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Background: In March 2020, the world health organization declared COVID-19 a world wide pandemic. Countries introduced public health measures to contain and reduce its spread. The effect of mandated societal lockdown to reduce the transmission of corona virus disease 2019 (COVID-19) on road traffic accidents is not known. For this we performed an in-depth analysis singdata of emergency and trauma centre UPUMS, Saifai. As most of the manpower was involved in managing Covid patients directly or indirectly, it was a challenge to manage these mass casualty patients who require intensive care as well as Medicolegal documentation, record keeping, Consent for life saving procedures in absence of Relatives. Material(s) and Method(s): We reviewed data on total 2876 road traffic accident records in UPUMS, Saifai from January 1, 2020 through September 30, 2020. We treated March 20th as the first day of mandated societal lock down and 1st July as the first day of re-opening. Result(s): We have found that the reis increase in road traffic accidents resulting in serious or fatal injuries during lockdown and post-lockdown period. There was increased Medicolegal burden in spite of the decreased medical resources, manpower as most of manpower and resources were being utilized for covid patients. Conclusion(s): Road traffic accidents are a prominent contributor to hospitalization and may negatively impact the existing hospital resources directed towards COVID-19.Copyright © 2023, World Informations Syndicate. All rights reserved.
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Road accidents have been identified as one of the main causes of death and have a significant effect on public health challenges, economic growth and development. The Iraqi transport infrastructure has suffered from the effects of war, carelessness, and lack of investment. As a result, road traffic accidents have increased, and the current efforts to address road safety are minimal in comparison to the growing level of citizen suffering. The objective of this study was to provincially analyze traffic accidents in Iraq using data from 2010 to 2020 to shed light on the current situation. Three key conclusions were made from the results: first, people aged 35 years and under was the age group recorded in the most traffic accidents;second, Al-Najaf province recorded the highest rate of traffic accidents;and third, COVID-19 lockdown in Iraq caused a 28.5 % decline in traffic accidents while fatality and injury rates fell by 28 % and 18.4 % respectively, when comparing with the data of the same period in 2019.
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Purpose of study COVID-19 has shifted the utilization of health care resources. Gaps remain in our understanding on how COVID-19 affects trends in pediatric trauma, the leading cause of mortality and morbidity during childhood and adolescence. We identified trends in the numbers and types of traumas presenting to a Level 1 Pediatric Trauma Center during the COVID-19 pandemic compared to prior years. Methods used We compared high acuity trauma visits (defined as traumas requiring admission, emergent surgical intervention or resulting in a fatality) presenting between January 1st and August 31st, 2020 to corresponding months in 2017-2019. We also evaluated the changes in mechanisms of injury during this time period. Data were analyzed using longitudinal time series analyses and t-tests. Summary of results Of 480 traumas presenting from January to August 2020, 227 (47.3%, 95%CI 42.7%-51.9%) were high acuity traumas. High acuity traumas declined significantly, as a state of emergency was declared, to a nadir of 16 in April 2020 (compared to the 2017-2019 mean of 38.3, p<0.001). As restrictions were lifted, high acuity traumas increased and surpassed previous years to a peak of 40 visits in August 2020 (2017-2019 mean 35.7, p<0.001). High acuity traumas as a proportion of total Emergency Department visits were higher from March to August 2020 compared to prior years (figure 1). There were more visits for high acuity assaults and child abuse but fewer for falls, drownings, and motor vehicle accidents from March to August 2020 compared to prior years, while visits for animal attacks remained stable Conclusions This analysis provides insight into how the COVID-19 pandemic has affected high acuity trauma in an inner-city pediatric population. Findings may be used to guide public health measures on safety and injury prevention as the pandemic continues and further restrictions are debated. (Figure Presented).
