Background: The COVID-19 disease outbreak that first surfaced in Wuhan, China, in December 2019, has taken the world by storm and ravaged almost every country in the world. Emergency departments (ED) in hospitals are on the frontlines, serving an essential function in identifying these patients, isolating them early whilst providing urgent medical care. This outbreak has reinforced the role of Emergency Medicine in public health. This paper documents the challenges faced and measures taken by a tertiary hospital's ED in Singapore, in response to the outbreak. Main body: The ED detected the first case of COVID-19 in Singapore on 22 January 2020 in a Chinese tourist and also the first case of locally transmitted COVID-19 on 3 February 2020. The patient journeys through the patient reception area in the ED and undergoes fever screening before being shunted to isolation areas within the ED. Management and disposition of suspect COVID-19 patients are guided by a close-knit collaboration between ED and department of infectious diseases. With increasing number of patients, backup plans for expansion of space and staff augmentation have been enacted. Staff safety is also of utmost importance, with provision and guidelines for personal protective equipment and team segregation to ensure no cross-contamination across staff. These have been made possible with an early setup of an operational command and control structure within the ED, managing manpower, logistics, operations, communication and information management and liaison with other clinical departments. Conclusion: With the large numbers of undifferentiated patients managed by the ED to date, more than 820 patients with COVID-19 have been identified in the hospital. Not a single member of the staff of the SGH Emergency Department has come down with the illness. The various measures undertaken by the department have helped to ensure good staff morale and strict adherence to safety procedures. We share the lessons learnt so that others who manage EDs around the world can benefit from our experience.

Singapore Med J 2020; 61(2): 92-95 https://doi.org/10.11622/smedj.2019083 O r i g i n a l A r t i c l e METHODS This study was conducted at the ED of Singapore General Hospital, which sees about 135,000 patients a year. A retrospective review of case records was performed for all injuries sustained by e-scooter users who presented to the ED from 2015 to 2016. Parameters collected include demographics, mode of arrival to the ED, triage category, mechanism of injury, injuries sustained, investigations performed and the clinical course of the patient within the ED and hospital. The study was INTRODUCTION The electric scooter has been gaining popularity locally as a commute mode. We aimed to understand the current landscape of electric scooter-related injuries in Singapore. METHODSA retrospective review was performed of the medical records of patients seen from 2015 to 2016 at an emergency department (ED) in Singapore. Patient demographics, circumstances of the accident, injuries sustained and clinical progress were analysed.RESULTS There were 36 cases, all of whom were electric scooter users. The median age was 34 (range 17-70) years and 66.7% were male. There was a 2.3-fold increase in the number of cases from 2015 to 2016. In 11 (30.6%) of cases, another road user was implicated. Two cases involved the use of protective equipment. 14 (38.9%) cases were conveyed by Emergency Medical Services. In the ED, 4 (11.1%), 17 (47.2%) and 15 (41.7%) cases were triaged as P1 (emergent), P2 (urgent) and P3 (ambulatory), respectively. Investigations were performed in the ED for 31 (86.1%) cases. External injuries were most common (72.2%), followed by extremity injuries (33.3%), with median Abbreviated Injury Scale scores of 1 and 2, respectively. Overall, the median Injury Severity Score was 1. Nine patients were admitted to the hospital with three requiring surgery. The median length of stay was 2 (range 1-6) days.CONCLUSION The incidence of electric scooter-related injuries appears to be on the rise and may potentially incur significant morbidity and healthcare costs. Further efforts at safety education and enforcement should be made to prevent accidents and minimise the impact of these injuries.

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Introduction: Injury is a significant cause of mortality and morbidity. We aimed to investigate which areas in Singapore have a significantly higher incidence of road traffic accidents (RTA) resulting in severe injuries (Tier 1), which is defined as an Injury Severity Score (ISS) greater than 15, and to develop a spatiotemporal model. Methods:Data was obtained from the National Trauma Registry. The RTA locations were geomapped onto the Singapore map, and spatial statistical techniques were used to identify hotspots with the Getis-Ord-Gi* algorithm.Results: From 1 January 2013 till 31 December 2014, there were 35,673 people who were injured as a result of RTAs and 976 Tier 1 RTA victims. A total of 920 people were included in the geospatial analysis. Another 56 were involved in RTAs that did not occur within Singapore or had missing location data and thus were not included. 745 (81.0%) were discharged alive, whereas 175 (19.0%) did not survive to discharge (median ISS 38.00, interquartile range 30.00-48.00). Most of the Tier 1 RTA victims were motorcycle riders (50.1%, n = 461), pedestrians (21.85%, n = 201) and cyclists (9.9%, n = 91). The majority were male and aged 20-40 years, and there was a peak occurrence at 0600-0759 hours. Nine hotspots were identified (p < 0.01). Conclusion:Information from studying hotspots of RTAs, especially those resulting in severe injuries, can be used by multiple agencies to direct resources efficiently.

Background: Patients with traumatic injuries presenting to the emergency department (ED) may be referred to another hospital for further management. Unnecessary referrals can inflate health-care costs and workload, as well as reduce provider and patient satisfaction. Objectives: In this study, we determined the proportion of unnecessary trauma referrals and described the characteristics of this patient population. Methods: A retrospective chart review was carried out between 1 January and 31 December 2016. Data regarding demographics, diagnosis and clinical course at the ED were collected in standardised forms. A referral was defined as unnecessary if the patient was discharged from the ED without a therapeutic procedure performed. Results: There were 121 trauma referrals. The mean age was 39.0±18.3 years old, and 94 (77.7%) patients were male. Seventy-eight (64.5%) of the referrals were from EDs in the same health-care cluster. Overall, 15 (12.3%) referrals were unnecessary, and of these, nine patients had sustained burns or were suffering from smoke inhalation. The length of stay of these unnecessary referrals was 197.0±96.2 minutes. Referring ED outside the health-care cluster was significantly associated with unnecessary referrals (odds ratio=4.42, 95% confidence interval 1.40–13.97, p=0.007). Conclusion: More than 1 in 10 trauma referrals were unnecessary. Further collaborative prospective studies with other EDs are needed to elucidate the underlying reasons for such unnecessary referrals so that targeted solutions can be implemented to reduce them in the future.