Emergency department utilization for substance use disorders and mental health conditions during COVID-19

Background As the emergency department (ED) has evolved into the de-facto site of care for a variety of substance use disorder (SUD) presentations, trends in ED utilization are an essential public health surveillance tool. Changes in ED visit patterns during the COVID-19 pandemic may reflect changes in access to outpatient treatment, changes in SUD incidence, or the unintended effects of public policy to mitigate COVID-19. We use a national emergency medicine registry to describe and characterize trends in ED visitation for SUDs since 2019. Methods We included all ED visits identified in a national emergency medicine clinical quality registry, which included 174 sites across 33 states with data from January 2019 through June 2021. We defined SUD using ED visit diagnosis codes including: opioid overdose and opioid use disorder (OUD), alcohol use disorders (AUD), and other SUD. To characterize changes in ED utilization, we plotted the 3-week moving average ratio of visit counts in 2020 and 2021 as compared to visit counts in 2019. Findings While overall ED visits declined in the early pandemic period and had not returned to 2019 baseline by June 2021, ED visit counts for SUD demonstrated smaller declines in March and April of 2020, so that the proportion of overall ED visits that were for SUD increased. Furthermore, in the second half of 2020, ED visits for SUD returned to baseline, and increased above baseline for OUD ever since May 2020. Conclusions We observe distinct patterns in ED visitation for SUDs over the course of the COVID-19 pandemic, particularly for OUD for which ED visitation barely declined and now exceeds previous baselines. These trends likely demonstrate the essential role of hospital-based EDs in providing 24/7/365 care for people with SUDs and mental health conditions. Allocation of resources must be directed towards the ED as a de-facto safety net for populations in crisis.

Comparative Evaluation of the Prognosis of Septic Shock Patients from before to after the Onset of the COVID-19 Pandemic: A Retrospective Single-Center Clinical Analysis

In this study, we investigated the mortality of septic shock patients visiting emergency departments (ED) before and after the coronavirus disease (COVID-19) pandemic onset. We retrospectively reviewed medical records and National Emergency Department Information System data of septic shock patients who visited the ED of a tertiary medical center in South Korea from February 2019 to February 2021. Following the COVID-19 pandemic onset, revised institutional ED processes included a stringent isolation protocol for patients visiting the ED. The primary goal of this study was to determine the mortality rate of septic shock patients from before and after the onset of the COVID-19 pandemic. Durations of vasopressor use, mechanical ventilation, intensive care unit stay, and hospitalization were investigated. The mortality rates increased from 24.8% to 35.8%, before and after COVID-19-onset, but the difference was not statistically significant (p = 0.079). No significant differences in other outcomes were found. Multivariable analysis revealed that the Simplified Acute Physiology Score III (SAPS III) was the only risk factor for mortality (OR 1.07; 95% CI 1.04-1.10), whereas COVID-19 pandemic was not included in the final model. The non-significant influence of the COVID-19 pandemic on septic shock mortality rates in the present study belies the actual mortality-influencing potential of the COVID-19 pandemic.

Torrent Monitoring and Early Warning Systems Development

The level of sustainability of a modern society is associated with the ability to manage unwanted stressors from the environment, regardless of origin. Torrential floods represent a hydrological hazard whose frequency and intensity have increased in recent years, mainly due to climate changes. In order to effectively manage the risks of torrents, it is necessary to apply early warning systems, since torrential floods are formed very quickly, especially on the watercourses of a small catchment area. The early warning system is part of a comprehensive torrential flood risk management system, seen as a technical entity for the collection, transformation, and rapid distribution of data. Modern early warning systems are the successors of rudimentary methods used in the past, and they are based on ICT and mobile applications developed in relation to the requirements of end users. The chapter presents an analysis of characteristic examples of the use. The main conclusion of the chapter indicates the need to implement early warning systems in national emergency management structures.

Evaluation of Learning Guidelines During the Covid-19 Pandemic

The Covid-19 epidemic has led in significant changes across the board, particularly in the realm of education. Every level of education seems to be being 'forced' to adapt in order to accommodate students studying from home via online media. Educators are expected to be innovative in their delivery of curriculum using online learning medium. The Covid-19 epidemic is a worldwide pandemic, and the National Public Health Board has declared a national emergency. A number of preventative measures have been implemented by the government in order to avoid and reduce the spread of the virus. It is hoped that we would acquire acclimated to the existing system as a learning culture in educational institutions.

Mobile Application for Incident Reporting

In the Philippines, reporting an incident always depends on self-reporting to the nearest law enforcer's office or calling a channel using a mobile phone. 911 is the National Emergency hotline to get assistance when an emergency occurs. However, the emergency hotline operated by the Emergency Network Philippines (ENP), cannot retrieve the reporter's location details immediately. Only when the reporters describe the exact location clearly. Yet, many circumstances that the reporters do not know when they are, or sometimes they have imprecise position information. Then, the law enforcers team may not be able to come to the right place efficiently on time. The incident reporting application incorporates the three types of incidents, classified as public disturbance, ordinance violation, and crime incident. To report an incident the application will automatically get the latitude and longitude of the mobile user or an option to manually pinned the location on the google map include also the incident type, description, and photos will be sent to the nearest barangay responder officer. The barangay responder officer able to request a backup officer, the rescue emergency unit such as a hospital ambulance or firefighters, or transfer a report to the nearest police station. The system also manages web admin for responder locations and generates statistical reports including charts and graphs. The positive feedback of the participants during the evaluation stage signifies that the application was accepted as tested and verified by the evaluation results.

Maximizing the Role of Emergency Medical Services in COVID-19 Response

The Centers for Disease Control and Prevention define six intervals of a pandemic: (1) investigation of cases, (2) recognition of the increased potential for ongoing transmission, (3) initiation of a pandemic wave, (4) acceleration of a pandemic wave, (5) deceleration of a pandemic wave and (6) preparation for future pandemic waves. Each of these stages has eight domains. Following China’s COVID-19 outbreak announcement, Israel’s National Emergency Medical Services (EMS) Organization immediately began working in conjunction with the Ministry of Health (MOH) to address the threat of the COVID-19 outbreak. This article will describe how a national EMS organization acted according to these pandemic intervals and domains. In the initial stages, EMS managed a checkpoint in the international airport voluntarily testing people for febrile symptoms. Calls to the dispatch centers that aroused the suspicion of COVID-19 resulted in EMS transport to the hospital with protective gear. During the period of first exposure, the scope of the medical emergency number was increased to include questions concerning coronavirus, telemedicine, and home sampling by protected EMS workers. In the contagion stages, epidemiological tests were conducted by the MOH and EMS began operating dedicated telephone triage, mass drive-through sampling, and finally, administration of vaccinations.