SAEM Pulse January-February 2024 by Society for Academic Emergency Medicine

JANUARY-FEBRUARY 2024 | VOLUME XXXIX NUMBER 1

www.saem.org

SPOTLIGHT PAYING IT FORWARD: GUIDING THE PROGRAMS THAT SUPPORT GRANT FUNDING An interview with

Manish N. Shah, MD, MPH

Office of Emergency Care Research

Decoding Your NIH Summary Statement page 52

Leading the advancement of emergency care through education and research, advocacy, and professional development in academic emergency medicine.

HIGHLIGHTS

SAEM STAFF Chief Executive Officer Megan N. Schagrin, MBA, CAE, CFRE mschagrin@saem.org

Sr. Director, Foundation and Business Development Melissa McMillian, CAE, CNP mmcmillian@saem.org Sr. Manager, Development for the SAEM Foundation Julie Wolfe, jwolfe@saem.org Manager, Educational Course Development Kayla Belec Roseen, kroseen@saem.org Manager, Exhibits and Sponsorships Bill Schmitt, wschmitt@saem.org

President’s Comments Celebrating SAEM's Impactful Year

SAEM Board Corner SAEM board liaisons provide a roundup of what's happening in the Society's many active groups.

Spotlight Paying it Forward: Guiding the Programs That Support Grant Funding – An Interview with Dr. Manish N. Shah

Airway Navigating Trauma Airway Responsibilities in the Modern Emergency Medicine Department

Case Studies in Social EM Mobile, Multidisciplinary Approach for Nonfatal Opioid Overdose Survivors

Critical Care EM A Day in the Life of an Emergency Medicine Intensivist

Diversity, Equity, Inclusion Chatter Matters: Fostering Equity with LanguageConcordant Care

ED Management & Preparedness Strategic Planning for EDs: Addressing Workforce Challenges Amid Labor Actions

Articles displaying the RAMS icon have been identified as being of interest and benefit to residents and medical students.

NIH Office of Emergency Care Research Decoding Your NIH Summary Statement

Oncologic Emergencies Closing The Knowledge Gap: Strengthening EM for a Growing Cancer Patient Population

Perspective Life and Death in the ED: Navigating the Complex Emotions of EM

Pharmacology Navigating the Complexities of Post-Cosmetic Surgery Complications: A Comprehensive Guide for Emergency Physicians

Guardians of Patient Safety: The Dynamic Role of the Emergency Medicine Pharmacist

Residents & Medical Students Enhancing Engagement and Team Dynamics in EM Residency With "Thinking Rounds"

Research Beyond Superiority: The Rise of Noninferiority Research

Sex & Gender Bridging the Sex- and Gender-Based Educational Divide: Insights and Lessons From an Innovative Program

Education The Crucial Role of Academic Coaching in Emergency Medicine

Toxicology Managing Hydroxychloroquine Toxicity: A Crucial Primer for EM Practitioners

Emergency Ultrasound Point-of-Care Ultrasound for Peritonsillar Abscess: Look Before You Drain

Virtual Advances in EM Data-Driven Innovations in Emergency Care: Harnessing AI for Improved Patient Outcomes

WE HAVE A NEW PHONE SYSTEM!

For the most up-to-date contact information, visit the “Contact Us” page.

Revolutionizing Shoulder Dislocation Management: A POCUS-Driven Paradigm Shift in Low-Resource Settings

Wellness in EM Resilience in EM: A Trauma-Informed Care Approach for Combating Burnout

Ethics in Action Enough Already: Ethical Considerations in Treating a Recurrent IV Drug User With Endocarditis

Wilderness Medicine Navigating Toxic Flora Part 2: Na Channel Openers

Faculty Focus “Can't Wait” is Emergency Medicine's “Can't Miss”

Leading the Way: Dr. Sanjey Gupta's Pioneering Contributions to Wilderness Medicine and Emergency Care

Director, Finance & Operations Doug Ray, MSA, dray@saem.org Manager, Accounting Edwina Zaccardo, ezaccardo@saem.org Director, IT Anthony "Tony" Macalindong, amacalindong@saem.org IT AMS Database Specialist Dometrise "Dom" Hairston, dhairston@saem.org Specialist, IT Support Dawud Lawson, dlawson@saem.org Director, Governance Erin Campo, ecampo@saem.org Manager, Governance Juana Vazquez, jvazquez@saem.org Director, Communications & Publications Laura Giblin, lgiblin@saem.org Sr. Manager, Communications & Publications Stacey Roseen, sroseen@saem.org Manager, Digital Marketing & Communications, Alison “Ali” Mistretta amistretta@saem.org Specialist, Web and Digital Content Alex Gorny, agorny@saem.org

Director, Membership & Meetings Holly Byrd-Duncan, MBA, hbyrdduncan@saem.org Sr. Manager, Membership George Greaves, ggreaves@saem.org Sr. Manager, Education Andrea Ray, aray@saem.org Sr. Coordinator, Membership & Meetings Monica Bell, CMP, mbell@saem.org Specialist, Membership Recruitment Krystle Ansay, kansay@saem.org Meeting Planner Kar Corlew, kcorlew@saem.org AEM Editor in Chief Jeffrey Kline, MD, AEMEditor@saem.org AEM E&T Editor in Chief Susan Promes, MD, AEMETeditor@saem.org AEM/AEM E&T Peer Review Coordinator Taylor Bowen, tbowen@saem.org aem@saem.org, aemet@saem.org

2023–2024 BOARD OF DIRECTORS Wendy C. Coates, MD President UCLA Department of Emergency Medicine David Geffen School of Medicine at UCLA Ali S. Raja, MD, DBA, MPH President Elect Massachusetts General Hospital/Harvard Members-at-Large Pooja Agrawal, MD, MPH Yale University School of Medicine Jeffrey Druck, MD The University of Utah School of Medicine Julianna J. Jung, MD Johns Hopkins University School of Medicine Nicholas M. Mohr, MD, MS University of Iowa

Michelle D. Lall, MD, MHS Secretary Treasurer Emory University Angela M. Mills, MD Immediate Past President Columbia University Vagelos

Ava E. Pierce, MD UT Southwestern Medical Center, Dallas Jody A. Vogel, MD, MSc, MSW Stanford University Department of Emergency Medicine Resident Member Michael DeFilippo, DO, MICP NewYork-Presbyterian - Columbia & Cornell

Geriatric EM Buprenorphine as a Potential Agent for Pain Control in Older Adults

Infectious Diseases & Epidemics Stemming the Rising Tide of Syphilis Through Emergency Department Screening

Informatics & Data Science EMS Informatics: Navigating the Challenges, Seizing the Opportunities

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Transformative Giving Join the Annual Alliance Today Briefs & Bullet Points SAEM Reports Membership Committee Special Report Academic Announcements Now Hiring

SAEM Pulse is published bimonthly by the Society for Academic Emergency Medicine, 1111 East Touhy Ave., Ste. 540, Des Plaines, IL 60018. (847) 813-9823 Disclaimer: The views and opinions expressed in this publication are those of the authors and do not necessarily reflect the official policies, positions, opinions, or views of the Society for Academic Emergency Medicine or its members. © 2024 Society for Academic Emergency Medicine. All rights reserved. No part of this publication may be reproduced, stored, or transmitted in any form or by any means without prior permission in writing from the copyright holder.

Happy New Year From SAEM!

A special “President’s Comments” from Dr. Wendy Coates

Celebrating SAEM's Impactful Year

Wendy Coates, MD UCLA Department of Emergency Medicine David Geffen School of Medicine at UCLA 2023-2024 President, SAEM

You are the heartbeat of our organization, the lifeblood, and soul that collectively make SAEM the special place it is. We are grateful to all 8,553 of you for your many valuable contributions that shape and define SAEM. From pre-med students to emeritus faculty, PhD scientists and educators, EMS practitioners, EM pharmacists, administrators, research associates, nurses, advanced practice providers, and friends, our diverse community brings multiple perspectives to ensure a promising tomorrow for academic EM. There is a place for everyone at SAEM, and each community within our organization is actively making a difference for patients and our specialty. Let’s take a moment to celebrate our many accomplishments of 2023 together, with a sneak peek at what’s in store for 2024 and how YOU can play a part in shaping SAEM’s bright future!

SAEM Academies, Committees & Interest Groups: Architects of EM Educational Content

In 2023, SAEM’s Academies, Committees, and Interest Groups demonstrated an unwavering commitment to their roles as pioneers in emergency medicine (EM) education and research. True to their nature, these groups emerged as the primary architects of EM educational content, contributing prolifically through articles, webinars, white papers, curricula, didactics, workshops, abstracts, guidebooks, toolkits, podcasts, and more. This year marked an exceptional level of activity and productivity, underscoring their pivotal roles in advancing EM knowledge and solidifying SAEM’s position as a hub for

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PRESIDENT'S COMMENTS

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a new Legacy Award in honor of Dr. Sheryl Heron.

Your active contributions to research and education have been remarkable this year! The SAEM23 Annual Meeting saw a record-breaking 3,890 registered attendees, marking SAEM's largest meeting to date. We received an unprecedented number of submissions, including 1,210 research abstracts, 376 didactic proposals, 162 Innovations, and 105 IGNITE! submissions. In addition, registered participants for Sonogames and Dodgeball exceeded all previous records.

In our commitment to fostering the professional growth of our members, SAEM provides educational courses tailored to diverse needs. Each course, led by content experts and leaders, offers robust networking and mentorship for sustained growth and expertise. The newly introduced Master Educator course enrolled its first class in 2023. The course offers early to mid-career faculty a collaborative network to deepen their knowledge of advanced education theory, work with expert mentors on projects, and build a network of informed collaborators. Both Advanced Research Methodology Evaluation and Design (ARMED) and Advanced Research Methodology Evaluation and Design: Medical Education (ARMED MedEd) are flourishing, with graduates securing independent grant funding and advancing the research infrastructure for EM. Our Emerging Leader Development Program (eLEAD) and Chair Development Program (CDP) courses are building networks of leaders, with eLEAD graduating its first cohort in May 2023 and selecting its first Advanced eLEAD Fellow to join the eLEAD faculty.

Member-Generated Content: A Key to Our Success

RAMS Keeps Setting Milestones

• The Simulation Academy initiated a innovation and excellence in emergency medicine education and research. Other 2023 highlights from SAEM’s committees, academies, and interest groups:

• The addition of the Academic

Emergency Medicine Pharmacists (AEMP) Interest Group and the Tactical and Law Enforcement Interest Group expanded SAEM’s list of interest groups to a total of 31

• AEMP successfully hosted its

inaugural conference in collaboration with SAEM23, drawing over 200 emergency medicine pharmacists and advocates. The group also collaborated with the University of South Carolina for ACPE accreditation for SAEM24.

• The Awards Committee presented

Emory University with the inaugural Outstanding Department Award for Excellence and Innovation in Diversity, Equity, and Inclusion.

• The Consultation Services Committee, in conjunction with AACEM, introduced three new consultations as part of its Consultation Services program: two for research and one for operations.

• The Fellowship Approval Committee

endorsed the first SAEM-approved simulation and social EM fellowships through the SAEM EM Fellowship Approval Program

• GEMA’s Humanitarianism Task

Force launched a new humanitarian research series of webinars.

SAEM PULSE | JANUARY-FEBRUARY 2024

• The Global Emergency Medicine

Fellowship Consortium became a new committee within the SAEM Global Emergency Medicine Academy (GEMA), unveiling a fully redesigned website, a new application portal, and a directory for global EM fellowships.

• CDEM revamped its CDEM M3

Curriculum, updated their M4 curriculum and tests, and relaunched its mentorship program. Additionally, the academy collaborated with RAMS on an Emergency Medicine Workforce Analysis: A Guide for EM Advisors

• ADIEM relaunched its LGBTQIA+

Mentoring Program and introduced

SAEM: Leading the Way in Education

Mentor Hour webinar series

• AACEM developed a Faculty Lectures Speakers Bureau

• AEUS created a professional development webinar series

• The Equity and Inclusion Committee

produced an annual report for the board on diversity metrics within SAEM, EM, and other national medical groups. They also continued to expand their DEI curriculum, offering online resources for educators teaching equity and inclusion topics.

SAEM23 Sets New Milestone

Throughout the year, you led 63 webinars on topics reflecting your expertise, and 252 of you authored 110 Pulse articles covering a wide spectrum of EM topics. This type of content ensures a diverse range of perspectives and insights, enriching the collective knowledge base and providing valuable resources for continuous learning and professional development.

SAEM Journals Make an Impact

Our journals thrive due to the dedication of their editorial boards, reviewers, and authors. Academic Emergency Medicine Education & Training (AEM E&T) achieved its first Impact Factor (1.8,) marking its debut in the top 46% of all EM journals. Academic Emergency Medicine (AEM) maintained its position as a leading EM journal with an Impact Factor of 4.4. Furthermore, in 2023, SAEM published the third Guideline for Reasonable and Appropriate Care in the Emergency Department (GRACE): Acute Dizziness and Vertigo in the Emergency Department as well as AEM Special Issue on Veteran Emergency Care.

In 2023, RAMS achieved significant milestones and made enhancements across various fronts. This year’s live and virtual Residency & Fellowship Fairs offered a convenient, centralized, and efficient way for residents, medical students, and residency/fellowship programs to connect and interact. Additionally, RAMS successfully introduced the RAMS Regional Ambassador Program, aimed at fostering a robust regional representation structure. RAMS also collaborated with CDEM, resulting in hosting the Emergency Medicine Workforce Analysis: A Guide for EM Advisors. Furthermore, RAMS expanded its online presence with the launch of the SAEM Instagram account in September 2023, fortifying the Society's connection with its resident and medical student members. These accomplishments collectively reflect RAMS’ commitment to fostering communication, collaboration, and member engagement throughout the past year.

A Banner Year for Research Grants

In 2023, the SAEM Foundation experienced a 60% increase in grant applications received, leading to a record-breaking $970,261 awarded to SAEM members for vital research for the 2024-25 grant cycle. This represents the largest single-year investment in SAEMF’s history! Your generosity made significant achievements possible, including the establishment of the Ali and Danielle Raja RAMS Medical Student Research Grant, which will be awarded for the first time in 2024. Generous donors also made possible the launch of the SAEMF Geriatric Emergency Medicine Research Catalyst Grant and the SAEMF/ Emergency Medicine Benchmarking Alliance (EDBA) during 2023. There are so many ways to give, and any amount is a worthwhile investment! Explore the tangible impact your donation makes in the Foundation’s new 2023 Impact Report.

EM Orgs Working Together to Advance Our Specialty

In 2023, SAEM remained dedicated to advancing emergency medicine (EM) through collaborative initiatives. At the National Institutes of Health (NIH), we initiated discussions and cultivated relationships with leaders, emphasizing member engagement and seeking increased federal funding for EM research. Dr. Jeremy Brown, Director of the Office of Emergency Care Research, actively contributed valuable insights and grant development tips through a regular column in SAEM Pulse.

Get Involved in Shaping SAEM’s Future! Here are ways for you to make an impact on the future of SAEM: • Run for a leadership position: Consider running for

a society-wide elected office on the SAEM Board of Directors, Nominating Committee, or Bylaws Committee.

• Explore sub-specialty roles: SAEM academies elect leaders

annually; check with them for details (membership is free with your SAEM membership).

• Volunteer for committees: Contribute to the Society’s work

by volunteering for committee service or leadership roles.

• Join/lead an Interest Group: Work with others to advance

your area of interest within the Society by leading or joining one of our many interest groups.

• Submit your work: Share your research and insights

through publications like AEM or AEMET, Pulse, or at the annual meeting via an abstract or didactic.

• Create a webinar: Share your expertise with colleagues by

organizing a webinar.

• Attend a Regional Meeting: Participate in an SAEM

Regional Meeting to share your research, receive/provide mentorship, and network with others in your area.

The SAEM Foundation played a vital role in supporting professional development by facilitating meetings between its grantees and representatives from all NIH Institutes at the NIH. Furthermore, SAEM hosted a Program Officer Event during the SAEM Annual Meeting, providing a platform for interactions with program officers from NIH and other federal agencies. Strategic alliances were formed with the National Institute of Mental Health (NIMH) and the National Institute of Allergy and Infectious Diseases (NIAID), complementing ongoing collaborations with the Office of Emergency Care Research at the National Institute of

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PRESIDENT'S COMMENTS

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Neurological Disorders and Stroke (NINDS). SAEM’s robust collaborations with other EM organizations encompass various initiatives. SAEM led the all-EM Diversity, Equity, and Inclusion (DEI) Task Force workgroup, collaborating with AACEM, AAEM, AAEM/RSA, ABEM, ACEP, ACOEP, CORD, EMRA, and RAMS, to develop best practices for ensuring a diverse workforce that effectively cares for all patients. As a founding member of the Competency-Based Medical Education (CBME) Task Force, led by the American Board of Emergency Medicine (ABEM), SAEM contributed to advancing CBME across the medical education spectrum, particularly focusing on assessment to align with new measures

introduced by the American Board of Medical Specialties (ABMS) and the Accreditation Council for Graduate Medical Education (ACGME). SAEM, CDEM, and AACEM were represented on the All-EM Match Task Force, addressing factors related to the recruitment and retention of top applicants to the specialty. Moreover, SAEM represented the academic viewpoint in the collaborative All-EM Workforce Task Force focused on the EM workforce. As part of October's Stop the Stigma EM Month, SAEM led an all-EM social media campaign, emphasizing the importance of well-being and mental health for EM practitioners throughout the year. SAEM renewed its partnership with the Geriatric ED Collaborative 4.0 and hosted a geriatric and DEI symposium at SAEM23. Additionally, SAEM renewed its partnership with

the Providers Clinical Support System (PCSS), funded through the Substance Abuse and Mental Health Services Administration (SAMHSA). These collaborations underscore SAEM’s commitment to fostering a supportive and innovative environment within the field of emergency medicine.

EM Chairs See Growth in Numbers, Initiatives

The Association of Academic Chairs of Emergency Medicine (AACEM) achieved a historic milestone in 2023, reaching its highest membership to date, with 178 members. Notably, AACEM celebrated the graduation of its inaugural cohort of participants from the Chair Mentorship Program. Additionally, to further enhance support for its members, AACEM established the Chair Resource and Support Workgroup, recognizing the importance of creating a robust framework for collaboration and resource-sharing among emergency medicine leaders.

The Records Keep Falling! SAEM members, your outstanding efforts shined bright in 2023! Your dedication, engagement, and active participation are the driving force behind SAEM’s success and were responsible for several records being surpassed in 2023, including: • Highest membership numbers in the Society’s 35-year history • Record-breaking 3,890 annual meeting attendees for SAEM23 • Unprecedented number of didactics, workshops, Innovations, and IGNITE!

SAEM PULSE | JANUARY-FEBRUARY 2024

submissions for SAEM23

• Highest number of committee interest forms submitted in SAEM history • Record 137 award nominations this year, the highest ever • Grant applications rose by 60%, resulting in a record $970,261 for vital research

— SAEMF's largest-ever annual investment!

Join Us for an Exciting 2024! We are immensely grateful for your contributions and invite you to continue with us on this exciting journey as we enter the new year: 1. Renew your SAEM membership 2. Join us at SAEM24, May 14-17 in Phoenix

In its commitment to promoting DEI, AACEM hosted quarterly webinars dedicated to addressing pertinent issues and fostering dialogue within the emergency medicine community. Additionally, the organization launched a Research Consultation Service focused on bolstering efforts to secure federal funding, demonstrating a strategic approach to advancing research initiatives. AACEM also expanded its outreach through the creation of the AACEM Faculty Lectures Speakers Bureau, offering a platform for members to share their expertise and insights.

Teamwork Makes the Dream Work

SAEM’s dedicated, flexible, and exceptionally capable staff, led by CEO Megan Schagrin, MBA, CAE, CFRE, consists of 22 professionals who skillfully steward the financial well-being of SAEM and the SAEM Foundation. They manage daily operations and support activities across all of SAEM’s academies, committees, interest groups, task forces, courses, meetings, programs, and activities. Working closely with this exceptional team has been a privilege, and their expertise is a daily marvel. In 2023, several of our SAEM staff earned the Certification in Association Management from the America Society of Association Executives (ASAE). Members of our meetings and membership team were chosen to present their work at the annual ASAE Center for Association Leadership conference, and the team’s director was appointed to serve on the ASAE Meetings and Exposition Professionals Advisory Council. SAEM aspires to be the foremost organization for nurturing academic leaders and influencing the future science, education, and practice of emergency and acute care. Our mission is to “to lead the advancement of academic emergency medicine through education, research, and professional development.” Your contributions are vital to our success, and we extend our heartfelt thanks for shaping SAEM into what it is today.

ABOUT DR. COATES: Wendy Coates, MD, is professor of emergency medicine at David Geffen School of Medicine at UCLA and senior faculty/ education specialist at UCLA Department of Emergency Medicine

What’s In Store for 2024? Strategic Planning to Guide Future Success

In early 2024, SAEM leadership, with the guidance of a professional facilitator, will develop new multiyear strategic plans for SAEM, SAEM Foundation, and the Association of Academic Chairs of Emergency Medicine (AACEM). Your SAEM leadership is committed to advancing SAEM as your primary community for networking and education. This year, we will dedicate three days to updating SAEM's Strategic Plan, reimagining our future to better serve our members and community. We will extend this facilitated opportunity to AACEM, the SAEM Foundation Board, RAMS, and the Academy Executive Committees.

A Focus on Competency-Based Medical Education (CBME)

In collaboration with the American Board of Emergency Medicine (ABEM) and its Competency-Based Medical Education (CBME) Task Force, SAEM will assemble an expert panel of members to formulate a strategy for implementing CBME in emergency medicine across the medical education continuum (undergraduate medical education, graduate medical education, continuing professional development). This strategy might include pilot implementations and collaboration with other EM organizations to devise a specialty-wide plan in accordance with Accreditation Council for Graduate Medical Education/American Board of Medical Specialties standards.

Strengthen the EM Match and Pipeline

SAEM, CDEM, and AACEM will collaborate with members of the All-EM Task Force to support successful recruitment in EM. This work will be wide-ranging and encompass diverse initiatives, such as data tracking, identifying necessary policy adjustments, and implementing measured changes to strengthen our specialty. Additionally, it will entail partnering with colleges, medical schools, and training programs to attract a broader range of candidates, including those from diverse backgrounds, to pursue careers in EM.

New Resources to Support Regional Meeting Planning

To enhance our regional meetings, SAEM will introduce a comprehensive guidebook to provide meeting leaders with detailed recommendations for planning and managing successful events.

Federal Funding for Emergency Care Research

SAEM will continue collaborating with the National Institute of Neurological Disorders and Stroke (NINDS) to align with the goals and objectives of the Office of Emergency Care Research, aiming to secure increased co-funded grants from NIH institutes. Additionally, we will advocate for another K12 grant for emergency medicine.

SAEM BOARD CORNER • In preparation for SAEM24, the Virtual Presence Committee is focusing on the production and promotion of podcasts, highlighting the FOAM Showcase, and implementing various other initiatives to enhance the event’s impact and outreach.

EMS IG Chair: Craig Cooley, MD, MPH, EMT-P

Overview

Michael DeFilippo, DO, MICP Resident Member SAEM BOD Chief Emergency Medicine Resident NewYork-Presbyterian – Columbia & Cornell Dr. DeFilippo is the SAEM Board Liaison for the following SAEM groups:

Virtual Presence Committee Chair: Aalap Shah

Overview

The Virtual Presence Committee is actively engaged in several innovative initiatives for the 2023-2024 period, focusing on enhancing the organization’s online presence and member engagement.

Updates/Status

SAEM BOARD CORNER

• The new SAEM Instagram account highlights the VPC’s recognition of the growing importance of visual-centric social media platforms. By leveraging Instagram, SAEM aims to engage a broader audience, especially younger members, and those more active on visual platforms, thereby expanding its reach and influence within the academic emergency medicine community.

• “Who’s Who in Academic EM” and “Ask a Chair” Podcast Series are designed to spotlight these individuals and provide a platform for them to answer questions from SAEM members in varied formats. The series aims to offer insights and experiences from leading voices in the field, fostering a deeper understanding and connection within the SAEM community.

The EMS Interest Group at SAEM is a dynamic collective focused on advancing emergency medical services through research, education, and collaborative innovation. This group connects professionals dedicated to improving pre-hospital care and integrating EMS systems with broader healthcare networks.

Updates/Status

• The EMS Interest Group has actively contributed to the field by writing and submitting comprehensive EMSfocused didactics for the SAEM24 conference • They are dedicated to creating and delivering relevant webinars that cater to the educational needs of academic emergency medicine physicians with a special interest in EMS.

CPR and Ischemia IG Co-chairs: William J. Meurer, MD; Jonathan McCoy, MD

Overview

The CPR and Ischemia Interest Group at SAEM is a specialized collective of professionals dedicated to advancing knowledge and practices in cardiopulmonary resuscitation and ischemic conditions within emergency medicine. This group fosters a collaborative environment for research, education, and clinical innovation, aiming to improve patient outcomes in acute cardiac care.

Updates/Status

• The CPR and Ischemia Interest Group is continually seeking research collaborators for projects nationwide, aiming to enhance the scope and impact of their studies in emergency cardiac care.

Climate Change and Health Chair: Gayle Kouklis, MD

Overview

The Climate Change and Health

Interest Group at SAEM is a forwardthinking collective that addresses the critical intersection of climate change and its impacts on public health and emergency medicine. This group is dedicated to researching, educating, and advocating for sustainable practices and policies that mitigate the health effects of climate change, fostering a multidisciplinary approach to this global challenge.

Updates/Status

• Didactic Submissions and Curriculum Development: The group is actively submitting didactics for the May meeting, focusing on emergency department greening and heat illness, while also collaborating with CDEM to integrate climate-related information into medical student curricula, inviting members interested in educational development to contribute. • SAEM Pulse Submissions and Mentorship: The group is encouraging submissions for SAEM Pulse to start a series on adapting emergency medicine practices for climate change challenges, particularly in areas like infectious and vector-borne diseases, and are offering mentorship opportunities to connect faculty with students and residents interested in climate change and health.

Wilderness Medicine IG Chair: Luke Apisa, MD

Overview

The Wilderness Medicine Interest Group at SAEM brings together a passionate community of emergency medicine professionals who focus on the unique challenges and practices of medicine in wilderness and remote environments. This group fosters research, education, and collaboration on topics ranging from outdoor injury management to environmental emergencies, aiming to enhance skills and knowledge in this specialized area of emergency care.

Updates/Status

• The Wilderness Medicine Interest Group actively engages SAEM members with monthly content, including diverse topics such as a recent informative webinar on space medicine

• To work collaboratively with other organizations within emergency medicine, and across the specialties, through partnership, education, and to promote shared common interests.

Updates/Status

• Record number of highly engaged academy members • Record number of teams for SonoGames 2023

Michelle D. Lall, MD, MHS

Secretary-Treasurer, SAEM BOD Associate Professor, Associate Residency Director, Medical Education Fellowship Director, Department of Emergency Medicine Emory University School of Medicine Dr. Lall is the SAEM Board Liaison for the following SAEM groups:

Academy of Emergency Ultrasound President: Christopher Thom, MD, RDMS

Overview

Founded in 2011, the Academy of Emergency Ultrasound (AEUS) is an international forum bringing together clinician sonologists with the common goal of advancing patient care and safety through the use of bedside ultrasound. AEUS task forces promote the development of education and research resources for medical students, residents, fellows, and faculty.

Mission:

• To advance education and research of ultrasound for the bedside evaluation of emergency medical conditions, resuscitation of the acutely ill or injured, guidance of invasive procedures, monitoring of certain pathologic states and as an adjunct to therapy. • To serve as a platform for discussion of subjects that are of concern to emergency medicine physicians practicing clinical sonography. • To support medical student, resident, fellow, and practicing emergency physician ultrasound training and education. • To foster individual and multicenter ultrasound research to advance the

• SonoSharkTank Winner: Augmented Reality Enhanced Ultrasound, Michael Del Valle, MD - Ultrasound Fellow, Denver Health • Annual medical student ultrasound scholarship award presented • Made updates and improvements to the AEUS narrated lecture series • SAEMF-AEUS grant applications • 16 didactic submissions for SAEM 24 • SAMMIES - AEUS research awards program • Developed AEUS SonoGallery • Created Professional Development webinar series • Collated research and education resources

Equity and Inclusion Committee Chair: Emily Binstadt, MD, MPH

Overview

The SAEM Equity and Inclusion Committee’s purpose helps achieve SAEM’s organizational goal of improving gender and cultural competency and diversity among SAEM members and leaders. The committee works to improve diversity, equity and inclusion in programs, activities, and membership. The committee is also ensures that all selected avenues to improve equity and inclusion are in alignment with SAEM Board’s strategic priorities.

