July-August 2002

S A E M

NEWSLETTER

Newsletter of the Society for Academic Emergency Medicine

PRESIDENT’S MESSAGE Some Thoughts Regarding Gender Issues in the Mentoring of Future Academicians As academicians in emergency medicine (EM), we must consider the steps we should be taking now to ensure that the next generation of EM academicians are fully prepared to fulfill the scientific, educational, and clinical roles of the Roger J. Lewis, MD, PhD future. One of the most important predictors of academic success, at least as judged by traditional measures (e.g., research productivity, publications, and extramural funding), is the availability of a mentor during the young academician’s critical period of development (e.g., fellowship and the first years as faculty). While a number of insightful authors have discussed a number of important aspects of the mentor, and of the mentor-mentee relationship, which increase their value to the young academician, in this column I will focus on a topic which is usually not mentioned: the issue of gender and its impact on the mentoring of young academicians. As in my last column, I will begin by considering a myth, a statement that seems eminently true, at least until explored more carefully.

Consider the following statement: "The process of mentorship should be gender blind; anything else is discriminatory and inappropriate." Although many of us are probably inclined to agree with this statement, possibly because it appeals to our sense of fairness and equity, I believe that this statement is not true and, moreover, belief in this myth is a barrier to the optimal training and academic development of women in academic emergency medicine.

Before addressing specific gender issues in mentorship, it is useful to review some recent studies evaluating the challenges facing women in academic medicine. In a recent study,1 Nonnemaker demonstrated that women are still under-represented in senior academic positions, despite near gender equality (44%) in incoming medical school classes. In addition, she found that women were more likely to enter academic careers than men, but less likely to be promoted to the level of Associate Professor. In an associated editorial,2 Catherine D. De Angelis stated that "…women who have reached the rank of Associate Professor have had time… to prove their worth. It just seems to take more proof for women than for men." [Dr. De Angelis is the current editor of the Journal of the American Medical Association.] In contrast to Nonnemaker’s study, which addressed both basic science and clinical departments within medical schools, Cydulka et al addressed the status of women in academic EM in a study published in Academic Emergency Medicine in 2000.3 Cydulka et al found that "Women in academic EM were less likely to hold major leadership positions, spent a greater percentage of time in clinical and teaching activities, published less in peer-review journals, and were less likely to achieve senior academic (continued on page 14)

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July/August 2002 Volume XIV, Number 4

Medical Student Interest Group Grants Deadline: September 4, 2002 SAEM recognizes the valuable role of EM Medical Student Interest Groups to the specialty and has established grants of up to $500 each to help support these groups' educational activities. Established or developing clubs, located at medical schools with or without EM residencies are eligible to apply. The deadline for this year's grants is September 4, 2002.

Applications can be obtained at www.saem.org or from the SAEM office. Information on the grants approved for funding earlier this year can be found in the January/February 2002 issue of the SAEM Newsletter. In addition two articles in the May/June issue of the Newsletter described recipients’ use of their grant funds.

Emergency Medicine Activities at the AAMC Annual Meeting The Association of Academic Chairs of Emergency Medicine (AACEM) and SAEM have developed a presentation and panel discussion to be held on Sunday, November 10, 2002 during the AAMC Annual meeting. The sessions will be held at the San Francisco Hilton Hotel.

All emergency physicians are invited to attend any of the sessions at no charge.

However, pre-registration for lunch is required.

You can register for lunch via email at saem@saem.org. Contact the SAEM office with any questions.

The sessions begin at 8:00 am with a presentation entitled “ED Overcrowding: Threat to EM Residency Training”, sponsored by SAEM. Speakers will include Brent Asplin, MD, Robert Derlet, MD, and Mark Henry, MD. At 9:45 am, John Moorhead, MD, will speak on “Workforce Issues in Emergency Medicine”. Dr. Moorhead is a past-President of ACEP and currently heads their Workforce Taskforce. At 10:45 am, AACEM will hold its Business meeting and from 11:30 am to 1:00 pm, lunch will be provided.

Once again, all emergency medicine physicians are welcome to attend.

Grant Review Initiative Report Jeff Kline, MD Carolinas Medical Center SAEM Research Committee At the 2002 SAEM Annual Meeting, the Research Committee embarked on a specific objective of implementing a mechanism to assist in the review of grant applications written by SAEM members. The ultimate vision of this project is to develop a network of reviewers who can assist in the development of competetive grant applications, especially for investigators who are located at hospitals with relatively limited academic resources to assist in grant writing. The committee recognizes this as a potential long-term project, so at this stage, the first step in making this vision a reality was to implement a system to review grants that have already been submitted and reviewed by extramural funding agencies and not yet approved for funding.

The Research Committee solicited and received several meritorious grant applications. The review panel chose two that were previously reviewed by federal funding agencies.

The brave souls who offered their applications for review were Dr. Leslie Zun of Finch University and Mount Sinai in Chicago and Dr. Larry Melnicker of New York Methodist Hospital. Dr. Zun's application was entitled, "Changing Behavior: Identifying and Treating At-Risk Youth" and Dr. Melnicker's project was, "The Sonography Outcomes Assessment Program (SOAP)." Dr. Zun's application had previously been reviewed at the Centers for Disease Control and Prevention (CDC) and Dr. Melnicker's had been reviewed by the Agency for Healthcare Research and Quality (AHRQ).

To review these applications, the Research Committee enlisted the expertise of Dr. Lynn Richardson, Vice Chairman of the Department of Emergency Medicine at Mount Sinai in New York City, the Honorable Dr. Jeffrey Runge, the Administrator for the National Highway Traffic and Safety Administration, and Dr. Judd Hollander, Director of Research at the University of Pennsylvania. All three reviewers have experience in reviewing federal grants.

The session was held in a small room to encourage a roundtable-type atmosphere and to foster face-to-face dialogue and to make the exchange of ideas more personal. Each applicant

first summarized his side of the story, and the reviewers then provided feedback. In the review of Dr. Zun's application, Dr. Richardson emphasized that the "devil is in the details" and suggested that the application had a relatively broad scope of aims and would be better served producing a more specific focus. Dr. Richardson suggested that the specific aims section be pared to one aim that is split out into several steps. Dr. Runge echoed Dr. Richardson's concerns, specifically stating that federal funding agencies are hesitant to approve an application which proposes to derive a scoring system. Dr. Richardson stated the importance of "hitching your wagon to an experienced investigator" to make the application stronger, and the requirement for the background of the grant to lead the reader exactly to a place where it is clear why the work needs to be done.

Dr. Runge emphasized the imperative to know the reviewers. What they want to see is a scoring system that has already been established and is being implemented. He also indicated that although the applicant does not know the exact identity of his or her reviewer, he can find out the basic background and publication history of the reviewers for any federally funded grant.

In review of the SOAP study, Dr. Hollander again hammered home the point of having a focus grant application and narrowing the breath of the specific aims into what could truly be considered the specific goal. In particular, Dr. Hollander suggested that the study be focused on one specific aim which could alone be an entire project. With what must be recognized as wry humor, Dr. Hollander offered multiple examples of the importance of writing the methods section in real terms that are explicit and detailed: "Who is going to fill out this form? Who will carry it to the office and where will it be stored? What will you do if you drop the form on the way to the office?" He indicated the need to enlist established statisticians who have specific publication history in solving the problems that will likely arise with analysis of the data from a multicenter ED study. He also indicated the need for the applicant to have a publication history in rigorous peer review journals. Others in the room offered pithy and helpful com2

ments during the session.

In general, the comments from the 50-odd persons participated in or observed the session were very positive. Several young investigators remarked that the session was valuable to what was happening in their careers at present. In follow-up, the two applicants also offered positive comments.

Dr. Zun called it a "wonderful learning experience that was unparalleled in interpreting the unspoken words from CDC." Dr. Zun is working on a revision of his application which will contain substantial changes based on the comments of the reviewers in the session.

Dr. Melniker thanked the Research Committee and the reviewers "for clarifying so many issues and confirming the need for new learning." The session allowed him to recognize that, "I have passionate collaborators on my ultrasound research, but our passion alone can not offset the complexity of SOAP." Dr. Melnicker used the experience as part of his decision to matriculate in an MPH program at Cornell's Masters Program in Clinical Epidemiology and Health Services Research.

Based on the experience in St. Louis, and the subsequent feedback, the Research Committee plans to continue this project. It should be emphasized that this "Roundtable Review" comprises only a first step for the development of a truly prospective grant reviewing mechanism. At this time, the Research Committee is again soliciting applications that have not yet been funded in an effort to repeat last year's effort. During the course of this year, the Research Committee will seek to devise a plan to make the review system a resource that can be used by members of SAEM. It is our eventual hope that once an application is approved through our review process that we will be able to keep a track record of all of those applications and with luck, the funding rate will be very high. Perhaps with this "stamp of approval" could take the form of a consensus letter that could be included as a appendix item for federal grant applications. It is our hope that in the future such a letter of endorsement will actually help improve the score of federally funded grant applications.

SAEM Research Training Grant Update Jason S. Haukoos, MD Harbor-UCLA Medical Center I am beginning the second-year of a two-year research fellowship at HarborUCLA Medical Center in Torrance, California. I became interested in emergency medicine, clinical research, and a career in academic medicine as a medical student at the UCLA School of Medicine. During my last year of residency at Harbor-UCLA Medical Center, I approached Roger J. Lewis, MD, PhD, about initiating a research fellowship.

Dr. Lewis discussed with me what he believed was required to achieve appropriate training in emergency medicine research that would translate into a productive academic career.

The first step was to obtain extramural funding for two years of training. I applied for and received a Resident Research Year Grant (now known as a Research Training Grant) from SAEM, as well as an Individual National Research Service Award (NRSA) from the Agency for Healthcare Research and Quality (AHRQ).

The foundation of my fellowship includes: (1) performing a study aimed at improving identification of undiagnosed HIV-infected patients who present to the emergency department (ED) by improving compliance with referrals from the ED for outpatient HIV counseling and testing (HIV-CT); (2) obtaining a Master of Science degree in Epidemiology from the UCLA School of Public Health; and (3) functioning as a clinical instructor in the Department of Emergency Medicine at Harbor-UCLA Medical Center.

The study is based on previous pilot data in which only approximately 10% of referred patients presented for outpatient HIV-CT after being referred from the ED. Of these, approximately 10% tested positive for HIV. At our institution, patients identified by emergency physicians as being at risk for HIV infection, based on current guidelines, are given instructions and directions to the Immunology Clinic at Harbor-UCLA Medical Center for confidential outpatient HIV-CT. The main goals of the current study are to determine whether a financial incentive will: (1) improve the proportion of patients who comply with HIV-CT; (2) improve the proportion of HIV-infected patients identified; and (3) improve the proportion of HIV-infected patients who enter into treatment for their disease. In addition, the Health Belief Model (a previously validated social psychological model designed to identify barriers to compliance with medical treatment) is being applied to all referred patients in the form of a questionnaire with the hope of identifying perceived or real barriers to HIV-CT. Patient enrollment is currently ongoing and will be complete by the end of my fellowship in June, 2003.

In the fall of my first fellowship year, I entered the UCLA School of Public Health to obtain a Master of Science degree in Epidemiology. The emphasis of this degree program is advanced research methodology and statistical analysis, and I will complete the degree this winter during the second year of my

fellowship. This has been an essential part of my fellowship, and I could not have achieved the same level of training without obtaining this degree. The level of sophistication and the degree with which I have learned about study design and analysis is truly unparalleled.

Additionally, during my first fellowship year, I presented abstracts at the 9th UCLA AIDS Institute Scientific Symposium in Culver City, California and the SAEM Annual Meeting in St. Louis, Missouri, and had an abstract accepted for presentation at the Research Forum at ACEP in Seattle, Washington, in October. Furthermore, I submitted two manuscripts for publication and have several others in preparation.

My experiences over the past year have reinforced my belief that several components are important for substantial training in research. These include: (1) a strong relationship with an established mentor; (2) a two-year time period in which to complete the fellowship; (3) performing a well-conceptualized research project in which the fellow acts as the principal investigator; (4) obtaining an advanced degree in research methodology and biostatistics; and (5) continuing with clinical duties. My fellowship, to this point, has been uniformly excellent, and I have acquired a foundation of skills that I hope will provide for a long and fulfilling career in academic emergency medicine.

Board of Directors Update The SAEM Board of Directors meets each month, usually by conference call.

This article will highlight the Board’s activities during the June and July conference calls.

