The Pulse - October 2015

the

Pulse

October 2015

Osteopathic Emergency Medicine Quarterly

Presidential Viewpoints

| Mark A. Mitchell, DO, FACOEP-D

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VOLUME XXXVI No. 4 Editorial Staff Timothy Cheslock, DO, FACOEP, Editor Drew A. Koch, DO, FACOEP-D, Assistant Editor Mark A. Mitchell, DO, FACOEP-D John C. Prestosh, DO, FACOEP Erin Sernoffsky, Editor Janice Wachtler, Executive Director Thomas Baxter, Graphic Design Manager Editorial Committee Timothy Cheslock, DO, FACOEP, Chair Drew A. Koch, DO, FACOEP-D, Vice Chair John C. Prestosh, DO, FACOEP Board Liaison/Associate Editor Stephen Vetrano, DO, FACOEP Andrew Little, DO Erin Sernoffsky, Editor Thomas Baxter, Graphic Design Manager The PULSE is a copyrighted quarterly publication distributed at no cost by the ACOEP to its Members, Colleges of Osteopathic Medicine, sponsors, exhibitors and liaison associations recognized by the national offices of the ACOEP. 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, 142 East Ontario Street, Chicago, IL 60611 ∙ (312) 587-3709 or electronically at marketing@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. Advertisements due dates can be found by downloading ACOEP's media kit at www.acoep.org/advertising. The ACOEP and the Editorial Board of The PULSE reserve the right to decline advertising and articles for any issue. ©ACOEP 2015 – All rights reserved. Articles may not be reproduced without the expressed, written approval of the ACOEP and the author.

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Osteopathic Emergency Medicine Quarterly

Table of Contents

Presidential Viewpoints...................................................................................................................3 Mark A. Mitchell, DO, FACOEP-D The Editor's Desk..........................................................................................................................4 Timothy Cheslock, DO, FACOEP Executive Director's Desk...............................................................................................................5 Janice Wachtler, BAE, CBA The On-Deck Circle........................................................................................................................6 John C. Prestosh, DO, FACOEP A Rare Presentation of Autoimmune Encephalopathy in the Emergency Department: Stiff-Person Syndrome in a Young Female........................................................................................9 Michael Neeki, DO; Nina Jabourian, DO; Alex Jabourian, DO; Alin Gragossian, MPH What Would You Do?..................................................................................................................11 Bernard Heilicser, DO, MS, FACEP, FACOEP-D ACOEP’s Council for Women in Emergency Medicine.................................................................12 Christine F. Giesa, DO, FACOEP What a Difference a DO Makes..................................................................................................13 Jaclyn McMillin, MS Congress Works to Address Mental Health Crisis........................................................................15 Laura C. Wooster, MPH The Patient Experience: A Review of the New Work by Brian Boyle..........................................16 Erin Sernoffsky American Academy of Emergency Nurse Practitioners: Who We Are.........................................17 Theresa M Campo DNP, RN, FNP-C, ENB-BC, FAANP Profile: Dr. (Maj.) Daniel Conway...............................................................................................19 Randy Lescault How to Write a Case Report.........................................................................................................21 Thomas Nappe DO and John Ashurst DO, MSc Clinical Quicksand........................................................................................................................23 Frank D. Gabrin, DO The Edge: Scientific Assembly 2015: How Far We’ve Come.........................................................26 Erin Sernoffsky Foundation Focus..........................................................................................................................27 Sherry D. Turner, DO, MPH, FACOEP Congratulations to the 2015 Honorees of the Legacy Gala!..........................................................29 ACOEP-RC President’s Report...................................................................................................30 Andrew Little, DO

Editor's Note Fall is a time of transition. As we see the farewell message from Dr. Mitchell as he passes the torch to Dr. Prestosh. I want to say to Mark, thanks for a job well done! You have inspired us. You have been an energetic force for the college, a great mentor and friend! And to Dr. Prestosh, our incoming president, I look forward to continuing to work with you as you take the helm of this great organization and continue to move us into the future! We will be right there with you as you are “in the Batter’s Box”, ready to support you and work with you on the challenges we face in the future.

We have a great edition for you this quarter. Please take a few moments to browse through and catch up on what is going on in your college. I can assure you that there will be something for everyone!

- Timothy Cheslock, DO, FACOEP

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Reflecting on the Past, Moving Toward the Future Education (GME). As of July 1, 2015 the clock has started with the end goal of having all of our Emergency Medicine residency programs ACGME approved within the next five years.

In the months leading up to July, 2015 we had several new programs approved and are looking forward to continued growth in emergency medicine residency programs. However, we also understand that some will make the decision not to make the transition and therefore will lose some programs during this transition.

We continue to have outstanding residency programs and our graduates are highly sought after at the completion of their training.

Presidential Viewpoints Mark A. Mitchell, DO, FACOEP-D

S

erving as President of the American College of Osteopathic Emergency Physicians for the past two years has been an amazing experience. During this time we have faced many challenges, greatest of these being the decision to go to a single accreditation system for Graduate Medical

We have also seen a continued demand by students for opportunities in Emergency Medicine. The number of applicants for each residency slot is amazing and there is no sign of it decreasing in the upcoming years. The ACOEP Student Chapter continues to grow and has had some outstanding leadership over the past few years. During my term the Board of Directors has made a commitment to the Student Chapters and has had many site visits to meet with them. The educational programs and activities that the Student Chapter puts on at our CME conferences in the Spring and Fall are amazing. I encourage you to look at their agenda, connect with the Student Chapter closest to you, and get involved with them.

They are eager to connect with you in any way that works for you.

During my tenure I have worked hard to establish relationships with others in healthcare, especially in emergency medicine. We have a good relationship with the leadership of the American College of Emergency Physicians (ACEP). For several years we have been invited to come to their fall Board of Directors Meeting. We have collaborated with them on key issues that all of us in the House of Emergency Medicine face. We also continue to have a Board Position the Emergency Medicine Action Fund. We have been actively involved with this since its inception. A new organization, American Academy of Emergency Nurse Practitioners (AAENP) has recently formed and we have been working closely with them.

Our goal is to work collaboratively with them on their continuing education needs. I would love to see hundreds of our NP and PA partners coming to our conferences and learn with us.

It was such an honor to work with John Becher, DO, FACOEP-D this past year as he served as President-elect of the American Osteopathic Association. As he gave his Inaugural Address to the AOA House of Delegates in July, those of us in Emergency Medicine were very proud to see one of our mentors ascend to this position. As he delivered his address there was no doubt to anyone present that he was very proud to be Continued on Page 7

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Growing the College

The Editor's Desk

Timothy Cheslock, DO, FACOEP

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COEP is very fortunate to have one of the larger osteopathic specialty colleges. We rank right up there behind the family practitioners and internists. We have a dedicated board, motivated members, active resident and student chapters that put a tremendous amount of effort into representing our specialty and our college in the medical community. While this is a true testament to the work of so many, there are many more that we can and should try to recruit into our ranks. I am speaking specifically today about osteopathic physicians that were trained in ACGME programs and ABEM boarded.

The participation of these individuals should be encouraged, more now than ever as we continue to move to a single ACGME post graduate accreditation program.

There has been a great amount of forward momentum in creating the new single ACGME accreditation process over the last year. There are now osteopathic physicians from our college on the Emergency Medicine Resident Review Committee, and there are osteopathic physicians sitting on the ACGME Board of Directors. The status of osteopathic medicine has been raised to new heights in the last year and I believe it safe to say what we have always known, is that we are finally on a track to full parity with our MD colleagues.

While the initial discussions about creating a single accreditation system for GME was met with skepticism, trepidation, and fear of the unknown, we are now beginning to see the results of many months of collaboration and discussion among the two bodies of medical education. This provides an opportunity to help grow our membership by encouraging osteopathic emergency physicians who have not participated in our College for whatever reason in the past to come back home to their roots.

speakers we offer. We do so in a smaller setting that often allows for much greater one on one interaction with the speaker.

I have heard many reasons from many physicians as to why they don’t belong to ACOEP. Everything from the cost of membership, by itself or in conjunction with societies, to the College doesn’t offer the type or variety of CME that I want or need, to I just don’t feel a need to belong. My personal response to all of these is when did you last look at what ACOEP really has to offer? Most tell me that they have not done so anytime recently. The College is strong and we want and encourage you take a look and see what we can offer to you!

If you have not checked out our new online CME offerings, it is something you should. You can now access past lectures and soon COLA review sessions for CME credit. Thanks to the tremendous work of the education department, the ACOEP staff and our technology staff, the college can now offer online CME. Keep any eye out for more offerings via the electronic platform in the near future!

Looking back over the just even the last five years I think there has been a great amount of change within the College. The quality of speakers at our CME programs has never been better! We have well-known, national speakers and have steadily been offering more hours and tracks. This year’s Scientific Assembly schedule

One of our other areas of strength is in our student and resident chapters. Their overall attendance has swelled in recent years, thanks to the hard work of the student and resident boards and motivated mentors that have gone above and beyond to offer outstanding workshops, skills stations and lectures on topics appealing to new and aspiring EM physicians.

Outside of our annual CME activities, Board members and many of you have been active participants through committees, advocacy, DO Day on the Hill, visiting the EM clubs at the Colleges and many other facets which really show the outstanding contribution our college makes to the specialty. As we continue to blaze a new path forward with the ACGME accreditation process we need more interested and motivated osteopathic physicians to join our ranks and help us to

he quality of speakers at our CME " Tprograms has never been better! We

have well-known, national speakers and have steadily been offering more hours and tracks.

"

is packed with many great opportunities and concurrent sessions and tracks that should appeal to a broad interest within emergency medicine. We have also been offering courses on Pre-hospital and EMS related topics, advocacy, research and medical directorship topics of interest. While we can never compete with the numbers or volume of other meetings, ask any regular attendee of our programs and you will find that they were pleased with the topics and

do what we do best, provide a home for all osteopathic emergency physicians that will meet your needs and represent your interests at the table in the complicated healthcare environment of today. Invite your colleagues to attend a future ACOEP event and encourage their membership in a great organization!

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Shifting Thoughts has on intern and residents. This research led to the institution of workhours regulations and limiting physicians in training to no more than 60 hours weekly. Even more current research has shown that this 60 hour work week for residents is pressing their ability to learn adequately, but that’s a story for another column.

Past research has shown resident physicians learn and retain information better when they are not tired. On the other hand, few articles, and even less research, have been written on the effect that shifting schedules has on established physicians. So I did a little digging and came up with some evidence for the rationale against shifting work schedules for physicians. So here goes, but let me iterate, I’m not a researcher, or necessarily a good research paper writer, so all my references will appear at the end of the article.

