Meg McInnes,1 Debra Kerr,2 Alan Hayes11Institute of Health & Sport, Victoria University, Melbourne, Victoria, Australia; 2School of Nursing & Midwifery, Centre for Quality & Patient Safety Research in the Institute for Health Transformation, Deakin University, Geelong, Victoria, AustraliaCorrespondence: Meg McInnes, Institute of Health & Sport, Victoria University, Melbourne, Victoria, Australia, Tel +61 3 9919 2170, Email meg.mcinnes@vu.edu.auBackground: Emergency medical service (EMS) use reduces time to treatment and improves outcomes in acute coronary syndrome (ACS), yet it is unknown whether all Australians have equitable access to EMS. This systematic review examined whether equity-related factors are associated with disparities in EMS use for patients with ACS in Australia.Methods: The review was pre-registered with PROSPERO (CRD42023466951). Six databases (MEDLINE, CINAHL, Web of Science, ScienceDirect, Cochrane and Scopus) were searched in June 2025 for articles published from inception until May 2025. Eligible studies involved adults presenting to Australian hospitals or emergency departments with ACS or acute non-traumatic chest pain and reported EMS use by at least one PROGRESS-Plus equity-related factor. Risk of bias was assessed using JBI checklists. Findings were synthesized using tabular analysis and a vote-counting summary.Results: Fourteen studies were identified, with twelve rated high quality. EMS utilization ranged from 36% to 79% and increased over time. Disparities were evident across multiple equity-related factors. Adults aged under 49 years had up to 68% lower odds of EMS use than those 65 years or older. Men had up to 11% lower odds than women. People born outside Australia had up to 15% lower odds, and those preferring non-English languages had 6– 20% lower odds. Residents of remote areas had up to 25% lower odds than major city residents, while individuals living alone had up to 48% higher odds than those living with others. Findings for socioeconomic status measures were mixed.Conclusion: EMS use for ACS in Australia is consistently lower among younger adults, men, people born overseas, those preferring non-English languages, and residents of remote areas. These findings can inform targeted interventions to improve EMS accessibility. Future research should examine the mechanisms underlying these access barriers, particularly for populations experiencing multiple forms of disadvantage.Keywords: cardiovascular diseases, disparity, emergency medical service utilization, health equity, healthcare access, myocardial ischemia
Theobald Hatangimana, Herbert Butana, Desire Rubanguka, Glorieux Twizeyimana, Khadar Digaale Abdishakour, Deresse TilahunDepartment of Surgery, School of Medicine, Africa Health Sciences University, Kigali, RwandaCorrespondence: Deresse Tilahun, Department of Surgery, School of Medicine, Africa Health Sciences University, Kigali, Rwanda, Email tmaed83@gmail.comBackground: Posterior rectus sheath hernia is an exceptionally uncommon interparietal hernia and may be difficult to recognize because the herniated bowel remains between abdominal wall layers.Case Presentation: A 49-year-old multiparous woman presented with acute severe pain, vomiting, fever, and inflammatory skin changes over a right paraumbilical swelling that had been present for six years. Ultrasound suggested a complicated abdominal wall cyst, whereas computed tomography demonstrated a right rectus sheath hernia. Emergency exploration revealed strangulated and perforated small bowel contained between rectus sheath layers, with enteric leakage into necrotic anterior abdominal wall tissues. Approximately 20 cm of gangrenous bowel was resected and a primary end-to-end anastomosis was performed. The small fascial defect was closed primarily without mesh because of the dirty infected field. The skin and subcutaneous wound were left open after debridement, managed with temporary packing and two further operative debridements, and closed secondarily after infection control. The patient recovered and was discharged in good clinical condition.Conclusion: Posterior rectus sheath hernia should be considered in atypical abdominal wall masses. Early computed tomography and urgent source control are essential when strangulation, perforation, or necrotizing infection is suspected.Keywords: posterior rectus sheath hernia, interparietal hernia, strangulated hernia, small-bowel perforation, necrotizing soft-tissue infection, case report
