The Pulse April 2007

The PULSE

Osteopathic Emergency Medicine Quarterly VOLUME XXXII NO. 2

APRIL 2007

Presidential Viewpoints Peter A. Bell, D.O., FACOEP

Invest in the Structure, Benefit from the Function When I was young I thought a lot about what I would be when I grew up. My life experiences helped shape my perceptions, change my paradigms, and better define my expectations. Eventually the idealism of youth was replaced with the reality of adulthood. The diversity of experiences helped to establish depth and breadth to my being.

I had a foundation, a center point, and a defined purpose. I was ready to serve.

A similar process occurs with organizations. They go through lifecycles. The ACOEP is now 32 years old. We have reached maturity. The pioneer generation gave way to the residency generation which is now training our current residents. I had the pleasure of training with many of our founders and have come to appreciate all they did, and what they envisioned. It is clear to me that our growth was dependant on service. The ACOEP is not the Board of Directors, the committee chairs, the office staff, or the members. It is ALL of us working together for a common goal. Today we all have the opportunity to give back to the organization that invested in us.

Without the ACOEP there would be no organized practice of osteopathic emergency medicine, nor would there be osteopathic emergency medicine residencies. Our

livelihood is a direct result of the conjoint efforts orchestrated through our specialty college.

So how does one invest in the structure of our organization? Regardless of where you are in your career, there is an opportunity. Each member has value. Diversity of talent and skills enables us to accomplish more. For this reason we have established a plan for service. It can be at any level and is dependant on your time, willingness, stage in life, and talents.

The first opportunity for service to the college starts with participation. As members participate in college sponsored events, the college becomes stronger. Bigger audiences bring economy of scale and allow for more sophisticated ventures. Our growth in continuing medical education is a direct result of member engagement.

The next opportunity is committee work. Committees are established to do the work of the college. Solicitation of members is done by the President in consultation with the committee chairs. In addition, a general inquiry is sent to the membership.

Each committee makeup is engineered to promote a strong working group.

Committees are charged with strategic goals, as well as projects from the Board.

The committees vet each idea, and formulate proposals designed to achieve a specific objective. In concert with the work of the Board and other committees, the college moves forward in its mission.

Liaisons are established both internally and externally. The internal liaisons are

The PULSE APRIL 2007

typically board members who assist the committee chairs in executing their duties.

They clarify direction, bring additional expertise to the committee, and assure continuity. External liaisons represent the interests of ACOEP to other organizations.

These liaisons serve a diplomatic role of gathering information, developing relationships, and promoting the good name of the ACOEP.

The Board of Directors is elected by the general membership to hear issues, approve committee proposals, develop finances, and provide general governance of the college. Weekly correspondence is necessary to maintain the level of commitment for Board service. Each Board member is tasked with liaison and committee duties, as well as special projects.

Opportunity for election to the Board of Directors begins with a member in good standing. For most members, this begins with frequent attendance at ACOEP meetings, followed by committee service, progression to committee leadership, and an expressed desire to serve on the Board.

Demonstration of long time service to the college through committee work or special assignment is more likely to solicit an invitation by the Nominating Committee, than a causal association with the College.

On yet another plane of service is the Executive Committee. This group deals with sensitive College issues on an almost daily basis. General direction is given by the continued on page 4

:PV KPJOFE B DP[Z MJUUMF JOEFQFOEFOU HSPVQ BOE OPX ZPV XBOU UP CF UIF EJSFDUPS CVU

"EFORE 9OU #AN "ECOME $IRECTOR 4HREE 0EOPLE 7ILL (AVE TO $IE OR 2ETIRE

"U &.1 ZPV MM IBWF FYDFMMFOU DBSFFS BEWBODF "U &.1 ZPV MM IBWF FYDFMMFOU DBSFFS BEWBODFNFOU PQUJPOT JODMVEJOH BDDFMFSBUFE MFBEFSTIJQ USBJOJOH XIJDI XJMM BMMPX ZPV NFOU PQUJPOT JODMVEJOH UIF PQQPSUVOJUZ UP UIF PQQPSUVOJUZ UP CFDPNF EJSFDUPS PO ZPVS PXO UJNFMJOF CFDPNF EJSFDUPS PO ZPVS PXO UJNFMJOF $BMM ,/08 &.1

&YU OPX UP IFBS

i%PO U (FU 4UVDL w yB EJTDVTTJPO PG UIF BEWBOUBHFT PG DIPPTJOH B DBSFFS QBUI UIBU XPO U MFBWF ZPV TUVDL XJUI OP DIBODF GPS BEWBODFNFOU 5IJT SFDPSEJOH JT QBSU POF PG (PPE %FDJTJPOT "WPJEJOH UIF 'JWF .PTU $PNNPO $BSFFS .JTUBLFT &NFSHFODZ 1IZTJDJBOT .BLF

0S EPXOMPBE UIF BVEJP BOE PS UFYU BU

XXX FNQ DPN BEWBODFNFOU

$SFBUJOH B .PSF 1FSGFDU 1SBDUJDF 5IF #FTU JO &NFSHFODZ .FEJDJOF

The PULSE APRIL 2007

Editorial Drew Koch, D.O., FACOEP, Editor

Committees The purpose of this writing is not to be critical of the College, but to shed a different perspective on the committees at ACOEP. Let us review again the committee structure of ACOEP as it has evolved over the past thirty plus years. Historically, the committees were extensions of The ACOEP Board of Directors and mostly comprised of Board members and the committees were chaired

by Board members. It was extremely difficult for members of the college to facilitate membership on a committee.

I was thwarted on numerous attempts over several years to become a committee member of ACOEP. It was only during the mid-1990’s during the presidency of the late, Benjamin A. Field, D.O., that committee membership was opened to the membership. Members of the College were welcomed to join the ACOEP committees; however, the committees were laden with Board Members who controlled the decision making process of the committees.

I was finally able to serve on several ACOEP committees during Dr Field’s presidency and continue serving on committees and I truly enjoy the process and experience.

However, it wasn’t until the presidency of

Joseph Kuchinski, D.O., that the committee membership was truly opened to the general membership and under his tutelage and direction given goals and objectives from which to operate. During this period, committees were chaired by members of the College who were not Board members and the Chairs reported their activities and meetings directly to the Board at the fall and spring Board meetings.

Recently, the structure of the committees transformed from being independent to being an extension of the Board. The committee structure was changed and a Board liaison was added to each committee.

The liaison reported the activities of the committee to the Board, which decreased the communication between the committees and the Board and made the communication more Board member – to Board of Directors. The Board Liaison introduced initiatives to the committees and the Board Liaison provided how these initiatives were to be achieved. This reduced the effectiveness of the committees thus rendering the committees impotent.

