This presentation provides a review of a case report regarding the often unrecognized emotional support experienced among leaders during crisis management.

Members of a statewide COVID-19 advisory group were surveyed as to their level of participation and perceived emotional wellness benefit resulting from group membership.

A majority of members across all disciplines and agencies reported a benefit of emotional wellness from group membership.

It is important in disaster settings, regardless of the labeled group function, to be mindful of the potential benefits to group members from not only a task standpoint but a process standpoint as well. In addition, it is important to recognize the multiple benefits of interdisciplinary interaction and inclusion.

The COVID-19 pandemic has impacted populations internationally, through infections and consequences of infections, and by the countermeasures to prevent the spread of the coronavirus. Concerns exist surrounding the impact of the COVID-19 pandemic on the mental health of youths in the Netherlands. Consequently, we studied quarterly trends and risk factors of suicidal ideation among Dutch youths from September 2021 onwards.

The Network GOR-COVID-19, a research group consisting of different organizations, monitors the effect of the COVID-19 pandemic on population health. As one element of this monitoring, quarterly data collections have been undertaken since September 2021 from a panel of youths (12 – 25 years of age) representative of the Dutch population. Online questionnaires collect data on self-reported health and wellbeing. We analyzed a selection of demographic, social activity, and mental health variables as potential risk factors for self-reported suicidal ideation in the previous three months. We assessed trends, performed longitudinal analyses, and conducted logistic and random forest regressions per quarterly round of data collection. Analyses were weighted for age, sex, educational level, and province where appropriate.

Approximately 4,500 youths participated in each quarterly questionnaire, with some participating more than once. Results showed substantial increases in self-reported suicidal ideation during and immediately after the third lockdown in the Netherlands in December 2021, rising from 9% to 17%, then slowly decreasing to 16% in May/June 2022, and to 13% in September 2022. In all multivariable analyses variables relating to mental health were indicated as risk factors. The strongest associations were seen in those experiencing mental health complaints and loneliness. Demographic variables were not strongly associated with suicidal ideation.

The monitoring conducted by The Network GOR-COVID-19 enables the tracking of trends in the impact of the COVID-19 pandemic on the mental health of Dutch youths in The Netherlands.

Healthcare workers (HCWs) are at increased risk of burnout, post-traumatic stress injury and suicide, compared to the public. Long-lasting increases in HCW distress are reported following pandemics. Such occupational stress can negatively impact individuals, organizations, and the overall healthcare system. Understanding HCW distress and needs can inform the development of resources to mitigate negative outcomes. Staff wellness data was gathered from a large academic health center during the COVID-19 pandemic, as part of a quality improvement project seeking to support staff wellbeing. Longitudinal trends of distress and preferences related to support were shared with leadership.

Monthly wellness assessments were sent to hospital staff via email. Assessments included screens for burnout, anxiety, depression and posttraumatic stress, questions regarding types of resources accessed, and open-ended questions regarding staff needs. Surveys were voluntary and confidential. Participants could provide their email to receive tailored resources based on individual results. Survey data was analyzed longitudinally to identify trends of distress over time.

A total of 2,518 wellness assessments were completed from April 2020-July 2021. An average of ~167 (range 17 – 946) HCWs responded per month and 638 staff provided their email addresses to receive a response; 497 of these completed assessments multiple times. The proportion of positive screens were, on average, 44%, 29%, 31% and 53%, for anxiety, depression, post-traumatic stress and burnout, respectively. Anxiety and post-traumatic stress scores decreased from April-August, then increased from September. The most reported source of support accessed was family/friends; ~40% of responders had not accessed formal mental health support.

When COVID-19 cases decreased and stay-at-home mandates were lifted, HCW distress was reduced. Burnout trended upwards through the pandemic. Peer/family support remained favored compared to formal mental health support, suggesting the importance to HCW of social support. HCW reported a preference for convenient access to supportive resources.

The mental health consequences of health emergencies and disasters have the potential to be sustained and severe. In recognition, the 2018 Kobe Expert Meeting on Health Emergency and Disaster Risk Management (Health EDRM), prioritized mental health as one of the key research areas of Health EDRM, to be addressed in a multi-country research project supported by WHO (Kayano et.al., 2019). As climate change, growing urbanization, population density and viral transmission generate increasingly severe hazards, attention to mental health will be critical.

