The study was led by Professor Shammi Ramlakhan, an emergency medicine consultant working at Sheffield Children’s Hospital, the University of Sheffield and Sheffield Hallam University in the United Kingdom. He presented the results at the congress on Sunday, describing a problem that emergency clinicians across Europe will recognise immediately. According to Ramlakhan, nearly a third of children with moderate to severe pain do not receive adequate pain relief within the 15 to 20 minutes recommended in international guidance. That gap matters, because unrelieved pain in childhood is not merely a momentary distress; it can heighten fear of medical care, complicate examinations and procedures, and leave lasting psychological imprints on young patients and their families.

The trial enrolled 152 children aged between one and 17 years who presented with moderate to severe pain at one of seven hospital emergency departments in the United Kingdom and Spain between May 2024 and May 2025. The majority of participants had limb injuries, including fractures and dislocations, while others had burns or injuries to soft tissue. These are precisely the presentations that fill paediatric emergency departments every day, and they are the cases in which timely analgesia can make the difference between a manageable visit and a traumatic ordeal.

Every child in the study received the same combination of two analgesic medications: sufentanil, a potent opioid, and ketamine, a dissociative anaesthetic with strong analgesic properties. The drugs were administered together via a nasal spray, with the dose adjusted to each child’s body weight simply by varying the number of puffs. This dosing system is one of the study’s most significant technical features. Intravenous cannulation, the traditional route for strong analgesia in emergency care, is itself painful, frightening and technically difficult in small, distressed children with injured limbs. A spray that eliminates the needle removes a major barrier to early treatment and allows analgesia to begin within minutes of arrival.

The researchers assessed each child’s pain using standard validated instruments at two time points: 15 minutes and 30 minutes after administration. They also monitored for adverse effects throughout. The results were striking. After 15 minutes, more than half of the children, 54 percent, were already in less pain. By 30 minutes, the vast majority, 88 percent, reported reduced pain, and in 86.2 percent of children the pain score had fallen by around half. For a single, needle-free administration delivered in a busy emergency department, that speed and magnitude of effect is notable, particularly given that the treatment window studied matches the timelines set out in international paediatric pain guidance.

Safety findings were equally encouraging. Side effects were mild and consisted of nausea or vomiting, dizziness and nasal itching. No major adverse events were reported. Ramlakhan noted that children tolerated the spray well and emphasised the practical significance of the result: the treatment gives doctors a simple and effective option in a setting where, in his words, very few options currently exist. The absence of significant drowsiness is also clinically relevant, because heavy sedation can obscure the neurological assessment of a child and complicate decisions about imaging and further management.

The nasal spray was being tested under the European Medicines Agency’s paediatric-use marketing authorisation, or PUMA, scheme. This regulatory pathway exists specifically to encourage manufacturers to develop and adapt medicines for children, a population that has historically been underserved by the pharmaceutical industry because paediatric formulations are commercially less attractive and clinically more demanding to validate. Many drugs used in paediatric emergency care are administered off-label, with dosing extrapolated from adult evidence. A product developed and authorised specifically for children, with a dosing system designed around their weight and their tolerance, addresses a structural weakness in paediatric medicine. The researchers say the treatment should be available for use in Europe in the near future.

Independent commentary on the work underlined how significant the gap is that this spray could fill. Dr Maša Sorić, a member of the European Society for Emergency Medicine abstract selection committee and head of the emergency department at University Hospital Merkur in Zagreb, Croatia, who was not involved in the research, pointed out that millions of children are seen in European emergency departments every year, many suffering painful injuries, and that being in hospital can itself be frightening for children and their families. In her assessment, the study evaluated a nasal spray containing two existing types of pain relief with a very simple dosing system, and the results suggest it reduces pain quickly and effectively without the need for an injection, without causing excessive drowsiness and with only mild side effects.

Sorić also framed the broader clinical context: doctors want to give patients effective treatments, including treatment for pain, but the analgesic options currently available for children are limited. Her remarks reflect a long-standing tension in emergency medicine. Strong opioids and anaesthetics are the tools that work fastest, yet in children they have traditionally required intravenous access, careful titration and monitoring resources that many departments struggle to mobilise quickly. Weaker oral medications, meanwhile, often act too slowly or too weakly for severe pain. A nasal spray that combines a fast-acting opioid with ketamine, dosed by puff count and requiring no cannula, sits in the gap between those extremes and could realistically be administered by nursing staff within minutes of triage.