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Introducction:-Covid 19 started out as a fast-spreading viral disease, in Wuhan in 2019. Soon, it spread across the globe and WHO declared it a Pandemic. Various countries took various measures to control its spread and transmission. By the time, countries recovered from it, a new wave would come along with different expressions and pathophysiology. When Covid 19 began, various health agencies in India started making protocols and standard ooperating procedures including conducting autopsies in COVID-19 infected bodies. Aims and Objectives:-Aim of our study is to analyze cause of death among all covid 19 positive cases brought for medicolegal autopsies from the time of lockdown for a period of one year. Our aim is to see if there were any factors which could have prevented these deaths. Material(s) and Method(s): A retrospective study of 1 year conducted from 25th March 2020 to 24th March 2021, (1st wave of Covid 19) was done in a tertiary care hospital in Bangalore. (Bowring and Lady Curzon hospital) Results: 39 Covid-19-positive unnatural deaths were handled with the youngest being 18 years old and the oldest beings 83. The majority turned out to be suicides (51.28%), then RTAs, falls, and natural death. The commonest method of suicide was hanging (35.89%), followed by poison consumption, and falling from a height. Conclusion(s): COVID-19 is a viral infection with variable clinical signs and variable fatality rates. There is much to learn about it. However, suicides in COVID-19 cases might not have ended death if some care, timely diagnosis, and treatment were provided.Copyright © 2023, Institute of Medico-legal Publication. All rights reserved.
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In recent years, diagnostics in the field of medicine has developed at an extremely rapid pace, thanks to the use and improvement of new medical devices and devices. The problem of timely and adequate diagnosis and treatment of the syndrome of obstructive sleep apnea (OSA) and snoring is particularly relevant world-wide. The disease has been proven to worsen the patients' quality of life, and may even threaten it. Obstructive sleep apnea and snoring syndrome (OSAS) is a widespread disease of social importance in which there is a reduction or cessation of airf low through the nose/mouth during sleep due to upper airway collapse. Obstructive sleep apnea affects the cardiovascular, endocrine, neurocognitive and other systems of the body. There are symptoms of loud snoring, choking, hypoxemia, and micro-awakenings, leading to sleep frag-mentation, daytime fatigue, and sleepiness. The latter greatly worsens the quality of life of patients. There are real risks to the life and health of the patient and others, given the possibility of falling asleep at the wheel in drivers with sleep apnea and participation in traffic accidents. To diagnose the syndrome, a poly-somnographic study is performed, which is still the gold standard. For a better diagnosis, it is recommend-ed to combine it with rhinomanometry. Treatment of OSA includes control of risk factors and removal of obstructive factors that make breathing difficult. Severe OSA syndrome is treated with continuous positive pressure ventilation (CPAP) during sleep, possibly in combination with intraoral devices. Rhinomanome-try can also be used to monitor the effectiveness of CPAP therapy in severe forms of the syndrome by deter-mining tissue resistance. The impact on patients with a milder form of OSA treated with intraoral devices is also monitored. The method can also be used in patients with allergic rhinitis, sinusitis of rhinogenic and other origin, and patients with orthodontic deformities. The correct choice of intraoral appliances for conservative treatment of OSA and timely diagnosis are key to successful treatment.Copyright © 2022, Bulgarian-American Center. All rights reserved.
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Background: Spondyloptosis is caused by high force trauma. The vast majority of cases occur in the sagittal plane and at transition points where ridged sections meet more flexible regions. Lateral thoracic spondyloptosis is extremely rare and there is no current consensus on the optimal treatment plan. Case Description: Here we present a case of a previously physically healthy 24-year-old polytrauma patient after he was struck as a pedestrian by a motor vehicle. Of note the patient was found to have lateral spondyloptosis between T9-10 with complete spinal cord transection. The patient also sustained multi-ligamentous left knee injury, pelvic fractures, open comminuted left tibia and fibular fracture, lacerated liver, bilateral renal lacerations, ischemic bowel, and an aortic arch pseudoaneurysm. Conclusion(s): Lateral thoracic spondyloptosis is a devastating injury with an extreme rate of persistent neurologic deficits. There is no unanimously accepted treatment because of the rarity if the injury and the poor outcomes that patients face. Additionally, patients who experience high level trauma often develop severe psychiatric illness, and the importance of identifying risk factors and implementing care early may improve patient outcomes.Copyright © AME Medical Journal.