Because of the recent changes in the membership application process, including the development of an attestation that the applicant is active in academic emergency medicine, rather than providing a letter verifying his/her faculty appointment, the Board agreed to discontinue the $25 membership initiation fee for all categories of SAEM membership. The Board noted that the initiation fee had been developed many years ago when considerable effort was need-

ed to process new member applications. With the advent of online applications and the recent changes in membership requirements that were approved as amendments to the Constitution and Bylaws by the membership, the Board agreed that the initiation fees should be discontinued. The new membership application is published on page 18 of this issue of the SAEM Newsletter.

The Board approved a proposed Resident Mentoring Program to be provided to the resident members of SAEM who have been appointed to an SAEM committee or task force. The goal is to provide an orientation to SAEM, as well 3

as to provide mentoring to residents to maximize their experience within SAEM. The Board also approved to provide all resident members with the opportunity to join one SAEM interest group without payment of interest group dues.

The Board approved a letter to be sent to Child magazine expressing concern over a recent article on pediatric emergency medicine. The letter was signed by the American Academic of Pediatrics, ACEP, and SAEM and has been accepted for publication.

The Board approved the Ultrasound Education Slide Set proposed by Sarah (continued on page 4)

Board of Directors Update (Continued) Stahmer, MD. The slide set will be posted on the SAEM web site in conjunction with the new Ultrasound Image Bank.

The Board approved the invitation of the National Association of EMS Physicians to jointly revise the EMS Fellowship Curriculum developed approximately ten years ago. The SAEM EMS Interest Group will work with NAEMSP to develop the revision that will be forwarded to the Board for approval.

The Board approved a proposal from Leslie Wolf, MD, to use the funds donated on behalf of Michael Spadafora, MD, to develop a scholarship program. The scholarship program will fund two individuals to attend the North American Congress of Clinical Toxicology each year. The program is being funded through the American College of Medical Toxicology and through the funds donated to SAEM in Dr. Spadafora’s memory. Further details will be published in upcoming issues of the Newsletter.

The Board approved a request from the Council of Emergency Medicine Residency Directors (CORD) to provide up to $500 to fund a CPC Reception to

be held during the ACEP Scientific Assembly. All CPC sponsors (ACEP, CORD, EMRA, and SAEM) will be asked to provide funding for the reception which will be held immediately following the CPC Finals Competition on October 7.

The Board reviewed the invitation from the American Academy of Emergency Medicine to participate in the AAEM International Meeting to be held in Barcelona in September 2003.

Dr. Judd Hollander was appointed as the Board Liaison to work with AAEM and develop a specific proposal for the Board’s consideration.

The Board approved a letter expressing support for the National Hospital Ambulatory Medical Care Survey. The letter also expressed concern with the triage measures currently included in the Survey.

The Board approved a proposed letter developed by the National Affairs Committee that outlined SAEM’s comments on the proposed changes in regulations under the Emergency Medical Treatment and Labor Act (EMTALA).

The text of the letter is published in this issue of the Newsletter.

The Board approved the development of a task force to develop a mechanism for improving the quantity and quality of educational research conducted and presented at the Annual Meeting. The task force will be chaired

by Katherine Heilpern, MD. The Board agreed to forward the references submitted by Adrienne Birnbaum, MD, and Jill Baren, MD, to ABEM for consideration for the ABEM Lifelong Learning Program.

The Board approved the proposed Patient Safety Curriculum submitted by Karen Cosby, MD, on behalf of the Patient Safety Task Force. The Board also approved a manuscript submitted

by Craig Newgard, MD, on behalf of the Research Committee. Both manuscripts will be submitted to AEM for consideration.

The next Board meeting will be held during the ACEP Scientific Assembly in Seattle on Monday, October 7 at 1:005:30 pm. The meeting room has not yet been confirmed but will be posted on the SAEM web site upon receipt. All SAEM members are invited to attend this, and all Board meetings.

Opportunities Available Through the SAEM Consult Service Glenn Hamilton, MD Wright State University Chair, Consulting Service Task Force The SAEM Consult Service has a long history beginning with the Society of the Teachers of Emergency Medicine (founded by Gus Russi in the late 1970s). Its greatest activity was under the guidance of Steve Dronen, MD, who chaired the Consulting Service for many years and provided over 70 consultations during the 1990s. The SAEM Consult Service is well prepared to offer its considerable capabilities to interested parties in our specialty.

Although a variety of services are available, the primary foci have been the following: 1. Establishment of an EM residency – this consult is in advance of application to the ACGME and RRC-EM for consideration of a new EM residency. The consultation will assess the suitability and potential of the site for residency training and assist in the development of the program information forms required by the ACGME. This service has been successfully offered to more than 40 programs in the last two decades.

2. “Mock” survey prior to RRC-EM site survey – this service serves as a preparatory guide to residencies preparing for their official site survey by the RRC-EM. This is a useful process for making sure the issues of potential concern by the RRC-EM are addressed, and convincing institutional administration of the benefits of EM and its continued support.

There have been more than 40 of these consults in the last 20 years.

3. Research Consultation – this relatively new aspect of the service helps programs develop a research program suitable to their environment. Several sites have participated in this type of consultation with appropriate guidance and net gains in their research activity.

4. Faculty Development – EM remains one of the few specialties that requires faculty development as part of its program requirements.

Programs who are initiating or having difficulty in this area may request a faculty development consultation 4

to assist in planning effective programs for their faculty.

Consultations are done by experienced individuals who are Program Directors, Academic Chairs, and/or RRC-EM Site Surveyors. Usually 1-2 individuals participate in the consultation depending upon the needs of the institution. The individuals are selected with input from the institution and the consult service. Fees are $1,250 per individual per day plus expenses. An additional $500 is paid to SAEM to support the administrative aspects.

The 1980s and 90s were a time of tremendous growth for EM residencies.

The Consult service played a significant role in sustaining the quality of these residencies and assisting numerous Program Directors in developing and creating solutions to their problems.

The SAEM Consult Service looks forward to assisting in residency or academic development needs. Please contact me directly or through SAEM for further information and assistance.

Anti-terrorism Funding James Olson, PhD Wright State University SAEM Research Committee Within one month of the September 11, 2002 attacks, President Bush recommended that Congress allocate $1.5 billion in new funding to enhance the country’s ability to respond to or repel a bio-terrorist attack. A furor for increased federal spending was spurned, in part, by the receipt of anthrax-contaminated letters sent through the US mail to congress persons and TV personalities.

Nine months later, the President endorsed a $28.9 billion anti-terrorism funding package of which bio-terrorism is a significant portion. With all the billions of dollars targeted toward these specific biological and medical issues, scientists and physicians are aligning their research programs and other activities toward these funding opportunities in order to contribute to this important national priority.

The majority of anti-terrorism funding is destined for training and for rebuilding and strengthening current infrastructure.

The bio-terrorism component of this funding is designed to increase the supply of current vaccine stockpiles and the range of organisms they target, strengthen surveillance programs that coordinate state and local public health systems, improve hospital disaster preparedness, and provide enhanced training for emergency workers. From this short list, the opportunities for emergency physician/scientists can easily be found. Since some of this federal money is being sent directly to the states as block grants for governors to fund their own programs as they see fit, local and state funding agencies may also be sought for specific projects. A list of bioterrorism funding by state can

be viewed at www.hhs.gov/ophp/funding.

The prime institute at NIH that is establishing new programs and refining current research programs relevant to bio-terrorism is the National Institute of Allergy and Infectious Diseases (NIAID).

Some of this money is destined to enhance the reserves of antibiotics and vaccines for specific likely bio-terrorism agents. Other research money will go to basic and applied research targeted at microbes and the specific and nonspecific host defense mechanisms against these microbes. These research dollars will be directed toward three major components of the NIAID Strategic Plan for Biodefense Research. First, is basic research to better our understanding of those microbes recognized as agents of bioterrorism (see Lane et al. Nature Medicine, 7:1271-1273, 2001). Second is research into the role of host defense in combating agents of bioterrorism.

Finally, funding will go toward construction and certification of biocontainment facilities.

Additional sources for funding relevant to bioterrorism can be found by searching any one of several funding opportunity databases such as those offered by InfoEd International (SPIN search) or the Community of Science.

Using the keyword “bioterrorism” on the SPIN search engine, I obtained a list of 10 programs in early August, 2002 including: Biodefense Research Training and Career Development Opportunities (http://www.niaid.nih. gov/dmid/bioterrorism/biodtraining020529.htm) and Hyperaccelerated Award/Mechanisms in Immuno-modula-

tion Trials (http://grants.nih.gov/grants/ guide/rfa-files/RFA-AI-02-003.html) from the NIAID and Scientific Research For Center For Drugs and Evaluation Research (http://www.eps.gov/spg/ HHS/FDA/DCASC/223-02-3003/listing.html) from the Food and Drug Administration. A similar search on the Community of Science database yielded 16 possible funding sources which included: Interagency Advanced Distributed Learning Emergency Management Training for Agricultural Bioterrorism Response from the Technical Support Working Group of the Combating Terrorism Technology Support Office (https://www.bids.tswg. gov/tswg/bids.nsf/Main?OpenFrameset &57YJ2V), Informatics for Disaster Management from the National Library of Medicine (http://grants1.nih.gov/ grants/guide/pa-files/PAR-02-137.html), and Diagnosis of Biological Threats Through Bioinformatics (A02-169) from the Department of Defense (http://www. acq.osd.mil/sadbu/sbir/solicitations/sbir 022/army022.htm).

Thus, from basic science on microorganisms to epidemiological assessments of public health data and applied disaster management, there is a source of research funding within the broad scope of the various anti-terrorism and biodefense bills which have emerged from Congress in the past year. The majority of funds will come through federal agencies such as the Department of Defense, the Food and Drug Administration and the NIH. However, local and state agencies also may provide funding for projects and should be consulted.

Call for Advisors The inaugural year for the SAEM Virtual Advisor Program was a tremendous success. Almost 300 medical students were served. Most of them attended schools without an affiliated EM residency program. Their “virtual” advisors served as their only link to the specialty of Emergency Medicine.

Some students hoped to learn more about a specific geographic region,

while others were anxious to contact an advisor whose special interest matched their own.

As the program increases in popularity, more advisors are needed. New students are applying daily, and over 100 remain unmatched! Please consider mentoring a future colleague by becoming a virtual advisor today. It is a brief time commitment – most communi-

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cation takes place via e-mail at your convenience. Informative resources and articles that address topics of interest to your virtual advisees are available on the SAEM medical student website.

You can complete the short application on-line at http://www.saem.org/advisor/ index.htm. Please encourage your colleagues to join you today as a virtual advisor.

Implications of the ACGME Work Group on Resident Duty Hours Recommendations Michael Beeson, MD Summa Health System Chair, SAEM Graduate Medical Education Committee In September of 2001, the Accreditation Council for Graduate Medical Education (ACGME) appointed the Work Group on Resident Duty Hours. This group was appointed to address concerns that restricted sleep could have a detrimental effect on patient safety, education, and resident safety and well-being.

On June 11, 2002, the Work Group issued its report, which consisted of common requirements of all accredited programs, institutional requirements for oversight and support, and strengthening the systems of compliance.

The standards are rigorous and welldefined. There will need to be changes made by many programs in order to come into compliance. The standards also address moonlighting activities, forcing the institution, individual residency program, and the resident to work together to stay in compliance. These standards therefore have implications that will affect all three.

The Work Group established common accreditation standards in regards to duty hours. The requirements are: 1. Residents must not be scheduled for more than 80 duty hours per week, averaged over a four-week period, with the provision that individual programs may apply to their sponsoring institution’s Graduate Medical Education Committee (GMEC) for an increase in this limit of up to 10 percent, if they can provide a sound educational rationale; 2. One day in seven free of patient care responsibilities, averaged over a four-week period; 3. In-house call no more frequently than every third night, averaged over a four-week period; 4. A 24-hour limit on in-house call duty, with an added period of up to 6 hours for inpatient and outpatient continuity and transfer of care, educational debriefing and didactic activities; no new patients may be accepted after 24 hours; 5. A 10-hour minimum rest period should be provided between duty periods; and 6. When residents take call from home and are called into the hospital, the time spent in the hospital

must be counted toward the weekly duty hour limit.

There are additional institutional oversight requirements, including, “Institutional policies on patient care activities external to the educational program (moonlighting), prospective approval of these activities, and monitoring their effect on performance in the educational program.” Of significance is the next institutional oversight statement which states, “Counting time spent in patient care activities external to the educational program that occur in the primary program and institution toward the weekly duty hour requirement.”

Institution The institution is required to provide oversight of each individual residency’s policies, require justification for increases above the 80 hour limit, provide an annual report on duty hour compliance, develop institutional policies related to patient care activities external to the educational program (moonlighting), and provide patient care support services such as phlebotomy, IV, and transport services. Every residency program goes through an internal review by the GMEC that reviews ACGME compliance prior to an accreditation site visit.

