S A E M
NEWSLETTER
Newsletter of the Society for Academic Emergency Medicine
PRESIDENT’S MESSAGE Thoughts of a Cat Herder Prior to beginning my term as President of SAEM I wondered what it would be like to serve in this role. Now, having completed most of my year as President, I occasionally reflect on what I have learned from this experience, and how this year Roger J. Lewis, MD, PhD has been different than I anticipated. In this column, I would like to share some of these thoughts, which I will call the “thoughts of a cat herder.” As I anticipated beginning my term, I considered those characteristics I admire in leaders, including vision for the future, the ability to motivate others, and personal integrity. While personal integrity is vitally important in everything we do as academicians and physicians, neither broad vision nor the ability to motivate others is truly essential to lead this Society. In essence, one just needs to be a good cat herder. Cats and academic emergency physicians share a number of personality characteristics. They are both fiercely independent and self-reliant. Many have an inherent distrust of authority; they don’t naturally identify or follow a leader and, while social, rarely spontaneously assemble in groups. [For the purist, I am discussing the social characteristics of the domesticated cat, not large wild cats of Africa.] However, when a particular task or goal catches their interest they pursue it with patience, skill, and tenacity. I have been consistently impressed this year with the ingenuity, energy, and individual efforts many of our members make to advance academic emergency medicine and improve the care of patients in the emergency department. In many cases, their efforts demonstrate tremendous vision for the future of our field. Our members have the vision and motivation essential to ensure an active, effective, and worthwhile Society. How does the Board of Directors guide a Society that is fundamentally composed of many creative, independent, and productive individuals? While the Board of Directors approves the goals and objectives of each SAEM Committee and Task Force each year, many of the best ideas for goals and objectives come from the members of the Committees and Task Forces, or from SAEM members at large. Furthermore, our Committees and (continued on page 19)
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March/April 2003 Volume XV, Number 2
Call for Non-Funded Grant Applications Richard E. Rothman, MD, PhD Johns Hopkins University Following the success of the small ‘Unfunded Grant Review’ Session last year, the Research Committee will again offer expert peer-review of grant applications. These may include either submitted unfunded applications, or applications that are near-ready for submission, but could benefit from additional feedback. This year there will be two sessions held at the Annual Meeting: (1) a series of small parallel informal feedback/review sessions, which will include the grant applicant and two expert reviewers (with a small audience of up to 10); and (2) a didactic session, which will use material from the smaller grant review sessions as a take-off point for education and discussion regarding grant applications. This session will include common errors, pitfalls, pearls for success. We are seeking submissions of non-funded applications. Faculty or fellows who are at various stages of the grant application process, from early drafts to submitted but unfunded applications, are encouraged to respond. Those who submit an application can expect to receive feedback and constructive criticism that will strengthen their application and increase chances for future funding. Reviews will be provided by a small panel of two to three EM reviewers who have reasonably extensive experience in the grant review process in both governmental and private sectors. Applications will be paired with expert reviewers according to the type of submission (i.e. basic, translational, clinical). Guidelines for submission: Submit the following: a 2-page synopsis submission consisting of (1) Title, authors and affiliations; (2) Abstract; (3) Hypothesis; (4) Specific Aims; (5) Methods (outlined or summarized) (6) Short summary of previous criticims by extramural committees; (5) One paragraph synopsis of areas that warranted explanation, in view of comments from prior review; (6) Names of agencies that have previously reviewed the application; and (7) A copy of the entire grant (optional but preferred). For those who have not yet submitted, send a draft of the entire grant application and a paragraph describing areas which are self-identified as problematic. The Research Committee will select up to 5 grants for review. Those selected will be prereviewed by at least 2 expert reviewers. At the Annual Meeting applicants will be asked to give a 5-10 minute oral presentation of their grant in a small closed session. Expert reviewers will give feedback and constructive criticism about how the application could be strengthened. The feedback process will include dialogue between the applicant and the review panel. Each application will also receive a written critique and summary of suggestions. Applicants must submit their 2-page submission (or their entire proposal) electronically to saem@saem.org. The deadline for receipt of applications is April 15, 2003. For questions, contact Rich Rothman at rrothman@jhmi.edu.