The study was experimental in design and involved people as its research subject, and its findings were presented at a congress rather than yet published in a peer-reviewed journal, so wider confirmation will be watched with interest. Even so, the combination of a large multi-centre cohort across two countries, validated pain assessments, a dosing method simple enough for routine practice and a clean safety profile makes a persuasive case. If the treatment reaches European emergency departments as its developers expect, the change could be felt immediately by the patients least equipped to articulate their suffering. A child with a broken arm who receives effective analgesia within fifteen minutes of arrival, without a needle, experiences a fundamentally different hospital visit from one who waits in pain. For clinicians who have spent years working around the absence of good paediatric pain options, a spray bottle may prove to be one of the most consequential tools the specialty has gained.

Subject of Research: Needle-free nasal spray analgesia for children with moderate to severe pain in emergency departments

Article Title: Nasal spray brings pain relief for children treated in the emergency department

Article References: Nasal spray brings pain relief for children treated in the emergency department. (n.d.). Original publication

Image Credits: AI Generated

DOI: Not provided

Keywords: nasal spray, pain relief, children, emergency department, sufentanil, ketamine, paediatric medicine, analgesia, European Emergency Medicine Congress, needle-free, PUMA, clinical trial

The patients in question arrived with what clinicians call hypertensive urgency: blood pressure readings of 180 mmHg or higher on the systolic, or top, number, or 110 mmHg or higher on the diastolic, or bottom, number, but without any symptoms or signs of acute damage to organs such as the heart, brain or kidneys. This presentation is extremely common, according to Dr Safa Dönmez, associate professor of emergency medicine at the University of Health Sciences, Ankara City Health Application and Research Center, who led the study. These patients receive standard blood pressure medication, but Dönmez noticed that many were also visibly anxious and frightened. That matters medically, not just emotionally. Anxiety triggers the release of stress hormones that constrict blood vessels and drive blood pressure even higher, and the emergency department itself, with its noise, bright lights and uncertainty, can amplify the problem.

That observation prompted a deceptively simple question: if patients could be made to feel calmer, would their blood pressure come down faster? To find out, Dönmez and his colleague Dr Kadir Yenal, an emergency medicine specialist at Ankara Bilkent City Hospital, randomised 130 patients into two groups of 65. Everyone received the same standard medication to lower blood pressure. The control group received nothing further. The intervention group, however, donned VR headsets of the kind familiar from gaming and were transported to a peaceful nature scene: a river winding through a forest, tall trees swaying overhead and a wooden suspension bridge spanning the water. Simultaneously, they listened to a carefully curated playlist of classical music on a smartphone, chosen for the calming, structured qualities of composers including Bach, Mozart, Debussy, Vivaldi, Tchaikovsky, Saint-Saëns, Haydn and Corelli.

The researchers tracked blood pressure at five time points: 15, 30, 60, 90 and 120 minutes after presentation. Rather than relying solely on the familiar top-and-bottom readings, they focused on mean arterial pressure, or MAP, a single figure that combines systolic and diastolic values to represent the average pressure in the arteries across one cardiac cycle. A normal MAP sits roughly between 70 and 100 mmHg; the patients in this study arrived with MAP readings of around 130 to 138 mmHg, well into dangerous territory. Anxiety was assessed with the State Anxiety Inventory, a validated questionnaire that distinguishes between state anxiety, how anxious a person feels in the moment, and trait anxiety, anxiety as an enduring personality characteristic, both scored from 20 to 80 with higher numbers indicating greater anxiety.

The results revealed a striking early advantage for the virtual forest. At 15 minutes, MAP in the control group had fallen from 138 mmHg to 126 mmHg, while in the VR group it dropped from 132 mmHg to 116 mmHg. At 30 minutes the figures were 119 mmHg for controls versus 112 mmHg for the VR group. Expressed as percentage reductions, the control group achieved 8 percent at 15 minutes and 14 percent at 30 minutes, compared with 12 percent and 15 percent respectively in the VR group. Because randomisation had left the VR group with slightly lower starting blood pressures, the team analysed both absolute values between groups and the magnitude of reduction within each group, a methodologically careful approach. Dr Yenal reported that after 15 minutes the VR group’s blood pressure had fallen approximately 4 to 5 mmHg more than the control group’s, a difference that was statistically significant, meaning it was unlikely to be due to chance.

