The Pulse Fall 2023/Winter 2024 by ACOEP

FALL 2023/WINTER 2024

TOGETHER WE STAND SCIENTIFIC ASSEMBLY HIGHLIGHTS 2023 AWARD WINNERS ALIGNING OUR EFFORTS

A STATE OF COMPLEXITY

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THE SAVE ACT PG 14

Save the Date

2024 Spring Seminar | April 27-May 1 Signia Orlando Bonnet Creek • Orlando, Florida

The Pulse VOLUME LIII No. 4

EDITORIAL STAFF Timothy Cheslock, DO, FACOEP, Editor Victoria Selley, DO, FACOEP, Assistant Editor Mary Kate de Leon, Marketing & Communications

TABLE OF CONTENTS 4

PRESIDENT’S REPORT Brandon Lewis, DO, MBA, FACOEP, FACEP

The Pulse is a copyrighted quarterly publication distributed at no cost by ACOEP to its Members, Colleges of Osteopathic Medicine, sponsors, exhibitors, and liaison associations recognized by the national offices of ACOEP.

THE ON-DECK CIRCLE Jennifer Axelband, DO, FACOEP

EXECUTIVE DIRECTOR’S DESK Martha O’Hanlon

RSO UPDATE Coral Byrns, DO, PGY-1, President

The Pulse and ACOEP accept no responsibility for the statements made by authors, contributors, and/ or advertisers in this publication; nor do they accept responsibility for consequences or response to an advertisement. All articles and artwork remain the property of The Pulse and will not be returned. Display and print advertisements are accepted by the publication through ACOEP, PO Box 1488, Warrenville, IL 60555, (331) 248-7799, or to info@ acoep.org. Please contact ACOEP for the specific rates, due dates, and print specifications. Deadlines for the submission of articles are as follows: January issue due date is November 15; April issue due date is February 15; July issue due date is May 15; October issue due date is August 15. Advertisement due dates can be found by downloading ACOEP's media kit at www.acoep.org/advertising. ACOEP and the Editorial Board of The Pulse reserve the right to decline advertising and articles for any issue. ©ACOEP 2023 – All rights reserved. Articles may not be reproduced without the expressed, written approval of ACOEP and the author. ACOEP is a registered trademark of the American College of Osteopathic Emergency Physicians.

WELLNESS COMMITTEE UPDATE 10 Tiffany Brown, DO, Chair MEMBERSHIP COMMITTEE UPDATE

12 Paula DeJesus, DO, FACOEP-D, MHPE 13 LAUREL ROAD PARTNERSHIP THE SAVE ACT 14 Jeremy Selley, DO, FACOEP

16 2023 ACOEP AWARD WINNERS 17 2023 FOEM COMPETITION WINNERS 18 SCIENTIFIC ASSEMBLY HIGHLIGHTS 20 SPECIAL DISNEY THEME PARK DISCOUNTED PACKAGES WHAT WOULD YOU DO? ETHICS IN EMERGENCY MEDICINE 22 Bernard Heilicser, DO, MS, FACOEP-D, FACEP

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PRESIDENT’S REPORT

Brandon Lewis, DO, MBA, FACOEP, FACEP

ALIGNING OUR EFFORTS

s I read some of the ongoing angst and argument on social media about different EM groups and practice models, I was reminded of a line from one of my favorite movies, Braveheart. In a scene where the Scottish nobles are arguing over which of them should be able to name a king, William Wallace points out to them that “you are so busy squabbling over the scraps from Longshanks (English king) table, that you’ve missed your right to something better”. I can’t help but feel that applies to our specialty right now. While there are certainly things in our specialty that need to be cleaned up, there are so many other forces aligned against Emergency Physicians that we would be much better served aligning our efforts against these negative forces. So, who are the “Longshanks” and allies of our industry? First, I would point to the federal government. Aside from the continuing expansion of unpaid obligations like EMTALA and other federal obligations, the federal government continues to ratchet down pay for physicians. In 2022, coming out of the COVID pandemic in which Emergency Physicians were hailed as “front line heroes”, CMS enacted a pay cut of almost 1%. In

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2023, physicians experienced a 2% pay cut in the Medicare reimbursement rate. The current proposed 2024 physician fee schedule would cut another 3.34% from our reimbursement. This does not even include a potential 4% cut due to a regulation known as “Pay go” intended to prevent deficit spending. These cuts all come at a time when inflation has been at its highest levels in decades. When compared to inflation, physicians have experienced a 22% decline in pay over the past two decades.

