OBJECTIVES:Heat-related emergencies are increasing in the United States (U.S.), but little is known about trends in prehospital heat-related encounters. This study examines temporal and geographic trends in prehospital heat-related encounters and assesses demographic and clinical factors associated with these heat-related encounters. METHODS:We used an observational study design and a retrospective analysis of the 2019-2023 National Emergency Medical Services Information System (NEMSIS) databases. We described the characteristics of heat-related encounters and compared the rates of heat-related complaints by year. Comparing 2019 to each year from 2020-2023, we used logistic regression to evaluate the odds of heat-related complaints. We then repeated these regressions for each U.S. census division to evaluate for regional variation in the trends of heat-related complaints. RESULTS:We included 120,181,275 non-heat-related encounters and 478,666 heat-related encounters. Compared to non-heat-related encounters, heat-related encounters involved younger patients, more males, and higher rates of tachycardia and hypotension. The odds of heat-related encounters increased in 2023 compared to 2019 (odds ratio (OR) 1.04, (1.03-1.05)), but other years were similar. There was significant regional variation in heat-related encounters between Census Divisions, though. The largest increases were: 2020 - Mountain (OR 1.13 (1.09-1.16)); 2021 - Pacific (OR 1.25 (1.22-1.29)); 2022 - Mountain (OR 1.23 (1.19-1.26)) and West South Central (OR 1.19 (1.17-1.22)); 2023 - West South Central (OR 1.54 (1.51-1.57)) and West North Central (OR 1.18 (1.14-1.22)) and Mountain (OR 1.29 (1.25-1.33)). CONCLUSIONS:While national odds and proportions of heat-related prehospital encounters have risen slightly in 2023 compared to 2019, certain geographic regions have experienced far greater increases. Further research is needed to identify vulnerabilities and optimize emergency response strategies.

Background: Family medicine training programs must evolve to meet emerging healthcare challenges, such as climate change, digital health integration, and emergency preparedness. Understanding institutional perspectives on curriculum gaps is essential for strategic educational planning and resource allocation across diverse healthcare systems. Objective: To assess family medicine training curriculum coverage across the Americas from the institutional perspective of professional associations, and identify priority areas for educational modernization. Methods: We made a cross-sectional institutional assessment across 19 countries in the Americas. All WONCA-affiliated family medicine professional associations completed standardized 22-item surveys assessing curriculum coverage across 25 core competency areas. Analysis focused on identifying institutional curriculum gaps using threshold methodology (competencies with <70% adequate coverage classified as priority gaps). Results: Professional associations achieved 100% participation across all target countries. Traditional clinical competencies showed universal institutional coverage (100% for non-communicable diseases, communicable diseases, emergency medicine, women's health, children's health, and adult health). Critical curriculum gaps emerged in contemporary competencies, with significant disparities, particularly in areas such as climate change and environmental health, telehealth integration, and healthcare management training. Conclusions: While family medicine institutions demonstrate strong curriculum coverage in traditional clinical areas, critical gaps exist in emerging competencies essential for 21st-century healthcare, with marked regional disparities. Climate change and environmental health represent the most significant institutional curriculum gaps, particularly affecting Latin American programs. Strategic curriculum modernization and targeted support are urgently needed to prepare family physicians for the contemporary healthcare challenges they face.

Background:Care in the hospital, post-arrest care, is a crucial component of out-of-hospital cardiac arrest (OHCA) management, but current OHCA databases contain limited post-arrest care data. To address this, we present the methodology for assembling a multicenter, real-world post-arrest care research registry using the Trinetx database. Methods:We queried the Trinetx research database (01/01/2000-02/19/2025), a federated database of electronic health record data from over 100 healthcare organisations in the US and internationally, to identify OHCAs from ICD codes for cardiac arrest related to emergency department (ED) visits. To define our cohort of patients eligible to receive post-arrest care, we identified OHCAs that survived to admission based on having a temporally associated inpatient encounter (based on encounter type/Current Procedure Terminology codes) or an ED visit lasting >24 h. We defined survival to discharge as 1) having an encounter after the hospitalisation and 2) having a death date after the end of the hospitalisation. We report patient characteristics and the number of clinical variables available in each data table for the cohort. Results:We identified 222,868 OHCAs and included 88,753 patients (39.8%) who survived to admission. The median age was 65, 60.3% were male, and 59.8% were White. Survival to discharge rate was 48.5%. The database contained 188,038,385 clinical data points: 40,868,707 vital signs, 52,145,594 labs, 17,781,035 procedures, 72,575,389 medication administrations, and 4,667,660 diagnoses. Conclusion:Using Trinetx real-world data, it is possible to create a multicentre, OHCA post-arrest care database with a substantial number of clinical variables, enabling novel post-arrest care research.