In order to maintain compliance with the duty hours requirement, each institution will need to review an annual report from each residency on duty hour compliance.

Residency The duty hours requirements will force numerous changes by every residency. Some will need to revise rotations to be in compliance. All programs will need to develop policies and compliance systems to ensure that the duty hours requirements are fulfilled. For emergency medicine rotations, all time spent in patient care activities, research, EMS, and conference time will count towards the 80 duty hours per week. As an example, if a program mandates twenty 10-hour ED shifts during the month, the actual time may in reality be 220 hours for the month due to “staying over” to complete patient care. Conference time of 20 hours, EMS time of 3 hours, and any other required duty hours will bring the total time up to 243 hours for a four week

period. Any external patient care activities (moonlighting) must be added to these hours, and must be within an average of 80 hours a week over the four week period. Additionally, each program must ensure that one day in seven is free of patient care responsibilities.

On off-service rotations, the emergency medicine residency program will need to work closely with the off-service departments to ensure compliance.

Formal written agreements between the two departments will need to incorporate the duty hours requirements. For off-service rotations in which there is inhouse call, it will be easy to approach and exceed 80 hours per week. As an example, if an intern is on a floor medicine service requiring in-house call every third day, the total hours will approach 20 days at nine hours each (180), and nine on-call days for an additional 135 hours, yielding 325 hours.

Additionally, after a total of 24 hours of continuous duty, there must not be any new patients added to that resident’s responsibilities (for example, new admissions). After an on-call period, there is a limit of up to 6 additional hours for inpatient/outpatient care, educational activities, etc. This will effectively force the resident who was on-call the night before to leave by 2:00 pm the next day after call.

Many programs either allow moonlighting, or weakly monitor and enforce a moonlighting policy. The new requirements mandate that moonlighting hours be counted towards the duty hours requirements, and that its effect on performance in the educational program be monitored. This will force each program to develop new moonlighting policies that will be in compliance with the duty hour standards. Additionally, prospective approval of moonlighting is now mandated, meaning that all planned moonlighting activities must be submitted to the program and that they must be counted toward the total duty hours.

It is clear that for those programs that minimally followed their residents’ moonlighting activities in the past, they must now monitor moonlighting hours to ensure the duty hours standards are not (continued on page 11)

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SAEM Meetings in Seattle

Resident Duty Hours (Continued) exceeded.

Resident The resident must take a proactive role in compliance with the duty hours requirements. Ideally, residents will work with their individual programs to monitor compliance on ED rotations as well as off-service rotations. The resident must remember that all moonlighting activities must be counted towards the weekly duty hour limit. It is now required that all residencies monitor moonlighting activities. This may seem intrusive, but will force significant change by the resident and the program in terms of how moonlighting is viewed.

Conclusion The new duty hours requirements will force institutions, residency programs, and residents to work together towards compliance with the duty hours requirements. The degree of change required to come into compliance will vary with each program and institution. However, even if an institution or residency is currently in compliance, at the least monitoring systems will need to be established that will ensure continued compliance.

S A E M

The following SAEM meetings will be held during the ACEP Scientific Assembly in Seattle. Meeting room assignments will be posted when confirmed by the ACEP office. All members are invited to attend.

Saturday, October 5 1:00-3:00 pm, Program Committee Executive Committee 4:00-6:00 pm, Program Committee 6:30-7:30 pm, Annual Meeting/Program Committee Task Force Sunday, October 6 8:00-12:00 noon, Didactic Subcommittee 11:00-12:00 noon, Undergraduate Committee 1:00-3:00 pm, Scientific Subcommittee of the Program Committee 3:00-4:30 pm, Medical Student/Resident Subcommittee of the Program Committee 3:00-4:30 pm, Public Health Task Force 4:30-5:00 pm, Program Committee Task Force meetings 5:00-6:00 pm, Program Committee Monday, October 7 10:00-11:00 am, Faculty Development Committee 1:00-5:30 pm, Board of Directors 1:30-2:30 pm, Ethics Committee 2:30-3:30 pm, Evidence Based Medicine Interest Group 3:30-5:00 pm, Graduate Medical Education Committee 5:00-6:30 pm, Grants Committee Tuesday, October 8 7:30-9:00 am, Financial Development Committee 9:00-10:00 am, Research Committee 3:00-4:00 pm, AEM Associate Editors 400-6:00 pm, AEM Editorial Board

Call for Photographs Deadline: February 17, 2003

Original photographs are invited for presentation at the SAEM 2003 Annual Meeting in Boston. Photographs of patients, pathology specimens, gram stains, EKG’s, and radiographic studies or other visual data may be submitted.

Submissions should depict findings that are pathognomonic for a particular diagnosis relevant to the practice of emergency medicine or findings of unusual interest that have educational value. Accepted submissions will be mounted by SAEM and presented in the “Clinical Pearls” session and/or the “Visual Diagnosis” medical student/resident contest.

No more than three different photos should be submitted for any one case. Submit one glossy photo (5 x 7, 8 x 10, 11 x 14, or 16 x 20) and a digital copy in JPEG or TIFF format on a disk or by email attachment (resolution of at least 640 x 48). Radiographs should be submitted as glossy photos, not as x-rays. For EKGs send an original and a digital image. The back of each photo should contain the contributor’s name, address, hospital or program, and an arrow indicating the top. Submissions should be shipped in an envelope with cardboard, but should not be mounted.

Photo submissions must be accompanied by a brief case history written as an “unknown” in the following format: 1) chief complaint, 2) history of present illness, 3) pertinent physical exam (other than what is depicted in the photo), 4) pertinent laboratory data, 5) one or two questions asking the viewer to identify the diagnosis or pertinent finding, 6) answer(s) and brief discussion of the case, including an explanation of the findings in the photo, and 7) one to three bulleted take home points or “pearls.”

The case history must be submitted on the template that is posted on the SAEM web site at www.saem.org and must be submitted electronically. The case history is limited to no more than 250 words. If accepted for display SAEM reserves the right to edit the submitted case history.

Submissions will be selected based on their educational merit, relevance to emergency medicine, quality of the photograph, the case history and appropriateness for public display. Contributors will be acknowledged and photos will be returned after the Annual Meeting. Academic Emergency Medicine (AEM), the official SAEM journal, may invite a limited number of displayed photos to be submitted to AEM for consideration of publication. SAEM will retain the rights to use submitted photographs in future educational projects, with full credit given for the contribution.

Photographs must not appear in a refereed journal prior to the Annual Meeting. Patients should be appropriately masked.

Submitters must attest that written consent and release of responsibility have been obtained for all photos EXCEPT for isolated diagnostic studies such as EKGs, radiographs, gram stains, etc. The attestation statement is included in the submission template.

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SAEM Responds to Proposed Changes in EMTALA On June 26 SAEM sent the following letter to Thomas A. Scully, the Administrator of the Centers for Medicare and Medicaid Services (CMS). The letter was developed by the National Affairs Committee, chaired by Robert Schafermeyer, MD. SAEM appreciates the opportunity to provide comments on the proposed changes in regulations under the Emergency Medical Treatment and Labor Act (EMTALA) as noted in the proposed FY 2003 Medicare Inpatient PPS Rule published in the Federal Register on May 9, 2002.

It is obvious that the regulatory language has been thoughtfully reviewed

by CMS and the proposed changes more closely reflect the original intent of Congress. SAEM is pleased with many common sense proposals that clarify the definitions and demonstrate CMS’ efforts to respond to physician concerns regarding EMTALA compliance.

EMTALA was passed in 1986 primarily in response to concerns that some hospitals across the country were refusing to treat indigent and uninsured patients or inappropriately transferring them to other hospitals solely for economic reasons. The intent of the law -to ensure that all individuals receive necessary emergency care regardless of their ability to pay or insurance status -- is consistent with the mission of academic emergency physicians and hospital emergency departments as integral components of America’s health care safety net. SAEM believes that CMS should provide very clear guidance as to when EMTALA requirements are met and where other, more appropriate, federal or state requirements prevail.

SAEM supports many of the refinements to the regulations, but has continuing concerns with a number of issues, some of which are included in the proposed regulatory changes, and some were not addressed at all.

Many of the proposed definitions are greatly improved; others would benefit from some additional changes and/or clarifications.

Comes to the emergency department. SAEM generally supports the draft regulation’s narrowed definition of an emergency department, confining it to an area, whether located on or off the hospital’s main campus, that is specially equipped and staffed to render initial evaluation and treatment of emergency medical conditions. However, the definition should not include the statement regarding the significant amount of time a facility is used for emergency screening and treatment. It is the nature of care provided that distinguishes it as a dedicated emergency department and the

amount of time it is used is not relevant.

Individuals who present to the ED are described in the proposed regulations as "not ‘patients’ (of the hospital) who request an examination or treatment or have such requests made on their behalf." The proposal goes on to define a request to exist if a "prudent lay person observer" believes that the individual needs examination or treatment.

An EMTALA obligation is triggered by a patient-generated request and SAEM recommends that CMS substitute the term "obvious implied request" instead of relying on perceptions of a prudent lay person to speak for patients that are unable to articulate their needs. Hospital personnel must be made aware of the individual’s presence and observe the appearance and/or behavior of that person in order to respond appropriately.

All hospitals need policies that describe steps to be taken to ensure that a person in clear need e.g. a visitor who collapses in the cafeteria, receives the care they need.

SAEM appreciates CMS’ recognition that some individuals who come to the ED are not seeking a medical screening exam to rule out a potential emergency.

SAEM requests that only those individuals requesting a "medical examination" be required to receive a medical screening exam by a physician or other qualified medical personnel. Hospitals should have protocols for patients presenting with specified complaints who can safely be seen and treated by designated qualified medical personnel.

Hospital property. SAEM is generally pleased with CMS’ clarifications of what is considered hospital property for EMTALA purposes. In addition to excluding structures on campus that are not part of the hospital, the definition includes the main building, driveway, parking lot and sidewalk. This description provides more precision for EMTALA purposes. The continued reliance on the "250 yard" rule fosters unnecessary ambiguity and should be rescinded by CMS. For provider-based entities remote from the main hospital campus, CMS makes it clear that the responsibility of the hospital is to have policies and procedures in place to see that potential emergencies are sent to the dedicated ED. Prior authorization. The proposed rule imposes a new requirement that directs the hospital to contact a 8

Medicare+Choice plan to obtain pre approval for post stabilization care for Medicare enrollees. It is difficult to identify the precise moment of stabilization in a busy ED, and with the current demands on most EDs today, many hospitals initiate calls to insurers, both commercial and M+C plans for specialty consultation, follow-up care, and/or hospital admission. EDs often do not receive timely responses from M+C plans or the patients' primary care physicians, with a few notable exceptions, do not have policies in place to ensure timely responses to ED calls.

Such requirements and this lag in response time add to the already overcrowded conditions in the ED. SAEM believes that a regulatory mandate to call M+C plans is unnecessary and unachievable in the current ED environment.

SAEM believes that when a patient in the ED requests that care be provided exclusively by his/her private physician, and refuses examination or treatment by the emergency physician, the EMTALA obligation should be considered discharged.

On-call. There are practical limitations for busy medical specialists who maintain their practice obligations and provide on-call services for several different hospitals where they have privileges.

Unfortunately, the proposed regulation does not address the problem of adequate and timely specialty coverage.

CMS regulatory language provides physicians with more flexibility, while continuing to impose the same level of responsibility on the hospitals to "maintain an on-call list of physicians on its medical staff in a manner that best meets the needs of the hospital’s patients."

SAEM is very concerned with how "best meets the needs" will be interpreted and recommends that regulatory language recognize capability limitations and substitute language from the statute which states that "the hospital must provide for an appropriate medical screening examination within the capability of the hospital’s emergency department…".

While the additional CMS guidance of June 13, 2002 is useful in clarifying that simultaneous call is permitted and that surgeons may schedule elective surgery while on-call, it does not resolve (continued on page 9)

Changes in EMTALA (Continued) the basic and significant dichotomy between increased flexibility for on-call physicians and strict enforcement of the law on facilities. This issue will continue to worsen as physicians weigh the risks of on-call against the potential benefits.