Second, I would point to the insurance companies who have very effectively lobbied to get a set of terrible implementation rules enacted around the No Surprises Act. Empowered by these rules, payers can unilaterally cancel long standing contracts with physicians and then offer a rate 20% or more lower with no recourse. If a physician group refuses, then they are out of network and must accept a “qualified payment amount” which is easily manipulated by insurers and is usually a markedly lower

amount. If the physician wants to dispute it, they pay $350 and wait for a dispute resolution process that is severely backlogged (only 9% of all claims filed since the law was enacted have been adjudicated). Next on the list are the Plaintiff’s attorneys. While some states have enacted medical malpractice reform and the frequency of malpractice claims have decreased, the payout of average claims have gone up significantly. For example, there was a recent case in Georgia where a jury awarded $75 million to a patient in whom a stroke diagnosis was delayed. There are more and more “lottery” type cases which can devastate a physician practice. While “Braveheart” is fiction and the quote attributed to William Wallace is as well, there is one historical quote from Benjamin Franklin that remains as true today as when he said it at the signing of the Declaration of Independence, “we must all hang together, or we will all hang separately”. If the house of emergency medicine cannot come together to focus on those trying to destroy our practices from the outside, there will be very little for us to squabble over internally!!–•–

Selley’s Social Club Spring conference in Orlando! This is an absolutely perfect time of year to be in Orlando. Springtime means warm weather without the humidity that makes exploring sometimes difficult! We will be sending an update out as we further plan our gatherings and opportunities. But I would start planning now for activities, particularly if you are bringing your family. The Disney parks and Universal studios will require reservations ahead of time. I would recommend going ahead and getting those tickets. Epcot is always a favorite both daytime and evening to “explore the world”. Refer

to pages 20 & 21 for special discounts to theme parks!

O t her t hings to consider while in Orlando • •

•

Shopping at one of the several mall and outlet areas nearby There are a whole host of restaurants at all of the parks and hotels. Disney Springs is always a favorite and there is an afternoon and evening show you can book there that is great! Favorite restaurants include: • Maria and Enzo’s Italian • T. rex is a hit for the kids! • Terralina • STK • Paddlefish

• Jaleo • If you are in the mood for sweets - get in the virtual queue early for Gideon’s bake house!! • The Bonnet Creek resort area has a beautiful winding road with multiple exclusive hotel resorts that will give you tons of choices for restaurants, spas and activities.

Spring Seminar Events Saturday, April 27, 2024 Bedside Ultrasound - Basic (fee) 1:00 pm - 4:30pm

Sunday, April 28, 2024 FOEM Case Competition 9:00 am - 12:30pm FOEM New Innovations Competition 2:00 pm - 5:00pm Bedside Ultrasound - Procedures (fee) 2:00 pm - 5:00pm Spring Seminar Welcome Party 6:00 pm - 8:00pm

Monday, April 29, 2024 COLA/CORE Review Course 5:00 pm - 9:00pm

Can’t wait to see you in Orlando!! *dates and times of events are subject to change

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THE ON-DECK CIRCLE

Jennifer Axelband, DO, FACOEP

A STATE OF COMPLEXITY: TEENAGE MENTAL HEALTH

s I pen my first Pulse communication as President Elect, I must thank the membership, my mentors and the board for all the support and encouragement I have received as I embark into this new role. Leading a college is challenging, communicating with the written word with a goal to strike a sense of importance is humbling. In my attempt to write, a flight of ideas crossed my mind, what does the membership want to read? Do I write about the year ACOEP has had with our accomplishments and goals? Should I write about what my focus and aspirations are? Do I address current events such as healthcare news, legislation, and advocacy? I then realized the deluge of topics in my head was not a flight of ideas, it was writers block. An overwhelming feeling of being stuck in the writing process without the ability to move forward and write anything new. Everything that came to mind has been highlighted in the past. The solution, I need to get personal. On September 14, 2023 my son came home from school, he’s 16 years old and attends a public high school. As a teenager, he sees me and my

Improving Access to Children’s Mental Health Care.

husband as annoying adults who he cannot have a meaningful conversation with because we do not understand his generation. His daily routine after school is to come into the house, eat every morsel of junk food he can find and then take a nap after an exhausting day of school and socializing. Usually I get a “Hi mom” or “What are you making for dinner?” from him. I ask how his day was and his reply is typical, alternating between “fine” or “boring”. September 14, a Thursday afternoon was different. My son called me from the bus and asked if I was home and said he needed to talk to me. My first thoughts were, how many days of detention, how much money or which class is he failing. I was not prepared for what came next. As he entered the house he said “She’s dead”, those were his words. I must have looked confused and shocked because he kept talking, talking and pacing, as he told me the story of his friend. They have known each other since middle school. They “dated” for a brief time in 6th grade, the equivalent of holding hands in school and calling each other boyfriend and girlfriend. With the pandemic and changes

Rates of Mental and Behavioral Health Service Providers by County, 2015.

Last reviewed March 8, 2023.

Accessed September 30, 2023.

in school attendance they stayed friends, stayed in the same friend group and social media circles. They texted or snapped or whatever regularly. He told me he was talking to her in school earlier in the week. He then told me what happened at the end of the school day. Her close girl friends were brought into the administrative office during the last period of school, 30 minutes later he and some other friends saw her friends leave the office crying hysterically and yelling “she’s dead”. His friend was not in school that day and no one had heard from her. My son’s face was a picture of disbelief, sadness and anger. My first thought was, is this true? The loss of a young bright life is tragic, you wouldn’t think it could get worse, but it did. That day the news channels and the internet exploded with the reality of the event, a double homicide. As the hours passed and one day lead into another more information was released to the public and formal announcements were made at school confirming his friend’s death. Sharp force trauma, the cause of death, was stated by the coroner and reported in the local news, to both his friend and her

When Your Child, Teenager, or Adult Son or Daughter has a Mental Illness or Substance Use Disorder, Including Opioid Addiction: What Parents Need to Know about HIPAA. Published January 2018. Accessed September 30, 2023.

