NHS strikes, Lebanon pager attacks, and maternal cardiac arrests - Primary Survey March 2026

What happens to an emergency department when staff go on strike? A new study published in EMJ examines this challenging scenario and its impact on patient flow. Another paper looks at the hybrid-warfare attack carried out in Lebanon, where exploding pagers caused a mass casualty incident, and what emergency departments can learn from managing that event. EMJ editor Prof. Richard Body adds some of his own reflections from the Ariana Grande concert terror attack in Manchester.  Two more complex situations round out the list of papers for this episode, covering out-of-hospital cardiac arrest in pregnant patients, and magnet ingestion in children.  Read the highlights: Primary survey Prehospital resuscitative hysterotomy: a practice review The pager explosions: lessons learnt from a hybrid-warfare mass casualty incident What health systems should learn from the Lebanon pager attack Diagnosis and management of paediatric magnet ingestion: a systematic review of clinical practice guidelines Evaluating the impact of NHS strikes on patient flow through emergency departments The EMJ podcast is hosted by: Prof. Richard Body, EMJ Deputy Editor, University of Manchester, UK (@richardbody) Dr. Sarah Edwards, EMJ Senior Associate Editor and Social Media Editor, Royal Derby Hospital, UK (@drsarahedwards) You can subscribe to the EMJ podcast on all podcast platforms to get the latest podcast every month. If you enjoy our podcast, please consider leaving us a review or a comment on the EMJ Podcast Apple (https://apple.co/4bfcMU0) or Spotify (https://spoti.fi/3ufutSL) page.

"Should we be giving blood transfusions to patients with traumatic cardiac arrest?" EMJ editor Prof. Richard Body and associate editor Dr. Sarah Edwards talk through some original research on the value of blood transfusions in this difficult situation. Next is the new UNCORKED study from the Trainee Emergency Research Network (TERN), with some sobering statistics on the prevalence of emergency care carried out in non-standard treatment places across the UK. Then we move to a world of high-pressure injuries, often caused by industrial spraying equipment, where things on the surface aren't quite as they seem. The last paper returns to the theme of cardiac arrests, examining the predictive value of end-tidal CO2 usage. Read the highlights: Primary survey: The association of blood transfusion and sustained return of spontaneous circulation in blunt traumatic out-of-hospital cardiac arrest Understanding corridor and escalation area care in 165 UK emergency departments: a multicentre cross-sectional snapshot study Recognising high-pressure injection injuries to the hand: a practice review with guidance for emergency physicians Prognostic accuracy of end-tidal carbon dioxide in cardiac arrest: a systematic review and meta-analysis The EMJ podcast is hosted by: Prof. Richard Body, EMJ Editor-in-Chief, University of Manchester, UK (@richardbody) Dr. Sarah Edwards, EMJ Senior Associate Editor and Social Media Editor, Royal Derby Hospital, UK (@drsarahedwards) You can subscribe to the EMJ podcast on all podcast platforms to get the latest podcast every month. If you enjoy our podcast, please consider leaving us a review or a comment on the EMJ Podcast Apple (https://apple.co/4bfcMU0) or Spotify (https://spoti.fi/3ufutSL) page.