OBJECTIVE:Literature evaluating pericapsular nerve group (PENG) blocks for regional anesthesia in hip fractures suggests that PENG blocks provide adequate pain relief, reduce opioid use, and have few adverse effects. However, these reports have investigated time frames that do not encompass the expected block duration. We assessed the potential of PENG block administration to reduce morphine milligram equivalent (MME) utilization. METHODS:This retrospective, single center, cohort study evaluated opioid utilization and related adverse events in adults with isolated hip fractures who received PENG block vs systemic analgesics alone for acute pain management. The primary outcome was the difference in preoperative MME utilization between groups. Secondary outcomes included pre-operative incidence of sedation and provision of non-opioid analgesics. The comparator group was identified via Mahalanobis distance matching. We compared MME utilization and cumulative laxative doses via paired t-test and sedation incidence via conditional logistic regression. RESULTS:We identified 53 patients who received PENG block following isolated hip fracture and matched them with 53 non-blocked controls. The mean age was 74.2 ± 12.4 years and 60.4 % were female. Specific fracture location did not differ between groups. MME utilization in the preoperative period was similar between groups (43.4 vs 42.9, 95 % confidence interval (CI) -18.8-17.7). There was no difference in documented sedation (odds ratio 1.5, 95 % CI 0.2-9.4) or cumulative doses of various laxative medications. CONCLUSION:Provision of PENG block for regional anesthesia following isolated hip fracture was not associated with a reduction in pre-operative MME utilization or opioid-related adverse events.

BACKGROUND: The social mission of health professional schools is to train a diverse group of providers to care for all populations. Community college students encounter more challenges than traditional students in accessing the resources and support, including mentorship, needed to prepare for graduate health professions programs. This project aimed to identify community college students' challenges. METHODS: We expanded an existing mentorship program, initially designed for medical and community college students, to include other specialties such as nursing, occupational therapy, physical therapy, and physician assistant programs. RESULTS: Mentees indicated that barriers to participating in extracurricular activities included work, opportunities for shadowing a healthcare provider, lack of time, financial barriers, and living far away from volunteer opportunities. CONCLUSION: By addressing resource challenges and establishing intentional pathways for community college students through effective mentorship, we may enhance diversity in healthcare and alleviate the shortage of primary care providers.

Between September 2022 and August 2024, a mixed-method study was conducted at the University of New Mexico Comprehensive Cancer Center to enhance sexual orientation and gender identity data collection to facilitate meaningful use of sexual orientation and gender identity data in clinical care for sexual and gender minority patients. This report presents findings from a center-wide readiness assessment survey to identify and analyze the complex challenges affecting sexual orientation and gender identity data collection implementation. Over a 1.5-month period, a REDCap online survey was distributed to assess organizational and individual readiness to implement and expand on the collection of sexual orientation and gender identity data at the cancer center. The survey consisted of 4 widely used readiness measures: Organizational Readiness for Implementing Change; Implementation Leadership Scale; Implementation Climate Scale; and an adapted version of the Lesbian, Gay, Bisexual, Transgender, Queer (or Questioning), Intersex Health Knowledge, Attitudes and Practice Scale. Findings specific to perceived gaps in leadership support and resource provision informed multilevel strategies to improve sexual orientation and gender identity data collection and use.

BACKGROUND:Health care professionals are in a unique position to enact health-related social change. Medicine is subject to regulation at the organizational, local, state, and national levels. Federal laws apply to physicians throughout the US; as such, federal policy affects physician practice intentions similarly. However, there is little research on state-level engagement in the political process and none on the participation by family medicine physicians. METHODS:This article examines the nature of physician civic engagement at the state level. Data were gathered and analyzed as part of the 2023 Council of Academic Family Medicine's (CAFM) Educational Research Alliance (CERA) survey of Family Medicine educators and practicing physicians. We used nonparametric statistics (Kruskal-Wallis tests) to analyze ordinal variables. Categorical variables were analyzed using χ2 tests. We used multivariable ordinal logistic regression to assess the joint effects of participant characteristics on study outcomes and to adjust for potential confounding. RESULTS:The policy question section of the survey received 709 responses, a response rate of 21%. Our results show a lack of civic engagement, including less than a third voting in state elections and only 4% making financial contributions to political campaigns. Seventeen percent of respondents reported considering relocating due to state health policies. For all questions, we observed variations by geographical region and gender. CONCLUSIONS:Our findings provide a timely analysis of family medicine physician participation in the political process, the effect of specific health policies, and how these policies are comparatively received among family medicine physicians in the United States.