With the rite of passage of each new President comes sweeping changes to the committees and their structure. Change is inevitable and hopefully for the betterment of the College. The following are highlights of the proposed committee changes set forth by Dr. Bell. Terms of committee service will be cyclical with

assignments of committee members to 1, 2, or 3 year commitments. Thereafter, all assignments will be 3 years and staggered, as well as, the terms of Chair, Vice Chairs and the Board Liaisons. The rationale is, in theory, to provide continuity of committee work, progression of leadership and well defined commitment period. Each committee will meet bi-annually and have at least one conference call annually.

Members are required to attend at least seventy-five percent of the meetings and actively participate in committee assignments. Committee project assignments will be selected from the ACOEP strategic plan and targeted through the Presidential objectives. The committees will perform the background work, formulate a plan and propose a budget for a particular project. The committee leadership will prioritize projects, delegate responsibilities, and implement approved proposals. The Board Liaison will continue to influence the Board of the committee’s proposals and funding. An evaluation of the committee’s projects and accomplishments will be reported bi-annually to the membership and board. Finally, the committee will self evaluate itself annually.

Prior to the sweeping changes initiated by Dr. Bell, there existed two reasons why members were involved in committee membership. One reason was for the continued on page 18

Table of Contents Presidential Viewpoints, Peter A. Bell, D.O., FACOEP . . 1

The Father of EMS . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

Editorial, Drew Koch, D.O., FACOEP . . . . . . . . . . . . . . 3

Case Report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

Executive Director’s Desk . . . . . . . . . . . . . . . . . . . . . . . . 5

EMS in Action . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

Open Letter to the Membership . . . . . . . . . . . . . . . . . . . 7

Emergency Department Ethics . . . . . . . . . . . . . . . . . . . 21

Update from the Hill . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Continuing Medical Education Calendar . . . . . . . . . . . . 22

Caught Up in the Web . . . . . . . . . . . . . . . . . . . . . . . . . 16

The PULSE APRIL 2007

THE PULSE–AN OSTEOPATHIC EMERGENCY MEDICINE QUARTERLY 142 E. Ontario St., Suite 1250 Chicago, IL 60611 312-587-3709/800-521-3709 Editorial Staff Drew A. Koch, D.O., FACOEP, Editor Peter A. Bell, D.O., FACOEP Fred G. Wenger, Jr., D.O., FACOEP Bobby Johnson, Jr., D.O., FACOEP Janice A. Wachtler, Executive Director Publications Committee Drew A. Koch, D.O., FACOEP, Editor & Chair Fred G. Wenger, Jr., D.O., FACOEP, Advisor Bobby Johnson, Jr., D.O., FACOEP, Vice Chair/ Asst. Editor James Bonner, D.O., FACOEP Annette Brunetti, D.O., FACOEP Randall A. Howell, D.O., FACOEP William Kokx, D.O., FACOEP The PULSE is published quarterly (January, April, July, and October) and distributed at no cost by the ACOEP to Members and libraries of Colleges of Osteopathic Medicine by the National Office of ACOEP. The Pulse and ACOEP accept no responsibility for statements made by contributors or advertisers.

Display and classified advertising are accepted. Display advertisements should be submitted as camera-ready, pdf, or jpg formats in black and /white art only.

Classified advertising must be submitted as typed copy, specifying the size, and number of issues in which the copy should be displayed.

The name, address, telephone numbers and E-mail address of the submitting party must accompany advertising copy. Advertisers will be billed for ads following the publication of their advertisements and payments will be due within 30 days of the issuance of the invoice.

The deadline for submission of advertising is the first of the month preceding publication, i.e., December 1, March 1, June 1, and September 1. The deadline for article submission is November 15, February 15, May 15, and August 15. ACOEP and the Editor reserve the right to decline advertising and articles for any issue.

The PULSE and ACOEP do not assume any responsibility for consequences or response to an advertisement. All articles and artwork remain the property of the Pulse and will not be returned.

Subscriptions to the Pulse are available to non-ACOEP members or other organizations at a rate of $50 per year.

ACOEP Launches New Online Job Service

The American College of Osteopathic Emergency Physicians announces the launch of its interactive job board, the ACOEP Career Center. With its focus on professionals in the fields of osteopathic emergency medicine, the ACOEP Career Center offers its members – and the profession at large – an easy-to-use and highly targeted resource for online employment connections.

“We’re very excited about the ACOEP Career Center, because we know how critical it is for employers in emergency medicine to attract first-rate talent with a minimum expenditure of time and resources,” Janice Wachtler, Executive Director of ACOEP said recently, “and it’s important for us to help enable smooth career transitions for our residents and others seeking employment in emergency medicine.”

Both members and non-members can use the ACOEP Career Center to reach qualified candidates. Employers can post jobs online, search for qualified candidates based on specific job criteria, and create an online resume agent to email qualified candidates daily. They also benefit from online reporting that provides job activity statistics. Hospitals seeking residents can now list their openings on the service, at no cost, and locate interested candidates with the same ability as employers to receive daily updates and the ability to scan resumes of these candidates online.

For job seekers, including residents, the ACOEP Career Center is a free service that provides access to employers and jobs, or residency programs in emergency medicine. In addition to posting their resumes, physicians and residents can browse and view available positions based on their criteria and save those positions for later review if they choose to do so. Physicians seeking employment or training may also create a search agent to provide email notifications of available positions that match their identified criteria.

The ACOEP Career Center has been developed in partnership with Boxwood Technology, Inc., the leading provider of career center services for the association industry, and the only such provider endorsed by the American Society of Association Executives (ASAE). In addition to hosting full-featured online career centers, Boxwood also provides technical support, customer service, accounting, context management, and ongoing product development. For more information on Boxwood Technology’s products and services, visit www.boxwoodtech.com or call 800-331-2177.

All information about ACOEP’s Career Center, visit www.acoep.org and click on Business Opportunities or call Mandy Lundeen, Membership Coordinator for further information.

continued from page 1

staggered appointment cycle. Anyone who has been appointed to a committee this year will be given a defined term up to 3 years.

Hopefully this will assure openings on each committee every year without disrupting the committee work or institutional memory. We hope this improved function will better meet the needs of the membership. It is our sincere intent to bring out the best in every member and find a niche within the college where every member can serve.

President and together with the Executive Director and ACOEP staff, the daily activities of the College is conducted.

This year we had a lot of individuals requesting committee assignments.

