Pre-COVID-19 physician awareness of mental health resources during and after Natural and Human-made Disasters.

OBJECTIVE: The physician mental health is critical during the recovery of Natural and Human made disasters (NHD), yet the accessibility of mental health resources to physicians has not been characterized. This study examined Emergency Medicine and Trauma physician knowledge of and access to mental health resources in NHD settings. METHODS: The survey was electronically disseminated to the American College of Emergency Physicians and the American Association of the Surgery of Trauma between February 4, 2020 and March 9, 2020. The 17-question survey assessed physician awareness and access to emergency preparedness resources at their institutions. RESULTS: 86% of responders (n = 229) were aware of written emergency response plans for their facility. While 31% were aware of the hospital's mental health policies and resources outside the emergency response plan, only 25% knew how to access these resources during and after NHDs. Finally, 10% reported incorporation of mental health resources during institutional practice drills. CONCLUSIONS: Physicians reported knowledge of emergency preparedness policies; however, significant gaps remain in physician knowledge and access to mental health resources NHD settings. As NHDs increase on a global scale, it is critical for health systems to ensure accessible infrastructure to support the mental wellbeing of health professionals.

Patterns in emergency department unscheduled return visits during the COVID-19 pandemic.

INTRODUCTION: Fear surrounding nosocomial infections, expanded telehealth, and decreases in ED (emergency department) utilization altered the way patients sought emergency care during the COVID pandemic. This study aims to evaluate COVID-19's impact on the frequency and characteristics of unscheduled return visits (URVs) to the adult and pediatric ED. METHODS: In this retrospective cohort study, the electronic medical record was used to identify ≤9-day URVs at a tertiary adult and pediatric ED from 4/16/19-2/29/20 (control) and 4/16/20-2/28/21 (COVID). The primary outcome, proportion of total ED visits made up by URVs, and secondary outcomes, patient characteristics (age), illness acuity (emergency severity index (ESI)), disposition, and mortality were compared between the cohorts. Pediatric and adult data were analyzed separately. A sub-analysis was performed to exclude patients with suspected respiratory infections. RESULTS: For adults, n = 4265, there was no significant difference between the proportion of ED census made up by URVs (4.56% (control) vs 4.76% (COVID), p = 0.17), mean patient age (46.33 (control) vs 46.18 (COVID), p = 0.80), ESI acuity (2.95 (control) vs 2.95 (COVID), p = 0.83), disposition (admission 0.32% (control) vs 0.39% (COVID), p = 0.69), and mortality (0.23% (control) and 0.49% (COVID), p = 0.15). When excluding possible respiratory infections comparisons remained insignificant. For pediatrics, n = 1214, there was a significant difference in the proportion of ED census made up by URVs (4.83% (control) to 3.55% (COVID), p < 0.01), age (5.52 (control) vs 6.43 (COVID), p = 0.01), and ESI acuity (3.31 (control) vs 3.17 (COVID), p < 0.01). There was no difference in disposition (admission 0.12% (control) vs 0% (COVID), p = 1). When excluding possible respiratory infections acuity (p = 0.03) remained significant. CONCLUSION: In the adult population, COVID did not significantly alter any of our outcomes. For pediatric patients, a decrease in the proportion of URVs and increase in acuity during COVID suggests that patients may have had other means of accessing care, avoided the ED, received more adequate care at initial presentation, or represented when more acutely ill.

School Nurses on the Front Lines of Health Care: Clinical Presentations Associated With COVID-19 Infection.

Over the past 2 years, COVID-19 has swept through the United States and our world, infecting millions of people. Due to the high transmissibility of this communicable disease, school-age children are at a unique risk because of close contact with others throughout the day. Many children who contract COVID-19 will go on to have asymptomatic or mild noncomplicated symptomatic infections. However, some children will develop severe or persistent symptoms. Given the unique position of school nurses in seeing a large volume of children and adolescents, it is important that they are familiar with the variable presentations and complications of COVID-19. Throughout this article, we discuss three cases of students presenting to the school nurse's office with signs and symptoms associated with COVID-19 infection.

School Nurses on the Front Lines of Healthcare: Infectious Diseases Popularized in the News.

School nurses may deal with students presenting with symptoms associated with infections popularized in the news. Although rare, the implications of missing or misdiagnosing these infections are potentially life-threatening and devastating. We present three students presenting with febrile illnesses associated with neurologic symptoms, a rash, and fatigue, focusing on the initial assessment and management of these students and their associated "hot topic" infection. The authors also discuss two public health organizations, Centers for Disease Control and Prevention (https://www.cdc.gov/) and the World Health Organization (https://www.who.int/), online references for the school nurse to research both emerging and common infectious diseases.

School Nurses on the Front Lines of Healthcare: The Approach to a Student With Anxiety and Posttraumatic Stress Disorder.

Mental illness is common, and its severity ranges from subclinical to severe, where the condition affects daily social and academic functioning. Because of its ubiquity, it is necessary that school nurses have an enhanced understanding of some of the mental health conditions that children and adolescents may be facing. As will be discussed, some mental health concerns present with somatic symptoms that may bring the student into the school nurse's office. If the nurse identifies mental health symptoms, he or she may be able to intervene, provide support, and direct the student for further management if necessary. This article will focus on anxiety in general before focusing on specific anxiety disorders, including posttraumatic stress disorder. We will begin by defining these conditions and then move into discussing potential present-day stressors, such as fear and anxiety associated with the recent coronavirus disease 2019 pandemic, and screening tools before closing with some suggestions for practice and a case wrap-up.

School Nurses on the Front Lines of Healthcare: The Approach to Maintaining Student Health and Wellness During COVID-19 School Closures.

In response to the novel coronavirus disease 2019 (COVID-19) pandemic, most states in the United States enacted statewide school closures, ranging in duration from 1 month to the remainder of the academic year. The extended durations of these closures present unique challenges, as many families rely on the school as a source of physical activity, mental health services, psychosocial support, child care, and food security. While the school doors may be closed, the school nurse can still play a vital role in emergency management. This article discusses challenges and proposes solutions to maintaining student health and wellness during extended school closures due to the COVID-19 pandemic. Furthermore, it is inevitable that until a vaccine for coronavirus is developed and readily available, many schools will continue to see future closures, though likely for shorter periods of time, as they respond to local outbreaks.