We recommend as does the American College of Emergency Physicians that: ● Since EMTALA essentially is a nondiscrimination law, SAEM believes that if the hospital maintains an on-call list and offers services to everyone who comes to the ED in a non-discriminatory fashion, it has met EMTALA obligations, within the limits of its capabilities. ● CMS should clarify its commitment, in the regulations, to a more equitable balance between the potential medical benefits of a transfer to another facility, where a more appropriately trained specialist is available, versus the risks of remaining in a hospital where the skills and experience of the local on-call physician may not be ideal for the services required by the patient. This would place greater reliance on the transferring physician’s clinical judgement as to the patient’s immediate needs. This commitment on CMS’ part should extend to specialty physician offices as well, where an ever growing number of medical services can be rendered safely and efficiently. This affirmative clarification would yield the added benefit of limiting the amount of time on-call physicians spend traveling to the hospital for relatively minor needs. A common sense analysis of clinical risks and benefits also should be an integral part of the improved training of state and regional office staff. ● CMS should support the goal of adequate medical specialty coverage by facilitating regional planning and interhospital agreements for coverage. This issue should be on the agenda of an EMTALA advisory committee proposed latter in this document.

Applicability. A major concern of physicians and hospitals is when are EMTALA obligations satisfied? The original intent of the EMTALA law was to impose responsibility on hospitals to provide medical evaluation for individuals who request it and prevent patients from being improperly transferred before stabilization. EMTALA was never intended to extend to inpatients (where a duty already exists) who are admitted through the ED. The proposed rule states that the EMTALA duty extends to an unstabilized admitted patient. The

proposal goes on to say that if an admitted patient is stabilized (which is documented in the medical record) and later decompensates, the duty to treat is governed by the hospital conditions of (Medicare) participation. Further, an elective (non-emergency) admission who becomes unstable also falls under conditions of participation, not EMTALA. Regulating care by how the patient is admitted is fundamentally flawed and exacerbates the confusion about when the EMTALA duty has been met. We request that CMS simplify the issue by creating a sharp delineation that EMTALA applies to any patient who comes to the ED and for whom a request for emergency care is made, until that patient is stabilized or admitted. Once the emergency physician has determined that the patient needs to be admitted, "conditions of participation" apply whether the patient is admitted through the emergency department, outpatient department, or is admitted on an emergency basis directly from a doctor’s office to surgery or a critical care unit. Patients are protected not only under conditions of participation, but by state laws, JCAHO-required hospital policy, and other standards of care. The EMTALA law was enacted to address non-discriminatory access to ED services, not to the outcome of inpatient services.

Additional recommendations Several of the proposed regulatory changes will foster a more sensible use of scarce ED resources. However, significant EMTALA compliance burdens remain unaddressed. Uneven enforcement and the absence of a mechanism for ongoing input from the physician and hospital community leave us very concerned about the benefits of the proposed changes. SAEM strongly supports additional steps that CMS should make, as outlined by the American College of Emergency Physicians: ● Enforcement. Emergency physicians and other medical specialists recognize that EMTALA definitions are legal rather than clinical, and urge CMS investigators to focus on whether the medical screening examination process is applied in a discriminatory manner, not whether the reviewer has any quality of care concerns. ACEP and SAEM recommend the following: 1) peer review, by an emergency or same specialty physician who is well-trained and knowledgeable about the EMTALA statute, and applies standards that assess dis9

crimination issues rather than solely medical outcome, be mandatory and prompt; 2) the regulations include a prohibition on removing peer review documents from the institution to avoid subverting state peer review privacy due to differing rules of evidence at the state and federal levels; 3) the results of peer review be shared immediately with the physician and/or hospital so a timely refutation or compliance plan can be prepared; and 4) physicians and hospitals be notified when the investigation is complete, regardless of the outcome, thus potentially avoiding unnecessary expenses. ● Consider deemed compliance with EMTALA in the face of a multi-casualty disaster where the ED and hospital are responding using community-developed protocols. ● Work with CMS to develop model compliance/safe harbors so practitioners have more surety about what is and is not considered compliant. ● Develop or support data collection to quantify the uncompensated care costs to physicians of EMTALA-mandated care and factor those costs into the practice expense component of the Medicare fee schedule. ● Advisory group. ACEP rand SAEM recommend that CMS appoint an EMTALA advisory group or committee comprised of emergency physicians and other EMS first responders, medical specialties, nurses, as well as hospitals to address the need to finance this unfunded mandate. After more than 15 years, the resiliency of the emergency care system and good will of providers is in jeopardy, and federal policy must be developed to address funding for uncompensated care with respect to EMTALA-mandated services, as well as to provide broader-based approaches to on-call coverage, EMS infrastructure, and EMTALA enforcement.

SAEM appreciates the opportunity to provide input on these important issues.

SAEM will work with CMS to ensure that EMTALA requirements are reasonable and treat all healthcare providers fairly, do not detract from patient care, nor threaten an important component of America’s health care safety net – the nation’s emergency departments. The Society for Academic Emergency Medicine thanks the Centers for Medicare and Medicaid Services for consideration of SAEM's views.

Academic Announcements SAEM members are encouraged to submit Academic Announcements on promotions, research funding, and other items of interest to the SAEM membership. Submissions should be sent to saem@saem.org by September 1 to be included in the September/October issue.

Charles K. Brown, MD, has been promoted to Professor of Emergency Medicine at The Brody School of Medicine at East Carolina University.

Dr. Brown has also been the director of the Emergency Medicine residency program since 1993.

Frederick M. Burkle, Jr, MD, MPH, has been appointed Deputy Assistant Administrator, Bureau for Global Health, U.S. Agency for International Development at the Department of State. Dr. Burkle was formerly Senior Scholar, Scientist and Visiting Professor, Departments of Emergency Medicine and International Health, Center for International Emergency, Disaster and Refugee Studies at the Johns Hopkins University.

Joseph Clinton, MD, will lead the new Department of Emergency Medicine at the University of Minnesota. The new department is the culmination of efforts between the University of Minnesota and Regions Hospital and will have approximately 45 faculty from both Hennepin County Medical Center and Regions Hospital. Dr. Clinton is currently also chief of emergency medicine at Hennepin.

Michael Gibbs, MD, has become Chair of the Department of Emergency Medicine at Maine Medical Center. He became chair on August 1.

Parker Hays, MD, has been named Emergency Medicine Residency Director at Carolinas Medical Center.

Debra Houry, MD, MPH, assistant professor, Emory University, and associate director of Emory’s Center of Injury Control, will be honored with the 2002 Jay Drotman Award from the American Public Health Association. The highly competitive award recognizes an outstanding young public health researcher under 30 years of age who has demonstrated potential in the health field by challenging traditional public health policy or practice in a creative and positive manner.

Charlene Irvin, MD, Catherine Marco, MD, and Jeff Kline, MD, have been named Associate Editors of Academic Emergency Medicine. Dr. Irvin is the Research Director at St. John Hospital and Medical Center and an Assistant Clinical Professor at Wayne State University. Dr. Marco is an Associate Professor of Surgery at the Medical College of Ohio and an attending physician at St. Vincent Mercy Medical Center in Toledo. Dr. Kline is the Director of Research at Carolinas Medical Center and an Assistant Professor of Emergency Medicine at the University of North Carolina, Chapel Hill.

Jennifer Isenhour, MD, was named assistant Emergency Medicine

Residency Director at Carolinas Medicine Center and assumed her duties on August 1.

Linda Lawrence, MD, has been selected to be the Commandant for the Uniformed Services University of the Health Sciences (USUHS) School of Medicine in Bethesda, Maryland. Dr. Lawrence, a Lt. Col. in the U.S. Air Force, is an Associate Professor in the Department of military and Emergency Medicine. She is also the first emergency physician to hold this position.

Robert E. O’Connor, MD, MPH, has been promoted to Professor of Emergency Medicine at Thomas Jefferson University. Dr. O’Connor is Director of Education and Research at Christiana Care Health System in Newark, Delaware.

Jon Olshaker, MD, has been appointed Professor and Chair of the Department of Emergency Medicine at Boston University School of Medicine and Chief of the Department of Emergency Medicine at Boston Medical Center.

Previously Dr. Olshaker was Professor of the Division of Emergency Medicine, Department of Surgery at the University of Maryland and Director of Emergency Care Services at the Veterans Affairs Medical Center in Baltimore.

Christina L. Schenarts, MD, has been named Assistant Residency Director for the Emergency Medicine Residency Program at The Brody School of Medicine at East Carolina University.

The Top 5 Most-Frequently-Read Contents of AEM – June 2002 Most-read rankings are recalculated at the beginning of the month. Rankings are based on hits received by articles archived on AEMJ.org.

1 2 3 4 5

Validation of the Canadian Clinical Probability Model for Acute Venous Thrombosis Acad Emerg Med Jun 01, 2002 9: 561-566. (In "CLINICAL INVESTIGATIONS") Droperidol--Behind the Black Box Warning Acad Emerg Med Jun 01, 2002 9: 615-618. (In "COMMENTARIES") Evaluation of Guidelines for Ordering Prothrombin and Partial Thromboplastin Times Acad Emerg Med Jun 01, 2002 9: 567-574. (In "CLINICAL INVESTIGATIONS") Scientific Priorities and Strategic Planning for Resuscitation Research and Life Saving Therapy Following Traumatic Injury: Report of the PULSE Trauma Work Group Acad Emerg Med Jun 01, 2002 9: 621-626. (In "SPECIAL CONTRIBUTIONS") Parents and Practitioners Are Poor Judges of Young Children's Pain Severity Acad Emerg Med Jun 01, 2002 9: 609-612. (In "CLINICAL PRACTICE") 10

Emory University Secures Three Year NIH Award About Treatment of Traumatic Brain Injury Junaid A. Razzak, MD Yale University SAEM Research Committee The Department of Emergency Medicine at Emory University recently secured a RO1 research grant from the National Institutes of Health (NINDS) for their study entitled "Progesterone treatment of blunt traumatic brain injury". It is a three-year, randomized, doubleblinded placebo-controlled clinical trial with three main goals: (1) to determine the safety of progesterone when given intravenously over three days, (2) to determine the pharmacokinetics of the drug in humans, and (3) to look for evidence of its efficacy in patients with traumatic brain injury (TBI). Dr. Arthur Kellerman, chairman of EM at Emory, is the principal investigator for this study; however, he is of the opinion that securing and implementing the grant would not have been possible without the efforts and commitment of David Wright, MD. Dr. Wright is a graduate of University of Alabama (UAB) Medical School and received his postgraduate training at the University of Cincinnati emergency medicine residency program. He cites several past experiences as being instrumental towards securing this award. During his time at UAB he secured a Howard Hughes fellowship

that enabled him to spend some time in a basic science lab. Dr. Wright joined Emory upon completing his residency, with a clear departmental expectation that he would focus on research. Dr. Wright sought a partnership with Donald Stein, PhD, professor of neurology and psychobiology and dean of the Emory University Graduate School of Arts and Sciences. Dr. Stein, who is recognized for his expertise in the area of brain repair and recovery following neurotrauma, was also looking for a clinical collaborator. Thus Dr. Wright was able to benefit from Dr. Stein’s lab and to gain expertise about research in the area of traumatic brain injury.

Dr. Wright subsequently applied for a small intramural grant from Emory to look for the differences in TBI among men and women. The SAEM scholarly sabbatical grant in 1999 came as a major turning point in his career. The sabbatical allowed him to buy down his clinical time for six months and use that time to study the dose-response relationship of progesterone in an animal model. During that time he was also able to create and lead a multi-disciplinary interest group comprised of five departments (emergency medicine,

neurology, neurosurgery, trauma surgery, and rehabilitation medicine) and three schools (Emory University School of Medicine, Morehouse School of Medicine and Rollins School of Public Health). The idea and support for the NIH funded clinical trial came directly as a result of discussions and collaboration between group members.

The conception and initial writing of the project started more than three years before the grant was secured.

The proposal was not funded on its initial review, but was funded after revision. Dr. Wright identified mentorship both within the department (Dr. Kellerman, Dr. Lowery) and outside the department (Dr. Stein) as well initial support from the Emory’s intramural grant and SAEM sabbatical grant as main factors for his success in securing this grant.

This award has had significant impact on the whole department. Four faculty members in Emergency Medicine now have protected research time. The department was able to hire a full-time research nurse and an epidemiologist. They have helped in other projects and the department has subsequently been able to secure many other

ABEM Call for Nominations As a sponsoring organization of the American Board of Emergency Medicine (ABEM), SAEM will develop a slate of nominees to submit to the ABEM Nominating Committee for consideration of the three or four seats that will be filled by election by the ABEM Board at its winter 2003 Board meeting. SAEM members wishing to be considered for the SAEM slate of nominees are invited to send a nomination to SAEM at saem@saem.org.

Nominations should include a current copy of the nominee’s curriculum vita, as well as a cover letter outlining the nominee’s qualifications. The deadline is September 6, 2002.