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RESOU

mother. A suspect was identified a few days later and shortly after identification was taken into police custody, his friend’s former boyfriend. Forthcoming were more details from the authorities and with more details my son became retreated in his conversations with me. My son did not talk as openly about how he was feeling or what he has encountered at school. I watched the news to try to keep up on the information stream he was experiencing. The local news reported on how a Go Fund Me account was active to assist in the funeral expenses with additional proceeds to be donated to a local charity for survivors of domestic and intimate partner abuse. I asked my son about attending the funeral. He planned to go alone, we disagreed about this plan, and he grew angry with me. He’s never been to a funeral, I expressed my “mom” concerns and eventually he agreed. September 23, 2023, I took my teenage son to his first funeral, a family funeral for a friend and her mother. At the funeral, I gave my son space and was just present for him if he needed me. I cried as the sadness was just overpowering. The music playing in the background was slow and deliberate for the loss of 2 young lives. Summertime sadness and tears in heaven replayed on a loop. I watched my son and his friends interact and my heart broke for them. Some of his friends were tearful and sad, others were stoic with unemotional faces, others seem

to be coping with conversation and socializing. I asked my son how are you doing? He replied consistently, unemotional “I’m fine” and “I can’t do anything about it anyway”. The lack of expressed feelings crushed me emotionally as I am thinking is he depressed, is he ok, does he need more than I can give? Sitting at a funeral allows you to think and be introspective. Who is there to address the mental wellness for these teenagers, not yet adults and not truly children? What resources do the schools provide? Who was there for his deceased friend? My son was able to look past his normalcy of superficial conversation to talk to me initially and now he seems to be closing off. What resources do today’s teenagers and children have aside from each other in shared grief? These questions all have answers, but the answers are not uniform or consistent and vary from school district to state to nationally. The mental health of everyone but more strikingly of teenagers has been impacted by the pandemic, by the regular exposure to violent events and by the stressors associated with everyday life. As adults it can be difficult to navigate the mental health system, as a teenager it is likely more confusing. Now consider a different perspective, do you as an emergency physician know how to traverse the complexity of the mental health system for adolescents? Do you know their rights? Do you know the resources and legislation?

Marianne Sharko, Rachael Jameson, Jessica S. Ancker, Lisa Krams, Emily C. Webber, S. Trent Rosenbloom; State-byState Variability in Adolescent Privacy Laws.

Randi O, Gould Z, States Take Action to Address Children’s Mental Health in Schools.

Pediatrics June 2022; 149 (6): e2021053458. 10.1542/

Accessed September 30, 2023.

In short, the system is daunting and complex. Federal policies have been revised and newly accepted that apply to childhood and adolescent mental health include the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA), the Patient Protection and Affordable Care Act of 2010 (ACA), the 21st Century Cures Act of 2016 (Cures Act), and the Supporting Children’s Mental Health Act of 2021 (SCMHA). On a state level, since the onset of the pandemic, 38 states have enacted nearly 100 laws focused on supporting schools in their role as one of the primary access points for pediatric behavioral health care. Consent for treatment has also been evolving as more adolescents are seeking mental health support independently. Maryland, California, and Illinois allow adolescents to consent for mental health treatment at age 12 independently. Not all states have the same provisions, to date, 18 states still require a person to be 18 years of age to consent to mental health treatment or have no law giving a right to consent to minors seeking mental health services. Unfortunately, we as a community of parents, family, physicians and healthcare providers are encountering tragic and violent events like my son and his classmates have experienced. As a parent we want to be that person who knows it all and can help our child, as a physician we need to know how to help all the children. There are some resources in the column on the right to assist you in knowing your state’s mental health laws. –•–

Sharko article table 1: State-by-State Policies on the Ability for Minors to Consent for Medical Services

Published February 14, 2022.

peds.2021-053458

URCES

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EXECUTIVE DIRECTOR’S DESK

Martha O’Hanlon Executive Director

LOOKING AHEAD TO SPRING SEMINAR Dear ACOEP Members, I am excited to introduce myself as the new Executive Director of the American College of Osteopathic Emergency Physicians. My name is Martha O’Hanlon, and I’m delighted to join the ACOEP family. I began my association management career back in 2010 as an operations associate and have since grown within the field, ultimately assuming the role of Executive Director at Affinity Strategies. With over 13 years of experience spanning various sectors, including business, trade, and healthcare organizations, I have had the privilege of building trust in client relationships, leading teams, managing both short and long-term projects, and developing annual budgets. My experience also includes managing international chapters, overseeing association certifications and industry designation programs, as well as administering all aspects of annual awards and volunteer recognition. In terms of my academic background, I hold a Bachelor of Arts degree in Communications from Illinois State University. Beyond my professional life, I enjoy spending quality time playing board and card games with friends and my husband, Dan. I also cherish moments spent with my family in Michigan, Chicago, and Virginia. I am thrilled to be part of the ACOEP community and look forward to the journey ahead as your Executive Director. It is my honor to serve you and work towards the continued success of our organization. As we move forward, I would like to highlight two significant events: 1

2024 Spring Seminar: ACOEP’s Spring Seminar is a vital event for our organization. The 2024 edition promises to be a valuable experience for all. Please mark your calendars and visit the link for more details and registration information.