Background: The overuse of medical resources is a global issue, often resulting in more harm than good. Within the United States, almost one-third of medical spending is unnecessary, with physicians being responsible for an estimated 10% of this waste, primarily through lack of care coordination and overtreatment. Identifying opportunities for cost savings while delivering quality care is a core competency requirement for all medical specialties. We took a pragmatic approach to improve medical students' decision-making in different contexts to assist them in understanding contextual factors when ordering care. Methods: This study retrospectively reviewed 193 high-value care prescriptions. Prescriptions were completed by 4th-year medical students completing a rotation in an outpatient, inpatient, or emergency room settingduring the 2020 and 2021 academic years. Indicators of interest included underlying reasons for testing, whether non-clinical effects of tests were considered, who the students discussed costs with, and whether students believed the course changed the management of the patient. Results: A majority of students described downstream effects on the healthcare system and effects related to patients, such as cost, time, transportation, stress or anxiety, missed work, and childcare. The financial cost was one of the primary considerations for patients, yet it was not routinely discussed with patients. Most students felt that the prescription tool did not change the management of the current patient. However, they did feel that the tool changed their approach to future patients with the same problem, which was the goal of this project. Conclusion: There is a need to consider the valuefor patients and the cost to the health care system when ordering tests and procedures. More workmust be done to encourage consideration and conversations about finances and socialdeterminants of health amongst all team members, including patients.

Background: Transitioning within medical school to new duties, roles and challenges represents a significant change in responsibility. Medical students may experience the imposter phenomenon, fearing exposure as a "fraud". Identifying when imposterism could peak during training, the student's historical social determinants and personal history that can lead to the overall imposter syndrome is very important, because during medical school, student wellness and professional identity typically decrease. This study aims to characterize the imposter phenomenon in medical students at a single institution as they transition from one academic year to the next. Methods: This study is a cross-sectional observational design. We constructed a 30-item survey using the Clance Imposterism Scale and selected demographic characteristics. Indicators of interest include: environment of upbringing, education, socioeconomic status, and race/ ethnicity. We analyzed the data using Pearson's Chi-Square and Fisher Exact tests, and a two-tailed Type I error of less than 5% to assess statistical significance. Results: Out of 387 students, we received 89 responses, resulting in a 23% response rate. Fourth-year medical students reported experiencing feelings of imposterism more frequently or intensely than students in the first three years. Females had frequent/intense levels of imposterism more than males or non-conforming individuals. More than 75% of individuals raised in rural areas experienced frequent to intense imposterism compared to those raised in suburban or urban environments. Completing an undergraduate degree with dedicated mentoring from physicians did not ameliorate feelings of not belonging. Conclusion: We characterized medical students by cohort to identify points of intervention. Our findings highlight the importance of addressing the imposter phenomenon, especially in environments like medical school, where the expectations to excel are intense. Recognizing that certain groups, such as females, underrepresented minorities, and first-generation college students, may be more susceptible to these feelings of inadequacy is an important step toward providing support and resources tailored to meet their needs.

IntroductionForeign body airway obstruction (FBAO) is a life-threatening condition. We aimed to quantify the impact of bystander FBAO interventions on survival and neurological outcomes.MethodsWe conducted a Japan-wide prospective, multi-center, observational study including all FBAO patients who presented to the Emergency Department from April 2020 to March 2023. Information on bystander FBAO interventions was collected through interviews with emergency medical services personnel. Primary outcomes included 1-month survival and favorable neurologic outcome defined as Cerebral Performance Category 1 or 2. We performed a multivariable logistic regression and a Cox proportional hazards modeling to adjust for confounders.ResultsWe analyzed a total of 407 patients in the registry who had the median age of 82 years old (IQR 73 to 88). The FBAO incidents were often witnessed (86.5%, n = 352/407) and they intervened in just over half of the cases (54.5%, n = 192/352). The incidents frequently occurred at home (54.3%, n = 221/407) and nursing home (21.6%, n = 88/407). Common first interventions included suction (24.8%, n = 101/407) and back blow (20.9%, n = 85/409). The overall success rate of bystander interventions was 48.4% (n = 93/192). About half (48.2%, n = 196/407) survived to 1-month and 23.8% patients (n = 97/407) had a favorable neurological outcome. Adjusting for pre-specified confounders, bystander interventions were independently associated with survival (hazard ratio, 0.55; 95% CI, 0.39 to 0.77) and a favorable neurological outcome (adjusted OR, 2.18; 95% CI, 1.23 to 3.95).ConclusionBystander interventions were independently associated with survival and favorable neurological outcome, however, they were performed only in the half of patients.