Executive Director's Desk Janice Wachtler, BAE, CBA

I

f you speak with any emergency physician and ask them the one thing they hate about emergency medicine, odds are they will say working the overnight shift. They will tell you they do ok with the mid-shift, but the night shift kills them. This is especially true for physicians who are core faculty and those older than 50. So you have to ask: why do doctors have to rotate shifts? Aren’t there emergency physicians who hate working days?

In shift work, everyone hears their own drummer because everyone has their own circadian rhythm; sure it can change if your schedule changes and you’re staying up later or going to bed earlier for a period of time. But research has shown that the majority of people, respond to daytime schedules from dawn to dusk, with the body experiencing dips in the morning about 10 a.m. and again about 2 p.m. As the daylight fades, the average person begins to tire.

Most people have rituals they follow before they go to sleep, it may be taking a hot bath or watching the news or weather, but as you prepare yourself for sleep, your body begins to tire. When this rhythm is disturbed it takes about two days to reset the body’s clock and get the person back to a normal schedule.

Dozens upon dozens of articles have been written exploring the effect of working long shifts

In many of the articles, the writers found that physicians who are required to work shifts often experience bouts of irritability, sleeplessness, high divorce rates and mental lapses. It was also reported that routine procedures done by emergency physicians who work tired, are completed more slowly than when they are on regular day shifts. While this generally doesn’t place a patient in danger, a tired physician may experience a slower reaction time that could do just that.

In one study, researchers asked physicians coming in for an overnight shift to take a series of tests and then to repeat the same cognitive tests after their shift had concluded. They found that in most cases emergency physicians experienced a 5-7% drop in cognitive knowledge. They also witnessed a slower response time for the questions.

So I guess the question is, how do we make this issue more palatable? Most physician schedulers have routinely scheduled doctors required to work night shifts in a pattern that will have him or her working a series of days, two mid-shifts, one overnight shift, mid-shift and day off. Their research has shown that if physicians are required to work a number of overnight shifts each month, these should be scheduled together with at least two days off after the shift to return to normal.

But what happens when a physician has to fill in at the last minute for a sick or vacationing colleague?

That question remains a mystery.

There were no simple answers to this question in any of the research. There was no magic bullet that would relieve the burden of working night shifts, although they did offer a suggestion to

reset your body’s clock. Authors suggested that when coming off an overnight shift, the physician should stay awake until their normal circadian rhythm went into effect. This dip in awareness hit about ten a.m. and when this drowsiness set in the physician should go to sleep in a quiet, dark room, waking about dinner time. They suggested that if the physician was to resume his or her regular schedule, he or she should stay awake until their normal bedtime and awake at their regular time the following day. If they were preparing for a second night shift, the physician should sleep for an eight-hour period waking up a few hours before reporting to work. They also suggested eating a high-protein meal before reporting to work.

All this left me with a few more questions . . . aren’t there people who are night owls? Who live for the nights and shun the daytime? I know several people like that, granted they’re not physicians, but some physicians have to be out there who are night-timers. If this is true, then why aren’t they specifically recruited to work overnight shifts? Why aren’t some core faculty designated as only night-time supervisors?

Perhaps if groups recruited specifically for these people, we could reduce the stress and strain on physicians who are already stressed out from the specialty and meeting the needs of the American Public on a 24/7/365 basis.

References:

• K uhn, G, 2001. Circadian Rhythm, Shift Work, and Emergency Medicine, Annals of Emergency Medicine, 37.1, p. 88-98.

• Gill, M., Haerich, P., Westcott, K., Godenick, K.L., and Tucker, J.A., 2006. Cognitive Performance Following Modafinil versus Placebo in Sleepdeprived Emergency Physicians: A Double-blind Randomized Crossover Study, J Acad Emerg Med, 13:158-165.

• Rollinson, D.C., Rathley, N.K., Moss, M., Sassover,K.C., Auerbach, S., Fish, S.S., 2003.

The Effects of Consecutive Night Shifts on Neuropsychological Performance of Interns in the Emergency Department, Annals of Emergency Medicine, 41.3 p.400 – 509.

• Lockley, S.W., Barger, L.K., Ayak, N.T., Rothschild, J.M., Czeisle, C., Landrigan, C.P., 2007. Effects of Health Care Provider Work Hours and Sleep Deprivation on Safety and Performance, The Joint Commission Journal on Quality and Patient Safety, 33:11, p. 7 – 19.

• Dula, D.J., Dula, N.L., Hamrick, C., Wood, G.C., 2001. The Effect of Working Serial Night Shifts on

Continued on Page 11

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Time Waits for No One recent past.

Time will continue to move on, and I have no doubt that the future of healthcare will continue to move forward in a rapid fashion.

ACOEP must face these changes with a strategic plan. Time will not allow the ACOEP to remain in our “status quo” and yet maintain a relevant position in healthcare concerns.

Just as time will change healthcare, so will time change the American College of Osteopathic Emergency Physicians.

What will not change is our College’s diligence in our mission to advocate for our patients. Placing our patients first is a tenet that time will not and cannot change. It will be necessary for our college not to merely adapt to what time has in store for us but to have in place a strategic plan that will fit with the future. ACOEP has no control as to what the future will bring us; however, we do have control as to how we work with what we are delivered. It is with pre-planning and having a strategic plan in place that will allow the ACOEP to ensure its viability and relevance in our healthcare system.

mound.” Some of the deliveries have included the Affordable Care Act, the SGR, Medicare reform, and much more. Some of these issues have been retired while others need further work and clarification to make them agreeable to the healthcare system. I look forward to being in the “batter’s box” and having a different view of what is being delivered from the “pitcher’s mound.” I realize that some pitches will be slow, and there will be time to decide on the correct reaction. I also realize there will be some fast pitches that will require

esterday is gone. Tomorrow " Yhas yet to come. We have only today. Let us begin. " – Mother Teresa

The On-Deck Circle

John C. Prestosh, DO, FACOEP, President-Elect

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s I write this last article as Presidentelect of the American College of Osteopathic Emergency Physicians, I cannot help but wonder where the past two years have gone. It only seems like a few months have passed since my term of President-elect began. The “On Deck Circle” has been an excellent position to further learn the intricacies of leading an organization such as our college. I believe this experience has prepared me for the next leadership position, taking my stance in the “batter’s box.” The time has now come for this change in both the lives of the College and me. It is very true that time waits for no one. It is with this knowledge that now is the time for the ACOEP to continue to move forward, we must be proactive with our planning so we will not to be reactive in the challenges that lie before us both in healthcare education and delivery.

The “On Deck Circle” has allowed me to have an interesting and informative perspective of what has been delivered from the “pitching

“sooner than later” decisions. I am fortunate to have a board of directors who are also looking to the future and helping make “split-second” decisions when necessary.

I cannot promise success in all our future endeavors related to healthcare issues.

However, I can promise that the entire board of directors and I are deeply concerned and committed to do what is best for our college and our patients. We will be diligent and timely with our decisions as time waits for no one.

I look back and view when my medical career began in the late 1970’s. I fast-forward to today and marvel at the number of years that have quickly passed and the changes that have occurred during that time span. The face of healthcare has undergone unbelievable and startling changes. The evolution of ultrasound, computerized tomography, magnetic resonance, and robotic surgery are just a few of the technological changes that have occurred in the

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"Thoughts" continued from page 3 an Emergency Physician. Our relationship and collaborative working relationship with the AOA continue to be very strong. We have many members of ACOEP who serve in various roles within the AOA and the Colleges of Osteopathic Medicine (COM). Many of our COMs have Emergency Physicians in senior leadership roles including, but not limited to JD Polk, DO; James Turner, DO; Don Sefcik, DO; Thomas Boyle, DO; Beth Longenecker, DO; Tom Green, DO; and John Graneto, DO. I have had the privilege to serve this past year as Chairman of the Bureau of Osteopathic Specialist (BOSS) and Dr. Becher has appointed me to a second term in this role. In addition we have several other members serving on various AOA Bureaus, Committees, and Councils.

As healthcare continues to undergo changes, so does our need to continue to advocate for our patients and practices. This past year we worked with many others in the house of medicine to finally have the Sustainable Growth Rate (SGR) formula repealed. Thanks to ACOEP leaders like Joe Kuchinski, DO, Chair of OPAC, we were able to finally move past this and not have to fight this battle over and over again. However, we will continue to need to advocate both in Washington, as well as our

home fronts to make sure that the interest of our patients and practices are front and center.

experience, expertise, and dedication that other organizations wish they had.

Our CME programs have continued to grow larger over the past several years. This is a direct result of the outstanding quality of the programs and the work of the ACOEP Staff and the CME Committee. We have hit record numbers of attendance and the post conference evaluations reflect the quality of the programs.

Be on the lookout of the announcement of some outstanding Keynote Speakers for our upcoming Spring 2016 Conference. In addition, the staff, especially Kristin Kennedy, has been working diligently to obtain accreditation thru Accreditation Council for Continuing Medical Education (ACCME). This is an extensive process to obtain this accreditation status and we are nearing the finish line.

As I turn over the gavel to Chuck Prestosh, DO I know ACOEP is in great hands. Chuck is well-respected and has a demeanor that will continue to guide our organization for the years ahead. He has a great Board of Directors that will be there to support him and his Executive Committee, as undoubtedly we will continue to have challenges ahead.

As I moved to downtown Chicago about two years ago, I have had to ability to spend more time in the ACOEP Chicago office than many of my predecessors. I can tell you first hand that we have an outstanding staff that works daily to meet the needs of our organization. They are experts in their respective areas and we are fortunate to have such a dedicated group working with us. The role model and leader, Jan Wachtler, is second to none in what she does. She brings a level of

I would also like to thank my wonderful wife, Laura, who has been there by my side. She is my rock and with her continued support and love has been felt on a daily basis. Now, I get to take a deep breath and spend some muchneeded time with her.

I am excited about where ACOEP is, but more so about where we will be in the future.

I will continue to be here to support the organization in any way I can.

Take care,

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A Rare Presentation of Autoimmune Encephalopathy in the Emergency Department: Stiff-Person Syndrome in a Young Female A Case Study Michael Neeki, DO; Nina Jabourian, DO; Alex Jabourian, DO; Alin Gragossian, MPH

I

ntroduction:

Stiff-person syndrome (SPS), previously known as stiff man syndrome, is a rare autoimmune disorder characterized by muscle stiffness, rigidity, and spasm involving the axial muscles. It typically presents in patients with histories of autoimmune disorders during their third or fourth decade of life, and is two times more common in women. The prevalence has not been reported; however it may be as rare as 1 per 1,000,000 persons. Only 150 cases have been documented from the 1960s to the 1990s1.