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Many people die on the streets every year. The value is declining year by year, but there are still plenty of them. Although the COVID-19 pandemic reduced the number of traffic accidents, it is still very high. For this reason, in order to do everything possible to minimize the number of road accidents, it is important to know the federal states with the most road accidents and what the accident forecast is for the next few years. The purpose of this article is to predict the number of road accidents by state in Poland. The survey was divided into two parts. The first is an analysis of the annual data of police statistics on the number of road accidents in Poland for the period 2000–2021, upon the prediction of the number of traffic accidents from 2022 to 2031 was decided. The second part of the study looked at monthly data from 2000 to 2021. Again, the forecasts analyzed were determined for the period from January 2022 to December 2023. The results of this study indicate that a decrease in the number of accidents is also expected in the coming years, which becomes especially clear when analyzing the annual data. It is worth noting that the prevailing COVID-19 pandemic has distorted the results obtained. The study was performed in MS Excel using the selected propensity model. © 2023 by the author.
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PURPOSE OF THE STUDY The paper aims to evaluate the effect of COVID-19 pandemic on a change in the number of major trauma cases, their mechanism and length of hospital stay as seen by a Level I Trauma Centre. MATERIAL AND METHODS The retrospective study included a total of 755 major trauma patients (ISS >= 16) treated at our Level I Trauma Centre in the period 2018-2019 ("pre-COVID-19 time") and 2020-2021 ("COVID-19 time"). The effect of COVID-19 infection on the change in the number and nature of major trauma, mechanism of injury, length of treatment during prehospital care, length of hospital stay, and mortality. RESULTS Of the total number of 755 patients with major trauma, in the "pre-COVID-19 time" 399 patients were treated, while in the "COVID-19 time" it was 356 patients (p = 0.10). The mechanism of major trauma did not change, road traffic accidents prevailed (61% vs. 56%, p = 0.25), the proportion of injuries due to falls from height increased (25% vs. 32.5%, p = 0.08), a significant decrease was observed in the category of severe skiing injuries (7 vs. 2, p = 0.003). The severity of injuries evaluated by Injury Severity Score remained unchanged (25 vs. 25, p = 0.08), but an increased number of patients with trau-matic brain injury (TBI) marked by the Abbreviate Injury Score (AIS) >= 4 was observed (38 vs. 56, p = 0.03). The total length of a hospital stay shortened (18 vs. 15 days, p = 0.04), but the mortality rate spiked (52 vs. 73 patients, p = 0.08). DISCUSSION In the "COVID-19 time", the total number of major trauma cases dropped just like in the other European countries. Despite restrictive measures imposing mobility restrictions, no change was reported in the mechanism of injury, with traffic accidents still prevalent, except for skiing injuries. Unlike the US, we did not see an increase in penetrating injuries due to interpersonal violence or suicidal behaviour. However, there was an increase in the percentage of patients with an isolated TBI as a result of a fall from height. An increase in mortality was reported due to an increase in severe TBI. The length of hospital stay was reduced as a result of efforts to maintain hospital bed availability. CONCLUSIONS During the COVID-19 pandemic, compared to the two years immediately preceding, no significant decrease in the number of major trauma cases was reported, despite the introduction of restrictive measures. The proportion of road traffic injuries remained the same, whereas the number of falls from height slightly increased, which consequently led to an increase in the number of severe TBI. The number of penetrating injuries due to acts of violence did not increase, but due to the lockdown there was a significant decrease in severe skiing-related injuries. The anti-epidemic measures in place did not prolong the pre-hospital care for severely injured patients.Copyright © 2022, Galen s.r.o.. All rights reserved.