The SAEM Board of Directors will review all nominations and submit a slate of nominees to ABEM by December 1, 2002.

Successful candidates are expected to be members of SAEM with considerable experience in SAEM and academic EM, as well as experience in ABEM. The SAEM Board does not nominate current members of the SAEM Board for consideration. In addition, ABEM has established the following criteria for nominated physicians: ● ● ● ●

Be a graduate of an ACGME-accredited EM residency program.

Be an ABEM diplomate for a minimum of ten years.

Have demonstrated extensive active involvement in organized EM. Ideally, this includes long-term experience as an ABEM item writer, oral examiner, or ABEM-appointed representative.

Be actively involved in the clinical practice of EM.

Physicians selected for the SAEM slate of nominees will be notified in October or November and will be required to submit the official ABEM nomination form, curriculum vita, and letter noting their willingness to serve if elected.

It is important to note that all organizations and individuals are invited to participate in the ABEM nomination process and further information can be obtained through the ABEM web site at www.abem.org. This Call for Nominations is published for the express purpose of developing the official SAEM slate of nominees.

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More Annual Meeting Highlights

Dr. Martin congratulates some of the 2001 Annual Meeting poster/paper award recipients who received formal acknowledgment during the Annual Business Meeting. (L-R) Henry E. Wang, MD, Marcus Martin, MD, Raymond Regan, MD, Bret Rogers, and Alex Limkakeng.

Bob Niskanen of Medtronic Physio Control congratulates Jason Borton, MD, the recipient of the 2002-2003 EMS Research Fellowship Grant.

Kristi Koenig, MD, introduced Scott R. Lillibridge, MD, Special Assistant to the Secretary for National Security and Emergency Management. Dr. Lillibridge presented a well-received lunch session on May 22.

Joe LaMantia, MD, received the CORD Impact Award for his work coordinating the 2002 CORD Core Competencies Conference.

Members of the Board and the past presidents met during the annual Past Presidents' Breakfast. (Front L-R) Sandra Schneider, MD, Roger Lewis, MD, PhD, Mary Ann Schropp (executive director), Bill Barsan, MD, John Marx, MD, and Marcus Martin, MD. (Back L-R) Art Sanders, MD, Dave Sklar, MD, Lewis Goldfrank, MD, Steve Davidson, MD, Jim Niemann, MD, Don Yealy, MD, Brian Zink, MD, Joe Waeckerle, MD, Louis Binder, MD, Kendall McNabney, MD, and Louis Ling, MD.

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The Program Committee did an extraordinary job planning the 2002 Annual Meeting. (Back L-R) Sue Stern, John Flaherty, Susan Promes, Dane Chapman, Diane Gorgas, Ellen Weber (Chair), Todd Larabee, Cathy Custalow, Mary Jo Wagner, Gary Vilke, Greg Garra, and Brian Euerle. Front (L-R) Terry Vanden Hoek, David Lee, Richard Shih, Jack Kelly, Adam Singer, David Guss, and Chris Barton.

Dr. Martin congratulates Debra Houry, MD, MPH, on the completion of her one-year term as the resident member of the SAEM Board.

CORD unveiled a new award in St. Louis to recognize program directors who have served 10, 15, and 20 years. Pictured are Sal Vicario, University of Louisville, and Gwen Hoffman, Spectrum Health in Grand Rapids, Michigan. Both have served as program directors for 20 years. Photos of other recipients will be published in the CORD Newsletter.

Dr. Martin welcomed past presidents of SAEM (and UAEM) at the Annual Meeting Banquet. (L-R) Dr. Martin, Mary Ann Schropp (SAEM executive director), Louis Ling, MD, Dave Sklar, MD, Steve Davidson, MD, Bill Barsan, MD, Lewis Goldfrank, MD, Sandra Schneider, MD, Kendall McNabney, MD, Jerris Hedges, MD, Joe Waeckerle, MD, and Art Sanders, MD. Other past presidents who attended the Annual Meeting included: Louis Binder, MD, John Marx, MD, Jim Niemann, MD, Richard Nowak, MD, and Brian Zink, MD.

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President’s Message (Continued) rank…".

So, if we accept the fact that women are entering the ranks of academics in substantial numbers, but are less likely to advance in rank, it is important to understand the barriers to advancement that women face in academic medicine.

In 2001, Yedidia et al4 interviewed leaders in clinical academic departments regarding their views on the barriers confronting women in academic medicine. The study population included 34 department Chairs and two Division Chiefs in five clinical specialties. In the opinions of these academic leaders, women primarily faced three barriers to advancement: 1) the constraints of traditional gender roles (e.g., time spent in child bearing and raising young children); 2) "sexism in the medical environment;" and 3) a "lack of effective mentors." Without intending to minimize the importance of gender roles and sexism as barriers to advancement, I would like to spend the rest of this column focusing on the third barrier: the lack of effective mentorship for women pursuing careers in academic medicine.

The goal of mentorship is to facilitate the acquisition of knowledge and academic skills required for long-term academic success and productivity. In order to explore the relationship between mentorship and gender further, it is necessary to make some generalizations. Although there are, of course, many exceptions to any generalization regarding gender, considering some generalizations may lead to further insights on the interaction between mentorship and gender.

Deborah Tannen, a linguist who has extensively studied the interaction between gender and language, describes two styles of interaction.5,6 According to Tannen, a typically masculine interactive style involves negotiation of status or rank within a hierarchy (i.e., is competitive).5 The important "currencies" when one uses a masculine style are rank and power. In contrast, a typically feminine interactive style emphasizes cooperation and the minimization of differences (i.e., is cooperative).5 With this style social harmony, communication, and connectedness are the important currencies.

Most formal academic interactions, such as faculty meetings and the questioning of lecturers after a presentation, are conducted in a competitive style. In this type of setting, the contributions of

faculty who choose to use a cooperative style are often not noticed. For example, many women find that their intellectual contributions in group academic settings (e.g., faculty meetings) are subsequently attributed to men who make similar but derivative comments. [If you are male and find this difficult to believe, please ask one of your female colleagues.] There are a wide variety of academic settings in which the accurate attribution of intellectual contributions is important. For example, the order of authorship on research manuscripts should accurately reflect the relative intellectual contributions and work product of the authors, especially since authorship position is often considered by promotion and tenure committees evaluating one’s publication record.

Faculty members using a cooperative style, generally women, have greater difficulty garnering the recognition, respect, and support of colleagues which is necessary for career development and academic promotion.

The first step in effectively addressing this type of subtle and unintentional gender bias is acknowledging that it exists. Since it does exist, effective mentorship requires addressing the issue, for example by helping those with a cooperative style to recognize those situations in which they may want to adjust their strategy. Whether or not a cooperative style should be as effective in academic settings as a competitive one is not the question—the question is whether the mentor acknowledges these issues and teaches the mentee effective strategies. This is analogous to the question of whether or not to teach a resident how to deal with difficult patients (e.g., patients with addictions or personality disorders). Although we all wish such patients were less frequent, any comprehensive training program includes instruction on strategies for optimizing the care of patients with personality disorders, addictions, and similar problems.

De Angelis noted in her editorial that "…mentors are more important than role models."2 It is often noted that an inadequate number of women in senior academic positions are available to serve as role models for women in junior faculty positions. Thus, if women are to find senior faculty to help guide them in their career and skill development, many will need to form mentor-mentee relationships with men. Dr. De Angelis

goes on to state that [my italics]:2 "Mentoring is also a very difficult problem to resolve, because mentors are generally senior faculty members, and relatively few senior faculty members are women. …

Although women do not necessarily need women mentors, men have not yet come forward to a degree necessary to make much difference. Also, the approach to mentoring women can be different from that for mentoring men. For example, women often do better than men in collaborative ventures, but they must be taught how to protect themselves from being exploited."

The mentor is often in a position to ensure that a junior faculty’s contributions are appropriately noticed. For example, in a group setting the mentor may redirect questions to the mentee, to ensure that all are aware of the mentee’s expertise. In addition, if the mentor is asked about research which they are conducting collaboratively, the mentor should redirect the electronic mail or telephone call directly to the mentee, again to assure that the intellectual product is attributed to the junior faculty member. Such actions also demonstrate the mentor’s confidence in the mentee’s ability to explain their joint work, which gives further credibility to the junior faculty member.

There are many settings in which a collaborative approach to academic activities may be more productive than a competitive one. For example, much health services research and clinical trials research requires the collaboration of many investigators, from multiple study sites, working towards a single goal. In such settings, a typically feminine style is probably preferable to a masculine one.

It is difficult to overstate the importance of a strong mentor-mentee relationship in the career development of research fellows and junior faculty members. Because women in junior faculty positions face different barriers to their advancement than men, and the primary goal of the mentor is to fully prepare the junior faculty member to ensure their future career success, it is important that the mentor both acknowledge and address these challenges. Since too few senior women in academic positions are available to serve as both men(continued on page 15)

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President’s Message (Continued) tors and role models for women entering academics, senior male faculty members must rise to the challenge and provide both support and guidance, tailored to the specific challenges women face in academic medicine.

References 1. Nonnemaker L. Women Physicians in Academic Medicine. New England Journal of Medicine 2000;342:399405.

2. De Angelis CD. Women in Academic Medicine: New Insights, Same Sad News. New England Journal of Medicine 2000;342:425-427.

3. Cydulka RK, D’Onofrio G, Schneider S, Emerman CL, Sullivan LM, on Behalf of the SAEM Women and Minorities Task Force. Women in Academic Emergency Medicine.

Academic Emergency Medicine 2000;7:999-1007.

4. Yedidia M, Bickel J. Why Aren’t There More Women Leaders in Academic Medicine? The Views of Clinical Department Chairs.

Academic Medicine 2001;76:453465.

5. Tannen D. You Just Don’t Understand: Women and Men in Conversation. New York: Ballantine, 1990.

6. Tannen D. Talking from 9 to 5.

Women and Men in the Workplace: Language, Sex and Power. New York: Avon, 1994.

Keep Your Membership Mailings Coming!

Be sure to keep the SAEM office informed of changes in your address, phone or fax numbers, and especially your e-mail address.

SAEM sends infrequent e-mails to SAEM members, but only regarding SAEM issues or activities.

SAEM does not sell or release its mailing list or e-mail addresses to outside organizations. Send updated information to saem@saem.org

EMF Grants Available The Emergency Medicine Foundation (EMF) grant applications are available on the ACEP web site at www.acep.org. From the home page, click on "About ACEP," then click on "EMF," then click on the "EMF Research Grants" link for a complete listing of the downloadable grant applications. The funding period for all grants is July 1, 2003 through June 30, 2004, except for the Congestive Heart Failure Award which will be funded for January 1, 2003 through December 31, 2003.

Directed Research Acute Congestive Health Failure Award This grant is sponsored by EMF and Scios, Inc. This request for proposals specifically targets research that is designed to improve the care for patients who present to the ED with acute congestive heart failure. Only clinical science proposals will be considered. Proposals may focus on methods of facilitating treatment through early diagnosis, intervention and treatment of acute congestive heart failure patients. Deadline: September 20, 2002. Notification: November 4, 2002.

Riggs Family Health Policy Research Grant Between $25,000 and $50,000 for research projects in health policy of health services research topics. Applicants may apply for up to $50,000 for a one or two year period. Grants are awarded to researchers in the health policy or health services area who have the experience to conduct research on critical health policy issues in emergency medicine. Deadline: December 20, 2002. Notification: March 2003.

Resident Research Grant A maximum of $5,000 to a junior or senior resident to stimulate research at the graduate level. Deadline: December 20, 2002. Notification: March 2003.

Career Development Grant A maximum of $50,000 to emergency medicine faculty at the instructor or assistant professor level who needs seed money or release time to begin a promising research project. Deadline: January 15, 2002. Notification: March 2003.

Research Fellowship Grant A maximum of $75,000 to emergency medicine residency graduates who will spend another year acquiring specific basic or clinical research skills and further didactic training research methodology. Deadline: January 15, 2002.

Notification: March 2003.

Neurological Emergencies Grant This grant is sponsored by EMF and the Foundation for Education and Research in Neurological Emergencies (FERNE). The goal of this directed grant program is to fund research on towards acute disorders of the neurological system, such as the identification and treatment of diseases and injury to the brain, spinal cord and nerves. $50,000 will be awarded annually. Deadline: January 15, 2003. Notification: March 2003.

Medical Student Research Grant This grant is sponsored by EMF and the Society for Academic Emergency Medicine (SAEM). A maximum of $2,400 over 3 months is available for medical students to encourage research in emergency medicine. Deadline: February 3, 2003. Notification: March 2003.

