Assessment of Emergency Department Staff Awareness of Policy and Expert Opinion Protocol Regarding Active Shooter Events.

OBJECTIVE: Active shooter incidents (ASI) have continued to increase over the years, with the majority of attacks occurring in the workplace. Workplace violence in the hospital setting is a growing concern in the emergency department (ED). While ASI are inherently unpredictable by nature, it is prudent to be prepared for these scenarios in the hospital to prevent fatalities. The goal of this study is to access the level of familiarity of emergency department staff with ASI hospital policy and response protocol. METHODS: A survey of ED employees was distributed using the Qualtrics® platform via an electronic link. The study was approved by the University of Central Florida College of Medicine's IRB. RESULTS: Only 10% had participated in an ASI drill in the past year. Personnel who answered "no" to the question, To your knowledge, is there a hospital-based emergency action plan in the event of ASI?, were significantly more likely to feel unprepared for an ASI (P < 0.0001). Those who did not receive training for a hospital-based emergency action plan were similarly less likely to feel prepared (P = 0.0002). CONCLUSION: Most ED providers in the survey reported feeling unprepared to handle an ASI in the emergency department. This study underscores the need to implement regular training on ASIs for ED staff.

Physician-Perceived Barriers to Treating Opioid Use Disorder in the Emergency Department.

Objective We aimed to assess physicians' perceptions of barriers to starting medication-assisted treatment (MAT) in the Emergency Department (ED), views of the utility of MAT, and abilities to link patients with opioid use disorder (OUD) to MAT programs in their respective communities. Methods This was a cross-sectional survey study of American emergency medicine (EM) physicians with a self-administered online survey via SurveyMonkey (Survey Monkey, San Mateo, California). The survey was emailed to the Council of Residency Directors in Emergency Medicine (CORD) listserv and HCA Healthcare affiliated EM residency programs' listservs. Attendings and residents of all post-graduate years participated. Questions assessed perceptions of barriers to starting OUD patients on MAT, knowledge of the X-waiver, and knowledge of MAT details. Statistics were performed with JMP software (SAS Institute Inc., Cary, NC) using the two-tailed Z-test for proportions. Results There were 98 responses, with 33% female, 55% resident physicians, and an overall 17% response rate. Residents were more eager to start OUD patients on MAT (71% vs 52%, p=0.04) than attendings but were less familiar with the X-waiver (38% vs 73%, p=0.001) or where community outpatient MAT facilities were (21% vs 43%, p=0.02). Conclusion Barriers in the ED were identified as a shortage of qualified prescribers, the lengthy X-waiver process, and the poor availability of outpatient MAT resources. EM residents showed more willingness to prescribe MAT but lacked a core understanding of the process. This shows an area of improvement for residency training as well as advocacy among attendings.

Testicular compartment syndrome: An unexpected diagnosis in a case of testicular pain.

This case discusses the presentation of a surprising diagnosis of testicular compartment syndrome in a patient with severe testicular pain and swelling in the Emergency Department.

Seymour Fracture in a Pediatric Patient: A Case Report.

In this report, the authors present the case of a child who sustained a specific type of mallet finger injury known as a Seymour fracture. This is an important injury to recognize in the emergency department as it is associated with significant morbidity if not treated appropriately. This is especially of concern in children, where the tissue can get trapped in the growth plate. Children also face a high risk of deformity due to growth arrest. Management includes thorough washout, reduction of displacement, and antibiotics and tetanus prophylaxis if there is an open fracture.

Hypercoagulable State in COVID-19: A Case Series of Three Patients.

The novel coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that originated in China in late 2019, has caused significant morbidity and mortality worldwide. Although fever, cough, and shortness of breath have been recognized as hallmark symptoms, other lesser known complications continue to be described. We report a series of three patients who presented to the emergency department, who tested positive for COVID-19, and were found to have or subsequently developed thromboembolic complications.

A Case of Disseminated Zoster in an Immunocompetent Patient.

The incidence of herpes zoster, more commonly known as shingles, is approximately 1.2 million individuals per year, which has been increasing worldwide. While the most common presentation of zoster is a rash and acute neuritis (the pain associated with the rash) within one or more contiguous dermatomes, other more serious manifestations such as herpes zoster ophthalmicus, acute retinal necrosis, Ramsay Hunt syndrome (herpes zoster oticus), aseptic meningitis, pneumonitis, bacterial superinfection and disseminated zoster ought to be considered by the clinician. This case report serves as a reminder for the emergency physician to bear these very serious complications in mind during the evaluation of a patient with suspected herpes zoster infection.