Updates/Status

• Created 4 subcommittees with participants ranging from medical students to full professors. 1. Data and Metrics - creates an annual report for the board regarding diversity metrics within SAEM, EM and other national groups in medicine. 2. Education - creates didactics and webinars to educate SAEM members

as well as staff on equity and inclusion topics. 3. DEI curriculum - building SAEM’s online resource for educators who want to teach equity and inclusion topics, with scalable content for various teaching methods. 4. Resources and Products - curates a resource library of recent published literature on equity and inclusion, writes Pulse articles, and specific project on developing a toolkit for considering issues with equitable and inclusive recruitment. • 7 didactic submissions with either primary or co-sponsorship • Project proposals — Goal: complete all 18 initial topics for SAEM’s DEI Curriculum

SAEM BOARD CORNER

knowledge of our field and improve patient care, safety and emergency department patient flow.

Finance Committee Chair: Marquita N. Norman, MD, MBA

Overview

The Finance Committee is responsible for overseeing SAEM’s financial operations and providing input into the sound fiscal management of the Society through monthly financial review, financial policy updates, and budgetary oversight. The committee reviews and makes recommendations to the SAEM Board regarding the annual budget, capital expenditures, and special projects.

Updates/Status

SAEM membership continues to track ahead of last year for both faculty and residents. Dues revenue reflects this growth with dues revenue above budget. Overall expenses are below budget resulting in a net margin above budget.

Education Research IG Co-chairs: Rebekah Cole, PhD, MEd, and Carmen Julia Martinez Martinez, MD, MSMEd

Overview

The Educational Research Interest Group exists to develop educational research projects. Review of Mission Statement: To serve as a hub for research networking, resources, knowledge, and expertise for advancing academic emergency medicine through educational research.

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Objectives:

• developing new educational research projects, including the facilitation of multicenter trials • facilitating collaboration and mentorship in medical education research • discussing and presenting information on educational research funding.

Updates/Status

• Multiple didactic submissions submitted for SAEM 24 • Grants Database • Education Research IG Expertise Database • Research Project Database

Evidence Based Healthcare and Implementation IG Chair: Carly Eastin, MD

Overview

The mission of the Evidence Based

Healthcare and Implementation (EBHI) Interest Group is the applied concept of merging healthcare professional expertise, research, and patient priorities/circumstances via a defined process of finding, appraising, and employing clinical science at the bedside. The interest group provides a network of expertise from the emergency medicine resident to the seasoned investigator, which serves as a forum for research, education, and clinical practice.

Objectives:

• Represent SAEM in recommending

high quality, high impact manuscripts to ABEM for the ABEM Key Advances.

• Support and assist with dissemination and implementation strategies for the SAEM GRACE Guidelines.

• Sponsor high-quality didactic

tation related to Implementation Science at the SAEM annual conference.

• Engage the membership regularly

and broaden the active core group through mentorship and collaboration for junior members.

• Collaborate with other national EM

organizations and/or relevant interest groups.

• Continue focus on inter-institutional

collaboration on journal clubs and scholarly projects, including original research or systematic reviews.

Updates/Status

• Several didactics submitted for SAEM24

• Peer Review Workshop • 2nd Annual Engineer Award presented at SAEM23

• ACGME Proposal to separate Peer Review as its own category for program reporting

submissions to the SAEM annual meeting.

• Sponsor the Rakesh Engineer Award,

to be given to an outstanding presen-

Join an Academy and/or Interest Group!

SAEM BOARD CORNER

Log into SAEM.org

Click “My Participation” in the upper navigation bar

Under “My Participation” click the “Update (+/-) Academies or Interest Groups”.

Free to Join!

Take care of yourself first.

SAEM BOARD CORNER

You can’t pour from an empty cup. #StopTheStigmaEM

ELECT YOUR 2024-2025 SAEM LEADERS! Voting is open Jan. 31-Feb. 23, 2024

SPOTLIGHT

PAYING IT FORWARD: GUIDING THE PROGRAMS THAT SUPPORT GRANT FUNDING An interview with Dr. Manish N. Shah, 2023-2024 SAEMF President Manish N. Shah, MD, MPH, is the chair of the BerbeeWalsh Department of Emergency Medicine at the University of Wisconsin School of Medicine and Public Health, where he is also a professor of emergency medicine, population health sciences, and geriatrics. As a clinician, researcher, and educator, Dr. Shah has dedicated his career to improving prehospital and emergency department care delivered to acutely ill older adults, specifically individuals living with dementia. His work focuses on developing, testing, and implementing innovative approaches to providing older adults with acute illness care that are safe, convenient, and effective. His pioneering efforts have helped to establish the field of geriatric emergency medicine and have advanced the role of ambulance-based paramedics to support community health efforts — now known as “community paramedicine.” Over his career, Dr. Shah has authored more than 175 publications and has received over $150 million in grants and contracts as principal or co-investigator.

SAEM PULSE | JANUARY-FEBRUARY 2024

In recent years, Dr. Shah’s efforts have also focused on training and developing the next generation of academic emergency medicine faculty, particularly researchers. He has mentored many students, residents, fellows, and faculty, including on career development awards, and until recently led the NIH-funded KL2 program at UW–Madison. Many of his mentees are now successful academicians and leaders in emergency medicine and beyond.

Dr. Shah, Mindy Shah, and daughter Alice in Scotland.

Dr. Shah’s long-tie involvement with the Society for Academic Emergency Medicine (SAEM) and the SAEM Foundation (SAEMF) spans several key roles. In geriatric emergency medicine, Dr. Shah served on the SAEM Geriatrics Task Force from 2005 to 2009 and chaired the Geriatrics Interest Group from 2005 to 2007. He was the vice president of the Academy of Geriatric Emergency Medicine from 2008 to 2011. Dr. Shah made significant contributions to committees, including chairing the Grant Committee from 2013 to 2015 and participating in various subcommittees. Since 2013, Dr. Shah has played a crucial role in the SAEMF. He directed the Emergency Medicine Foundation/Society for Academic Emergency Medicine Foundation Grantee Workshop from 2015 to 2022 and assumed strategic leadership roles on the SAEMF Board of Trustees from 2019, including Secretary/Treasurer, presidentelect and, currently, as president. From 2007 to 2019, Dr. Shah served on the editorial board of Academic Emergency Medicine (AEM). He received recognition as an Outstanding Peer Reviewer in 2004 and 2006. His leadership roles, committee involvement, and grant contributions underline his dedication to academic and research aspects of emergency medicine. In 1996, Dr. Shah received the SAEM Excellence in Emergency Medicine Award. The SAEM Young Investigator Award in 2006 acknowledged his early achievements. The 2019 Gerson-Sanders Award and 2020 Academic Career Achievement Award, both presented by AGEM, recognized his impact on geriatric emergency medicine. In 2022, Dr. Shah received the AGEM Pioneer Award and the 2021 SAEM Young Investigator Award for Best Abstract, Presentation, and Manuscript, showcasing groundbreaking contributions. These awards collectively highlight Dr. Shah's enduring commitment, significant contributions, and leadership in emergency medicine.

Dr. Shah and daughter Alice having lunch in London.

“Established physician-scientists need to pay it forward— and it is fun and energizing! When I look at my schedule, I get excited about my meetings with mentees.” Why did you choose academic emergency medicine and who or what influenced your decision? When I was in college, I worked as an emergency department (ED) technician for one year, and loved it — the pace, the teamwork, and the ability to help anyone, anytime, for anything. Whether I was helping resuscitate a cardiac arrest or major trauma, waiting at the end of a runway for a plane that was in trouble, or being with a patient who’d just had the worst day of their life, I loved it. As I went through college, I learned I loved research as well. Then, during my first year of medical school, former SAEM President Sandy Schneider became my mentor and showed me how I could integrate my interests into a career in academic emergency medicine (EM). And, as they say, the rest is history.

How did you become involved with SAEM and, subsequently, the SAEM Foundation (SAEMF)? Dr. Schneider told me — the somewhat clueless medical student — to join SAEM, so I did! At the meetings she kept introducing me to people and she encouraged me to join the Research Committee and then the Grants Committee. By being on the Grants Committee and then chairing it, I got to see the incredible impact that SAEM and the SAEMF have on our specialty. I’d had success in obtaining federal grants and I continued on Page 14

continued from Page 13 wanted to pay it forward to the next generation. To me, the obvious way of doing that was becoming part of SAEMF and helping guide the grant programs and support our grants.

You have dedicated your career to improving prehospital and emergency department care delivered to acutely ill older adults. Given the aging population and shortage of health care practitioners, geriatric emergency departments are positioned to play a vital role moving forward. Do you feel EDs are adapting adequately and swiftly enough to fill this growing gap? What more needs to be done? How best does emergency medicine address this unique need? Emergency medicine has been working hard to improve the care delivered to acutely ill older adults. Research and education are critical to understanding how we can improve the care we deliver, and then actually ensuring we deliver that care. We have been doing a very good job developing our researchers and research portfolio and developing educational and operational best practices (sometimes in the absence of data). This work needs to expand even more and then we need to more rapidly translate these findings to practice. I am pretty impatient, so I think we should and can do this faster, but I also realize that we have had a pandemic, staffing shortages, and a host of other issues. Ultimately, we need to support high quality research, education, and implementation of best practices.

SAEM PULSE | JANUARY-FEBRUARY 2024

What role have SAEM, AGEM, and SAEMF’s funding opportunities played in advancing geriatric emergency medicine?

I am sure people are sick of hearing this from me (I am sure AGEM is!) but I give credit to the Jahnigen Career Development Award that I received in 2002 for jump starting my career. That work led to my K Award, which led to all my future work. The Jahnigen Award (which is now the GEMSSTAR) was supported by SAEM and is now supported by SAEMF, the Emergency Medicine Foundation (EMF), and others. Beyond the money, which is important, SAEM, the Geriatrics Task Force, the Geriatrics Interest Group, and Academy of Geriartic Emergency Medicine (AGEM) have been the places to go for collaborators and mentors who have all helped me as I have developed my research and translated the research to help patients every day.

You are also a dedicated mentor focused on training and developing academic emergency medicine faculty and trainees, particularly researchers. Why should established physicians seek out protégés to mentor? The only way emergency medicine is going to develop into a specialty with significant grant funding and impactful research is by growing our own. Our trainees and new faculty cannot do it on their own. They need to have the drive and grit, but they also need to have the mentorship, coaching, and sponsorship from those of us who are more experienced. Established physician-scientists need to pay it forward— and it is fun and energizing! When I look at my schedule, I get excited about my meetings with mentees.

Dr. Shah and daughter Alice having high tea during a trip to London.

Congratulations on being elected as the 2023-24 president of the SAEMF Board of Trustees. What do you hope to accomplish during your tenure? Adrian Tyndall is a hard act to follow as president of the SAEMF Board of Trustees. During my tenure we have a few major tasks: 1.) increase our fundraising so that we can support a broader portfolio of grants; 2.) develop our next 5-year plan; and most importantly, 3.) refine our process to respond to new opportunities.

This past September marked your one-year anniversary as chair of the BerbeeWalsh Department of Emergency Medicine at the University of Wisconsin School of Medicine and Public Health. How did SAEM help prepare you for this leadership role? What can you share with colleagues regarding making the transition to leadership? Transitioning to leadership is something that happens over multiple years, even decades. It is critical to learn the skills and then apply them, whether it is by leading a small team, a research group, a division, or a department. SAEM has provided valuable training, both at the SAEM Annual Meeting and through courses like the Chair Development Program (CDP). More importantly, SAEM is composed of other leaders who are always willing to help and to be a network for advice and development. I would not be here without the likes of Jim Adams, Don Yealy, Sandy Schneider, and others.

What do you believe are the biggest challenges of developing a successful NIH-funded research career. How do you feel SAEM and SAEMF is addressing these challenges and supporting the next generation of research and education leaders? Funding, training, support. The SAEM and SAEMF is addressing these challenges by offering early grants, providing

Up Close and Personal Name three people, living or deceased, whom you would invite to your dream dinner party. Mahatma Gandhi, Mark Twain, and Winston Churchill.

What's the one thing few people know about you? I love seeing Shakespeare’s plays at the Globe Theater.

St. Louis Cardinals vs. Chicago Cubs in London.

Dr. Shah's daughter, Alice, is a third-degree black belt in taekwondo and competes nationally.

training opportunities (e.g., Advanced Research Methodology Evaluation and Design (ARMED), ARMED MedEd, and the EMF-SAEMF Grantee Workshop), and supporting the chairs and more senior faculty to develop the research careers of others.

EMF as well as successful researchers in emergency medicine and leaders from granting agencies (e.g., NIH, AHRQ, CDC, PCORI), we hope to keep the participants engaged in research and accelerate their careers. Regarding my top 3 pearls of wisdom, that is tough because we talk about so much during those 3 days, but I guess they would be:

What is a personal philosophy that has guided your leadership both at your institution and in your work as an SAEMF leader? My grandfather embodied what we now call the servant-leadership approach. I really admired him for that approach, and it has guided my leadership for my entire career.

You led the EMF-SAEMF Grantee Workshop for many years, helping to build essential peer connections for young investigators, providing them with the tools needed to strengthen their research grant writing success, and paving the way for their productive careers in EM research. For those who are not able to participate in the workshop, what are the top 3 pearls of wisdom you would like to share? The Grantee Workshop is probably my favorite event of the year. By bringing together the grantees from SAEMF and

1. Get great mentorship to help you develop your career. 2. Federal (and foundation) granting agencies want to help you — reach out to them and engage with them.

What is your guiltiest pleasure (book, movie, music, show, food, etc.)? When travelling internationally, flying first class. It makes the vacations so much more enjoyable.

What is one of your favorite quotes? There are two that I find relevant (depending on the settings): Life is really simple, but we insist on making it complicated —Confucious And a recent one that really reflects research:

3. Obtaining a grant is hard work and it is fun work that requires the same focus and determination that you need to become an emergency physician, but you can do it!

Nothing can happen in decades, and then decades can happen in weeks. —George Galloway, Scottish MP

You also recently became an SAEMF Legacy Society donor. Tell us more about this important decision that will help to continue your support of SAEMF well into the future?

Complete the following sentence: In high school I was voted most likely to…

The Legacy Society allows me to continue to impact emergency medicine researchers long after I am gone. Nothing means more to me. I can determine how much I want to gift to SAEMF, and thus I can balance family needs and my charitable giving priorities.

—argue a point just to argue, whether I believed in it or not, because I loved taking the unpopular position on topics. (Thankfully we did not do these sorts of votes!)

AIRWAY

Navigating Trauma Airway Responsibilities in the Modern Emergency Medicine Department SAEM PULSE | JANUARY-FEBRUARY 2024

By Ethan Coit; Cody McIlvain, MD; Kayla Enriquez, MD; Alexander Bracey, MD; and Joseph Brown, MD, on behalf of the SAEM Airway Interest Group

The historical responsibility for emergency airway management of critically ill patients post-trauma rested with anesthesiologists, irrespective of location. This trend began to shift with the establishment of emergency medicine (EM) as a distinct medical discipline. Since then, it has become commonplace for emergency physicians (EPs) to perform emergency airway procedures in trauma settings, particularly at institutions with EM residencies. Despite evidence demonstrating the high performance of EPs in managing trauma patients requiring endotracheal intubation (ETI), airway management remains variable between institutions and is often a shared responsibility

between a combination of emergency physicians, anesthesiologists, and/or trauma surgeons. While data from 2015 suggested that EPs are responsible for most trauma airways in the US, Canada, and Australia, more recent practice patterns in the United States (U.S) are less clear. To explore current trends in the responsibility of trauma airway management in emergency departments (EDs), we conducted a survey using the SAEM Airway Interest Group Listserv. Respondents comprised primarily academic EPs (92.5%), practicing in urban settings (62.5%), and affiliated with Level I Trauma Centers (97.44%) across the

U.S. Figure 1 depicts the geographic distribution of survey participants. Our study specifically focused on trauma airway management, given the unique challenges these scenarios pose in EDs. Trauma patients not only face a heightened risk of technically challenging intubations and significant comorbidities, but also contend with the complexity of a multidisciplinary physician team, where roles and responsibilities may be less clearly defined compared to airway management for medical patients in the ED. We hypothesized that our findings would further illustrate the consolidation of responsibility to EPs, with anesthesia playing a limited or supporting role in the institutions where they remain involved.

Figure 1: Geographic distribution of survey respondents by US region. Displayed as the number of respondents. The Northwest region includes Alaska, and the West Coast Region includes Hawaii.

Figure 2: Survey results regarding the management of adult trauma airways in the ED. Results are displayed as the percentage of respondents.

Our findings indicate that 61.5% of the institutions represented by our respondents do not have anesthesia respond to activated trauma alerts unless explicitly consulted (Figure 2). Additionally, 28.2% of respondents reported that anesthesiology responds to activated trauma alerts but refrains from participating in airway management unless specifically requested by EPs. Notably, 5.2% of respondents reported that anesthesiology either collaboratively manages or exclusively oversees airways in trauma cases. These results closely parallel the survey responses concerning the management of pediatric trauma airways. Among respondents in EDs that handle pediatric patients, 58.8% stated that anesthesia does not respond to activated trauma alerts unless explicitly consulted, while 26.5% reported that anesthesia responds but refrains from participation unless specifically requested by EPs. These results, along with findings from similar prior surveys, assist in quantifying the current responsibilities of EPs and anesthesiologists in managing trauma airways, revealing a distinct consolidation of responsibility to EPs for both adult and pediatric trauma. Nevertheless, this practice has not been universally adopted, as evidenced by the 5.2% of respondents reporting that anesthesia either collaboratively manages or entirely oversees adult trauma airways. These institutions deviate from the prevailing practice pattern for trauma airway management in emergency departments across the U.S. Considering the body of evidence demonstrating the capability of EPs to consistently and successfully manage trauma patients requiring endotracheal

ABOUT THE AUTHORS Ethan Coit is a current fourthyear medical student at the University of Colorado School of Medicine pursuing emergency medicine residency training in 2024. Dr. McIlvain is a fourth-year resident at Denver Health Residency in Emergency Medicine. He will be starting a fellowship in Administration and Operations after residency.

intubation (ETI), we advocate for a shift in practice at these outlier institutions. We propose a model in which EPs are the primary physicians responsible for intubating trauma patients, while acknowledging the potential for scenarios that may still benefit from collaborative airway management between anesthesiologists and EPs. It's important to note that our survey predominantly represents Level I Trauma Centers in academic and urban/suburban settings. As such, it may not fully capture how this arrangement may differ in smaller, more rural EDs with limited resources and without EM residents, where the role of anesthesia may appropriately be more prominent.

Dr. Enriquez is an associate professor in the Department of Emergency Medicine at the University of California, San Francisco. She holds various roles within her department, including Global Health Fellowship Director, Global Health Section Co-director, Faculty Development Committee Co-director, Women's Council Co-director, and Zuckerberg San Francisco General Hospital ED Airway Director. Dr. Bracey is an emergency physician practicing at Albany Medical Center in Albany, NY. He currently serves as the fellowship director of the Resuscitation and Emergency Critical Care program and the assistant program director for the emergency medicine residency at Albany Med. Dr. Brown is an assistant professor at the University of Colorado, where he is a member of the Ultrasound Group. He previously chaired the SAEM Airway Interest Group.

CASE STUDIES IN SOCIAL EM

Mobile, Multidisciplinary Approach for Nonfatal Opioid Overdose Survivors SAEM PULSE | JANUARY-FEBRUARY 2024

By Alexander Ulintz, MD; Cole Ettingoff, MPH; Robert Lowe, MD; Michael S. Lyons, MD, MPH, on behalf of the SAEM Social Emergency Medicine & Population Health Interest Group

Social emergency medicine (“social EM”) considers the broader social context of a patient’s presentation and reflects the complex interplay between patients who desire care and the systems that provide it [1]. Social EM interventions are an increasingly prioritized component of emergency medicine, though they are often limited by “the four walls” of a brick-and-mortar health care facility [2] One method for extending the reach of social EM into communities is through emergency medical services (EMS). EMS, first conceptualized as a transport service for the critically

injured, has grown under the close guidance of emergency medicine physicians towards a vision of EMS as an integrated community asset providing a spectrum of personcentered care beyond exclusively transportation [3]. This vision is exemplified by two related models of care delivery: mobile integrated health (mobile, inter-professional, needs-based care integrating acute, chronic, and preventions services) and community paramedicine (an expanded spectrum of care provided by EMS clinicians) [4,5] In this Case Study in Social Emergency Medicine, we highlight the work of

the Columbus Division of Fire’s Rapid Response Emergency and Addiction Crisis Team (RREACT)—a mobile, multidisciplinary outreach team aimed at reducing deaths from opioid overdose. Columbus, Ohio, witnessed an eightfold increase in opioid-related deaths while paradoxically having one of the nation’s worst overdose deaths-toavailable treatment facility ratios [6-9]. While emergency departments engaging in social EM improved screening and linkage to treatment for patients following overdose, nearly one-fourth of individuals who overdose refuse EMS transportation to an emergency

“Social emergency medicine goes beyond the confines of traditional healthcare facilities, recognizing the intricate interplay between patients and the systems that serve them. The limitations of 'the four walls' can be overcome by extending the reach of social EM into communities through innovative approaches like emergency medical services (EMS).”

department, often citing withdrawal symptoms, anticipation of inadequate care, and stigmatizing treatment [10,11]. Furthermore, predicting the times and locations when individuals are accepting of harm reduction education and/ or linkage to treatment is difficult and may not occur during an emergency department visit. In response to the urgent need to extend social EM services to individuals at high risk of subsequent fatal overdose but were never seen in an emergency department, RREACT seeks to connect individuals to communitybased resources via a multidisciplinary outreach team comprised of firefighter/ EMS clinician, social work, and community agencies. RREACT’s goal was to establish post-overdose outreach protocols that reduce barriers to care, including direct transportation to treatment, in-home harm reduction, and longitudinal case management. While the team is designed to help any individual with opioid use disorder, due to an overwhelming volume of referrals, they often focus on individuals who refused transportation and would otherwise not have access to social EM interventions. The team makes in-person contacts with individuals within

a few days of their 9-1-1 call to introduce available services and understand how they may best help an individual. In addition to working directly with the person who overdosed, the mobile, multidisciplinary outreach team is also able to see the patient in their social context and engage with the patient’s support system (including family and friends) to provide more robust harm reduction education and resources – an apparent advantage over brick-andmortar-based interventions. Since 2017, RREACT has received over 10,000 referrals for help and has directly linked or transported over 1,200 individuals to substance use treatment, many of whom would have otherwise not have contacted a health care provider after their overdose. Among a growing number of examples, many of which will be highlighted in subsequent Case Studies in Social Emergency Medicine, we offer one EMS-based model for extending social EM into communities to address social determinants of health at the places and times where they most directly impact patients.

Primary Source Materials 1. Social Emergency Medicine: Embracing the Dual Role of the Emergency Department in Acute Care and Population Health 2. Beyond the Four Walls: The American College of Emergency Physicians 2022 New Practice Models Task Force Report 3. EMS Agenda 2050: A People-Centered Vision for the Future of Emergency Medical Services 4. The definition of a community paramedic: An international consensus 5. Mobile Integrated Health Care and Community Paramedicine: An Emerging Emergency Medical Services Concept 6. Franklin County, Ohio Comprehensive Addiction-Related Data 7. Disparities Between US Opioid Overdose Deaths and Treatment Capacity: A Geospatial and Descriptive Analysis 8. Modeling dynamics of fatal opioid overdose by state and across time

9. Opioid Treatment Deserts: Concept development and application in a US Midwestern urban county 10. Non-transport after Prehospital Naloxone Administration Is Associated with Higher Risk of Subsequent Non-fatal Overdose 11. Refusal to accept emergency medical transport following opioid overdose, and conditions that may promote connections to care

ABOUT THE AUTHORS Dr. Ettingoff is a medical student with a passion for all things related to social EM, EMS, and public health.

Dr. Ulintz is an instructor of emergency medicine, AHRQ T32 postdoctoral clinical scholar, and MPH candidate at The Ohio State University. Through his primary research in post-overdose harm reduction via emergency medical services clinicians, he seeks to understand how out of hospital systems of care influence public health outcomes. Dr. Lyons is a professor of emergency medicine and director of population health & health services at The Ohio State University Department of Emergency Medicine. He has over two decades of expertise in developing and implementing screening and linkage to care interventions, including several opioid response initiatives in Ohio. Dr. Lowe is the EMS medical director for Columbus (Ohio) Division of Fire and a clinical professor of emergency medicine at Ohio University. Following a career in aerospace engineering, Dr. Lowe has spent over 20 years as an emergency medical services physician, including medical direction, education, and leadership roles.

CRITICAL CARE EM

A Day in the Life of an Emergency Medicine Intensivist SAEM PULSE | JANUARY-FEBRUARY 2024

By Gregory P. Wu, MD; Alexandra “June” Gordon, MD; and David Peltier, DO, on behalf of the SAEM Critical Care Interest Group

Emergency medicine-intensivists (EMI) are subspecialists who have completed emergency medicine (EM) residency and subsequently pursued various critical care fellowships, such as critical care medicine, surgical critical care, anesthesia critical care medicine, or neurocritical care. This diverse array of fellowships leads to a range of expertise and experiences among EMI physicians. In the emergency department (ED), practice is typically governed by departments of EM, while in the intensive care unit (ICU), practice is generally overseen by departments of medicine, surgery, neurology, and critical

care. As a result, EMI physicians may be members of multiple departments, practice in various clinical settings, and navigate diverse practice situations. A significant amount has been written about emergency medicine critical care (EMCC) training and optimal pathways for pursuing it. However, there is a notable scarcity of information describing the actual landscape of EMCC practice. This article seeks to address this gap by outlining three distinct practice arrangements observed among emergency medical intensivist (EMI) physicians.

Full Time Intensive Care Unit Alexandra “June” Gordon, MD

In my role as a Stanford emergency medicine and critical care physician, I divide my time between the medicalsurgical intensive care init (MSICU) and the emergency critical care program (ECCP). The ECCP is a novel initiative where dual-boarded emergency intensivists provide dedicated resuscitative care and triage to critically ill patients from 2 p.m. to midnight, Monday through Friday, in the emergency department (ED), on the floors, and in the ICU.

“Being a bridge between various departments, connecting inpatient and outpatient realms, spanning the divide between the floors and ICUs, and medical and surgical contexts is enjoyable, but this duality brings its own set of challenges.” — Alexandra “June” Gordon, MD I am privileged to be part of an institution with a rich history of training and employing emergency medicinecritical care medicine (EM-CCM) physicians, providing me with a distinctive and robust practice. In the MSICU, I collaborate with a multidisciplinary team comprising residents in medicine, emergency medicine, and anesthesia, as well as advanced practice providers (APPs), and critical care fellows (CCM, ACCM, NCC, SCC, PCCM). Mornings begin with rounds where we make plans for the day. Often, these plans are interrupted by the immediate need to stabilize existing patients and address urgent matters. Post-rounds, we handle consultations, perform necessary procedures, and

engage in goals-of-care discussions. Amid these demands, we try to incorporate time for teaching. Being a bridge between various departments, connecting inpatient and outpatient realms, spanning the divide between the floors and ICUs, and medical and surgical contexts is enjoyable, but this duality brings its own set of challenges. While the emergency department feels like home, my visibility there is reduced, and I worry about not maintaining my emergency medicine skills. However, my presence in the ICU has facilitated involvement in other roles and hospital committees, offering opportunities for personal and professional growth and expanding the footprint of emergency medicine.

Juggling two schedules and navigating double administrative duties, including conferences, evaluations, interviews, and numerous faculty meetings, adds complexity to the equation. My emergency medicine training was excellent and crucial to my skills and identity as an intensivist.

Full Time Physician David Peltier, DO

I am a physician trained in emergency medicine-surgical critical care, currently exclusively practicing in emergency medicine at Maria Parham Hospital, a small community hospital 40 minutes

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“In a setting with limited access to specialists, we often depend on tertiary center ICUs for advanced care. Due to the current state of health care in the United States, these transfers can encounter delays of up to 12-24 hours. Unfortunately, but also fortuitously, this circumstance enables me to apply my critical care training, making a meaningful impact while overseeing patients boarding in our ED.” — David Peltier, DO

CRITICAL CARE EM

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from our nearest tertiary center in Durham, North Carolina. Our emergency department (ED) comprises 20 beds with a single physician providing coverage, supplemented by advanced practice provider (APP) staff. Additionally, our hospital houses eight general intensive care unit (ICU) beds. You might ask "Dave, why did you invest an additional two years in training

for a career that does not require the extra preparation?" This is a valid question from both a financial and temporal perspective, one I am happy to address.

precise, smooth, and uninhibited, while concurrently enhancing my type 2 thinking (the deliberate, methodical, and organized type), making it more thorough, well-rounded, and strategic.