It's the first issue of 2026, and the first with new editor-in-chief Prof. Richard Body heading the journal. He is joined by senior associate editor Dr. Sarah Edwards, as they take a look at some highlights of the issue.  First in the line-up is a paper looking at how "Same day emergency care" units, or SDECs, have come to mean quite different things across the UK. In some cases, the rule-out processing of SDECs harks back to "What the ED used to do" in past years. The next paper is an examination of the treatment methods for paracetamol overdose, specifically the SNAP protocol for accelerated infusion of N-acetylcysteine. This new analysis considers the likelihood of anaphylactoid reactions across age groups. Third to be discussed is a retrospective study on the relationship between length of stay and morbidity and mortality in older patients. This large study from Singapore suggests a systemic change in approach is needed for handling triaging and discharge of this patient group. The final topic is facial lacerations, with a Best Evidence Topic report addressing the use of topical silicone gel. Many patients are rightly concerned about scarring on such a personal part of the body as their face, and the report finds some encouraging support for use of the gel to improve cosmetic healing. Read the highlights: January 2026 primary survey How is same day emergency care (SDEC) being implemented across England? Scottish and Newcastle Antiemetic Protocol (SNAP) 12-hour acetylcysteine regimen for paracetamol overdose reduces anaphylactoid reactions without compromising hepatic protection in all age groups: a secondary analysis Association between age and length of stay in the emergency department in a tertiary care hospital: a retrospective observational study Should we be advising patients to use topical silicone gel for wound care following facial laceration suturing in the emergency department ?  The EMJ podcast is hosted by: Prof. Richard Body, EMJ Editor-in-Chief, University of Manchester, UK (@richardbody) Dr. Sarah Edwards, EMJ Senior Associate Editor and Social Media Editor, Royal Derby Hospital, UK (@drsarahedwards) You can subscribe to the EMJ podcast on all podcast platforms to get the latest podcast every month. If you enjoy our podcast, please consider leaving us a review or a comment on the EMJ Podcast Apple (https://apple.co/4bfcMU0) or Spotify (https://spoti.fi/3ufutSL) page.

One thing you'll never hear in the emergency department is the sound of silence. And if the hubbub should start to lower, woe betide the ED staffer who dares to say, "it's looking quiet tonight." But should we really be so concerned? A paper in this episode's roundup takes a look at superstition versus science. Staffing concerns is another ever-present topic when it comes to the ED, and Rick and Sarah share an insightful evaluation of the time saving offered by voice recognizing "AI scribes". The numbers show some serious benefits, but do they really work? The same question can be asked of the X-ray assessment tools that are rolling out in emergency departments across the world. Rick and Sarah take a look at a study detailing their affect on correct diagnoses. There's also also a case-based paper discussing practices for evaluating IUD-related issues using ultrasound. This is the final issue with Prof. Ellen Weber serving as the Editor-in-Chief of the Emergency Medicine Journal. Ellen's tenure has been a long and successful one, and everyone in the podcast team wishes her the best in retirement from the post.     Read the highlights: December 2025 primary survey Passing the torch SONO case series: transabdominal pelvic point-of-care ultrasound of intrauterine devices in the emergency department Impact of ‘the Q word’ on hospital speciality activity levels: a narrative systematic review Observational service evaluation of voice recognition technology in the emergency department: association with electronic note-writing efficiency Evaluating the impact of AI assistance on decision-making in emergency doctors interpreting chest X-rays: a multi-reader multi-case study The EMJ podcast is hosted by: Prof. Richard Body, EMJ Deputy Editor, University of Manchester, UK (@richardbody) Dr. Sarah Edwards, EMJ Senior Associate Editor and Social Media Editor, Royal Derby Hospital, UK (@drsarahedwards) You can subscribe to the EMJ podcast on all podcast platforms to get the latest podcast every month. If you enjoy our podcast, please consider leaving us a review or a comment on the EMJ Podcast Apple (https://apple.co/4bfcMU0) or Spotify (https://spoti.fi/3ufutSL) page.

Despite what the CPR doll might suggest, cardiac arrest patients are not always white, lean and male. So why is that the case for resuscitation training? The first paper in this episode addresses this lack of representation and the impact it has on resus performance. The next paper is a practice review of functional neurological disorder (FND), highlighting the poor diagnosis rate and history keeping for this condition, as well as offering ways to communicate with patients. There's also a paper on the dilemma of febrile infants with concurrent viral and bacterial infections, and another on aeromedical service sedation protocols in the Australian Outback.   Read the highlights: November 2025 primary survey We need to talk about Annie Diversity of CPR manikins for basic life support education: use of manikin sex, race and body shape — a scoping review Recognising and managing functional neurological disorder in the acute healthcare setting Prevalence of serious bacterial infections and performance of inflammatory markers in febrile infants with and without proven viral illness Risk of complications using a sedation protocol for aeromedical retrieval of acutely unwell mental health patients: a retrospective cohort study in Outback Australia   The EMJ podcast is hosted by: Prof. Richard Body, EMJ Deputy Editor, University of Manchester, UK (@richardbody) Dr. Sarah Edwards, EMJ Senior Associate Editor and Social Media Editor, Royal Derby Hospital, UK (@drsarahedwards) You can subscribe to the EMJ podcast on all podcast platforms to get the latest podcast every month. If you enjoy our podcast, please consider leaving us a review or a comment on the EMJ Podcast Apple (https://apple.co/4bfcMU0) or Spotify (https://spoti.fi/3ufutSL) page.