The Asia Pacific Disaster Mental Health Network was established in 2020 to foster advancements in mental health research and policy in the region. Building connections between researchers, practitioners and policy makers, the Network includes broad representation from interdisciplinary scholars and organizations across eight Asian and Pacific nations. A research agenda was designed in early meetings, and collaborative research projects were established.

The Network has supported the development of innovative disaster mental health research investigating community engagement in recovery, psychosocial interventions, and evaluation frameworks. A recent multilingual systematic review of more than 200 longitudinal studies identified the long-term trajectories of post-traumatic stress symptoms, depression and anxiety following disasters and pandemics (Newnham et al., 2022). Synthesized evidence of risks related to age, gender and disaster type were determined to inform intervention targets.

The Asia Pacific Disaster Mental Health Network established a platform for scholarly connection, intervention planning and knowledge dissemination. This presentation will provide an overview of the Network’s activities, and research highlights that have identified targeted points for policy and practice.

Violence against healthcare workers (HCWs) and lack of public trust threatens the foundation of the physician-patient relationship in Trinidad. The primary aim of this study was to determine the prevalence of violence against Trinbagonian HCWs in the public sector. Secondary objectives included determining risk factors for violence and mistrust between the public and providers.

A cross-sectional analysis of 434 Trinbagonian HCWs in the public sector was conducted using a modified World Health Organization (WHO) data collection tool, distributed via social media and administrative emails, and snowballed for two months. Fifteen semi-structured interviews were conducted regarding trust in the healthcare system with patients selected from various communities.

Of the 434 respondents, 45.2% experienced violence and 75.8% witnessed violence against HCWs in the past 2 years. Verbal abuse (41.5%) was most common. Perpetrators were patients (42.2%) and patients’ relatives (35.5%). Chi-square analysis highlighted that HCWs with the highest probability of being abused were aged 25-39 (63.8%), had 2-5 years of work experience (24.9%), specialized in emergency & internal medicine (48.6%), and cared for psychiatric & physically disabled patients (p-value <0.001). HCWs believed the threat of violence negatively impacted their performance (64.5%), and further action was necessary for mitigation (86.4%). Patients interviewed doubted physicians' altruism, competence (80%) and honesty (53.3%), expressed mistrust in their physician (46.7%), and cited poor infrastructure/management (66.7%) and dissatisfaction with care (60.0%) as factors that contributed to violence.

Analysis revealed that violence against Trinbagonian HCWs in the public sector deteriorated patient experience and adversely affected psychological well-being, efficiency, and job satisfaction. Results suggested mistrust of HCWs by the population. Interventions should be instituted to support at-risk HCWs and educate the public to avoid recurrence.

International psychosocial support guidelines reflect consensus on support principles and interventions. However, no consensus exists on what recipients consider important elements of service delivery. Within two contexts – after a potentially traumatic event (PTE) and people with Spinal Muscular Atrophy (SMA)–the aims were to contribute to (1) understanding which psychosocial support aspects are considered important by recipients and relevant stakeholders; (2) developing instruments to test and integrate those aspects in practice, in order to evaluate the quality of psychosocial support from the recipient’s perspective.

Concept mapping was used to achieve consensus on key themes of psychosocial support. These were operationalized in surveys and pilot-tested, conforming to the Consumer Quality Index. This determines the importance and needs for improvement.

Concept mapping resulted in eight key themes within the PTE context and six in the SMA context. PTE survey (N= 132) results showed key themes “an approach that starts from the needs and capacities of the affected one” and “monitoring individuals affected and initiating follow-up where needed” were most important. Key theme “providing information on common emotional reactions” received the highest score of perceived need for improvement. SMA survey (N= 57) results showed key themes “an approach that incorporates all aspects of a human being” and “a respectful approach and awareness of personal boundaries” as most important. The perceived need for improvement of the key theme “availability and accessibility of quality information” was ranked the highest.

The similarities between both contexts support the notion that there are universal aspects of psychosocial support. Simultaneously, the context-specific idiosyncrasies found underscore the necessity to adapt to context. The surveys have the potential to contribute to a growing toolbox of quality evaluation instruments.

The COVID-19 pandemic and the measures taken to contain it, have had a substantial effect on mental health of populations worldwide. Uncertainties about the future and one’s own health, as well as restrictive measures drastically altered people’s lives. To anticipate and mitigate the probable mental health impact, mental health and psychosocial support (MHPSS) interventions have been recommended and implemented. The objective of this systematic review is to provide an overview of different types of MHPSS interventions and the quality of the scientific evidence in the context of a pandemic.