The process began in April and was completed in December. It was not easy, and not everyone was appointed to a committee. Because the college has grown so large, and because there is growing interest to serve, we are instituting a 3 year

The PULSE APRIL 2007

Executive Directors Desk Janice Wachtler

When Rights Collide Last year, an article in the Washington Post appeared in my electronic mailbox, submitted to me by several doctors who were upset at the prospect of Healthcare Workers having the right to deny care to patients based on their personal beliefs. I have to admit that this raised my concerns, not as a physician, but as a patient, or potential one. This article went on to address the fact that several states were considering legislation that would potentially pit the provider against the patient as far as right to life issues and one’s own religious beliefs. More recently, the Chicago press covered a case of a pharmacist who refused to fill birth control prescriptions because it was against his personal beliefs and the end result was intervention by the State of Illinois.

My immediate thoughts on both instances were how unfair this would be to the patient. Taking it further think of how unfair this would be to the patient in an emergency situation. While the patient has the right to choose his or her personal healthcare provider, making choices based on the physician’s practice techniques and personal tenets, what of the patient who is brought into an emergency room who cannot choose providers, what of their right? Is it the physician’s right not to choose to administer a birth control method to the woman who was a victim of rape or incest because he or she believes that all life, no matter how it was conceived, is precious and sacred? What of a potential child’s right who is born of rape and either raised not a beloved child but as a constant reminder of an incident that was hateful and hurtful to his or her mother? Would that physician condemn that child to a non-loving environment because of his or her religious beliefs? Does the physician

have the right to choose what will happen to that child? Will he or she contribute to that child’s welfare or have any responsibility after that potential child is born as to his or her well-being?

The Hippocratic and Osteopathic Oaths both state that the first thing a physician should do is “no harm” to his or her patients. I believe nurses, pharmacists, and dentists have similar oaths too. So when is it appropriate to interfere with a patient’s right to choose?

This is further complicated by the move of many hospital systems to faith-based ownership, which may or may not have regulations about the administration of contraceptive methods and abortion and the physician activities regarding them.

Again, the patient’s individual rights are not always adhered to or even considered in an emergency. After all, the unconscious patient or the patient who is unable to take him or herself to an emergency room will have no say as to the treatment if the hospital has such policies. So where does that leave the patient, I don’t know, do you?

I have asked these very questions of physicians in many specialties and have gotten numerous and varying answers. Many physicians believe that the patient has the right to request and be treated with a “morning after pill” to prevent pregnancy in the case of rape or incest, without the physician’s personal beliefs taking precedence. Many believe that if they objected to this treatment, simply on the basis of their personal tenets, they would seek out a physician to take charge of the care for this patient. Almost across the board, most held that patient care was the primary concern. Many who object to birth control have offered the opinion that they would take care of the patient but not necessarily suggest this as a routine part of their care, however, if the patient requested they would acquiesce to their wishes despite their own religious beliefs.

But what happens when legislation

The PULSE APRIL 2007

restricts patient rights? Is it the State’s right to deny the patient all the options available?

Will States allow healthcare workers to opt out of caring for patients based on ethnicity, sexuality, religion, and taken it farther, appearance? Does any of this belong in medicine?

While I cannot offer an opinion for anyone but myself I would be hard pressed to say that no legislation should be predicated on a religious or morale covenant when it comes to a person’s right to health care. Healthcare is a personal statement and no one should make decisions for the patient except the patient. Patient care is based on information and informed consent, and it is the decision of the patient, not the provider, to determine what is best for him or herself.

If a healthcare provider has strong beliefs he or she should consider the nature of healthcare. No one makes someone become a healthcare worker that is a personal decision based on many things.

There is no promise that a physician or healthcare worker will only care for patients who are nice, or clean, or thin, or straight.

There is no promise that a physician or healthcare worker will never see a victim of rape or incest, or simply wishing to terminate a pregnancy or that they will have to make a personal decision on their care in this instance. It is a personal choice to put on that white coat, or nursing pin or cap, and it is a personal choice where to practice, but it’s not a personal choice not to treat someone in need of health care. If a healthcare worker seeks a specific patient base, whether that be based on urban / rural situation; ethnicity and religious make up of its inhabitants the healthcare worker will need to locate his or her practice in a specific area where others with share similar beliefs, physical characteristics, religions and lifestyles.

Also, how would you feel if a patient refused your care because of your personal continued on page 10

The PULSE APRIL 2007

March 2007

Dear Member, In March, the Board of Directors made the decision to no longer meet conjointly with the American Osteopathic Association during their Convention and Scientific Seminar program in 2008 and 2009. The Board did vote to meet concurrently in the same city over the same dates in 2008. This will still allow our members to network with their fellow physicians in different specialty practices. Arrangements will be made to attend Alumni luncheons. This decision is consistent with the feedback received from a majority of our membership over the past several years.

Since its recognition as a specialty affiliate in 1978, ACOEP has conjointly met with the AOA. This relationship has allowed the ACOEP to provide its members with quality programs and camaraderie with other DOs. Unfortunately, the AOA has imposed restrictions over the years that have caused us to change scheduled events.

In addition, financial arrangements have been unpredictable. Our members have registered complaints on the locations and dates selected for the meetings. The quality and price of hotel accommodations and meeting rooms has also been a concern. We hope to remedy these concerns in 2008.

The ACOEP has contracted with Caesar’s Palace in Las Vegas, for the dates of October 27 – 30, 2008 to present its first concurrent program. Committee and Board meetings are expected to take place on Saturday and Sunday, October 25th and 26th. A formal notice of the meeting dates, hotel rates, and schedules will be made available to members within the next few months. Registration will be handled by the ACOEP and each participant will be provided with a ticket to his or her Alumni Luncheon. Tickets to the AOA Presidential Reception can be ordered separately. We are working out the logistics such that participants will have access to the AOA’s Convention Floor, and have access to emergency medicine-related vendors at our location.

We have established a reputation among emergency medicine professionals as presenting quality educational events. We hope to enhance this expectation. We have provided our members with value-related educational hours at upscale venues. We hope to improve on this expectation.

So, will concurrent meetings be permanent? We don’t know. But the Board of Directors felt this would be the right time for a change as we plan for the future.

Thank you for your continued support of the College and we look forward to better serving your educational needs in the future.

Sincerely,

Peter A. Bell, D.O., FACOEP President

Thomas A. Brabson, D.O., FACOEP President-elect

The PULSE APRIL 2007

chose ECI “Ibecause they help me to schedule all the important things in my life.

”

ThE naTIon’s prEmIEr, prIvaTEly-ownEd sTaffIng and managEmEnT Company. founded by physicians • owned by physicians • physicians managing physicians

800.253.1795 / www.eci-med.com

The PULSE APRIL 2007

Update from the Hill Raul J. Garcia, D.O., FACOEP Chair, Governmental Affairs Committee

There Is a New Legislation in Town How about our Healthcare System?

