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Resident education in emergency medicine (EM) relies upon a variety of teaching platforms and mediums, including real-life clinical scenarios, simulation, academic day (lectures, small group sessions), journal clubs, and teaching learners. However, the coronavirus disease 2019 (COVID-19) pandemic has disrupted teaching and learning, forcing programs to adapt to ensure residents can progress in their training.1 Suddenly, academic days cannot be held in person, emergency department (ED) volumes are dynamically changing, and the role of residents in ED procedures has been questioned. Furthermore, medical student rotations through the ED have been cancelled, decreasing resident exposure to undergraduate teaching. These changes to resident education threaten resident wellness and will have downstream effects on training and personal professional development. In response, programs must develop strategies to ensure that residents continue receiving high-quality training in a safe learning environment. In this review, we will cover recommended strategies put forth by two large EM programs in Ontario (Table 1).

Objective: Prompt detection of infectious disease outbreaks and rapid introduction of mitigation strategies is a primary concern for public health, emergency and security management organizations. Traditional surveillance methods rely on astute clinical detection and reporting of disease or laboratory confirmation. Although effective, these methods are slow, dependent on physician compliance and delay timely, effective intervention. To address these issues, syndromic surveillance programs have been integrated into the health care system at the earliest points of access; in Ontario, these points are primary care providers, emergency departments (ED), and Telehealth Ontario. This study explores the role of Telehealth Ontario, a telephone helpline, as an early warning system for detection of gastrointestinal (GI) illness. Methods: Retrospective time-series analysis of the National Ambulatory Care Reporting System (NACRS) ED discharges and Telehealth Ontario data for GI illness from June 1, 2004 to March 31, 2006. Results: Telehealth Ontario recorded 184,904 calls and the NACRS registered 34,499 ED visits for GI illness. The Spearman rank correlation coefficient was calculated to be 0.90 (p<0.0001). Time-series analysis resulted in significant correlation at lag (weekly) 0 indicating that increases in Telehealth Ontario call volume correlate with increases in NACRS data for GI illness. Conclusion: Telehealth Ontario call volume fluctuation reflects directly on ED GI visit data on a provincial basis. Telehealth Ontario GI call complaints are a timely, novel and representative data stream that shows promise for integration into a real-time syndromic surveillance system for detection of unexpected events. Objectifs : La détection précoce d'épidémies de maladies infectieuses et l'introduction rapide de stratégies d'atténuation représentent une préoccupation de premier plan pour les organismes de santé publique, de secours et de gestion de la sécurité. Les méthodes de surveillance traditionnelles s'appuient sur la détection Clinique et le signalement astucieux de maladies ou sur leur confirmation en laboratoire. Même si ces méthodes sont efficaces, elles sont lentes, dépendent du bon vouloir du médecin et retardent l'intervention efficace et opportune. Pour aborder ces questions, les programmes de surveillance syndromique ont été intégrés aux systèmes de soins de santé dans les premiers points d'accès. En Ontario, ces points sont les fournisseurs de soins primaires, le service des urgences et Télésanté Ontario. Dans cette étude, nous explorons le rôle de Télésanté Ontario, une ligne d'aide téléphonique, comme système d'avertissement précoce pour la détection des maladies gastro-intestinales (GI). Méthodes : Nous avons effectué une analyse rétrospective des séries chronologiques des congés du service des urgences du Système national d'information sur les soins ambulatoires (SNISA) et des données de Télésanté Ontario sur les maladies GI, du 1er juin 2004 au 31 mars 2006. Résultats : Télésanté Ontario a enregistré 184 904 appels et le SNISA a reçu 34 499 visites aux urgences concernant les maladies GI. Nous avons calculé le coefficient de corrélation de rang à 0,90 (p<0,0001). L'analyse de séries chronologiques a donné lieu à une corrélation importante au point 0 (hebdomadaire), indiquant que les augmentations du volume d'appels à Télésanté Ontario sont en corrélation avec celles des données du SNISA concernant les maladies GI. Conclusion : Les fluctuations du volume d'appels à Télésanté Ontario reflètent directement les données sur les visites aux urgences à l'échelon provincial concernant les maladies GI. Les appels concernant les maladies GI effectués auprès de Télésanté Ontario représentent un filon de données représentatif, nouveau et opportun qui laisse entrevoir l'avenir d'un bon oeil en ce qui concerne leur intégration dans un système de surveillance syndromique en temps réel pour la détection d'événements inattendus.