A systematic search of interventions for reducing mental health problems or risks due to the COVID-19 pandemic was performed in November 2021 and repeated for new records in August 2022. APA PsycInfo, Embase, Ovid MEDLINE(R) ALL, EBM Reviews and Web of Science databases were systematically searched for relevant articles. The methodological quality of selected articles was assessed using the NHLBI Quality Assessment Tool for Systematic Reviews and Meta-Analyses.

A summary of the content and quality of MHPSS interventions during the COVID-19 pandemic is provided. The interventions could be clustered predominantly into existing MHPSS categories of “Basic aid”, “Information”, “Emotional and social support”, “Practical support” and “Health care”. Nevertheless, the evidence supporting the applicability and the effectiveness of such measures is limited when it comes to the mitigation of mental health problems.

The clustered overview of different COVID-19 interventions points at strong similarities with interventions in general evidence-based MHPSS guidelines. However, there is a need to integrate more systematic monitoring, evaluation and research to appraise the applicability and effectiveness of MHPSS measures in future pandemics and other crises.

Cumulative disasters have been shown to influence mental and physical health in both responders and victims, with studies showing associations in rates of depression and Post Traumatic Stress Disorder. Systemic problems that impact patient care such as limited resources, overcrowding of emergency rooms, and staffing shortages can be morally challenging for healthcare workers. Andrew Jameton, in 1984 defined Moral Distress (MD) as the inability of a moral agent to act according to his or her core values and perceived obligations due to internal and external constraints. Unresolved MD can create significant long-term debilitating physical and mental damage. Emergency medical providers on the island of Grand Bahama had the unique experience of responding to both the aftermath of Hurricane Dorian and the Covid-19 Pandemic. The aim of this study is to determine the prevalence of Moral Distress (MD) in Accident & Emergency (A&E) Physicians, Nurses, and Emergency Medical Service (EMS) staff at the Rand Memorial Hospital (RMH) in the Bahamas.

This is a descriptive, qualitative, prospective cross-sectional study, utilizing a three-part survey sent to participants. Sociodemographic information, Hurricane Dorian & Covid-19 experiences, and responses to a validated modified Moral Distress Scale will be collected and uploaded to a secure, encrypted data management program. The data will be analyzed using the most current IBM SPSS statistical analysis package. Descriptive and Inferential statistics will be used to determine the impact of Hurricane Dorian & Covid-19 on MD and its associated sociodemographic factors.

Data collection and analysis are planned for completion by March 1, 2023.

Addressing the causes of Moral Distress early can help improve healthcare systems’ resiliency by ensuring a healthy and supported workforce equipped with the resources to respond to future disasters.

Disasters and humanitarian crises can have a tremendous impact on the mental health and psychosocial well-being of affected populations. Reliable and practical evidence-informed mental health and psychosocial support (MHPSS) guidelines are indispensable for policy and practice to address the mental health impact. Our objective was to review the quality of available guidelines and to explore similarities and differences in content.

The review was conducted in two steps. Firstly, MHPSS guidelines, frameworks, manuals and toolkits were selected via a systematic literature review as well as a search in the grey literature. A total of 13 MHPSS guidelines were assessed independently by 3–5 raters using the Appraisal of Guidelines for Research and Evaluation–Health Systems (AGREE-HS) instrument. Secondly, we analyzed the content of the highest-ranking guidelines.

Guideline quality scores varied substantially, ranging between 21.3 and 67.6 (range 0–100, M= 45.4), with four guidelines scoring above midpoint (50). Overall, guidelines scored highest (on a 1–7 scale) on topic (M = 5.3) and recommendations (M = 4.2), while implementability (M = 2.7) is arguably the area where most of the progress is to be made. The four guidelines proved largely similar, overlapping or at least complementary in their MHPSS definitions, stated purpose of the guidelines, user and target groups, terminology, and models used. Many recommended MHPSS measures and interventions were found in all of the guidelines and could be categorized. The guidelines stress the importance of monitoring needs and problems, evaluating the effect of service delivery, deliberate implementation and preparation, and investments in proper conditions and effective coordination across professions, agencies, and sectors.

The MHPSS knowledge base embedded in guidelines is rich and contains invaluable content for disaster risk reduction. Although application contexts differ geographically, available guidelines should allow policymakers and practitioners globally to plan, implement, and evaluate MHPSS actions.