SPS has associations with other autoimmune disorders, epilepsy, and certain cancers such as adenocarcinoma of the breast.

Patients with SPS have elevated IgG levels against glutamic acid decarboxylase (GAD) in their cerebrospinal fluid. This antibody is also found in pancreatic beta cells in patients with type 1 diabetes, which explains the common comorbidity of type 1 diabetes in patients with SPS1. These IgG antibodies attack GABAergic neurons and nerve terminals in the CSF, resulting in muscle stiffness, rigidity, and a characteristic stiff gait that typically leads to frequent falls3.

Diagnosis is aided by EMG studies and testing for anti-GAD or anti-amphiphysin antibodies, together with the physical exam. EMG studies may demonstrate simultaneous continuous low frequency motor unit activity in agonist and antagonist muscles that is responsive to Diazepam. GAD antibodies are highly specific (99%), although the absence of GAD antibodies does not rule out SPS. Physical exam findings include; prodrome of stiffness and rigidity in axial muscles, slow progression of stiffness resulting in impairment of ambulation, presence of superimposed episodic spasms that are precipitated by sudden movement, noise, or emotional upset, normal findings on motor and sensory nerve examinations, and normal intellect4.

Benzodiazepines are the treatment of choice for SPS. Ideal treatment regimens are

has very specific diagnostic criteria " SPS that make it difficult to diagnose, especially in the emergent setting. " still under investigation, including the use of other GABA-mediating medications, IVIG, plasmapharesis, behavioral and physical therapy.

Certain benzodiazepines, muscle relaxants, and immunosuppressants have shown to improve clinical outcomes4,6,7.

Case Presentation: A 35-year-old Caucasian female with history of seizure disorder, type 1 diabetes mellitus, stroke, chronic pain syndrome, and Hepatitis C was brought into the emergency department (ED) by ambulance after experiencing a seizure at a local grocery store. Upon arrival, the patient was tachypneic, tachycardic, and non-responsive.

History was obtained from paramedics and the patient’s significant other. According to her boyfriend, prior to the seizure, the patient suddenly felt weak and dizzy, became stiff, and fell. She then demonstrated what was described as tonic-clonic-like activity for over 30 minutes, without regaining consciousness. En route, paramedics had given the patient 5mg of intramuscular midazolam.

On physical examination, hypertonia in all extremities and a right lateral gaze were noted. In addition, the patient had an insulin pump. Upon further questioning, the boyfriend mentioned that her blood sugar had recently been elevated and that her insulin pump was malfunctioning. An accu-check was obtained and blood sugar was 315 mg/dl. The patient was started on intravenous fluids, as well as another 5mg of intravenous midazolam without any response. She was then given 2mg of intravenous lorazepam and loaded with 1 gram of intravenous levetiracetam. The patient became more alert about 50 minutes after arrival, however she continued to exhibit hypertonia throughout her

stay in the ED. She became verbal after a second dose of lorazepam and complained of generalized stiffness. Computed tomography of her brain was obtained, which showed no acute changes. Labs showed an elevated hemoglobin A1C level of 7.3%, and a glucose level of 342 mg/dl. Differential diagnoses included status epilepticus, complex seizure with postictal state, intracranial hemorrhage, stroke, DKA, anxiety disorder, benzodiazepine withdrawal, and other iatrogenic etiologies.

Prior records were reviewed and it was noted that the patient had multiple visits to the ED for breakthrough seizures. Due to the prolonged seizure-like activity and lack of complete recovery from the symptoms, the patient was admitted to the medicine team for further workup and neurologic evaluation. Upon admission, an EEG was obtained, which showed no epileptiform activity during episodes of tremor. An antiGAD antibody level was obtained and elevated.

Thorough neurology examination and laboratory evaluations revealed that the patient had a condition known as stiff-person syndrome that caused stiff axial muscles and episodic spasms similar to seizure-like activity, amongst other diagnostic criteria. The condition was aggravated by her uncontrolled blood sugars.

Discussion: Stiff-person syndrome is a rare autoimmune disease that presents in an ambiguous manner.

It has very specific diagnostic criteria that make it difficult to diagnose, especially in the emergent setting.

The treatment of choice for stiff-person Continued on Page 9

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Judith Tintinalli, MD, MS, FACEP — AND —

Peter Rosen, MD, FACS, FACEP, FAAEM

Empowering Leaders in Emergency Medicine

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What Would You Do? Ethics in Emergency Medicine In this issue of The Pulse we will review the dilemma presented in the July, 2015 issue.

The president of a private ambulance company offered this situation: A home hospice nurse contacted a Bernard Heilicser, private ambulance DO, MS, FACEP, to transport a 79 FACOEP-D year-old patient with metastatic ovarian cancer to Hospital A, where the patient’s physicians is on staff, with a transport time of 20 minutes. Crew finds patient in moderate respiratory distress, O2 sat 76% on room air. With 15L O2 the O2 sat improves to 90%. A legitimate DNR order is present. Medical Control is contacted and orders transport to Hospital B, with ETA of 3-5 minutes. Our patient is fully oriented and wants Hospital A. The crew is comfortable with this request.

"Stiff Person Syndrome" continued from page 9 syndrome is diazepam, 20mg to 300mg per day, depending on the severity of the disease5. Muscle relaxants, such as baclofen, have also shown improved clinical outcomes6. In this particular instance, patient stabilization was attempted with midazolam and lorazepam, with minimal improvement in symptoms. However, there are no studies to compare the efficacy of different benzodiazepines in the treatment of stiff-person syndrome, especially in the emergent setting. This patient’s case was complicated by the fact that her history and physical presented as seizure-like activity with a post-ictal state. However, this may have been a rare manifestation of SPS. The management of this patient would have likely been similar, whether or not the diagnosis of SPS was known. Nevertheless, this case was a classic instance that demonstrated the importance of a thorough medical history. The patient’s SPS exacerbation may have been precipitated by her uncontrolled glucose levels, due to her malfunctioning insulin pump. Education of her comorbid diseases and the importance of tighter glucose levels, together with the recommended treatment with diazepam and baclofen, would have reduced her likelihood of having a recurrent acute medical emergency.

The problem is that Medical Control is the Resource Hospital (EMS oversight institution) and is ordering transport to the closest hospital (B). Consequently, the paramedics have no override capability.

As a paramedic, what would you do?

This case presents a difficult situation for the crew. The patient wants her hospital and Medical Control believes she should go to the closest, and so orders.

A fundamental principle of medical ethics is autonomy, it is considered paramount. The patient is considered to have decision-making capacity which is necessary for acceptance of her autonomy by EMS. She should be allowed to sign a release for transport to a more distant hospital with appropriate informed refusal documentation. However, physician control has declined to honor this.

we choose beneficence—we know what is in the patient’s best interest. This can be problematic for all involved. What if the patient or appropriate surrogate does not accept this decision and decides to simply refuse transport? A crashing patient is better arriving by ambulance than taxi.

Yes, there are situations where we must override questionable circumstances, but we must be sensitive to the consequences of denying legitimate patient rights. This is what makes emergency medicine so challenging and enjoyable.

Please send your thoughts and ideas to WhatWouldYouDo@acoep.org Every attempt will be made to publish them when we review this dilemma in the next issue of The Pulse.

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

As emergency physicians in crowded, chaotic EDs, at times contending with many psychotic patients and confused medical patients, we often make dogmatic decisions, not wanting to risk potential bad outcomes. Consequently,

Thank you.

"Thoughts continued from page 5

References: 1. H elfgott SM. Stiff-man syndrome: from the bedside to the bench. Arthritis Rheum 1999; 42:1312.

2. Clardy SL, Lennon VA, Dalmau J, et al. Childhood onset of stiff-man syndrome. JAMA Neurol 2013; 70:1531.

3.

McEvoy K. Stiff-man syndrome. In: Office Practice of Neurology, Feske S, Samuels M (Eds), Churchill-Livingstone, New York 1996.

4. Lorish TR, Thorsteinsson G, Howard FM Jr. Stiff-man syndrome updated. Mayo Clin Proc 1989; 64:629.

5.

Alexopoulos H, Dalakas M. A Critical Update on the immunopathogenesis of stiff person syndrome. European Journal of Clinical Investigation. 2010. 1018–25.

6. Stayer C, Tronnier V, Dressnandt J, et al. Intrathecal baclofen therapy for stiff-man syndrome and progressive encephalomyelopathy with rigidity and myoclonus. Neurology 1997; 49:1591.

7. Nakane S, Fujita K, Shibuta Y, et al. Successful treatment of stiff person syndrome with sequential use of tacrolimus. J Neurol Neurosurg Psychiatry 2013; 84:1177.

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the Cognitive Functioning of Emergency Physicians, Annals of Emergency Medicine, 38:2, p.152 - 428.

Gaba, D. M., Howard, S. K., 2002. Fatigue Among Clinicians and the Safety of Patients, N Engl J Med, v 16, 1249 – 1295.

Machi, M.S., Staum, M., Callaway, C.W., Moore, C., Jeong, K., Suyama, J., Patterson, P.D., Hostler, D., 2012. The Relationship Between Shift Work, Sleep, and Cognition in Career Emergency Physicians, J Acad Emerg Med, 10.111, p. 85-91.

Smith-Coggins, R., Rosekind, M.R., Buccino, K. R., Dinges, D. F., Moser, R. P., 1997. Rotating Shiftwork Schedules: Can We Enhance Physician Adaptation to Night Shifts? J Acad Emerg Med 4:951-961.

Weinger, M.B., Ancoli-Israel, S., 2002. Sleep

Deprivation and Clinical Performance. JAMA c 287:8 p.955-957.

Sleep and Circadian Rhythm Disorders, Sleep Disorders Health Center, http://www.webmd.com/sleepdisorders/guide/circadian-rhythm-disorders-cause Howard, S.K., Sleep Deprivation and Physician

Performance: Why should I care? 2005. Proc (Bayl Univ Med Cent), 18(2): 108-112.

Olson, E. J., Drage, L. A., Auger, R. R., 2009. Sleep Deprivation, Physician Performance, and Patient Safety, Chest 136:5, p. 1389-1396.