Firstly, I am optimistic that my supplementary training and experience will and has already proven beneficial to the patients under my care in ways that would not have been achievable without this extra training. I have observed that my fellowship has refined my type 1 thinking (the rapid, automatic, and intuitive type), rendering it more

In a setting with limited access to specialists, we often depend on tertiary center ICUs for advanced care. Due to the current state of health care in the United States, these transfers can encounter delays of up to 12-24 hours. Unfortunately, but also fortuitously, this circumstance enables me to apply my critical care training, making

“The MICU allows for more contemplation about a patient and the opportunity for longitudinal care. This rotational approach keeps me invigorated and engaged.” — Gregory Wu, MD a meaningful impact while overseeing patients boarding in our ED. Secondly, my training has given upon me a broadened perspective. It has empowered me to adopt a more forwardthinking approach, positioning the patient for success in the ICU and anticipating challenges in their care. Moreover, it has enabled me to provide improved insight, reassurance, and support to both the patient and their family members. Thirdly, as the sole ED-ICU trained provider in the hospital, I have become an integral part of hospital-wide quality improvement initiatives. Unexpectedly yet excitingly, I have assumed a role as the ED liaison to the ICU. I have been able to offer aid and insights to ICU quality improvement projects and have become a participant in the monthly critical care staff meetings. I believe this approach brings a comprehensive, multidisciplinary dimension to the care we extend to our most critically ill patients. Lastly, my training affords me diverse career prospects in the long term. While I derive satisfaction from my current role, I do not envision maintaining an exclusive focus on emergency medicine indefinitely. Currently, I am contemplating several options, including providing critical care consultation at my current hospital, dedicating part-time hours to the ICU at my current hospital, or obtaining ICU privileges at another hospital. I appreciate being in a position that offers lateral mobility, allowing me to pivot to an entirely different medical role should it align with my professional trajectory.

Half Emergency Medicine/Half Medical Intensive Care Unit Gregory Wu, MD

My background includes completion of an EM residency followed by a critical care medicine fellowship. I allocate my time between the emergency department and the medical intensive care unit (MICU). Prior to any buydowns, I work approximately six ED shifts and one to two weeks in the MICU per month.

In the EM setting, my practice is typical for an academic ED: supervising residents and advanced practice providers, and managing patients independently. I also handle critically ill traumas as well as pediatric cases involving fevers. A unique aspect of my practice involves the ED Critical Care Consultant Team (EDC3T), which comprises seven EM physicians with critical care training. Of these, five have completed a critical care fellowship, and two have completed resuscitation fellowships. The EDC3T provides consultation and backup to primary ED teams for critically ill patients, whether in the early stages of resuscitation, undergoing critical care while awaiting an ICU bed in the ED, or transitioning to a lower level of care. The EDC3T is decentralized, offering care wherever the patient is in the ED. On MICU days, I lead a team of residents or fellows and receive transfers from the ED, floor, and other hospitals. The days can be long, because in addition to being the daytime MICU attending, I am occasionally on overnight home-call. During overnights, we have in-house residents and fellows with a home-call attending. I generally stay until patients are stabilized to minimize overnight issues. Weekends can be especially hectic, as I supervise multiple ICU teams. My practice mirrors that of other medical intensivists: rounding, performing intubations, bronchoscopies, chest tubes, various types of temporary vascular access, and diagnostic procedures. The MICU at my institution is a closed ICU, which means the medical intensivist is the attending of record, with others serving as consultants. This structure fosters a strong sense of ownership over patients and their outcomes. I appreciate the equilibrium that this dual practice provides. I enjoy the swift decision-making in the ED with promptly resolved cases. The MICU allows for more contemplation about a patient and the opportunity for longitudinal care. This

rotational approach keeps me invigorated and engaged.

Conclusion

Emergency Medical Intensivist (EMI) physicians are experiencing growth both in numbers and diversity of practice. The scope of their responsibilities and the reasons behind their decisions are primarily determined by the EMI, and as EMI physicians become more prevalent, it is likely that new practice arrangements and situations will emerge.

ABOUT THE AUTHORS Dr. Wu is an associate professor of emergency medicine and internal medicine at Albany Medical College. He is an emergency physician and medical intensivist. He is the clerkship director for critical care and the associate fellowship director for resuscitation and emergency critical care. He is the current chair of the SAEM Critical Care Interest Group. Dr. Gordon is an assistant professor of emergency medicine and critical care at Stanford University Hospital. She works in both the emergency department and the medical ICU at Stanford University Hospital where she also completed her emergency medicine residency and critical care medicine fellowship. She is the associate program director for the critical care medicine fellowship and serves as the past chair of the critical care cedicine section of the American Academy of Emergency Medicine (AAEM). Dr. Peltier is an emergency physician at Maria Parham Medical Center. He completed an emergency medicine residency and a surgical critical care fellowship at Albany Medical Center. His interests include bridging the gaps between intensive and emergency care.

DIVERSITY, EQUITY, INCLUSION

SAEM PULSE | JANUARY-FEBRUARY 2024

Chatter Matters: Fostering Equity with Language-Concordant Care

By Jason Rotoli, MD; Zachary Bopp; Adam Rockter; Alex Kleinmann, MD; and IV Mirus, MD on behalf of the SAEM Academy for Diversity and Inclusion in Emergency Medicine There are hundreds of languages spoken in the United States. Consequently, language discordance between health care providers and patients is a common occurrence. Despite historical divergence in opinions regarding the genuine impact of language discordance in health care, contemporary studies assert the positive effects of patient-provider language concordance on care outcomes in the U.S. Fostering language-concordant care requires strategic planning at both the individual and institutional levels. This strategic approach not only aligns

with health care policy and accreditation standards but also enhances metrics for patient-centered care. Follow-up assessments are essential to ensure that these processes effectively address the specific needs of the target community. With over 7,000 languages used worldwide and more than 350 languages spoken in the U.S., it is unsurprising that unmet health care needs and adverse outcomes have been documented in minority groups with discordant linguistic and cultural

backgrounds from their providers [1]. Individuals with limited English proficiency (LEP) often experience increased comorbidities, heightened physical harm from medical errors, and elevated utilization of emergency services due to a lack of access to primary care or preventative services. For instance, the Deaf and hard of hearing (DHH) constitute an ethnolinguistic minority with a wide range of hearing abilities and communication preferences, including American Sign Language (ASL), which serves as the primary language in this

“Despite historical divergence in opinions regarding the genuine impact of language discordance in healthcare, contemporary studies assert the positive effects of patient-provider language concordance on care outcomes in the U.S.” community. As a minority group, DHH encounter health care inequities akin to those experienced by other marginalized groups, resulting in health disparities such as increased use of disparate emergency service provisions and communication barriers within the health care system [2]. Similarly, Spanish-speaking patients in the U.S. also exhibit higher comorbidities, lower satisfaction with care, and reduced intervention and hospitalization rates compared to their English-proficient counterparts [1].

To alleviate communication barriers and address health disparities in Limited English Proficiency (LEP) patients, the utilization of qualified interpreters is not only mandated by law but has also become the gold standard, offering several benefits. These advantages include reduced transmission of misinformation, diminished medical errors, and heightened patient satisfaction with care [3]. Nevertheless, there is data indicating that, although interpreters enhance accessibility to

care, there may be an alternative option that fosters greater understanding, treatment adherence, and an opportunity for improved collaborative healthcare planning—language-concordant care [1]. Language Concordant Care (LCC) is broadly defined as the delivery of health care in a shared minority language [1]. In the U.S., health care interactions are generally presumed to occur in English continued on Page 26

DEI

continued from Page 25 by default, making LCC encompass the use of any non-English language. Accurately defining LCC is challenging due to the absence of specific state or federal guidelines on determining provider language fluency. Moreover, societal ideologies, attitudes, and cultural values play a role in influencing the delivery of LCC.

SAEM PULSE | JANUARY-FEBRUARY 2024

Despite some ambiguity surrounding the definition of Language Concordant Care (LCC), most contemporary literature demonstrates improved health care outcomes when language concordant care is implemented. Notably, a recent meta-analysis found that, when considering minority language fluency, LCC led to fewer missed appointments and reduced wait times, a lower likelihood of repeat visits to the emergency room for chronic conditions, and enhanced access to after-hours care via telephone [1]. Studies have also underscored measured benefits for Limited English Proficiency (LEP) patients in the areas of primary care

“The imperative to enhance communication with linguistic minority populations is central to providing equitable care to at-risk communities.” services (increased utilization), diabetes management (reductions in LDL and HbA1c), and cancer treatment (higher rates of radiation therapy after breast cancer surgery) [4]. Beyond quantitative evidence demonstrating the advantages of language concordance between providers and patients, narrative analyses have explored the qualitative improvements in patient care. Specifically, reports indicate that patients often experience an increased sense of trust and a greater ability to convey their needs. These benefits are not solely experienced by patients, as health care workers also discuss an improved ability to assess patient needs [5]. While more work is needed to precisely characterize the effects of provider language fluency and proficiency on health care outcomes, it is evident that there are crucial tangible benefits to the health care system when providers and patients can communicate fluently in a shared language.

Emergency physicians play a crucial role as America's medical safety net, positioned at the intersection of social determinants of health and population health. Improving communication with linguistic minority populations is central to providing equitable care to at-risk communities. Improving the delivery of Language Concordant Care (LCC) within the emergency department demands a comprehensive approach, encompassing both individual and institutional operational changes. On an individual level, emergency physicians should familiarize themselves with departmental language policies and utilize available resources within the department to optimize interactions with Limited English Proficiency (LEP) populations. Additionally, providers should be cognizant of departmental policies governing the ability to provide care in another (minority) language. At the institutional level, several recommendations can foster and

maximize LCC opportunities. Institutions should offer proper training for providers to optimize interactions with LEP patients, utilizing institution-specific resources. To enhance the likelihood of patients interacting with physicians who use their preferred language, a systematic process within the emergency department (ED) is essential. This process can leverage patients' documented preferred language, utilizing the electronic medical record or another health care physician database, cross-referencing with providers' language proficiencies. Aligning these two data points during the triage process in the ED can strategically pair patients with the most linguistically appropriate available provider. This approach, observed in other settings, has the potential to improve metrics and patient outcomes, resulting in quicker disposition times, reduced use of emergency services, fewer medical errors, and enhanced patient satisfaction with improved treatment adherence [1,4]. For patients who may have bypassed the initial screening process, the implementation of a provider identification tag indicating alternative language competency could prove beneficial. Additionally, integrating LCC in health care settings can contribute to a more diverse workforce that aligns with patient needs, healthcare policy, and accreditation standards emphasizing cultural humility, including language access services and LCC, in providing equitable care. This transformative shift begins with the active recruitment of diverse bilingual or multilingual providers who reflect the linguistic and cultural diversity of the patient population. When resources for LCC are already available, the efficient management of these resources becomes paramount, involving language proficiency assessment, staff allocation, and quality improvement assessment. Prior to patient care, implementing a standardized method to assess provider language proficiency, often facilitated through

the language services department, is imperative to ensure effective communication. Equally crucial is the ongoing measurement of the impact of LCC on patient outcomes, requiring an appropriate feedback mechanism. Continuous assessment of the effectiveness of LCC initiatives enables ongoing refinement and improvement in the delivery of language-concordant care. The immediate impact of enhanced communication within the LEP population could result in a better understanding of their condition and care provisions in the emergency department. The longterm success of Language Concordant Care (LCC) in the ED has the potential to mitigate health care disparities and offer an effective solution for delivering more equitable care to linguistic minority populations. Potential enhancements in metrics such as patient satisfaction, reduced readmission rates, and lower medical error rates in the care of LEP patients can serve to justify investments in time and resources for LCC initiatives. Demonstrating improved patient care outcomes through these efforts can contribute to the reduction of existing health disparities and erroneous health expenditures. Finally, additional studies incorporating a standardized LCC definition, clear definitions of provider language fluency, and standardized methodologies are necessary to further elucidate how effective communication in linguistic minority populations will enhance both patient- and hospital-centered outcomes.

Primary Source Material 1. Scoping Review: Definitions and Outcomes of PatientProvider Language Concordance in Healthcare 2. Use of Routine Emergency Department Care Practices with Deaf American Sign Language Users 3. Do Professional Interpreters Improve Clinical Care for Patients with Limited English Proficiency? A Systematic Review of the Literature 4. A Systematic Review of the Impact of Patient–Physician Non-English Language Concordance on Quality of Care and Outcomes

5. Speaking My Patient's Language: Bilingual Nurses’ Perspective about Provision of Language Concordant Care to Patients with Limited English Proficiency

ABOUT THE AUTHORS Zachary Bopp is a fourth-year medical student at Sidney Kimmel Medical College at Thomas Jefferson University. His scholarly interests within emergency medicine include healthcare disparities and optimizing interactions with patients with limited English proficiency. Dr. Mirus is an assistant professor of emergency medicine at UT Southwestern and Health Equity Scholar for UTSW/Parkland Health. As a CODA and ASL interpreter, he bridges gaps in Deaf Health through research and education, committed to addressing the health needs of the Deaf community. Dr. Mirus is a member of the ADIEM Accommodations Committee. Dr. Rotoli is associate residency director, Department of Emergency Medicine and director, Deaf Health Pathways, at the University of Rochester Medical Center. Adam Rockter is a medical student at the University of Rochester School of Medicine and Dentistry. He is planning on entering a family medicine residency. Dr. Kleinmann is a clinical assistant professor of emergency medicine at Thomas Jefferson University Hospital. His clinical work and research interests include education, telemedicine, and the care of patients with limited English proficiency.

About ADIEM The Academy for Diversity & Inclusion in Emergency Medicine (ADIEM) works towards the goal of diversifying the physician workforce at all levels, eliminating disparities in health care and outcomes, and insuring that all emergency physicians are delivering culturally competent care. Membership in SAEM's academies and interest groups is free. To participate in one more groups: 1.) log into SAEM.org; 2.) click “My Participation” in the upper navigation bar; and 3) click “Update (+/-) Academies or Interest Groups.”

ED MANAGEMENT & PREPAREDNESS

Strategic Planning for EDs: Addressing Workforce Challenges Amid Labor Actions SAEM PULSE | JANUARY-FEBRUARY 2024

By Kristen Kelly, MD and Gururaj Shan, MD

As various industries nationwide grapple with the challenges posed by striking workers, from Hollywood to hospitality, emergency departments must be prepared to function with a reduced workforce. In the past year alone, hospitals across the country have confronted strikes involving residents and nurses —two essential groups in patient care. While department leaders debate the reasoning behind these actions, there is no doubt that adequate preparation for a strike can mitigate impacts to patient care. We suggest incorporating labor action contingency

“In the event of an impending labor action involving Emergency Department nurses, it is crucial to compile a list of nursing tasks from hospital policies and regulatory bodies.” plans into the existing disaster plans implemented by emergency departments and hospitals. Much like preparations for other disaster scenarios, effective planning is essential to minimize operational

disruptions and ensure the safety of patient care during labor actions. Understanding the collective bargaining units within the hospital and comprehending their potential ramifications in the event of a strike

enables emergency department and hospital leaders to proactively secure essential resources before anticipated strikes occur. Unlike various other departments, the emergency department (ED) often must remain open and fully operational during a labor action. Consequently, ED leaders are in a unique position to formulate plans that ensure they can effectively advocate for resources should the need arises. Labor actions usually begin with the issuance of a strike notice by the collective bargaining unit. While the strike can be called off at any time, this initial notice serves as the trigger for planning and resource acquisition. Throughout this phase, the hospital works to understand anticipated needs and initiates the recruitment of contract workers to fill potential staffing gaps. This process often involves determining which services will persist and which might temporarily cease. Such decisions can influence the potential diversion status for the emergency department (ED), particularly if the discontinuation of specific services (e.g., Cath Lab, CT scanner) hinders the hospital's ability to function as a receiving center for certain critical patients. Furthermore, this action frees up staff from those units to be reassigned to the ED and other areas of the hospital to provide assistance with various tasks. To prepare for an influx of nonemergency department providers with diverse skill sets, the ED should anticipate rapid onboarding. Establishing daily provider and nursing diads to lead each zone is crucial for overseeing care, assigning tasks, and addressing acute needs. Ideally, both individuals in the diad possess ED-specific training, familiarity with the staff, knowledge of the space, and awareness of available resources. This enables them to effectively guide teams in providing optimal care for patients. An effective strategy for determining genuine needs and identifying potential applications for redeployed staff involves the creation of a task grid. Deconstructing the responsibilities of the striking group into specific tasks, as illustrated below for nurses, enhances comprehension of potential deficiencies. Subsequently, a comparison of these tasks with the skills and capabilities of other team members and redeployed staff facilitates the distribution of work to a broader team during the strike. The grid

below illustrates how tasks traditionally assigned to nursing could be allocated and overseen by other team members, such as pharmacists, LPNs, residents, and others. In the event of an impending labor action involving emergency department nurses, it is crucial to compile a list of nursing tasks from hospital policies and regulatory bodies. This list should delineate tasks that either a) must be executed by registered nurses (RNs), or b) could be carried out by others, including technicians (e.g., EKGs), respiratory therapists (e.g., point-ofcare blood gases), licensed practical nurses (LPNs), physician sssistants (PAs), medical doctors (MDs), and medical students. Organizing a grid that colorcodes tasks based on job titles can be beneficial for distribution to MD-RN leaders per zone, allowing real-time reference. For each task, leadership should consider not only the legal capacity to perform it but also who is the most suitable person for the job. For instance, though many in the department may be capable of performing EKGs, assigning this responsibility to non-union emergency room technicians is likely more efficient and effective than asking physicians from other departments, who may not have conducted an EKG in many years.

most severe situations, it may become imperative to identify attending providers capable of conducting medical screening exams and expediting discharges in order to rapidly alleviate patient numbers. Additionally, collaborating with local emergency medical services (EMS) to ensure the attainment of appropriate diversion status is essential.

Finally, effective strike preparation requires substantial involvement from ancillary services. Hospitals should establish security plans to ensure that striking workers do not disrupt ambulance arrivals. Moreover, creating safe pathways for workers willing to cross the picket line enables staff members to commute to work without encountering harassment. Given the presence of media outside the hospital, and their potential attempts to enter, it is imperative to develop security plans and designate media liaisons to mitigate these potential risks. This proactive approach helps prevent intrusions into patient care and privacy. With the specter of more labor actions looming at major hospital systems nationwide, we strongly urge department leaders to scrutinize their respective labor pools and consider the aforementioned strategies to enhance preparedness for operating without certain members of their core team or with last-minute replacements.

After identifying potential redeployment plans, teams should collaborate to formulate contingency plans based on anticipated staff levels and projected patient volume. Until the day of the strike, accurately gauging how many members will choose to cross the picket line can be challenging, leading to conservative estimates when hiring temporary contract workers to address staffing gaps. Consequently, the emergency department may find itself significantly understaffed. Developing a stepwise escalation plan that considers the available staff and the number of patients in the ED facilitates more seamless responses when resources become scarce. In the

ABOUT THE AUTHORS Dr. Kelly serves as an assistant professor and assistant medical director in the Department of Emergency Medicine at Icahn School of Medicine at Mount Sinai in New York. Dr. Shan is an assistant professor and assistant medical director in the Department of Emergency Medicine at Icahn School of Medicine at Mount Sinai in New York.

EDUCATION

The Crucial Role of Academic Coaching in Emergency Medicine

SAEM PULSE | JANUARY-FEBRUARY 2024

By Erin Simon, DO; Rebecca Merrill, MD; and Ashley Heaney, MD, on behalf of the SAEM Education Committee

Physicians face unique challenges daily in the fast-paced, high-stress world of emergency medicine. To excel in this field, individuals must possess a strong medical knowledge base and the ability to make swift, critical decisions in highpressure situations. Academic coaching emerges as a valuable resource to aid physician leaders in developing the skills and knowledge essential for success in this dynamic field. This article explores the significance of academic coaching in emergency medicine, its benefits, and its potential impact on the growth and development of physicians.

Understanding Academic Coaching in Emergency Medicine

Academic coaching in emergency medicine involves a one-on-one relationship between a seasoned

“Emergency medicine is a diverse field with a wide range of skills and knowledge required. Academic coaching tailors the learning experience to the individual's needs, helping them acquire the necessary skills and expertise to succeed.” medical professional (the coach) and a less experienced individual (the coachee) seeking guidance and support in their professional journey. Unlike traditional classroom learning, academic coaching is highly personalized, focusing on the coachee’s specific needs, goals, and challenges.

Benefits of Academic Coaching Tailored Learning Experience Emergency medicine is a diverse field with a wide range of skills and knowledge required. Academic coaching tailors the learning experience to the individual's needs, helping them

continuous learning and personal growth within the profession. As physicians continue to enhance their knowledge and skills, patients benefit from improved care and outcomes. The healthcare system benefits from having more competent and confident emergency medicine physicians. Academic coaching benefits physician leaders; therefore, adding this to an emergency medicine residency may be beneficial as residents progress through their training.

Conclusion

In the high-stakes world of emergency medicine, academic coaching plays a vital role in supporting the growth and development of physicians. It offers a personalized and structured approach to learning and skill development, leading to better patient care and a more resilient healthcare workforce. As the field of emergency medicine continues to evolve, academic coaching becomes even more critical in nurturing excellence among its physicians.

ABOUT THE AUTHORS

acquire the necessary skills and expertise to succeed. Building Confidence Confidence is vital in the emergency department. Coaches can provide support and encouragement to boost the coachee's confidence, ensuring they make well-informed, timely decisions under pressure. Career Advancement For physicians, career advancement is a frequent goal. Academic coaching can help individuals set and achieve career goals, including moving into leadership roles or gaining expertise in specialized areas. Stress Management Emergency medicine is known for its high-stress environment. Coaches can teach stress management techniques, enabling physicians to maintain their mental and emotional well-being while working in the demanding emergency medicine environment. Lifelong Learning Medicine is an ever-evolving field. Coaches help coachees learn how to

stay up-to-date with the latest research, techniques, and technology to ensure they provide the best possible care to their patients.

The Role of the Coach

An academic coach in emergency medicine should ideally be an experienced physician. The coach's role encompasses several key responsibilities: 1. Assess the coachee's strengths and weaknesses. 2. Help the coachee to identify and set specific goals. 3. Provide guidance and resources for achieving those goals. 4. Offer constructive feedback and support during the learning process. 5. Monitor progress and make necessary adjustments to the coaching plan.

The Impact of Academic Coaching

Academic coaching has a significant impact on emergency medicine physicians. It fosters a culture of

Dr. Simon holds the position of professor of emergency medicine at Northeast Ohio Medical University. In her professional capacity, she serves as the research director for the Cleveland Clinic Akron General Emergency Medicine Program and holds the role of medical director at the Cleveland Clinic Bath Emergency Department. simone@ccf.org. Dr. Merrill is a graduate of the Medical Scholars Program at Michigan State University College of Human Medicine. Currently, she holds the positions of Clinical Experiential Director for the emergency medicine clerkship and M3 clerkships course director. She is also the program director for the emergency medicine residency at Cleveland Clinic Akron General. merrilr2@ccf.org. Dr. Heaney is an attending physician in the Department of Emergency Medicine at Cleveland Clinic Akron General. She currently serves as associate program director for Cleveland Clinic Akron General’s Emergency Medicine Residency and assistant clerkship director for the emergency medicine Ccerkship. heaneya@ccf.org

EMERGENCY ULTRASOUND

Point-of-Care Ultrasound for Peritonsillar Abscess: Look Before You Drain SAEM PULSE | JANUARY-FEBRUARY 2024

By Zachary Boivin, MD and Christiana Baloescu, MD, MPH on behalf of the SAEM Academy of Emergency Ultrasound

When patients arrive at the emergency department with a sore throat, there is often consideration for the diagnosis of peritonsillar abscess (PTA), particularly if the patient exhibits tonsillar swelling. Patients commonly undergo either computed tomography (CT) imaging or a blind drainage is attempted to make the diagnosis. Point-of-care-ultrasound (POCUS) can be employed bedside to assess for PTA, utilizing either an oral or transcervical approach. The use of POCUS can improve drainage success, as evidenced by a small study by Constantino et al.

which demonstrated a 100% drainage success rate with POCUS compared to a 50% success rate with blind drainage. A more recent study by Gibbons et al. not only indicated an improvement in drainage success but also reported a reduction in ENT consults, emergency department return visits, and patient length of stay.

Intraoral Approach and Anatomy

In the intraoral approach, a highfrequency (5–8 MHz) endocavitary transducer is utilized. The primary obstacles to the adoption of the intra-

oral approach are the limited availability of the endocavitary transducer, followed by the necessity for high-level disinfection protocols. It is crucial to apply a sterile transducer cover to the endocavitary transducer, ensuring gel is applied to the transducer footprint before placing the cover to prevent air particle interference. No gel is required on the outside of the transducer cover, as the patient’s oral secretions will serve a similar function. After obtaining patient consent, provide the option of a topical anesthetic spray and allow the patient

may be observed, indicating movement of the internal contents of the abscess. This distinctive appearance is different from peritonsillar cellulitis, which may exhibit clinical similarities; however, point-of-care ultrasound (POCUS) reveals an enlarged tonsil size and hyperemia, accompanied by superimposed color or power Doppler signals. Figure 1

Figure 2

Conclusion

A systematic review and meta-analysis conducted by Kim et al. affirm that the identification of a peritonsillar abscess (PTA) through point-of-care ultrasound (POCUS) demonstrates a sensitivity of 74% and a specificity of 79%. Notably, the study indicates that the intraoral approach has higher sensitivity (91%) compared to the transcervical approach (80%), establishing it as the preferred method of evaluation when available. Figure 3

to self-insert the endocavitary transducer into their mouth. Direct the transducer along the hard palate and toward the side of pain and tonsillar swelling until contact is established with the posterior pharynx. The typical anatomy of a tonsillar ultrasound using an endocavitary transducer is illustrated in Figure 1. A normal tonsil should exhibit a size of less than 2 cm and have a triangular or oval shape with a homogeneous echotexture. An advantage of employing the intraoral approach is the capacity to observe the carotid artery located posterior to the tonsil. If the indicator is directed sagittal (towards the head), the carotid artery will appear longitudinally; however, if the indicator is oriented toward the patient’s right, the carotid artery is observed in cross-section. Measurement of the distance to both the carotid artery and the center of the abscess is essential to ensure proper needle depth during drainage, thereby reducing the risk of complications such as arterial injury, severe bleeding, and descending mediastinitis.

Transcervical Approach and Anatomy

In instances where an endocavitary transducer is unavailable or the patient does not consent to the intraoral approach, the transcervical approach (also known as the transcutaneous or submandibular approach) can be employed to assess for peritonsillar

abscess (PTA). Evaluation of the tonsils can be accomplished using either a high-frequency linear transducer or a low-frequency curvilinear transducer. The choice of transducer should be based on the patient’s age and body habitus, with adult patients often benefiting from the increased depth offered by the curvilinear transducer. Position the transducer under the angle of the mandible, angled superiorly, with the indicator directed anteriorly (or towards the ceiling if the patient is lying supine). Figure 2 illustrates the normal anatomy of the transcervical approach. The key landmark for this approach is the tongue, and asking the patient to move their tongue aids in its identification. The tonsil should be posterior to the tongue, and with the indicator directed anteriorly, the tonsil will appear on the non-indicator side of the ultrasound image. A limitation of the transcervical approach is the inability to measure the distance to the abscess and the carotid artery when planning for drainage.

Appearance of a Peritonsillar Abscess

When present, a peritonsillar abscess manifests as a well-circumscribed hypoechoic or anechoic fluid-filled cavity with irregular margins, typically observed along the posterolateral aspect of the tonsil (see Figure 3). Application of color Doppler reveals no Doppler flow within the abscess. When gentle pressure is applied with the transducer, “swirl sign”

The use of POCUS for PTA has the potential to decrease both CT scan use and the number of unsuccessful abscess drainage attempts. While this POCUS examination type may at first seem daunting, it can be quickly learned through practice, and can help improve patient care. The adoption of POCUS for PTA holds promise in reducing both the utilization of CT scans and the frequency of unsuccessful abscess drainage attempts. While the initial impression of this POCUS examination may appear daunting, it can be quickly learned through practice, and can help improve patient care.

ABOUT THE AUTHORS Dr. Boivin is an emergency ultrasound fellow at Yale, with a focus on medical education and research in point-of-care ultrasound. He completed his training at the University of Connecticut Emergency Medicine residency program. Connect with him on Twitter: @ZachBoivinMD and via email at zboivin.md@gmail.com. r. Baloescu is an assistant D professor of emergency medicine at Yale, with a keen interest in point-of-care ultrasound and research related to artificial intelligence. Connect with her on Twitter: @CBaloescu and via email at Christiana.Baloescu@yale.edu.

EMERGENCY ULTRASOUND

Revolutionizing Shoulder Dislocation Management: A POCUS-Driven Paradigm Shift in Low-Resource Settings By Eddie G. Rodriguez Aquino, MD; Michelle I. Surillo Gonzalez, MD; and Miguel F. Agrait González, MD, on behalf of the SAEM Academy of Emergency Ultrasound

SAEM PULSE | JANUARY-FEBRUARY 2024

The Case

This case involves a 52-year-old male with no pertinent medical history who presented to the emergency department with a complaint of right shoulder pain after a fall. He reports that, during the fall, his right shoulder struck a wall. The patient arrives at the ED, and a physical examination reveals evidence of squaring-off of the right shoulder, along with a concomitant decrease in active and passive range of motion compared to the left shoulder. Simple enough, right?