Ischemic cardiovascular disease is the leading cause of death in Canada. In ST elevation myocardial infarction (STEMI), time to reperfusion is a key determinant in reducing morbidity and mortality with percutaneous coronary intervention (PCI) being the preferred reperfusion strategy. Where PCI is available, delays to definitive care include times to electrocardiogram (ECG) diagnosis and cardiovascular laboratory access. In 2004, the Cardiac Care Network of Ontario recommended implementation of an emergency department (ED) protocol to reduce reperfusion time by transporting patients with STEMI directly to the nearest catheterization laboratory. The model was implemented in Frontenac County in April 2005. The objective of this study was to assess the effectiveness of a protocol for rapid access to PCI in reducing door-to-balloon times in STEMI. Two 1-year periods before and after implementation of a rapid access to PCI protocol (ending March 2005 and June 2006, respectively) were studied. Administrative databases were used to identify all subjects with STEMI who were transported by regional emergency medical services (EMS) and received emergent PCI. The primary outcome measure was time from ED arrival to first balloon inflation (door-to-balloon time). Times are presented as medians and interquartile ranges (IQRs). Statistical comparisons were made using the Mann-Whitney U test and presented graphically with Kaplan-Meier curves. Patients transported under the rapid access protocol (n = 39) were compared with historical controls (n = 42). Median door-to-balloon time was reduced from 87 minutes (IQR 67-108) preprotocol to 62 minutes (IQR 40-80) postprotocol (p < 0.001). In our region, implementation of an EMS protocol for rapid access to PCI significantly reduced time to reperfusion for patients with STEMI.

This report describes the occurrence of pneumonitis in a young male immediately after inhalation of aerosolized chemicals subsequent to motor vehicle airbag deployment. The clinical presentation was one of mild shortness of breath associated with bilateral alveolar infiltrates on chest radiology. Not previously described, this diagnosis should be considered in the differential of pulmonary infiltrates in motor vehicle crash patients.

Emergency department (ED) overcrowding in Canada is an ongoing problem resulting in prolonged wait times, service declines, increased patient suffering, and adverse patient outcomes. We explored the relationship between socioeconomic status (SES) and ED use in Canada's universal health care system to improve our understanding of the nature of ED users to both improve health care to the most deprived populations and reduce ED patient input. This retrospective study took information from the National Ambulatory Care Reporting System (NACRS) database for all ED visits in Ontario between April 1, 2003, and March 31, 2010. As there is no direct measure of SES available from ED visit records, a proxy measure of SES was used, namely a deprivation index (DI) developed from material and social factors from the 2006 Canadian census using the patient's residential neighbourhood. DI scores were assigned to ED visit records using Statistics Canada's Postal Code Conversion File, which links postal and census geography. A total of 36,765,189 visits occurred during the study period. A cross-province trend was found wherein the most deprived population used EDs disproportionately more than the least deprived population (relative risk: 1.971 95% confidence interval 1.969-1.973, p < 0.0001). This trend was stable across the entire study period, although the divergence is attenuating. Social determinants of health clearly impact ED use patterns. People of the lowest SES use ED services disproportionately more than other socioeconomic groups. Focused health system planning and policy development directed at optimizing health services for the lowest SES populations are essential to changing ED use patterns and may be one method of decreasing ED overcrowding.

