This chapter focuses on the acutely traumatized person presenting to the emergency department (ED) and addresses grief and bereavement along with the vicissitudes, various sub-types of response: acute, impacted, delayed, traumatic, and chronic. It also addresses how the emergency physician (EP) can best recognize and manage acute trauma and grief, and identifies other presentations that may be indirect expressions of bereavement or trauma. EDs are in themselves traumatic places where people receive unexpected bad news, a serious diagnosis, the need for emergency, life-threatening surgery, the loss of a loved one's life. Traumatic grief is a risk factor for mental and physical morbidity, including an increased incidence of suicide within the first 2 years of bereavement. The chapter examines how care providers can recognize the signs of their own secondary or vicarious traumatization and identifies strategies to prevent or remedy them.