Introduction

Our tendency is to follow the established protocol learned during residency, which typically includes acquiring a radiograph to confirm the suspected diagnosis. Afterward, we ready the patient for conscious sedation, undertake a reduction attempt, and conclude with a

post-reduction x-ray. Once the shoulder is back in its place, we patently wait for the patient to wake up. However, what if the reduction is unsuccessful or doubts persist about its success? At this point, decisions need to be made. Do we choose to administer repeated sedation and attempt another reduction, along with additional imaging? Perhaps a simpler and more effective alternative exists. We often take for granted the ready availability of sufficient monitoring for sedation and 24/7 access to x-rays. However, in rural or resource-limited settings, this may not be the norm. A solitary x-ray technician could be responsible for the entire hospital and might be engaged in duties in the ICU. Depending on physician availability and institutional protocols, there may be insufficient staff to concurrently manage

both sedation and joint reduction. Additionally, this consideration does not factor in the relatively small but tangible risks associated with sedation, particularly if it needs to be administered more than once. It’s time for Point-ofcare Ultrasound (POCUS) to guide us.

Why Ultrasound?

Diagnosing a shoulder dislocation is typically straightforward, but specific cases pose challenges, particularly in larger or uncooperative patients. While x-rays are generally diagnostic, their immediate availability can be an issue, and interpretation may be hindered by suboptimal positioning, leading to delays in diagnosis and treatment. Point-of-care Ultrasound (POCUS) serves both as a diagnostic tool and a direct-visualization method for shoulder dislocation reductions. Recent

Primary Source Material

1. Point-of-care ultrasonography for the management of shoulder dislocation in ED 2. Accuracy of Ultrasonography in Diagnosis of Shoulder Dislocation: A Systematic Review 3. Ultrasound-guided interscalene nerve block vs procedural sedation by propofol and fentanyl for anterior shoulder dislocations 4. Musculoskeletal Ultrasonography to Diagnose Dislocated Shoulders: A Prospective Cohort 5. Intra-articular lidocaine versus intravenous sedation for closed reduction of acute anterior shoulder dislocation in the emergency department: a systematic review and meta-analysis

Picture 1: POCUS view of a normal shoudler joint. Courtesy of Miguel Agrait, MD

advancements have resulted in reduced machine footprint, offering an array of portable and cost-effective options that are more accessible in low-resource environments. Utilizing this modality enables near immediate confirmation of the suspected diagnosis and facilitates prompt initiation of pain control for expedited reduction.

The New Methodology

Consider this a novel approach to management and evaluation. If there is a strong suspicion of a shoulder dislocation, opting for a bedside shoulder ultrasound is the chosen course. For optimal visualization of the joint, employ a curvilinear probe and adopt a posteriorto-anterior perspective. Position the probe parallel to the scapular spine and slide laterally to attain a view of the empty glenoid fossa with the humeral head positioned deep (anterior) to it. Congratulations, the diagnosis is confirmed! Subsequently, an ultrasoundguided intraarticular injection with lidocaine can be administered to facilitate a painless shoulder reduction, eliminating the need for conscious sedation. Throughout the reduction process, the probe can be maintained in the same position to observe real-time progress or confirm the reduction post-completion. Subtle internal and external rotation of the arm will reveal movement of the humeral head in the glenoid, affirming a successful reduction.

Picture 2: POCUS imaging of an anterior shoulder dislocation. Courtesy of Miguel Agrait, MD

Conclusion

The above case was managed using this methodology, resulting in a significant reduction in the patient’s length of stay in the ED through prompt confirmation of the diagnosis with bedside ultrasound imaging. Moreover, the necessity for plain films for post-reduction assessment was completely obviated. Traditionally, plain films, particularly the scapular Y view, have long served as the gold standard for diagnosing shoulder dislocations and confirming proper reduction. Now, point-of-care ultrasound (POCUS) has illustrated its potential benefits in confirming the diagnosis and ensuring proper realignment with minimal manipulation of the patient’s shoulder. Consequently, this approach diminishes ED length of stay and alleviates patient discomfort both before and after reduction. Furthermore, in locations where X-ray services are either not readily available or entirely absent, the presence of POCUS equipment proves instrumental in successfully managing such dislocations, circumventing scenarios that might otherwise necessitate consultation, transfer, or other dispositions, resulting in increased length of stay and patient dissatisfaction. Once again, POCUS for the win!.

ABOUT THE AUTHORS Dr. Rodriguez, triple-boarded in EM/PEM/AEMUS-FPD, is an assistant professor of emergency medicine and pediatric EM division director at Centro Medico Episcopal San Lucas. He completed a pediatric EM fellowship at NewYork-Presbyterian Brooklyn Methodist and an advanced emergency medicine ultrasonography fellowship at SUNY Downstate/ Kings County Hospital where he plays an essential role in the program's leadership. Dr. Surillo is an assistant professor of emergency medicine and ultrasound EM division director at Centro Medico Episcopal San Lucas. She completed an advanced emergency medicine ultrasonography fellowship at NewYorkPresbyterian Brooklyn Methodist Hospital. Dr. Surillo serves as the ultrasound clerkship director for Ponce Health Sciences University. Dr. Agrait is an assistant professor of emergency medicine and sports medicine section director at Centro Medico Episcopal San Lucas. He completed his fellowship at Georgetown University. His expertise in musculoskeletal ultrasound and procedural guidance plays a pivotal in the program’s education. Dr. Agrait currently serves as Puerto Rico National Basketball team physician.

About AEUS The Academy of Emergency Ultrasound is an international forum bringing together clinician sonologists with the common goal of advancing patient care and safety through the use of bedside ultrasound. Joining AEUS is free! Just log in to your member profile. Click “My Account” in the upper right navigation bar. Click the “Update (+/-) Academies and Interest Groups” button on the left side. Select the box next to the academy you wish to join. Click “save.”

SAEM PULSE | JANUARY-FEBRUARY 2024

ETHICS IN ACTION

Enough Already: Ethical Considerations in Treating a Recurrent IV Drug User With Endocarditis By Jeremy Simon, MD, PhD

The Case

The patient, a cachectic 34-year-old intravenous (IV) opiate user, presents with complaints of fever, chills, and weight loss. In addition to these symptoms, he exhibits irritability and reluctance to answer questions or undergo a physical exam. He attributes his condition to "the computer." Since the patient does not appear to be in distress and his vitals are unremarkable

(temperature 37.7°C, blood pressure 110/70 mmHg, heart rate 85 bpm, respiratory rate 14 breaths per minute), you decide to consult the electronic medical record (EMR) for further insights. The EMR reveals a history of the patient's previous visit to the emergency department (ED) six weeks prior with a similar complaint, accompanied by a fever of 38°C. Blood cultures were drawn, and due to his high risk for infective endocarditis, admission was

planned. However, the patient left soon after blood tests were drawn. Subsequent analysis of the blood cultures revealed gram-positive cocci in clusters in 2 out of 4 bottles, but not one was able to reach the patient. However, the patient returned by himself the next day, was admitted for intravenous (IV) antibiotics, and diagnosed with infectious endocarditis based on an echocardiogram showing a vegetation on the tricuspid valve. After receiving two doses of antibiotics, he

“It amounts to telling the patient that he has a fixed number of attempts to improve. However, just as quitting smoking may require multiple attempts before success, this patient might need several tries without his full narcotic dose before completing a course of antibiotics.” left again. Over the following six weeks, he represented to the ED eight more times with the same complaints, leaving each time after receiving one to six doses of antibiotics. The patient initially received vancomycin, but once the cultures came back, he was switched to oxacillin. Upon discussing this history with the patient, he says he does not feel well and expresses a desire for treatment, claiming he intends to stay for the full course this time. Notably, similar statements were documented in prior visits. You question the rationale behind readmitting the patient. The previous hospitalizations not only failed to benefit the patient but potentially exacerbated the situation. The repeated starting and stopping of antibiotics contribute to the development of drug-resistant bacteria, posing risks to both the patient and public health. The recurrent cycle of admissions and discharges appears to create wasteful “busywork” for the house staff and consumes valuable hospital resources, including occupied beds in an already crowded facility. It may be time to break this cycle by not readmitting the patient.

However, several temporary solutions, such as clonidine, methadone, and buprenorphine, are available to address this issue. If withdrawal has not been addressed in previous visits, these interventions should be offered, and may mitigate his immediate impulse to leave. Engaging in a frank conversation with the patient may reveal additional barriers that can be identified and addressed. Practically speaking, despite medication, the patient's addiction makes it unlikely that he will remain in the hospital for the full duration of a standard intravenous (IV) antibiotic course for endocarditis. Consequently, it may be necessary to explore alternative treatment regimens. Even if these alternatives (e.g., IV antibiotics suitable for outpatient completion or oral antibiotics) are not theoretical optimality, practicality dictates that the most effective treatment is one the patient can complete. Consulting with infectious disease specialists can aid in evaluating whether any of these options are appropriate or could be appropriate after a short inpatient stay.

Deciding against admitting a patient, even when it may initially seem to be in the patient's best interest, is seldom justifiable and should not be an impromptu decision. Instead, the ethical approach is to proactively address and eliminate the obstacles hindering the patient from receiving appropriate treatment. It is unlikely that the patient does not desire treatment; his frequent presentations suggest a genuine intent to recover. If that is the case, there must be underlying reasons for the patient's inability to stay in the hospital long enough to receive an adequate course of treatment.

However, there is a possibility that the consultant may not find any less burdensome regimen acceptable, or the patient may indicate an unwillingness to stay even if treated for withdrawal. In that case, not admitting the patient could be considered. Adhering to the principle that the best treatment is one that will be completed, and inadequate treatment is not truly a treatment, it follows that there is no necessity to admit the patient if it appears unlikely that he can successfully complete even a modified or narcotic-assisted treatment. While this consideration holds relevance in certain cases, it presents challenges in the current situation.

Considering the patient's intravenous drug use, withdrawal emerges as one plausible explanation for his departures.

This approach relies on predictions about future outcomes, predictions that are inherently uncertain. If the situation is

The Discussion

altered by treating his withdrawal, there is reason to hope that the hospital course will deviate from past occurrences and the patient's expectations. It cannot be assumed that circumstances will be the same as before. Even if no significant changes are made (except, perhaps, the IV antibiotic regimen), not admitting the patient is problematic. It amounts to telling the patient that he has a fixed number of attempts to improve. However, just as quitting smoking may require multiple attempts before success, this patient might need several tries without his full narcotic dose before completing a course of antibiotics. Patients do not have a finite number of attempts, and as physicians, we lack the authority to impose such limitations, even when motivated by a desire to reduce antibiotic resistance or mitigate physician burnout. The only circumstance in which refusing admission to the patient might be deemed acceptable is if it is established that his recurrent elopements are not a result of a failure of will but rather due to his disinterest in treatment, using the diagnosis to secure a brief stay in the hospital for a night or two. While such a scenario is improbable in this case, given the absence of a history of frequent visits before the onset of illness, determining this motive is beyond the capacity of an individual doctor. Moreover, hospital administration is unlikely to be inclined to undertake such an evaluation.

ABOUT THE AUTHOR Dr. Simon is a professor of emergency medicine at the Columbia University Medical Center, in addition to serving as faculty associate at the Columbia Center for Clinical Medical Ethics. Dr. Simon is also a senior research associate for the department of philosophy at the University of Johannesburg.

FACULTY FOCUS

“Can't Wait” Is Emergency Medicine's “Can't Miss” SAEM PULSE | JANUARY-FEBRUARY 2024

By Kiran Pandit, MD, MPH

In the emergency department (ED), medical residents from various specialties and senior students frequently encounter challenges in devising effective workup and treatment plans for patients. Their plans often fall short, leading to comments expressing confusion about the rationale behind ED practices. The root cause might be a lack of exposure to the core goals and priorities of emergency medicine (EM), which form the basis of EM's unique thought processes and workflows. This prompts the question: What exactly is the EM approach, beyond the commonly perceived tasks of triaging patients and ruling out life-threatening conditions?

The EM approach stands in stark contrast to care in clinics and inpatient settings, challenging prevailing misconceptions held not only by healthcare workers but also by the general public. To bridge the gap between expectations and reality, let's examine the distinctions in roles and responsibilities within the ED.

The Four Primary Functions of the ED A prevailing myth, both among patients and health care learners, envisions medical care as a linear process: a patient presents a problem, sees a doctor, undergoes questioning and examination, receives a definitive diagnosis, and is then treated accordingly. However, the ED's role can

be reconceptualized into four primary functions: "can't wait" diagnoses, symptom relief, reassurance, and linkage to care. 1. "Can't Wait" Diagnoses Traditional medical school teaching often emphasizes "can't miss" diagnoses, primarily those associated with lifethreatening conditions, including cancer. Given the ED's perceived focus on life-threatening cases, there's an expectation among patients and learners that conditions like cancer should be worked up and diagnosed in the ED. This, however, is a misconception. The ED prioritizes time-sensitive diagnoses, coining the term "can't wait" to encapsulate the emphasis on conditions requiring immediate attention

“In the emergency department (ED), medical residents often face challenges in devising effective plans for patients, revealing a gap in exposure to the core goals of emergency medicine.” in another ED. To inspire confidence and trust in the decision to return home, the third function of the ED comes into play: reassurance. Patients appreciate hearing positive news, such as "Good news! What we figured out today is that you do not have a condition requiring hospitalization or emergency surgery, and it's safe for you to go home." Clear communication about the ED's role in medical decision-making is crucial for reassuring patients.

to prevent significant morbidity and mortality. This understanding clarifies why certain non-urgent procedures, like colonoscopies, are not performed in the ED, while emergencies like cord compression receive immediate attention. The central theme in EM is time, making "can't wait" diagnoses the priority, rather than the commonly perceived "can't miss" diagnoses. 2. Symptom Relief Without Definitive Diagnosis However, not all patients seeking care in the ED have "can't wait" diagnoses. Many present with severe symptoms that necessitate immediate attention but do not fall into the life-threatening category. The prevailing belief, rooted in traditional teaching, is that a definitive diagnosis must precede treatment. Contrary to this, the ED routinely provides symptom relief without waiting for a confirmed diagnosis. This constitutes the second main function of the ED. By considering potential diagnoses and conducting risk-benefit analyses for treatment interventions, the ED helps patients feel better even without a confirmed diagnosis. For instance, a patient with an erythematous, warm,

painful joint might receive treatment with analgesia and anti-inflammatory medications, pending further outpatient investigation. Clear communication is vital in explaining the decision-making process to patients and learners who might question treating symptoms without a definitive diagnosis. With a focus on "can't wait" diagnoses, the ED acknowledges that diagnostic uncertainty at discharge is normal. This challenges the notion that every doctor visit should result in a definitive diagnosis. Some issues can wait for an outpatient workup due to limited ED resources and the unavailability of certain tests, such as EGDs, PFTs, Holter monitoring, and biopsies. Patients need to understand that while tests for medical emergencies are available in the ED, outpatient follow-up is essential for the subsequent steps in the diagnostic process and treatment. 3. Reassurance for Patients Patients often express frustration when discharged without a diagnosis, fearing that their condition might worsen. This uncertainty prompts some to seek care

4. Linkage to Care Having addressed "can't wait" diagnoses, provided symptom relief, and reassured patients, the ED's fourth main function comes into focus: linkage to care. Serving as the gateway to the health care system, the ED links patients to their next steps, whether it's a primary care physician, physical therapist, social worker, nurse, or specialist. This process demands humility and a focus on the patient's needs, emphasizing that linking patients to subsequent care steps enhances the efficiency of the health care system without diminishing the expertise of EM physicians. Understanding these four functions is not only beneficial for patients but also aids learners who may initially find the challenges of the ED perplexing. Learners, driven by the expectation of making definitive diagnoses and then treating them, might face a misalignment between perceived professional roles and the reality of the ED. Addressing this misalignment is crucial for learners' professional identity formation and well-being. In essence, clarity regarding the EM approach is vital for a comprehensive understanding of the ED's multifaceted functions, contributing to the well-being of both patients and health care professionals.

ABOUT THE AUTHOR Dr. Pandit is an emergency physician and assistant dean for faculty development at the Albert Einstein College of Medicine.

SAEM PULSE | JANUARY-FEBRUARY 2024

FACULTY FOCUS

Leading the Way: Dr. Sanjey Gupta's Pioneering Contributions to Wilderness Medicine and Emergency Care By Nidhi Garg, MD, on behalf of the SAEM Faculty Development Committee Dr. Sanjey Gupta is a leader in wilderness medicine with a distinguished history of service in various roles and capacities within emergency Dr. Sanjey Gupta medicine. Currently, Dr. Gupta holds the position of professor of emergency medicine and chair of the emergency department (ED) at South Shore

University Hospital (SSUH) within the Northwell Health in New York. He is a fellow of the Academy of Wilderness Medicine of the Wilderness Medical Society, holds board certification in addiction medicine, and is a diplomate of the American Board of Preventive Medicine. Dr. Gupta has completed extensive administrative leadership training, including media training from Thunder 11 Public Relations and Physician Leadership Development

Program by Northwell Health. Additionally, he holds an MBA from Louisiana State University and has received leadership training from the Harvard T.H. Chan School of Public Health. In his role as chair of the SSUH ED department, Dr. Gupta oversees operations and academics. SSUH is a 341-bed tertiary referral center serving eastern Long Island, verified by the American College of Surgeons as a Level II adult trauma center. It is also a

“Dr. Gupta leads by example, embodying a perfect mix of academics and administration, navigating the storms of emergency medicine with a cool and calm demeanor.” thrombectomy-capable primary stroke center and a percutaneous coronary intervention center. Recognized centers of excellence at SSUH include cardiology, orthopedics, neuroscience, and women’s health. The ED at SSUH serves approximately 83,000 patients annually, boasting a newly expanded space with over 55,000 square feet, 94 beds, a dedicated observation unit, two x-ray suites, a behavioral health unit, and seven critical care/resuscitation bays.

Staffing for the emergency department comprises 30 attending physicians, 18 emergency medicine residents, 10 transitional year residents, 28 physician assistants, and 75 registered nurses. Approximately 20% of patients seen at the SSUH Emergency Department are admitted. SSUH hosts a three-year ACGMEaccredited emergency medicine residency program and recently initiated a transitional

year residency program with emergency medicine as the core department. The department utilizes a split-flow model for patient care and includes a 12-bed observation unit. Dr. Gupta has been a longstanding member of the Wilderness Medicine Society and actively contributes to its initiatives. Over the past decade, he has continued on Page 43

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“In his commitment to continuous improvement, Dr. Gupta not only revitalized emergency departments but also championed initiatives that garnered accolades, like the Gold Stroke Plus award for improved stroke care metrics.” FACULTY FOCUS

continued from Page 41 taught wilderness medicine didactics and workshops at the SAEM Annual Meeting. Currently, he plays a crucial role the development of a proposed SAEM Wilderness Academy and serves on the Wilderness Medical Society (WMS) Research Committee. Additionally, he is the former research committee chair for WMS and serves as the faculty advisor for the Wilderness Club at Zucker School of Medicine at Hofstra/Northwell. Recently, Dr. Gupta served as the keynote speaker at the Mid Atlantic Student Wilderness Medicine Conference (MASWMC) 2023 in Philadelphia, PA. He also serves as a medical officer of the NY-4 DMAT unit (National Disaster Medical System). Dr. Gupta is a graduate of the North Shore University Hospital EM program and began his career at New York Presbyterian Queens. He ascended through the ranks to assistant chair, fulfilling roles such as resident research mentor, assistant program director, and later, assistant emergency department chair. Dr. Gupta has successfully balanced academic and administrative responsibilities, contributing significantly to teaching, research, and departmental operations. He represented New York ACEP as a board member and remains an active council member. In 2014, Dr. Gupta assumed the role of chair at Long Island Jewish Valley Stream/ Northwell Health, where he revitalized the emergency department, elevating it to new standards. His collaborative approach with nursing leadership resulted in successful quality improvement projects, including the introduction of a zero operational cost split-flow process for ambulatory, vertical patients. This initiative led to a notable reduction in door-to-discharge time by 21%. During his tenure, Dr. Gupta introduced an EMS education night, a quarterly

event for local volunteer and professional EMS. This initiative not only increased ambulance visits by almost 20% but also provided educational credits for EMS and nursing staff. Under his leadership, the team at Long Island Jewish Valley Stream/ Northwell Health received the Gold Stroke Plus award for achieving improved stroke care metrics. In August 2015, Dr. Gupta was promoted to executive vice chair at Long Island Jewish Medical Center, the tertiary care center for the Northwell Health System. He is a top leader in the emergency service line and participates in the High Potential Leadership Program for Northwell Health System. Collaborating with nursing leaders, he initiated the intake 2.0 Lean process and planned a reboot of split flow vertical intake. Currently, he is working with nursing and hospital leadership to find solutions for improved flow and redesigning. Dr. Gupta, along with his associate chairs and faculty, launched an enhanced version of Performance Improvement/Quality Management for physicians and the department. Believing in continuous improvement, Dr. Gupta designed the physician assistant (PA) education process to enhance the education and skill level of the PA team at LIJ. Every Wednesday afternoon, all PA staff at LIJ receive didactic education from EM faculty. Dr. Gupta's commitment to continuous improvement extends to palliative and geriatric care, where he launched social work and multidisciplinary team approach programs. As a leader, Dr. Gupta prioritizes physician wellness and satisfaction. He implemented various feedback mechanisms, including display boards for metrics and Press Ganey scores, as well as detailed personal reviews of physicians. Dr. Gupta introduced a "shout-out" board in the department, providing an open forum for ED staff to acknowledge colleagues for outstanding contributions.

Dr. Gupta’s contribution to leadership was recognized in 2016 when he was awarded the Emergency Department Director of the Year award from the Emergency Medicine Foundation/ACEP. The award recognized the “emergency physician leader who has demonstrated exemplary collaborative skills in the ED, producing the highest quality of patient care.” Despite his administrative and academic responsibilities, Dr. Gupta remains an active ED physician, displaying exceptional efficiency and garnering popularity among residents. He plans resident wellness sessions, mentors residents one-onone, and actively participates in resident selection by conducting interviews and providing input to residency leadership. Dr. Gupta's exceptional interpersonal and mentoring skills have contributed to recruiting numerous ED physicians and developing several department leaders for the emergency medicine service line of Northwell Health. His leadership style, commitment to mentorship, and dedication to emergency medicine have motivated individuals to pursue careers in this vital specialty. As a mentee of Dr. Gupta, I can attest to the invaluable lessons learned from his exemplary attitude and leadership. In a field where the pipeline is a serious concern, leaders like Dr. Gupta play a crucial role in nurturing and inspiring the next generation of emergency medicine professionals.

ABOUT THE AUTHOR Dr. Garg is director of emergency medicine research at South Shore University Hospital/ Northwell Health and associate professor of emergency medicine for the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell.

GERIATRIC EM

Buprenorphine as a Potential Agent for Pain Control in Older Adults SAEM PULSE | JANUARY-FEBRUARY 2024

By Sarah Perelman, MD, and Katherine Selman, MD, on behalf of the SAEM Academy for Geriatric Emergency Medicine

Whether presenting for a newly infected chronic sacral ulcer, rib fractures resulting from a fall, or a myriad of other complaints, older adults constitute 15-20% of emergency department visits. Controlling their pain presents unique challenges for emergency medicine physicians. Older adults may receive less adequate pain control in the emergency department compared to their younger counterparts, and clinicians may be reticent to provide opioids to older adults reporting severe pain. This hesitation may arise from concerns about respiratory depression, heightened side effects, reduced metabolism, or the fear of exacerbating delirium. However, it is crucial to note that pain itself can induce or worsen delirium, potentially trapping the

patient in a vicious cycle of heightened morbidity and diminished ability to articulate their pain. While physicians in the United States are most familiar with buprenorphine as a treatment for opioid use disorder, several studies suggest that this medication holds promise as an effective agent for acute pain control. Moreover, its side effect profile and metabolism make it well-suited for use in older adults. Buprenorphine is a semisynthetic partial opioid agonist that is available in transdermal, intravenous, and sublingual forms. While most opioid full agonists, such as fentanyl or morphine, have a linear relationship between pain control and respiratory depression,

buprenorphine has a ceiling effect on respiratory depression but not on analgesia. A study comparing the safety profile of fentanyl and buprenorphine indicates the latter is much safer, calculating its odds ratio of analgesia to respiratory depression to be 13.5, comparted with fentanyl’s odds ratio of 1.2. Buprenorphine is also not immunosuppressive, and can treat a wide array of pain phenotypes including neuropathic, heat, nociceptive and cancer pain. Buprenorphine, a semisynthetic partial opioid agonist, is available in transdermal, intravenous, and sublingual forms. Unlike most opioid full agonists such as fentanyl or morphine, which exhibit a linear relationship between

“Buprenorphine, a semisynthetic partial opioid agonist, is available in transdermal, intravenous, and sublingual forms. Unlike most opioid full agonists such as fentanyl or morphine, which exhibit a linear relationship between pain control and respiratory depression, buprenorphine demonstrates a ceiling effect on respiratory depression while maintaining analgesic efficacy.” pain control and respiratory depression, buprenorphine has a ceiling effect on respiratory depression, but not on analgesia. A comparative study evaluating the safety profiles of fentanyl and buprenorphine indicates that the latter is significantly safer, with an odds ratio of analgesia to respiratory depression of 13.5, in contrast to fentanyl’s odds ratio of 1.2. Additionally, buprenorphine is not immunosuppressive and can effectively address a wide variety of pain phenotypes, including neuropathic, heat, nociceptive, and cancer pain. In older adults specifically, multiple studies have affirmed the safety and efficacy of the buprenorphine transdermal patch for treating chronic pain, eliminating the need for age-related dose adjustments. A sizable prospective cohort study conducted in Spain revealed comparable pain control at the same dosages in patients under 65, aged 65-75, and over 75 years old, with no increases in adverse events associated with age. Moreover, the buprenorphine transdermal patch induces less cognitive dysfunction than other opioids, a significant consideration when attempting to minimize delirium in hospitalized older adults. Additionally, as it is predominantly cleared by the gastrointestinal tract as bile, with less than 5-10% excreted by the kidneys, no renal dose adjustments are required. This is key for older adults who may exhibit age-related renal impairment despite normal serum creatinine

measurements. While buprenorphine undergoes first-pass metabolism in the liver, it is well tolerated in patients with mild to moderate hepatic failure and exhibits minimal drug-drug interactions at therapeutic concentrations. These properties prove advantageous in the emergency department, where the administration of pain medicine often precedes the completion of all labs, and standardized dosing aligns with the fastpaced environment. While the majority of these studies primarily focus on chronic pain management, there is a growing body of research—particularly in the postoperative context—indicating that buprenorphine is effective in addressing acute pain as well. A study conducted in the United Kingdom involving geriatric patients with femoral neck fractures demonstrated that transdermal buprenorphine not only provided effective pain control but also contributed to improved mobilization on the first day compared to the national average, with delirium rates below the national average. Another study involving patients aged 60-75 undergoing total knee replacement revealed that transdermal buprenorphine delivered superior pain control compared to Tylenol and tramadol, with no increase in adverse reactions. In the emergency department setting, a 2012 study published in the Annals of Emergency Medicine found that 0.4mg sublingual buprenorphine demonstrated equivalency to 5mg intravenous morphine

in terms of pain control for patients presenting with acute fractures. Despite this noteworthy finding, a more substantial body of literature is essential before buprenorphine can potentially replace morphine or acetaminophen as first-line agents in the emergency department’s arsenal. The distinctive properties of buprenorphine, however, suggest its potential as an emerging frontline agent for pain control, particularly in the geriatric population. Further studies on its efficacy, some of which are presently underway, could provide valuable insights for geriatric patients seeking care in the emergency department.

ABOUT THE AUTHORS r. Perelman is an emergency D medicine resident and chief resident at Cooper University Hospital in Camden, NJ. She will be pursuing a fellowship in geriatric emergency medicine at Massachusetts General Hospital next year. Dr. Selman is an assistant professor of emergency medicine at Cooper Medical School of Rowan University and attending physician at Cooper University Hospital. She completed geriatric emergency medicine fellowship at University of North Carolina Chapel Hill and is an active member of AGEM.

About AGEM The Academy of Geriatric Emergency Medicine (AGEM) works to improve the clinical care of older patients, prepare trainees to care for older patients, and advance the geriatric EM research agenda. Joining AGEM is free! Just log into your member profile. Click “My Account” in the upper right navigation bar. Click the “Update (+/-) Academies and Interest Groups” button on the left side. Select the box next to the academy you wish to join. Click “save.”

INFECTIOUS DISEASES & EPIDEMICS

Stemming the Rising Tide of Syphilis Through Emergency Department Screening SAEM PULSE | JANUARY-FEBRUARY 2024

By Kiran Faryar, MD, MPH and Kimberly Stanford, MD, MPH on behalf of the SAEM Emergency Medicine Transmissible Infectious Diseases and Epidemics Interest Group

There has been a precipitous rise in syphilis cases over the past two decades, following a historic low in 2000-2001. Syphilis, a debilitating disease, can remain asymptomatic for years but eventually leads to various neurologic, vascular, and other complications. When transmitted to a fetus during pregnancy, congenital syphilis results in stillbirth, miscarriage, and congenital anomalies. According to the Centers for Disease Control and Prevention (CDC), the rate of primary and secondary (P&S) syphilis increased by 28.6% between 2020 and 2021, affecting all genders, geographic regions, and age groups.