2024 Spring Seminar

Virtual Grand Rounds Webinars: We are constantly evolving to meet the changing needs of our members. Our Virtual Grand Rounds provide a cutting-edge platform for education and collaboration. To access these valuable resources, please visit the link for more information.

Virtual Grand Rounds

I am excited to embark on this journey with you all, and I look forward to your continued support and engagement as we work together to shape the future of ACOEP.

Mart ha O’H anlon Martha O’Hanlon ACOEP Executive Director

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ACOEP RSO BOARD

Coral Byrns, DO RSO President

RSO UPDATE This academic year is off to a strong start for our resident and student organization. We started the quarter with our Scientific Assembly in Washington D.C. where we had a great turnout. This is the highest number of attendees we have had at a conference since returning from COVID-19 virtual conferences and we are thrilled. We had over 145 residents and students attend the conference and participate in an escape room themed leadership academy, several lectures from many wonderful speakers, a residency fair, research symposium, and multiple workshops to include things like chest tubes, intubations, ultrasound, and more. At our Scientific Assembly we held elections within our college and nominated our RSO board for the 2023-2024 academic year. We also awarded our Club of the Year to Arizona College of Osteopathic Medicine Emergency Medicine Interest Group (EMIG) and our Student of the Year to Mohammad Abuakar, OMS III at Idaho College of Osteopathic Medicine. Each academic year our Director of Student Affairs hosts quarterly calls with the Presidents of each osteopathic medical school’s EMIG. Our Director of Student Affairs recently held our first call and we are excited to report that each EMIG reported significant interest in their respective EMIG, bringing in a large increase in membership for the college. This academic year we want to continue to encourage resident and student involvement. Some of our recent and upcoming events include a Mass Casualty Incident Symposium hosted by Norman Regional in Norman, OK and ACOEP RSO for residents and students in October as well as a Residency Symposium planned for February in Orlando, FL hosted by the RSO and local residency programs. We also have plans to host virtual lecture series for residents to discuss topics like contract negotiation and finding a job after residency. We have high hopes for the future of Emergency Medicine and will continue to advocate for our specialty. –•–

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ACOEP WELLNESS COMMITTEE

WELLNESS COMMITTEE UPDATE

Tiffany Brown, DO Chair

PHYSICIAN WELLNESS SURVEY RESULTS

The Physicians Wellness Committee recently sent out a survey to gauge the needs of our great organization. We had 148 survey participants from the college and will use this information to help us address the high level of both physician fatigue and lack of focus on provider wellness. We will do this by offering education, resources, options, and interventions to help providers thrive during their careers. As a committee, we want to create opportunities for wellness and health. Achieving wellness is a multifaceted journey that involves various strategies and practices. Some key actions people often take to attain wellness include regular exercise, eating a balanced diet and paying attention to nutritional value, getting adequate sleep, stress management practices, building social connections, focusing on mental health care, steps toward better self-care, participating in preventative healthcare, maintaining a healthy work life balance, working toward a positive mindset, limiting harmful habits, engaging in continuous learning, increasing environmental awareness. In our survey we asked, “What do you specifically do to achieve wellness?” Participants answered that they exercise (32%), go on vacations (28%), and partake in hobbies (22%). We all know that engaging in physical activity is essential for maintaining good

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health. Taking time for self-care activities like hobbies or relaxation can help maintain emotional balance. 12% of participants answered “other” and their answers were a combination of the top 3 survey answers. Seeking professional help when dealing with mental health challenges is vital. Therapy, counseling, or support groups can be beneficial. Practicing stress reduction techniques like meditation, deep breathing and mindfulness can help manage daily pressures and promote mental wellness.

We asked, “What are the elements of wellness that you desire?” There were 3 elements that accounted for over 75% of the responses. These elements were “Decreased workload” at 29%, “Control Over Schedule” at 26%, and “Time with Family” at 21%. I believe that if we start by centering our attention on these 3 elements, this will contribute the most to improving health and wellness among our members.

Decreased Workload Research suggests that reducing work hours can decrease employee stress and improve well-being without impacting productivity. the benefits that organizations and individuals can experience by implementing workload reduction strategies are improved employee well-being, increased productivity, enhanced job satisfaction, maximized employee retention, improved work life balance, and prevention of burnout. Control Over Schedule Having control over your schedule can significantly improve wellness. Research indicates that having little discretion over how work gets done is associated not only with poorer mental health but also with higher rates of heart disease. Conversely, giving workers more choice or control over their work schedules has been found to improve their mental health. Even relatively small changes in worker autonomy can make a difference in employee well-being.

In addition to the workplace, having control over your schedule outside of work can also contribute to wellness. Having a regular routine can help lower stress levels, form good daily habits, take better care of your health, feel more productive, and feel more focused. Developing healthier routines and habits in our lives can lead to positive feelings, relationship satisfaction, increased energy, inspiration, and a feeling that we are using our creative talents, skills, and abilities to engage in activities. By having control over your schedule, you can better manage your time and allocate it to activities that promote well-being. This includes spending quality time with family and loved ones, engaging in physical fitness activities, pursuing hobbies and interests, and taking breaks when needed. Ultimately, having control over your schedule allows you to strike a balance between work commitments and personal life, leading to improved overall wellness. Time with Family Spending more time with family instead of working all the time can have numerous benefits. Taking breaks from work and spending time with loved ones can help reduce stress and anxiety levels. It can foster open communication, strengthen bonds and reinforce positive family dynamics. Quality family time has been linked to improved mental health outcomes, including reduced risk of posttraumatic stress disorders. Regularly engaging in activities with family members can boost self-esteem and create a sense of belonging leading to increased happiness and satisfaction. It’s important to strike a balance between work commitments and spending quality time with loved ones.