Sleep, Drive and Your Body Clock, National Sleep Foundation, http://sleepfoundation.or/sleeptopics/sleep-drive-and-your-body-clock

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ACOEP’s Council for Women in Emergency Medicine Christine F. Giesa, DO, FACOEP

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he Edge: Spring Seminar 2015 in Fort Lauderdale was an overwhelming success. While most of our members returned home to their families and the ED, several of us continued with travels to various other spring meetings. A lot of time was spent traveling through airports and waiting for flights. When one travels alone there is a lot of time for reflection. Adam Levy was waiting for a flight on the West Coast, and I was waiting for flight on the East Coast when the flight of ideas began. The AMA Women’s Association had just met in Chicago. Did ACOEP ever consider a focus group for women in emergency medicine? This was an intriguing idea and certainly one that gathered much momentum.

It made perfect sense since women comprise 31% of our membership. There certainly was a need and most importantly, a desire. We began to discuss the possibility of a women’s council of osteopathic emergency physicians. Following many weeks of exciting conversations, the ACOEP Council of Women in Emergency Medicine was approved.

The ACOEP Council of Women in Emergency Medicine (The Council) represents a diverse group of professional women. We are clinicians. We are educators. We are researchers.

We are department chairman and program directors. We are leaders in emergency medicine.

We work full time, part time, and per diem.

We work locally and locum tenens. We work long shifts 24/7/365. We are wives, mothers, daughters, sisters, and best friends. We stand with our feet in the fire holding a cell phone texting the nanny. We put our heart and soul in all we do, and emergency medicine is in our heart and soul.

Our name was chosen to include all women associated with the practice emergency medicine, not just physicians. The Council will provide us with a means to come together, share experiences and resources, and to gain insight through a powerful network for every step in our career.

The Women’s Firsts are not the only

e are educators. We are researchers. " W We are department chairman and program directors. We are leaders in emergency medicine.

"

In the history of ACOEP, there is a long list of distinguished Women Firsts.

WOMEN FIRSTS First Women Members

Kathryn R. Meyer, D.O. Jane Gannett, D.O.

April 9, 1980 January 26, 1981

First Women Fellows

Joan Gable Eileen Singer, D.O. Sandra Schwemmer, D.O. Jennifer Bantley, D.O.

1988 1989 1990 1991

First Woman SC President

Paula Willoughby

1990

First Woman Program Director

Mary J. Hughes, D.O.

1992

First Woman RC President

Paula Willoughby, D.O.

1993

First Woman Program Chair

Carolyn Zonia, D.O.

1997

First Women Board Members

Mary J. Hughes, D.O. Sandra Schwemmer, D.O. Paula J. Willoughby, D.O.

1994 – 1997 1997 – 2002 1998 - 2008

First Woman Certifying Board Member Eileen Singer, D.O. First Woman President of ACOEP

1994

Paula Willoughby DeJesus, D.O. 2004 - 2006

distinguished women in our college. All of us bring a valuable uniqueness to our profession.

Please consider lending your support to the AC OEP Council of Women in Emergency Medicine. We plan to have an annual meeting at the Scientific Assembly with the intention of expanding to include a meeting at the Spring Seminar.

The inaugural luncheon meeting of the ACOEP Council of Women in Emergency Medicine will be Monday October 19, 2015 12:30-2:30pm at the Loews Portofino Bay Hotel, Universal Studios, Orlando, FL. I look forward to meeting all of you. Together we are strong.

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What a Difference a DO Makes Jaclyn McMillin, MS

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hree years ago I had never advocated on behalf of an organization. I had never taken advocacy courses, and I certainly didn’t know the process involved in order to speak to a legislator. But after over four years of working at ACOEP, of learning the political gridlock and rules changes that physicians face on a daily basis, I became inspired to help make a difference. I wanted to be a positive force for change, but found myself at a loss as to where to begin. The more I learned, the more I realized that many of our members shared my frustration—we want to make a difference, but we don’t know how.

This spring I graduated with a Master’s degree from DePaul University in Public Service Management with a Concentration in Health Care Administration. The goal of this program is to develop ethical leaders in order to manage and make organizational decisions regarding healthcare and a large part of my training centered around current issues regarding health care and training, and proper advocacy and policy techniques.

Working with the Governmental Affairs Committee, ACOEP staff, and Board there are many exciting opportunities on the horizon, making advocating for healthcare advancement and reform easier and less intimidating. We will utilize social media, ACOEP’s website and publications, and in-person training to develop tools geared towards making advocacy less intimidating, your representatives more accessible, and your message more clear.

My advocacy courses taught me the basics: definitions, how legislation is written, how to contact your current representatives and legislators, and how to advocate for your cause by setting up meetings and writing letters. I also examined how administrative rules are formed, particularly in regards to political action committees (PAC) and PAC donations and support.

In order to advocate effectively for your cause or organization, it is extremely important to understand the development and implementation of public policy. You must define policy problems, evaluate alternatives using legal, economical, and political criteria, and anticipate problems of policy

future of emergency medicine belongs to " Tthehestudents and residents poised to assume leadership roles as their careers advance. " implementation by providing solutions to numerous outcomes.

As emergency physicians you are already well-positioned to tackle these steps. You have first-hand insight into existing problems, and your every day experiences help to formulate ideas for alternatives. Together we can work to anticipate policy problems or roadblocks, and map out a strategy to make our message heard.

Already we have ramped up efforts on social media to keep ACOEP members informed of ongoing political struggles, news, and updates.

If you aren’t already, follow us on Twitter and Facebook so that you can remain engaged.

I encourage you to share your opinions, ask questions, and spark conversations online.

We are in the process of building a new section of the website, dedicated to giving you the tools you need to advocate effectively. This site will include links to easily find your national, state and local representatives, instructions on the best ways to contact them through letters and meetings. There will be instructions, ideas, policy updates, and information on how to get involved.

The future of emergency medicine belongs to the students and residents poised to assume leadership roles as their careers advance. As they have so many opportunities and obstacles ahead of them it is important to give them the tools and knowledge they need to confidently advocate for themselves and their patients. With this in mind we are launching new initiatives aimed at visiting schools and programs and providing in-person training and policy updates.

ACOEP is strong, but we are stronger when we join our voices with others who are also fighting for progress. With this in mind we will continue to forage strong relationships with other associations, such as the AOA who spearhead the annual DO Day on the Hill, a unique opportunity to meet, in person, with the nation’s leaders and decision-makers.

This is a time of great change, and with this change comes great opportunity. It is my goal, and that of ACOEP, to empower you with the tools, knowledge and support you need to advocate for emergency medicine, physicians, and patients. Together, we can make history.

ACOEP’s Governmental Affairs Committee Wants You! The Governmental Affairs Committee is one of ACOEP’s fastestgrowing groups. As pressure ramps up in Washington, this Committee is an excellent tool for change.

Learn how to effectively lobby your representatives, the best avenues to make your voice heard, and how to influence change in the face of healthcare.

For more information on how to get involved email: jmcmillin@acoep.org

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WE WANT TO

Emergency Physicians do incredible things every day and we want your stories!

Send your story ideas to ThePulse@acoep.org, we would love to share your experience with our members.

HEAR FROM YOU!

We also encourage you to email ThePulse@acoep.org to share your thoughts on specific articles that you read here. We want to keep the conversation rolling, whether you agree or disagree with a point of view represented in our articles, we want to highlight various perspectives from our diverse membership.

Introducing ACOEP Digital!

A Custom App tailored for your digital life!

ACOEP is proud to launch ACOEP Digital, your hub for conference information, course materials, and more!

Available for all smartphones and tablets, this free app allows you to access current and past course materials, create custom schedules, explore didactic topics, and much more!

To download, search “ACOEP” in your phone’s app store.

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Congress Works to Address Mental Health Crisis Laura C. Wooster, MPH Associate Vice President, Government Relations American Osteopathic Association

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n the last three months, and in the wake of additional mass shootings, three bipartisan pieces of legislation addressing the current mental health crisis have been introduced in Congress. Congress has recognized that the nation’s mental health system is in urgent need of reform and improvement, and emergency departments should not be the primary setting for treating those with mental illnesses. As Senator Chris Murphy (D-CT) said, “the reality is what’s changed. There’s been another dozen individuals who have walked into crowded places and started shooting . . . I think the consciousness of the Congress is in a fundamentally different place because of the increasing number of mass shootings and the growing recognition that we can’t let political differences over gun policy stop us from reforming the mental health system.”

In July, Senators Lamar Alexander (R-TN) and Patty Murray (D-WA), the chairman and ranking member of the Health, Education, Labor, and Pensions (HELP) Committee, respectively, were joined by seventeen other senators in introducing the Mental Health Awareness and Improvement Act. This bipartisan legislation updates programs that improve awareness of mental health conditions and support individuals, schools, and health care providers in addressing mental health needs.

Representative Tim Murphy (R-PA), a clinical psychologist, has reintroduced his Helping Families in Mental Health Crisis Act, which he had first introduced in the last Congress in response to the Sandy Hook shooting, with Representative Eddie Bernice Johnson (D-TX).

After soliciting feedback to help improve the bill, Congressman Murphy has reintroduced this legislation to reflect the input of mental health providers and professionals, patient advocacy groups, individuals and families, and others. The legislation, which is co-sponsored by 105 representatives, reforms current mental health practices and helps to address the current shortage in psychiatric and mental health providers. It also:

a doctor and as a person, I know people " Ainsmy life who are affected by mental illness. " – Senator Bill Cassidy, M.D. (R-LA) • e stablishes an Assistant Secretary for Mental Health and Substance Use Disorders within the U.S. Department of Health and Human Services; • establishes a National Mental Health Policy Laboratory to drive innovative models of care; • allows for same-day billing under Medicaid for treatment of physical and mental health for the same patient, in the same location, on the same day; and, • repeals the current Medicaid exclusion on inpatient care for adults with mental illness.

This month, a Senate companion to this bill was introduced by Senators Bill Cassidy, M.D. (R-LA) and Christopher Murphy (D-CT), titled the Mental Health Reform Act. Senator Cassidy said, “As a doctor and as a person, I know people in my life who are affected by mental illness. We all do – we all have seen the homeless veteran who needs and deserves care, or the person we went to high school with who is missing the reunion because they are

struggling with serious mental illness. Many have their first episode of major mental illness between the ages of 15 and 25, starting down a path that ends with their life and their family’s lives being tragically altered. This bill attempts to identify these young people and stop that path from ever opening up and preventing the first episode of serious mental illness, or, once identified, to begin a new path, a better path, a path towards wellness. This is about making those individuals, their families and society, who are threatened with serious mental illness whole.”