Although prehospital emergency care in a civilian versus military context may differ in terms of working conditions and injuries, in both contexts the exposure to stressful and extreme events are present. Besides the continuous reports of post-traumatic stress symptoms, an alarming increase of burnout and suicide in (emergency) physicians is recognized as well. However, most of the research on this topic is either retrospective or peri-recovery, which might have an impact on the availability of information with regard to causes and underlying processes. Hence, in the current study, we conducted an in-depth study of well-functioning emergency caretakers, studying their profile while including their perspective on both their professional and personal context and the interconnectedness with their operational performance.

We used a mixed method approach, combining the results of a quantitative questionnaire and a thematic analysis of 23 in-depth semi-structured interviews to gain additional qualitative information. We interviewed well-functioning and operating prehospital emergency professionals, recruited in three different settings, i.e., a military hospital, a military Special Operations Surgical Team, and a civilian hospital in the capital city.

The quantitative part showed a preference for task-oriented coping. However, the interviews broadened this result, showing how the personnel are continuously seeking to find a balance between emotional connection and disconnection. Several risk-factors for mental injury were detected and the support and recognition from both the personal and professional environment showed to be crucial in finding a balance between job passion and the sacrifice of one's personal life.

The interviews showed that a variety of interrelated underlying professional and personal factors are related with how emergency personnel perceive and cope with stress events. A systemic approach to prevent mental health problems is highly recommended.

The COVID-19 pandemic has not only put a strain on the health care system throughout the world but has had an extreme impact on health care workers caring for these patients on a daily basis. These workers have been isolated from their families and experienced significant stress and loss at work and home. Some health care workers experienced rationing of care, inadequate personal protective equipment, and found themselves without the resources needed to care for patients. This paper reports on a systematic review of wellness and stress interventions targeting healthcare workers during the COVID-19 pandemic.

A systematic review of Pubmed and SCOPUS articles published between January 1, 2020 and November 1, 2022 was conducted using the terms “healthcare worker”, “nurse”, “doctor”, “paramedic”, ”emergency medical technician”, “mental health”, “resilience”, “wellness”, “stress”, “sleep” , “intervention”, “Covid-19”, “coronavirus”, and “pandemic.” These results were imported into Covidence. Inclusion criteria were studies on interventions of healthcare workers. Exclusion criteria were papers not describing health care workers, papers not describing interventions, health care workers not caring for COVID19 patients, and papers not written in English.

A total of 26 papers were included in the analysis after the final screen. These papers were examined and sorted into groups based on the types of interventions on health care workers. The groups of interventions included 1. Psychological interventions, 2. Wellness or well-being interventions, 3. Work-related interventions, and 4. Pharmacologic interventions. Two studies were longitudinal in nature. The most common intervention was psychological (10), followed by work-related interventions (6).

Psychological interventions were the most commonly deployed and included hotline establishment or speaking with a therapist. This was followed by wellness interventions such as exercise, sleep regulation, breathing exercises, and healthy eating. Fewer interventions were included in the work-related or pharmacologic categories. Data regarding effectiveness and feasibility of interventions was heterogenous.

Arrival to the emergency room (ER) can increase stress levels in patients and family members. Thus, there is a need for a short and effective form of PFA provided by ER staff members, to reduce acute stress responses (ASR). Past studies have shown that psychological interventions based on emotional expression do not help to regulate extreme emotional expressions nor does it prevent post-traumatic stress disorder (PTSD). Alternatively, the Six C's model adopts a neuropsychological approach that focuses on cognitive communication, challenging for efficient activation, organizing the event's chronological order and reduction in loneliness by committing to stay with them. This experimental design study examined the effectiveness of the Six C's model on reducing signs of ASR.

Sixty-three participants (mean age 41.8 years) voluntarily took part. They were randomly assigned to the Six C's intervention (experimental condition) or to supportive emotional expression (control condition). They listened to a three minute audio recording of a real emergency 911 phone call. Interventions (SIX C's or emotional) were provided before and after listening to the recording. Before, immediately after, and five minutes after the recording, participants' anxiety, heart-rate variability (HRV) and mental resilience levels were measured.

For all three outcomes, the Time x Group interactions were statistically significant. Following "simple effects", analysis revealed that The Six Cs participants showed lower anxiety and less reductions in HRV and resilience than controls immediately after the stressor. Furthermore, the Six C's participants recovered faster on all three outcomes compared to controls, five minutes after the stressor.