INTRODUCTION: Type II Odontoid Fractures (T2OF) are the most prevalent cervical spine fractures in adults =65 years old. Nonetheless, there is insufficient data regarding the influence of frailty on outcomes for both nonoperative and operative, treatment approaches. METHODS: We conducted a retrospective review of T2OF patients from 2015 to 2020 using the ACS-TQIP® database. Using unmatched and propensity score-matched (PSM) risk-adjusted models we assessed the association between frailty and all adverse outcomes. Survival probabilities were examined using Kaplan-Meier (K-M) plots and frailty-based risk stratification. Our outcomes include major complications, hospital length of stay (LOS), nonhome discharge (NHD), mortality rates, and survival probabilities. RESULTS: There were 22,440 T2OF patients, comprised of 31.8% (n = 7,138) robust, 35.2% (n = 7,913) typical, 22.9% (n = 5,158) frail, and 9.9% (n = 2,231) very frail patients. Results from unmatched multivariable analyses revealed a dose-dependent relationship between frailty and all outcomes, in both cohorts (p < 0.05). PSM resulted in 3,942 nonoperative and operative matched pairs. Preoperative characteristics were similar between cohorts, except for age: 75 years (IQR: 60-83) nonoperative and 70 years (IQR: 56-78) operative, and male sex: nonoperative 1,799 (55.8%) and operative 439 (61.1%). Significant mortality reductions (43-77%; p < 0.05) were observed in the operative cohort compared to the nonoperative cohort across all frailty strata. As expected, the operative cohort had longer LOS and increased NHD risk ranging from 64-97%, p < 0.001. In K-M analyses, survival declined significantly across increasing frailty strata p < 0.001. CONCLUSIONS: Increasing frailty in T2OF patients was independently associated with major complications, LOS, NHD, and decreased survival. Interestingly, operative patients exhibited improved survival compared to nonoperative patients across all frailty strata. These findings highlight the importance of frailty in T2OF management and care coordination.

Introduction: The United States lacks a national interfacility patient transfer coordination system. During the coronavirus 2019 (COVID-19) pandemic, many hospitals were overwhelmed and faced difficulties transferring sick patients, leading some states and cities to form transfer centers intended to assist sending facilities. In this study we aimed to explore clinician experiences with newly implemented transfer coordination centers. Methods: This mixed-methods study used a brief national survey along with in-depth interviews. The American College of Emergency Physicians Emergency Medicine Practice Research Network (EMPRN) administered the national survey in March 2021. From September-December 2021, semi-structured qualitative interviews were conducted with administrators and rural emergency clinicians in Arizona and New Mexico, two states that started transfer centers during COVID-19. Results: Among 141 respondents (of 765, 18.4% response rate) to the national EMPRN survey, only 30% reported implementation or expansion of a transfer coordination center during COVID-19. Those with new transfer centers reported no change in difficulty of patient transfers during COVID-19 while those without had increased difficulty. The 17 qualitative interviews expanded upon this, revealing four major themes: 1) limited resources for facilitating transfers even before COVID-19; 2) increased number of and distance to transfer partners during the COVID-19 pandemic; 3) generally positive impacts of transfer centers on workflow, and 4) the potential for continued use of centers to facilitate transfers. Conclusion: Transfer centers may have offset pandemic-related transfer challenges brought on by the COVID-19 pandemic. Clinicians who frequently need to transfer patients may particularly benefit from ongoing access to such transfer coordination services. [West J Emerg Med. 2024;25(5)758-766.]

