A 2017 systematic review and meta-analysis demonstrated the unwavering recurrence of low back pain (LBP) presentation in emergency departments (ED) [1]. In early 2020, the SARS-CoV-2 pandemic depleted resources as ED providers tended to COVID-19 patients. Simultaneously, pain management routine care was deemed "non-essential." 1 These unattended pain complaints were likely to present to the overburdened ED. LBP in the ED has become increasingly common and challenging to manage [2]. Efficiently triaging non-emergent LBP may redirect and improve ED service utilization. Less traditional providers may be better suited to manage musculoskeletal (MSK) pain. Appropriate clinical acumen is key in preventing overutilization of diagnostic tests and target interventions for ED LBP patients [3]. Furthermore, current clinical practice guidelines recommend nonpharmacologic treatment for acute or subacute LBP [4].Early conservative management for ED LBP has been associated with reduced pain and disability even when compared to patients with conservative outpatient physical therapy referrals [5]. Multiple studies point out integrated ED MSK-specialist (MSK-S) reduced length of stay, imaging utilization, and opioid administration rates [6], and improved overall ED metrics when compared to patients seen by typical ED providers [7]. Additionally, a 2018 systematic review and meta-analysis supports nonpharmacologic interventions for reduction of overall ED utilization and length of stay, and are effective in reducing pain in the ED with the potential to improve patient satisfaction, outcomes and quality of life [8]. The purpose of this correspondence is to describe how pandemic-related healthcare pressures led to an accelerated implementation of ED MSK-S in VA ED.VA Palo Alto Health Care System (VAPAHCS) 2019 proprietary data revealed approximately 60% of cases presenting to the ED were urgent/emergent MSK complaints, primarily LBP. As the rate of COVID-19 increased, it became vital to preserve VAPAHCS ED resources by reducing ED MSK complaints. On March 31st, 2020, the Santa Clara Public Health Department ordered the postponement of non-essential healthcare. With urgency to fulfill veteran's needs and aid in controlling the pandemic, the immersion of MSK-S into the ED was accelerated. Acknowledgements to Clinton Daniels, DC, MS for providing consultation guidance and recommendations for research formatting and quality assurance of the final manuscript.Integration into the ED went into effect on March 30, 2020 through June 8th, 2020. Designated MSK-S care was provided during peak hours by chiropractic and physical therapy departments.

Objective: To explore parents' experiences and views relating to their use of children's emergency healthcare services during the Covid-19 pandemic. Design: Qualitative telephone interview study using in-depth interviews, based on the principles of grounded theory. Recorded, transcribed verbatim, managed in NVivo version 12, analysed by thematic analysis. Setting: North East England, United Kingdom. Participants: Parents of children aged 0-8 years. Findings: Three major themes emerged from the interview data: Risk to children and families, Sources of Information, and Making Healthcare-seeking Decisions. These themes encompassed a range of intellectual and emotional responses in the way that parents interpreted information related to Covid-19, and their sense of responsibility towards family and wider society. Conclusions: Together these themes aid understanding of the changes in paediatric emergency department attendances reported in the early months of the Covid-19 pandemic in the UK. The analysis suggests that public health messaging directed at those seeking urgent care for children may be inadequate and lead to adverse consequences, the impacts of which require further study and refinement.