Aim The COVID-19 pandemic has significantly impacted Emergency Medical Services (EMS) operations throughout the country. Some studies described variation in total volume of out-of-hospital cardiac arrests (OHCA) during the pandemic. We aimed to describe the changes in volume and characteristics of OHCA patients and resuscitations in one urban EMS system. Methods We performed a retrospective cohort analysis of all recorded atraumatic OHCA in Marion County, Indiana, from January 1, 2019 to June 30, 2019 and from January 1, 2020 to June 30, 2020. We described patient, arrest, EMS response, and survival characteristics. We performed paired and unpaired t -tests to evaluate the changes in those characteristics during COVID-19 as compared to the prior year. Data were matched by month to control for seasonal variation. Results The total number of arrests increased from 884 in 2019 to 1034 in 2020 ( p = 0.016). Comparing 2019 to 2020, there was little difference in age [median 62 (IQR 59–73) and 60 (IQR 47–72), p = 0.086], gender (38.5% and 39.8% female, p = 0.7466, witness to arrest (44.3% and 39.6%, p = 0.092), bystander AED use (10.1% and 11.4% p = 0.379), bystander CPR (48.7% and 51.4%, p = 0.242). Patients with a shockable initial rhythm (19.2% and 15.4%, p = 0.044) both decreased in 2020, and response time increased by 18 s [6.0 min (IQR 4.5–7.7) and 6.3 min (IQR 4.7–8.0), p = 0.008]. 47.7% and 54.8% ( p = 0.001) of OHCA patients died in the field, 19.7% and 19.3% ( p = 0.809) died in the Emergency Department, 21.8% and 18.5% ( p = 0.044) died in the hospital, 10.8% and 7.4% ( p = 0.012) were discharged from the hospital, and 9.3% and 5.9% ( p = 0.005) were discharged with Cerebral Performance Category score ≤ 2. Conclusion Total OHCA increased during the COVID-19 pandemic when compared with the prior year. Although patient characteristics were similar, initial shockable rhythm, and proportion of patients who died in the hospital decreased during the pandemic. Further investigation will explore etiologies of those findings.

Note: This is a revision of the previous joint policy statement titled "Guidelines for Care of Children in the Emergency Department." Children have unique physical and psychosocial needs that are heightened in the setting of serious or life-threatening emergencies. The majority of ill and injured children are brought to community hospital emergency departments (EDs) by virtue of proximity. It is, therefore, imperative that all EDs have the appropriate resources (medications, equipment, policies, and education) and capable staff to provide effective emergency care for children. This policy statement outlines resources necessary for EDs to stand ready to care for children of all ages. These recommendations are consistent with the recommendations of the Institute of Medicine (now called the National Academy of Medicine) in its report "The Future of Emergency Care in the United States Health System." Although resources within emergency and trauma care systems vary locally, regionally, and nationally, it is essential that ED staff, administrators, and medical directors seek to meet or exceed these recommendations to ensure high-quality emergency care is available for all children. These updated recommendations are intended to serve as a resource for clinical and administrative leadership of EDs as they strive to improve their readiness for children of all ages. BACKGROUNDThe National Hospital Ambulatory Medical Care Survey reported that in 2014 there were approximately 5,000 EDs in the United States. Of the more than 141

Objective At a time when the COVID19 vaccine was approved for everyone > 12 years of age, we sought to identify characteristics and beliefs associated with COVID-19 vaccination acceptance. Methods We conducted a cross-sectional survey study of parents of children aged 3-16 years presenting to one of 9 emergency departments from June-August 2021 to assess parental acceptance of COVID-19 vaccines. Using multiple variable regression, we ascertained which factors were associated with parental and pediatric COVID-19 vaccination acceptance. Results Of 1491 parents approached, 1298 (87%) participated of which 50% of parents and 27% of their children > 12 years of age were vaccinated. Characteristics associated with parental COVID-19 vaccination were trust in scientists [adjusted odds ratio (aOR) 5.11, 95% confidence interval (CI) 3.65-7.15], recent influenza vaccination (aOR 2.66, 95% CI 1.98-3.58), college degree (aOR 1.97, 95% CI: 1.36-2.85), increasing parental age (aOR 1.80, 95% CI 1.45-2.22), friend/family member hospitalized with COVID-19 (aOR 1.34, 95% CI 1.05-1.72) and higher income (aOR 1.60, 95% CI 1.27-2.00). Characteristics associated with pediatric COVID-19 vaccination (≥ 12 years) or intended COVID-19 pediatric vaccination (children < 12 years) were parental trust in scientists (aOR 5.37, 95% CI 3.65-7.88), recent influenza vaccination (aOR 1.89, 95% CI 1.29-2.77), trust in the media (aOR 1.68, 95% CI 1.19-2.37), parental college degree (aOR 1.49, 95% CI: 1.01-2.20), and increasing parental age (aOR 1.26, 95% CI 1.01-1.57). Conclusions COVID-19 vaccination acceptance was low. Trust in scientists had the strongest association with parental COVID-19 vaccine acceptance for both parents and their children.

This article provides recommendations for pediatric readiness, scope of services, competencies, staffing, emergency preparedness, and transfer of care coordination for urgent care centers (UCCs) and retail clinics that provide pediatric care. It also provides general recommendations for the use of telemedicine in these establishments. With continuing increases in wait times and overcrowding in the nation's emergency departments and the mounting challenges in obtaining timely access to primary care providers, a new trend is gaining momentum for the treatment of minor illness and injuries in the form of UCCs and retail clinics. As pediatric visits to these establishments increase, considerations should be made for the type of injury or illnesses that can be safely treated, the required level training and credentials of personnel needed, the proper equipment and resources to specifically care for children, and procedures for safe transfer to a higher level of care, when needed. When used appropriately, UCCs and retail clinics can be valuable and convenient patient care resources.

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