Planning for the next pandemic: Reflections on lessons from the uncontained transmission phases of the COVID-19 pandemic and their impacts on emergency departments in Australia.

Australia was a world leader in managing the earlier waves of the COVID-19 pandemic. Subsequently, three major turning points changed the trajectory of the pandemic: mass vaccinations, emergence of more transmissible variants and re-opening of Australia's borders. However, there were also concomitant missteps and premature shifts in pandemic response policy that led to mixed messaging, slow initial vaccination uptake and minimal mitigation measures in response to the Omicron variant. The latter marked Australia's entry into a new phase of (or approach to) the pandemic: widespread transmission. This led to an exponential increase in cases and significant impacts on the health system, particularly, EDs. This paper reflects on this phase of the pandemic to urge for system-level changes that instal better safeguards for ED capacity, safety and staff well-being for future pandemics. This is essential to strengthening our health system's resilience and to better protecting our communities against such emergencies.

Advancing leadership in Australasian emergency medicine: Taking stock and looking ahead.

Since 2018, the Australasian College for Emergency Medicine has collaborated with the Swinburne University of Technology on a research project to understand and enhance the leadership capacity of emergency physicians, beginning with Australasian Directors of Emergency Medicine (DEMs). Over the last 3 years, this research programme has revealed the complexity of leadership in emergency medicine, illuminating the strengths and limitations of extant research and suggesting promising new directions for emergency medicine leadership and leadership development research. This programme has also shed new light on the knowledge, skills and abilities that DEMs need to develop to catalyse change in the systems where DEMs practice both medicine and leadership. We propose that an approach to leadership development that reflects the diversity of DEMs' leadership challenges and the complexity of leadership in emergency medicine would go a long way to enhancing the sophistication, effectiveness and impact of the leadership in emergency medicine.

Planning for the next pandemic: Reflections on the early phase of the Australian COVID-19 public health response from the emergency department.

EDs play a crucial role as frontline health services throughout public health emergencies, including pandemics. The strength of the Australian public health response to coronavirus disease 2019 (COVID-19) has mitigated the impact of the pandemic on clinical services, but there has still been a substantial impact on EDs and the health system. We revisit major events and lessons from the first wave of COVID-19 in Australia to consider the implications and avenues for system-level improvements for future pandemic and public health emergency response for EDs. Notwithstanding, the remarkable efforts of healthcare workers across the health system, COVID-19 has uncovered structural and planning challenges and highlighted weaknesses and strengths of the Australian federation. In anticipating future pandemics and other public health threats, particularly in the face of climate change, hard-won lessons from the COVID-19 response should be incorporated in future planning, policies, practice and advocacy.

Early lessons from COVID-19 that may reduce future emergency department crowding.

The COVID-19 pandemic has produced significant changes in emergency medicine patient volumes, clinical practice, and has accelerated a number of systems-level developments. Many of these changes produced efficiencies in emergency care systems and contributed to a reduction in crowding and access block. In this paper, we explore these changes, analyse their risks and benefits and examine their sustainability for the future to the extent that they may combat crowding. We also examine the necessity of a system-wide approach in addressing ED crowding and access block.

Management of adult cardiac arrest in the COVID-19 era: consensus statement from the Australasian College for Emergency Medicine.

INTRODUCTION: The global pandemic of coronavirus disease 2019 (COVID-19) has caused significant worldwide disruption. Although Australia and New Zealand have not been affected as much as some other countries, resuscitation may still pose a risk to health care workers and necessitates a change to our traditional approach. This consensus statement for adult cardiac arrest in the setting of COVID-19 has been produced by the Australasian College for Emergency Medicine (ACEM) and aligns with national and international recommendations. MAIN RECOMMENDATIONS: In a setting of low community transmission, most cardiac arrests are not due to COVID-19. Early defibrillation saves lives and is not considered an aerosol generating procedure. Compression-only cardiopulmonary resuscitation is thought to be a low risk procedure and can be safely initiated with the patient's mouth and nose covered. All other resuscitative procedures are considered aerosol generating and require the use of airborne personal protective equipment (PPE). It is important to balance the appropriateness of resuscitation against the risk of infection. Methods to reduce nosocomial transmission of COVID-19 include a physical barrier such as a towel or mask over the patient's mouth and nose, appropriate use of PPE, minimising the staff involved in resuscitation, and use of mechanical chest compression devices when available. If COVID-19 significantly affects hospital resource availability, the ethics of resource allocation must be considered. CHANGES IN MANAGEMENT: The changes outlined in this document require a significant adaptation for many doctors, nurses and paramedics. It is critically important that all health care workers have regular PPE and advanced life support training, are able to access in situ simulation sessions, and receive extensive debriefing after actual resuscitations. This will ensure safe, timely and effective management of the patients with cardiac arrest in the COVID-19 era.