One of the most consequential studies presented at the congress addressed a bottleneck that every emergency department will recognise. Around 95% of patients who call an ambulance with chest pain are transported to hospital, yet only a minority turn out to have a condition requiring admission. Barbra Backus of Amsterdam University Medical Center in the Netherlands presented preliminary results of a trial testing whether combining a high-sensitive point-of-care troponin test with the HEART score in the prehospital setting could safely reduce hospital referrals. In the before phase of the trial, 539 patients received usual care before any transport decision was made. In the after phase, 483 patients had a blood sample taken at the scene, analysed by the point-of-care troponin test while crews carried out their usual examinations. Crews then calculated the first four components of the HEART score, covering medical history, age, ECG findings, and risk factors, to estimate each patient’s risk of a major adverse cardiovascular event.

The results were dramatic. Before implementation, only 19 of 539 patients, or 3.5%, were left at home; after implementation, 165 of 483 patients, or 34.2%, avoided hospital transport, a difference of 30.6 percentage points with a 95% confidence interval of 25.9 to 35.3 and a p value below 0.001. Crucially, safety appeared preserved: of the 165 patients left at home, just one, or 0.6%, suffered a major adverse cardiovascular event within 30 days, compared with zero of the 19 left at home under usual care. The researchers concluded that prehospital HEART scoring could significantly reduce hospital referral and medical consumption while allowing more patients to be safely managed at home, a finding with obvious implications for ambulance services across Europe.

Overcrowding, the perennial barrier to safe emergency care, was examined from a different angle by Ryan McHenry of the University of Glasgow. He reported a multicentre prospective snapshot cohort study of the association between emergency department occupancy and all-cause 28-day mortality in adults aged 16 and over. The study spanned 134 emergency departments in Wales, Northern Ireland, and England and recruited 19,034 patients across five time periods in 2025, with associations determined using mixed-effects logistic regression. For every 10% increase in occupancy on the day a patient was seen, the relative risk of 28-day all-cause mortality rose by 1%, with a 95% confidence interval of 0 to 1 and a p value of 0.036. Models assessing the proportion of patients held in escalation areas, the practice often described as corridor care, showed similar findings. The team translated the results into a clinical risk calculator intended to quantify the mortality cost of crowding in real time.

In a striking example of low-cost technology entering the resuscitation room, Safa Dönmez of the University of Health Sciences in Ankara, Türkiye, presented a randomised controlled trial of virtual reality combined with classical music in patients with hypertensive urgency. A total of 130 patients were enrolled, 65 in each arm, with one group receiving standard care alone and the other standard care plus a natural environment simulation delivered through VR goggles accompanied by classical music. Mean arterial pressure was measured at baseline and at 15, 30, 60, 90, and 120 minutes, while anxiety was assessed with the State Anxiety Inventory. Mean arterial pressure was significantly lower in the VR group at 15 minutes and 30 minutes, although not at later timepoints, and anxiety reduction was significantly greater in the VR group, with median change scores of 8.0 versus 4.0 in the control group. The intervention proved effective for early haemodynamic stabilisation but not for long-term blood pressure control, suggesting a niche role as a rapid, drug-free adjunct in the first half hour of care.

Perhaps the most eye-catching presentation concerned the delivery of automated external defibrillators by drone. Hillary Minka of APHP-Hôpital Lariboisière in France reported a geospatial analysis of the Île-de-France region that used national out-of-hospital cardiac arrest registry data from seven departments, excluding central Paris, to model three strategies: strengthening the network of fixed AEDs, deploying drones to deliver AEDs, and combining the two. The region was divided into IRIS units, the smallest census areas used by the French National Institute of Statistics, and the time for an AED to reach the centre of each unit was estimated under each strategy. AED availability proved highly heterogeneous, with clear deficits in rural and peri-urban areas. Fixed AED densification alone would have required 1712 additional devices across 1893 units, some 3605 in total.