Thomas R Knobl,1 Tyler N Carruth21Emergency Department, HCA Florida Bayonet Point Hospital, Hudson, FL, USA; 2Cresilon, Inc., Department of Clinical Education, Brooklyn, NY, USACorrespondence: Thomas R Knobl, Emergency Department, HCA Florida Bayonet Point Hospital, Hudson, FL, 34667, USA, Tel +1 727 858 2633, Email tknobl@neurospatms.comAbstract: Gunshot wounds (GSWs) to the head or face are among the most complex injuries secondary to a number of vital structures in a relatively small volume of space. Hemorrhage can be difficult to control with traditional techniques, and ongoing hemorrhage can further complicate securing the airway. We present the use of a hemostatic gel in a facial GSW. A 74-year-old male suffered a self-inflicted GSW to the submandibular region with significant hemorrhage in the setting of a suspected overdose of apixaban (Eliquis) and alprazolam (Xanax). Traditional methods were unable to control the bleeding, and a syringe of Traumagel, a hemostatic gel, was then deployed into the complex wound, which achieved hemostasis.Keywords: traumagel, GSW, hemorrhagic control, trauma, case report, facial injury
Amado Alejandro BaezUniversidad Nacional Pedro Henríquez Ureña (UNPHU), Santo Domingo, Dominican RepublicCorrespondence: Amado Alejandro Baez, Email aalbaez@unphu.edu.do
Andres Ramiro Ardila Jara,1 Catalina Barbosa Malagon,1 Laura Daniela Castillo Moreno,1 Fredy Alexander Rojas,2 Gabriel Camilo Beltrán Rojas,2 Alejandro Medina Adam,1 María José Romero Troya,1 Leonar Giovanni Aguiar Martinez2,31Faculty of Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia; 2Emergency Medicine, Pontificia Universidad Javeriana, Hospital Universitario San Ignacio, Bogotá, Colombia; 3Department of Internal Medicine, Pontificia Universidad Javeriana, Hospital Universitario San Ignacio, Bogotá, ColombiaCorrespondence: Leonar Giovanni Aguiar Martinez, Department of Internal Medicine, Pontificia Universidad Javeriana, Hospital Universitario San Ignacio, Bogotá, Colombia, Email laguiar@javeriana.edu.coBackground: Left Without Being Seen (LWBS) rates are widely recognized as a key quality indicator in Emergency Departments (ED) worldwide. Their clinical relevance is substantial, given the documented association between LWBS and increased morbidity and mortality among patients presenting to the ED. However, the available evidence is extensive and highly heterogeneous; therefore, a scoping review represents a more appropriate approach for synthesizing the evidence than a systematic review or meta-analysis.Objective: This scoping review aims to synthesize current evidence regarding population characteristics, underlying determinants, and potential interventions associated with LWBS rates, pondering the need to strengthen strategies for identifying and reducing these events.Design: Scoping review conducted according to PRISMA-ScR guidelines. We searched four databases (PubMed, Scopus, Oxford Academic, and EBSCO) between Jan 01, 2020 – Dec 31,2025. To meet the eligibility criteria, studies were required to be observational analytical, interventional, or evidence synthesis, given the limited evidence found, posters involving studies of human participants in ED settings.Results: Ninety-four publications were included with de eligibility criteria Most studies were interventional and conducted in North America; however, systematic reviews and additional studies from Europe, Asia, Australia, South America, and the Middle East were also identified. Reported LWBS rates varied widely across settings and were influenced by both community-level and individual-level factors, including demographic characteristics, EDs staffing, time of presentation, chief complaint, and facility resources, as well as contextual factors such as the COVID-19 pandemic. The available evidence demonstrated considerable heterogeneity in the definition and characterization of LWBS causes, largely due to differences in reporting practices, documentation, and descriptions of events related to this outcome. Numerous interventions aimed at reducing LWBS rates were described.Conclusion: LWBS is a key emergency care quality indicator driven by waiting times, crowding, and temporal factors. It predominantly affects low-acuity, socioeconomically vulnerable adults. Physician-in-triage reduces LWBS, while predictive models identify high-risk patients. Associated with revisits and mortality, LWBS requires flow optimization and context-adapted strategies. Standardized frameworks are needed to strengthen evidence.Keywords: emergency department abandonment, risk factors, interventions, LWBS