Medical Liability Reform

After trying to pass Medical Liability Reform for so many years, this will take a back seat with the new Congress. Most of the Democratic leaders strongly oppose reforms set forth on previous years and highly supported by the AOA and ACOEP such as capitation on non-economic damages. If there is any bill introduced on this issue will be to reform medical liability through reviewing and changing current laws involving medical liability insurance companies but not touching upon any restrictions on lawyers or law suits vs. physicians.

Last Elections

Analysis of the last elections gives us some interesting results. According to experts in Washington, democrats and republicans were consistent in voting on a partisan basis. There was not much crossing of party lines when individuals voted in the last elections. Being a nonpresidential voting year, the turnout was about 20% lower than in 2004 and both parties had an equal percentage of people going to the polls. According to experts, the difference came from the independent vote, more specifically from young people over 18 years of age and younger than 30.

(The ones who would be mostly called upon if there were to be a draft)

What does it mean for us to have a new party leading Congress? All attention is on the new Congress now to evaluate if the Democrats can really do anything to change things around. Remember that the focus will swiftly switch in six months to the 2008 presidential elections. None of the two parties will want to take on a complex issue leading to the presidential elections.

Medicare Physician Payment

This issue is sympathetic to both parties but no one has the answer yet.

The need for comprehensive reform of the physician payment formula is in focus but the complexity of change and cost associated with it is monumental. The current cost estimate of changing the formula is about $230 billion dollars.

Due to the fact that there are leaders on both sides of the isle that would like to see some positive flow in physician payments, there may be bills introduced to try and remedy the issue for a couple of years while they figure out how to change the formula. ACOEP and the AOA will stay alert as to any bills introduced on this issue.

Graduate Medical Education

This is an issue that may receive greater consideration under the new Congress.

Democrats should be more supportive of expanding postgraduate education.

Elimination of residency caps will remain difficult but non-hospital training and increasing training programs will receive

The PULSE APRIL 2007

stronger consideration.

There will probably not be any reduction of J-1 visas to foreign medical grads with the new Congress but Democrats may be amiable to redistributing the J-1 slots across state lines.

The AOA is looking at ways to introduce initiatives to help new graduate medical education hospitals. The lag time from beginning postgraduate programs to payments of such programs from the federal government can financially burden hospitals and in some cases is the cause for great hospitals to refuse to be a part of postgraduate education. We are actively looking at ways to change this.

Student Loan Financing

The Democrats pledged to reform the Nation’s student loan program. These changes include increasing the amount under the PELL grant program, increasing the amount under the Stafford program, reducing interest rates for loans. There will be great opposition from lenders who may drop off the federal student loan program.

The AOA and ACOEP will continue to support any efforts on this end including the total elimination of capitation for student loan interest deduction that may or may not come up with the new Congress.

Access to Healthcare and Uninsured

The Democratic leadership may resurrect the “Medicare for All” Health Care system but with a $600 billion dollar price tag, it will probably not get much support.

There is bi partisan on the expansion of State Children’s Health Insurance Program.

There is a good possibility that legislation may be introduced to expand this program through college years.

A proposal for small business health continued on next page

Update from the Hill, continued from page 9

plans may have some opportunities as well after some Democrat leaders have expressed interest in this old republican issue.

Medicare Prescription Drug Benefit

This issue will probably not have major overhaul since the current plan has been favorable received. The Democrats will push to have the Department of Health deal with the cost of prescription drugs with the pharmaceutical companies and also push to remove the gap in coverage established before where the beneficiary had to incur all cost between $2250 and $5100.

Health Information Technology

There will be a push for a comprehensive interoperable health information system that does not compromise patient confidentiality.

Rural Health

Rural Health should benefit from the new Congress due to the interest of expanding access to healthcare. Rural hospitals should see an increase in funding that might equate on a larger focus to non-physician providers.

Executive Director's Desk, continued from page 5

appearance, religion or beliefs? Would that impact on your right to practice medicine?

Will States need to pass legislation on Patient Rights to countermand Healthcare Worker Rights?

Corrections

In the January 2007 edition, we learned that several articles had errors in them, and for that we truly apologize to our readers and to the people affected by them.

First, our sincere apologies go out to Matthew Tews, D.O., one of the winners of AOF’s Emerging Leader Awards for 2006. Dr. Tews, a graduate of the Des Moines University College of Osteopathic Medicine and the emergency medicine resi-

10

Specialty Hospitals

The Democrats are divided in this issue. Some believe that specialty hospitals will improve quality and reduce cost. Others believe that this will limit access to healthcare. This will not be a high priority.

NIH

NIH funding for research should increase even though the money may go to support research in controversial issues such as embryonic stem cells.

Please see our website for the latest news on these federal issues, state issues and more. The Government Affairs committee welcomes your views on any of these or other issues that you think we should be concentrating our efforts in federally or in your state.

On other NEWS… National Library of Medicine/AOA Partnership

Final preparations are under way for the launch of a National Library of Medicine/ AOA partnership. The pilot project will encourage physicians to educate their patients about the value of using MedlinePlus.gov to find high

quality, reliable medical information that is free of advertising.

(From AOA Washington report)

Becky Lyon, deputy associate director for the Library operations explained that the website is an interactive and easy to use web site where our patients can obtain further information about their condition.

This will benefit Emergency Department patients that are discharged and want further answers to their health questions.

This web site is regulated and is a great source for patient tutorials as well as access to medical journal articles. The web site includes lists of hospitals and physicians, information on medications, links to thousands of clinical trials, health information in Spanish, and more. We encourage all of our members to use the web site and critique it.

DO NOT FORGET TO SIGN UP FOR “DO DAY ON CAPITOL HILL 2007” (April 26th, 2007) We are working on having an event on the night of Wednesday, April 25th for all ACOEP members who come to D.C. Registration is available at https://www.do-online.org/ index.cfm?PageID=doday

While I will not speak for the ACOEP and this article does not endorse a specific side of this debate, I think this is a question we each will have to answer when and if the situation arises. I only address this now as a discussion issue that may, unfortunately, arrive at healthcare institutions doorsteps and in physicians’ realm of responsibility

as the Country goes forward in this decade.