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Nosocomial myiasis is a rare event that has a higher incidence in the hospitals of poor and developing countries. The presence of nosocomial myiasis reflects the need for improved medical facilities and increased awareness among healthcare personnel. Severely ill patients are more susceptible, such as those with impaired consciousness, paralysis, and underlying diseases. The two cases here in described represent the first report of nosocomial myiasis in the Kurdistan Province, in Western Iran and one of them is the first report of myiasis involving a COVID-19-infected patient. The causal agent was Lucilia sericata. The taxonomical identification of the larvae of the second and third instar was based on the morphology of the cephaloskeleton, anterior spiracles, and peri-treme plaques.Copyright © 2023 Zobairy et al.
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The COVID pandemic provides a natural experiment examining how a 50-60% reduction in pedestrian activity might lead to a reduction in pedestrian deaths. We assessed whether the reduction in pedestrian deaths was proportional to a one-to-one matching presumed in statistics correlating mobility with fatality. The primary analysis examined New York (largest city in US), and the validation analysis examined Toronto (largest city in Canada). We identified pedestrian activity in each location from the Apple Mobility database, normalized to the baseline in January 2020. We calculated monthly pedestrian deaths from the Vision Zero database in each city with baseline data from 3 prior years. We found a large initial reduction in pedestrian deaths during the lockdown in New York that was transient and not statistically significant during the summer and autumn despite sustained reductions in pedestrian activity. Similarly, we found a large initial reduction in pedestrian deaths during the lockdown in Toronto that was transient and not sustained. Together, these data suggest the substantial reductions in pedestrian activity during the COVID pandemic have no simple correlation with pedestrian fatality counts in the same locations. An awareness of this finding emphasizes the role of unmeasured modifiable individual factors beyond pedestrian infrastructure or other structural contributors.
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Disaster means any earthquake, Volcano Tsunami, flood, drought, snowfall, snow rock fall, landfall and other natural things happen, will affect the daily people life. There are two kind of disasters i.e natural and manmade or artificial. Tsunami, Volcano, earthquake, flood etc. are called natural disaster and the road accidents and accidents in the factories are examples for Artificial Disasters. Any disaster that will affect the whole people of a country, is called a national disaster Covid-19 Pandemic, which spread all over the world including our country is a national disaster. Disaster management is how we prepare for and respond to and learn from the effects of disaster whether manmade or natural. The Government of India and Tamil Nadu Government will create a separate Commission for the disaster management and rescue operations. To the better functions of the Indian disaster management, the people have to give full Corporation then only their management and rescue and Rehabilitation system will function effectively and the benefit will be fruitful, sometimes the government will give instructions such as announcements must be owed by the people properly without fear. Government take some initiatives and the people should be more responsive and cooperative. Copyright © 2022, Anka Publishers. All rights reserved.
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Aim: The nationwide impact of the coronavirus disease (COVID-19) pandemic on major trauma in Japan is unknown. The nationwide registry-based data of the Japanese Trauma Data Bank were analyzed to elucidate the impact of COVID-19 on the epidemiology, treatment, and outcomes of major trauma patients. Methods: Among patients transported directly from the injury site by ambulance with an Injury Severity Score of ≥16, we compared patients managed from April to December in 2019 to those managed from April to December in 2020. Results: In total, 9792 patients were included in this study (2019, n = 5194; 2020, n = 4598). There were no significant differences in age or sex, but there were significant differences between 2019 and 2020 in the rates of "self-injury (suicide)", "motor vehicle accident", "fall from height", "fall down", and "fall to the ground", which are factors associated with patient age. Injury severity in 2019 and 2020 did not differ to a statistically significant extent, but the rate of major spinal injury increased. The time of prehospital care significantly increased in 2020 compared to 2019. There was no noticeable change in hospital treatment or in-hospital mortality between 2019 and 2020. Conclusion: This study suggests that the COVID-19 pandemic might have altered the injuries of major trauma; however, medical services for major trauma were well supplied in Japan in 2020.