The atmosphere of the emergency department can be a hard thing to put into words, with intense emotions washing over patients and staff alike. This month we feature a poem, powerfully illustrating the drama and stress inside the ED bubble. One of the recurring sources of uncertainty for patients is the question, “How long until I’m seen, doc?”, and there’s a paper following up on that issue with a personalised approach. A framework that has been employed by NHS England, aimed at dealing with the problem, is Same Day Emergency Care (SDEC). The next paper finds there is a limited evidence on the impact of SDECs, as well as confusion around their definition. Another paper on the subject of patient flow shows that while digital solutions are promising, you can’t replace a streaming nurse for critical decisions. To finish the episode is a 10-year retrospective review on the use of blood in paediatric trauma, drawing on the data of the Trauma Audit Research Network. Read the highlights: October 2025 primary survey Whose turn is it? Poetry: the art of expression “How long until I am seen, doc?” Modelling paediatric emergency department waiting times to make personalised predictions Impact of same day emergency care services on urgent and emergency care delivery outcomes: a systematic review Blood product use in paediatric trauma: lessons from the TARN data The EMJ podcast is hosted by: Prof. Richard Body, EMJ Deputy Editor, University of Manchester, UK (@richardbody) Dr. Sarah Edwards, EMJ Senior Associate Editor and Social Media Editor, Royal Derby Hospital, UK (@drsarahedwards) You can subscribe to the EMJ podcast on all podcast platforms to get the latest podcast every month. If you enjoy our podcast, please consider leaving us a review or a comment on the EMJ Podcast Apple (https://apple.co/4bfcMU0) or Spotify (https://spoti.fi/3ufutSL) page.

"What is your understanding of your father's illness?" This is the kind of question that may be posed by emergency clinicians in the context of end-of-life care. But as a survey of Thai and American emergency departments finds, approaches to these conversations can be quite different globally. This episode also features another angle on end-of-life care, highlighting the persistent impact that deprivation has when it comes to likelihood of hospital conveyance. On a different subject, there is a qualitative study of the management of acute asthma presentations, seeking to find any marginal gains that may present a chance for optimisation. The fourth and final paper is about acute coronary syndromes in the emergency department, presenting some surprising statistics on length of stay. Read the highlights: September 2025 primary survey Deprivation is associated with hospital conveyance among patients who are terminally ill Are acute asthma presentations to the emergency department an opportunity for optimising long-term management? A qualitative study on beliefs and behaviours of healthcare professionals Comparing approaches to code status conversations between Thai and American emergency clinicians: a survey study Acute coronary syndrome rule-out strategies in the emergency department: an observational evaluation of clinical effectiveness and current UK practice The EMJ podcast is hosted by: Prof. Richard Body, EMJ Deputy Editor, University of Manchester, UK (@richardbody) Dr. Sarah Edwards, EMJ Senior Associate Editor and Social Media Editor, Royal Derby Hospital, UK (@drsarahedwards) You can subscribe to the EMJ podcast on all podcast platforms to get the latest podcast every month. If you enjoy our podcast, please consider leaving us a review or a comment on the EMJ Podcast Apple (https://apple.co/4bfcMU0) or Spotify (https://spoti.fi/3ufutSL) page.