Hopefully whatever personal decision is made, it will be a decision that you will make that will be the best decision for you and your patient.

dency at Michigan State University, College of Osteopathic Medicine in East Lansing was honored by the American Osteopathic Foundation at its annual event as one of the Emerging Leaders in the Osteopathic profession. Our congratulations are sent to Dr. Tews for his achievement and we wish him continued success in his professional and personal life.

ates spearheaded (the Resident Jeopardy Tournament) since its inception and had an amazing turnout.” In reality, the Resident Jeopardy Tournament was the idea of two current residents at Good Samaritan Hospital in West Islip, New York, Shan Ahmed, D.O. and Leo Huynh, D.O. This event has been a successful and fun event at the Resident Chapter meeting and we thank them for sharing their ideas with the Chapter.

Also, in our article, Resident Activities in Las Vegas, the author stated, “Recent St. Barnabas gradu-

The PULSE APRIL 2007

AstraZeneca

is pleased to support the

American College of Osteopathic Emergency Physicians AstraZeneca is one of the world’s leading healthcare companies, providing innovative, effective medicines for serious medical conditions.

Skilled research is at the heart of our continuing success and we spend more than $2.7 billion each year on the discovery and development of new and improved medicines.

Our track record of innovation includes leading treatments for gastrointestinal disorders, heart disease, cancer, central nervous system (CNS) disorders, respiratory diseases and pain and infection.

With US headquarters based in Wilmington, Delaware, we are committed to maintaining a flow of new products around the world which protect and improve human health and quality of life.

www.astrazeneca-us.com Š 2002 AstraZeneca Pharmaceuticals LP

The PULSE APRIL 2007

11

research and development organization With 100 years of combined experience, scientists at AstraZeneca have discovered and developed several of today’s leading prescription medicines—pharmaceuticals that contribute to a higher quality of life for millions of patients and to a better health economy worldwide.

Based in Sweden, AstraZeneca’s R&D organization is international in scope and comprised of approximately 10,000 researchers. Through its own resources and through collaboration with dozens of universities and strategic alliances with numerous research and biotechnology companies, AstraZeneca has broad access to advanced technologies in biomedical research, including genomics, bio informatics, chemical libraries, high throughput screening and product delivery systems.

leading with products

AstraZeneca’s success ratio of bringing new

Priority research is being conducted for the

products to market is among the best in the

development of treatments for high cholesterol,

pharmaceutical industry. The company

blood clot formation, lung cancer and other

produces a wide range of products that make

types of cancer.

significant contributions to treatment options and patient care.

With an R&D pipeline that has been recognized as the best in the industry, the company is well

AstraZeneca has one of the world’s leading

equipped to maintain a flow of high quality

portfolios to treat cancer and gastrointestinal

medicines over the coming years. These

disorders, in addition to the areas of anesthesia

medicines will offer improved health and quality

(including pain management), cardiovascular

of life for patients, better health economics for

disease, respiratory and central nervous system

society and attractive growth for AstraZeneca.

disorders.

12

The PULSE APRIL 2007

AstraZeneca is a major international research

AstraZeneca operates nine different R&D sites

based pharmaceutical company engaged in the

and has sales activities in over 100 countries

development, manufacture and marketing of

and manufacturing facilities in 19 countries.

ethical (prescription) pharmaceutical products. Our

The Company has a workforce of more than

long heritage of innovation and documented ability

50,000 strong—with over 10,000 employees in the

to develop new concepts in medicine has made us

U.S. alone.

one of the top five pharmaceutical companies in the world.

AstraZeneca PLC is headquartered in London with its U.S. headquarters located in Wilmington, Delaware. Wilmington is also the global home for the company’s Central Nervous System (CNS) commercial and research and development efforts.

The PULSE APRIL 2007

13

leading in the community and the workplace patient assistance program AstraZeneca is acutely aware of the growing costs of healthcare in the United States. The AstraZeneca Foundation Patient Assistance Program (PAP) (formerly the Zeneca Pharmaceuticals Foundation Patient Assistance Program), which has been in existence since 1978, and the

In addition to its products and research and development efforts, AstraZeneca provides health education information, support services and health guidance to millions of Americans through public awareness campaigns including: • National Breast Cancer Awareness Month • Prostate Cancer Awareness Month • Capitol Hill Briefing Program with Asthma and Allergy Foundation of America (AAFA) • National Alliance for the Mentally Ill (NAMI) Helpline Online

AstraZeneca LP Patient Assistance

• NAMI’s Campaign to End Discrimination

Program provide AstraZeneca products

• Migraine Mentors Program with the

free of charge to patients who cannot afford them and who do not have insurance or other programs that can provide the product. Currently there are more than 250,000 patients enrolled in these programs. Over the past year, AstraZeneca donated medicines valued at over $250 million to indigent patients across the United States and Puerto Rico.

National Headache Foundation • Clinical Outcomes Research Initiative (CORI) with the American Society for Gastrointestinal Endoscopy • Nationwide Asthma Screening Program with the American College of Allergy, Asthma and Immunology (ACAAI) • Human Medicine Symposium Series with the Minority Health Institute While AstraZeneca is committed to educating the public, the business’s commitment to its own employees is equally important. AstraZeneca offers onsite breast, prostate, colorectal and skin cancer screenings as well as preventive health programs for employees in all of our therapeutic areas.

www.astrazeneca-us.com © 2002 AstraZeneca Pharmaceuticals LP

14

The PULSE APRIL 2007

Student Chapter Update Joshua Morrison, M.S., President

Winter is winding down and spring draws rapidly nearer, which means it’s time for some Arizona sun! We are very excited to continue the tradition of giving back to the membership and will be hosting our annual outing for the members and their families. Join us for a “Night at the Ballpark” on Wednesday, April 11th, as the Arizona Diamondbacks take on the Cincinnati Reds. Transportation to and from the park will be provided. To RSVP, call the ACOEP office at 1-800-521-3709.

Before you go, however, be sure to visit the student-run OMM clinic that Wednesday afternoon from 1-5pm, and let us assist you in preparing for a relaxing evening out.

Before I get into the update, I would like to share a few experiences with you, starting with an invitation I received for breakfast with the AOA President. I must admit that I was not expecting much in the way of true conversation, but I was definitely up for a good breakfast. During the peak of winter, Dr. John Strosnider made his way to Biddeford, Maine, to visit the University of New England College of Osteopathic Medicine, and on this especially cold morning he sat down to breakfast with our local student leaders. Surprisingly, I found Dr. Strosnider not only easy to talk to, but actually eager to take on tough questions.

I gave him everything I had, from the combined match to the traditional internship requirements, and without hesitation he looked me right in the eyes and gave me straight answers.

The AOA match process is really not an obstacle but a gift. Students from all over the world compete for spots in the ACGME match, but you must have the unique training of an osteopathic medical education to be eligible for the AOA match program. We live in a medical field that is growing; the government has asked schools across the country to increase their class sizes; new institutions are opening every year; and all this is in an effort to meet the forecasted physician shortage. However, the number of graduate medical education programs remains constant and the government is showing no desire to increase that number.

