Background: COVID-19 is an emerging infectious disease, that is heavily challenging health systems worldwide. Admission Arterial Blood Gas (ABG) and Lung Ultrasound (LUS) can be of great help in clinical decision making, especially during the current pandemic and the consequent overcrowding of the Emergency Department (ED). The aim of the study was to demonstrate the capability of alveolar-to-arterial oxygen difference (AaDO₂) in predicting the need for subsequent oxygen support and survival in patients with COVID-19 infection, especially in the presence of baseline normal PaO₂/FiO₂ ratio (P/F) values. Methods: A cohort of 223 swab-confirmed COVID-19 patients underwent clinical evaluation, blood tests, ABG and LUS in the ED. LUS score was derived from 12 ultrasound lung windows. AaDO₂ was derived as AaDO₂ = ((FiO₂) (Atmospheric pressure − H₂O pressure) − (PaCO₂/R)) − PaO₂. Endpoints were subsequent oxygen support need and survival. Results: A close relationship between AaDO₂ and P/F and between AaDO₂ and LUS score was observed (R² = 0.88 and R² = 0.67, respectively; p < 0.001 for both). In the subgroup of patients with P/F between 300 and 400, 94.7% (n = 107) had high AaDO₂ values, and 51.4% (n = 55) received oxygen support, with 2 ICU admissions and 10 deaths. According to ROC analysis, AaDO₂ > 39.4 had 83.6% sensitivity and 90.5% specificity (AUC 0.936; p < 0.001) in predicting subsequent oxygen support, whereas a LUS score > 6 showed 89.7% sensitivity and 75.0% specificity (AUC 0.896; p < 0.001). Kaplan–Meier curves showed different mortality in the AaDO₂ subgroups (p = 0.0025). Conclusions: LUS and AaDO₂ are easy and effective tools, which allow bedside risk stratification in patients with COVID-19, especially when P/F values, signs, and symptoms are not indicative of severe lung dysfunction.

Emergency medicine (EM) has evolved significantly over the past 50 years, transitioning from a focus on acute injuries and illnesses to include primary and specialty care, disaster response, and social issues. To date, nearly 60 countries have officially recognized EM as a medical specialty. However, growing patient demands, healthcare staff shortages, and an aging population have strained emergency departments, worsening working conditions for EM professionals and compromising patient care. To address these challenges, formal recognition of EM as a specialty is crucial. As a specialty, EM offers significant benefits. It improves patient outcomes by ensuring structured, standardized training that equips specialists with the skills to manage acute conditions such as trauma, stroke, and myocardial infarction. Countries with recognized EM specialties have reported reduced morbidity and mortality and enhanced healthcare resilience during crises like pandemics and mass casualty events. Additionally, professional recognition aids in recruitment, retention, and reducing burnout among EM practitioners by establishing clear career pathways. Furthermore, it ensures specific paraclinical training in areas such as patient flow, and it strengthens healthcare systems. However, despite these benefits, challenges remain. Resource diversion from primary care, increased healthcare costs, and the initial investment required for training programs are potential drawbacks to EM specialty recognition. Achieving EM recognition will require a strategic collaborative approach, focusing on education, professional support, and collaboration across healthcare sectors.

At the end of October 2023, CoSMEU (Italian Society of Emergency Medicine Residents) conducted an electronic survey among the Italian Emergency Medicine (EM) residents. Technical skills, lecture programs, research, and types of employment have been investigated. 421 (21.5.%) residents from all the 34 Italian EM schools responded. Great heterogeneity of training and the lack of opportunities in research about EM topics are reported. The importance of research in EM was recognized by half of those surveyed, but only one-third are actively engaged in the EM scientific community. While one-third of EM residents have accepted a job contract, nearly all of them are against contracts with Calabria Decree from the 2nd year of residency. The ideal workplace is a combination of in-hospital and pre-hospital settings, and almost all of the EM residents believe that the most frightening part of being an EM doctor is the hard-working condition.

Dear Editor, When faced with a crisis, particularly when it involves humanitarian aid, emergency medicine (EM) practitioners push themselves to question, “How can we help?” and “To the best of our knowledge and skills, what can we truly do?”. The mindset of EM personnel is presumably one of "How can I help in these situations?" and, more crucially, "How can I help the most effectively?". To answer these questions, we present our experience in Ukraine.

The growing complexity of Emergency Medicine (EM) - due to overcrowding, boarding, and the expanding social role of emergency departments - requires standardized and structured training models. Simulation in medicine is essential for education, training, and improving patient care. Italian EM residency programs face additional challenges, including variable training quality and limited access to simulation-based education. To address these issues, the University of Pavia has developed a five-year simulation curriculum integrated into its EM residency program. This study presents this model and evaluates its alignment with national and European standards. A descriptive comparative analysis was conducted by aligning the curriculum's learning objectives and simulation activities with the European Society for Emergency Medicine (EUSEM) Core Curriculum and the guidelines set by the Italian Ministry of Education (MIM), incorporating feedback from national associations. Each competency was classified independently as fully, partially, or not covered. The goal of this model is to standardize training quality, increase preparedness for complex emergencies, and promote a reflective professional culture. The curriculum includes more than 25 simulation sessions each year, progressing from foundational procedural and cognitive skills (Years 1–2: ultrasound, ventilation, suturing, ACLS-like scenarios) to complex interdisciplinary simulations (Years 3–4: trauma, pediatrics, resuscitation), culminating in advanced training covering leadership, ethics, medico-legal aspects and maxi-emergencies (Year 5). Training modalities include high- and low-fidelity simulations, peer-to-peer learning, and 3D-printed skill trainers. Feedback is collected after each session and annually. Facilitators are certified through SIMMED, EEDUSIM, and other accredited programs, and they undergo regular retraining. The curriculum has achieved 95% alignment with European standards and 100% alignment with Italian standards. The only gaps identified are in a few procedures, such as Extracorporeal Membrane Oxygenation and Resuscitative Endovascular Balloon Occlusion of the Aorta. Simulation-based education fills critical gaps in EM training, especially in non-technical skills, procedural readiness, and crisis decision-making. The Pavia model, although developed in a single center, aligns with national and international standards. Its innovative features, such as the use of 3D printing, integration within clinical training, and potential collaboration among different EM residency programs, suggest that it is a scalable proposal for national adoption. Broader implementation could support standardization in EM, make the specialty more attractive, and improve workforce preparedness in Italy.