The advantage, however, proved time-limited. From 60 minutes onwards, the two groups were essentially equivalent, a pattern the researchers interpret as evidence that the intervention accelerates early stabilisation rather than providing long-term blood pressure control. Even so, Dönmez argues that this early window carries real clinical weight. In a busy emergency department, bringing blood pressure under control quickly matters both for patient safety and for the efficient use of resources, and if a non-drug intervention can modestly speed that process, it has practical value. The technology involved is inexpensive, easy to use and free of side effects, which makes the prospect of routine adoption considerably less daunting than a new pharmacological agent would be.

The anxiety data told an equally compelling story. At baseline, the VR patients were significantly more anxious than the controls, with trait anxiety scores of about 46 compared with about 38, an unlucky quirk of randomisation that ultimately made the results more impressive rather than less. Over the observation period, trait anxiety fell by an average of eight points in the VR group versus four points in the control group, a statistically significant difference. By the end of the two hours, both groups had reached similar post-intervention anxiety levels, but the VR group had travelled much further from a higher starting point of anxious temperament. As Yenal noted, that greater improvement from a worse baseline is precisely what makes the finding notable.

The study has clear strengths: it was randomised, it used the same standardised equipment for blood pressure measurement in both groups, and not a single patient dropped out. But the limitations are honest and instructive. The baseline difference in blood pressure between groups complicates interpretation. It was a single-centre trial with only two hours of follow-up. Crucially, because the headset and the music were always delivered together, it is impossible to say which component drove the effect, or whether both are necessary. And since patients and staff could see who was wearing the headsets, a placebo effect cannot be excluded. The team now plans larger multi-hospital studies with longer follow-up, separate testing of VR and music, and an investigation of whether letting patients choose their own music changes the outcome.

Independent experts are cautiously encouraged. Dr Felix Lorang, head of the emergency department at Klinikum Lippe in North Rhine-Westphalia, Germany, and a member of the EUSEM abstract selection committee who was not involved in the research, said that although the study was single-centre, the results are interesting and deserve further investigation. In his view, they raise the possibility that the approach is not only safe and feasible but offers meaningful benefits, particularly in reducing anxiety and achieving faster blood pressure control in the early stages of treatment, and might even avoid unnecessary medication. He emphasised that the intervention was used in addition to, not instead of, adjustment of blood pressure medication. For patients, Dönmez offers a vivid summary: if you arrived in the emergency department frightened, with markedly elevated blood pressure, a few minutes in a peaceful virtual forest listening to Mozart would likely be very welcome indeed.

Subject of Research: Virtual reality and classical music therapy for reducing blood pressure and anxiety in emergency department patients with hypertensive urgency

Article Title: Virtual reality and classical music help to reduce blood pressure in patients in an emergency department

Article References: Virtual reality and classical music help to reduce blood pressure in patients in an emergency department. (n.d.). Original publication

Image Credits: AI Generated

DOI: Not provided

Keywords: virtual reality, classical music, hypertensive urgency, emergency medicine, blood pressure, mean arterial pressure, anxiety, randomised controlled trial, non-pharmacological intervention, patient care, stress hormones, European Emergency Medicine Congress

The study compared records of patient deaths within 28 days of emergency department attendance with information on how full the department was on the day each patient was seen. Occupancy was calculated in a straightforward way: by dividing the number of patients being treated by the number of available treatment spaces such as cubicles. A department with 50 cubicles and 50 patients operates at 100 per cent occupancy; with 40 patients it sits at 80 per cent, and with 60 patients it is at 120 per cent. By this measure, the departments in the study were operating at an average of 175 per cent occupancy, meaning that on a typical day many patients were being treated in spaces never designed for clinical care.

Analysis of the data showed that for every ten per cent increase in occupancy, the risk of dying from any cause within 28 days rose by one per cent. When the researchers extrapolated this relationship across the United Kingdom, they estimated that emergency department crowding could have contributed to 554 deaths a week during the study period, compared with a hypothetical situation in which every department had one space for every patient. Because the study covered the majority but not all of UK emergency departments and was, as the authors acknowledge, relatively small in statistical terms, the plausible range of excess deaths is wide: anywhere between 33 and 1,083 per week. Even at the lowest end of that range, the researchers note, the figures track similar estimates of harm from long waits and crowding published in earlier work.