Residency programs will continue to become more and more competitive, and our AOA training positions will secure our placement in top-quality graduate medical education. Just as those before us worked hard to provide today’s opportunities, we must strive to continue strengthening our profession, our college, and our education.

The AOA is protecting our future, and the ACOEP ensures that our residency programs provide exceptional training. As medical students, it is now our responsibility and privilege to take advantage of these opportunities.

It is said that much of the future can be learned from the past, and as we progress into this new century we must not forget where our profession has been.

Dr. Strosnider brought up the latest topic on his AOA president’s blog: Some students had inquired about changing the degree name to include “medical,” so that our initials would be closer to our allopathic colleagues and cause less confusion. MDO? OMD? After some discussion about the essentially impossible steps that would have to be taken, Dr. Strosnider commented, “If you wanted an “MD” at the end of your name, you have gone to the wrong school.”

As students, we need to understand that people spent their lives fighting for our rights to those letters, “DO,” and it is truly our privilege to join their ranks.

I was inspired by Dr. Strosnider and proud to be an osteopathic student working to join the ranks of a truly great profession. As I mulled over my lessons of the morning, my position as Student Chapter president began to take on new form.

What had started as a great opportunity to participate in the college as a student leader had become without a doubt a great honor.

I realized I had been granted a unique position to serve my fellow students, my college, and my profession. Many challenges lie ahead, but many great people who have gone before me served so that I was allowed these challenges - these are not obstacles, but gifts.

Following my visit with Dr. Strosnider, I was given the opportunity to speak at the ACOEP program directors workshop in

The PULSE APRIL 2007

Reno. During the trip, I had many great one-on-one conversations with directors from across the country. I can now honestly say to my fellow students that if you are concerned that any of these programs may be lacking something, they are - YOU! I only wish that every student could experience the intensity and dedication that these folks possess, and it was at that point that I realized the direction for my inspiration.

The objectives of the student chapter clearly state that we exist to educate osteopathic medical students about emergency medicine, as well as to promote the establishment of quality postgraduate programs.

This is the core of our organization, and our goals have been set with these in mind.

Communication at the national level is better than ever, thanks to the direction of our vice-president Jamie Hinkle (KCUMB) and the efforts of our treasurer Michael Archer (LECOM), secretary Justin Arnold (NSUCOM), and immediate past president Josh Linebaugh (KCUMB). Our improved communication has allowed us to stimulate more student participation with the college. Through the guidance of our advisor, Dr. Duane Siberski, and our board liaison, Dr. Beth Longenecker, we plan to open up new avenues for student involvement.

We are extremely appreciative of the work done by the previous national officers and will strive to retain continuity in our organization. The dedication from our previous president, Josh Linebaugh, has been pivotal to our steady progress.

Although he will soon leave our ranks as a student, I know he will always be there for us. We wish him great success, and for his family health and happiness always. See you in Arizona!

Thoughts are like arrows: once released, they strike their mark.

Guard them well or one day you may be your own victim.

—Navajo Indians

15

Caught Up in the Web A Progress Report on the Website Reconstruction Last August the new website of the ACOEP premiered with a big sigh, some prayers, and a sense that this thing was bigger than anything we could have done even five years previously. Somehow, the planets and stars, staff and vendors aligned and the site was wonderful. We stood silently and whispered, “Wow,” under our breath and sent out announcements to members, vendors, and our specialty peers.

We are now well into Phase Two and despite some snags and bumps, we are able to announce that you now have the ability to post and apply for 06-EM-471 5:21 PM Page positions on the5/2/06 site. Employers can now list their company on the Career Page,

place a job description, requirements for the positions and establish a mailbox on the site at which they can retrieve prospective applicants and even contact them via the web to establish an interview time. This service is available at a fee for the service provided by a third party company.

Need a resident to fill a spot in your residency? List it for no cost on the Career Page. It works just like a job board for employment and is pretty handy for timestrapped program directors.

We are now Google-able for employment so physicians seeking positions can Google Emergency Medicine for a link to the site and the Career Page.

The remainder of Phase Two will be to bring the Member Page on board with the import of our new member data1 base.

We anticipate that we will have this section fully operational in the summer and

then we will move onto Phase Three which will bring on-line registration for our CME programs and online payment of CME fees and dues. The due date for the completion for Phase Three is early 2008.

We are currently looking into other services that the website can provide including, allowing us to email members when the newest issue of The Pulse is available and providing members with a direct link. We think we will be able to do this once the member database in aligned with the site and when some issues with Comcast are resolved, so that we can contact members utilizing Comcast as their email service.

If you have any ideas on functions or services we can provide to you in the future, please contact the ACOEP.

career

Your is moving.

We’ll make sure it’s direction. in the

right

The best practice begins at EmCare.

If there’s one thing your job has taught you, it’s that your training never ends. At EmCare, we make professional development and continuing education a priority for physicians. Programs like the EmCare Leadership Institute and our Internet Training System enable you to open new doors and further your career. And that is one very valuable lesson.

800-EmCare1 (800-362-2731) recruiting@emcare.com www.emcare.com/opportunitywatch

16

The PULSE APRIL 2007

The Father of EMS Second of a series Wayne Jones, D.O., FACOEP Dominique Jean Larrey was born the son of a French shoe maker.

The only education available to him was through the village priest. At the age of 13 he was orphaned and sent to live with his uncle the chief surgeon in Toulouse.

Larrey studied and completed a surgical apprenticeship with his uncle before moving to Paris to attend the University of Paris.

One of his anatomy professors was none other than Dr. Joseph Ignace Guillotin.

Though Dr. Guillotin did not invent the infamous machine, he championed the cause winning the honor of having the contraption named after him (he felt it was more humane). His family later changed their last name after a failed attempt to replace the term “guillotine”.

Larrey felt he must repay his country for giving him such fortune. He entered the service as a ship’s surgeon on the frigate Vigilante but resigned due to chronic sea sickness. Larrey returned to Paris to work with renowned surgeon Pierre-Joseph Desault. Desault, though a surgeon, was the first to describe the diseases of the kidney causing dehydration and related medical disorders.

Larrey believed passionately in human rights and was in the crowd of people who stormed the prison Bastille - marking the French Revolution. He became a field surgeon under Napoleon with the rank of Major. He quickly recognized the futility of treating those wounded on the battlefield.

Tradition allowed the dead and injured to be removed from the battle field only as the fighting would cease, every 24-36 hours.