Early intervention in mental health means that patients are treated in a more appropriate setting that meets their health care needs, and it means that emergency departments are better able to focus limited resources on other emergent conditions. Congress returns in September and is expected to consider these bills that address the lack of sufficient funds available to care for those with mental illnesses, and provide much-needed improvements to aid them in accessing timely care.

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The Patient Experience A Review of the New Work

by Brian Boyle Erin Sernoffsky

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very day emergency physicians are asked to save lives. All ages, backgrounds, races, and religions come to the emergency department for help at their darkest hours—when they are afraid, confused, and in pain. With literal life-and-death decisions at stake it can be difficult to look past the injury or illness at hand and to see the entire person asking for help; to see through the shroud of fear and pain and engage with individual and their family, to come to know the mother, father, child, friend.

In his second book, The Patient Experience, Brian Boyle deftly bridges this gap. Using his own harrowing experience as a platform, Boyle poignantly provides a glimpse into the mind of a patient and gives incredible insight into the myriad of ways healthcare providers can affect outcomes, survival, and the ability to thrive.

The Patient Experience is a must-read for physicians of every specialty, and his message is ultimately one of hope, healing, and building a partnership between patients, their families, and the dedicated professionals who care for them in the scariest moments of their lives.

More than simply a memoir, this is a workbook for all care providers offering suggestions, reflection questions, and real-world solutions to problems faced in hospitals nationwide. Most startling is how simple and straightforward many of his suggestions are—unpretentious ways to engage the patient and their family, to set realistic goals and expectations.

took three years to complete, " Mbuty recovery it started with emergency medicine. " liver was lacerated and his kidneys failed. In addition to a concussion, his ribs, clavicle and pelvis were shattered.

As Brian’s life hung in the balance, healthcare professionals joined the fight to save him. Their tireless work kept him alive through surgeries, blood transfusions, and around the clock monitoring. Brian was placed in a medicallyinduced coma and fought every step of the way to remain present, fight back, and heal.

After months that included time in the ICU, rehabilitation, therapies, and blood transfusions Brian has not only made a full recovery, he has gone on to compete in endurance sports, even completing the Hawaii Iron Man Traithalon.

Brian is a Keynote Speaker at The Edge: Scientific Assembly 2015, and his message has particular importance for emergency physicians.

In a recent interview he said, “The foundation of my background began in the trauma/emergency department of the healthcare system. From my accident scene, to shock trauma, and then to the operating room - my life was in the hands of my emergency providers, nurses, and physicians.

When a trauma/emergency patient is brought into this environment, time is of the essence.

These gifted men and women are responsible for

caring and treating for that individual and helping to get them onto a successful road to recovery, which begins the moment they are brought into the hospital. My recovery took three years to complete, but it started with emergency medicine.”

Brian’s experience was catastrophic, but through the support of his family, the tireless work of his healthcare team, and his own indefatigable spirit, he has not only made a full recovery, but he has triumphed. Every medical professional that Brian encountered left an imprint, much of the time in ways that the provider might not even know.

Brian’s journey has become his life’s calling— he is an advocate for blood donation, for patients and care providers alike. He has spread his message in countless interviews, speeches, and articles. He has appeared on the Today Show, The Ellen DeGeneres Show, he has received awards, championed blood drives, all while working as an advocate for patients, and a resource for physicians. Brian has spoken world-wide, all while finishing college and competing in endurance sports.

Brian’s story is harrowing, but sadly not unique in the emergency department—a day begins like any other and ends in a fight for life. Brian had just graduated high school and was preparing for a college career on the swim team. He was a smart kid with a bright future.

On a sunny day after swim practice a collision with a dump truck threw all of that into chaos and he and his family began a terrifying journey.

In the accident Brian’s heart was pushed to the other side of his chest. His lung collapsed, his

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American Academy of Emergency Nurse Practitioners: Who We Are Theresa M Campo DNP, RN, FNP-C, ENB-BC, FAANP Board Member and Chair of Education American Academy of Emergency Nurse Practitioners Co-Director Family Nurse Practitioner Program College of Nursing and Health Professions Drexel University Philadelphia, PA

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mergency Nurse Practitioners (ENPs) are part of a dynamic team of healthcare providers who provide high quality patient care in the emergency and urgent care settings. The American Academy of Emergency Nurse Practitioners (AAENP) is an organization promoting “high quality, evidence based practice for nurse practitioners providing emergency care for patients of all ages and acuities in collaboration with an interdisciplinary team.” Through inter-professional and interorganizational relationships, the AAENP supports initiatives in research, practice, and policy.

Established in 2014, the AAENP was organized to support and represent the emergency nurse practitioner (ENP) role and its providers at a time when the role was unclear with relation to the Advanced Practice Registered Nurse (APRN) model. The APRN model defines the role of the advanced practice nurse into four categories; certified nurse midwife, certified registered nurse anesthetist, clinical nurse specialist and nurse practitioner.

For each of these roles there is a population focus. These are family/individual across the lifespan, adult-gerontology, pediatrics, neonatal, women’s health/gender specific, and psychiatric/ mental health. There is a further educational differentiation for APRNs educated for pediatric and adult-gerontology roles based on patient care needs. Pediatric and adult-gerontology primary care APRNs are educated to provide care which is continuous and focused on primary care patient needs while pediatric and adultgerontology acute care APRNs are educated to provide care to patients with unstable, complex health conditions in the acute care setting, such as inpatient and ICU settings. Following graduate education at either the masters or doctoral level,

he organization has built progressive " Trelationships with numerous national

nursing and medical organizations in the United States

"

the APRN is eligible for national certification based on the role and population of study and practice. Licensure is regulated by individual state board of nursing requirements subsequent to the APRN achieving national board certification in most states. The ENP role is unique in that it spans lifespan and acuity continuums. When viewed in relation to the APRN model, the role of the ENP is considered a specialty role. For APRNs engaged in specialty practice areas (i.e. emergency/urgent care, cardiology, oncology, etc), the additional competencies, scope of practice, and regulations are overseen by the professional specialty organization.

Board certification as an ENP is currently only offered through the American Nurses Credentialing Association utilizing a portfolio format. The board certification requires a candidate to have a master degree, post-master certificate or doctorate as an FNP, AGNP, or Pediatric nurse practitioner (PNP). It also requires a minimum of 2000 hours of advanced practice in the emergency/urgent care setting, 30 hours of continuing education in the specialty, and fulfillment of professional development categories (academic credit, presentations, publication, etc) (ANCC 2015). Pediatric primary and acute care APRNs, FNPs and adultgerontology primary and acute care APRNs may all be eligible for ENP specialty board certification if they meet these requirements.

AAENP is the specialty organization representing ENP education and practice. The organization has built progressive relationships with numerous national nursing and medical organizations in the United States (US). These relationships allow AAENP to better represent its members and assist in moving the role of the ENP forward. These relationships encourage collaboration between the organizations to provide education, training, policy, and research to ensure expansion of the ENP role and are key components of the mission of AAENP. The five priorities of AAENP are education, practice, research, professional development and leadership, and policy. The evolving model of AAENP can be viewed in Figure 1. This model demonstrates that as the representative specialty organization AAENP’s five priorities are continuous and impacted by the key organizational relationships. Inter-professional collaboration is of the utmost importance to facilitate revision and update of competencies, education, research and policies shaping practice.

AAENP is evaluating and updating the entrylevel and advanced competencies, regulations, and scope of practice of ENPs in practice.

All three of these practice priorities are being evaluated and updated utilizing research and evidence based practice recommendations and guidelines. The role of the ENP has expanded and evolved over time in response to the dynamic

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Education

AANP

Practice

AANPCP

AAENP Members Research

Policy

Figure 1 AAENP model

characteristics of patients and industry. This evolution requires continuous evaluation and dissemination of current recommendations to all healthcare stakeholders (providers, educators, policy makers, organizations, etc).

Fundamentally, education is a multifaceted and multilevel priority. It encompasses academic graduate and post-graduate education including emergency nurse practitioner programs, postgraduate fellowships, and continuing education courses and workshops. Currently there are six ENP programs in the US. AAENP is working to develop recommendations for consistent ENP program curricula to ensure graduates are fully prepared in to practice in this subspecialty area. The organization is also evaluating post-graduate fellowship programs which may bridge the educational gap of the new graduate.

Additionally, post-graduate fellowships may offer additional specialty expertise for the NP who has been practicing in another specialty/sub-specialty to competently practice in the emergency/urgent care settings. The last component of this priority is to provide and promote continuing education courses and workshops that are offered at state and national conferences as well as through the AAENP website.

Recently AAENP partnered with Wolters Kluwer Health (LWW) to provide its members with Advanced Emergency Nursing Journal as the official publication. While the journal offers some continuing educational opportunities,

targeted modules available as webinars and other electronicallydelivered modalities are currently being developed. Quarterly newsletters are offered to inform members of the initiatives, accomplishments and educational opportunities offered by AAENP and other supportive organizations.

Research initiatives exploring current practice trends, quality patient care, current Professional guidelines, and effects Development and of collaboration and Leadership inter-professional relationships on patient care not only support the role of the ENP but also the expansion of the role within the professional team.

Doctoral (PhD and DNP) projects can be focused on the initiatives set forth by AAENP as well to support practice and change. Partner organizations are currently being explored for collaborative research opportunities.

Finally, AAENP is actively involved in numerous legislative and policy initiatives. The ever changing climate of healthcare requires close evaluation of the legislative changes occurring which can impact ENP practice. Efforts to date have been focusing on supporting ENP practice to the fullest scope of education, as well as assisting state boards of nursing and hospital credentialing bodies to appropriately interpret the APRN model. The ENP role is beyond the role and population focus of the APRN model; the entire ENP role is housed within the very tip of the triangle in the specialty practice area.

Expansion of the ENP specialty role to meet the current demands nationally is supported

by ENP programs, post-graduate fellowship, continuing education and board certification for current and future ENPs. Partnerships with organizations such as ACOEP allow realization of AAENP initiatives & mission within the interdisciplinary realm most reflective of our practice.

References • A merican Academy of Emergency Nurse Practitioners (2015). Retrieved from http://aaenpnatl.org

• A PRN concensus workgroup (2008). Concensus model for APRN regulation: licensure, accreditation, certification, and education retrieved from http://www.nursecredentialing.org/APRNConsensusModelReport.aspx • Emergency Nurse Practitioner Eligibility Criteria retrieved from http://www.nursecredentialing.org/ EmergencyNP-Eligibility • National Organization of Nurse Practitioner Faculties (2010). Adult-gerontology primary care nurse practitioner competencies retrieved from http://c.ymcdn.com/sites/www.nonpf. org/resource/resmgr/competencies/adultgeropccomps2010.pdf • National Organization of Nurse Practitioner Faculties (2012).