A new paper on the challenging diagnosis of acute appendicitis has us wondering, can it be spotted with just a glance? The reality is never so simple. This episode we also discuss low-value overtesting, cardiac arrest trial consent, and patient discharge into police custody. As with many aspects of the ED, they each have a layer of legal pressure to consider.   Read the highlights: August 2025 primary survey   The EMJ podcast is hosted by: Prof. Richard Body, EMJ Deputy Editor, University of Manchester, UK (@richardbody) Dr. Sarah Edwards, EMJ Senior Associate Editor and Social Media Editor, Royal Derby Hospital, UK (@drsarahedwards) You can subscribe to the EMJ podcast on all podcast platforms to get the latest podcast every month. If you enjoy our podcast, please consider leaving us a review or a comment on the EMJ Podcast Apple (https://apple.co/4bfcMU0) or Spotify (https://spoti.fi/3ufutSL) page.

The NHS plans to set up mental health emergency departments throughout England. A survey discussed this episode highlights the importance of mental health assessments, finding that nearly a quarter of suicide deaths in a one year period had come after hospital or emergency department contact. Another survey raises the question, "How well is your ED prepared for a major incident?" and the statistics do not inspire confidence. Two more papers in this episode offer potential bulwarks against burnout of ED staff: global health outreach work, and self-rostered rotas. But there may be some downsides to watch out for too. Finally, a look at pulse oximetry for testicular torsion diagnosis. Read the highlights: July 2025 Primary Survey Contact with emergency departments and hospitals in England before suicide death: a retrospective cohort study Global health experience of staff working in UK emergency care: a reflexive thematic analysis A survey of major incident preparedness in English type 1 emergency departments In emergency settings, does the use of testicular pulse oximetry aid diagnosis of testicular torsions? Investigating the impact of self-rostering on EM trainee wellbeing and recovery: a national survey The EMJ podcast is hosted by: Dr. Richard Body, EMJ Deputy Editor, University of Manchester, UK (@richardbody) Dr. Sarah Edwards, EMJ Senior Associate Editor and Social Media Editor, Royal Derby Hospital, UK (@drsarahedwards) You can subscribe to the EMJ podcast on all podcast platforms to get the latest podcast every month. If you enjoy our podcast, please consider leaving us a review or a comment on the EMJ Podcast Apple (https://apple.co/4bfcMU0) or Spotify (https://spoti.fi/3ufutSL) page.

Can salbutamol be used be used to relieve pain in renal colic patients? Starting off this month's episode, a randomised trial seeks to find the answer. Then a topic of interest for anyone seeing patients with a phobia of needles, namely a study comparing coolant spray with topical anaesthetic cream for reducing pain from intravenous cannulation. Next, randomisation is a necessary tool for many trials, but what if you want something that's less high-tech, and more high-street? That's right, scratch cards! And finally, fear of not making the right decision dominates when it comes to  paramedic conveyance to the paediatric emergency department. "We just take them in," "parents know best," and "if only they could talk" are some of the revealing quotes found in the study wrapping up this month.   Read the highlights: June 2025 Primary Survey Salbutamol for analgesia in renal colic: a prospective, randomised, placebo-controlled phase II trial Comparison of the effects of vapocoolant spray and topical anaesthetic cream (lidocaine–prilocaine) on pain of intravenous cannulation: a randomised controlled trial Letter: Allocation concealment using scratchcards in an emergency department drug trial Factors influencing paramedic conveyance decisions when attending children with minor head injury: a qualitative study The EMJ podcast is hosted by: Dr. Richard Body, EMJ Deputy Editor, University of Manchester, UK (@richardbody) Dr. Sarah Edwards, EMJ Semior Associate Editor and Social Media Editor, Royal Derby Hospital, UK (@drsarahedwards) You can subscribe to the EMJ podcast on all podcast platforms to get the latest podcast every month. If you enjoy our podcast, please consider leaving us a review or a comment on the EMJ Podcast Apple (https://apple.co/4bfcMU0) or Spotify (https://spoti.fi/3ufutSL) page.