people experiencing homelessness; the opposite effect was found in the second year (86.1 min shorter). Mean ED lengths of stay in 2024–5 were significantly higher on days when there were more people staying in the Toronto shelter system. The hospital-affiliated warming centre, operated in collaboration with a community partner agency with expertise in delivering person-centred supports to homeless and marginalized populations, has the potential to reduce ED length of stay among people experiencing homelessness by providing a safe, alternative space for overnight sheltering. Ongoing monitoring of this type of intervention is necessary to mitigate unintended service model outcomes, such as ED return visits related to warming centre access.
Pulmonary embolism is a serious condition requiring accurate diagnosis, management, and risk stratification to guide treatment and disposition. While outpatient management for pulmonary embolism may be safe for select patients, its application in the emergency department (ED) setting remains uncertain. This study aimed to evaluate the safety of outpatient management for patients presenting to the ED with pulmonary embolism. This was a health-record review of patients with confirmed pulmonary embolism in 2 large EDs of a tertiary care hospital. Stable patients were discharged by the ED physicians, usually without consultation and patients were seen in a specialized thrombosis clinic within 48 h. Anticoagulation follow-up was coordinated through the thrombosis clinic. We reviewed electronic hospital records using a standardized data collection form. The primary outcome was return to the ED within 5 days due to early clinical deterioration requiring escalation of treatment. Descriptive statistics are presented. Out of the 300 patients initially screened, 253 patients had confirmed pulmonary embolism and were evaluated in this review. Ten were excluded (3 admitted for another reason, 5 were discharged by the consulting service, 1 left against medical advice, 1 died in the ED). Of the 243 patients in the final analysis, 101 patients (41.6
Although simulation-based education is well known to support skill development such as Advanced Cardiovascular Life Support skills, it is not well incorporated in the Canadian junior undergraduate medical education curriculum. Medical students at the University of Toronto in collaboration with the local Base Hospital created ResusWars, a simulation-based education initiative. The aim of ResusWars is to introduce Advanced Cardiovascular Life Support theory and increase early access to simulation-based education for junior medical students. Pre- and post-event surveys showed that participants felt more confident managing time-sensitive scenarios and were more comfortable with simulation following participation in ResusWars.
To perform the first external validation of the Melbourne ASSET Score for predicting the need for intravenous (IV) antibiotic therapy in pediatric emergency department (ED) cellulitis. This prospective cohort study (January 2022–January 2024) at a Canadian tertiary pediatric ED enrolled children aged 6 months to 18 years with cellulitis. Exclusion criteria included orbital cellulitis, immunocompromised state, clinical toxicity, and inability to tolerate oral antibiotics. The primary outcome was IV versus oral antibiotic administration at 24 h. Secondary outcomes included interrater reliability and treatment failure. Among 229 children (median age, 5.7 years; 38
Inhaled isopropyl alcohol has demonstrated benefit in managing nausea in emergency departments. This study investigated inhaled isopropyl alcohol’s effect on patients with substance-related nausea at 20 Canadian electronic dance music festivals. This double-blind randomized control trial enrolled patients aged 18 years or older, who self-reported substance use, and presented with nausea. Exclusion criteria were allergy to isopropyl alcohol, inability to inhale through nares, inability to verbally report nausea level, and prior antiemetic given by medical staff. Randomization was to 70