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Modeling traffic accident frequency is an important issue to better understand the accident trends and the effectiveness of current traffic policies and practices in different countries. The main objective of this study is to model traffic road accidents, fatalities, and injuries in Jordan, using different modeling techniques including regression, Artificial Neural Network (ANN), and Autoregressive Integrated Moving Average (ARIMA) models, and to evaluate the impact of Covid-19 pandemic on traffic accident statistics for the year of 2020. To accomplish these objectives, traffic accidents, registered vehicles (REGV), population (POP), and economic gross domestic product (GDP) data from 1995 through 2020 were obtained from related sources in Jordan. Results of the analysis revealed that accidents, fatalities, and injuries have an increasing trend in Jordan. Also, it was found that the developed ANN models were more accurate for accidents, injuries, and fatalities prediction than ARIMA, which was also better than regression which comes in the last place in terms of its prediction power. Finally, it was concluded that strategies are undertaken by the government of Jordan to combat Covid-19;including complete and partial banning on travel, had resulted in a considerable reduction of accidents, injuries, and fatalities by about 35, 37, and 50%, respectively.
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The increasing number of food delivery riders (p-Hailing) in Malaysia has been recorded since COVID-19 took place. P-hailing riders are usually exposed to long hours in traffic and are more prone to get involved in traffic accidents. This matter has been one of the pressing problems in the transportation industry. This study focused on assessing the contributing factors of traffic accidents involving p-Hailing riders and determining the perception of p-Hailing riders towards the delivery time frame with regards to traffic accident involvement. A qualitative approach was used, and face-To-face/online interviews were conducted among p-hailing riders in Shah Alam, Selangor. Thematic and descriptive analyses were adopted, and it was found that several factors such as red light running, speeding and slippery roads were the factors of traffic accidents among p-Hailing riders. Delivery time frame did not have much impact on rider's accident cases;instead, it was the behavior of the rider itself. © 2022 IEEE.
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The COVID-19 pandemic significantly affected the performance of the transport sector and its overall intensity. Reducing mobility has a major impact on road traffic accidents. The aim of this study is to forecast the number of road traffic accidents in Poland and Slovakia and to assess how the COVID-19 pandemic affected its trend. For this purpose, data for Poland and Slovakia in the selected relevant period were analyzed. Based on actual data from the past, a forecast was made for the future considering two scenarios - one where there is no effect of pandemic, and another with effect of pandemic. Forecasting the number of accidents in Poland was carried out using selected time series models related to linear trend (Holt and Winters method) and the exponential model. In the case of Slovakia, the model without trend and the exponential model were used to forecast the number of traffic accidents. The results of the research show that the pandemic caused a decrease in the number of traffic accidents in Poland by 31% and in Slovakia by 33%. This is a significant decline, but it is linearly dependent on restrictive measures that affect the mobility of the population. A similar trend can therefore be expected on a European scale.