[...]these concepts have been set aside by CAEP.The coordination of patient care across multiple healthcare venues and providers Health care promotion and injury prevention Leadership and administration: leading interdisciplinary patient care teams, medical management, policies & procedures, emergency equipment & design, physician staffing, budgets Medical systems Within the emergency department: including patient triage, throughput and discharge External to the emergency department: including but not limited to pre-hospital transport & care and disaster planning & management Teaching relevant emergency medicine skills, knowledge and attitudes to other physician and non-physician health care providers Generation of emergency medicine knowledge through research and knowledge translation Patient safety and quality improvement related to emergency medicine CAEP Definition of an Emergency Physician An emergency physician is a physician who is engaged in the practice of emergency medicine and demonstrates the specific set of required competencies that define this field of medical practice.The Royal College of Physicians & Surgeons of Canada The College of Family Physicians of Canada (Emergency Physicians with equivalent non-Canadian training and certification are also recognized in Canada eg The American Board of Emergency Medicine) CAEP Statement on the Importance of Emergency Medicine Certification in Canada It is CAEP’s vision, that by 2020 all emergency physicians in Canada will be certified in emergency medicine by a recognized certifying body.* Toward that vision, provincial governments and Faculties of Medicine must urgently allocate resources to increase the numbers of emergency medicine postgraduate positions in recognized training programs so the Colleges are able to address the gap in human resources and training.CAEP recognizes that the Royal College of Physicians and Surgeons of Canada (Royal College) residency program is the single training program in Canada designed to produce designated specialists in emergency medicine.* Specialist designation by the Royal College of Physicians & Surgeons of Canada is only obtainable through successful completion of one of following: a RCPSC-accredited specialty residency training program OR specialty emergency medicine training by a program acceptable to the RCPSC and a period of appropriate emergency medicine practice at a high level as determined by a formalized RCPSC practice assessment and certification process CAEP Board of Directors Jill McEwen, MD, FRCPC, Department of Emergency Medicine, CAEP President & corresponding author, University of British Columbia, Vancouver General Hospital, Vancouver, BC; Stéphane Borreman, MD, CCFP(EM), CAEP AMUQ Representative, Department of Emergency Medicine, McGill University Health Center, Montreal, QC Jaelyn Caudle, MD, FRCPC, Department of Emergency Medicine, Queen’s University, Kingston General Hospital, Kingston, ON* Tom Chan, MD, CCFP(EM), Division of Emergency Medicine, University of Toronto, Toronto, ON Alecs Chochinov, MD, FRCPC, Department of Emergency Medicine, University of Manitoba, Winnipeg Regional Health Authority, Winnipeg, MB Jim Christenson, MD, FRCPC, Department of Emergency Medicine, University of British Columbia, St. Paul’s Hospital, Vancouver, BC; Tom Currie, MD, CCFP(EM), Department of Emergency Medicine, Dalhousie University, Cape Breton Regional Hospital, Sydney, NS* Benjamin Fuller, BSc, MD, MCFP,CCFP(EM), FCFP, CCPE, Division of Emergency Medicine, University of Toronto and Queens University, Lakeridge Health Oshawa, Ontario Michael Howlett, MD, CCFP(EM), Department of Emergency Medicine, Dalhousie University, Saint John Regional Hospital, Saint John, NB Josh Koczerginski, MD, Chair, CAEP Resident Section, Department of Emergency Medicine, University of British Columbia, Vancouver, BC Martin Kuuskne, MD, Past-Chair, CAEP Resident Section, Department of Emergency Medicine, McGill University, Montreal, QC* Rodrick Lim, MD, FRCPC, Chair, CAEP Pediatric Section, Department of Paediatrics/Division of Emergency Medicine, Schulich School of Medicine & Dentistry, Western University, Children's Hospital at London Health Sciences Centre, London, ON Bruce McLeod, MD, FRCPC, CAEP Past-President, Department of Emergency Medicine, Valley Regional Hospital, Kentville, NS Paul Pageau, MD, CCFP(EM), CAEP President-Elect, Department of Emergency Medicine, University of Ottawa, The Ottawa Hospital, Ottawa, ON Chryssi Paraskevopoulos, MD, CCFP(EM), Department of Emergency Medicine, McGill University, St. Mary’s Hospital Centre, Montreal, QC Rebeccah Rosenblum, MD, FRCPC, Department of Emergency Medicine, University of Alberta, Royal Alexandra Hospital, Edmonton, AB Ian Stiell, MD, FRCPC, ABEM, Chair, CAEP Academic Section, Department of Emergency Medicine, University of Ottawa, Ottawa Civic Hospital, Ottawa, ON *Past (2014-15) CAEP BoardREFERENCES 1.

Ischemic cardiovascular disease is the leading cause of death in Canada. In ST elevation myocardial infarction (STEMI), time to reperfusion is a key determinant in reducing morbidity and mortality with percutaneous coronary intervention (PCI) being the preferred reperfusion strategy. Where PCI is available, delays to definitive care include times to electrocardiogram (ECG) diagnosis and cardiovascular laboratory access. In 2004, the Cardiac Care Network of Ontario recommended implementation of an emergency department (ED) protocol to reduce reperfusion time by transporting patients with STEMI directly to the nearest catheterization laboratory. The model was implemented in Frontenac County in April 2005. The objective of this study was to assess the effectiveness of a protocol for rapid access to PCI in reducing door-to-balloon times in STEMI. Two 1-year periods before and after implementation of a rapid access to PCI protocol (ending March 2005 and June 2006, respectively) were studied. Administrative databases were used to identify all subjects with STEMI who were transported by regional emergency medical services (EMS) and received emergent PCI. The primary outcome measure was time from ED arrival to first balloon inflation (door-to-balloon time). Times are presented as medians and interquartile ranges (IQRs). Statistical comparisons were made using the Mann-Whitney U test and presented graphically with Kaplan-Meier curves. Patients transported under the rapid access protocol (n = 39) were compared with historical controls (n = 42). Median door-to-balloon time was reduced from 87 minutes (IQR 67-108) preprotocol to 62 minutes (IQR 40-80) postprotocol (p < 0.001). In our region, implementation of an EMS protocol for rapid access to PCI significantly reduced time to reperfusion for patients with STEMI.