This study showed the Six C's model moderates people's ASR. Furthermore, the Six C's method helps people to "bounce back" faster psychologically and neuro-physiologically. These findings support using the Six C's model to reduce ASR and increase resilience, which is highly relevant to ER staff.

This presentation describes an initiative to provide psychosocial support to children in Ukraine during the ongoing war using a children’s storybook, coloring book, and activity book. The resources promote emotion identification, self-expression, coping skills, and social support–variables with empirical support in promoting children’s mental health in response to trauma.

The book: “An Unusual Situation” is a bibliotherapy intervention for children struggling with difficult situations. By identifying with the characters, children learn about their own struggles, they learn that other children share similar concerns, and learn important coping skills.

The book was translated into Ukrainian and Russian; supplementary materials including a coloring book, activity book and a guidebook were developed. Following a three-hour training, Ukrainian mental health professionals worked with children on the materials in their respective wartime settings.

Results of the following research questions will be presented:

1. 1) How do mental health professionals working with children in Ukraine utilize the associated book resources measured by a survey and completed by the professionals engaged in the project.

2. 2) What do children who use these resources report about their experiences coping with the ongoing war, measured by:

   1. a) Collecting children’s responses in the activity book.

   2. b) Surveying the mental health professionals about their observations of the children during the intervention process.

3. 3) Does the intervention reduce children’s distress, interpersonal functioning, or problematic behaviors, measured by pre-post scores on the Youth Outcome Questionnaire 2.0.

This pilot study will provide information to guide the implementation of a broad psychosocial support intervention for children living in the setting of the ongoing war in Ukraine. Conclusions to be presented include:

1. 1) Tailoring the intervention to the current needs of Ukrainian children

2. 2) Designing a wide-scale implementation plan tailored to Ukrainian mental health professionals’ recommendations

3. 3) Addressing barriers to implementation.

Self-affirmation is known to buffer the development of anxiety symptoms into depressive symptoms, and a study during the early days of the COVID-19 pandemic revealed a role for this self-affirmation. In Japan, the COVID-19 pandemic has occurred repeatedly, and at this point (November 16, 2022), prior to an eighth wave. The possibility of ameliorating the psychological effects of this prolonged COVID-19 pandemic through efficient interventions targeting self-affirmation will be examined.

Study dates: June 25, 2020; September 25, 2020; February 10, 2021; November 24, 2021; February 7, 2022; August 31, 2022

Survey participants: Registered monitors of the research company (Neo Marketing Co., Ltd.) Each 1,000 respondents

Questionnaire:

1. 1) Attributes: gender, age, region, number of family members

2. 2) DASS-21 (Depression, Anxiety, Stress Scale-21)

3. 3) LSNS-6 (the Lubben Social Network Scale-6)

4. 4) Self-affirmation

CIPS (Clance Impostor Phenomenon Scale)

Rosenberg Self-Esteem Scale (Japanese version)

The self-affirmation scale (CIPS; Rosenberg Self-Esteem Scale) was measured from the 4th to the 6th survey.

Contribution of each factor to depressive symptoms:

The DASS-21 Depressive Symptom Scores from the 4th through 6th surveys were examined using Prediction One with the DASS-21 Anxiety Symptom Score, DASS-21 Stress Score, Connections Score, Rosenberg, and CIPS score as factors to determine their contribution.

At the time of the second survey (September 25, 2020), DASS-21 scores peaked and then declined. CIPS and Rosenberg Self-Esteem Scale scores showed no change from the 4th to the 6th session. The result of contribution of each factor to depressive symptoms by Prediction One showed anxiety symptoms contributed the most to depressive symptoms.

A model in which self-affirmation prevents anxiety symptoms from progressing to depressive symptoms is reasonable until the 7th wave of the COVID-19 pandemic in Japan.

Coastal area cities Jakarta and Semarang in Indonesia portray higher hazard that links to an annual sinking rate of up to 20cm. Four main factors have been determined to contribute: groundwater extraction, sea-level rise (SLR), land subsidence, and coastal floods. It accounts for people living in those high-risk regions to prevent the exacerbating situation.

This study’s main objective is to generate risk mapping in Jakarta and Semarang using Geographic Information System (GIS) from three open-source websites: Surging Seas, OpenStreetMap (OSM), and Healthsites.io. Through GIS analysis, prediction can be analyzed more accurately with precision when the sinking hits slowly to identify the risks involved.