Smallpox Vaccination for Emergency Physicians Joint Statement of the American Academy of Emergency Medicine and the Society for Academic Emergency Medicine AAEM and SAEM support preparations to improve readiness to care for victims of a possible bioterrorism attack using smallpox. However, we believe there is insufficient evidence to recommend that emergency physicians be vaccinated against smallpox at this time. Although we cannot recommend the vaccine, we do not oppose voluntary immunization of those who wish to receive the vaccine. In the event of a documented smallpox case or a credible, imminent threat, the benefits of smallpox vaccination would become clearer. The organizations will continue to monitor the issue and update these recommendations as more information on vaccine safety and risk of an exposure becomes available. The risks of smallpox vaccination appear to be small, but they are not zero. Risks are higher for those who have never been previously vaccinated. The possible benefit of smallpox vaccination at this time appears to be negligible. It is impossible to do a rigorous scientific analysis of the risk/benefit ratio for smallpox vaccination at this time, because the risk of a smallpox attack is unknown. The probability that any individual physician would be among those to see the first few cases of a smallpox outbreak is extremely low. It is likely that smallpox vaccine can provide protection up to several days after exposure. A strategy to ensure timely vaccination of exposed health care workers if a smallpox case is identified would avoid the risk of unnecessary adverse reactions to smallpox vaccine at a time when smallpox does not exist. Emergency physicians should work with public health authorities to ensure that such mechanisms are in place. Some emergency physicians may choose to receive smallpox vaccine at this time—especially those who are concerned about their ability to receive timely post-exposure vaccination. Smallpox vaccination should proceed
cautiously, to insure the safety of health care workers and our patients. Preevent smallpox vaccination of health care workers should be guided by the following principles: Pre-exposure smallpox vaccination should be offered on a voluntary basis. Although smallpox vaccination appears to be relatively safe, there are some risks. Health care workers should be given the best available scientific information so they can make informed decisions about vaccination. It must be recognized that the scientific data regarding the risks of vaccinating health care workers under current conditions are limited. There should be no negative repercussions for health care workers who do not wish to be vaccinated. Confidentiality should be protected when screening for potential contraindications to vaccination. Health care workers should be protected from liability related to vaccination. Vaccinated emergency physicians and other health care workers should be protected against liability for any adverse reactions that may occur to patient contacts, as long as ACIP (Advisory Committee on Immunization Practices) post-vaccination recommendations are followed. Health care workers who are vaccinated for smallpox should be compensated for any illness or loss of income that results from serious adverse reactions. State workers’ compensation programs, as well as individual medical insurance or disability insurance, should provide coverage for any vaccinationrelated illness and loss of income that may result from inability to work. If these entities do not provide coverage, then compensation should be made available through other programs. Coverage for illness or disability related
to vaccination should be clearly established before a vaccination program is initiated. Health care workers should be aware that most programs would not provide any compensation for brief inability to work due to a minor reaction. Recommendations regarding vaccine site care and patient-care precautions after vaccination should be clear and based on the best scientific data. The June, 2001 ACIP recommendations (MMWR June 22, 2001 / 50(RR10);1-25) suggested that newly vaccinated HCWs avoid contact with immunosuppressed patients. However, the October 2002 supplemental recommendations (http://www.bt.cdc.gov/ agent/smallpox/vaccination/acip-recsoct2002.asp) do not recommend any administrative leave or practice restrictions, but rather emphasize vaccine site care with proper covering, including gauze and semipermeable dressing. Because emergency health care workers have little or no control over the types of patients for whom they will be caring, it is important to have a clear consensus that no patient care restrictions are necessary. Smallpox vaccination of health care workers should be monitored closely for safety, and vaccination recommendations revised if necessary. Because scientific data regarding the safety of smallpox vaccination of health care workers under current conditions are limited, it is important to carefully collect data on the safety and effectiveness of vaccination. Vaccination programs should proceed at a pace that allows analysis of data from the first vaccine recipients before more widespread vaccination is implemented. If the results of these studies indicate unacceptable risk, then vaccination recommendations should be promptly revised accordingly.