The hybrid strategy delivered far better value. Drone deployment significantly reduced access times, producing a median gain of 3.76 minutes, with the greatest improvements in peripheral and highly congested areas. The proportion of cardiac arrest cases in which an AED could arrive within 5 minutes rose from 30 to 40% under road-based strategies to more than 95% once drone delivery was incorporated. The modelling determined that just 200 drone bases combined with 871 fixed AED sites could cover 99.41% of out-of-hospital cardiac arrests in the region, some 28,349 cases. Because every minute of delay in defibrillation after cardiac arrest reduces survival, gains of this magnitude could translate into thousands of additional survivors, and the framework offers a template for other metropolitan regions wrestling with territorial inequalities in AED access.

Pain relief featured prominently in two trials. Rittirak Othong of Vajira Hospital in Bangkok, Thailand, presented a single-centre, randomised, double-blind, placebo-controlled superiority trial of 10% lidocaine spray during rabies immunoglobulin infiltration, an essential but notoriously painful component of post-exposure prophylaxis. Seventy-six participants aged 18 to 65 were randomly assigned 1:1 to lidocaine spray or placebo, with pain assessed on a 100-mm Visual Analog Scale for up to 30 minutes after infiltration and satisfaction on a 10-point Likert scale. The lidocaine group reported significantly lower median pain during needle penetration, 25.0 versus 56.5, and during immunoglobulin infiltration, 46.5 versus 77.0, both with p values below 0.001, and satisfaction was significantly higher at 8.0 versus 6.0. No adverse events occurred during the 30-minute observation window.

For children, needle-free analgesia took centre stage. Shammi Ramlakhan of Sheffield Children’s Hospital in the UK presented the PDC 01-0202 trial, a single-arm, multicentre phase 2/3 study registered as NCT06364072, evaluating intranasal sufentanil/ketamine in paediatric patients with moderate to severe acute pain. Between May 2024 and May 2025, 155 patients aged at least 1 and under 18 years received weight-based dosing at seven emergency departments in the UK and Spain, with 152 included in the efficacy analysis. The primary endpoint was the responder rate, defined as a pain score of 4 or less, at 15 and 30 minutes. Some 54% of participants reached that threshold at 15 minutes and 88% at 30 minutes, while 95.4% achieved at least a 30% reduction in pain intensity from baseline at 30 minutes and 86.2% achieved a 50% reduction. Treatment-emergent adverse events occurred in 46.5% of participants, most mild, and no severe events were reported, supporting the feasibility of rapid intranasal analgesia in children.

Finally, Tommaso Bellini of IRCCS Istituto Giannina Gaslini in Genoa, Italy, reported a prospective single-centre observational study asking whether two immune cell markers, neutrophil CD64 and monocyte CD169, could distinguish bacterial from non-bacterial infections in febrile infants aged 90 days or younger. Existing risk stratification tools are highly sensitive for severe bacterial infections but poorly specific, driving unnecessary antibiotics and invasive procedures. Sixty infants were enrolled, comprising 27 with non-bacterial infections, 12 with bacterial infections, and 21 age-matched healthy controls, with ratios measured by flow cytometry. The combined CD64/CD169 ratio separated the three groups most strongly, with values of 0.33, 16.22, and 1.10 respectively and a p value below 0.001. The area under the receiver operating curve reached 0.993 for the combined ratio, comfortably exceeding 0.951 for CD64 alone, 0.94 for procalcitonin, and 0.89 for C-reactive protein. The researchers concluded that, with validation in larger cohorts, the CD64/CD169 ratio could support antibiotic stewardship and spare infants unnecessary invasive testing, capping a congress that repeatedly demonstrated how refined measurement, whether in an ambulance, a drone flight path, or a flow cytometer, can make emergency care faster, safer, and more humane.

Subject of Research: Emergency medicine research presented at the EUSEM 2026 congress, including prehospital diagnostics, department overcrowding, drone AED delivery, pain management, and paediatric infection biomarkers

Article Title: EUSEM Congress 2026

Article References: EUSEM Congress 2026. (2026). eClinicalMedicine, Article 104277. https://doi.org/10.1016/j.eclinm.2026.104277

Image Credits: AI Generated

DOI: 10.1016/j.eclinm.2026.104277

Keywords: EUSEM, emergency medicine, troponin, HEART score, drones, defibrillators, virtual reality, hypertensive urgency, lidocaine, intranasal analgesia, febrile infants, CD64/CD169

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