Achieving wellness can be hindered by various elements, both internal and external. One significant internal barrier is a lack of motivation or discipline, making it challenging to adopt healthier habits. Poor selfesteem and negative self-perception can also impede progress, as can unresolved emotional issues and stress. Additionally, external factors such as a fast-paced lifestyle, financial constraints, and limited access to healthcare can create obstacles to wellness. Social pressures, unrealistic beauty standards as well as environmental factors can also negatively impact overall well-being. Recognizing and addressing these obstacles is crucial for individuals striving to attain a state of wellness, emphasizing the importance of a holistic approach to health. In our survey we also asked, “What are the elements that are preventing wellness?” Our poll shows that the top elements that are preventing wellness include stress (33%), lack of autonomy (24%), and other (25%). When we looked at what “other” entailed, it was workload, uncooperative administration, horrible work schedules, high taxes, regulatory bodies and their mandates, patients’ unrealistic expectations and our legal malpractice system.

Stress is modifiable and having a plan of action to combat the many stressors of life is key. Stress can have a significant impact on wellness. Chronic stress can lead to a range of physical and mental health problems, including heart disease, diabetes, anxiety, and depression. Stress can also cause inflammation in the body, which can contribute to the development of chronic diseases. Stress can also affect your behavior and lifestyle choices. For example, when you’re stressed, you may be more likely to engage in unhealthy behaviors such as overeating, smoking, or drinking alcohol. These behaviors can further exacerbate the negative effects of stress on your health. In addition to physical health problems, stress can also impact your mental health. Chronic stress has been linked to depression and anxiety disorders. It can also lead to burnout, which is characterized by emotional exhaustion, cynicism, and reduced professional efficacy. In conclusion, it’s important to remember that achieving wellness is a personal journey, and what works for one person may differ from another. Everyone’s journey towards wellness is unique. It’s important to assess the specific needs of your life and tailor these strategies accordingly. –•–

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MEMBERSHIP COMMITTEE UPDATE CALLING ALL MEMBERS! The Membership Committee is looking for members! Specifically, members who would be interested in evaluating what resources and services our members need. Our strategies as physicians are certainly changing as the landscape of how and where we practice continues to evolve. With this in mind, the Membership Committee wants to reflect what our members face with products and connections that meet their challenges. Currently ACOEP provides access to the journal WestJEM for up to date research and information. Throughout the year there are multiple educational offerings provided. These offerings have been available at live events through both in-person and live stream attendance, digitally on-demand through the Digital Classroom, virtually as a part of our webinar series, and post event review. These educational opportunities offer discounted access to medical information resources ensuring that you stay current with the latest trends. In addition, the College provides resources for financial guidance and rental car and travel discounts. Also, membership fees are not one size fits all by providing graduated fees for new physicians. To learn more about membership categories check out the details on our website. In looking at all the resources that are available, the Membership Committee is charged with keeping these current and relevant. What is spot on? What isn’t useful? What is out there that we haven’t even considered? What is a must have? How we support each other? How can access to the College be improved? Contact me at pwd9817@gmail.com for questions, ideas, and how you can become involved with the Membership Committee. Attendance to conferences is not required as we will be doing our work virtually. I invite students, residents, and attendings to help change the College with your ideas.

TELL US HOW WE CAN BETTER SUPPORT YOU Click here to take our 1 question survey

Take the Survey

ACOEP MEMBERSHIP COMMITTEE

Paula DeJesus, DO, FACOEP-D, MHPE Membership Committee Chair

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Student Loan Forgiveness Consultation

Explore your student loan options with an expert guide. Did you know there’s more than one path to forgiveness? Get the facts and federal policy updates – and develop your personalized plan – on a free 30-minute consultation with one of our student loan specialists at GradFin.

ACOEP Member Benefit ACOEP members get a $50 discount on a GradFin Membership.1

A GradFin student loan consultation will help you:

Apply for IDR

Understand your incomedriven repayment (IDR) and forgiveness options.

Navigate PSLF

See if you qualify and help you stay on track for public service loan forgiveness (PSLF).2

Explore Refinancing

Compare simple refinancing options that could help you save on student loans.

Stay the Course

If you’re already in the right repayment program, GradFin helps you stay on track.