Residency Vacancy Service The SAEM Residency Vacancy Service was established more than ten years ago to assist residency programs and prospective emergency medicine residents. The Residency Vacancy Service is posted on the SAEM web site at www.saem.org. Residency programs are invited to list their unexpected vacancies or additional openings by contacting SAEM. SAEM monitors and updates the listings. Prospective emergency medicine residents are invited to review these listings and contact the residency programs to obtain further information. Listings are deleted only when the residency program informs SAEM that the position(s) are filled. 2
SAEM Web Editor-in-Chief Sought The SAEM Board of Directors is initiating a search for an SAEM member to serve as an Editor-in-Chief for the SAEM web site (www.saem.org). The web site is an increasingly important source of information on all aspects of academic emergency medicine for emergency physicians, residents, and medical students. The web site complements SAEM's other media resources, the SAEM Newsletter and our peerreviewed journal, Academic Emergency Medicine. The Web Editor-in-Chief will be responsible for editorial and content decisions, revision of the organization of
the site, improving the presentation of materials, and suggesting changes that will augment end-user functionality. Technical support, script programming, and the actual uploading of content will continue to be handled by the SAEM staff and by paid consultants to SAEM. The Web Editor-in-Chief will report directly to the SAEM Board of Directors. It is anticipated that initial appointments will be for two years, subject to renewal. This position represents an excellent opportunity for an SAEM member with technical vision and excellent organizational skills who wishes to increase their involvement in the Society. The position
will require frequent interactions with the Board of Directors, Committee and Task Force Chairs, and other members. Interested members should send a letter of interest which includes: (1) a description of relevant experience and activities; (2) a brief description of the applicant's vision for the SAEM web site; and (3) URLs for any web site(s) the applicant has developed. Letters of interest should be addressed to Roger J. Lewis. The deadline for receipt is May 9, 2003. One or more members of the Board will interview applicants during the upcoming Annual Meeting in Boston.
Report from the AAEM/SAEM Smallpox Vaccine Work Group Gregory J. Moran, MD Olive View-UCLA Medical Center Worth W. Everett, MD University of Pennsylvania David J. Karras, MD Temple University Nicki T. Pesik, MD Emory University Matthew David Sztajnkrycer, MD, PhD Mayo Clinic On December 13, President Bush formally announced the national smallpox vaccination program. The plan involves vaccinating health care workers who would respond to possible smallpox cases, including emergency physicians. Although not all aspects of the program are clearly established, it appears that vaccination of health care workers will occur in the near future. AAEM and SAEM support preparations to improve readiness to care for victims of a possible bioterrorism attack using smallpox. However, we believe there is insufficient evidence to recommend that emergency physicians be vaccinated against smallpox at this time. Although we do not recommend the vaccine, we do not oppose voluntary immunization of those who wish to receive the vaccine. In the event of a documented smallpox case or a credible, imminent threat, the benefits of smallpox vaccination would become clearer. The organizations will continue to monitor the issue and update these recommendations as more information on vaccine safety and risk of an exposure becomes available. The risks of smallpox vaccination appear to be small, but they are not