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Opportunities Through the AACEM Consult Service Glenn Hamilton, MD Wright State University Chair, AACEM Consulting Service Since the Association of Academic Chairs in Emergency Medicine (AACEM) was founded in 1989, the Consult Service of the Association has had an active role. The primary focus of this service is to assist academic medical centers in establishing academic departments of emergency medicine in the United States and Canada. The service has had a contributing role in the development of several departments and is currently at various stages of discussion with three or four sites considering this important decision.

The AACEM and SAEM Consult Services have worked closely together.

The Consult Service’s activities include: 1. Overview assessment of the status of emergency medicine in an academic medical center to determine the suitability and timing for evolving to academic departmental status.

2. Assisting divisions or other institutional entities in developing a proposal for development of an academic department in the institution.

3. Site surveys to assist the division as well as the Dean’s office and hospital administration in their decision

S A E M

making regarding the potential and appropriate time table for development of an academic department.

4. Discussions at any level of decision making with emergency medicine leadership about the approach, negotiations, documentation and timeframe of developing an academic department.

The actual consultation consists of two current Academic Chairs of Emergency Medicine who are selected conjointly by the consult service and the institution. These Chairs usually spend two days at the site and develop a report regarding the specific questions asked of them. Current fees for this service are $1,500 per individual per day plus overnight expenses. In addition, $500 is contributed to AACEM for administrative purposes.

One significant accomplishment of the service was to develop a monograph entitled “Establishing the Academic Department of Emergency Medicine: Commentary on Five Phases of Development”. The monograph reviews the five major phases of development beginning five years before and continuing five years after the actual establishment of an academic depart-

ment. This useful monograph is available from the AACEM Office through SAEM Administrative Offices.

Currently, the consult service is developing a listing of current sites that may have the potential for evolving from their current institutional status into a formal Academic Department of Emergency Medicine. Contacts with individuals in emergency medicine at these sites will be made over the next several years.

Emergency Medicine essentially doubled its number of academic departments in the 1980’s and doubled that number again in the 1990’s. Currently, there are 63 academic departments in the United States in 124 medical schools. This leaves the opportunity for one more doubling to ensure the complete integration of emergency medicine into academic medicine throughout the country.

Please contact me if you may have an interest in discussing the potential of an academic Department of Emergency Medicine at your institution. The full talent and capability of the AACEM is directed toward this most important goal.

Call For Nominations Young Investigator Award Deadline: December 13, 2002

In May 2003, SAEM will recognize a few young investigators who have demonstrated promise and distinction in their emergency medicine research careers. The purpose of the award is to recognize and encourage emergency physicians/scientists of junior academic rank who have a demonstrated commitment to research as evidenced by academic achievement and qualifications. The criteria for the award includes: 1. Specialty training and certification in emergency medicine or pediatric emergency medicine.

2. Evidence of significant research collaboration with a senior clinical investigator/scientist. This may be in the setting of a collaborative research effort or a formal mentor-trainee relationship.

3. Academic accomplishments which may include: a. postgraduate training/education: research fellowship, master’s program, doctoral program, etc. b. publications: abstracts, papers, review articles, chapters, case reports, etc. c. research grant awards d. presentations at national research meetings e. research awards/recognition The deadline for the submission of nominations is December 13, 2002, and nominations should be submitted electronically to saem@saem.org. Nominations should include the candidate’s CV and a cover letter summarizing why the candidate merits consideration for this award. Candidates can nominate themselves or any SAEM member can nominate a deserving young investigator. Candidates may not be senior faculty (associate or full professor) and must not have graduated from their residency program prior to June 30, 1996.

The core mission of SAEM is to advance teaching and research in our specialty. This recognition may assist the career advancement of the successful nominees. We also hope the successful candidates will serve as role models and inspirations to us all. Your efforts to identify and nominate deserving candidates will help advance the mission of our Society.

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Call for Papers AEM 2003 Consensus Conference: Disparities in ED Health Care

S A E M

Deadline: March 1, 2003 The Editors of Academic Emergency Medicine announce the 2003 AEM Consensus Conference on "Disparities in Health Care" to be held on May 28, 2003 in Boston, the day before the SAEM Annual Meeting.

Disparities in health care are likely to present both within the ED decision making process and in the larger healthcare system. The US emergency departments might be important sources of information about both facets. However, disparities need to be recognized in order to be addressed.

Do inequalities exist in our treatment of emergency patients? If so, under what circumstances, at what level and for what reason? In the larger healthcare system there is evidence that people of color and women do not always receive the same level of care. Are such disparities real? When, why, how, do disparities occur?

Who is at risk of receiving less than optimal care? What is the degree of disparity? How can disparity be eliminated? In a larger sense, what are the best ways to promote a highly reliable system of low variability? Do we teach our residents to deliver disparate care? How does the greater healthcare system contribute to real or perceived disparities in ED management? Are disparities sometimes due to systems incompetence? Is there a relationship between the degrees of inequality and degrees of system incompetence? How can we study these questions? What measures can be used?

Most emergency physicians assume that there should be no disparities in health care. If the general public holds this believe as well, why has our society has not insisted upon the development of an equitable system of healthcare?

The goals of the conference will be to examine the presence, causes, and outcomes related to disparities of healthcare as they occur in emergency departments, and determine the degree to which forces from outside have an impact on our patients. The conference will aim to describe means of defining, assessing, measuring, and researching disparities that may occur in emergency care. The hope is to establish a research agenda for further assessment of these, and other related questions. The conference is a logical progression in the AEM consensus series, which has included "Errors in Emergency Medicine," "The Unraveling Safety Net, " and " Assuring Quality."

We therefore issue this Call for Papers related to the topic of Disparities in ED Health Care. Submitted manuscripts must be received at the AEM editorial office by March 1, 2003. Electronic submission to aem@saem.org of the original and a blinded copy is required. Also include a cover letter indicating that the submission is in response to this Call. Accepted papers will be published in the late fall of 2003, along with Proceedings from the Consensus Conference.

Questions can be directed to Michelle Biros (biros001@maroon.tc.umn.edu) or Jim Adams (jadams@nmh.org).

Call for Abstracts 2003 Annual Meeting May 29-June 1 Boston, Massachusetts Deadline: January 7, 2003 The Program Committee is accepting abstracts for review for oral and poster presentation at the 2003 SAEM Annual Meeting. Authors are invited to submit original research in all aspects of Emergency Medicine including, but not limited to: abdominal/gastrointestinal/genitourinary pathology, administrative/ health care policy, airway/anesthesia/analgesia, CPR, cardiovascular (non-CPR), clinical decision guidelines, computer technologies, diagnostic technologies/radiology, disease/injury prevention, education/professional development, EMS/out-of-hospital, ethics, geriatrics, infectious disease, IEME exhibit, ischemia/reperfusion, neurology, obstetrics/ gynecology, pediatrics, psychiatry/social issues, research design/methodology/statistics, respiratory/ENT disorders, shock/critical care, toxicology/environmental injury, trauma, and wounds/burns/orthopedics.

The deadline for submission of abstracts is Tuesday, January 7, 2003 at 3:00 pm Eastern Time and will be strictly enforced. Only electronic submissions via the SAEM online abstract submission form will be accepted. The abstract submission form and instructions will be available on the SAEM web site at www.saem.org in November. For further information or questions, contact SAEM at saem@saem.org or 517-485-5484 or via fax at 517485-0801.

Only reports of original research may be submitted.

The data must not have been published in manuscript or abstract form or presented at a national medical scientific meeting prior to the 2003 SAEM Annual Meeting. Original abstracts presented at national meetings in April or May 2003 will be considered.

Abstracts accepted for presentation will be published in the May issue of Academic Emergency Medicine, the official journal of the Society for Academic Emergency Medicine. SAEM strongly encourages authors to submit their manuscripts to AEM. AEM will notify authors of a decision regarding publication within 60 days of receipt of a manuscript.

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NOTE: Join SAEM in the last quarter of 2002 and receive membership benefits for the rest of 2002 and all of 2003 with payment of one year’s due payment.

SAEM Membership Application

NOTE: $25 initiation fees have been discontinued. Also, resident members may select membership in one interest group at no charge.

Please complete and send to SAEM with appropriate dues, and supporting materials.

SAEM • 901 N. Washington Ave. • Lansing, MI 48906 • 517-485-5484 • Fax: 517-485-0801 • www.saem@saem.org Name ______________________________________________________________________ Title: MD DO PhD Other _________ Home Address _______________________________________________________________ Birthdate_________________ Sex: M F ___________________________________________________________________________________________________________ Business Address ______________________________________________________________________________________________ ___________________________________________________________________________________________________________ Preferred Mailing Address (please circle): Home Business Telephone: Home ( ______ ) ______________________________ Business ( ______ ) ______________________________ FAX: ( ______ ) _____________________________________ E-mail: ____________________________________________________ Medical School or University Faculty Appointment and Institution (if applicable): _________________________________________________ Membership benefits include: • subscription to SAEM’s monthly, peer-reviewed journal, Academic Emergency Medicine • subscription to the bimonthly SAEM Newsletter • reduced registration fee to attend the SAEM Annual Meeting Check membership category:

❒ Active

❒ Associate

❒ Resident

❒ Fellow

❒ Medical Student

Active: individuals with an advanced degree (MD, DO, PhD, PharmD, DSc or equivalent) who hold a university appointment or are actively involved in Emergency Medicine teaching or research. Annual dues are $365 payable when the application is submitted. The application must be accompanied by a CV. I attest that I hold a university appointment or am actively involved in Emergency Medicine teaching or research: ❒ Yes ❒ No Associate: health professionals, educators, government officials, members of lay or civic groups, or members of the public who have an interest in Emergency Medicine. Annual dues are $350 payable when the application is submitted. The application must be accompanied by a CV. Resident: residents interested in Emergency Medicine. Annual dues are $90 payable when the application is submitted. My anticipated date (month and year) of residency graduation is_________. (A group discount resident member rate is available. Contact SAEM for details.)

Fellow: fellows interested in Emergency Medicine. Annual dues are $90 payable when the application is submitted. My anticipated date (month and year) to complete my fellowship is_________.

Medical Student: medical students interested in Emergency Medicine. Annual dues are $75 (includes journal subscription) or $50 (excludes journal subscription), payable when the application is submitted. My anticipated medical school graduation date (month/year) is _________.

Interest Groups: SAEM members are invited to join interest groups. Include $25 annual dues for each interest group (resident members may join one interest group at no charge): ❒ airway ❒ CPR/ischemia/reperfusion ❒ clinical directors ❒ diversity ❒ domestic violence ❒ EMS ❒ ethics

❒ evidence-based medicine ❒ geriatrics ❒ health services & outcomes research ❒ injury prevention ❒ international ❒ medical student educators

❒ neurologic emergencies ❒ pain management ❒ pediatric emergency medicine ❒ research directors ❒ simulation ❒ substance abuse ❒ toxicology

❒ trauma ❒ ultrasound ❒ web-educators ❒ youth violence prevention

My signature certifies that the information contained in this application is correct and is an indication of my desire to become an SAEM member.

Signature of applicant _______________________________________________________________________ Date ________________ 18

FACULTY POSITIONS

The Institute for International Emergency Medicine and Health at Brigham and Women’s Hospital and the Division of Emergency Medicine at Harvard Medical School are now accepting applications for their International Medicine Fellowship.

ANN ARBOR, MI – FACULTY ACADEMIC/CLINICAL STAFF POSITION. Seeking BC/BP EM physician to join St. Joseph Mercy Hospital. Level II Trauma Center with on-site Medflight air ambulance service that sees 92,000 patients annually between the ED, adult and pediatric ambulatory care centers, and chest pain observation unit. Approved EM Residency program sponsored by hospital and U of M Medical Center. Employed positions offer excellent remuneration plus faculty stipend, productivity bonus, paid malpractice, relocation allowance, cafeteria-style benefits, 401(k), long-term disability, flexible scheduling, and more. Contact Nancy Ely @ 800-4663764, ext.337; nely@epmgpc.com; or visit us @ EPMGPC.com.

Fellowship involves: Two-year track combining clinical emergency medicine, international fieldwork and research project.

Academic classes lead to a Masters Degree at the Harvard School of Public Health.

Academic appointment at Harvard Medical School.

Clinical emergency medicine at affiliated teaching hospitals.

Participation in training of medical students and residents.

Competitive salary, benefits, CME, international travel funds, and training course expenses.

Opportunity to tailor experience to meet specific interest in disaster response, emergency medical systems development, health education, human rights, health emergencies, international public health, and refugee relief.