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SESSION TITLE: Systemic Diseases with Deceptive Pulmonary Manifestations SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/18/2022 12:25 pm - 01:25 pm INTRODUCTION: Pulmonary cavitary lesions can have varying etiologies. Among these, Lemierre syndrome is an uncommon disease which usually presents with symptoms of upper respiratory tract infection with unilateral neck pain, tenderness or swelling. In recent years, antibiotic stewardship for upper respiratory illnesses has led to its delayed diagnosis resulting in possible increased morbidity and mortality. There have been few reported cases of pulmonary cavitary lesions as the initial presentation of Lemierre syndrome. Our patient presented with incidental bilateral pulmonary cavitary lesions, which led to a diagnosis of Lemierre syndrome. CASE PRESENTATION: A 30-year-old gentleman with no significant past medical history visited urgent care for reproducible chest pain following motor vehicle accident. Chest x ray obtained for suspected rib fracture showed bilateral patchy and rounded opacities, confirmed by CT as bilateral cavitary nodules and consolidation. He was referred to our hospital for further care. Two weeks prior, following administration of COVID booster vaccine, he had developed fever, sore throat, tender lump behind left ear, left jaw and anterior left neck. Most symptoms self resolved in 3-5 days except persistent fever. On arrival, patient was febrile to 102F and hemodynamically stable. Physical examination revealed dry mucous membranes and erythematous pharynx. Labs were significant for leukocytosis of 24.5uL with bandemia and elevated inflammatory markers. Three sets of blood cultures were drawn and empirically started on vancomycin and piperacillin/tazobactam. Echocardiogram ruled out heart valve vegetations. CT angiography of neck showed intraluminal thrombi in left internal jugular vein. Blood cultures finalized to Fusobacterium nucleatum and antibiotics were tapered to metronidazole. Due to persistent fever, anticoagulation was initiated with apixaban 5mg twice daily. Pan CT showed improvement in size of many pulmonary septic emboli. After 48 hours of patient being afebrile, he was discharged on antibiotics and apixaban for at least 4 weeks until surveillance CT angiography showed non progression of thrombus. DISCUSSION: Lemierre syndrome is septic thrombophlebitis of internal jugular vein which presents within 1-3 weeks following upper respiratory tract infections with multi-system complications. Management involves prolonged antibiotic course with use of anticoagulation and vein stripping still being debated. Our patient came to the hospital with an incidental finding of bilateral cavitary pulmonary lesions which went on to be diagnosed as Lemierre syndrome from positive blood cultures and CT angiography findings. CONCLUSIONS: Lemierre syndrome is an uncommon disease with mortality up to 18%. A call out to health care providers to keep a low threshold for its diagnosis in patients with initial presentation of bilateral pulmonary cavitary lesions, warranting prompt management. Reference #1: Sinave CP, Hardy GJ, Fardy PW. The Lemierre syndrome: suppurative thrombophlebitis of the internal jugular vein secondary to oropharyngeal infection. Medicine (Baltimore). 1989 Mar;68(2):85-94. PMID: 2646510. Reference #2: Golpe R, Marín B, Alonso M. Lemierre's syndrome (necrobacillosis). Postgrad Med J. 1999 Mar;75(881):141-4. doi: 10.1136/pgmj.75.881.141. PMID: 10448489;PMCID: PMC1741175. Reference #3: Lee WS, Jean SS, Chen FL, Hsieh SM, Hsueh PR. Lemierre's syndrome: A forgotten and re-emerging infection. J Microbiol Immunol Infect. 2020 Aug;53(4):513-517. doi: 10.1016/j.jmii.2020.03.027. Epub 2020 Apr 4. PMID: 32303484. DISCLOSURES: No relevant relationships by Sumukh Arun Kumar No relevant relationships by Megna Machado No relevant relationships by Sushmita Prabhu No relevant relationships by PAWINA SUBEDI No relevant relationships by Mithil Gowda Suresh No relevant relationships by Bradley Switzer
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To understand the current emergency care crisis and the solutions that can be brought to it, it is necessary to analyze the origins of emergency medicine. Its pre-hospital dimension, which is sometimes criticized and decried, comes directly from the response to major health crises. Its regulatory recognition took time and was the subject of many discussions before resulting in a law in 1986. Bringing together the pre-hospital and hospital components of Emergency Medicine has led to the creation of a new medical specialty. Recent events, including the COVID crisis, have shown the adaptability and scalability of this system and its relevance. The current emergency crisis is part of a larger phenomenon affecting the entire hospital. Many solutions exist to optimize both upstream, downstream patients flow and the organization of the Emergency Room (ER). But, beyond these considerations, it is within the framework of an overhaul of the healthcare system that a new contract must be defined bringing together professionals and the public, around the demand and not only the existing offer of healthcare. It is the best guarantee of the relevant use of emergency medicine resources, both hospital and pre-hospital.