zero. Risks are higher for those who have never been previously vaccinated. The possible benefit of smallpox vaccination at this time appears to be negligible. It is impossible to do a rigorous scientific analysis of the risk/benefit ratio for smallpox vaccination at this time, because the risk of a smallpox attack is unknown. The probability that any individual physician would be among those to see the first few cases of a smallpox outbreak is extremely low. It is likely that smallpox vaccine can provide protection up to several days after exposure. A strategy to ensure timely vaccination of exposed health care workers if a smallpox case is identified would avoid the risk of unnecessary adverse reactions to smallpox vaccine at a time when smallpox does not exist. Emergency physicians should work with public health authorities to ensure that such mechanisms are in place. Some emergency physicians may choose to receive smallpox vaccine at this time—especially those who are concerned about their ability to receive timely post-exposure vaccination. Smallpox vaccination should proceed cautiously, to insure the safety of health care workers and our patients. Preevent smallpox vaccination of health care workers should be guided by the following principles: Pre-exposure smallpox vaccination should be offered on a voluntary basis. Although smallpox vaccination appears to be relatively safe, there are some risks. Health care workers should be given the best available scientific 3
information so they can make informed decisions about vaccination. It must be recognized that the scientific data regarding the risks of vaccinating health care workers under current conditions are limited. There should be no negative repercussions for health care workers who do not wish to be vaccinated. Confidentiality should be protected when screening for potential contraindications to vaccination. Health care workers should be protected from liability related to vaccination. Vaccinated emergency physicians and other health care workers should be protected against liability for any adverse reactions that may occur to patient contacts, as long as ACIP (Advisory Committee on Immunization Practices) post-vaccination recommendations are followed. Health care workers who are vaccinated for smallpox should be compensated for any illness or loss of income that results from serious adverse reactions. State workers’ compensation programs, as well as individual medical insurance or disability insurance, should provide coverage for any vaccinationrelated illness and loss of income that may result from inability to work. If these entities do not provide coverage, then compensation should be made available through other programs. Coverage for illness or disability related to vaccination should be clearly established before a vaccination program is initiated. Health care workers should be aware that most programs would not provide any compensation for brief (continued on page 4)
Report from Smallpox Vaccine Work Group inability to work due to a minor reaction. Recommendations regarding vaccine site care and patient-care precautions after vaccination should be clear and based on the best scientific data. The June, 2001 ACIP recommendations (MMWR June 22, 2001 / 50(RR10);1-25) suggested that newly vaccinated HCWs avoid contact with immunosuppressed patients. However, the October 2002 supplemental recommendations (http://www.bt.cdc.gov/ agent/smallpox/vaccination/acip-recsoct2002.asp) do not recommend any administrative leave or practice restrictions, but rather emphasize vaccine site care with proper covering, including gauze and semipermeable dressing. Because emergency health care workers have little or no control over the types of patients for whom they will be caring, it is important to have a clear consensus that no patient care restrictions are necessary. Smallpox vaccination of health care workers should be monitored closely for safety, and vaccination recommendations revised if necessary. Because scientific data regarding the safety of smallpox vaccination of health care workers under current conditions are limited, it is important to carefully collect data on the safety and effectiveness of vaccination. Vaccination programs should proceed at a pace that allows analysis of data from the first vaccine recipients before more widespread vaccination is implemented. If the results of these studies indicate unacceptable risk, then vaccination recommendations should be promptly revised accordingly. To ensure that emergency physicians have the best information available on which to make their own decision regarding vaccination, we would like to make you aware of the following resources for information regarding smallpox and vaccination: 1. The CDC homepage for smallpox information is at: www.bt.cdc.gov/ agent/smallpox/index.asp.This index includes links for more detailed information on smallpox vaccine, protection from previous smallpox vaccination, vaccine contraindications and side effects, vaccination techniques, precautions after vaccination, etc. 2. Information on risk of adverse reactions from smallpox vaccine is avail-
3.
4.
5.
6.