Alarmingly, the reported cases of congenital syphilis surged by 755% from 2012 to 2021, reaching 3,761 cases nationwide in 2022. This increase occurred concurrently with a rise in P&S syphilis among young women. Lack of timely testing and adequate treatment during pregnancy contributed to 88% of congenital syphilis cases. The same populations facing limited access to prenatal and other preventive care also experience a disproportionate impact from syphilis and are more likely to seek health care in the emergency department (ED). Routine HIV screening in programs in EDs have gained

recognition for their effectiveness in diagnosing HIV among populations that are challenging to reach. As national and state organizations advocate for a syndemic approach encompassing HIV, sexually transmitted infections, and substance use, this principle should be extended to other significant health threats, including syphilis. Emergency departments may serve as the sole point of contact with the health care system for some patients, highlighting a unique responsibility to address public health threats extending beyond emergency conditions. By addressing these

“No babies should be dying in 2024 from an easily preventable disease. Patients affected by syphilis rely on the ED for their care, and addressing the syphilis epidemic is our responsibility as emergency physicians.” needs proactively, we can prevent future emergencies, connect patients with necessary care, and ultimately reduce health inequities. Routine ED syphilis screening has demonstrated high rates of syphilis diagnosis, mainly among asymptomatic patients, and identified larger numbers of women with syphilis than traditional testing, which will be critical to curbing the congenital syphilis epidemic. In a recent CDC report addressing congenital syphilis, EDs were highlighted as key settings for syphilis testing during pregnancy. The prominence of the ED as a critical access point for syphilis prevention can be largely attributed to the research and advocacy efforts of members belonging to the SAEM EMTIDE (Emergency Medicine Transmissible Infectious Diseases and Epidemics) Interest Group. These group members have successfully implemented both universal and targeted syphilis screening programs in their EDs, demonstrating high acceptability among both patients and staff. Routine syphilis screening in EDs has proven effective in diagnosing syphilis at elevated rates, particularly among

asymptomatic patients. Moreover, it has identified larger numbers of women with syphilis compared to traditional testing methods. This heightened detection is pivotal in mitigating the congenital syphilis epidemic. As a result of the efforts of its members in this area, EMTIDE has been chosen to coordinate the inaugural national gathering on emergency department (ED) syphilis screening and prevention of congenital syphilis. This event, sponsored by the CDC and the National Association of County and City Health Officials (NACCHO), will bring together key stakeholders from EDs nationwide, along with representatives from major governmental and national organizations. The convening will establish the foundation for national policy, identify infrastructure gaps addressable by health departments, and collect evidence supporting EDs in implementing their screening programs. Public health interventions, such as ED screening programs, play a critical role in safeguarding the health of our nation. Emergency departments are uniquely positioned to reach populations most in need. No babies should be dying in 2024 from an easily preventable

disease. Patients affected by syphilis depend on EDs for their care, and it is the responsibility of emergency physicians to address the syphilis epidemic.

ABOUT THE AUTHORS Dr. Stanford is an emergency physician and implementation scientist specialized in interventions that decrease health disparities, primarily focusing on emergency department screening for HIV, syphilis, and other sexually transmitted infections. She is funded by a K23 from NIAID to study the implementation of routine syphilis screening in the emergency department. Contact: @KimStanfordMD, kstanford@bsd.uchicago.edu Dr. Faryar is an emergency physician and researcher with a focus on integrating public health into emergency department settings. She serves as research director for the Department of Emergency Medicine at University Hospitals Cleveland Medical Center and chair of the SAEM Research Director’s Interest Group. Contact: Kiran.Faryar@UHhospitals.org

INFORMATICS & DATA SCIENCE

EMS Informatics: Navigating the Challenges, Seizing the Opportunities SAEM PULSE | JANUARY-FEBRUARY 2024

By Arwen Declan, MD, PhD; Mat Goebel, MD; James McClay, MD; Michael Lozano, MD; Betty Yang, MD and Robert Turer, MD, on behalf of the SAEM Informatics and Data Sciences Interest Group

The emergency medical services (EMS) system, a critical component of health care, faces a profound challenge: the absence of a cohesive informatics framework. The SAEM Informatics and Data Sciences Interest Group (IDSIG) explored EMS informatics with experts Dr. Mat Goebel, Dr. Mike Lozano, Dr. Betty Yang, and Dr. Jim McClay, who emphasized the opportunity to better serve our shared EMS/EM patients with an integrated approach to EMS data management. Even though EMS clinicians play a pivotal role in the health care continuum, “there is a lot of data that’s gathered, but

“There is a lot of data that's gathered, but we aren’t necessarily doing very much with it.” – Dr. Mat Goebel we aren’t necessarily doing very much with it,” observes Mat Goebel, MD. Quality patient care in EMS hinges on the smooth communication of patient data across the continuum from first contact, such as 9-1-1 call centers, to prehospital responders and hospital

clinicians. The outcomes-oriented feedback needed to evaluate and improve the quality of care requires bidirectional communication between prehospital and hospital systems. As emergency medicine (EM) clinicians, we appreciate the vital

“Despite these challenges, including inconsistent implementation, limited interoperability, and overall low utilization, NEMSIS has played a pivotal role in shaping EMS data management and translating EMS data insights into clinical applications.” scene information gathered by our EMS colleagues. However, many emergency departments miss key information because they never receive electronic patient care records from EMS. Similarly, EMS clinicians need crucial outcomes feedback to learn from patient encounters and to recognize the impact that their prehospital interventions have on patient outcomes. Yet, many hospital systems do not return patient outcome data to their EMS partners. In an optimal system, these crucial information transfers would be automated within a cohesive, bidirectional data management framework. The lack of standardized data management limits opportunities to enhance patient care within EMS and may affect outcomes for all patients entering the hospital system via EMS. As Dr. Jim McClay notes, “I’m flabbergasted that we don’t yet have a shared repository of EMS information.”

Current EMS data management faces limitations and fragmentation.

EMS data is inherently complex, given its incident-based nature. Unlike a typical hospital Electronic Health Record (EHR) that maintains one record per patient, an EMS EHR documents one record per incident, including a unique patient identifier for each individual involved in the incident. Additionally, EMS data collection formats vary by EHR vendor and location, while data management personnel and practices also exhibit variability by location. Consequently, data extraction becomes a challenging task. Dr. Mike Lozano emphasizes that data extraction without robust technical support carries unique risks, particularly when dealing with live 9-1-1 databases: “Who wants to be the person who crashes regional 9-1-1 because you asked for too much data in a query?” Data sharing between EMS organizations and their partner hospitals faces limitations due to immediate

constraints and variable state privacy laws. Despite the potential benefits of record linkages supporting better patient care through bidirectional data sharing pipelines, most EMS organizations operate within data silos. Therefore, despite existing technical opportunities, there is no cohesive infrastructure supporting the efficient use of clinical data.

Current efforts to establish a national EMS repository focus on the National EMS Information System (NEMSIS).

Despite numerous visions for EMS health care information exchange, such as the NHTSA 1996 EMS Agenda for the Future, EMS Agenda 2050, and the NAEMSP 2014 Position Statement), NEMSIS stands out as the most successful and widely implemented common data system. Developed in the early 2000s through collaboration between the National Association of State EMS Officials (NASEMSO) and the National Highway Traffic Safety Administration (NHTSA), NEMSIS aims to create a standardized framework for collecting and sharing EMS data nationwide. This framework facilitates data-driven decision-making and enhances the quality of patient care by establishing a uniform data set. As NEMSIS evolves, it holds significant potential to shape EMS data management and clinical practices. The NEMSIS data dictionary has defined a common language, enabling EMS agencies to share data with their respective state departments of record. However, its impact is dampened by inconsistent definitions, variable data use and support at local, state, and national levels, and uneven adoption. The most recent version, NEMSIS 3.5, released in 2021, has not been uniformly adopted. Despite these challenges, including inconsistent implementation, limited interoperability, and overall low utilization,

NEMSIS has played a pivotal role in shaping EMS data management and translating EMS data insights into clinical applications.

Data-driven insights from EMS play a transformative role in clinical practice.

Systems that effectively implement strategic data management, like SeattleKing County, demonstrate the immense impact and potential of such systems on patient care. The Seattle-King County system maintains longstanding registries that link dispatch, EMS, and hospital care. Utilizing these data, the system executes quality improvement measures and applies research insights to achieve “unbelievable outcomes,” according to Betty Yang, MD. This program has utilized integrated quality improvement, outcomes-driven research, and data management to develop community health interventions for hypertension and diabetes (Treviño et al., EMSWorld 2008) and high-performing endotracheal intubation endotracheal intubation (Rea, JEMS 2011) and cardiac arrest (Jacobs et al., Circulation 2004) care programs. Similarly, the Resuscitation Outcomes Consortium (ROC) combined EMS and hospital data from multiple sites to advance care for critical illnesses such as trauma and cardiac arrest (ROC, e.g., Newgard et al., Resuscitation 2008 and Kurz et al., Resuscitation 2018). ROC played a crucial role in establishing the basis for optimal CPR (rate, depth, recoil, and chest compression fraction), influencing guidelines for cardiac arrest care both in- and out-of-hospital. Despite the transformation in CPR and an increase in survival rates from 46% to 33% for witnessed ventricular fibrillation in out-of-hospital cardiac arrest (Rea et al., Circulation 2016), the consortium is no longer funded. The ROC consortium continued on Page 51

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“Who wants to be the person who crashes regional 9-1-1 because you asked for too much data in a query?.” – Dr. Mike Lozano INFORMATICS & DATA SCIENCE

continued from Page 49 exemplifies how harnessing prehospital data and hospital outcomes can rapidly transform the care of time-critical conditions and improve overall outcomes.

Opportunities for collaboration are plentiful.

These examples illustrate the powerful impact of data-driven EMS insights to improve the clinical care of our shared EMS/EM patients. They should encourage and challenge us as emergency physicians to support further advances in EMS information systems. EMS informatics remains a relatively niche sub-field; only one EMS informatics abstract was presented at the last American Medical Informatics Association annual conference (Nov. 2023) which featured over 600 presentations and more than 2,000 attendees. Despite emergency physicians being well-represented in informatics, there may be limited awareness among informaticists and EMS clinicians regarding collaboration opportunities. Emergency physicians are well-placed to connect EMS clinicians with informaticists and other collaborators, offering critical insights and leadership that can propel EMS informatics forward for the benefit of patient care. While the current fragmentation of EMS information systems and the absence of interoperability remain major impediments to optimal data-driven patient care, the growth of EMS informatics is promising. Emergency physicians should actively collaborate with and support our EMS colleagues in developing a unified, interoperable data repository that integrates pre-hospital and hospital data, enabling bidirectional data flow. Effectively harnessing and managing EMS data is essential for gaining new insights that will optimize the care of our shared EMS/EM patients.

ABOUT THE AUTHORS Dr. Declan is the assistant research director at Prisma Health Upstate and a clinical assistant professor at the University of South Carolina School of Medicine-Greenville & Clemson University. She applies informatics methods to enhance patient care and support the clinician workforce. Dr. Goebel is an EMS fellow at Baystate Medical Center who recently completed a research fellowship. He studies large publicly available datasets to address clinically relevant questions. Dr. McClay is currently chief registration and inspection officer and interim chair of the Department of Biomedical Informatics, Biostatistics, and Medical Epidemiology at the University of Missouri in Columbia. His research focuses on building the infrastructure for the reuse of clinical data in evidence generation and outcomes improvement in community health. Dr. Lozano is a collaborative assistant professor at the University of South Florida and assistant medical director for Pinellas County (FL) EMS. He pursues strategic approaches to enhance healthcare quality and delivery. Dr. Yang is an assistant professor of emergency medicine at UT Southwestern and an associate medical director of the UT Southwestern/Parkland BioTel EMS System. She focuses on resuscitation, striving to improve the care of critically ill and injured patients in prehospital and emergency settings. Dr. Turer is an assistant professor of emergency medicine and clinical informatics at UT Southwestern in Dallas, TX, and currently chairs the SAEM Informatics and Data Science Interest Group.

NIH OFFICE OF EMERGENCY

Decoding Your NIH Summary Statement

Office of Emergency Care Research

By Jeremy Brown, MD In our previous column, we noted that all submissions assigned to an NIH Study Section receive an important and detailed letter post-review, known as the Summary Statement. True to its name, it is a concise written summary of the comments from primary reviewers, who are members of the study section assigned to evaluate the proposal. Furthermore, it encompasses a summary of the broader discussion that occurred, outlining the project's overall strengths and weaknesses. Even submissions not fully discussed at the meeting, owing to their insufficient strength for a fundable score, receive a summary statement. The primary reviewers' written comments constitute the bulk of the statement, presented anonymously, and aligned with the NIH scoring system's 9-point rating scale (1 = exceptional;

9 = poor). This identical scale is applied to overall impact scores. Each proposal undergoes assessment based on five review criteria: significance, investigator(s), innovation, approach, and environment. However, it is noteworthy that as of January 2025, these criteria will undergo consolidation into three factors: • Factor 1: The Importance of the Research (significance, innovation), scored 1-9 • Factor 2: The Rigor and Feasibility (approach), scored 1-9 • Factor 3: The Expertise and Resources (investigator, environment), assessed as either sufficient for the proposed research or not, with reviewers providing an explanation in the latter case. Typically, each summary statement undergoes a comprehensive review,

with at least three evaluations provided. However, the exact number hinges on the quantity of primary reviewers involved, and this number may range from as few as three to as many as eight or nine. While consensus often emerges among reviewers on major issues, it is not uncommon to encounter disparate scores when reading through a summary statement. For instance, one reviewer might perceive the problem addressed by a proposed clinical trial as highly significant and urgent, while another reviewer may express reservations, contending that the foundational science or supporting animal studies lack sufficient persuasiveness to advance to a human trial. These variations occasionally stem from the diverse backgrounds and expertise of the reviewers; a pathologist's perspective may differ

CARE RESEARCH Office of Emergency Care Research

“It is worth noting that even submissions not thoroughly discussed during the meeting, owing to their insufficient strength for a fundable score, receive a summary statement.” from that of a clinician. This underscores the importance of specifically requesting a reviewer with the expertise needed to understand your proposal—an aspect we delved into in our previous column, "Demystifying the NIH Peer Review Process." However, these differing opinions may also arise from valid scientific disagreements, leading to a range of scores among reviewers. The summary statement is not merely a critique; it also offers suggestions on how to improve your proposal. Therefore, it merits careful and openminded consideration, as it represents the insights of your peers who are deeply invested in the success of your scientific proposal. Should you decide to resubmit (a prudent step for nearly everyone, as very few proposals secure funding after just one round of reviews), it is imperative to conscientiously address each comment. It's understandable that you may disagree with or question the scientific validity of certain comments, and not every suggested improvement is one

that you should automatically embrace. But if you opt not to adopt a suggestion from the summary statement, make sure you provide a clear explanation in the cover letter accompanying the revised application. Ignoring these comments is not advisable. Reviewers have taken the time to offer their perspectives, and as a minimum courtesy, you should engage with their feedback, even if you hold a differing viewpoint. Reading a summary statement can be a disheartening experience. A project that has consumed your efforts for many months, or even years, and one in which you believed, may not have secured a favorable score, or even been discussed. I am intimately familiar with this sentiment because that is what happened when I submitted my first proposed clinical trial to the NIH. The reviewers identified so many flaws that it never even made it into the top half of the proposals and therefore was not discussed. After tending to my bruised ego, I took the constructive feedback

to heart, reworking the proposal in alignment with the reviewers' suggestions. After a second review the project secured funding. The summary statement is your friend and usually offers very valuable advice. So, pay attention!

ABOUT THE AUTHOR Dr. Brown is the director of the Office of Emergency Care Research (OECR) where he leads efforts to coordinate emergency care research funding opportunities across NIH. Additionally, Jeremy is the primary contact for the NINDS Exploratory and Efficacy FOAs and serves as NIH's representative in government-wide efforts to improve emergency care throughout the country. He is also the medical officer for the SIREN emergency care research network which is supported by both NINDS and NHLBI. Jeremy.brown@nih.gov

ONCOLOGIC EMERGENCIES

SAEM PULSE | JANUARY-FEBRUARY 2024

Closing The Knowledge Gap: Strengthening EM for a Growing Cancer Patient Population

By Molly O’Shea, MD and Jason J. Bischof, MD, on behalf of the SAEM Oncologic Emergencies Interest Group A recent analysis of the Nationwide Emergency Department Sample from 2006 to 2012 revealed approximately 29.5 million emergency department (ED) visits by adult patients diagnosed with cancer, constituting 4.2% of all ED visits. This population exhibited a significantly higher admission rate compared to patients without a cancer diagnosis (59.7% versus 16.3%). The prevalence of this ED population is on the rise, driven by the aging demographic and advancements in cancer treatments. In 2023, an estimated 1.9 million new

cancer diagnoses are projected in the United States, with approximately 600,000 associated deaths. Acknowledging this trend, the American Board of Emergency Medicine (ABEM) Model of the Clinical Practice of Emergency Medicine (EM Model) has incorporated significant oncologyrelated revisions in both the 2019 and 2022 versions. Prior to 2019, the Model lacked a dedicated core content area for oncology. The 2022 Model made further important strides to improve

the training of emergency medicine (EM) physicians by incorporating complications from chemotherapy and immunotherapy as content areas. This is particularly pertinent, given that an estimated nearly 40% of cancer patients are eligible for immunotherapy. Despite the Model’s comprehensive update to cover oncology topics, this does not translate into immediate improvement of knowledge and instruction for EM residents, as the 2022 Model’s impact on EM Qualifying Examinations is not anticipated until 2024.

“Residency programs should intensify their efforts to augment education in these specific areas of interest.” While a majority of surveyed EM program directors acknowledge the importance of preparing residents for oncologic emergencies, a considerably smaller proportion believe that their didactic curriculum is adequate. Only 17% of programs provide dedicated didactic training on immunotherapy. Residency programs should intensify their efforts to augment education in these specific areas of interest. Members of the SAEM Oncologic Emergencies Interest Group have identified instructional gaps, encompassing topics such as immunotherapy treatments and their side effects, the management of cancer-related symptoms, the influence of oncologic treatment on common emergency presentations, and the provision of emergent treatment for newly diagnosed patients. Non-emergency medicine national guidelines can serve as a foundation for both EM training and the clinical management of oncologic emergencies. The American Society of Clinical

Oncology (ASCO) has issued guidelines encompassing various topics, including managing immune-related adverse events in patients receiving immune checkpoint inhibitors and chimeric antigen receptor T-cell therapy, as well as the utilization of opioids for treating cancer-related pain. Adherence to these standardized guidelines will result in better outcomes and emergency department treatment for patients with cancer. The National Comprehensive Cancer Network (NCCN) is another valuable resource for improving emergency department care. Collectively, the EM community should actively seek opportunities to contribute to the future revisions of national guidelines specifically addressing this patient population. The Comprehensive Oncologic Emergencies Research Network (CONCERN) was established to improve the outcomes of cancerrelated emergencies through fostering collaboration between emergency medicine and oncology—a successful model of interdisciplinary

cooperation. Identifying knowledge gaps in coordination with our oncology counterparts and developing novel partnerships for clinical care and research will enable us to provide improved care for this expanding, medically complex, and vulnerable ED population in the future.

ABOUT THE AUTHORS Dr. O’Shea is a third-year resident in the Department of Emergency Medicine at The Ohio State University Wexner Medical Center, Columbus, OH.

r. Bischof is an associate D professor in the Department of Emergency Medicine at The Ohio State University Wexner Medical Center, Columbus, OH. He is the chair of the SAEM Oncologic Emergencies Interest Group.

PERSPECTIVE

Life and Death in the ED: Navigating the Complex Emotions of EM SAEM PULSE | JANUARY-FEBRUARY 2024

By Jasmine Y. Gale, MD

What just happened? What is wrong with this world? He was sleeping! It was 10 a.m. on a Monday morning in his own bed, not 3 a.m. Saturday during a drug deal gone wrong — as if that would make it easier. He was somebody’s son. He was younger than I am. I felt the warmth of his heart, but it was empty in my hands. I was suddenly overcome with anger, sadness, and then — guilt. Entering the family room, I sensed the family were unaware of the news I was about to share. His aunt grabbed my face and shouted. His sister wailed. His mother banged on the wall slid into a helpless crumple, producing gutwrenching sounds that only a mother

who has lost her child can make. I had just informed this family that their 23-year-old previously healthy son, brother, and nephew was dead. Two hours earlier, the trauma pager went off: “multiple gunshot wounds to chest. CPR in progress. ETA 5 min.” As I raced to the trauma bay I almost burst with excitement over the potential life-saving procedures and real-time learning opportunities I was about to receive. I felt lucky to be the PGY-2 emergency medicine (EM) resident rotating on trauma that morning. My attending prepped the thoracotomy kit, a completely foreign tool for me this early in my training. Heavy steel instruments that resembled garage tools tumbled onto the sterile

field. I was shown how to use the mallet to crack open the sternum just as EMS rolled in. The patient was intubated with the automated CPR device pounding on his chest. We paused the device. No pulse. The attending shoved a scalpel into my shaking hand. I cut into his left chest, and blood immediately poured out. Ugh, hadn’t I put on surgical boots? I placed the rib spreader upside down. The trauma surgeon corrected me. I was suddenly staring directly at the patient’s lungs. I thought to myself, “How cool is that?” I saw the bullet hole straight through his lung. My hands replaced the automated CPR device and I literally held the patient’s heart in my hands. “I can’t wait to tell my coresidents about this,” I thought to myself. The sternal mallet did

its job, and I cracked open the chest. We extended the incision across to his right chest and I couldn’t help but think, “How surreal is it that I just intentionally broke his bone? Blood began to pour out of his right side. At least I’d worn maroon scrubs. The blood would blend in. The trauma surgery attending determined there was nothing to clamp. The damage was too extensive. “Time of death 10:11 AM.” Well, that was something I had never seen —let alone done. The team shared a moment of silence and then went on to the next task. I immediately started the death paperwork before the next trauma arrived and the day got busy. I talked to the police to obtain the relevant details for the medical examiner and organ bank. He was a 23-year-old male who’d just been released from prison. Shot 3 times in the chest while he was at home, sleeping. I paused. I wished I hadn’t been given that last detail. Knowing he was innocently sleeping and just out of prison made it unbearable. My adrenaline had slowed, and the horror of the case began to sink in. How could I have been so nonchalant—no, how could I have been so excited —about this tragedy? Tragedy isn’t even a big enough word to describe it. Social work called. The family was ready for me.

After a death like this, long before the grief is processed, I am required to gather information from the family for the death paperwork and processing. Do they have a funeral home in mind? Do they want an autopsy? They are expected to move immediately from grief to a to-do list. This family, like many others, ask if they can see their loved one, but they are not allowed because this is a medical examiner case, and he had already been brought downstairs for investigation. I left the devastated family so we could all begin to process this injustice. I needed to cry, but I must finish rounds. I can’t believe I’m worried about how I feel when it can’t even begin to compare to what his mother is feeling. Why don’t we have enough cry spaces in the ED? Word spread fast. I was already receiving text messages from my coresidents, “OMG. I can’t believe you got to perform an emergency department thoracotomy! I’m so jealous!” We see tragic, horrific, unthinkable cases every shift during EM residency. “At least I got a chest tube out of it” are phrases I have said and heard, in an effort to numb my emotions and find some sense in the senseless. Am I a better doctor for thinking this way, or am I worse? What kind of “monster” can’t wait to brag to their friends about the cool procedures they got during a catastrophe? Well, most EM residents are

that kind of “monster.” We think this way to cope and survive. We think there must be valuable learning opportunities in every case, no matter how painful, otherwise, how could we continue caring for our patients, or for ourselves? Just as important as the procedural skills, if not more so, are the debriefing process and support network. Discussing tough cases helps us learn and process and reminds us we’re not alone. I found that same coresident who texted me that he was jealous of this case and cried on his shoulder, as he validated my experience. I feel lucky to have such a strong bond with my fellow coresidents, and I hope others have something similar. It can be easy to lose perspective in the chaos, but this juxtaposition of exhilaration and grief during medical disasters is what makes us human—and better doctors— and I hope I never lose it.

ABOUT THE AUTHOR Dr. Gale is a third-year emergency medicine resident at the University of Massachusetts in Worcester, MA. She completed medical school at Tufts University in Boston, MA. After residency graduation, she will be attending Dartmouth for a Wilderness Medicine Fellowship.

SAEM PULSE | JANUARY-FEBRUARY 2024

PHARMACOLOGY

Navigating the Complexities of Post-Cosmetic Surgery Complications: A Comprehensive Guide for Emergency Physicians By Kingsley Essel Arthur

Introduction

The surge in popularity of cosmetic surgery has given rise to a parallel increase in postoperative complications, necessitating prompt and effective pharmacological management. These complications range from infections and bleeding to pain and psychological distress. Emergency physicians play a critical role in addressing these complications, especially when patients present with post-cosmetic surgery issues in emergency departments.

The need for pharmacological management is underscored by the potential for adverse outcomes if these complications are not promptly addressed. Complications such as wound infections, thromboembolic events, and skin necrosis require timely intervention to prevent further deterioration and ensure optimal patient outcomes. The escalating trend of cosmetic surgery tourism has brought to light unique challenges, including the rapid growth of Mycobacterium infections

and the financial impact on health care systems [1]. This further emphasizes the importance of pharmacological interventions in managing post-cosmetic surgery complications.

Infection Management

Infection management is a critical aspect of pharmacological intervention in the context of post-cosmetic surgery complications. Antibiotics are the cornerstone of first-line treatment for bacterial or fungal infections following cosmetic surgical procedures.

Addressing psychological distress involves thoughtful consideration of pharmacological interventions alongside non-pharmacological approaches for comprehensive patient care.

Practical Guide for Emergency Physicians

A practical guide for physicians necessitates the development of an algorithm for evaluating and managing common post-cosmetic surgery complications. This guide should delineate the appropriate timing for consulting specialists and emphasize the importance of tailored pharmacological interventions to optimize patient outcomes.

Conclusion

“Effective pain management not only enhances patient comfort but also contributes to faster recovery and improved overall outcomes.” The selection of an appropriate antibiotic depends on the type of infection and patient-specific factors, such as the individual’s medical history, allergies, and potential drug interactions. Vigilant monitoring for adverse effects and drug interactions is crucial to ensure the safety and efficacy of antibiotic therapy in this patient population.

Bleeding Control

The management of bleeding in the context of post-cosmetic surgery complications involves the utilization of anticoagulants and hemostatic agents [2] . In cases of life-threatening bleeding, the reversal of anticoagulation becomes a critical consideration, particularly in patients on multiple medications. The challenges posed by the presence of multiple medications further complicate the management of bleeding. This necessitates a comprehensive understanding of the interactions and potential adverse effects associated with these pharmacological interventions.

Inflammation and Pain Relief

The management of inflammation and pain involves the use of corticosteroids, NSAIDs, and analgesics. Balancing the potential risks of adverse effects and the risk of addiction associated with these pharmacological interventions is crucial. Drawing insights from Bicket et al., the importance of adequate pain management post-cosmetic surgery is underscored, emphasizing the role of opioid medications in controlling post-operative pain. Effective pain management not only enhances patient comfort but also contributes to faster recovery and improved overall outcomes.

Psychological Distress

Understanding psychological factors, as investigated by Chen et al. regarding social media use, self-esteem, and cosmetic surgery, is crucial. This research sheds light on the potential influence of social media on body image perceptions and cosmetic surgery decisions.

The management of post-cosmetic surgery complications requires a multifaceted approach, encompassing pharmacological interventions and comprehensive patient care. Continued research efforts are essential to advance the understanding and management of these complications, ultimately improving the quality of care provided by emergency physicians.