Adult-gerontology acute care nurse practitioner competencies retrieved from http://c.ymcdn.com/sites/www.nonpf. org/resource/resmgr/competencies/adultgeroaccompsfinal2012.pdf • National Organization of Nurse Practitioner Faculties (2013).

Population-focused nurse practitioner competencies retrieved from http://c.ymcdn.com/sites/www.nonpf. org/resource/resmgr/Competencies/ CompilationPopFocusComps2013.pdf

AAENP Priorities Education • Academic • Emergency Nurse Practitioner Programs • Post-Graduate • Fellowship • Continuing Education/Workshops Practice • Competencies • Regulations • Scope of Practice Research • Initiatives Professional Development and Leadership • Annual Conference • Advanced Emergency Nursing Journal • Newsletter • Inter-professional and Interorganizational relationships Policy • Legislative and regulatory changes and advancements

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Profile: Major Daniel Conway, DO Randy Lescault

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s a child Daniel Conway spent quite a bit of time in a hospital emergency room. Through those visits, he knew early in life that he wanted to be a doctor in emergency medicine.

“I was an active child,” Conway said. “I was into a lot of sports and stayed active. I broke a bone in my arm, my leg and my hand among other injuries.”

Conway, now Dr. (Maj.) Conway, is an active duty Soldier in the U.S. Army, stationed at Fort Belvoir, Virginia. He works as an Emergency Room physician in the Fort Belvoir Community Hospital. Conway joined the Army in 2004 after graduating from the Catholic University in Washington, D.C. with a Bachelor of Science in Biology.

“I signed up my senior year at college,” Conway explained. “I decided to use the HPSP (Health Professions Scholarship Program) to help pay for medical school. The scholarship paid for tuition and monthly rent. It allowed me to do a lot that I wouldn’t have been able to afford otherwise. I replaced a 20-year-old vehicle and didn’t have to work part time to pay living expenses.”

Students selected for the Army HPSP are members of the Individual Ready Reserve until they go onto active duty after graduating medical school.

Upon graduating from the New York College of Osteopathic Medicine in Old Westbury, New York, Conway reported to Fort Sam Houston, San Antonio, Texas. He spent three years in residency at the Army’s level 1 Trauma Center, Brooke Army Medical Center in emergency medicine. Following that, Conway remained at BAMC for a one-year fellowship in emergency ultra sound.

Conway says he enjoyed working at BAMC because it gave him an opportunity to treat veterans from World War II. “As an ER doctor I get to take care of guys who put their life on the line,” Conway said.

During his tour of duty in San Antonio Conway went to Okinawa, San Francisco

s an ER doctor I get to take care of guys " Awho put their life on the line." and Tampa where he presented classes on emergency medicine to special operations Soldiers.

“One of my goals,” Conway said, “is being engaged with special operations in training and academics. We ask them to do a lot in places where a medical person might not be available.

Teaching them is very special. They are like sponges; there to learn.”

After working at BAMC for four years, Conway was reassigned to the 3rd Sustainment Brigade, 3rd Infantry Division, Fort Stewart, Georgia where he served as the brigade surgeon.

It was during this time Conway deployed to Afghanistan and assisted the Afghanis with running their clinic. While working at Fort Stewart, Conway also worked for the Georgia Emergency Associates.

baseball team any longer he does play catch in the yard with his two sons.

The HPSP is awarded to college graduates who qualify and are planning a career in healthcare. The scholarship pays for tuition and provides a monthly stipend of more than $2,000. To find out about HPSP or the opportunities provided by a career in Army healthcare go to www.healthcare.goarmy.com.

Dr. (Maj.) Daniel Conway is an active duty Army physician working in the Emergency Room, Fort Belvoir Community Hopsital, Fort Belvoir, Virginia. Conway is a graduate of the New York College of Osteopathic Medicine in Old Westbury, New York.

Today, in addition to working at the Fort Belvoir Community Hospital, Conway serves as a staff physician at both the Commonwealth Emergency Physicians and the AlexandriaSpringfield Emergency Physicians in Alexandria, Virginia.

Conway hopes to move his career into the academic side of medicine.

“I really enjoyed being a teacher,” he said, “and would like to work with new residents and teach combat medics.”

When not busy with one of his jobs Conway likes to golf and read.

While not actively on a

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How to Write a Case Report Thomas Nappe DO - Rocky Mountain Poison & Drug Center, Denver Health and Hospital Authority, Denver, CO and John Ashurst DO, MSc - Department of Emergency Medicine, Duke Lifepoint Memorial Medical Center, Johnstown, PA

Writing for scientific publications has become an essential component of not only academic advancement but also the dissemination of medical knowledge. Medical writing comes in many different forms but the starting point of scientific writing for most new academicians is usually the case report.

The British Medical Journal of Case Reports describes a case report “as a narrative that describes, for medical, scientific or educational purposes, a medical problem experienced by one or more patients.” 2 The earliest form of the case report can be dated back to 1600 BC in the form of the Edwin Smith Papyrus, written by the ancient Egyptians.3 In this text the authors discussed 48 typical case histories with their associated treatments.3 The case report was later used by Hippocrates, Galen, and Hurwitz to describe how different treatment modalities affected the outcomes of patients. 3 However, it wasn’t until the Renaissance did we see the case report take the form that it is today.

Later in the 20th century, case reports fell out of favor and were placed at the lowest tier of the research hierarchy. Recently, however, the case report has once again gained popularity in the medical literature and is being published with great frequency. This editorial will serve as a guide to both novice and expert scientific writers alike, in the art of writing and publishing a case report, by the usage of the CARE guidelines and personal experience. 2 Abstract The abstract should be able to stand-alone from the manuscript but deliver the same message to the reader. Most authors prefer to write the abstract of all manuscripts last because it incorporates all other aspects of the manuscript into one concise and cohesive thought.

An abstract is usually 200 words or less and begins with a broad statement about the disease or condition in which the author is describing. 2 The CARE guidelines then recommend these five components to the abstract: Rationale

lways note and record the unusual . . . " APublish it. Place it on permanent record as

a short, concise note. Such communications are always of value.1

"

for the case report, Presenting concerns of the patient, Diagnoses, Interventions (including prevention and lifestyle), Outcomes, and Main lessons learned from this case.2 By following this method, authors will have described the disease process in enough detail to aid another clinician in the diagnosis and management of a particular disease as a summary.

Introduction

– Sir William Osler

This section is a good area to reference images (radiographs, MRI or CTs) if they were obtained. The authors should de-identify these images and obtain consent from the patient if at all possible. In the last paragraph, the author should describe the therapeutic interventions that were employed, and the disposition and outcomes, with follow up if available.

Discussion

The introduction allows the author to frame the case that will be discussed later in the manuscript. This section of the manuscript should have several references from the current literature and it is always a good starting point to describe the first case of a particular disease or the total amount of diseases described in the literature. In the last sentence of this section the authors should describe what would be discussed later in the manuscript. For instance, “The pathophysiology, diagnosis and management of disease X will be discussed”.

Case The case is the nuts and bolts to the manuscript and is usually broken down into several paragraphs. The first paragraph is the presenting complaint written in the classic “history of present illness format.” In this paragraph, the authors should also discuss pertinent positives and negatives from a review of systems. The next paragraph should discuss the patients past medical history, current medications and social history if relevant. The third paragraph typically is the physical exam findings that are pertinent to the case and should include a full set of vital signs. Next, the authors should describe the diagnostic results from the case with included normal references for each laboratory value.

The discussion should serve as the “how to treat” portion of the manuscript. An easy way to write this part of the manuscript is once again to begin with a broad paragraph about the incidence of the particular disease in which you are discussing. Next, you should describe the pathophysiology surrounding the disease in order to better aid the clinician understand the disease if it is rare. Also in this section, the clinical symptoms of the disease can be discussed. The third paragraph should include how a clinician makes the diagnosis through history and physical exam findings, laboratory data and imaging where applicable.

The authors should have the “gold standard” diagnostic modality listed and sensitivity and specificity of tests where applicable. Lastly, the author should discuss the different treatment modalities for the disease. All of these paragraphs should include references from the current literature, with each reference being less than 10 years old for pathophysiology and 5 years for treatments if available.

Conclusion/References The conclusion is a paragraph where the author can summarize the “take away message” from the case and can put their own perspective on the case that was discussed. Most case reports have less than 10 references from the current literature but

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it is recommended to follow each authoring journals standards from their “guidelines to authors” section.

Through the usage of the above template in association with the CARE guidelines,2 we hope that we have created a general framework to aid authors in completing the authorship of a case report. If you should have any questions in regards to writing or publishing you can follow John Ashurst @ Johnnymedicine on Twitter and also through the handle #WritingIsHard and Thomas Nappe @TomNappe on Twitter.

UPCOMING EVENTS Preconference OMT Workshop: "A Comprehensive Approach to SI Joint Pain and Sacral Dysfunction" December 3, 2015 8 hours category 1-A credit anticipated, pending approval of the AOA CCME Sheraton Hotel at Keystone Crossing, Indianapolis Sponsor: Indiana Osteopathic Association

References 1. T hayer WS. Osler, The Teacher Sir William Osler, Bart. Baltimore: Johns Hopkins Press; 1920. pp. 51–52.

2. Gagnier J, Kienle G, Altman D et al. The CARE guidelines: Consensus based clinical case reporting guideline development. BMJ Case Reports. 2013 PMID: 24155002 3. Nissen T and Wynn R. The history of the case report: A selective review. JRSM Open; 2014; 5(4).

Contact: IAO, (317) 926-3009 or www.inosteo.org

34th Annual Winter Update December 4 - 6, 2015 25 hours category 1-A credit anticipated, pending approval of the AOA CCME Sheraton Hotel at Keystone Crossing, Indianapolis Sponsor: Indiana Osteopathic Association Contact: IAO, (317) 926-3009 or www.inosteo.org

ACOEP ANNOUNCEMENTS Are Your CME Credits Up to Date?

The current CME Cycle ends this year! Have you been keeping track of your credits?

Visit www.osteopathic.org to check your status and make sure that you’re on track.

ACOEP has great options for excellent education and the CME hours you need before the cycle ends. The Edge: Scientific Assembly offers up to 39 hours of Category 1A CME Credit! You can also earn 1B credit from the comfort of your home through ACOEP’s new Digital Classroom. Check out recordings of past conferences, COLA and Board Reviews, EMS Tracks and more at www.acoep.org/classroom.