able at: www.bt.cdc.gov/agent/ smallpox/vaccination/reactionsvacc-clinic.asp In a recent study of adult primary vaccinees, 36% were sufficiently ill to miss work, school, or recreational activities or to have trouble sleeping. Based on a 1968 nationwide study of smallpox vaccination, the approximate risks of serious adverse reactions for first-time vaccinees are as follows: Serious, but not life threatening reactions (inadvertent inoculation, generalized vaccinia): 49 per million Life threatening reactions (encephalitis, progressive vaccinia, eczema vaccinatum): 14 per million Death: 1 per million The risks for those who were previously vaccinated are much lower. A document on provider liability is available on the CDC website at www.bt.cdc.gov/agent/smallpox/vac cination/section-304-qa.asp. Section 304 of the Homeland Security Act provides legal protection to hospitals and qualified health professionals who administer the smallpox vaccine. It is not clear whether this includes liability protection for health care workers who receive the vaccine. The plan in its current form provides no compensation for health care workers, their families or others who may become ill due to the vaccine. AAEM and SAEM urge health care workers to make sure prior to being vaccinated that their health and disability insurers will cover such illnesses and to determine what workers’ compensation coverage will be provided by their states due to loss of time at work should they become ill. AAEM and SAEM hope to obtain further clarification about liability coverage and compensation. More information regarding provider liability can be found at: http://biotech.law.lsu.edu/blaw/bt/sm allpox/spnews.htm Information regarding the specifics of the national smallpox vaccination strategy may be found at www.bt.cdc.gov/agent/smallpox/vac cination/vaccination-program-statement.asp. The CDC smallpox response plan version 3.0 is at www.bt.cdc.gov/ 4
agent/smallpox/responseplan/index.asp. This document includes detailed information on the CDC’s planned response in the event of a smallpox event. 7. The National Network for Immunization Information has Qand-A documents for the public (www.immunizationinfo.org/features/index.cfm?ID=48) and health professionals (www.immunizationinfo.org/healthProfessionals/hp_featuredarticle.cfm?ID=49). 8. A group of smallpox papers were recently published on the NEJM website and can be found at: Perspective: Smallpox Vaccination — The Call to Arms T.L. Schraeder and E.W. Campion http://content.nejm.org/cgi/content/abstr act/NEJMp020177v1 Special Article: A Model for a SmallpoxVaccination Policy S.A. Bozzette and Others http://content.nejm.org/cgi/content/abstr act/NEJMsa025075v1 Special Article: The Public and the Smallpox Threat R.J. Blendon and Others http://content.nejm.org/cgi/content/ abstract/NEJMsa023184v1 Current Concepts: How Contagious Is Vaccinia? K.A. Sepkowitz http://content.nejm.org/cgi/content/abstr act/NEJMra022500v1 Sounding Board: A Different View of Smallpox and Vaccination T. Mack http://content.nejm.org/cgi/content/abstr act/NEJMsb022994v1 Letter to the Editor: A Smallpox False Alarm J.A. Hanrahan, M. Jakubowycz, and B.R. Davis http://content.nejm.org/cgi/content/abstr act/NEJMc021898v1 AAEM and SAEM are committed to protecting the interests of emergency physicians and our patients as we work with federal, state and local agencies to implement a smallpox vaccination program that is based on sound scientific principles.
Additional Views on the Smallpox Vaccine Report Working Group The issues relating to the Smallpox Vaccine are important for emergency physicians. Therefore, in addition to the efforts of the AAEM/SAEM Working Group published in this issue SAEM invited Dr. Kelen, Dr. McNamara, and Dr. Schneider to provide alternate views on the report and position statement. I appreciate the time and effort the position statement took. However, I have chosen to be vaccinated. This is not a decision I came to lightly. Here are my considerations: 1. Is there a reasonable threat? Who knows? This is simply a matter of faith. Do you believe it or not? Since I could not answer this, I moved on to the next question. 