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
Hassan Adan Ali Adan1– 31Faculty of Medicine, Mogadishu University, Mogadishu, Somalia; 2Department of Emergency Medicine, Mogadishu Somali Turkiye Recep Tayyip Erdogan Training and Research Hospital, Mogadishu, Somalia; 3Department of Research, Somali Society for Emergency Medicine (SOSEM), Mogadishu, SomaliaCorrespondence: Hassan Adan Ali Adan, Department of Emergency Medicine, Mogadishu Somali Turkiye Recep Tayyip Erdogan Training and Research Hospital, Digfer Road, Hodon, Mogadishu, Somalia, Tel +252615386228, Email xsnkheyr@gmail.comAbstract: Effective prehospital emergency care is a core component of an emergency care system because assessment, initial stabilization, communication, and transport begin before definitive hospital treatment. In Somalia, prehospital services remain fragmented, with substantial reliance on informal transport and limited access to trained responders, standardized protocols, dispatch, and coordinated referral. Somalia-specific reports have documented major gaps in organized prehospital care, including limited ambulance capacity and a lack of a unified national system. This Perspective examines these barriers and proposes a pragmatic pathway for reform that prioritizes governance, workforce development, community first response, dispatch and communication, ambulance standards, and linkage with receiving hospitals. Rather than proposing an expensive high-resource model, the paper advocates phased development beginning with context-appropriate first-responder and basic ambulance-provider training, followed by regulated expansion of advanced prehospital care as workforce, financing, and clinical governance mature. Existing Somali experience with WHO-supported emergency-care training provides a foundation for local capacity building, while regional experience from Kenya illustrates the value of policy, regulation, data, and coordinated dispatch. Mobile communication technologies may offer a feasible bridge where conventional dispatch infrastructure is limited. The immediate priority should be to establish a nationally coordinated, measurable, and sustainable prehospital system that connects communities, responders, ambulances, and hospitals.Keywords: prehospital care, emergency medical services, Somalia, trauma, emergency medical technicians, health systems strengthening
Mostafa Dayraki,1 Shahzad Anjum,1– 3 Lolwa AlKhulaifi,1 Lara Miranda,1 Duha Adil Musa Mohmmad,1 Atika Jabeen,1 Zain Ali Bhutta,1 Yavuz Yigit1,41Department of Emergency Medicine, Hamad Medical Corporation, Doha, Qatar; 2College of Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar; 3College of Medicine, QU Health, Doha, Qatar; 4Blizard Institute, Queen Mary University, London, UKCorrespondence: Yavuz Yigit, Yavuz Yigit, College of Medicine, QU Health, Qatar University, P.O. Box 2713, Doha, 3050, Qatar, Tel +97430616054, Email yyigit@qu.edu.qaBackground: Incidental findings (IFs) on computed tomography of the kidneys, ureters, and bladder (CT KUB) are increasingly common in emergency departments (EDs) due to the widespread use of advanced imaging. These findings, often unrelated to the primary diagnostic indication, present clinical and operational challenges, particularly in high-volume, demographically diverse settings.Objective: To evaluate the prevalence, classification, and clinical significance of incidental findings on CT KUB scans performed in the ED for suspected obstructive uropathy, and to identify factors associated with clinically significant IFs and evaluate their clinical outcomes.Methods: A retrospective single-center observational study was conducted at a national tertiary-care hospital in Qatar, including all adult patients who underwent non-contrast CT KUB for suspected renal colic between January 1 and November 30, 2024. Demographic, clinical, and radiological data were extracted. IFs were categorized as major, moderate, or minor based on clinical relevance. Outcomes included prevalence and distribution of IFs, subsequent management actions, and factors associated with major IFs.Results: Of 2786 CT KUB scans analyzed, 1531 (54.9%) revealed at least one incidental finding. Most incidental findings were classified as minor (63.2%), whereas 6.1% were major and 30.8% were moderate according to the highest-severity incidental finding per scan. Major IFs (e.g, suspected malignancy, aortic aneurysm) accounted for most urgent interventions and admissions. Multivariable analysis identified that older age, nationality, fever, desaturation, and abdominal tenderness were independently associated with major IFs (all p< 0.05). Management of the primary condition was delayed due to IFs in only 0.6% of cases. The most frequent IFs were vascular calcifications, bone lesions, and hernias.Conclusion: Incidental findings on CT KUB are common in the ED, with a significant proportion requiring further intervention or specialist referral. The high prevalence in a younger, multi-ethnic population underscores the need for context-specific protocols, structured reporting, and robust follow-up systems.Keywords: CT KUB, incidental findings, emergency department, obstructive uropathy, risk stratification
Background:Parotitis, inflammation of the parotid gland, is most commonly attributed to infection, salivary duct obstruction, or autoimmune disease; trauma-induced parotitis is uncommon, and blunt-trauma cases are reported less frequently than penetrating injury. Case presentation:We describe a 4-year-old boy who presented to the emergency department with left-sided facial swelling one day after a low-velocity slap to the cheek during play. Examination showed tender left parotid swelling without bruising, pain-limited trismus, and no facial nerve, otologic, oral cavity, or temporomandibular joint abnormalities; a whole-body skin survey and a formal social-work assessment for non-accidental injury were unremarkable. Computed tomography, obtained because the mechanism of injury required clarification and mandibular fracture could not initially be excluded on clinical grounds, showed parotid enlargement with adjacent fat stranding and no fracture. Markedly elevated serum amylase, with normal inflammatory markers and negative viral serology, supported a diagnosis of traumatic parotitis after systematic exclusion of infectious, obstructive, and suppurative causes. The child was managed conservatively and recovered fully within two weeks. Conclusion:This case adds to the limited literature on post-traumatic parotitis by illustrating that even a low-velocity, everyday mechanism such as a slap can produce isolated parotid swelling in children, an association not previously emphasized outside higher-energy blunt trauma. It highlights the value of a structured differential work-up, judicious imaging, and routine safeguarding assessment in this presentation.