Primary Source Material

1. Medical Tourism in Aesthetic Breast Surgery: A Systematic Review 2. Control of bleeding in surgical procedures: critical appraisal of HEMOPATCH (Sealing Hemostat) 3. Prescription opioid analgesics are commonly unused after surgery 4. Complications of Cosmetic Surgery Tourism: Case Series and Cost Analysis 5. Complications of laser dermatologic surgery” Lasers in surgery and medicine (2006) 6. Association between the use of social media and photograph editing applications, self-esteem, and cosmetic surgery acceptance 7. Plastic Surgery Complications: A Review for Emergency Clinicians

ABOUT THE AUTHOR Kingsley Essel Arthur is a pharmacist and graduate student at Kwame Nkrumah University of Science and Technology, Ghana, specializing in pharmacology and advanced toxicology. His focus is on postcosmetic surgery complications an fuels his passion for emergency medicine. Kingsley is an active member of the SAEM Academic Emergency Medicine Pharmacists Interest Group. Contact him at @kofiessel_35, kofiessel35@gmail.com

PHARMACOLOGY

Guardians of Patient Safety: The Dynamic Role of the Emergency Medicine Pharmacist SAEM PULSE | JANUARY-FEBRUARY 2024

By Morgan Kimball, PharmD; Megan Dibbern, PharmD; Luke A. Neff, PharmD; and Ellen Robinson, PharmD

Have you ever wondered about the multifaceted role of pharmacists in emergency medicine? Contrary to the perception of merely being pill dispensers, we function as guardians of patient safety, actively preventing unnecessary medication use while prioritizing evidence-based, patientcentered care. In the high-stakes environment of the emergency department (ED), we stand as a vital force against medication errors, meticulously verifying prescriptions even in high-pressure scenarios. Operating within various acute environments, emergency medicine pharmacists (EMPs) seamlessly

collaborate with health care teams, providing real-time bedside assistance to providers and nurses. Our expertise extends beyond order verification and medication dispensing; we customize medication dosages in critical situations and promptly make patientspecific recommendations to optimize outcomes. Our evolving role keeps us at the forefront of cutting-edge therapies and enables other specialties to focus on their unique areas of expertise. During times of drug scarcity, we navigate available alternatives, act as stewards in antimicrobial usage, and serve as a compendium of pharmacokinetics and

pharmacodynamics. Some hospitals are equipped to provide around-theclock support, while others may have less coverage. Nonetheless, your EMP strives to seamlessly integrate into interdisciplinary teams to offer comprehensive assistance at any hour of the day. In our shop, we actively engage in bedside patient care and much more. Specific details of the contributions made by EMPs are outlined below (Morgan et al):

Stroke Alerts

• Reconcile home medications for anticoagulation through interviews with patients, families, or caregivers.

Credit: Mac Whaley, Whaley photography

Figure 1 - Clinical pharmacist workflow in the emergency department.

• Offer tailored recommendations on antihypertensive medications and assist in their safe titration to achieve therapeutic goals. • Provide expert guidance on dosing, preparation, and safe administration of thrombolytics at patient's bedside.

Cardiac Arrest

Heart Alerts

• Offer informed recommendations on P2Y12 agents, aspirin, statins, and heparin for optimal patient care.

Obstetric Emergencies

• Ensure medication availability for imminent delivery and immediate access to postpartum hemorrhage and other obstetric emergency medications.

High-Acuity Bedside Resuscitation

• Offer guidance on preferred induction and paralytic agents based on patientspecific factors for rapid sequence intubations. • Assist in dosing and preparing RSI and other peri-intubation medications. • Ensure immediate access to postintubation sedation.

• Provide medication recommendations targeting reversible causes of cardiac arrest. • Appropriately prepare and administer Advanced Cardiovascular Life Support (ACLS) and Pediatric Advanced Life Support (PALS) medications.

Trauma

• Recommend and prepare necessary fluids, antibiotics, vaccinations, reversal agents, hyperosmolar therapies, and vasopressor support. • Facilitate appropriate Advanced Trauma Life Support (ATLS) treatment recommendations. These roles underscore the pharmacist's crucial involvement in the emergency department, though they are not exhaustive. Our position remains dynamic and adaptive. As medicine advances, we continuously evolve to match its pace. Always remember, if you seek assistance in improving patient outcomes, your dedicated and enthusiastic EMP is either at the bedside or just a phone call away.

“Unlike the perception of merely being pill dispensers, we function as guardians of patient safety, actively preventing unnecessary medication use while prioritizing evidencebased, patient-centered care.”

ABOUT THE AUTHORS Dr. Kimball is an emergency medicine pharmacy resident at University Health in San Antonio, TX. She is a member of the academic emergency medicine pharmacists interest group and earned her Doctor of Pharmacy at the University of Iowa. Contact: morgan.kimball@uhtx.com Dr. Dibbern is a secondyear pharmacy resident in emergency medicine at University Health in San Antonio, TX. She is a member of the academic emergency medicine pharmacists interest group and completed her Doctor of Pharmacy at the University of Texas at Austin. Contact:. megan.dibbern@uhtx.com r. Neff is a board-certified D emergency medicine pharmacist at University Health in San Antonio, TX. He completed his Doctor of Pharmacy at the University of New Mexico College of Pharmacy. Contact: luke.neff@uhtx.com Dr. Robinson is a board-certified emergency medicine pharmacist at University Health in San Antonio, TX. She earned her Doctor of Pharmacy at the University of the Incarnate Word Feik School of Pharmacy and serves as the emergency medicine residency program director. Contact: ellen.robinson@uhtx.com

RESIDENTS & MEDICAL STUDENTS

Enhancing Engagement and Team Dynamics in EM Residency With "Thinking Rounds" SAEM PULSE | JANUARY-FEBRUARY 2024

By Andrew Yocum, MD, on behalf of the SAEM-RAMS Pulse Sub-Committee

In the fast-paced world of emergency medicine, effective team communication is vital. Emergency medicine residency program administrators, responsible for overseeing the training and development of future physicians, face unique challenges in fostering effective team dynamics and engagement. "Thinking rounds," an innovative approach to meetings, has emerged as a promising solution to these challenges.

The Concept of Thinking Rounds

Thinking rounds are structured yet dynamic meetings designed to foster active participation and collaborative problem-solving. Drawing inspiration from the interactive and fast-paced

environment of emergency medicine, these rounds are characterized by their emphasis on open dialogue, diverse input, and collective decision-making. The aim is to create a more inclusive and engaging meeting experience wherein every team member, from administrators to residents, possesses a voice.

Example of a Thinking Round in Action Imagine a scenario in emergency medicine residency administration where the objective is to tackle resident burnout. In a thinking round, every participant, including faculty, administrators, and residents, is allocated two minutes to present their perspectives and solutions. An

administrator might advocate for the enhancement of mentorship programs, a faculty member might propose adjustments in shift scheduling, and a resident may highlight the importance of mental health support. This approach ensures a diverse range of insights and solutions, gathered in a brief, focused session.

Improving Meeting Engagement

Conventional meetings frequently grapple with uneven participation, where a handful of dominant voices typically steer the conversation. Thinking rounds counter this issue by organizing contributions in a way that ensures equal participation. The implementation

“Thinking rounds are structured, yet dynamic, meetings designed to encourage active participation and collaborative problem-solving.” of the two-minute rule, for example, promotes succinct and focused sharing of ideas, allowing more voices to be heard within a limited timeframe. This not only democratizes the meeting but also cultivates a sense of equity and respect among participants.

2. Clear Objectives: Set specific goals for each thinking round to maintain focus and ensure productive outcomes.

Fostering Team Dynamics

4. Time Management: Adhere strictly to the time limit for each speaker to keep discussions concise and on track.

Emergency medicine thrives on teamwork, and thinking rounds emulate this ethos in the administrative setting. By assigning value to contributions based on content rather than hierarchy, these rounds assist in leveling traditional power structures. This egalitarian approach is crucial in cultivating mutual respect and understanding within the team, ultimately fostering a more cohesive and collaborative work environment.

Practical Implementation of Thinking Rounds

1. Set the stage: Thinking rounds may feel foreign to those unfamiliar with the concept. Explain the process and its rationale before initiating.

3. Diverse Participation: Include members from all levels of the residency program to capture a broad range of perspectives.

5. Facilitation: Designate a facilitator to guide the discussion, manage time, and ensure that every member has an opportunity to speak. 6. Actionable Follow-up: End each round with a summary of key points and a plan for implementing the proposed solutions. Thinking rounds provide an innovative approach to improving meeting engagement and team dynamics in emergency medicine residency administration. By promoting equal participation, cultivating respect, and

encouraging diverse perspectives, these rounds not only optimize meeting efficiency but also elevate the overall functionality of the team. As emergency medicine continues to evolve, the adoption of forward-thinking strategies such as thinking rounds becomes essential for effectively navigating the complexities of residency administration and ultimately improving the quality of patient care.

ABOUT THE AUTHOR Dr. Yocum, an attending emergency physician and associate program director at Cleveland Clinic Akron General since 2016, is also an assistant professor at Northeast Ohio Medical University, his alma mater. Additionally, he serves as the medical director for the Copley Fire Department and as a SWAT physician with the Akron Police Department.

RESEARCH

Noninferiority Testing

Superiority Testing

Beyond Superiority: The Rise of Noninferiority Research

SAEM PULSE | JANUARY-FEBRUARY 2024

By Uyen Tu Nguyen and Ed Durant, MD, on behalf of the SAEM Research Committee

Researchers utilize a variety of study designs to investigate the efficacy and safety of innovative interventions. One tool in the researcher’s toolkit that deviates from the customary approach of superiority trials is the noninferiority design. This method allows clinicians to refine existing standards while also exploring novel therapies that offer additional advantages, such as fewer side effects, reduced costs, improved recovery time, and increased accessibility. Superiority testing has traditionally been the standard design for evaluating new interventions. By comparing treatment against control groups, researchers can test if group outcomes are statistically different from each other in either treatment arms. The null

“The noninferiority design empowers clinicians to refine existing benchmarks while also exploring novel therapies that offer additional advantages, such as fewer side effects, reduced costs, improved recovery time, and increased accessibility.” hypothesis in this design assumes no statistically significant difference, so rejection of the null hypothesis in testing indicates a difference between two interventions [1-3]. It is important to note, however, that failing to reject the null hypothesis (i.e., finding no statistically

significant difference between two interventions) does not indicate that two treatments are equivalent. This is where noninferiority research reverses the traditional framework. Because the null hypothesis of a

“By comparing treatment with control groups, researchers can determine whether group outcomes differ statistically in either treatment arm. The rejection of the null hypothesis in testing suggests a disparity between the two interventions.” noninferiority design instead assumes that there is a statistically significant difference between two treatment arms, a rejection of this hypothesis indicates that the experimental therapy is statistically not worse than the standard (within a margin determined a priori [1-3]. A finding of noninferiority provides validity evidence for the clinical effectiveness of new therapeutics, increasing clinician confidence in offering patients interventions that may be more affordable, safer, and convenient without unacceptably compromising clinical benefits. The choice of noninferiority testing can be informed by several factors, including when a placebo treatment is unethical, when there is an already-effective standard treatment, and when an experimental treatment has the potential to have similar outcomes in addition to other advantages such as affordability or accessibility [6]. For example, in the case of anticoagulation for stroke prevention in atrial fibrillation, it is no longer ethical to test new treatments against a placebo when effective therapies such as warfarin already exist. Although warfarin may have many clinical benefits, the need for regular monitoring threatens medication adherence in populations with restricted healthcare access. In this case, a noninferiority design would be appropriate when evaluating novel anticoagulants that

are expected to have similar efficacy to warfarin while also providing additional benefits, such as eliminating the need for frequent blood testing. Successful noninferiority research requires four main components: an established comparator, predetermined noninferiority margin, adequate sample size, and appropriate statistical analysis [3,4] Identifying an appropriate comparator is crucial. This control must be a wellestablished treatment with consistently demonstrated efficacy in previous studies, while also reflecting characteristics of the patient population under current investigation. The choice of a noninferiority margin also involves careful consideration. The noninferiority margin indicates a clinically meaningful difference in outcomes between the new treatment and active control [5]. This margin can be represented by an absolute difference, risk ratio, or percentage of effect from the standard treatment. Selection of the noninferiority margin is also directly linked to the determination of the required sample size. Like superiority testing, the sample size calculation involves considerations related to statistical power, variability in outcome, and significance level. It is important to note that sample size determination is specific to the statistical method employed. The most widely used statistical analysis is the twosided test (TOST) procedure, although

“It is crucial to note that the failure to reject the null hypothesis (i.e., finding no statistically significant difference between two interventions) does not imply equivalence between the two treatments.”

other common approaches such as t-test, chi-square test, or survival analysis have been utilized [3]. Despite being an effective research tool, noninferiority testing is often poorly understood and inaccurately designed. When applied appropriately, noninferiority studies can support new therapeutics with additional benefits while also preserving the acceptable margin of desirable clinical outcomes established by the standard treatment. It is important to consider the challenges of noninferiority trials. To avoid false claims of noninferiority, the research design must justify its choice of margin, established comparator, sample size, and statistical analysis.

Primary Source Material 1. Noninferiority and equivalence designs: issues and implications for mental health research 2. Interpreting the results of noninferiority trials—a review 3. Challenges in the Design and Interpretation of Noninferiority Trials 4. Understanding equivalence and noninferiority testing 5. Defining the noninferiority margin and analysing noninferiority: An overview 6. Understanding noninferiority trials

ABOUT THE AUTHORS Uyen Tu Nguyen is a third-year medical student at University of California, Davis, School of Medicine

Dr. Durant is an emergency physician at Kaiser Permanente Modesto Medical Center in California. He is the research director for the emergency medicine residency program and the local research chair for the Kaiser Central Valley service area.

SAEM PULSE | JANUARY-FEBRUARY 2024

SEX & GENDER

Bridging the Sex- and GenderBased Educational Divide: Insights and Lessons From an Innovative Program By Jennica Siddle, MD, MPH, on behalf of the SAEM Sex & Gender Interest Group The medical student enrolled in our Sex and Gender in Emergency Medicine (SGEM) elective course asked, “Am I not able to examine that patient, considering they are a man with abdominal pain?” As most emergency medicine (EM) professionals know, women experiencing heart attacks may exhibit symptoms that deviate from the “typical,” and adult women are more prone to urinary tract infections than men, among other trends. In

this course, the medical student is assigned the responsibility of becoming acquainted with these health trends specific to women. However, what additional components does this course cover? My response was, “Of course, you can examine male patients, and and you won’t believe what you’re about to discover!” I understood that the sex and/or gender of each patient could offer insights into an individualized

approach and contribute to a public health-relevant perspective in the case discussion, patient care, and the comprehension of their disease or pathology. Shortly after examining the patient and conducting a thorough PubMed search, the student returned, eager to share their findings. Interestingly, the patient’s male sex increased the likelihood of diverticulitis. It turns out there are several proposed

“The SGEM course emphasizes that incorporating even the most basic demographics of sex or gender can lead to nuanced discussions about disease presentation, diagnostic workup, treatment, and outcomes.” pathophysiological pathways suggesting that androgens provide less protection to the male gastrointestinal tract. Other sex and gender-specific examples our students discovered during the elective were: • Increased risk of sepsis in males related to androgens • Increased seizures in males • Increased risk of death and prolonged intubation in COVID-19 in males • Higher rapid use of antibiotics in sepsis for males • Increased risk of UTI in male infants thought to be androgen related • Increased risk of allergic reaction in young males, then shifting to higher risk in females after menarche • Less frequent Alzheimer’s dementia in males • Increased risk of psychosis in men smoking cannabis • Less coronary angiography offered for women with chest pain, but higher inhospital mortality, repeat MI, and stroke • The existence of catamenial (menstruation related) seizures in females, and effect of OCPs on seizure meds • Catamenial pneumothorax in patients with endometriosis! • Higher testing for pulmonary embolism in females but lower use of thrombolysis treatment, an increased risk of RV damage • Increased SVT in females, with better success of electrophysiology mapping and ablation done in the premenstrual phase The purpose of the SGEM course is to “untrain” us, as traditionally trained physicians who often view each patient through the same lens. The course underscores that incorporating even the most basic demographics of sex or gender can lead to nuanced discussions about their disease presentation,

diagnostic workup, treatment, and outcomes, as well as potential side effects from interventions. Historically, scientific and medical education has frequently overlooked fundamental cellular differences (sex) and cultural constructs (gender), tending to default to a proposed common mean — typically male in both sex and gender. As demonstrated by our students’ experiences in the course, a little re-examination and purposeful “turning over the rocks” right in front of your face can reveal a wealth of additional insights. At the University South Carolina School of Medicine Greenville medical campus, we are actively addressing the historical discrepancy in medical education, which has traditionally lacked a sex and genderbased approach to patient care. This initiative leverages the expertise of several in-house scholars and leaders in the field. I, Jennica Siddle, am responsible for teaching the SGEM elective, and I collaborate closely with Dr. Alyson McGregor, our associate dean of faculty and clinical affairs, as well as Dr. Mary Rojek, who serves as the director and founding committee member of the American Medical Women’s Association (AWMA) Sex and Gender Health Collaborative. In our inaugural year of offering the SGEM elective, we are mindful that other institutions have previously incorporated successful, similar sex- and gender-based educational programs. Drawing from our experience, we extend an invitation and encouragement to institutions that have not yet considered a course with this particular focus to explore similar opportunities for their learners. Our elective features instruction on utilizing a dedicated PubMed search tool highlighting the wealth of sex and gender-specific evidence-based research ready to be integrated into our clinical translational knowledge. For additional resources, the Laura W. Bush Institute for Women’s Health website, specifically Sex and Gender

Specific Health.org, offers numerous invaluable learning modules and resources. This includes instructions on using the search tool, which are available under Resources: Literature Search & Database Resources. The 2016 NIH policy on inclusion of sex as a biological variable in research has broadened the scope of research dedicated to sex- and gender-based medicine while simultaneously highlighting existing knowledge gaps. In emergency medicine, we are fortunate to witness the full spectrum of the human condition and provide care to individuals in their unique circumstances. It is now time to align scientific advancements with the realities of clinical, individualized care for patients of all sex and gender presentations. This begins with addressing and bridging the educational gap in SGEM.

ABOUT THE AUTHOR Dr. Siddle is a clinical assistant professor at the University South Carolina School of Medicine Greenville and an emergency medicine physician at PrismaHealth -Upstate.

TOXICOLOGY

Managing Hydroxychloroquine Toxicity: A Crucial Primer for EM Practitioners SAEM PULSE | JANUARY-FEBRUARY 2024

By Kyle Suen, MD on on behalf of the SAEM Toxicology Interest Group

Introduction and Clinical Uses Hydroxychloroquine toxicity is a rare diagnosis that both adult and pediatric emergency department physicians should be aware of and ready to critically manage to prevent morbidity and mortality.

Hydroxychloroquine is an aminoquinoline derivative that currently has the following Food and Drug Administration (FDA) approved clinical indications: 1. For the treatment of uncomplicated malaria due to P. falciparum, P.

malariae, P. ovale, and P. vivax, and for the prophylaxis of malaria in geographic areas where chloroquine resistance is not reported. 2. For the treatment of chronic discoid lupus erythematosus and systemic erythematosus in adults. 3. For the treatment of acute and chronic rheumatoid arthritis in adults The mechanisms by which hydroxychloroquine work as an antimalarial are theorized to be via inhibition of malarial heme polymerization, similar to other

amino-alcohols and aminoquinolines, such as quinine and chloroquine. However, the precise mechanism is unknown. The mechanism by which hydroxychloroquine works as a disease modifying anti-rheumatic drug is also unclear.

History: How Did We Get Here? The first effective treatment for malaria was quinine, an amino-alcohol, derived from the bark of the cinchona tree. Quinine, despite its effectiveness, exhibited numerous adverse effects in therapeutic use, prompting pharmaceutical advancements to

“Hydroxychloroquine toxicity, though rare, demands heightened awareness from emergency clinicians due to its potential for significant morbidity and mortality.” explore safer alternatives. Among these alternatives are the aminoquinolines chloroquine and hydroxychloroquine. Although chloroquine is considered to be roughly three times more toxic than hydroxychloroquine, both substances have the potential to cause serious clinical effects due to their narrow toxicto-therapeutic windows.

and may predispose individuals to torsade de pointes (TdP). 3. Profound hypokalemia may manifest, believed to stem from extracellular shifts of potassium into the intracellular space rather than an actual potassium deficit. The severity of hypokalemia serves as an indicator of toxicity. 4. Inhibition of the ATP-dependent potassium efflux pump on beta-islet cells: This inhibition triggers insulin release and has the potential to induce hypoglycemia. 5. Alpha-1 adrenergic receptor blockade: Inhibition of vascular smooth muscle contraction in the peripheral vasculature can lead to vasodilation, potentially exacerbating cardiovascular effects.

Figure 1: Chemical structure of chloroquine and hydroxychloroquine, taken from Wikipedia

Human Toxicity

While the anti-malarial and anti-rheumatic mechanisms of hydroxychloroquine remain unclear, the pathways through which it causes human toxicity are well documented. Hydroxychloroquine exhibits many various mechanisms of action, with the following considered to be of paramount clinical significance:

The pronounced impact on cardiac conduction, in conjunction with peripheral vasodilation, has the potential to result in significant myocardial dysfunction, leading to subsequent hypotension, shock, and cardiac collapse. If left unaddressed, there is a risk of developing lethal arrhythmias, further exacerbating cardiac dysfunction and potentially resulting in cardiac and respiratory arrest. Neurological symptoms, such as confusion and altered mental status, may manifest in cases of hydroxychloroquine toxicity. The onset of altered mental status, hypoglycemia, electrolyte imbalances, and cardiovascular collapse is frequently described as sudden and exhibits rapid progression if not promptly recognized and managed.

1. Sodium channel blockade: The inhibition of cardiac sodium channels results in a slower rate of depolarization, as evidenced by a prolonged QRS duration on the EKG. 2. Potassium channel blockade: Inhibition of cardiac potassium channels suppresses the rectifier potassium current, potentially leading to a prolonged QT interval. This elongation increases the relative refractory period

Increasing Hydroxychloroquine Use and Risk for Overdose and Toxicity

Hydroxychloroquine toxicity is an infrequent diagnosis, with fewer than 50 cases reported in the literature. However, there has been a notable surge in hydroxychloroquine usage since the outset of 2020. In the early stages of the COVID-19 pandemic, initial reports touted the efficacy of hydroxychloroquine (alongside other pharmaceuticals) as a novel treatment for COVID-19 infections. The FDA granted Emergency Use Authorization (EUA) status for hydroxychloroquine and chloroquine as medications for COVID-19 on March 28, 2020, only to revoke its EUA on June 15, 2020 following unsuccessful validation studies. Presently, hydroxychloroquine lacks FDA-approved indications for treating COVID-19 infections. Despite evidence contradicting its efficacy in COVID-19 treatment, the increased utilization of hydroxychloroquine has resulted in elevated exposures and a rise in toxicity cases. From January 1, 2020, to April 26, 2020, there were 283 reported exposures to chloroquine and hydroxychloroquine to U.S. Poison Control Centers, reflecting a 42% increase compared to the same period the previous year. America’s Poison Centers (formerly the American Association of Poison Control Centers) reported a 93% surge in exposure calls in April 2020 compared to April 2019. Given its narrow toxic-to-therapeutic window and the escalating use and exposures in recent years, it is crucial for adult and pediatric emergency department clinicians to recognize and comprehend how to manage patients experiencing hydroxychloroquine overdose and toxicity.

Management Strategies Figure 2: EKG of a 16 yo F who ingested 24h hydroxychloroquine in a suicide attempt

It is crucial for any clinician operating in the emergency setting to acknowledge continued on Page 71

SAEM PULSE | JANUARY-FEBRUARY 2024

THERAPEUTIC

DOSING

Activated Charcoal

50-100g PO, NGT/OGT (1 g/kg in pediatric patients)

Dextrose

D50 bolus, d5 or d10 infusions

Sodium Bicarbonate (NaHCO3)

1-2 mEq/kg IV boluses at 3-5m intervals to reverse abnormality or to target serum pH 7.55 Followed by 150 mEq in 1L d5W continuous infusion at 2x maintenance infusion rate

Potassium

KCl infusion, target potassium 4 mEq/L with cautious repletion

Magnesium

Magnesium sulfate 1-2g

Diazepam*

2 mg/kg over 30 minutes, followed by 1-2 mg/kg/day for 2-4 days

Vasopressors

Epinephrine*, norepinephrine, phenylephrine should be titrated to effect, with consideration of institutional maximum doses

Intravenous Lipid Emulsion

1.5 mL/kg lean body mass (~100 mL) bolus over 2-3 minutes, followed by 0.025 mL/kg/min. If benefit seen, can consider additional bolus

Table 1: Dosing regimens for therapeutics used in hydroxychloroquine toxicity *Following a lethal ingestion of chloroquine, those who received early intubation, diazepam and epinephrine infusions were more likely to survive than those who did not (p = 0.0003).

TOXICOLOGY

continued from Page 69 the considerable morbidity and mortality associated with hydroxychloroquine toxicity. Any patient presenting with a reported ingestion should be treated early and aggressively. In cases of intentional hydroxychloroquine ingestion, a medical toxicologist should be consulted. This consultation can be facilitated through a medical toxicology consultation service or the regional poison center. Activated charcoal administration should be considered for those presenting early after ingestion, and to help in gastrointestinal decontamination, unless contraindicated. The consideration of performing gastric lavage or whole bowel irrigation should be discussed on a caseby-case basis with a medical toxicologist. Hypoglycemia can be managed with dextrose-containing fluids. In cases of refractory hypoglycemia, the consideration of octreotide is appropriate. For QRS prolongation resulting from sodium-channel blockade, treatment involves sodium-containing fluids. Sodium bicarbonate is recommended, with a targeted serum pH between 7.45 and 7.55. In situations where sodium bicarbonate is unavailable or contraindicated, hypertonic sodium chloride and sodium acetate can be considered. Prolongation of the QTc interval can be addressed by optimizing electrolytes, including potassium, magnesium, and

calcium. Torsade de pointes (TdP) can be managed with defibrillation.

to controls without the combination. Therefore, early intubation, diazepam, and epinephrine infusions should be considered in cases of moderate to severe hydroxychloroquine toxicity. Intravenous lipid emulsion therapy can be considered for refractory cases and has demonstrated success in several reported case studies. Although there have been associations between lipid emulsion and extracorporeal membrane oxygenation (ECMO) circuit dysfunction, there are reports indicating safe concomitant use of intravenous lipid emulsion therapy and ECMO. In instances of refractory and severe hydroxychloroquine toxicity, the use of cardiac assist devices such as ECMO may be necessary. Effective management often requires collaboration among emergency physicians, critical care physicians, cardiologists, ECMO teams, and medical toxicologists.

Careful and frequent management of hypokalemia is essential. Potassium repletion should be approached cautiously, as initial intracellular shifts may reverse following acute toxicity, leading to potentially life-threatening hyperkalemia. If hyperkalemia occurs, appropriate management is warranted, with a target potassium concentration often set at 4 mEq/L.

While serum concentrations may be measured, they do not contribute to the clinical management of hydroxychloroquine toxicity.

Hypotension, resulting from cardiac dysfunction and peripheral vasodilation, can be effectively managed with intravenous fluids. In cases of refractory hypotension or hemodynamic instability, vasopressors such as norepinephrine and epinephrine are often indicated.

Hydroxychloroquine exposures are on the rise, elevating the risk of overdoses and associated toxicity. Emergency medicine clinicians must exercise vigilance in treating this infrequent but serious diagnosis. Consultation with a medical toxicologist is advisable for cases involving acute intentional ingestions. Implementing aggressive and early management strategies, drawing from insights gleaned from historical chloroquine toxicity studies, may prove effective in enhancing outcomes and reducing morbidity and mortality.

Diazepam is recommended for the management of cardiac dysrhythmias and hemodynamic instability. Animal studies conducted in the 1980s yielded promising results, demonstrating that diazepam improved hemodynamic conditions in cases of acute chloroquine poisoning. This improvement was evidenced by a decrease in QRS duration and increased excretion of chloroquine. Subsequent prospective human studies confirmed the effectiveness of a combination therapy involving early mechanical ventilation, diazepam administration, and epinephrine for patients experiencing acute ingestion of a lethal dose of chloroquine. This combination therapy was shown to be effective in preventing morbidity and mortality when compared

Renal replacement therapy, such as hemodialysis, is not recommended for hydroxychloroquine toxicity due to unfavorable pharmacokinetic and toxicokinetic properties. (see Table 1)

Conclusion

ABOUT THE AUTHOR Dr. Suen is an assistant professor of emergency medicine in the Henry JN Taub Department of Emergency Medicine at the Baylor College of Medicine. He is also a practicing medical toxicologist and associate director of the medical toxicology service at Ben Taub Hospital and Texas Children’s Hospital.

VIRTUAL ADVANCES IN EM

SAEM PULSE | JANUARY-FEBRUARY 2024

Data-Driven Innovations in Emergency Care: Harnessing AI for Improved Patient Outcomes

By Norawit Kijpaisalratana, MD; Suhanee Mitragotri; Abdel Badih el Ariss, MD; and Shuhan He, MD, on behalf of the SAEM Virtual Presence Commitee In recent years, the health care sector has encountered escalating challenges, including a rising burden of illness, epidemiological events, and an increased demand for health services. Particularly amid the ongoing pandemic, it has become apparent that numerous unmet needs persist within health care departments, notably within the emergency department (ED), which is typically the initial point of contact for patients upon hospital arrival. Emergency departments (EDs) across the United States grapple with issues

such as service overcrowding, extended waiting periods, and constrained or fatigued staff. Even before the pandemic, when EDs operated under normal conditions, these challenges were prevalent, suggesting that they were not solely attributable to the pandemic. Ultimately, these issues have a substantial impact on patients, resulting in elevated mortality rates, complication rates, instances of patients leaving before receiving care, prolonged time to treatment, and an overall decline in patient satisfaction.