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INTRODUCTION: The popularity of cycling in the United Kingdom is increasing, with a further rise likely due to recent government cycling promotion schemes. This study aims to characterise fractures sustained due to cycling-related collisions in patients presenting to a Major Trauma Centre, in the region with the highest cycling rates in the United Kingdom. METHODS: A retrospective analysis of cycling injuries presenting to our centre between January 2012 and December 2020 was performed using a prospectively collected electronic database. Comparison of fracture characteristics was made according to patient age and mechanism of injury (collision with a motorised vehicle versus collision with a non-motorised object.). RESULTS: Of the 737 patients who suffered a cycling-related injury, 292 (39.6%) suffered at least 1 fracture to the appendicular skeleton. Overall, fractures were most commonly seen in those over 50 years of age. Upper limb fractures were more common than lower limb fractures. Fractures sustained during motorised injuries were more likely to require surgical intervention than those sustained during non-motorised collisions. CONCLUSION: This study provides valuable information regarding the nature, epidemiology and treatment of fractures sustained following cycling-related accidents, adding to the paucity of similar literature in the field. Given the likely increase in future cycling uptake, our results are important to clinicians treating patients with cycling-related injuries and policymakers designing safety interventions.
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Fractures, Bone , Orthopedics , Accidents, Traffic , Fractures, Bone/epidemiology , Fractures, Bone/etiology , Fractures, Bone/surgery , Humans , Injury Severity Score , Middle Aged , Retrospective Studies , Trauma CentersABSTRACT
Résumé Pour comprendre la crise actuelle des urgences et les solutions que l’on peut y apporter, il est nécessaire de d’analyser les origines de la médecine urgence. Sa dimension pré hospitalière qui est parfois critiquée et décriée est directement issue de la réponse à des crises sanitaires majeures. Sa reconnaissance réglementaire a pris du temps et a fait l’objet de nombreuses discussions avant d’aboutir en 1986 à une loi. Le rapprochement de la composante pré hospitalière et hospitalière de la Médecine d’Urgence a permis la création d’une nouvelle spécialité médicale. Des événements récents, notamment la crise COVID, ont montré l’adaptabilité et l’évolutivité de ce système et sa pertinence. La crise actuelle des urgences fait partie d’un phénomène plus global qui touche tout l’hôpital. De nombreuses solutions existent optimiser aussi bien l’amont, l’aval et l’organisation du service d’accueil des urgences (SAU). Mais, au-delà de ces considérations c’est dans le cadre d’une refonte du système de soins qu’il faut définir un nouveau contrat rassemblant les professionnels et le public, autour de la demande et pas seulement l’offre existante de soins. C’est le meilleur garant d’une utilisation pertinente des ressources de médecine d’urgence aussi bien hospitalières que pré hospitalières. Summary To understand the current emergency care crisis and the solutions that can be brought to it, it is necessary to analyze the origins of emergency medicine. Its pre-hospital dimension, which is sometimes criticized and decried, comes directly from the response to major health crises. Its regulatory recognition took time and was the subject of many discussions before resulting in a law in 1986. Bringing together the pre-hospital and hospital components of Emergency Medicine has led to the creation of a new medical specialty. Recent events, including the COVID crisis, have shown the adaptability and scalability of this system and its relevance. The current emergency crisis is part of a larger phenomenon affecting the entire hospital. Many solutions exist to optimize both upstream, downstream patients flow and the organization of the Emergency Room (ER). But, beyond these considerations, it is within the framework of an overhaul of the healthcare system that a new contract must be defined bringing together professionals and the public, around the demand and not only the existing offer of healthcare. It is the best guarantee of the relevant use of emergency medicine resources, both hospital and pre-hospital.