Background and relevance: The imposter phenomenon (IP) is characterized by high achieving individuals experiencing “chronic feelings of self-doubt, the fear of being discovered as an intellectual fraud, and a perception of being less intelligent or competent than peers.”1 Limited data exist on how feelings of imposter syndrome may affect aspects of one’s mental health. In the current climate of healthcare worker burnout, it is important to consider factors that may predispose individuals pursuing a career in healthcare to mental and emotional disengagement to assist in amelioration. This study aims to investigate the association between the occurrence of the imposter phenomenon and the frequency of depressed mood among students of the health professions on a global scale. Design and Methods: Student members of The Network: Towards Unity for Health responded to the Clance IP Scale and the PHQ-2 questionnaire. The analysis correlates indicators of (1) Region of study; (2) Area of study; (3) Year of study; (4) Preclinical vs. clinical stage of training; (5) Imposter Scale Score; and (6) Depression Score. We used Wilcoxon Rank Sum tests and linear regression to assess statistical significance. Results: More than three-quarters (89%) of respondents hadIP scores indicating moderate imposter feelings. A total of 68% of respondents had a PHQ-2 score indicating higher frequency of depressed mood. We found a significantly positive association between IP and depression scores. Conclusion: It is important to consider imposter syndrome as a potential risk factor for psychological distress among students in healthcare. Early identification is necessary as the presence of IP was shown to have a significantly positive relationship with the frequency of depressed mood. Familiarizing institutions with this relationship allows for early intervention.

AimThe incidence and characteristics of thiopental‐related adverse events (AEs) in elderly patients during procedural sedation and analgesia (PSA) have not been well studied. We aimed to characterize thiopental‐related AE in elderly patients during PSA and compare the incidence of AE in elderly patients with non‐elderly adults.MethodsThis is a secondary analysis of the Japanese Procedural Sedation and Analgesia Registry (JPSTAR). We included all adult patients who received thiopental for PSA in the emergency departments and excluded patients who received concomitant sedative(s) in addition to thiopental or patients with missing body weight data. We compared the incidence of AE between the non‐elderly (18–64 years) and elderly groups (≥65 years).ResultsThe JPSTAR had data on 379 patients who received thiopental for PSA and included 311 patients for analysis. Most (222/311, 71.3%) were elderly. Cardioversion was the most common reason for PSA (96.1%). The AE incidence between groups overall was similar, however, hypoxia was significantly more frequent in the elderly compared with the non‐elderly group (10.3% versus 2.2%; adjusted odds 5.63, 95% confidence interval 1.27–25.0). The initial and total doses of thiopental were significantly lower in the elderly group than in the non‐elderly group (1.95 mg/kg versus 2.21 mg/kg and 2.33 mg/kg versus 2.93 mg/kg, respectively).ConclusionsAlthough elderly patients received lower doses of thiopental, hypoxic events were significantly more frequent in this group compared with the non‐elderly patients. However, the AE incidence was similar.

BackgroundAn ambulance traffic crash not only leads to injuries among emergency medical service (EMS) professionals but also injures patients or their companions during transportation. We aimed to describe the incidence of ambulance crashes, seating location, seatbelt use for casualties (ie, both fatal and nonfatal injuries), ambulance safety efforts, and to identify factors affecting the number of ambulance crashes in Japan.MethodsWe conducted a nationwide survey of all fire departments in Japan. The survey queried each fire department about the number of ambulance crashes between January 1, 2017, and December 31, 2019, the number of casualties, their locations, and seatbelt usage. Additionally, the survey collected information on fire department characteristics, including the number of ambulance dispatches, and their safety efforts including emergency vehicle operation training and seatbelt policies. We used regression methods including a zero-inflated negative binomial model to identify factors associated with the number of crashes.ResultsAmong the 726 fire departments in Japan, 553 (76.2%) responded to the survey, reporting a total of 11,901,210 ambulance dispatches with 1,659 ambulance crashes (13.9 for every 100,000 ambulance dispatches) that resulted in a total of 130 casualties during the 3-year study period (1.1 in every 100,000 dispatches). Among the rear cabin occupants, seatbelt use was limited for both EMS professionals (n = 3/29, 10.3%) and patients/companions (n = 3/26, 11.5%). Only 46.7% of the fire departments had an internal policy regarding seatbelt use. About three-fourths of fire departments (76.3%) conducted emergency vehicle operation training internally. The output of the regression model revealed that fire departments that conduct internal emergency vehicle operation training had fewer ambulance crashes compared to those that do not (odds of being an excessive zero -2.20, 95% CI: -3.6 to -0.8).ConclusionTwo-thirds of fire departments experienced at least one crash during the study period. The majority of rear cabin occupants who were injured in ambulance crashes were not wearing a seatbelt. Although efforts to ascertain seatbelt compliance were limited, Japanese fire departments have attempted a variety of methods to reduce ambulance crashes including internal emergency vehicle operation training, which was associated with fewer ambulance crashes.

