ObjectiveTo describe our experience performing ED procedural sedation in a country where emergency medicine (EM) is a relatively new specialty.MethodsThis is a prospective observational study of adult patients undergoing procedural sedation by emergency physicians (EPs) or EM residents in eight hospitals in the Netherlands. Data were collected on a standardised form, including patient characteristics, sedative and analgesic used, procedural success, adverse events (classified according to World SIVA) and rescue interventions.Results1711 adult cases were included from 2006 to 2013. Propofol, midazolam and esketamine (S+ enantiomer of ketamine) were the most used sedatives (63%, 29% and 8%). We had adverse event data on all patients. The overall adverse event rate was 11%, mostly hypoxia or apnoea. There was no difference in adverse event rate between EPs and EM residents. However, there was a significantly higher success rate of the procedure when EPs did the procedural sedation (92% vs 84%). No moderate (unplanned hospital admission or escalation of care) or sentinel SIVA outcomes occurred (pulmonary aspiration syndrome, death or permanent neurological deficit).ConclusionAdverse events during procedural sedation occurred in 11% of patients. There were no moderate or sentinel outcomes. All events could be managed by the sedating physician. In a country where EM is a relatively new specialty, procedural sedation appears to be safe when performed by EPs or trained EM residents and has comparable adverse event rates to international studies.

BackgroundPersonal protective equipment (PPE) used by healthcare workers was scarce during the COVID-19 pandemic. The aim of this study was to assess whether telemedicine (using iPads) reduced PPE use in emergency department (ED) patients who were treated in contact isolation, and whether telemedicine had a positive effect on patient anxiety and satisfaction.MethodsWe conducted a prospective single centre before-and-after study including ED patients ≥18 years who were treated in contact isolation. PPE use, the Hospital Anxiety Scale and the 15-item Picker Patient Experience Questionnaire were compared between the control period (8 April to 14 April 2020) and intervention period (15 April to 24 April 2020).ResultsWe included 25 patients in each period. PPE use per patient was higher for physicians in the control period (mean 1.7; 95% CI 1.5 to 1.9) compared with the intervention period (mean 1.2; 95% CI 1.0 to 1.3, p<0.01). Total PPE use per patient contact for ED physicians decreased from 42 out of 42 patient contacts in the control period, to 29 out of 66 patient contacts in the intervention period (difference 54.3%; 95% CI 50.1% to 58.6%, p<0.01). Reported anxiety and satisfaction were not significantly different.ConclusionPPE use by physicians can successfully be reduced by using telemedicine in the ED without increasing anxiety or dissatisfaction. This study was a first step to gain experience with telemedicine in the ED which has the potential to reduce PPE use in future pandemics or other patients with an indication for contact isolation.