Schedule your free 30-min student loan consultation

laurelroad.com/partnerships/acoep/medical-students All credit products are subject to approval. IMPORTANT INFORMATION: The U.S. Department of Education recently announced a student loan debt relief plan which includes forgiveness of up to $10,000 for qualifying federal student loans and up to $20,000 for qualifying Pell Grant recipients. For more information, please read the announcement. Please note that if you refinance qualifying federal student loans with Laurel Road, you may no longer be eligible for certain benefits or programs and waive your right to future benefits or programs offered on those loans. Examples of benefits or programs you may not receive include, but are not limited to, student loan debt relief or public service loan forgiveness, repayment options such as Income Based Repayment or Pay As You Earn, or COVID-19 relief benefits such as a 0% interest rate, suspension of payments or loan forgiveness. Please carefully consider your options when refinancing federal student loans and consult StudentAid.gov for the most current information. 1. ACOEP members get a $50.00 discount on an annual program membership with GradFin (“Offer”). The discount will be applied on the current annual membership fee of $249.00 and will automatically apply at checkout. This Offer is only available to current ACOEP members, is non-transferable and cannot be applied to previous membership purchase(s). This Offer cannot be redeemed for cash or combined with other offers and is subject to cancellation at any time and without notice. 2. To qualify for PSLF, you must be employed by a U.S. federal, state, local, or tribal government or not-for-profit organization (federal service includes U.S. military service); work full-time for that agency or organization; have Direct Loans (or consolidate other federal student loans into a Direct Loan); repay your loans under an income-driven repayment plan; and make 120 qualifying payments. For full program requirements, visit www.studentaid.gov/manage-loans/forgiveness-cancellation/public-service. Laurel Road and GradFin are brands of KeyBank N.A. All products offered by KeyBank N.A. © 2023 KeyCorp® All Rights Reserved. Laurel Road is a federally registered service mark of KeyCorp. 3 Corporate Drive, 4th Floor, Shelton, CT 06484, USA. 2023_07_ACOEP

THE SAVE ACT ACOEP ADVOCACY COMMITTEE By Jeremy Selley, DO, FACOEP

Safety from Violence for Healthcare Employees (SAVE) Act H.R. 2584 – Introduced in April 2023 by Larry Buchson, M.D. (R – Ind. 08) and Madeline Dean (D – Pa. 04).

MAKE YOUR VOICE HEARD

Sens Marco Rubio (R – FL) and Joe Manchin (D – WV) introduced the companion bill on September 12, 2023 in the US Senate. The SAVE Act, if passes, provides much needed protections for our healthcare workers. The bill, which is modeled after current protections for aircraft and airport workers, like flight crews and attendants, would create enhanced legal penalties for individuals who knowingly and intentionally assault or intimidate hospital employees. This bill does have protections for individuals who may be mentally incapacitated due to illness or substance abuse.

Click Here for More Details

The American College of Osteopathic Emergency Physicians (ACOEP) supports this legislation to help deter healthcare worker violence that has long been a problem, especially with a post Covid-19 pandemic increase in violence. We commend Representatives Buschon and Dean and Senators Rubio and Manchin on this legislation to enact federal law against criminals that assault or intimidate Healthcare workers. Please urge your Representative and Senators to sign on to these bills so we can get the SAVE Act passed and enacted into federal law.

! s u Join

CME available

Virtual Grand Rounds Series Sessions held October through April 5-6pm CT REGISTER HERE

Once you register, you will be able to access sessions that have already taken place through your digital classroom account.

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Sessions will be available for purchase through the digital classroom after the series ends.

Coaching is a highly effective tool that has been used in highlevel corporate positions and professional sports for years. It takes intelligent people from feeling unfulfilled in their lives to feeling envigorated and hopeful. Multiple randomized controlled trials have shown statistically significant results in wellbeing for physicians.

Laura Cazier, MD

Choose between: Self-guided 12-week video lecture course Private 1:1 coaching sessions with a coach who is also a physician Both for greater progress (RECOMMENDED)

Amanda Dinsmore, MD

Kendra Morrison, DO

We are 3 EM doctors, so expect results STAT. Think of this as work-life resuscitation. With over 50 years combined working in busy ERs, we understand your situation. We've been there. Let us teach you the tools you need to thrive.

2023 ACOEP

Award Winners

SSA23 CASE STUDY 1st Place

Keep Your Eyes Peeled: An Unusual Cause of Eye Redness and Swelling Official Presenter: Matthew Lam, BS, University of Illinois Chicago, IL

Juan Acosta DO, MS, FACOEP-D, FACEP Bruce D. Horton, D.O., FACOEP, Lifetime Achievement Award

Project Authors: Matthew Lam BS, Rebecca Raven MD, Stacy J. Hooker MD, Pholaphat Inboriboon MD

2nd Place

Unsuspected Ingestion from Garden Plant Could Have Been Fatal

John Ashurst DO, MSc Benjamin A. Field, D.O., FACOEP, Mentor of the Year Award

Official Presenter: Nataliya Makhdumi, MS, OMS III, Garnet Health Medical Center, NY Project Authors: Dr. Michael Mascola, DO, PGY II, Nataliya Makhdumi, MS, OMS III, Dr. Avindra Ramnarain DO, Dr. Thomas Liu, MS, DO.