Aim: Foreign body airway obstruction (FBAO) dueto food can occur wherever people eat, including in hospitals. We characterized in-hospital FBAO incidents and their outcomes.Methods: We searched the Japan Council for Quality Health Care nationwide in-hospital adverse events database for relevant events from 1,549 institutions. We included all patients with FBAO incidents dueto food in the hospital from January 2010 to June 2021 and collected data on the char-acteristics, interventions, and outcomes. FBAO from non-food materials were excluded. Our primary outcomes were mortality and morbidity from FBAO incidents.Results: We identified 300 patients who had a FBAO incident from food. The most common age group was 80-89 years old (32.3%, n = 97/300). One-half (50.0%, n = 150/300) were witnessed events. Suction was the most common first intervention (31.3%, n = 94/300) and resulted in success-ful removal of foreign body in 17.0% of cases (n = 16/94). Back blows (16.0%, n = 48/300) and abdominal thrusts (8.1%, n = 24/300) were less frequently performed as the first intervention and the success rates were 10.4% (n = 5/48) and 20.8% (n = 5/24), respectively. About one-third of the patients (31%, n = 93/300) died and 26.7% (n = 80/300) had a high potential of residual disability from these incidents.Conclusion: FBAO from food in the hospital is an uncommon but life-threatening event. The majority of patients who suffered from in-hospital FBAO incidents did not receive effective interventions initially and many of them died or suffered residual disability.

Abstract 1,3-β-d-Glucan (BDG) is commonly used for diagnosing invasive fungal infections (IFIs). While exposure to cellulose-based hemodialyzers is known to cause false-positive BDG results, the impact of modern hemofilters used in continuous renal replacement therapy (CRRT) remains unclear. This retrospective, single-center cohort study aimed to evaluate the effect of CRRT on BDG levels in critically ill patients. We included adult intensive care unit (ICU) patients with ≥1 BDG measurement between December 2019 and December 2020. The primary outcome was the rate of false-positive BDG results in patients exposed to CRRT compared to unexposed patients. Propensity score analysis was performed to control for confounding factors. A total of 103 ICU patients with ≥1 BDG level were identified. Most (72.8%) were medical ICU patients. Forty patients underwent CRRT using hemofilter membranes composed of sodium methallyl sulfonate copolymer (AN 69 HF) (82.5%) and of polyarylethersulfone (PAES) (17.5%). Among the 91 patients without proven IFI, 31 (34.1%) had false-positive BDG results. Univariable analysis showed an association between CRRT exposure and false-positive BDG results. However, the association between CRRT exposure and false-positive BDG results was no longer significant across three propensity score models employed: 1:1 match (n = 32) (odds ratio (OR) 1.65, p = .48), model-adjusted (n = 91) (OR 1.75, p = .38), quintile-adjusted (n = 91) (OR 1.78, p = .36). In this single-center retrospective analysis, exposure to synthetic CRRT membranes did not independently increase the risk of false-positive BDG results. Larger prospective studies are needed to further evaluate the association between CRRT exposure and false-positive BDG results in critically ill patients with suspected IFI.

Introduction: Clinical trial recruitment and retention of individuals who use substances are challenging in any setting and can be particularly difficult in emergency department (ED) settings. This article discusses strategies for optimizing recruitment and retention in substance use research conducted in EDs. Methods: Screening, Motivational Assessment, Referral, and Treatment in Emergency Departments (SMART-ED) was a National Drug Abuse Treatment Clinical Trials Network (CTN) protocol designed to assess the impact of a brief intervention with individuals screening positive for moderate to severe problems related to use of non-alcohol, non-nicotine drugs. We implemented a multisite, randomized clinical trial at six academic EDs in the United States and leveraged a variety of methods to successfully recruit and retain study participants throughout the 12-month study course. Recruitment and retention success is attributed to appropriate site selection, leveraging technology, and gathering adequate contact information from participants at their initial study visit. Results: The SMART-ED recruited 1,285 adult ED patients and attained follow-up rates of 88%, 86%, and 81% at the 3-, 6-, and 12-month follow-up periods, respectively. Participant retention protocols and practices were key tools in this longitudinal study that required continuous monitoring, innovation, and adaptation to ensure strategies remained culturally sensitive and context appropriate through the duration of the study. Conclusion: Tailored strategies that consider the demographic characteristics and region of recruitment and retention are necessary for ED-based longitudinal studies involving patients with substance use disorders.