BROOKLYN, NEW YORK: Seeking a BC/BP physician to join the staff at The Brooklyn Hospital Center. We offer a great working environment (85K visits/yr. and newly renovated ED in mid-2000) along with direct involvement in our fully accredited EM residency-training program. The right person will be offered a competitive package and the opportunity to work with a dynamic, collegial all BC staff. Send CV to: Lisandro Irizarry MD MPH, Chair Emergency Medicine, The Brooklyn Hospital Center, 121 Dekalb Ave. Brooklyn, NY 11201. Fax: 718-250-6528, phone 718-250-6889.

COOK COUNTY HOSPITAL, CHICAGO, IL: The Department of Emergency Medicine is seeking energetic and motivated candidates for a faculty position. Applicants must be residency trained and BC/BE in EM. The Department has 54 residents in a PGY II-IV format and 26 faculty. The EDs care for 115,000 adult, 30,000 pediatric and 5000 Level I trauma patients each year. A new 463 bed Cook County Hospital will be completed in the fall of 2002. The department offers a very competitive benefit package and protected time to pursue educational, administrative and research projects.

Contact: Jeff Schaider, MD, FACEP, Department of Emergency Medicine, 1900 West Polk Street 10th floor, Chicago, IL 60612, Telephone - 312 633 5451 jschaider@ccbh.org

Requires: Residency Training in Emergency Medicine.

Completion of application process, interview, and selection.

Inquiries should be sent to the fellowship director: Mark A. Davis, MD, Institute for International Emergency Medicine and Health, Department of Emergency Medicine, Brigham and Women’s Hospital, PBB-Ground Pike, 75 Francis St., Boston, MA 02115, or by email to madavis@partners.org.

Phone (617)732-5813; fax (617)264-6848.

GEORGIA: MEDICAL COLLEGE OF GEORGIA: EMERGENCY ULTRASOUND FELLOWSHIP. The Department of Emergency Medicine at the Medical College of Georgia is offering a one-year fellowship in emergency ultrasound. The Medical College of Georgia is a level-one trauma center with high volume and high acuity yielding ample pathology for bedside ultrasound diagnosis. The emergency department has three ultrasound machines, including a state of the art machine capable of tissue harmonics and 3-D imaging. The fellow will be exposed to a broad range of emergency ultrasound applications and numerous ultrasound research projects with one of the most experienced and published emergency ultrasonographers in the country. Competitive salary. If interested please send CV and cover letter detailing your interest to: Michael Blaivas, MD, RDMS, Department of Emergency Medicine, Medical College of Georgia, 1120 15th Street, AF-2056, Augusta, GA 30912-4007. E-mail is preferred: blaivas@pyro.net GEORGIA: MEDICAL COLLEGE OF GEORGIA. The Department of Emergency Medicine has two openings for full-time Emergency Medicine attendings. Must be board certified or board eligible in emergency medicine.

Established emergency medicine residency program with nine residents per year. Spacious, new ED facilities. New contiguous children’s hospital and beautiful pediatric ED. Over 67,000 visits per year. Level I trauma center for pediatric and adult patients. Augusta is an excellent family environment and offers a variety of social, cultural and recreational activities. Compensation and benefits are excellent and highly competitive. Contact Larry Mellick, MD, Chair and Professor, Department of Emergency Medicine, 1120 15th Street, AF 2036, Augusta, GA 30912; 706-721-6619, lmellick@mail.mcg.edu . EOE NEW YORK – THE BROOKLYN HOSPITAL CENTER. is seeking applications for Residency Director. We have a fully accredited PGY 1–4 residency and accept 6 residents/year. We see 85,000 visits/year and boast a newly expanded department opened in mid 2000. Applicants must be board certified in EM and have previous experience in resident education and research. A competitive package along with an extremely collegial atmosphere will be offered to the right candidate. Qualified applicants should send a cover letter and CV to Lisandro Irizarry MD MPH, Chair, Dept of Emergency Medicine, The Brooklyn Hospital Center 121 Dekalb Ave. Brooklyn NY 11201 THE OHIO STATE UNIVERSITY: Assistant/Associate or Full Professor.

Established residency training program. Level 1 Trauma center. Nationally recognized research program. Clinical opportunities at OSU Medical Center and affiliated hospitals. Send curriculum vitae to: Douglas A. Rund, MD, Professor and Chairman, Department of Emergency Medicine, The Ohio State University, 016 health Sciences Library, 376 W. 10th Avenue, Columbus, OH 43210 or call (614) 293-8176. Affirmative Action/Equal Opportunity Employer.

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OREGON: The Oregon Health Sciences University Department of Emergency Medicine is conducting an ongoing recruitment of talented entrylevel clinical faculty members at the assistant professor level. Preference is given to those with fellowship training, experience in collaborative clinical research, and writing skills. Please submit a letter of interest, CV, and the names and phone numbers of three references to: Jerris Hedges, MD, MS, Professor & Chair, OHSU Department of Emergency Medicine, 3181 SW Sam. Jackson Park Road, UHN-52, Portland OR 97201-3098.

Emergency Medicine Rochester, Minnesota The Department of Emergency Medicine is seeking a full-time academic emergency physician.

QUINCY MEDICAL CENTER seeks board certified/prepared emergency physicians with outstanding clinical skills and an interest in teaching.

Additional opportunity exists for a qualified candidate as EMS Director.

QMC (31,000 visits/year) is an affiliate of Boston Medical Center and a teaching site for the Boston University EM residency program. Faculty will have a BU academic appointment and opportunity to rotate to Boston Medical Center, the regions busiest Level I Trauma center. Please direct inquires to: William Baker, MD, Assistant Chief EM, or Octavio Diaz, MD, Chief, Quincy Medical Center, phone: (617) 376-5549; E-mail: odiaz@quincymc.org. Affirmative action/equal opportunity employer.

The opportunity includes: ● practice in a 77,000 visit/year, Level 1 trauma center, with over 17, 000 pediatric visits; ● teaching in an emergency medicine residency program, as well as teaching of off-service residents and medical students; ● prehospital/aeromedical program including paramedic base station, 3 rotor and 1 fixed-wing aircraft and; ● research, with administrative support and intramural funding available; ● dynamic faculty with commitment to practice, education and research.

UNC-CHAPEL HILL, 2 openings for either tenure-track or clinical track physicians. Rank/salary commensurate with experience. Successful tenuretrack candidates will be Board Certified/Board Prepared in Emergency Medicine and/or Pediatric Emergency Medicine with an interest in clinical cardiology, neurosciences research, pediatric EM, and/or EMS medical direction. Clinical track faculty are expected to do clinical work only. UNC Hospitals is a 665-bed Level I Trauma Center. The Emergency Department sees upward of 40,000 high acuity patients per year, is active in regional EMS, ACLS/ATLS/BTLS education and has an aeromedical service. Send CV to Edward Jackem, MBA, Department of Emergency Medicine, CB #7594, Chapel Hill, NC 27599-7594. (919) 966-9500. FAX (919) 966-3049. UNC is an Equal Opportunity/ADA Employer.

Candidates must be: ● residency-trained emergency medicine specialists; ● ABEM board certified or eligible; ● individuals with a demonstrated interest in academic emergency medicine as proven by performance in residency or fellowship training, or faculty positions; ● Minnesota medical licensed or eligible.

Competitive salary with an excellent benefit package and academic appointment through the Mayo Medical School. For further information, contact: Wyatt Decker, M.D. Chair, Department of Emergency Medicine Mayo Clinic 1216 Second Street SW Rochester, MN 55902 Phone (507) 255-6501

THE UNIVERSITY OF CALIFORNIA, DAVIS, SCHOOL OF MEDICINE is recruiting for a full-time faculty at the Assistant, Associate or Full Professor level, in the Division of Emergency Medicine and Clinical Toxicology. A residency-training program in emergency medicine began over 10 years ago and currently has 29 residents. The UCDMC Emergency Department provides comprehensive emergency service as a Level I trauma center, as well as a paramedic base station and training center. Candidates for this position must be board certified or eligible in emergency medicine, and be eligible for licensure in California. For consideration, a letter outlining interests and experience, and curriculum vitae should be sent to Robert Derlet, MD, Chair, Emergency Medicine Search Committee, University of California, Davis, Medical Center, 2315 Stockton Blvd., PSSB 2100, Sacramento, CA 95817. Alternatively, an e-mail to Kerry Geist, Manager, Division of Emergency Medicine at klgeist@ucdavis.edu will be accepted.

This position will be open until filled, but applicants will not be accepted after 10/15/02. The University of California is an affirmative action/equal opportunity employer.

Mayo Foundation is an affirmative action and equal opportunity employer and educator.

HEAD OF DEPARTMENT OF EMERGENCY MEDICINE THE UNIVERSITY OF IOWA University of Iowa Health Care is looking for an academic and clinical leader to head a new Department of Emergency Medicine in the Carver College of Medicine and to direct the Emergency Treatment Center at University of Iowa Hospitals and Clinics. The UI Carver College of Medicine has made a commitment to develop an academic department from the existing Program in Emergency Medicine. Witt/Kieffer has been retained to assist in the recruitment of this departmental executive officer.

The Director and Department Head will be a full-time faculty member at the Associate or Full Professor rank, and will report to the Collegiate Dean. Board certification is required either in emergency medicine or in an appropriate discipline with equivalent qualifications based on experience. Previous administrative experience in an emergency medicine program or department is also required. Candidates must be eligible for an Iowa medical license.

The individual will lead the institution in establishing Iowa’s first residency in emergency medicine and the first Department of Emergency Medicine. As Department Head, the individual will be responsible for the educational and residency programs; research programs; faculty recruitment and development; and clinical programs in emergency medicine. Excellent research opportunities are present for EM faculty, including research within the clinical operation of the Emergency Treatment Center (ETC), and in collaboration with the Injury Prevention Center and other units of the College of Public Health.

As Director of the ETC, the individual will oversee the ETC (faculty, staff and budget), helicopter and ground critical care transport services, the paramedic training program, and will lead departmental participation in state and local EMS activities.

The University of Iowa Health Care comprises the University of Iowa Hospital and Clinics and the Roy J. and Lucille A. Carver College of Medicine. The hospital is an 873-bed teaching facility and is a nationally recognized teaching hospital. The Carver College of Medicine has a budget of $339 million, currently enrolls 680 medical students, and is ranked 10th in NIH research support among public medical colleges. The Emergency Treatment Center (ETC) has 29,923 visits annually and is a Level I trauma center. The hospital has approved a $17 million capital plan to renovate and expand the ETC. The successful applicant will be expected to help guide this project.

For additional information, please send a resume in confidence to:

UNIVERSITY OF CALIFORNIA, IRVINE recruiting two new full-time faculty: 1) Assistant or Associate Clinical Professor. Appointment in the clinical scholar series possible. Board preparation or certification in EM required.

Fellowship or advanced degree strongly desired. 2) Experienced EM researcher. Appointment as Associate or Professor in Clinical Scholar series.

Substantial protected time. Board certification in EM required. MPH, PhD or research fellowship/training strongly desired. UCI Medical Center is a 472bed tertiary care hospital with all residencies. The ED is a progressive 33-bed Level I Trauma Center with 46,000 patients, in urban Orange County.

Collegial relationships with all services. Excellent salary and benefits with incentive plan. Send CV to Mark Langdorf, MD, MHPE, FACEP, UCI Medical Center, Route 128. 101 City Drive, Orange, CA 92868. UCI is an equal opportunity employer committed to excellence through diversity.

VANDERBILT UNIVERSITY: The Department of Emergency Medicine has an unexpected opening for a clinician-educator at a level commensurate with qualifications. Please consider joining our successful Department. We have 1st and 4th year medical student rotations, a Level I Trauma Center, contiguous Pediatric and Adult ED’s, a superb residency and all the other components of a well established program. We provide great benefits and Nashville is a great city. Please reply to Corey M. Slovis, M.D., Chairman, Department of Emergency Medicine, Vanderbilt University, 703 Oxford House, Nashville, TN. 37232-4700.

Email: corey.slovis@mcmail.vanderbilt.edu. Vanderbilt is an equal opportunity employer.

Neill Marshall Witt/Kieffer - Dallas 5420 LBJ Freeway, Suite 460 • Dallas, Texas 75240 972-490-1370 or fax resume to 972-490-3472 E-mail: neillm@wittkieffer.com The University of Iowa is an Affirmative Action/Equal opportunity Employer. Women and minorities are strongly encouraged to apply.

