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Creation of an acute psychiatric observation improves ED and acute psychiatric service throughput while supporting the efficient allocation of scare inpatient psychiatric beds. This novel approach demonstrates the promise of extending successful observation care models from medical to psychiatric illness with the potential to improve the value of acute psychiatric care while minimizing the harms of ED crowding.

One commonly reported phenomenon in the first months of the Covid-19 era in the United States has been the reduction in emergency department (ED) visits and hospitalizations of patients with heart attacks, strokes and other acute, non-Covid illnesses [1]. Less is known about whether and how the number of patients presenting to EDs for psychiatric problems has changed.Prior to the pandemic, there were reasons to believe that psychiatric ED visits might increase. Many people could experience distress such as anxiety, sadness, grief and anger during this uncertain time [2]. Because of physical distancing measures, normal sources of support might be less directly accessible. People with pre-existing mental illness may be particularly vulnerable to such change. Alterations to outpatient practices may mean that prior mental health treatment could be disrupted. Access to social services such as shelters or soup kitchens might decrease.Connecticut reported its first case of Covid-19 on March 8, 2020. Several local school districts shuttered the following week, and the governor issued an order for the suspension of non-essential business and for residents to stay at home effective March 23. As of the end of April, 27,700 cases and 2257 Covid-associated deaths had been reported in the state [3].Yale-New Haven Hospital (YNHH) is a 1541-bed tertiary care medical center with three local EDs (two in downtown New Haven and one in a nearby suburb), the sixth largest hospital by bed capacity in the country. The psychiatric emergency service (PES) is staffed 24 h per day and treats patients 16 years and older. Each year, the ED has about 200,000 patient visits per year including roughly 9000 PES visits.At YNHH, PES and overall ED volumes for January, February and early March 2020 were similar to prior years (see Table 1). However, starting in the last two weeks of March through the first week in May, PES volume declined about 26%, from an average of 24.2 patients per American Journal of Emergency Medicine xxx (xxxx) xxx YAJEM-159056; No of Pages 2

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Participants were unable to inflate endotracheal tube cuff to safe pressures and were unable to identify endotracheal tube cuffs with excessive intracuff pressure by palpation. Clinicians should consider using devices such as manometers to facilitate safe inflation and accurate measurement of endotracheal tube cuff pressure.

Background-Communication failures contribute to errors in the transfer of patients from the emergency department (ED) to inpatient medicine units. Oral (synchronous) communication has numerous benefits but is costly and time-consuming. Taped (asynchronous) communication may be more reliable and efficient, but lacks interaction. We evaluated a new asynchronous physicianphysician sign-out compared to the traditional synchronous sign-out.

The chemical algorithm of the proposed CBRN-capable mass casualty triage system can be applied rapidly by trained paramedics, but a significant under-triage rate (10.7%) was seen in this pilot test. Further refinement and testing are needed, and effect on outcome must be studied.