Satellite data geographical analysis risk mapping done via Surging Seas, OpenStreetMap (OSM), and Healthsites.io showed that by 2050, North, West, part of Central Jakarta and Semarang will sink 5.6 meters below sea level with an annual sinking rate up to 20cm. Critical infrastructure will be affected in Jakarta, including Soekarno-Hatta International Airport and Tanjung Priok Port. Similarly, in Semarang, the Jenderal Ahmad Yani International Airport, Tanjung Mas Port, and Terboyo Bus Station are affected as well. Consequently, it will situate 13 million at both coastal cities as the worst impacted, categorized by the World Bank data, updated Sept 2022 as Urban Poverty, the population living at 2.15 US Dollar a day poverty line. Those living below the poverty line are also deprived of education and access to infrastructure, mainly electricity, water and sanitation hygiene indicators measured by the World Bank 2021 and 2022, Multidimensional Poverty Measure.

As a conclusion, GIS mapping of Jakarta and Semarang by 2050 using Surging Seas, OpenStreetMap, and Healthsites.io showed a high risk of sinking, especially in the northern areas of both cities, with the mapping done as of April 2022.

Non-coordinated support during disasters has negative effects on affected communities and people. From the 2004 Indian Ocean Tsunami, the United Nations introduced a cluster approach to avoid gaps and duplication of aid. Japan's disaster coordination of support for health and medical care was organized after the 2017 Kumamoto earthquake. The Ministry of Health, Labour and Welfare (MHLW) announced and issued the notice that the prefectures need to establish a system related to health and medical activities in the event of a large-scale disaster. In July 2022, welfare content was added. This study investigated the current status of health sector organizational coordination among health, medical, and welfare responders during 2022 the Large-Scale Earthquake National Exercise (LSENE).

The 2022 LSENE was conducted on October 1, 2022 with participation from the Disaster Medical Assistant Team (DMAT) and responders from each prefecture's health and welfare divisions and organizations. Each responder's exercise log sheet and the exercise controller's evaluation were reviewed.

Even though there was a notice from the MHLW, organized coordination was conducted only by several medical and health teams. DMAT is the only team with a system to dispatch teams from non-affected prefectures and coordinate well to allocate teams. Some other health and welfare organizations did not have a dispatching system. They had difficulty sending teams to affected areas, especially due to a lack of a systematic response system, training, coordination headquarters, and information sharing. It was suggested that information sharing and coordination among responders is necessary, although information gathering and request judgments related to dispatch coordination are different for each organization.

In order to smoothly coordinate support teams for health, medical, and welfare in the event of a disaster, it is necessary not only to improve the coordination headquarters for health, medical, and welfare but also to verify its operation through training.

Demand for prehospital emergency services has been increasing worldwide. Significant challenges exist in meeting response times in rural environments when faced with surges in demand related to weather events or sustained demand surge such as the pandemic environment. Significant pressure also exists in the hospital environment receiving such large volumes of patients with short duration handovers to allow prehospital assets return to their primary roles. The aim of this study is to determine trends for ambulance presentations in a rural emergency department over seven years with absolute numbers and percentage of overall attendances.

A retrospective analysis of anonymized electronic registration data on the iPMS system from initiation in 2014 to 2022 including total registration numbers, presentation by ambulance, and handover times. Excel is used to record and examine data.

ED attendances rose from 29,236 in 2014 to 43,184 in 2021 with total ambulance presentations ranging from 4,859 in 2014 (16.62% of attendances), maxing in 2019 at 10,326 out of total attendances of 42,637 (24.22% of attendances).Lowest monthly ambulance presentations occurred in April 2014 (441 or 15.82% of 2788 attendances) and maximal monthly presentations was 1,023 in May 2022 (23.38% of 4376 attendances). Lowest percentage of attendances arriving by ambulance occurred in May 2014 with 14.97% (468) out of 3,127 ED presentations. Highest percentage of attendances arriving by ambulance occurred in January 2021 with 33.67% (875) of 2,599 ED presentations which was during the lockdown phase of COVID in Ireland.

Overall total numbers of patients arriving by ambulance has been steadily increasing for years but numbers (and percentages) dramatically increased during COVID and this has been sustained in the POST Lockdown pandemic phase. Strategies are required to manage demand, increase turnaround and educate the public on appropriate use of prehospital emergency services.

