Burnout is a major healthcare issue [1] which has intensified with additional stressors arising from the ongoing 2019 Novel Coronavirus (COVID-19) pandemic [2,3]. Emergency Department (ED) healthcare workers (HCWs) have had one of the highest incidences of burnout [4][5][6] even prior to the pandemic. Being at the frontline in direct contact with patients suspected or confirmed to have a COVID-19 infection exacerbates this [7].To evaluate the prevalence of burnout in this population and the preferred methods of coping with the COVID-19 situation, we conducted a cross-sectional study amongst doctors and nurses in our regional health cluster's Emergency Departments (EDs) and Urgent Care Center (UCC). This was performed in end-May, three months into an escalation of hospital workflows in response to the pandemic, at which time Singapore had seen more than 30,000 cases of COVID-19 infections [8]. Approval from the relevant institutional review board was obtained for waiver of consent. Anonymized data was collected via an online questionnaire which covered sociodemographic data, COVID-19 related anxiety and stress as well as coping strategies. These questions were developed based on previous studies and expert opinions on mental health and coping in infectious disease outbreaks [9][10][11]. We evaluated for burnout using the Copenhagen Burnout Inventory (CBI) [12].The primary outcome was the proportion of moderate-to-severe burnout amongst the HCWs, defined by a score of 50 or higher in the personal domain of the CBI. Secondary outcomes assessed included factors associated with moderate-to-severe burnout and preferred methods of coping with the COVID-19 situation.A total of 337 HCWs (210 nurses and 127 doctors) participated in the survey. The overall response rate was 60.2% (69.4% for doctors and 55.7% for nurses). The most common age range was between 21 and 30 years old (46.4%). Majority of respondents were female (67.7%). Most respondents (84.6%) had already been working in the ED or UCC prior to the COVID-19 pandemic while the rest were deployed to augment departmental manpower.Using the CBI, the mean score of personal burnout was 49.2 (SD 18.6). A significant proportion of respondents reported moderate-tosevere personal burnout (49.3%). Nurses had significantly higher CBI scores than doctors, with the mean personal burnout scores for nurses

Major guidelines have advocated early intervention with D2B <60-90 min. 2-4 In the wake of the COVID-19 pandemic, PPCI services have been reorganized in order to meet local or national strategies to cope T he coronavirus disease 2019 (COVID-19) pandemic has strained the global health system in an unprecedented manner. The effect on the delivery of health services is likely to be greater in time-sensitive services such as primary percutaneous coronary intervention (PPCI) for acute ST-segment elevation myocardial infarction (STEMI). Delay in treatment, including time from symptom onset to

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Objective: Terminally ill patients at their end-of-life (EOL) phase attending the emergency department (ED) may have complex and specialized care needs frequently overlooked by ED physicians. To tailor to the needs of this unique group, the ED in a tertiary hospital implemented an EOL pathway since 2014. The objective of our study is to describe the epidemiological characteristics, symptom burden and management of patients using a protocolized management care bundle. Methods: We conducted an observational study on the database of EOL patients over a 28-month period. Patients aged 21 years and above, who attended the ED and were managed according to these guidelines, were included. Clinical data were extracted from the hospital’s electronic medical records system. Results: Two hundred five patients were managed under the EOL pathway, with a slight male predominance (106/205, 51.7%) and a median age of 78 (interquartile range 69-87) years. The majority were chronically frail (42.0%) or diagnosed with cancer or other terminal illnesses (32.7%). The 3 most commonly experienced symptoms were drowsiness (66.3%), dyspnea (61.5%), and fever (29.7%). Through the protocolized management care bundle, 74.1% of patients with dyspnea and/or pain received opiates while 59.5% with copious secretions received hyoscine butylbromide for symptomatic relief. Conclusion: The institution of a protocolized care bundle is feasible and provides ED physicians with a guide in managing EOL patients. Though still suboptimal, considerable advances in EOL care at the ED have been achieved and may be further improved through continual education and enhancements in the care bundle.