2. What would I do if a case of smallpox appeared in my ED? The likelihood is that I would not be on duty, but I would most certainly get a call. Would I stay at home and let my already-exposed faculty continue to care for the patient(s)? Would I rush in and relieve the faculty? This is similar to the decision made by the physicians who cared for flu victims in 1918, and in the early days of the AIDS epidemic. The answer here was easy for me. Based on my past performance, I would clearly respond to the ED. 3. Knowing that I would undoubtedly respond, should I rely on post exposure prophylaxis? Here again the decision for me was clear. While there is attenuation of the disease with PEP, the question is: how soon will the vaccine be given in a crisis? Knowing I would respond, I would prefer not to rely on post exposure attenuation. 4. What are the risks of getting the vaccine? For me they are small, though undoubtedly real. I have been vaccinated twice without incident. There are no contraindications in my household. That is not true for many of my faculty (all the more reason I would rush in). I agree with many who are concerned about illness/disability coverage. Luckily, my institution has agreed to cover these issues fully. This I believe is a very legitimate argument for those not covered to forego vaccination. 5. Is there a risk to my patients? Again my institution (which was one of the primary sites for research on smallpox vaccine) stands behind the CDC’s recommendation and will allow us to work, albeit with a great deal of precautions. Sandy Schneider, MD University of Rochester Although I respect the position statements, and recognize that it is specific to emergency practitioners, after considerable deliberation, the Hopkins enterprise came to a different conclusion. We
consulted the experts within the Center for Civilian Biodefense http://www.hopkins-biodefense.org, ethicists, clinicians, and scientists who have had direct experience with smallpox, vaccinations, and vaccine development, military experts, state and local government, and our legal experts. It was a tough decision and could have gone the other way if we hadn't gotten cooperation of the State. Here were some of the factors. 1. We came to the conclusion that the risk of a smallpox outbreak was unknown, therefore we could not with confidence say it is zero or even infinitesimally small. 2. We also reviewed the literature, including preprints of the recent (Jan 29th) NEJM articles. One of these articles modeled under what circumstances various types of vaccination policies would be appropriate. For some very low probability scenarios, pre-vaccination of healthcare workers makes sense. 3. Finally, not being assured that the risk was zero, we wanted a cadre of confident, protected healthcare workers, who would in fact show up to work, while others were being vaccinated in the case of an event. 4. We could not convince the government at this time to give us control over stocks of vaccine (although this may yet happen) vaccination has to be in the hands of the State. 5. It is unclear if the next generation of vaccines would be safer or as effective. 6. We convinced our State to change its plans and "Go Slow" (6-8 months), allowing us to shut off or ramp up as we gained more experience here and around the country. 7. We involved every level of the Institution, from the leadership to the "experts" to the rank and file employees. Regarding the latter, we had many open meetings at multiple sites with physicians and staff. 8. Hopkins' own experience over the last 15 years of smallpox vaccinations for research or travel purposes, including those not previously vaccinated, has revealed no major effects. The Israeli experience (17K or so to date) has revealed one major complication: transmission of vaccinia to an immunocompromised spouse. (This index individual would not have qualified to receive vac5
cine here). The U.S. military vaccinated literally millions from the 60's to the early 1990's, with no major complications known. Gabe Kelen, MD Johns Hopkins University Certainly there will be some cases of vaccine complication presenting to the ED. I would assume most of us would go to the CDC web site, contact the local public health agency, and involve our infectious disease consultants in any major issue. The CDC believes covering the immunization site is all that is needed for returning to work, but at my institution the ID folks said they would want anyone who receives the vaccine to be out of work for 18-21 days given our transplant and other immuno-suppressed patients. The institution is not allowing vaccine recipients to work. While waiting for a smallpox case may be the only level of risk at which emergency physicians would consider vaccination, there should be a well-conceived plan for how emergency services in each community would be delivered during such a public emergency. Who will come in to relieve one of us at the end of the shift under such circumstances, if