Given these challenges, novel approaches increasingly explore the potential of data analytics and informatics to streamline workflow in EDs. By employing advanced decision-support tools rooted in predictive analytics, EDs gain critical insights insights for optimizing resource allocation. Decision tools with predictive analytics offer valuable guidance on the most effective utilization of available ED resources. This approach aims to curtail wasteful spending and excess resource expenditure, ensuring the delivery of

“AI's potential to streamline emergency care is evident in its ability to predict patient outcomes, optimize resource allocation, and enhance diagnostic efficiency.” clinical care with maximum efficiency. Recognizing these persistent challenges, health care professionals are increasingly motivated to leverage the synergies of data analytics and health informatics. This strategic shift is not purely theoretical; rather, it represents a practical, evidence-based method for refining ED workflows. Predictive analytics, a cornerstone of modern decision-support tools, has already begun to provide actionable insights. This enables the judicious use of ED resources, minimizing waste and optimizing the delivery of clinical care. The transformative impact of data is profound, ensuring that decision-making is informed, strategic, and centered on the patient. To illustrate this, this article will examine successful case studies demonstrating how data analytics has revolutionized operations within emergency departments (EDs).

Improving Prehospital Care

Impact Metrics: Dispatch Time, Response Time, Transport Time Several steps precede a patient’s arrival at the ED. Frequently, an ambulance is responsible for transporting an individual from their location to the nearest ED. EDs commonly encounter ambulance “bunching,” a situation where multiple ambulances arrive at the ED simultaneously. Bains et al. introduced the Centralized Ambulance Destination Determination (CAD-D) project, evaluating the effects of involving an active hospital physician and paramedic supervisor in directing ambulance distribution. This initiative resulted in reduced surge rates at some of the busiest hospitals. Artificial intelligence (AI) could play a pivotal role in facilitating the distribution process, operating under the guidance of hospital physicians and paramedic supervisors to ensure even distribution of ambulances across hospitals, thereby averting patient overcrowding. Lam et al. devised a discrete-event simulation model aimed at improving ambulance response times. This model possesses the capability to guide policy

decisions regarding ambulance allocation. Additionally, Blomberg et al. devloped a machine learning model designed to predict instances of out-of-hospital cardiac arrest during emergency calls, addressing the potential oversight of these risks during such communications. The utilization of AI and data analytics holds promise in supporting ambulance operations and enhancing the overall efficiency of prehospital care.

Aiding in Triage Protocol

Impact Metrics: Door to Doctor Time, Time to Antibiotics, Left Without Being Seen Rate The triage process in EDs is frequently characterized by a prolonged and slow workflow, resulting in extended wait times for patients to consult with a specialist. Delshad et al. introduced an AI-based triage system for ED patients, demonstrating decision-making capabilities that were comparable or superior to those of human clinicians. AI has the potential to aid in the triage process, contributing to improved efficiency and accuracy in ED triaging. Chen et al. developed an AI-enabled dynamic risk stratification platform capable of analyzing patient electrocardiography (ECG) and chest X-ray scans to assess their relative risk. Platforms such as these may prove beneficial in EDs by quickly categorizing patients based on their risk levels, facilitating easier prioritization for physicians and medical staff in determining which patients to attend to first. Data analytics and AI not only exhibit potential in improving patient triaging and risk stratification but also hold promise in determining optimal patient allocation to different hospital departments. For instance, Ortiz-Barrios et al. devised a discrete event simulation capable of predicting a patient’s probability of ICU admission following a COVID-19 diagnosis. A tool of this nature could prove valuable in EDs for identifying patients most likely to be admitted to the ICU or another hospital department. This information allows these departments to prepare adequately for bed space and staff requirements.

Enhancing Diagnostic Efficiency

Impact Metrics: Length of Stay, Time to Diagnosis, Diagnosis Accuracy, Time to Treatment Upon arriving in the ED, patients typically undergo a series of diagnostic evaluations, ranging from routine blood tests to more intricate imaging scans. Harnessing machine learning capabilities has the potential to streamline this process. A study by HS Hunter-Zinck has demonstrated the feasibility of utilizing initial information collected at triage to predict the clinical orders a physician might request. This predictive approach has the potential to streamline workflows, with automatic suggestions for clinical orders, potentially reducing patients’ length of stay in the ED. The application of AI in imaging diagnostics has shown promise as a tool to aid clinicians in detecting fractures. A systematic review and meta-analysis indicate that the diagnostic performance of AI is comparable to that of clinicians, with pooled sensitivities and specificities exceeding 90% for both AI and human experts. This suggests that AI could serve as a valuable adjunct in clinical settings, supporting timely and accurate fracture diagnosis. Moreover, AI applications in acute stroke imaging play an increasingly vital role in the swift identification of critical conditions. According to a relevant review, AI has proven instrumental in detecting urgent situations such as large vessel occlusions and intracerebral hemorrhages in CT scans and angiograms. These advancements facilitate the prompt initiation of appropriate medical interventions, which are crucial for reducing the impact of stroke-related morbidity and mortality.

Streamlining Patient Disposition Impact Metrics: Length of Stay, Mortality Rates, Revisit Rates Determining the most appropriate disposition for a patient—whether they

continued on Page 75

SAEM PULSE | JANUARY-FEBRUARY 2024

VIRTUAL ADVANCES IN EM

continued from Page 73

should be admitted, transferred, or discharged—is a pivotal decision point in the emergency room. Effective decisions at this juncture are essential not only for ensuring positive patient outcomes but also for optimizing the utilization of available resources. For example, a study by Falavigna, analyzing patient data in emergency departments, has demonstrated that neural networks can predict the need for hospitalization post-syncope with high sensitivity and specificity, thereby significantly enhancing the appropriateness of medical treatments and hospital efficiency. By scrutinizing patterns and outcomes from prior patient data, these advanced tools can offer predictive insights that guide physicians’ decisions. Moreover, for discharged patients, there exists an opportunity to leverage generative AI to tailor discharge instructions. Alternatively, automated pictographic systems such as Glyph, developed at the University of Utah, can enhance discharge instructions with pictographs. This innovation aims not only to save physicians’ time but also to enhance patients’ short-term retention of their discharge instructions.

Monitoring and Alert

Impact Metrics: In-Hospital Mortality Rates, Morbidity Rates There are instances when patient admission or transfer is not immediately feasible, requiring ongoing treatment in the ED. In such cases, patients may unexpectedly deteriorate, manifesting symptoms like hypotension, altered consciousness, or even cardiac arrest. Utilizing data analytics and machine learning, as exemplified in a study conducted by Samsung Medical Center

PATIENT CARE PROCESS

METRIC

UNITS

Improving Prehospital Care

Dispatch Time Response Time Transport Time

Minutes Minutes Minutes/Hours

Aiding in Triage Protocol

Door to Doctor Time Time to treatment (ATB, thrombolytic, PCI) Left Without Being Seen Rate

Minutes Minutes/Hours Percents

Enhancing Diagnostic Efficiency

Length of Stay Time to Diagnosis Diagnosis Accuracy Time to Treatment

Minutes/Hours Minutes/Hours Percents Minutes/Hours

Streamlining Patient Disposition

Length of Stay Mortality Rate Revisit Rates

Minutes/Hours Percents Percents

Monitoring and Alert

In-hospital Mortality Rates Morbidity Rates

Percents Percents

and Sungkyunkwan University in South Korea, enables the identification of patterns in patients at risk and the potential prediction of latent shock likelihood. Another noteworthy study demonstrates that specific vital sign trajectories, such as fluctuating blood pressure and heart rate, correlate with a higher probability of in-hospital cardiac arrest. This predictive capability, derived from the analysis of extensive datasets from ED visits, allows for the reduction of both morbidity and mortality rates among patients by facilitating early intervention. The integration of AI into clinical practice demands not only models with high predictive accuracy and interventions that deliver tangible benefits, but also a clear understanding and seamless integration with existing protocols to expedite treatment. Equally important is the ethical application of AI, which calls for transparent algorithms, stringent data privacy, and thorough patient communication and consent processes. These elements collectively form the foundation for upholding and enhancing the standard of patient care.

“In the dynamic landscape of healthcare, leveraging data analytics and AI is not just a theoretical shift but a practical, evidencebased approach to refining workflows and improving patient outcomes.”

ABOUT THE AUTHORS Dr. Kijpaisalratana is a research fellow in clinical data science at Mass General Brigham's Emergency Department. With a background in emergency medicine, his work is focused on applying data analytics and health care technology to improve patient care and outcomes in the health care sector. Suhanee Mitragotri is a premedical student at Harvard College, studying neuroscience with a minor in global health and health policy. She has a passion for exploring the intersection of healthcare and data science. You can reach her at suhaneemitragotri@college. harvard.edu or @SuhaneeMi. Dr. Ariss is a research fellow specializing in clinical data science at Mass General Brigham's emergency department. He recently completed his emergency medicine training at the American University of Beirut Medical Center. He now focuses on using AI and machine learning to improve emergency medicine practices. Dr. He is a dual-board certified physician in emergency medicine and clinical informatics. He works at the Laboratory of Computer Science and in the Emergency Medicine Department at Harvard Medical School. His interests lie at the intersection of acute care and computer science, focusing on algorithmic approaches to systems, large actionable data, and Bayesian interpretation.

WELLNESS IN EM

SAEM PULSE | JANUARY-FEBRUARY 2024

Dall-E generated image depicting the emotional and psychological challenges faced by emergency physicians

Resilience in EM: A Trauma-Informed Care Approach for Combating Burnout By Taylor Brown, MD; Kamna Balhara, MD, MA; Vytas Karalius, MD; Al’ai Alvarez, MD; and P. Logan Weygandt, MD, on behalf of the SAEM Wellness Committee Emergency physicians, while professionals in their field, are also individuals with very real and human reactions to the world beyond the hospital walls. Dysfunctional aspects of our health care system, such as staffing shortages, hospital boarding, and heightened workplace violence, indisputably play a role in the nearly

62% of emergency physicians reporting burnout, according to the latest AMA survey. Tumultuous global upheavals, including armed conflict, terrorist attacks, and a surge in domestic hate crimes, along with increasing polarization and isolation, may weigh heavily on both our colleagues and us.

These factors can make an already demanding job even more arduous. The language of trauma and trauma-informed care (TIC) offers a valuable framework for discussing these challenges and presenting potential solutions. The Substance Abuse and Mental Health Services Administration defines trauma as

“Dysfunctional aspects of our health care system, such as staffing shortages, hospital boarding, and heightened workplace violence, indisputably play a role in the nearly 62% of emergency physicians reporting burnout, according to the latest AMA survey.” “[resulting] from an event, series of events, or set of circumstances that is experienced by an individual as physically or emotionally harmful or threatening and that has lasting adverse effects on the individual’s functioning and physical, social, emotional, or spiritual well-being.” Using this definition, it is easy to see how colleagues may experience trauma at work and bring previous traumatic experiences with them. Individuals may exhibit various reactions to potentially traumatic experiences, ranging from numbness and disconnection to hypervigilance and irritability/anger. A crucial step in addressing the burnout crisis is to name these behaviors as trauma reactions and normalize the range of reactions.

Managing Individual Reactions

If you identify one of these reactions in yourself during a clinical shift, TIC provides a framework for response: Calm, Contain, Care, Cope. In the moment, strive to remain calm and professional. Consider containing a triggering interaction by removing yourself from the situation. The principle of Care prompts us to extend grace with ourselves and acknowledges that all reactions to potentially traumatic events are normal. Reflect on healthy coping strategies you have employed in the past and adapt them to the workplace setting. If physical activity aids in decompression, consider taking a lap around the ED or taking a quick walk outside. Consider incorporating grounding exercises like box breathing and brief mindful meditation into your routine to de-escalate in the moment and sustain a sense of calm. Cultivating self-awareness regarding your reactions allows for proactive management when confronted with trauma. The polyvagal theory explains how traumatic experiences can shift our autonomic state into more primitive survival modes (fight, flight, freeze), influencing emotional

regulation and social behavior. In other words, individuals may react differently when triggered: some may enter a hyperactivated, agitated mode, while others may experience “freeze” states, passively waiting out the traumatic experience or until help arrives. While the 4C’s framework assists us in managing immediate crises, acknowledging the long-term psychological effects of such experiences is crucial. Our bodies and minds absorb these traumas, requiring time and space for processing. Seeking mental health support is essential, not only for navigating the crisis but also for healing and rebuilding resilience over time. Mental health services play a key role in this process. This perspective underscores the fundamental need for comprehensive mental health care, integrating both immediate coping strategies and ongoing support for sustained mental health.

Supporting Colleagues

Peer support is a core principle of TIC. When considering how best to support our colleagues, the 4 Rs framework can prove beneficial: Realize, Recognize, Respond, Resist. The initial step is to realize the significant stress our colleagues may be facing both at home and in the workplace. Subsequently, we can recognize the signs and symptoms of trauma reactions, such as those mentioned above. Responding involves offering statements of validation and empathy (e.g., “I also feel frustrated and overwhelmed when we are shortstaffed”). Finally, we can collaborate with colleagues to resist re-traumatization in the future.

Advocating for Institutional Support

While the previously outlined approaches can aid in navigating the crisis, but systematic change requires systemic solutions. Some individuals may fin healing and a decrease in burnout by actively engaging in advocacy at an

institutional and policy level. Consider joining wellness, equity, and inclusion committees and task forces within your home department or institution. SAEM provides opportunities through academies such as ADIEM, committees like the Equity and Inclusion Committee, and the Wellness Committee, as well as interest groups. Additionally, SAEM supports initiatives through both small and large grants.

ABOUT THE AUTHORS Dr. Brown is chief resident of Emergency Medicine at Beth Israel Deaconess Medical Center.

Dr. Balhara is an associate professor and associate residency program director at Johns Hopkins Emergency Medicine.

Dr. Karalius is a Medical Education fellow at Stanford University Emergency Medicine.

Dr. Alvarez is a clinical associate professor and director of wellbeing at Stanford University Emergency Medicine. He is chair of the SAEM Wellness Committee. Dr. Weygandt is an assistant professor and associate residency program director at Johns Hopkins Emergency Medicine.

WILDERNESS MEDICINE

SAEM PULSE | JANUARY-FEBRUARY 2024

Rhododendron. Credit: Kevin Watkins

Navigating Toxic Flora Part 2: Na Channel Openers By Kevin Watkins, MD, on behalf of the SAEM Wilderness Medicine Interest Group This article extends the discourse on cardiotoxic plants, building upon the previous installment in the NovemberDecember issue of SAEM Pulse that provided an overview of cardiac glycosides. In brief, cardiac glycosides are present in numerous plants and animals, inducing digoxin-like toxicity. The second category of cardiotoxic plants comprises sodium channel openers. This group encompasses

toxins such as aconitines, veratrum alkaloids, and grayanotoxins, which bind to open voltage-gated sodium channels, maintaining their openness. This ultimately leads to conduction block through prolonged depolarization. Toxicity typically initiates as gastrointestinal (GI) irritation, followed by neurotoxic and cardiotoxic effects. Neurotoxicity manifestations include visual impairment, vertigo, ataxia,

paresthesias, weakness, paralysis, seizures, and coma. Common findings encompass prolonged QTc, heightened ventricular automaticity, bradycardia, and hypotension. Bidirectional ventricular tachycardia may also manifest. For patients affected by sodium channel opener toxicity, supportive care is the mainstay, as no specific antidotes

“Supportive care remains the cornerstone in managing sodium channel opener toxicity, with no specific antidotes available. Atropine, vasopressors, and antiarrhythmics play crucial roles in addressing bradycardia, shock, and severe toxicity.” Monkshood. Credit: Bernd Haynold are available. Atropine may be required for bradycardia, and vasopressors may be necessary for shock. Magnesium can be beneficial for suppressing afterdepolarizations, while antiarrhythmics are frequently indicated for severe toxicity. Although attempted, cardioversion often proves unsuccessful for arrhythmias. In severe cases, successful use of cardiopulmonary bypass has been documented. Aconitine-containing plants, including monkshood (Aconite napellus), wolfsbane (A. vulparia), Chinese aconite (A. carmichaelii), A. kusnezoffii, and larkspurs (Delphinium species), proliferate in mountainous meadows throughout the United States. These plants, integral to traditional Chinese medicine, have been associated with significant toxicities. Diterpenoid alkaloids aconitine, mesaconitine, and hypaconitine, concentrated primarily in the roots, are highly toxic, with approximately one gram of the plant proving fatal. Symptoms emerge rapidly, and death may ensue within hours. Ventricular arrhythmias are the predominant cause of mortality, posing challenges in treatment; preferred agents include flecainide and amiodarone. Veratrum alkaloids are chiefly found in the Veratrum and Zigadenus genera within the lily family. False hellebores (V. viride), typically present in swampy areas in the eastern U.S., are commonly confused with ramps. White hellebores (V. album) are prevalent in Alaskan meadows. Death camas and mountain camas (Zigadenus spp.), distributed across the U.S., may be mistaken for wild onion despite lacking onion-like odors. These plants often induce increased vagal tone, resulting in bradycardia and hypotension, responsive to atropine and fluids.

Grayanotoxins are found in plants of the Rhododendron genus native to temperate regions and primarily include rhododendrons, azaleas, and mountain laurels. Toxic ingestions typically arise from honey produced from the pollen, often referred to as “mad honey.” Most cases reported originate from the eastern Black Sea region of Turkey, where it is intentionally produced and marketed as an alternative medicine. Some individuals may deliberately ingest it for recreational purposes. Merely one spoonful (15 grams) can induce illness, though most exposures result in minimal harm. Presentations often resemble those associated with veratrum alkaloids.

Larkspur. Credit: Jane Richardson

In conclusion, sodium channel openers comprise diverse groups, commonly instigating GI effects followed by neurotoxic and cardiotoxic consequences. Treatment often centers on robust supportive care, given that many cases are not severe, although managing severe cardiotoxicity can pose challenges.

ABOUT THE AUTHOR Dr. Watkins is an assistant professor of emergency medicine at Northeast Ohio Medical University and core faculty at the Cleveland Clinic Akron emergency medicine residency program, where he serves as division head of wilderness medicine. He enjoys teaching with the track and elective as well as the local Wilderness Life Support for the Medical Professional (WLS:MP) program and Cuyahoga Valley Wilderness Medicine Conference. He is a member of the SAEM Wilderness Medicine Interest Group. @kwat2122

Veratrum viride. Credit: Simon Barrette

Death camas. Credit: Walter Siegmund

Transformative Giving Leads to 2024 Funding Opportunities that Encourage More Research and Engage Aspiring Researchers Each year, the SAEMF plays a pivotal role in making a career-defining impact on aspiring researchers and fostering the next generation of emergency medicine leaders. Last year, we invested a record-breaking $970,261 in funding for the 2024-25 grant cycle to champion transformative advancements in our field and to empower promising researchers, creating a ripple effect that extends far and wide. SAEMF donors play an instrumental role in opening doors, igniting passion, and shaping the trajectory of emergency medicine by making it possible for grant programs like these to be offered. Take a moment to read about our new donor-initiated grant programs in 2024. Specific details and eligibility criteria will be announced in March 2024. If you would like to set up a donor-initiated funding opportunity through SAEMF, contact Julie Wolfe at jwolfe@saem.org. See saemfoundation.org for a complete view of SAEMF’s 2024 funding opportunities portfolio.

2024 SAEMF Geriatric Emergency Medicine Research Catalyst Grant Funding: $10,000 Deadline: Thursday, August 1, 2024 by 5 p.m. CT REQUEST FOR APPLICATIONS Application portal opens May 1, 2024 SAEMF is grateful to Michelle Blanda, MD, longtime SAEM member and SAEMF donor, for her visionary gift that has made it possible to offer this grant in 2023 and 2024. This grant will: • Fund the work of one early career investigator with a project focused on GEM • Address research questions leading to improved emergency care and quality of life of older patients

• Allow for preliminary data collection, analysis, or collection of pilot data that will further support greater research endeavors • Complement the GEMSSTAR matching funds program by providing seed funding for applicants who desire to eventually apply to the NIA’s program It is never too early to start planning! Apply beginning May 1, 2024 on saemfoundation.org

The Ali and Danielle Raja RAMS Medical Student Research Grant Funding: $2,500 grant award and $1,905 scholarship Deadline: Thursday, August 1, 2024 by 5 p.m. CT Check saemfoundation.org this Spring for the RFA Application portal opens May 1, 2024 SAEMF is grateful to Dr. Ali Raja, SAEM PresidentElect, for his vision and generosity. He and his wife Danielle Raja have generously contributed to establish a distinguished RAMS Medical Student Research Grant annually for a period of 10 years. The grant will encourage diversity in early career researchers. It will fund projects focused on social determinants of health; diversity, equity and inclusion; health equity; or, ED operations. It will provide a "career-shaping" scholarship for the grantee to participate in the Medical Student Ambassador Program for SAEM’s Annual Meeting and will include a one-year SAEM membership for awardee. The Request for Applications (RFA) will be available online in Spring 2024 with an August 1, 2024 deadline. Until then, please contact grants@saem.org for more information.

Medical Students: Looking for Funding for Your Research or Education Projects? The SAEMF plays a pivotal role in making a career-defining impact on aspiring researchers and fostering the next generation of emergency medicine leaders like you. Take time in January to take advantage of one of these excellent career development opportunities.

2024 EMF-SAEMF Medical Student Research Grant Funding: $5,000; up to 4 awards Deadline: Tuesday, January 19, 2024 by 5 p.m. CT APPLY The Emergency Medicine Foundation (EMF) and Society for Academic Emergency Medicine Foundation (SAEMF) collaborate to provide stipends aimed at inspiring medical students, who represent the future of emergency medicine research and education, to engage in and explore emergency medicine research. Application may be made by either a specific medical student or by an EM residency program wishing to sponsor a medical student research project. Learn more about past grantees here.

2024 Emergency Medicine Interest Group (EMIG) Grant Funding: $500; multiple awards Deadline: Wednesday, January 31, 2024 by 5 p.m. CT APPLY The SAEMF acknowledges the valuable contributions of Emergency Medicine Medical Student Interest Groups (EMIGs) by awarding $500 grants to bolster their educational initiatives. These grants aim to foster the growth of emergency medicine education among medical students, identify innovative teaching methods, and support EMIG educational projects. Proposals should focus on educational activities or projects related to undergraduate education in emergency medicine. You can learn about past EMIG Grantees here.

Donate Today!

SAEMF Impact on Career Development SAEMF donors play an instrumental role in opening doors, igniting passion, and shaping the trajectory of emergency medicine by making it possible for grant programs like these to be offered. Become an Annual Alliance donor today and empower promising researchers, creating a ripple effect that extends far and wide.

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1. Chang AK, Lee S, Le R, Ata A, Harland K, Khan A, McMillan M, Mohr N; Academic Emergency Medicine Grants Committee. Influence of Society for Academic Emergency Medicine Foundation’s Research Training Grant on postaward academic federal funding. Acad Emerg Med. 2022 Jul;29(7):874-878. doi: 10.1111/acem.14456. Epub 2022 Mar 10. PMID: 35108429.

Join the Annual Alliance Today and Make 2024 a Transformative Year for Emergency Medicine (EM) Research! The need for advancements in EM research is pressing, and your support can play a pivotal role in addressing the challenges we face. Currently, there is a notable shortage of emergency medicine-trained physicians focusing on research careers, and the number of NIH-funded investigators at the federal level remains insufficient. Furthermore, emergency medicine receives a disproportionately lower share of NIH grant funding compared to other medical specialties, hindering the progress and growth of this critical field.

Partner with SAEMF to Increase EM Research NIH-Funded Principal Investigators in Departments of Emergency Medicine 125 100

Join the 2024 Annual Alliance Your donation is a meaningful investment not only for the future of EM but in the lives of promising researchers and educators. Generous donations foster the growth of aspiring researchers – like SAEMF Research Training Grant Recipient, Craig Newgard, MD, MPH – enabling career development, and providing essential research training throughout their career journeys.

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The SAEM Foundation (SAEMF) stands at the forefront of efforts to enhance EM research, striving to bridge these gaps and pave the way for groundbreaking discoveries that can save lives. By joining the Annual Alliance, you can contribute to the development of education research as a rigorous field of inquiry, ensuring that emergency medicine receives the attention and resources it deserves. Now, more than ever, your support is crucial. As we usher in the new year, let's commit to making 2024 a transformative year for EM research. Thank you for considering this opportunity to make a difference. Together, we can ensure that EM research receives the attention and resources it needs to thrive.

Professor and serves as the Director for the Center for Policy and Research in Emergency Medicine at Oregon Health & Science University

• SAEMF Grant: SAEM Research Training Grant, 2000 • Subsequent funding: Over $18.5 million as Principal Investigator (PI) from NIH, AHRQ, CDC, HRSA, and multiple foundations, and over $4.2 million in career development awards with mentees as PI • Publications since SAEMF award: 208 Dr. Newgard has been fortunate to have his research integrated to national and international guidelines (e.g., ACLS, National Guideline for the Field Triage of Injured Patients), and to state and national health policy. In 2019, he was elected to the National Academy of Medicine.

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a community of academic emergency medicine leaders who are passionate about improving emergency care. As a member of the Annual Alliance, you will be a part of an esteemed network of leaders in emergency medicine who strive to advance emergency medicine! Donate Now!

Annual Alliance Benefits

Individual Donor Benefits

All Dues Medical Young Resident Mentor Advocate Sustaining Enduring Donors Check Off Student Professional

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Online Donor Listing Donor Ribbon on Community Website Annual Meeting - VIP Ticket to RAMS Party Annual Meeting - Name on Donor Board Annual Meeting - Early Notice of Hotel Registration Annual Meeting - Early Notice of Course Registration Annual Donor Pin Name in SAEM PULSE* Social Media Recognition Annual Meeting Coffee and Networking Annual Meeting VIP Lounge Access Annual Meeting - Name on Slides at Opening Plenary Session Annual Meeting - Photo on Slides at Opening Plenary Session Annual MeetingGuaranteed Room at the Conference Host Hotel Annual Meeting - Limo Transportation Conference Invitation to SAEM Board Reception Named Recognition for Select Grants and Programming

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$3,000 $5,000 $10,000 $10,000+ $1,000 paid over paid over paid over in one 3 years 3 years 2 years year *If donation/pledge is committed by February 1.

Learn more about the impact of your SAEMF donation.

BRIEFS & BULLET POINTS FEATURED NEWS Academy Award Nominations Now Open!

Each year SAEM’s academies present award in recognition of excellence and achievement in their respective fields of interest. For details and qualifications, visit the academy award webpages and nominate yourself or someone you admire for one of these honors. The deadline is February 9, 2024. (Note: to be eligible for an award a nominee must be a member of the presenting academy. Join an academy for free through your SAEM profile!).

CLOSING IN JANUARY Medical Students, Apply by January 11 to Secure a Coveted MSA Slot

Medical students! The SAEM Medical Student Ambassadors Program is an exceptional opportunity to collaborate directly with SAEM leadership in planning and executing the SAEM Annual Meeting. As a member of this key volunteer force, you’ll gain full access to the event, enjoy a waived registration fee, meet with SAEM leaders for academic mentorship, and receive a letter of commendation for your files. Responsibilities include attending research sessions, live-tweeting educational content, and facilitating smooth transitions between lectures. This program offers a unique chance to actively contribute to emergency medicine while building valuable connections. Broaden your experience, make a meaningful impact on the future of medical education, and pick up an impressive addition to your CV! URiM DEI Scholarships are available!

Submit IGNITE!, Innovations, Clinical Images by January 11!

The SAEM24 program committee is currently accepting IGNITE!, Innovations, and Clinical Images submissions for possible presentation at the SAEM Annual Meeting, May 14-17, 2024, in Phoenix, Arizona. Elevate your visibility, earn professional recognition, and propel your career forward by showcasing your work at SAEM24. Don’t let this opportunity pass you by! Questions? Reach out to education@saem.org. Your contributions matter—we’re counting on you!

January 12 Is the Deadline to Apply for the Master Educator Course!

Open to early and mid-career faculty in medical education, the year-long SAEM Master Educator course empowers participants to deepen their understanding of educational theory, refine program design and implementation skills, and enhance effectiveness in diverse teaching environments. Kicking off at the SAEM Annual Meeting in Phoenix, AZ, on May 14-17, 2024, the course includes two in-person workshops, monthly webinars, and the development of educator portfolios. With a focus on post-residency physician members aspiring to lead educational programs or core faculty roles, the course is an opportunity to sharpen teaching skills and explore education science. Learn more and apply by January 12, 2024. Scholarships are available!

eLead Applications Are Due January 20

Open to mid-level faculty members with at least five years post-residency experience, the year-long Emerging Leader Development Program (eLEAD) program, which kicks off at the SAEM Annual Meeting in Phoenix, AZ, May 1417, 2024, offers a meticulously structured curriculum. The program is presented by SAEM Association of Academic Chairs in Emergency Medicine (AACEM) and focuses on cultivating foundational leadership skills, fostering a meaningful career network, and creating pathways to diverse opportunities in the field. Ideal candidates bring mid-level leadership experience. The $1,450 course fee covers tuition and meals for in-person sessions, providing exceptional value for dedicated professionals. Learn more and apply by January 20, 2024.

SAEM24 UPDATES SAEM24 Registration is Open, Secure Early Bird Rates by March 12!