Mortality was high as many soldiers with extremity wounds would develop gangrene by the time they saw a physician. Patient transports were slow large wagons, not allowing for rapid treatment. Larrey soon

realized the need for better medical organization and transport on the battle field.

Larrey watched as the artillery volante or “flying artillery” would race onto the battle field, discharge its round and return for reloading. Why not transport injured in the same way? It was not long before Larrey’s “ambulance volante” would be placed into action. One or two patients would be transported soon after injury with immediate medical attention. Larrey perfected the art of amputation. It has been said he could perform a leg amputation in one minute and an arm in 17 seconds.

Larrey felt any soldier should be treated with respect to severity of injury and

The PULSE APRIL 2007

not rank, social standing or nationality. He used the term trier or “sort” to describe his method of triage. Not only did he win the hearts of his countrymen but those of his combatants. At the end of the war, while Napoleon was exiled, Larrey was set free.

His compassion on the battle field had won his freedom.

Larrey’s ambulance design, surgical techniques and triage principles remained relatively unchanged for nearly 100 years.

It would not be until the end of WWI that ambulance design would change. He truly deserves the title of “Father of EMS”.

17

Case Report Theodore A. Spevack, D.O., FACOEP

Danger In The House: Isopropyl Alcohol

We report the case of a 27 y/o male who, while being evaluated in the emergency department, ingested a full 16-ounce bottle of isopropyl alcohol, 70%.

The patient rapidly became somnolent and bradypneic, lost his gag reflex, and required endotracheal intubation with mechanical ventilation. He was transferred to the intensive care unit, where his stay was complicated by hypokalemia, mild renal failure, and hyperosmolarity.

Fortunately, he fully recovered from the ingestion, and was eventually transferred to the psychiatric service for further care.

Subsequently, we canvassed the hospital and found that while isopropyl alcohol in liquid form was supplied to many departments, very few had any medical use for it.

70% isopropyl alcohol is widely used in the hospital setting as a skin disinfectant, but is supplied in individually impregnated sterile pads (1¼ inch by 1¼ inch), which provides a much safer means of application.

Most departments used the bottled isopropyl alcohol only for the cleaning of various non-medical surfaces, especially desks and telephones. We therefore the removed the product from all patient care

areas of the hospital, and suggest other hospitals and medical facilities consider doing the same.

Editorial, continued from page 5

time. If too much is expected of committee members and undue hardships are placed upon them, there will be no members who will volunteer to serve on the committees.

It is a delicate balance between having committees and its member’s responsible and placing undue burdens upon the members.

Now, there is third reason why members join committees and become committee chairs to utilize these positions as a stepping stone to the Board of Directors.

It is important for any organization to have a pool of talent that is tapped upon for leadership positions and utilizing committee chairs as the source of leadership cannot be refuted. However, not every vice-chair or chair covets a Board position. Working up the committee ladder to the Board involves a large time commitment that not every committee member can commit.

There are career, personal, family and community commitments that take precedence over committee member’s commitments.

Finally, there are individuals who just want to serve the College and are not interested in leadership positions. Hopefully, there is a place in the College for individuals who just want to volunteer their time and are not interested in leadership roles.

The only other concern regarding

the changes to the committees is that committees’ retain autonomy in project assignments either through the ACOEP strategic plan or through the presidential objectives. It is imperative that the committees be allowed to attain the presidential objectives and assignments on their own without mandates from the Board and board liaison.

Several committees were merged to decrease the duplicity of activities and to better serve the needs of the membership. The size of the committees has been increased which should increase the participation of the committee and create a quorum for the committee to conduct business. These changes were inevitable and necessary to improve the health of the College committees.

Any changes that are going to enhance the committee’s effectiveness and increase membership participation are welcome.

Healthy committees are essential for the continued well being and success of the College

purpose of fulfilling criteria to become a Fellow in the College and the other was self-fulfillment and the act of giving back to the College. Several members of the College have utilized committee membership as one of the requirements for obtaining the honorary title of Fellow in the American College of Osteopathic Emergency Physicians, and once Fellowship is obtained they are no longer involved in committee participation. Before the College opened up the committees to the members it was very difficult to utilize committee membership as one of the criteria for Fellowship.

I enjoy serving on College committees and feel it is one way that I can give something back to the College and the profession. By being involved, I feel I contribute to the well being and the future of the organization. It would be ideal if every member of the College would serve on a committee or volunteer their time for the organization, but not everyone has the time or the inclination to serve the College.

Serving on a committee or giving time to the College is all voluntary and unreasonable expectations and demands should not be placed on anyone volunteering their

18

The PULSE APRIL 2007

Dr. Spevack is a Clinical Professor and Chair of the Department of Emergency Medicine at the New York College of Osteopathic Medicine, Old Westbury, New York and Director Ex-Officio of the Department of Emergency Medicine at St. Barnabas Hospital, Bronx, New York

EMS in Action Wayne Jones, D.O., FACOEP and Michael Gallagher

Meet You at the Gate

On January 25th of this year, an unexpected snowstorm struck my hometown of Erie, Pennsylvania. Within an hour, the gale force winds carrying an arctic blast of lake snow enveloped the area.

Visibility was reduced to several feet and the wind chill had incapacitated the effect of salt on the road surfaces, and one of our major interstates (I-90), fell victim to a fifty plus car pile-up.

The scene stretched for 10 miles.

Reports of 3 dead floated on the airways and in reality only one would perish, and multiple injured filled the airwaves. Hospitals were on stand-by for injuries. I, myself, was called to the scene to evaluate a truck driver who could not be removed from the wreck. His foot was crushed within the dash of the vehicle and EMS was considering amputation of the foot in order to save his life. Below, is a story told by a friend, and freelance photographer, Mike Gallagher.

the wheel of the truck dangling over the gorge.” He smiled an ironic smile, “Last night one person won 250 million in a lottery; today I tell you I am luckier than that person because some man put his own life in serious jeopardy just to save mine.

When we made it to safety I was in tears and I turned to thank him and he walked

a few of my photos and understand why this act of bravery has me in tears more than 24 hours since Ron Hall walked up to me on that bridge.

I wish you all a great day and no matter what life throws at you take time to value what little time we truly get to be alive!

away into a snow whiteout and I never even got to get his name.”

In the eyes and heart of Ron Hall, he met a hero or an angel. Whatever the case in a world of so much bad there is some good if one man is willing to put the life of someone he did not even know above his own!

I have had the good fortune to produce photos and videos for rock stars like Pat Monahan, NFL Hall of Famer, Dan Marino, All Pro Quarterback, Marc Bulger, and so many others; but when the time comes to sit down and write that book you can bet the unknown hero and the grateful trucker are sure to be featured in a prominent fashion. I hope you all can view

Thanks RON HALL, for sharing your story with me. To the hero that saved him; we may never know your name, but I would guess that when your day finally comes there will be a place on the other side of the Pearly Gates that already has been reserved for you.