Join ACOEP’s Digital Faculty!

ACOEP’s Digital Classroom is rapidly expanding, providing custom-made lectures and demonstrations. Get in on the ground floor of this exciting initiative and join the ACOEP Digital Faculty. All faculty receive stipends, as well as scholarly activity.

To find more information, or to submit lecture proposals, email CME@acoep.org

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Clinical Quicksand Frank D. Gabrin, DO

I

n the ER today, whenever we walk up to our patient’s bedside, we have multiple concerns on our mind. Often, we’re acutely aware that our patient has been waiting a very long time for us and is anxious and upset. Before we even step in to see them, we’re thinking about our introduction and choosing the right words to diffuse our patient’s angst. We’re also thinking about each step of the process we need to do to make the right diagnosis and find the perfect treatment plan.

We have to be concerned with our efficiency, speed, performance metrics, documentation and our patient’s satisfaction with what we do as well. All while remaining aware of the needs of the other patients we’re simultaneously caring for and the many patients still waiting for us in the lobby. Many times, we feel all like it’s all we can do to just “stay out of trouble.”

A feeling of dread comes up the minute we see certain problematic clinical complaints pop up on the board and we think, “Oh no.... I hope they don’t put that one in my bed space!” I call these types of patient encounters “Clinical Quicksand.” In these encounters, we all know that no matter how nice, polite, efficient or helpful we try to be, it’s most probably going to go badly. It’s almost as if, from the moment we step into our patient’s room, the interaction between us begins to sink into a sea of negativity that’s very difficult, if not impossible, to escape.

Acute on chronic low back pain, migraine headaches, fibromyalgia, acute drug and alcohol intoxication and withdrawal, sickle cell crisis, reflex sympathetic dystrophy, peripheral neuropathy, and cyclic vomiting syndrome, are just some of the clinical conundrums where, more often than not, there’ll be angry insults heralded at us and our nurses. There’ll be a call to the nursing supervisor and a threat of a lawsuit. At the very least there’ll be a patient complaint, along with a request for another doctor. Why? All we did was walk into the room and say hello, right?

Sinking in quicksand I recently had a case where I stepped into the quicksand. When I first walked into the room and introduced myself, he didn’t even allow me

n these encounters, we all know that no matter " Ihow nice, polite, efficient or helpful we try to be, it’s most probably going to go badly." to ask the questions to formulate his history.

He told me everything I needed to know was in the computer. He was irritated that I wanted to examine him and continually interrupted me to demand pain medicine immediately. “What are you waiting for, I need pain medicine now!”

“You don’t care because you’re not the one laying in the bed in all this pain.”

He was allergic to all pain medicines but morphine, and was already taking 30 mg of oral morphine every four hours at home. He’d run out of his monthly allotment earlier and he was demanding that I give him 30 mg of intravenous morphine and would be satisfied with nothing less.

I told him that I’d be willing to give him 5 mg of IV morphine every fifteen minutes up to a total of 30 mg, but he was convinced this wouldn’t work. In 30 years of practicing medicine I’ve never given, and can’t imagine giving, more than 10 mg of morphine IV in one dose. When I do order 10 mg of IV morphine my patient is already intubated and on life support. There was just no way that I could, in good conscience, give him 30 mg of morphine IV push. He refused an oral dose of 30 mg of morphine. He did not want IV fluids or oxygen and he initially refused his EKG, his CXR and blood work.

He was very loud and screaming at all of us for “refusing” to help him. I tried talking softly, reassuring him that I’d keep giving him the morphine in small doses until his pain was relieved. I tried reasoning with him. He accused me of being a bad doctor and hurled obscenities at me. I raised my voice to get his attention and he accused me of abusing and badgering him.

When his blood work came back, I called his physician to get him admitted for pain control as well as a blood transfusion. His hemoglobin was incredibly low. He was clearly in crisis. When I went back into the room to share this information with him, he became

violently angry and demanded the 30 mg of IV morphine again. I asked him if he would consent to a blood transfusion and he refused to answer. Not yes. Not no. He felt that he needed to be pain free before he could make a decision like that, and he felt that getting blood was not going to lessen his pain.

There was nothing I could do to help this man and, worse yet, he was very upset with me, asking for the spelling of my name and threatening complaints, legal action and bodily harm. All I could do was walk away. He was admitted to the hospital, but he was still in pain and he did not allow me to order the blood he needed.

The whole situation was just awful. I felt like a failure. A loser. A zero. I’d sunk into the quicksand and couldn’t get out. The recovery from the emotional drain I experienced as a result of this negative encounter with this man, who was clearly in need of medical care, took days if not weeks to resolve and pass.

What’s really going on for us in these problematic, difficult and arduous encounters?

What, if anything, can we do to change the way these interactions unfold? How can we make it better, for our patients and ourselves?

Is it possible to walk away from these situations feeling good about who we are and what we do?

Is there a way to avoid the clinical quicksand that lurks within our emergency departments?

Who chose what?

To better answer, we need to go back to the beginning. Why did we make the huge decision to commit to a life in medicine in the first place?

What was our intention? What motivated us to spend all those years in college, medical school, internship and residency, delaying personal gratification in our young lives?

I believe our original intention, our purpose for committing ourselves to the process of going

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to medical school, and beyond, is because we wanted to make a difference and make the world a better place by caring for others in need.

In order to do this, we embarked on a process of rigorous medical training and post graduate education lasting many years. We had to focus completely to accomplish each step required along the way. These are necessary and time consuming steps for getting and maintaining our credentials, but, in the process we can get distracted from our original purpose for becoming a doctor in the first place.

Think about this. We worked really hard to get here, but no one actually wants to become a patient in our emergency room. When someone comes to us for help, it’s because they have a problem that’s outstripped their resources and they can’t solve it themselves. We are the only ones that chose to be here.

so wrapped up in the process, that we can completely miss our purpose.

Without purpose, there is no joy or happiness in the process and everything that we experience can seem random and meaningless.

This is nearly impossible to tolerate. On the other hand, when we’re clear on our purpose, we’re willing to withstand and tolerate any kind of process, difficulty, struggle and pain. Think about athletes training for the Olympics or yourself during medical school and finals week.

When patients come to the emergency room, they’re already overwhelmed by their situation. Who’s ever on their best behavior when they’re overwhelmed? They’re frustrated and can behave badly. It’s quite natural for us to try to distance ourselves from this kind of

pain by making our patients bad behaviors their problem, not ours.

One of the ways we do this is by unconsciously objectifying our patients with labels. We refer to them as the guy with chest pain in room 16, the abdominal pain in room 37, the hungry homeless guy in room 7, and the drug seeker in 42. We use these labels as a way to distance ourselves from our patients and their pain and focus only on the process of our work.

The problem is that by doing this, we’ve shifted actions away from our original purpose and intention to care and make a difference these patients. When we’re focusing only on the process of their situation, we completely miss giving them care. Furthermore, focusing Continued on Page 25

We, and our patient, both know that there is no cure for their common cold, flu, heart disease, back pain, cancer or HIV/AIDS. We have lots of treatments for what’s affecting them and ways to make things better, but we don’t have a cure for anything. Our sign says Emergency Care. Our patients come to us because they have a universal expectation that in us, they will find someone who will give it to them.

When I think about what it means to care, I always go back to a famous quote by Father Henri Nouyen. He teaches us that the word care comes from the Gothic kara, meaning “to lament, to grieve, to experience sorrow, or to cry out with.” He says, “The friend who can be silent with us in a moment of despair or confusion, who can stay with us in an hour of grief and bereavement, who can tolerate not knowing . . . not healing, not curing . . . that is a friend who cares.”

We made a choice long ago to put ourselves into a position, as a physician, to be able to care and make a difference. We chose emergency medicine and the chaotic environment of the emergency department as a place for us to give that care. We chose to find our fulfillment here.

So what’s the problem then?

Losing perspective We’ve become perceptually blind. There is a great youtube video called “The Invisible Gorilla.” (http://www.theinvisiblegorilla.com/ videos.html) If you’ve watched the video before, you already know the point is that if you keep your eye on the ball, you won’t see the gorilla. It’s the same in our work. We can get

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"Quicksand" continued from page 24 only on the process allows us to justify our behavior, even if it lacks human dignity. In any encounter where the process doesn’t include on our original intention to care, there is little chance of either one finding the care we’re both looking for.

Staying on track After reflecting about how awful that encounter made me feel, I see now how I sunk.

My thinking was wrong even before I stepped into the room to see this man. When I saw him on the board, I was thinking about me.

I was thinking about staying out of trouble.

Of course I wanted to care for him, that goes without saying, but I was distracted by all those “other” things and got stuck in the process.

My expectation before I even walked into the room was that it’d be a difficult encounter.

My focus was on not having a problem, staying under the radar and staying out of harms way.

And, because I was expecting trouble, that’s exactly what I found.

Had my focus been squarely on finding a way to care and make a difference no matter what, things may have turned out differently for both of us. Had my focus been on my patient’s need to feel better, rather than on my own need to stay out of trouble, I may have seen other ways to care and make a difference. After all, what I want at the end of the day is to feel good because of the effort I exert to care and make a difference.

Keeping our eyes on the prize helps us to transform the process of what we do in each encounter. We will find ourselves more often

in the right place, saying the right things and doing whatever it takes in the right moment.

It’s in this way that we can walk away from every encounter feeling good knowing that we did all we could, everything that was within our power, to make it better, and it won’t matter what others think. We’ll be able to walk away from the hospital feeling good knowing we did the right thing.

Care, no matter what There are always two realities going on at the same time. We have the reality of the process required for our work and our purpose for doing it. What we see and what we live is dependent on our perspective, our focus and our attention.

To drive this point home and give us a tool to use that will help us stay focused on our purpose, think of the famous optical illusion where you look at a picture and you either see a goblet or two faces. When we look at this picture, we can either see one or the other, but not both. The moment we see the goblet, the faces disappear. The moment we see the faces, the goblet disappears.

Imagine that the angry and accusing patients we encounter are the faces in the picture. They are only one reality. We can shift our perspective and see the goblet, our purpose and our prize.

In every encounter we have an opportunity to make this shift so that we can give our care, no matter what the obstacle or difficulty.

Whenever we make the choice to shift our realty, the quicksand disappears. Try using this the next time a difficult encounter pops up on the electronic tracking board.