Registration is now open for SAEM24, to be held May 14–17, 2024 at the Sheraton Phoenix Downtown. We can’t wait to welcome you with an expansive lineup of expert educational content, ground-breaking research, cutting edge innovation, energetic events, career development opportunities, and a chance to connect in person with your friends and colleagues! For early bird pricing,

SAEM24 Housing is Now Open! Secure Your Room Block Rate by April 11

The Sheraton Phoenix Downtown is the official host hotel for SAEM24 meetings, educational sessions, and several social events. Book your room by April 11 to receive the special SAEM room block rate of $249. Rates are available on a firstcome, first-served basis. The SAEM24 Host Hotel offers exceptional comfort and service and is located right in the heart of Downtown Phoenix, just steps away from the growing arts and culture scene with plenty of nightlife and entertainment nearby.

Announcing Onsite Childcare at SAEM24: Reserve Your Spot by March 12!

SAEM is pleased to offer onsite childcare/ day camp services through Jovie’s team of professionals to look after your child(ren) (infant through age 12) at SAEM24 so you can enjoy and participate in the annual meeting knowing they are being well cared for. Jovie will provide childcare via an onsite day camp at the SAEM24 host hotel, with age-appropriate arts, crafts, and fun activities for children. Reserve your spot by March 12.

Residency & Fellowship Fair: 3 Options for Elevating Your Program’s Potential

The 2024 SAEM Residency & Fellowship Fair provides a cost-effective recruitment opportunity, reaching hundreds of potential candidates in a single event, reducing the overall cost per candidate reached, streamlining the recruitment process, and saving you valuable time and resources. The fair facilitates interactive discussions, enabling candidates to ask questions and gain a deeper understanding of your program, leading to more informed decisions for them and providing you with a clearer assessment of each candidate’s suitability for the program. Choose from THREE cost effective options: 1) our live event at SAEM24 on Thursday, May 16, 2024, 2) our virtual event, July 22-25, 2024, or 3) opt for both and save! Learn more and register your program today!

It’s Team Signup Season!

Registration for team events is open. Show your team spirit. Pull your Dodgeball, SonoGames®, and SimWars rosters together and sign up today!

SAEM JOURNALS Two Exciting Opportunities for Aspiring Editors in Emergency Medicine! Applications are currently being accepted for resident and fellow editor positions for SAEM’s two peer-reviewed journals, both providing a unique opportunity for mentorship and hands-on experience in peer review, editing, and the journal publishing process. AEM Education and Training (AEM E&T) Fellow Editor-in-Training: Apply by February 17, 2024 Academic Emergency Medicine (AEM) Resident Editor-in-Training: Apply by February 2, 2024

MEMBERSHIP NEWS Renew Your Membership and Update Your Profile!

2023 has been an extraordinary year for SAEM, but we’re just getting started! It’s going to be an amazing 2024 for SAEM and we hope you’ll share in our success by renewing your SAEM membership today. Renewing is easy. Just log into your member account and click the «Pay Dues» button. While you’re there, take a few minutes to update your member profile. New features for membership profiles now allow you to add your pronouns, fellowships, and related demographical information to keep the community and your fellow colleagues in the know! For the most comprehensive guide to SAEM’s member benefits, be sure to check out our updated SAEM Membership Guide!

Educational Offerings Guide Highlights SAEM Resources for Each Phase of Your Career

SAEM provides an extensive range of programs and resources tailored to every stage of your academic emergency medicine career. Explore our diverse range of courses, training programs, virtual and live learning experiences, academy and interest group initiatives, and curated curricula. Our Educational Offerings By Career Level guide simplifies your search, providing a user-friendly, easy-to-navigate overview of the learning opportunities available to you at every phase your professional journey.

SAEM Launches Research Consultation Services SAEM Consultation Services now offers specialized research guidance to academic EM departments in two crucial areas.

• SAEM Research Consult Service — Federal Funding aids academic EM departments in developing sustainable federally funded research programs, offering expert guidance at every stage of the process. We focus on providing comprehensive assistance to NIH-funded Principal Investigators and identifying diverse federal funding sources. • SAEM Research Consultation Service — General supports departments in securing non-federal funding. Our expertise includes designing post-doctoral initiatives, establishing resident-focused scholarship programs,

and integrating scholarly pursuits into faculty development.

SAEM Webinars Put a Wealth of Knowledge Right at Your Fingertips

As a valued SAEM member, enjoy complimentary access to a diverse array of live and recorded webinars covering a spectrum of emergency medicine topics to help you stay abreast of the latest developments in EM. Bookmark the SAEM webinar page to ensure you never miss out on our regularly refreshed lineup. Elevate your learning experience with SAEM webinars — where staying informed is both accessible and enriching.

Start the year off right! Join SAEMF’s Annual Alliance and support more researchers/educators like Dr. Ryan Pedigo as they make a difference in emergency medicine’s future. “This grant was transformative for me. I had pursued multiple different career development programs since graduating (the UCLA Medical Education Fellowship, the Stanford Faculty Development program, etc.), but, I had never had formal training in medical education research. Being allowed protected time to obtain a Master of Health Professions Education degree and focusing on medical education research methods and working with my mentor Dr. Wendy Coates has been a wonderful experience. Since getting this additional training, I feel much more well rounded as a scholarly educator and am going to be able to give back so much more for the rest of my career.” – Ryan Pedigo, MD, MHPE, Associate Residency Program Director, HarborUCLA Medical Center; Assistant Professor of Emergency Medicine, David Geffen School of Medicine at UCLA and SAEMF Education Research Grant Recipient

Did you know…

Your gift now will count towards participation in the Chairs’ Challenge and the Academy, Committee, Interest Group Challenge that take place later this year. Give once and you are done! It’s easy to become a Mentor level donor with an annual monthly gift of just $83. Join now to take advantage of 2024 benefits. It's easy: donate online today or download the pledge form and your gift will help fund future researchers, educators, and leaders. Thanks for considering a gift to fund emergency medicine’s future!

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SAEM REPORTS ACADEMIES

Academy of Administrators in Academic Emergency Medicine FY23 Academic Emergency Medicine Benchmark Surveys Update

The AAAEM Benchmark Committee is actively gathering data for the FY23 academic year as part of the annual benchmark surveys. These surveys play a crucial role in benchmarking the clinical, educational, and research missions of academic emergency medicine departments/divisions. If you have any inquiries or require assistance in submitting your organization’s data, please reach out to Alyssa Tyransky at alyssa.tyransky@osumc.edu. AAAEM will be unveiling certain FY23 data collection results at the AAAEM booth during SAEM24. Feel free to drop by to discover more about the surveys and AAAEM.

Academy of Women in Academic Emergency Medicine AWAEM announces key developments in its ongoing mission to support women in academic emergency medicine. The organization acknowledges the commitment and crucial role of its the executive committee, committee chairs, and active members in achieving its core goals of recruitment, retention, mentorship, and advancement: Margaret Samuels-Kalow, MD, MPhil, MSHP, appointed and empowers three new leaders: Amy Hildreth, MD (microsite), Lexie Mannix, MD, and Chelsea Allen, DO (social media chairs). Tara Overbeeke, MD, and the newsletter committee highlight achievements, wellness tips, and feature committee chairs and emergency departments. Taylor Stavely, MD, vice president of membership, guides wellness committee chairs, Mia Karamatsu, MD, and Wendy Sun, MD, as they share wellness tips, life hacks, and webinar development. Katja Goldflam, MD, the membership chair, supports Alina Tsyrulnik, MD, to drive member engagement. Rachel Shing, MD, leads the Global Health committee, curating applications for the AWAEM/GEMA Travel Award. Corrie Chumpitazi, MD, MS, vice president of corporate development, mentors committee members, Amy Zosel, MD, MSCS, and Nancy Jacobson, MD, who lead the Awards Committee. Jennifer Love, MD, and JoAnn Moser, MD, MS, contribute to the research committee with the AWAEM K club, research consult service, and pilot grant development. Laura Walker, MD, heads the leadership and clinical operations committee. Ynhi Thomas, MD, vice president of education, collaborates on proposals with didactics committee chairs Kathleen Wittels and Lauren Walter, resulting in 14 didactic submissions recommended for AWAEM sponsorship.

Introducing Two Resources to Support Women in Academic EM

AWAEM introduces two resources: the AWAEM Speakers Bureau with nearly 100 experts on EM topics and the AWAEM

Letter Writers Bureau, supporting women’s advancement in academic emergency medicine. The organization invites all interested parties to learn more and get involved.

INTEREST GROUPS Evidence-Based Healthcare and Implementation Call for Submissions: Rakesh Engineer Award

Are you planning to submit an abstract on implementation science for the 2024 SAEM Annual Meeting? The EvidenceBased Healthcare and Implementation Interest Group invites submissions of accepted abstracts focusing on implementation science for consideration for the annual Rakesh Engineer Award. This award pays tribute to the late Dr. Rakesh Engineer, a dedicated and passionate advocate of implementation methodology and bringing science to the bedside. Eligible abstracts should concentrate on a project or study that evaluates the implementation or de-implementation of a process leading to evidence-based improvements in patient care. Submitted abstracts will be evaluated by members of the Evidence-Based Healthcare and Implementation Interest Group, and the top thre e finalists will be judged live at SAEM24. The 2023 Rakesh Engineer Award was presented to Dr. Joshua Jacquet and team from Cleveland Clinic in Akron, OH, for their abstract titled “Large-Scale Implementation of Fascia Iliaca Compartment Blocks in an Emergency Department.” For more information visit here. To nominate yourself or a colleague, scan the QR code on the right or click this link. Submissions close March 31, 2024.

Palliative Medicine Introducing the Palliative Medicine Speakers Bureau SAEM’s Palliative Medicine Interest Group is pleased to introduce the Palliative Medicine Speakers Bureau, a valuable program connecting health care professionals, educators, and organizations with experts in the field of palliative medicine. This resource features a comprehensive database of speakers specializing in a range of topics, including communication skills, symptom management, quality improvement, and systems/ pathways of care. The Palliative Medicine Speakers Bureau provides access to a diverse group of experts with in-depth knowledge and experience in palliative medicine. The database provides detailed information about each speaker, including their credentials, current positions, affiliated institutions, and board certification status in Palliative Medicine. Speakers are available to address various aspects of palliative care, ensuring a broad spectrum of topics to meet your organization’s specific needs. Click here to access the Palliative Medicine Speakers Bureau, your gateway to a wealth of knowledge and expertise.

MEMBERSHIP COMMITTEE SPECIAL REPORT SAEM DEI Member Recruitment/Retention Plan: Ensuring a Diverse Membership Diversity, equity, inclusion, and belonging are essential in emergency medicine because a diverse workforce is better equipped to deliver quality, patient-centered care to more people through improved access to care, enhanced learning environments, increased cultural humility, greater chances for physician–patient concordance, heightened recognition of inequities in care, and increased opportunities for health equity research. (Martin, M., Heron, S., Moreno-Walton, L. and Walker Jones, A. (2016) Diversity and inclusion in Quality Patient Care. Springer) The importance of DEI is echoed in the Joint Statement from Emergency Medicine Organizations on Efforts to Diversify Health Care Professionals in the United States: “Following the recent U.S. Supreme Court decisions on the consideration of an applicant’s racial or ethnic background in the higher education admissions process, our emergency medicine organizations stand together in our efforts to diversify health care professionals, including physicians, in the United States. Additionally, we reaffirm our responsibility to addressing health care disparities and inequities as we deliver exceptional care to all patients who enter our emergency departments. Evidence indicates race and ethnicity concordance are factors recognized by and important to patient outcomes and their access to quality health care. This is particularly important in emergency care, where patient-physician trust must be established quickly and a substantial portion of patients are from underrepresented and marginalized racial/ethnic groups. Further, diversity in the health professions also improves the educational experiences of students, resident physicians, the teaching experiences of faculty, and the overall health of our communities. Our organizations are committed to strengthening the diversity of health professionals, including physicians, and promoting staffing of hospitals and their emergency departments with individuals of diverse race and ethnicity for the health and wellbeing of our patients. If the court’s decisions in Students for Fair Admissions (SFFA) vs Harvard and SFFA vs the University of North Carolina requires changes to current law and practices, we stand ready to work together and with other stakeholders to foster a diverse health professions workforce.” SAEM recognizes that a diverse membership is crucial because it fosters inclusion, drives innovation, encourages learning, promotes better decision-making, and contributes to membership growth. To enhance recruitment and retention of diverse members and leaders, SAEM has implemented a DEI recruitment and retention plan. The following will be implemented as part of that plan:

diverse imagery, authentic stories, and heartfelt testimonials that resonate with a broader audience.

Diverse Leadership Representation Initiative

SAEM will champion diversity within our leadership ranks, recognizing the immense value diverse perspectives bring. By fostering a leadership team that embodies inclusivity, we strengthen our appeal to potential members from varied backgrounds. We will encourage diverse opportunities within SAEM by ensuring that nomination opportunities are communicated across multiple channels including email, social media, and the website.

Empowering Networking

SAEM will promote established dynamic networking opportunities and support groups tailored to underrepresented communities to foster connections, shared experiences, and a profound sense of belonging within our organization. This will include promoting activities within academies, committees, and interest groups, SAEM’s DEI Curriculum and other DEI spaces and resources in recruitment emails, social media, and the onboarding process. Annual Meeting networking opportunities will also be promoted including ADIEM LBGTQ+ trivia, the AGEM dinner, the Sex and Gender Scavenger Hunt, the AWAEM\ADIEM Luncheon, etc.

Widening Our Channels of Communication

As part of our commitment to reaching out to a diverse audience, SAEM will continue to expand and diversify our communication channels ensuring that our materials and messages are disseminated widely and resonate with potential members. Social media will be increasingly leveraged to connect with individuals from diverse backgrounds, maximizing our outreach efforts.

Targeted Engagement with Diverse Institutions

To foster a more diverse membership, SAEM will proactively reach out to institutions that serve diverse populations. By forging strong connections with these organizations, we aim to create mutually beneficial partnerships and encourage a more inclusive representation within our community.

Empowering Collaboration with Diverse Student Organizations

SAEM will actively collaborate with diverse student organizations and their conference attendees to extend our network of potential members.

Evaluation for Ongoing Improvement

SAEM will embrace a culture of continuous improvement, consistently evaluating the effectiveness of our recruitment plan and using feedback from new and existing members to refine and optimize our strategies.

Enhanced Diversity Assessment

By implementing these enhanced outreach strategies, SAEM is confident in our ability to create a more diverse and inclusive membership. Our commitment to broadening our reach aligns with our vision to be the premier organization for developing and supporting academic leaders and shaping the future science, education, and practice of emergency and acute care.

Inclusive Marketing and Outreach Campaign

Submitted on behalf of the SAEM Membership Committee by Ramana Feeser, MD, chair of membership committee; Ava E. Pierce MD, member-at-large, SAEM Board of Directors, and Marquita Norman, MD, MBA, chair of the SAEM Finance Committee and a member of the SAEMF Board of Trustees.

SAEM will enhance diversity assessments by analyzing SAEM’s membership to gain valuable insights into the current diversity representation. One of the initial steps will be to pull demographic data and identify any gaps in opportunities. A marketing campaign will be implemented that showcases SAEM’s commitment to diversity and inclusion by utilizing

ACADEMIC ANNOUNCEMENTS Duke Emergency Medicine Announces Creation of Division of Translational Health Sciences The Duke Department of Emergency Medicine Section of Translational Health Sciences has transitioned to a division. The research-focused division is the first division within the new department. The Division of Translational Health Sciences will be Dr. João Vissoci dedicated to utilizing translational research methods to advance access to and quality of emergency healthcare locally, nationally, and globally. “The division will catalyze the department’s innovative scholarship and accelerate research’s impact on clinical care and patient and population outcomes,” said division chief João Vissoci, PhD.

Dr. Latoshia Henderson Appointed Assistant Director of Quality and Patient Safety for Columbia University Department of EM Latoshia Henderson, MD has been appointed assistant director of quality and patient safety, Columbia University Department of Emergency Medicine. She was previously the assistant medical director at NewYork-Presbyterian Allen Hospital for Columbia University Dr. Latoshia Henderson Department of Emergency Medicine and a faculty leader for the Columbia University Vagelos College of Physicians and Surgeons Emergency Medicine Interest Group.

Dr. Bernard Chang Appointed Associate Dean for Faculty Health and Research Career Development at Columbia University Bernard P. Chang, MD, PhD, has been appointed as the associate dean for faculty health and research career development at Columbia University Vagelos College of Physicians and Surgeons (VP&S). Dr. Chang will serve as the associate director of the Irving Institute for Clinical and Translational Dr. Bernard P. Chang Research. He will partner with the Columbia University Irving Medical Center Well-Being Initiative for an enterprise-wide scientific investigation to improve faculty health and professional well-being. Dr. Chang is the Tushar Shah and Sarah Zion Associate Professor of Emergency Medicine and vice chair for research in the Columbia University Department of Emergency Medicine.

Dr. Brendan Carr Appointed Chief Executive Officer, Mount Sinai Health System Brendan Carr, MD, MA, MS, has been appointed the new chief executive officer of the Mount Sinai Health System. As chief executive officer, Dr. Carr will oversee all critical strategic, operational, and businessbuilding areas of the Health System, including its eight hospitals, the Icahn Dr. Brendan Carr School of Medicine at Mount Sinai, and more than 400 ambulatory locations and physician practices. Dr. Carr is currently a professor in Emergency Medicine at Icahn Mount Sinai and chair of emergency medicine for the Mount Sinai Health System.

Dr. Dylan Cooper Named Chief of the Division of Medical Simulation at Indiana University School of Medicine Dylan Cooper, MD, has been named Chief of the Division of Simulation, Indiana University School of Medicine (IUSM), Department of Emergency Medicine. The Fairbanks SIM center is one of the largest in the country, supporting simulation education for the IU School of Medicine, Dr. Dylan Cooper IU Health, IU School of Nursing, and Allied Health professionals. He currently serves as a professor of clinical emergency and director of simulation education in the IUSM Department of Emergency Medicine. In addition, he developed and currently directs the IUSM simulation elective for fourth-year medical students and Faculty Development in Simulation Course, a regional offering to faculty from all professions. Dr. Cooper has been the recipient of several awards for his contributions to simulation education, including the Trustee Teaching Award and Scholar Educator Award.

Dr. Paul Musey Named Enterprise Clinical Research Operations Medical Director at Indiana University School of Medicine Paul Musey, Jr., MD, MSc, is the new medical director for the Enterprise Clinical Research Operations (ECRO) at Indiana University School of Medicine (IUSM), Department of Emergency Medicine. In his new capacity, Dr. Musey will play a pivotal role in advancing the shared objective of Dr. Paul Musey the IU School of Medicine and IU Health to enhance statewide clinical research and facilitate high-impact clinical trials. His focus will particularly center on bolstering trials related to cardiovascular disease and neurosciences. Dr. Musey currently serves as associate professor of emergency medicine and director of research at IUSM.

Dr. Ali S. Raja Appointed Mooney-Reed Endowed Chair in Emergency Medicine at Harvard

Baylor EM Residency Receives 2024 ACGME Barbara Ross-Lee, DO Diversity, Equity, and Inclusion Award The Baylor College of Medicine, Henry JN Taub Department of Emergency Medicine, Emergency Medicine Residency has been chosen as a recipient of the 2024 ACGME Barbara Ross-Lee, DO Diversity, Equity, and Inclusion Award. The award honors ACGMEaccredited sponsoring institutions and programs, as well as specialty organizations working to diversify the underrepresented physician workforce and create inclusive workplaces that foster humane, civil, and equitable environments. The award will be presented in March during the 2024 ACGME Annual Educational Conference in Orlando, Florida.

Dr. Rahul Sharma Named Barbara and Stephen Friedman Endowed Professor of EM at Weill Cornell Medicine Rahul Sharma, MD, MBA, has been appointed as the inaugural Barbara and Stephen Friedman Professor of Emergency Medicine at Weill Cornell Medicine. He is chair of the Department of Emergency Medicine at Weill Cornell Medicine and emergency physician-in-chief at New York Dr. Rahul Sharma Presbyterian-Weill Cornell Medical Center. Dr. Sharma is also the founder and executive director of the Center for Virtual Care at Weill Cornell Medicine. Holding dual faculty appointments as a professor of emergency medicine and population health sciences, he is a national authority in emergency medicine, healthcare operations, telemedicine, and virtual healthcare. He holds several executive health care leadership roles and serves on national committees and boards of many organizations. He is widely published in peer-reviewed publications and has been a guest speaker at several national and international programs. Dr. Sharma has an established record as a medical educator and is the recipient of two national teaching awards and the founder of several innovative programs.

Ali S. Raja, MD, DBA, MHP is the inaugural holder of the Mooney-Reed endowed chair in the Department of Emergency Medicine at Massachusetts General Hospital. He also serves as deputy chair within the department and holds positions as a professor of emergency medicine Dr. Ali S. Raja and radiology at Harvard Medical School. An author of over 200 publications, his research focuses on improving the appropriateness of resource utilization in emergency medicine. He contributes to healthcare leadership as the president-elect of the Massachusetts Chapter of the American College of Healthcare Executives and as the secretary/treasurer on the SAEM Board of Directors. He also serves on the boards of both Boston MedFlight and Spaulding Rehabilitation Hospital. In addition to these roles, Dr. Raja serves on the boards of Boston MedFlight and Spaulding Rehabilitation Hospital. His extensive background includes serving as a critical care air transport team commander for the US Air Force, a civilian flight physician, a tactical physician for various local, state, and federal agencies, and a physician with MA-1 DMAT.

Dr. Thea James Promoted to Professor at the Boston University School of Medicine Thea James, MD, MPH, MBA was promoted to professor at the Boston University Chobanian & Avedisian School of Medicine. Dr. James currently serves as Vice President of Mission and Associate Chief Medical Officer at Boston Medical Center where she co-directs the Health Dr. Thea James Equity Accelerator. Dr. James has spent her career interrogating the root causes of perpetual low health status among patients in safety net health care systems. Her work has evolved to understand the role that health care systems, health providers, payors, and structural policies play in creating inequities that drive predictable low health status. Dr. James has served on multiple state and national committees, including Attorney General Eric Holder’s Task Force on Children Exposed to Violence, and Boston Mayor Walsh’s Health Inequities Task Force. Her extensive work led to a new discipline, Social Emergency Medicine. Dr. James received the AMA Excellence in Medicine Award in 2018. The American College of Emergency Physicians established the Dr. Thea James Social Emergency Medicine Lifetime Achievement Award in 2020 in recognition of her contributions, and she was named the first recipient. She is a founding member of the Health Alliance for Violence Intervention.

Academic Announcements continued on Page 90

ACADEMIC ANNOUNCEMENTS continued from Page 89

Dr. Ciara Barclay-Buchanan Named Chief Medical Officer, UW Health's University Hospital Ciara Barclay-Buchanan, MD, has been promoted to chief medical officer for UW Health’s University Hospital. BarclayBuchanan will play a pivotal role in steering the hospital’s focus on health equity; clinician well-being; and the pursuit of improved outcomes and lower costs. Her Dr. Ciara Barclay-Buchanan responsibilities will extend to overseeing medical staff administration and graduate medical education. Dr. Barclay-Buchanan is an associate professor in the BerbeeWalsh Department of Emergency Medicine, University of Wisconsin–Madison.

Dr. Jeannette M. Wolfe Appointed to the Joy McCann Professorship for Women in Medicine Jeannette M. Wolfe, MD, professor of emergency medicine, UMass Chan Medical School, has been appointed to the Joy McCann Professorship for Women in Medicine, marking her as the first faculty member from UMass Chan-Baystate to receive an endowed position. The Dr. Jeannette M. Wolfe professorship aims to recognize and reward female physician faculty showcasing leadership in medical education, mentoring, research, patient care, and community service. Dr. Wolfe has held leadership roles in Baystate’s Women in Medicine and Science organization and SAEM’s Academy of Women in Academic Emergency Medicine. Having received the SAEM award for the Advancement of Women in Emergency Medicine in 2020, Dr. Wolfe, in her new role, will initiate sustainable projects to provide essential support and tools for the success of women faculty in medicine.

Dr. Frantz Gibbs Promoted to the Clinical Professor at Boston University School of Medicine Frantz Gibbs, MD, was promoted to the rank of clinical professor at the Boston University Chobanian & Avedisian School of Medicine. Dr. Gibbs is a clinician-educator who recently joined BU Chobanian & Avedisian School of Medicine/Boston Medical Center from Brown University Dr. Frantz Gibbs Warren Alpert Medical School and Lifespan Rhode Island Hospital where he served for 20 years in a variety of roles, including assistant medical director of emergency medicine and physician administrator triage officer of the day for the Lifespan Epicenter Interhospital Transfer System. He was the creator and first director of the Point of Care Ultrasound Program in the Rhode Island

Hospital Emergency Department at. Dr. Gibbs served as president of Rhode Island ACEP and was a recipient of the ACEP National Faculty Teaching Award, and the 40th Anniversary Hero of Emergency Medicine Award. He has served on the SAEM Equity and Inclusion Committee and the Data Metrics Subcommittee.

Dr. Megan Leo Promoted to Clinical Associate Professor at Boston University School of Medicine Megan Leo, MD, was promoted to clinical associate professor at the Boston University Chobanian & Avedisian School of Medicine. Dr. Leo is a clinician-educator who serves as medical director for quality and patient safety for the department of emergency medicine. She was formerly the Dr. Megan Leo director of emergency ultrasound at Boston Medical Center for 10 years where she was responsible for the training and credentialing of attending and resident physicians within the department. Dr. Leo has held several national leadership positions including past president of the Academy of Emergency Ultrasound (AEUS), past secretary of the Society of Clinical Ultrasound Fellowships (SCUF), past chair of the American Institute of Ultrasound in Medicine (AIUM) international ultrasound interest group. She also has experience in international ultrasound education curriculum development and training experience in Rwanda and Kenya.

Dr. Kerry McCabe Promoted to Clinical Associate Professor at Boston University School of Medicine Kerry McCabe, MD, was promoted to clinical associate professor at the Boston University Chobanian & Avedisian School of Medicine. Dr. McCabe is a clinicianeducator who co-created a longitudinal curriculum for emergency medicine interns to address the role of shame and Dr. Kerry McCabe resilience in learning and to cultivate a community of vulnerability, inclusion, and support. She also co-created curricula to improve communication, foster inclusivity, and develop confidence and tools for navigating unexpected difficult conversations. She has spoken nationally on resident attrition, interrater agreement on ACGME milestones assessments, and the role of emotion in the medical educational process. Dr. McCabe has been a faculty sponsor in developing the curriculum for and administering the department’s residency peer support program, as well as the residency’s Justice, Equity, Diversity, and Inclusion Committee. She has served as the department’s vice chair for education since 2019. On a national level. Dr. McCabe

has served on multiple planning committees for the Council of Residency Directors in Emergency Medicine. She currently serves on the SAEM programming committee and the CORD Board of Directors.

Dr. Jordan Spector Promoted to Clinical Associate Professor at Boston University School of Medicine Jordan Spector, MD, was promoted to clinical associate professor at the Boston University Chobanian & Avedisian School of Medicine. Dr. Spector is a nationally recognized leader in emergency medicine education who has dedicated his career to mentoring the next generation of Dr. Jordan Spector emergency medicine physicians. He currently serves as the residency program director for emergency medicine at Boston Medical Center, a role he assumed in 2019 after nearly five years as associate director. The department established the Jordan A. Spector Residency Appreciation Award in his honor for steadfast excellence in mentorship, leadership, and achievement. He has mentored more than 200 residents and medical students over his career. On the national level, Dr. Spector is an active member of the Council of Residency Directors in Emergency Medicine (CORD-EM), fulfilling several roles during his career, including chairing multiple subcommittees. He serves on the Massachusetts ACEP education committee and is an examiner for the American Board of Emergency Medicine oral board certification exam.

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Penn State Health Emergency Medicine About Us: Penn State Health is a multi-hospital health system serving patients and communities across central Pennsylvania. We are the only medical facility in Pennsylvania to be accredited as a Level I pediatric trauma center and Level I adult trauma center. The system includes Penn State Health Milton S. Hershey Medical Center, Penn State Health Children’s Hospital and Penn State Cancer Institute based in Hershey, Pa.; Penn State Health Hampden Medical Center in Enola, Pa.; Penn State Health Holy Spirit Medical Center in Camp Hill, Pa.; Penn State Health Lancaster Medical Center in Lancaster, Pa.; Penn State Health St. Joseph Medical Center in Reading, Pa.; Pennsylvania Psychiatric Institute, a specialty provider of inpatient and outpatient behavioral health services, in Harrisburg, Pa.; and 2,450+ physicians and direct care providers at 225 outpatient practices. Additionally, the system jointly operates various healthcare providers, including Penn State Health Rehabilitation Hospital, Hershey Outpatient Surgery Center and Hershey Endoscopy Center. We foster a collaborative environment rich with diversity, share a passion for patient care, and have a space for those who share our spark of innovative research interests. Our health system is expanding and we have opportunities in both academic hospital as well community hospital settings.

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