The research team also examined the impact of so-called corridor care, in which patients receive treatment in non-standard clinical spaces such as corridors, waiting rooms or other areas not equipped for emergency medicine. Corridor care was likewise linked to an increase in the risk of death, broadly in line with the risk associated with the occupancy rate itself. This parallel finding matters for practical reasons: while corridor care is a visible symptom of a department in crisis, it is harder to quantify consistently across hospitals. Occupancy, by contrast, is a simple number that most departments already record, which makes it a far more usable early-warning indicator for hospital managers and health systems trying to gauge when conditions have become dangerous.

Dr McHenry framed the findings against a backdrop of deteriorating emergency care internationally. Emergency department overcrowding, he noted, is an increasing public health concern, with existing evidence showing that long delays increase patient mortality and that crowding is also associated with poor experiences for both patients and staff. He argued that traditional measures of emergency department crowding were developed at a time when the problem was far less severe, and that these older metrics are simply not sufficient to describe the crisis that currently exists in emergency care. The new study, he suggested, provides the direct evidence linking crowding itself, rather than waiting times alone, to patient deaths.

The scale of the study is one of its principal strengths. Data were collected with the help of hundreds of collaborators across 139 emergency departments, giving the researchers what they describe as a detailed and accurate view of how crowding and corridor care affect patients across a whole health system rather than at a handful of sites. Although the study was based on UK hospitals, the researchers argue that given the levels of overcrowding now reported in hospitals around the world, the relationship they observed is likely to hold in many other countries, even allowing for regional differences in how emergency care is organised and delivered.

To translate the findings into practice, the team has built an online risk calculator that allows emergency department staff to estimate the risks to patients when their department is operating beyond capacity. The tool is intended to give clinicians and managers a concrete, quantitative sense of how the conditions on a given day may be affecting outcomes, rather than relying on anecdote or intuition. The researchers say they are already engaging with governments to ensure the research feeds into health service policy, and that the next step is to identify solutions that work in tackling emergency department crowding at its sources.

Independent commentary from the European Society for Emergency Medicine underlined the wider systemic picture. Dr Felix Lorang, a member of the EUSEM abstract selection committee and head of the emergency department at Klinikum Lippe in North Rhine-Westphalia, Germany, who was not involved in the research, observed that around the world the need for emergency care is growing while infrastructure fails to keep pace. Many departments, he said, are operating far beyond capacity, and the phenomenon known as exit block, in which patients are stuck in the emergency department because no inpatient ward beds are available, places an even greater burden on staff. That, in turn, makes it harder for doctors and nurses to deliver the treatment patients need, or even the minimum treatment required to prevent further harm.

Dr Lorang described the research as making it unmistakably clear to patients, medical professionals and hospital managers alike that overcrowding and corridor care mean many emergency patients will not survive. He argued that understaffed and inadequately resourced emergency departments are, in themselves, an independent and dangerous health risk, and that the results are especially critical for governments, politicians and health services because saving lives in emergency care is achievable. The routes he identified are structural rather than clinical: preventing overcrowding through sufficient staffing, and through emergency departments that are adequately planned and equipped for the demand they actually face.

The study’s implications extend well beyond the United Kingdom. Emergency departments in many countries routinely operate above their designed capacity, and the mechanism the research points to, in which the sheer density of patients in a department erodes the safety margin for every individual within it, is not specific to any one health system. As an observational study, the research establishes a strong association rather than a definitive causal chain, and the authors themselves call for further studies to confirm the findings and to arrive at a more precise estimate of the harms from crowding. Even so, the combination of scale, geographic reach and a dose-response pattern, in which risk rises steadily with each increment of occupancy, gives the result unusual weight. If the estimate of hundreds of excess deaths a week is even broadly correct, emergency department crowding ranks among the most consequential and most preventable patient safety problems in modern health care, and the one per cent figure offers policymakers a simple, sobering arithmetic: every increment of relief delivered to a crowded department translates directly into lives that may be saved.

Subject of Research: The association between emergency department overcrowding, corridor care and increased patient mortality

Article Title: Study shows how risk of death rises with rate of overcrowding and corridor care in hospital emergency department

Article References: Study shows how risk of death rises with rate of overcrowding and corridor care in hospital emergency department. (n.d.). Original publication

Image Credits: AI Generated

DOI: Not provided

Keywords: emergency medicine, hospital overcrowding, corridor care, patient mortality, occupancy rate, emergency departments, observational study, patient safety, exit block, health policy, European Emergency Medicine Congress, risk calculator