3rd Place (TIE)

Rose Anna Roantree DO, FACOEP Robert D. Aranosian, D.O., FACOEP Excellence in EMS Award

Neurogenic Pulmonary Edema, Disseminated Intravascular Coagulation, and Tension Pneumothorax in an Adolescent Patient with Spontaneous Subarachnoid Hemorrhage Official Presenter: Kathleen Fleming, DO, Desert Regional Medical Center, CA

Alin Gragossian DO Willoughby Award

Christopher Colbert DO, FACOEP Excellence in Education Award

16 | THE PULSE FALL 2023/WINTER 2024

Project Authors: Kathleen Fleming, DO; Tara Billings, DO, MPH, FAAP

3rd Place (TIE)

Mosquitoes, Monsoons & Meningoencephalitis: Identifying West Nile Virus Meningoencephalitis in an Elderly Patient Official Presenter: Kelsey Newbold, OMS III, Midwestern University, AZ Project Authors: Kelsey Newbold OMS III, Alice Lee MD, Charles Finch DO

SA23 CPC

SS23 NEW INNOVATIONS 1st Place

Project Authors: Julia Schearer, BS; Sammie Sposet, BS; David Ross, DO; Danielle Kowal, BA

1st Place

Norman Regional

Kirk Kerkorian School of Medicine at UNLV

Angel Shavalier Residents

Novel Portable Training Model for Skull Trephination by NonNeurosurgeons

Institution: Rocky Vista University College of Osteopathic Medicine

2nd Place

Rachel Kern Jefferson Northeast EM/FM 3rd Place

Ashley Mawhinney Jefferson Northeast EM

2nd Place

Project Authors: Mohamad Moussa MD; Caroline Kraft; Andrew Throckmorton MPH; Stephen Grider, DO Institution: University of Toledo College of Medicine and Life Sciences

1st Place

John Schroeder Faculty

The Role of Direct Order Entry for Medical Students in the Emergency Department

SA23 ORAL ABSTRACT Kristina Domanski

2nd Place

Grace MacMillan New York Institute of Technology College of Osteopathic Medicine – Old Westbury 3rd Place

Nathan Hollister Kirk Kerkorian School of Medicine at UNLV

2nd Place (TIE)

Jeffrey Gardecki

SA23 POSTER

2nd Place (TIE)

Olubunmi Olarewaju

1st Place

Natalie Siegfried 3rd Place

Development and Implementation of a Pediatric Emergency Department Asthma Pathway in the Community Hospital Project Authors: Brooke Atkinson, DO; Krysten Newcomer, DO; Tara Billings, DO, MPH, FAAP

Norman Regional Hospital, OSU Emergency Medicine Residency

SA23 RESEARCH PAPER 1st Place

Nina Cast Integris Southwest Medical Center

2nd Place

Jean-Dominique Foureau Broward Health 3rd Place

January Moore Broward Health

Institution: Desert Regional Medical Center

FOEM Competition

Winners

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SCIENTIFIC ASSEMBLY FLASHBACK! Thank you to our attendees, speakers, and presenters for making the 2023 Scientific Assembly another great event! Our CME Committee put together an amazing lineup for the general sessions and our RSO Board had record turnout by offering workshops, escape rooms, and specific student and resident tracks. More than 400 attendees took part in 41 lectures, 1 keynote session, LIVE EM Over Easy podcasts, 2 FOEM competitions and hours of dedicated content for students and residents. We are looking forward to seeing everyone at the 2024 Spring Seminar, April 27 - May 1 in Orlando, FL. Register now to get early bird savings!

18 | THE PULSE FALL 2023/WINTER 2024

CHECK OUT ACOEP’S DIGITAL CLASSROOM WHEN YOU NEED ON-DEMAND CME CREDITS

Digital Classroom Link

Give Us Your Input As an organization, throughout the year we have a number of things we would like to keep the membership informed about whether that be our conferences, advocacy topics, webinars, or a number of other items. We’d like to get your feedback on preferred communication styles for receiving information and updates so we can share this information in the most efficient way possible. Take a minute to let us know your thoughts so we can be sure to focus our efforts when sending out correspondence from the college. Which platforms do you spend the most time reviewing? What method would you want to see used more for communications and updates? Are there other options not considered that you would prefer?

Take the Survey!

FALL 2023/WINTER 2024 THE PULSE

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Resort

DISNEY’S HOLLYWOOD STUDIOS ®

EPCOT®

MAGIC KINGDOM® PARK

DISNEY’S ANIMAL KINGDOM® PARK

Special 2024 Meeting/Convention Theme Park Tickets

Valid 7 Days Before, During & 7 Days After Your Meeting or Convention Dates* To enter a Park, both a Park reservation and valid Ticket on the same day are required. A Park reservation must be made for each day of entry. Reservations are subject to availability. Check the Park Availability Calendar: disneyworld.com/availabilitycalendar For details on making a park reservation please visit disneyworld.com/parkpass

After 1 PM Park Ticket

Twilight Park Ticket

Admission to one Walt Disney World ® Theme Park after 1:00 p.m. for one day.

109

Admission to one Walt Disney World ® Theme Park after 5:00 p.m. for one day.

Magic Kingdom® Park OR Epcot ® OR Disneyʼs Hollywood Studios® OR Disneyʼs Animal Kingdom® Theme Park

1-Day Theme Park Tickets 1-Day Magic Your Way Park Hopper ® Ticket: Ages 10+

195

Ages 3-9

190

Visit more than one Theme Park on the same day – Magic Kingdom ® Park, Epcot ®, Disney's Hollywood Studios ® and Disney's Animal Kingdom ® Theme Park. Prices include tax.

disneyworld.disney.go.com/genie

With the updated Park Hopper® experience, Guests must make a Disney Park Pass reservation via the Disney Park reservation system for the first park they plan to visit (reservation requirements are subject to change) AND enter that first park prior to visiting another. After entering that first park, Guests will be able to visit the next park starting at 2 p.m. until each park’s regularly scheduled closure. At this time a park reservation is not required after the first park, but is subject to the park’s capacity limitations.