Nothing good will result if we go in with the intention to stay out of trouble and, once we’re already in the process, it is very difficult to alter the course of events. But if we go in with the idea that our purpose is to care, it’s all going to be good because our words and actions will demonstrate our intention to care. It serves us well to remember that what we want from our work is the good feeling that comes from truly caring for others.

Finally, I saw a great movie the other day, “Ricky and the Flash.” There was a moment when the main character was complaining that her kids hate her, and her significant other looks at her and says; “It’s not your kids job to love you, it’s your job to love your kids!” I think that pretty much sums it all up! It’s our purpose to care, no matter what! Living from our purpose is what will make us all feel better!

Until next time: Go care, make a difference and change (y)our world!

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The Edge: Scientific Assembly 2015 How Far We’ve Come Erin Sernoffsky

T

he Edge: Scientific Assembly is around the corner and ACOEP’s office is buzzing with activity and anticipation.

This year’s conference can be summed up in one word: Energy. The lecture hall will pulse with energy as the nation’s leaders in emergency medicine deliver the latest, most exciting updates in emergency medicine. Lauded faculty such as Kevin Klauer, DO, Mimi Lu, MD, and Michael Epter, DO, make this a truly cutting edge experience, and keynote lectures by Brian Boyle and newly instated AOA President John Becher, DO, provide fresh perspective, and insight into the changing medical landscape.

Attendees will also have the opportunity to customize their own schedule with ACOEP’s first-ever breakout lecture series. Rapid-fire lectures and specialized tracks make this an excellent chance to delve deeper into the topics most pertinent to your practice.

ttendees will also have the opportunity to " Acustomize their own schedule with ACOEP’s first-ever breakout lecture series."

There are also ample opportunities to relax and have fun with your fellow attendees. For the first time ever, the Welcome Reception is moved offsite! In partnership with Island Medical Management, ACOEP will provide busses to shuttle attendees to Jimmy Buffett’s Margaritaville where the entire restaurant will be reserved exclusively for ACOEP. What better way to kick off an exciting meeting than with a frozen margarita, taking in the beautiful view of Universal Studios?

The FOEM Gala returns, this time with a mysterious flare. Join the masquerade that kicks off with a glittering outdoor cocktail reception.

Elegant food, dancing, entertainment, and most importantly the chance to honor the dedicated,

generous individuals who make FOEM’s mission a reality!

This year you can even blow off some steam with a new game. Click is a scavenger hunt that attendees can play through the conference app.

Points are awarded for competing challenges and answering trivia questions. Top the leader board and win prizes!

The Edge: Scientific Assembly 2015 will engage and energize every attendee. New speakers, dedicated tracks, more social events, more chances for CME, and even a blood drive, all combine to make this conference bigger, more exciting, and more valuable than ever before.

What’s New at The Edge: Scientific Assembly • Breakout Lecture Series • EMS Director’s Track

OCTOBER 18-22, 2015 Loews Portofino Bay Hotel Universal, Orlando, FL

• Inaugural Meeting of ACOEP’s Council of Women in Emergency Medicine • Off-Site Welcome Reception at Jimmy Buffett’s Margaritaville • Phase III of the Faculty Development Track • Blood Drive with OneBlood • Expanded Ultrasound Lab

HURRY, THERE'S STILL TIME TO REGISTER!!

• New Physicians in Practice Track

Visit www.acoep.com to register today

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FOEM Beacon | OCTOBER 2015 masthead_Layout 1 4/18/13 10:24 AM Page 1

• A FOUNDATION DEDICATED TO RESEARCH IN OSTEOPATHIC EMERGENCY MEDICINE

Foundation Focus Sherry D. Turner, DO, MPH, FACOEP President

H

ow well do you know your Foundation?

The Foundation for Osteopathic Medicine (FOEM) has a long history of working for ACOEP’s members—providing research support, training opportunities for resident and new physicians in practice to distinguish themselves in competitions, social events, and so much more.

FOEM fills vital fundraising role for ACOEP, giving its members a financial mechanism to donate funds to support their profession and College. This is a role that was inaccessible only a few years ago.

As you prepare to attend another conference, full of training opportunities, competitions, the Faculty Development Track, and of course the FOEM Legacy Gala, it is an excellent time to reflect on your Foundation—who we are, what we do, and how we make a substantive difference in your practice.

10 Facts You Need to Know About FOEM 1. T he Foundation was founded in 1998 as the non-profit arm of the American College of Osteopathic Emergency Physicians.

While ACOEP can provide CME, they cannot fund research grants or accept donations. ACOEP and FOEM work hand-inhand to fulfill the full spectrum of member needs.

2. The Foundation allocates over $10,000 annually in awards and grants to qualified researchers.

3. Over 100 residents per year compete in the Foundation’s five resident research competitions.

4. T he Foundation provides research grants to osteopathic emergency physicians and clinical investigators in topics such as emergency medicine, disaster medicine, emergency medical services, medical toxicology, and/or pediatric emergency medicine.

5. T he FOEM Research Network (FRN) is an easy way to access additional funding, data, to conduct multicenter studies, and access the global research database of the American Heart Association. It takes less than an hour for research sites to join the FRN. 6. T he Foundation sponsors and develops curriculum for the ACOEP Faculty Development Track which educates core faculty on how to conduct exceptional research projects, write grants, and implement the changes being presented by the Single Pathway.

7. T he Foundation’s website offers basic guidelines for research that provide simple step-by-step instructions for the successful completion of research. Mentorship is available through the FOEM Board for those that need an extra hand.

8. T he Foundation’s research competitions provide detailed feedback to participants, CME to attendees, and physicians acting as judges in our competitions are provided CME and Scholarly Activity.

9. Donations made to the Foundation are 100% tax deductible as charitable contributions.

10. I n 2015, the Foundation launched its Planned Giving Program, providing their most dedicated supporters the ability to include the Foundation in their estate plans.

Fr

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2015-FOE

FOEM Beacon | OCTOBER 2015

Monday, October 19, 2015

at 7 o’clock in the evening Loews Portofino Bay Hotel • Orlando, Florida All proceeds benefit the Foundation for Osteopathic Emergency Medicine and its mission to improve patient care through quality research and education.

For more information or to purchase tickets, visit www.foem.org/gala or call StephanieWhitmer at 312.445.5712.

Supporting Sponsor: Champagne Toast Sponsor: Friends:

Continued on Page 28

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Photobooth Sponsor:

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Congratulations to the 2015 Honorees of the Legacy Gala!

On Monday, October 19, the Foundation for Osteopathic Emergency Medicine will host its 5th annual Legacy Gala: Dinner & Awards Ceremony. The Legacy Gala serves to recognize the top researchers in the field, as well as the most generous benefactors of the Foundation.

Florence and Joseph Wachtler Spirit Award: Presented to donors with a lifetime donation level of $50,000.00 or more Joseph Kuchinski, DO, FACOEP-D FOEM Pillar Award: Presented to donors with a lifetime donation level of $5,000 or more Fahim Shan Ahmed, DO, MS, FACOEP, FACEP Jack Field, DO Drew Koch, DO, MBA, FACOEP-D William Lynch, Jr. Jon Pierre Pazevic, DO, FACOEP, FACEP John C. Prestosh, DO, FACOEP Theodore Spevack, DO, FACOEP-D FOEM Partner Award: Presented to donors with a lifetime donation level of $2,500 or more Bernadette Brandon, DO, FACOEP Joseph Dougherty, DO, FACOEP Gregory Frailey, DO, FACOEP FOEM 500 Club: Presented to donors with an annual donation level of $500 or more Juan F. Acosta, DO, MS, FACOEP-D Fahim Shan Ahmed, DO, MS, FACOEP, FACEP Michael Allswede, DO Gregory J. Beirne, DO, FACOEP, FACEP Aimee Blagovich, DO Timothy J. Cheslock, DO, FACOEP Joseph Dougherty, DO, FACOEP Jack B. Field, DO Steven D. Hollosi, DO, FACOEP Drew A. Koch, DO, MBA, FACOEP-D Joseph J. Kuchinski, DO, FACOEP-D Beth A. Longenecker, DO, FACOEP William Lynch, Jr. Mark A. Mitchell, DO, FACOEP-D Victor J. Scali, DO, FACOEP-D Jeremy Kent Selley, DO, FACOEP & Victoria H. Selley, DO, FACOEP Bryan D. Staffin, DO, FACOEP-D Robert E. Suter, DO, MHA, FACOEP-D, FACEP, FIFEM James Turner, DO, FACOEP & Sherry Turner, DO, FACOEP Janice Wachtler, BAE, CBA FOEM Research Flame Award: Presented to the ACOEP Residency Program with the highest average score for research papers St. John Medical Center, Westlake, OH

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the PULSE | OCTOBER 2015

ACOEP-RC President’s Report College of Emergency Physicians, as I had read their publications in the ED lounge where I worked prior to medical school, but was unsure if there was an osteopathic equivalent. While searching the internet I found that there was a conference to be held in Las Vegas for the American College of Osteopathic Emergency Physicians (ACOEP). I went to this conference where I knew no one. Luckily for me, that did not last long. I quickly met DOs from around the country who practiced emergency medicine (EM) and who were residents in osteopathic EM programs.

Andrew Little, DO ACOEP Resident Chapter President

L

ong before I became a DO, I had a desire to be an emergency medicine physician. These two thoughts merged shortly after beginning my first year of medical school. I knew of the American

While at this conference I had the opportunity to meet Mark Mitchell DO, then a member at large of the ACOEP Board of Directors, who noticed my enthusiasm for EM and encouraged me to run for a national student position within ACOEP. The next day I was elected to be the ACOEP Student Chapter’s conference committee co-chair. Little did I know, that single event would prove to be a turning point. Over the last seven years, I have had the honor and privilege of being an officer within the ACOEP Student and Resident Chapters, serving two years as the Student Chapter President and now serving as the Resident Chapter President.

been truly blessed. I have had countless opportunities and experiences to serve, learn, improve, be inspired, mentored and become a mentor. I have learned to be a better person in the many facets of my life - father, husband, son, friend and physician - and have had the opportunity to walk among the giants of the osteopathic and emergency medicine communities. If you said that, in my time of service within the ACOEP, I have gained more than I could ever give, you would be right.

So as this is my last message to you as the Resident Chapter President, I invite all of our members to give ACOEP a try. Come to a conference, attend one of our review course, write for one of our publications. If you do, I promise you will not be disappointed, you will feel welcome and you will want to get more involved.

Thank you,

Andy Little, DO ACOEP National Resident Chapter President ACOEP Board of Directors

During my time with ACOEP, I have

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