Subject: Who's Luckier than this Truck Driver?

Date: Sat, 27 Jan 2007 02:24:02

I met truck driver Ron Hall; the man behind the wheel of this rig during a fifty car pile up on I-90 in Erie Pa. He opened his door when his truck came to a stop, looked down, and knew he was dangling 200 feet above the Winter Green Gorge.

He thought he was going to die. When he looked back across the bridge a man in a Carhart sweatshirt was walking the 8-inch wide guide wall in an attempt to save the trucker before his rig would fall.

The man climbed on the wreckage, broke out the windshield, and pulled him out of the cab and walked him back along the ledge to safety. When this driver, Ron Hall, approached me, I said, “Were you one of the drivers in this wreck?” “No,” he said "I am the Power Ball winner who was behind

The PULSE APRIL 2007

Mike Gallagher is a free-lance photojournalist from Erie, Pennsylvania. This article is used with his permission.

19

20

The PULSE APRIL 2007

Emergency Department Ethics Bernard Heilicser, D.O., MS, FACEP, FACOEP

What Whould You Do?

The following case was submitted

by David Rosenbaum, M.D., from the Department of Emergency Medicine at Ingalls Hospital in Harvey, Illinois.

A 48 year-old female with a history of HIV presented to the Emergency Department by EMS after an apparent seizure. She was accompanied by one of her sons, who was unaware of the HIV status. The patient had become confused earlier that afternoon at a store and could not ambulate. The son got her home with difficulty and placed her on a couch.

Soon after, the patient experienced a tonic episode, followed by a vague shaking. EMS was called.

On arrival to the ED, the patient was obtunded and unresponsive to painful stimuli. Her eyes were deviated to the left and the extremities were flaccid. Although breathing spontaneously, the gag reflex was absent. Vital signs were Blood Pressure 246/121, Respirations 10, Pulse 124, Pulse Ox 100% on NRB, and Glascow of 7. An intracerebral hemorrhage was suspected.

Prior to CT scan the patient was intubated for airway protection. This was discussed with the son. The CT revealed only old lacunar infarcts and chronic changes, with no acute bleeds.

At that point, further conversation with the son ensued. Apparently, he had learned from other family members that the patient “did not want to be on a machine” or have her life prolonged. There was no written advance directive. He requested life support be removed. It was explained to him that the patient likely had a seizure and was in a prolonged postical state, and this immediate condition was potentially reversible. It was also stated to the son that additional family involvement would be important.

Approximately one hour later, the entire primary family arrived (all aware of the HIV status), all requesting discontinuation of life support measures. This included

all three sons, a sister and a grandfather.

There was no written advance directive, but clearly the patient had discussed end-of-life issues with her family.

What would you do?

Please send us your thoughts and ideas (fax 1-708-915-2743). Every attempt will be made to publish them when we review this case in the next Pulse.

If you have any cases in your practice that you would like to present or have reviewed in the Pulse, please fax them to us.

Seek wisdom, not knowledge.

Knowledge is of the past; wisdom is of the future.

—Lumbee Indians

ACOEP has recognized Monica H. Masters

Financial Advisor Financial Planning Specialist (800) 621-2842, ext. 3338 As a Financial Advisor for: Investments, Lending, Insurance and Financial Planning.

Three First National Plaza, Suite 5100, Chicago, IL 60602

© 2006 Citigroup Global Markets Inc. Member SIPC. Smith Barney is a division and service mark of Citigroup Global Markets Inc. and its affiliates and is used and registered throughout the world. CITIGROUP and the Umbrella Device are trademarks and service marks of Citigroup Inc. or its affiliates and are used and registered throughout the world.

4.25 x 5.5 The PULSE APRIL 2007

21

Continuing Medical Education Calendar 2007 April 10–14

ACOEP Spring Seminar Sheraton Wild Horse Pass Resort and Spa Chandler, AZ 25 hrs Category 1/1A Credit

24-26

Navigator Conference 2007 National Academies of Emergency Dispatch Riviera Hotel and Casino Las Vegas, NV CDE credit provided www.emergencydispatch.org

25-28

2007 National Trauma Meeting American Trauma Society Key Bridge Marriott Arlington, VA 703-524-6400

August 1–4 New Frontiers in Toxicology Hotel (TBA), Cleveland, OH 25 hrs of Category 1A 20-22

September 14 – 15 Oral Board Review Four Points Sheraton, Chicago, IL 10 hrs Category 1A 30

May 3-6 110th Annual Convention Indiana Osteopathic Association Radisson Hotel at Star PLaza Merrillville, TN 30+ Category 1A Credit 800-942-0501 / 317-926-3009

13th Annual San Antonio Symposium Henry B. Gonzalez Convention Center San Antonio, TX www.hjf.org

AOA Convention Opens San Diego, CA

October 1-4 ACOEP Scientific Seminar San Diego, CA 25 Category 1A Credit

4–5 Oral Board Review Four Points Sheraton, Chicago, IL 10 hrs Category 1A

2008 January 2008 9-14 Emergency Medicine: An Intense Review Westin Hotel River North, Chicago, IL 40-42 hrs Category 1A Credit 40-42 hrs Category 1Credit

22

February 5-9 COLA Essentials Marco Island Hilton Hotel Marco Island, FL 25 Category 1A Credit 25 Category 1 Credit (pending)

The PULSE APRIL 2007

Coming Soon

Oral Board Review Chicago, Illinois May 4-5, 2007 and September 15-16, 2007

The PULSE APRIL 2007

23

Is your career as a physician as fulfilling as you always hoped it would be?

TeamHealth offers more.

You’ve wanted to be a physician for as long as you can remember. Whatever your goals—to serve on a national specialty task force, to reach out to mentor residents, to serve as an ED medical director, or to have the flexibility to enjoy life outside of work—TeamHealth provides the resources and support to help you be the kind of physician you’ve always wanted to be. Leave behind the administrative hassles of managing a physician practice and let TeamHealth support you in

is your career all you dreamed it would be?

providing exceptional patient care. Isn’t that why you became a physician in the first place?

If your career isn’t all you dreamed it would be,

call TeamHealth today.

800.818.1498

ACOEP NEWSLETTER

Presorted Standard U.S. Postage

PAID

Chicago, IL Permit No. 2177

142 E. Ontario Street, Suite 1250 Chicago, Illinios 60611

24

www.teamhealth.com

The PULSE APRIL 2007