BONUS!

Buy a 2 day or longer ticket and get ONE visit of your choice from the following: • Disney’s Typhoon Lagoon Water Park1 • Disney’s Blizzard Beach Water Park1 • Disney’s Winter Summerland Miniature Golf Course (before 4 p.m.)2 • Disney’s Fantasia Gardens Miniature Golf Course (before 4 p.m.)2

• Disney’s Oak Trail Golf Course for one round of golf (greens fees) or one round of FootGolf 3 • ESPN Wide World of Sports Complex4 Based on venue being open. Bonus visits only applicable during ticket validity dates.

Multi-Day Base Tickets & Options Advance-Purchase Savings! Multi-Day Theme Park Base Ticket +1 BONUS Visit Visit One Park Per Day, Plus one bonus visit.

Multi-Day Theme Park Base Ticket with Park Hopper ® Option +1 BONUS Visit

Ages 10+ Ages 3-9 Ages 10+

Visit more than one Theme Park on the same day, Plus one bonus visit.

Ages 3-9

Multi-Day Theme Park Base Ticket with Water Park and Sports Option +1 BONUS Visit

Ages 10+

Visit One Park Per day, Plus one bonus visit, and more visits to bonus locations (# of visits = ticket duration).†

Ages 3-9

Multi-Day Theme Park Base Ticket with Park Hopper ® Plus Option +1 BONUS Visit

Ages 10+

Visit more than one Theme Park on the same day, Plus one bonus visit, and more visits to bonus locations (# of visits = ticket duration).†

Ages 3-9

2 Days

3 Days

4 Days

5 Days

24282 $23324

37382 $35891

48990 $47073

32270 $31311

45369 $43878

58043 $56126

61877 $59853

31737 $30779

44837 $43346

56445 $54528

34400 $33441

47499 $46008

60173 $58256

52824 $50801 $

60279 $58256 64007 $61983

Prices include tax. Tickets are non-transferable, non-refundable and exclude activities/events separately priced. Ticketsʼ first use (or use of a 1 day ticket) must be during the dates of your meeting/convention or during the 7 days before or after your meeting/convention. Theme park tickets with multiple days, bonus visits or options, if any, must be used within 14 days after the date of first use. First use must occur between 10/24/23 and 12/31/24 but after 12/31/24, the amount paid for an unused ticket may be applied towards the purchase of a new standard ticket available at our theme park ticket windows at the then current price, so long as the new ticket purchase price is equal to or greater than the amount paid for the original ticket. Multi-day prices reflect advance-purchase savings on full-day tickets of 2 days or longer when purchased before your meeting/convention. Savings based on the non-discounted price for the same ticket sold at Disney-owned and -operated Guest Service desks in the Central Florida area as of 10/24/23. Prices subject to change without notice. Theme parks, attractions and other offerings are subject to availability, closures, change or cancellation without notice or liability. Park admission, offerings and ticket options are not guaranteed. We reserve the right to cancel any offering. † Total number of visits varies based on number of days on the ticket purchased. 1 Water Parks subject to rehabilitation, seasonal and weather closures. 2 Valid for one round. 3 Tee times are required for Disney’s Oak Trail Golf Course and are subject to availability. To make a tee time, call 407-WDW-GOLF. FootGolf is available every Wednesday, Saturday, and Sunday after 2:30 PM, subject to availability. 4 Valid only on event days. There are no events on some days; some events require an additional admission charge. Operation of concessions, venues and attractions varies based on event schedule. Visit espnwwos.com for information.

Bernard Heilicser, DO, MS, FACEP, FACOEP-D

What Would You Do? Ethics in Emergency Medicine

In this issue of The Pulse, we present the case of a 48 year-old male who unfortunately had a cardiopulmonary arrest in the field, and was subsequently resuscitated in the emergency department. Our patient, was intubated on a ventilator and entirely unresponsive. Neurology consulted in the emergency department, and using cold calorics determined the patient to be brain dead and pronounced the patient dead. The patient’s wife had difficulty accepting this and asked for a second opinion. Consequently, we have a patient legally dead, but his wife is requesting a second opinion. What, if any, considerations or options do you have?

WHAT WOULD YOU DO? Please visit the ACOEP X (formerly Twitter) feed and share your thoughts on this case using #WWYD-Pulse in your comment.

If you have any cases that you would like to present or be reviewed in The Pulse, email them to us at info@acoep.org. ACOEP X Link

22 | THE PULSE FALL 2023/WINTER 2024

PO Box 1488, Warrenville, Illinois 60555

MOUNT PROSPECT, IL

The Pulse Fall 2023/Winter 2024

Articles inside

WELLNESS COMMITTEE UPDATE PHYSICIAN WELLNESS SURVEY RESULTS

A STATE OF COMPLEXITY: TEENAGE MENTAL HEALTH

ALIGNING OUR EFFORTS