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The College of Medicine at the University of Florida Gainesville Campus is recruiting for the position of Clinical Assistant Professor/Clinical Associate Professor in the Department of Emergency Medicine. This teaching hospital emphasizes active involvement with Emergency Medicine residents and medical students. The position could advance to tenure accruing depending upon qualifications and level of experience. The ideal applicant will be residency and board certified in Emergency Medicine, mature with an academic track record, and significant teaching experience. Faculty will provide clinical guidance and supervision of treatment delivered in the ED. A progressive, democratic, superb, 10-person faculty group of team players with emphasis on quality emergency care with dedicated customer service. Shands at UF is the hub of a multi-hospital network. Emergency Medicine medically directs county EMS and hospital transport including the ShandsCare helicopter. Shands Hospital at the University of Florida offers a competitive salary and benefits package including relocation incentives. Great compensations, Great benefits package, Great City!

Molecular Brain Resuscitation Fellowship The Molecular Brain Resuscitation Laboratory at the University of Pennsylvania is offering a two-year research fellowship to Emergency Medicine Residency graduates interested in studying the molecular mechanism of acute neuronal injury caused by stroke, cardiac arrest and head trauma. This training program is part of a multidisciplinary collaboration between NIH-funded laboratories in the Departments of Emergency Medicine, Neurosurgery, Neurology and Pharmacology.

The fellowship is supported by an Institutional Training Grant from the Society for Academic Emergency Medicine. Fellows will be enrolled in the Neuroscience Graduate Program enabling them to pursue a PhD in Neuroscience. Clinical duties are limited to 4 ED shifts/month. Salary ~95K. Start date July of 2003.

Send letter of interest and curriculum vitae to: Robert W. Neumar, MD, PhD Hospital of the University of Pennsylvania Department of Emergency Medicine 3400 Spruce Street Philadelphia, PA 19087 Voice: (215) 898-4960 Fax: (215) 573-5140 Email: rneumar@mail.med.upenn.edu Website: http://www.uphs.upenn.edu/em/brain/

Application deadline: September 30, 2002. Anticipated start date: November 1, 2002. Please send CV to David C. Seaberg, MD, F.A.C.E.P. Associate Professor and Associate Chairman, Department of Emergency Medicine, University of Florida, 1600 SW Archer Road, PO Box 100186, Gainesville, FL 32610-0392. Women and minorities are encouraged to apply. University of Florida is an Affirmative Action Equal Opportunity Employer.

Residency Director Cook County Hospital Chicago, Illinois The Department of Emergency Medicine at Cook County Hospital is seeking candidates for Residency Director.

Applicants must be residency trained and board certified in Emergency Medicine and active at the national level with resident education and training. Applicants should be energetic, motivated and possess outstanding teaching and leadership skills. The Department of Emergency Medicine at Cook County Hospital has 54 residents in a PGY II-IV format and 26 full time faculty. The Emergency Departments care for 115,000 adult, 30,000 pediatric and 5,000 Level I trauma patients each year. A new 463 bed Cook County Hospital will be completed in the fall of 2002 with a new state of the art ED electronic information system. The Residency Director is in charge of the Education Division within the department supervising all educational activities and provides leadership and mentoring for the Associate and Assistant Residency Directors. The department offers a very competitive benefit package and protected time to pursue educational, administrative and research projects. Faculty appointments are at our medical school affiliate, Rush Medical College.

Interested candidates should contact: Jeff Schaider, MD, FACEP, Associate Chairman Department of Emergency Medicine Cook County Hospital 1900 West Polk Street 10th floor Chicago, IL 60612 Telephone - 312 633 5451 jschaider@ccbh.org

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University of Cincinnati Medical Center

Recipients of Visual Diagnosis Contest Announced During the 2002 Annual Meeting in St. Louis a Visual Diagnosis Contest was open to all residents and medical students in attendance. The following winners are to be congratulated on their excellent diagnostic skills:

Open Rank: The University of Cincinnati Department of Emergency Medicine has a full-time academic position available with research, teaching, and patient care responsibilities. Candidate must be residency trained in Emergency Medicine with board certification/preparation. Salary, rank, and track commensurate with accomplishments and experience. The University of Cincinnati Department of Emergency Medicine established the first residency training program in Emergency Medicine in 1970.

The Center for Emergency Care evaluates and treats 76,000 patients per year and has 40 residents involved in a four-year curriculum. Our department has a long history of academic productivity, with outstanding institutional support.

Medical Student Winners: Patrick Stamps-White, University of Iowa.

Resident Winner: Jason Nace, MD, Christiana Care.

The medical student winners will receive a free Annual Meeting registration to the 2003 Annual Meeting.

The resident winner will receive a textbook and a free Annual Meeting registration to the 2003 Annual Meeting.

Please send Curriculum Vitae to: W. Brian Gibler, MD Chairman, Department of Emergency Medicine University of Cincinnati Medical Center 231 Bethesda Avenue Cincinnati, OH 45267-0769

University of Cincinnati Medical Center

Newsletter Advertising The SAEM Newsletter is mailed every other month to the 5,500 members of SAEM. Advertising is limited to fellowship and academic faculty positions. All ads are posted on the SAEM web site at no additional charge.

ANNOUNCING The University of Cincinnati Department of Emergency Medicine has established a second Endowed Chair in Emergency Medicine. We are seeking an established clinician scientist to hold the Endowed

Deadline for receipt: September 1 (Sept/Oct issue), October 15 (Nov/Dec issue), February 1 (March/April), April 1 (May/June), June 1 (July/August), and August 1 (September/October). Ads received after the deadline can often be inserted on a space available basis.

DISTINGUISHED CHAIR FOR CLINICAL RESEARCH IN EMERGENCY MEDICINE

Advertising Rates: Classified Ad (100 words or less) Contact in ad is SAEM member ......................................$100 Contact in ad non-SAEM member ..................................$125 1/4 - Page Ad (camera ready) 3.5" wide x 4.75" high ....................................................$300

The University of Cincinnati Department of Emergency Medicine established the first Residency Training Program in Emergency Medicine in 1970. We have a long history of productive research with special emphasis on Cardiovascular, Neurovascular, Toxicology/HBO, and Outcomes investigation. This Endowed Chair offers a special opportunity for an individual to pursue a leadership position in Emergency Medicine.

To place an advertisement, e-mail, fax or mail the ad, along with contact person for future correspondence, telephone and fax numbers, billing address, ad size, and Newsletter issues in which the ad is to appear to: Jennifer Mastrovito at jmastrovito@saem.org, via fax at (517) 485-0801 or mail to 901 N. Washington Avenue, Lansing, MI 48906. For more information or questions, call (517) 485-5484 or jmastrovito@saem.org.

Individuals interested in this opportunity are encouraged to contact: W. Brian Gibler, MD Richard C. Levy Professor of Emergency Medicine Chairman, Department of Emergency Medicine University of Cincinnati College of Medicine 231 Albert Sabin Way Cincinnati, OH 45267-0769 513/558-8086 FAX: 513/558-4599 e-mail: Diane.Shoemaker@uc.edu

All ads posted on the SAEM web site at no additional charge.

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SAEM 2003 Research Grants Emergency Medicine Medical Student Interest Group Grants These grants provide funding of $500 each to help support the educational or research activities of emergency medicine medical student organizations at U.S. medical schools. Established or developing interest groups, clubs, or other medical student organizations are eligible to apply. It is not necessary for the medical school to have an emergency medicine training program for the student group to apply. Deadline: September 4, 2002.

Research Training Grant This grant provides financial support of $75,000 per year for two years of formal, full-time research training for emergency medicine fellows, resident physicians, or junior faculty. The trainee must have a concentrated, mentored program in specific research methods and concepts, and complete a research project. Deadline: November 1, 2002.

Institutional Research Training Grant This grant provides financial support of $75,000 per year for two years for an academic emergency medicine program to train a research fellow. The sponsoring program must demonstrate an excellent research training environment with a qualified mentor and specific area of research emphasis. The training for the fellow may include a formal research education program or advanced degree. It is expected that the fellow who is selected by the applying program will dedicate full time effort to research, and will complete a research project. The goal of this grant is to help establish a departmental culture in emergency medicine programs that will continue to support advanced research training for emergency medicine residency graduates. Deadline: November 1, 2002.

Scholarly Sabbatical Grant This grant provides funding of $10,000 per month for a maximum of six months to help emergency medicine faculty at the level of assistant professor or higher obtain release time to develop skills that will advance their academic careers. The goal of the grant is to increase the number of independent career researchers who may further advance research and education in emergency medicine. The grant may be used to learn unique research or educational methods or procedures which require day-to-day, in-depth training under the direct supervision of a knowledgeable mentor, or to develop a knowledge base that can be shared with the faculty member’s department to further research and education. Deadline: November 1, 2002.

Emergency Medical Services Research Fellowship This grant is sponsored by Medtronic Physio-Control. It provides $60,000 for a one year EMS fellowship for emergency medicine residency graduates at an SAEM approved fellowship training site. The fellow must have an in-depth training experience in EMS with an emphasis on research concepts and methods. The grant process involves a review and approval of emergency medicine training sites as well as individual applications from potential fellows. Deadline: November 1, 2002.

Neuroscience Research Fellowship This grant is sponsored by AstraZeneca. It provides one year of funding at $50,000 for an emergency medicine resident, graduate, or junior faculty member to obtain a mentored research training experience in cerebrovascular emergencies. The research training may be in basic science research, clinical research, or a combination of both, and the mentor need not be an emergency medicine faculty member. Completion of a research project is required, but the emphasis of the fellowship is on the acquisition of research skills. Deadline: November 1, 2002.

EMF/SAEM Medical Student Research Grants This grant is co-sponsored by the Emergency Medicine Foundation and SAEM. It provides up to $2,400 over 3 months for a medical student to encourage research in emergency medicine. More than one grant is awarded each year. The trainee must have a qualified research mentor and a specific research project proposal. Deadline: February 3, 2003.

Geriatric Emergency Medicine Resident/Fellow Grant This grant is made possible by the John A. Hartford Foundation and the American Geriatric Society. It provides up to $5,000 to support resident/fellow research related to the emergency care of the older person. Investigations may focus on basic science research, clinical research, preventive medicine, epidemiology, or educational topics. Deadline: March 3, 2003.

Further information and application materials can be obtained via the SAEM website at www.saem.org.

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S A E M

NEWSLETTER

Society for Academic Emergency Medicine 901 N. Washington Avenue Lansing, MI 48906-5137

Presorted Standard U.S. Postage PAID Lansing, MI Permit No. 485

Newsletter of the Society for Academic Emergency Medicine Board of Directors Roger Lewis, MD, PhD President Donald Yealy, MD President-Elect Carey Chisholm, MD Secretary-Treasurer Marcus Martin, MD Past President James Adams, MD Glenn Hamilton, MD Katherine Heilpern, MD James Hoekstra, MD Judd Hollander, MD Donald J. Kosiak, Jr., MD

Editor David Cone, MD David.Cone@yale.edu Executive Director/Managing Editor Mary Ann Schropp mschropp@saem.org Advertising Coordinator Jennifer Mastrovito Jennifer@saem.org

“to improve patient care by advancing research and education in emergency medicine”

The SAEM newsletter is published bimonthly by the Society for Academic Emergency Medicine. The opinions expressed in this publication are those of the authors and do not necessarily reflect those of SAEM.

S A E M

Call for Didactic Proposals 2003 Annual Meeting May 29-June 1, 2003 Boston, Massachusetts Deadline: September 9, 2002

The Program Committee is soliciting proposals for didactic sessions for the 2003 Annual Meeting. Didactic sessions should emphasize issues of research, education, clinical advances in Emergency Medicine, and faculty development. Didactics may be aimed at medical students, residents, junior faculty and/or senior faculty.

The format may be a lecture, panel discussion, or workshop. The Program Committee will also review proposals for pre- or post-day workshops, or multiple sessions during the Annual Meeting aimed at in-depth instruction in a specific discipline. Didactic proposals should support the mission of SAEM and should fall into one of the following categories: • • • •

Education (education methodology, improving the quality of education, enhancing teaching skills) Research (research methodology, improving the quality of research) Career Development State-of-the-Art (presentation of cutting-edge basic science or clinical research that has important implications for further investigation or the future practice of emergency medicine) • Health Care Policy and National Affairs Note that State-of-the-Art sessions are not a review of the literature of a summary of clinical practice. All submitters are asked to briefly explain how the session meets the SAEM mission.

The deadline for submission is Monday, September 9, 2002 at 5:00 pm Eastern Time. Only on-line submissions will be accepted. To submit a proposal, complete the on-line Didactic Submission Form at www.saem.org. For additional questions or information, contact SAEM at saem@saem.org or 517-485-5484 or via fax at 517-485-0801.