To determine if lockdown measures related to the COVID-19 pandemic changed the frequency and epidemiology of geriatric patient emergency medical service (EMS) facilitated visits to the emergency department (ED) in Hamilton, Ontario, Canada.

A retrospective chart review was conducted comparing ED presentations of patients over 65 years of age presenting to two academic hospitals in Hamilton, Ontario via EMS between March 17, 2020, and July 15, 2020 (the first wave of the COVID-19 pandemic) to March 17, 2019, and July 15, 2019 (pre-pandemic).

Total EMS facilitated geriatric ED number of visits decreased by 17.3% during the first wave of COVID-19 in 2020, relative to the same seasonal time frame in 2019 (March 17- July 15). Visits were more dramatically decreased in the first 8 weeks after the pandemic was declared but then recovered to pre-pandemic levels thereafter. More geriatric patients visiting the ED via EMS were admitted during the initial stages of the COVID-19 pandemic, relative to 2019. However, the acuity and epidemiology of visits remained the same during the first wave of the COVID-19 pandemic, relative to 2019.

Lockdown measures during the first wave of the COVID-19 pandemic coincided with decreased geriatric EMS ED visits in the initial two months after the pandemic was declared. Visit numbers recovered as the first wave ended. The epidemiology, as well as the overall acuity, did not change.

Trauma is one of the leading causes of death in patients under 40 years of age. The Advanced Trauma Life Support (ATLS) Guidelines are widely accepted as the standardized approach to trauma and classify hemorrhagic shock according to heart rate (HR), blood pressure (BP), urinary output, and mental status. Paradoxical bradycardia (defined as HR <60 bpm) in hemorrhagic shock is an uncommon presenting feature and presents a diagnostic challenge to the physician; its true incidence is unknown.

A case of paradoxical bradycardia was examined as a presenting feature in hemorrhagic shock.

A 17-year-old male patient presented to our Emergency Department (ED) with collapse and abdominal pain following a collision with another player during a sports match.

The patient was hypotensive (BP 92/42) and bradycardic at triage, with a heart rate of 50. He was pale and diaphoretic with a Glasgow Coma Scale of 13/15, thready pulses, and localized peritonitis in the left upper quadrant of his abdomen.

An increase in blood pressure was observed following initial fluid resuscitation; however, this was transient and preceded the onset of profound hypotension (BP 64/30). Bradycardia with a heart rate between 50-60bpm was persistent despite resuscitative efforts.

Abdominal ultrasound demonstrated intraperitoneal free-fluid, and Computerized Tomography confirmed the presence of a grade V splenic laceration. He was taken to the operating theater for emergency laparotomy and underwent splenectomy. A 2.3 liter hemoperitoneum was found intraoperatively. There were no further complications post-operatively, and he made a full recovery.

Tachycardia is a potentially unreliable marker of blood loss, especially in young, healthy patients. A high index of suspicion is necessary to prevent this uncommon but life-threatening feature of hemorrhagic shock from being overlooked.

St. Joseph's Mission Hospital, Nyabonda, Kenya is the site chosen for a new Trauma Response Center as part of a new national highway development scheme. This highway will significantly increase in traffic volume expected in the region. With increased traffic volume, there will be an expected increase in trauma presentations as well as medical presentations due to increased populations in the area. This center is expected to serve a population of four million people. To date, the majority of nurses, medical officers and doctors in the pre-existing facility received no formal post graduate training in medical and surgical emergencies.

Global Emergency Medical Skills (GECS) is a registered charity, with an aim to provide medical education for the management of both trauma and medical emergencies for both adults and children. GECS was invited to attend St. Joseph's Missionary Hospital to provide education to nurses, medical officers and doctors. A curriculum encompassing the management of medical and surgical emergencies through both didactic lectures, practical skills training and simulation based workshops was composed and delivered by a group of 11 faculty, crossing Emergency Medicine, Intensive Care, Anesthesia and General Medicine. This curriculum had 28 participants and was conducted over a five day period. A "train the trainer" model was employed to ensure the strongest candidates were chosen for further training on how to deliver course material and organized simulations for future colleagues in St. Josephs Trauma Center.

Questionnaires of both staff and students have highlighted the utility of GECS and its curriculum in preparing staff for the opening of this new trauma center.

This program was the first of its kind undertaken in St. Joseph's Hospital and has provided valuable education to the staff of this new trauma center. This project has enabled the continuity of this knowledge through chosen trainers.