Mental Health and Addictions Education in the Emergency Department

Evidence-based guidance for including Trauma-Informed Care principles in practice and reducing stigma in health care.


We acknowledge that everyone is unique with their own life experiences. This contributes to the way we perceive certain information.

Some people who have experienced trauma might have triggers (sights, sounds, smells, words, places, etc.) that can cue neurobiological responses that are similar to the initial trauma being triggered. Fight, flight, freeze, and appease are well known involuntary responses that can show up when people are triggered, and it encompasses a full range of cognitive, biological, emotional, sensory, and behavioral changes in that moment (Haskell, 2012).

Being triggered is different from having difficulty understanding a topic. It is normal to feel unsettled about difficult topics. The main difference is that an individual must have experienced trauma to experience being triggered, whereas an intellectual challenge has nothing to do with trauma.

We want to preface this module by telling you that we will be talking about trauma symptoms and trauma-informed care principles. If you have experienced trauma and come across something that is triggering, you might feel overwhelmed, anxious, or panicked. In these cases, please take care of yourself in a way that works for you. This might mean using some grounding techniques such as focusing on sights, sounds, and smells around you; taking a bathroom break; taking slow, deep breaths; going for a walk; thinking of something happy or comforting to you; or taking a temporary break from the learning.

We encourage everyone to notice what they need while working through this module and take care of those needs in a way that works for them.

Resources to access if you’re noticing you need something additional when you’re reviewing the module content:

Canadian Research

76% of participants (n=2991) identified being exposed to at least 1 traumatic event in their lifetime. (Van Ameringen et al., 2008)


In an Alberta study on Adverse Childhood Experiences it was concluded that 56% of the population they surveyed (n=1207) had at least one ACE score. Having one ACE score increased the probability of experiencing another one by 84%. (MacDonald, 2014)

In a Calgary study 69.1% of the participants reported having one ACE score and 18.1% had a score of 4 (n=3922). ACEs predicated interpersonal difficulties in adulthood. Emotion dysregulation played a factor in the interpersonal difficulties. (Poole et al, 2018).

In a Lunenburg county (N.S.) study on Adverse Childhood  Experiences and Resiliency it showed that 73% of participants (ages 18-86, n=226) had at least one ACE score and 31% reported 4 or more ACEs. (Ross, 2019)

“Prevalence of adverse childhood experiences among individuals aged 45 to 85 years: a cross-sectional analysis of  the Canadian Longitudinal Study on Aging” (10 Provinces). It showed that 61.6% of participants had at least one ACE  and 35.6% reported having two more ACEs  (n=44,817). ( Joshi et al., 2021)

In a study examining the protective factors and mental health of undergraduate Dalhousie students (n=322) with ACES, 74.85% had at least one ACE and 31% had four or more ACES ( Ross et al., Publication pending)

Trauma and Trauma-informed Care

Trauma results from experiences that overwhelm a person’s capacity to cope.

(IWK, Nova Scotia Health & Government of Nova Scotia, 2015)

Accidents, natural disasters, childhood abuse and neglect, sexualized violence, witnessing violence, and medical interventions (among many other sources) can result in trauma.

Post-traumatic stress disorder (PTSD) is an example of a diagnosis used to describe a mental health response that can result from trauma. Other Other diagnosis include (but are not limitted to depression and substance misuse (Trauma-informed Approaches, 2015). 

Trauma-informed practice (TIP) is a universal and systemic approach to service provision. It is based on an understanding of the prevalence of many forms of violence and trauma among children and adults – developmental, historical, simple/complex, weather-related, war-related, gender-based – and the wide range of adaptations people make to cope.

(IWK, Nova Scotia Health & Government of Nova Scotia, 2015)


What do trauma-informed services look like in health care?

Trauma-Informed Care (TIC) e-Learning Series

Alberta Health Services (AHS) has made the Trauma-Informed Care (TIC) e-Learning Series portion of its Trauma Training Initiative available to health care providers outside the AHS system. The initiative is for those who wish to develop their knowledge and skills in relation to trauma-informed care.

Take the TIC e-Learning Series

Links to the surveys and e-Learning modules are below. Please complete the pre-competency survey before beginning the modules. Upon completion of the course, you must complete the post-competency survey and the certificate request form to obtain your certificate of participation.

1. Take the Pre-Competency Survey

2. Take the Modules

3. Take the Post-Competency Survey

4. Get your Certificate of Completion from vendor

Confirmation of Completion

Once you have reviewed all the material, click the link below and select the name of the module and date of completion. Fill out the rest of the form and click on Submit. Save or print your certificate, if you have not received a certificate from a 3rd party.


Confirmation of completion


Ameringen, M., Mancini. C., Patterson, B., & Boyle, M. H. (2008). Posttraumatic stress disorder in Canada. CNS Neuroscience & Therapeutics, 14, 171-181.

Adriaenssens, J., de Gucht, V., & Maes, S. (2012). The impact of traumatic events on emergency room nurses: findings from a questionnaire survey. International journal of nursing studies, 49(11), 1411–1422.

Bahadirli, S., & Sagaltici, E. (2021). Post-traumatic stress disorder in healthcare workers of emergency departments during pandemic: A cross-sectional study. The American Journal of Emergency Medicine, 50, 251-255.

Copeland, D., & Henry, M. (2018). The relationship between workplace violence, perceptions of safety, and professional quality of life among emergency staff members in level 1 trauma centre. International Emergency Nursing, 39, 26-32.

IWK, Nova Scotia Health & Government of Nova Scotia (2015). Trauma-informed approaches: An introduction and discussion Guide for health and social service providers.

Haskell, L. (2012) Becoming trauma informed (N. Poole & L. Greaves, (Ed.). Centre for Addiction and Mental Health.