they are not immunized? I think the position statement addresses that, and I agree that there needs to be a plan for rapid vaccine distribution in the event of a case. Most states plan to have 50-100 people at each hospital immunized, but in reality hundreds will require early vaccination if a case ever walks in to the ED. Consider all of the personnel who have not been immunized: the security and registration folks, people in the waiting room and treatment area, EMS, etc. If there is no plan to deliver vaccine rapidly and the word is out, who will report to duty anywhere in the hospital, let alone the ED? The bottom line for this issue, in my view, is that the vaccine can harm your patients and yourself and currently there is zero proof that we need it. The odds of being the physician on duty when the first case of smallpox in the whole world comes in to your ED is quite remote. If the government has more evidence they should show it to us. Robert McNamara, MD Temple University
Research Fund Update Frank Counselman, MD Eastern Virginia Medical School SAEM Financial Development Committee The inaugural launch of the SAEM Research Fund is off to an impressive start. To date, contributions total over $42,000. To those members who have contributed, we thank you. If you have not had the opportunity to contribute, please consider joining your fellow members in contributing to this worthy effort. The mission of the SAEM Research Fund is three-fold: to improve the care of patients in the Emergency Department and prehospital setting through medical research and scientific discovery; to enhance research capability within the field of Emergency
Professor ($2500 or more) James G. Adams, MD Michelle H. Biros, MS, MD Gabor D. Kelen, MD, FRCP(C) Mary Ann Schropp Susan A. Stern, MD Mentor ($1000-$2499) Michelle Blanda, MD Glenn C. Hamilton, MD Donation in Memory of George & Maxine Hamilton Roger J. Lewis, MD, PhD John A. Marx, MD Sponsor ($500-$999) Gail Anderson, MD Felix K. Ankel, MD Michael Callaham, MD Carey D. Chisholm, MD Steven C. Dronen, MD Kelly Anne Foley, MD Katherine L. Heilpern, MD James W. Hoekstra, MD Kenneth V. Iserson, MD, MBA Michael Lucchesi, MD Marcus L. Martin, MD Brian J. O'Neil, MD Phillip L. Rice, Jr., MD Donation in Memory of Dr. Nina Mazur Joseph A. Salomone, III MD Scott A. Syverud, MD Donation in Memory of William Spivey & Michael Spadafora
Medicine; and to support investigators in pursuit of the skills necessary to conduct ethical and important research to create new knowledge for the benefit of all patients in the Emergency Department. The emphasis of the SAEM Research Fund is to support research training grants, open to all members who seek such training. One hundred percent of your contributions go directly to the Fund. The administrative costs of maintaining the Research Fund are borne separately by the SAEM operating budget. Remember, your donation
Unity Physician Group University Emergency Medicine Foundation Donald M. Yealy, MD Brian J. Zink, MD Investigator ($250-$499) Christopher Beach, MD Bellevue Hospital Carlos A. Camargo, Jr MD, DrPH Theodore A. Christopher, MD Francis L. Counselman, MD Gary M. Gaddis, MD, PhD Marianne Gausch Hill, MD Susan L. Gin-Shaw, MD David A. Guss, MD Cherri Hobgood, MD Robert S. Hockberger, MD Judd E. Hollander, MD Sheldon Jacobson, MD James H. Jones, MD Louise Kao, MD Kevin J. Knoop, MD Richard M. Levitan, MD Anthony L. Macasaet, MD Lawrence A. Melniker, MD E. Jedd Roe, III MD Robert W. Schafermeyer, MD Fred Anthony Severyn, MD Marc David Squillante, DO Donation in Memory of Alphonse Squillante Matthew J. Walsh, MD Michael D. Witting, MD
is 100% tax deductible. We would like to have 100% participation of the membership in supporting the SAEM Research Fund. Please consider making a donation equal to two to three hours of work. Make your check payable to “SAEM Research Fund” and mail it to: Society for Academic Emergency Medicine, 901 N. Washington Ave., Lansing, MI 48906. You can also make your donation online by going to www.saem.org and click on “Click here to contribute to the Research Fund”.
Supporter ($100-$249) James T. Amsterdam, DMD, MD, MMM Donation in Honor of Edie A. Ales John W. Becher, DO Steven L. Bernstein, MD Louis S. Binder, MD Michael Bohrn, MD Mark Alan Borenstein, MD Russ Braun, MD, MPH, MBA Judith C. Brillman, MD E. Martin Caravati, MD, MPH Amy Church William C. Dalsey, MD Daniel Danzl, MD Carla'nne Dukes, DO John Eric Duldner, Jr., MD James A. Feldman, MD Susan S. Fish, PharmD, MPH Gregory Garra, DO Romolo I. Gaspari, MD Lowell W. Gerson, PhD Leon L. Haley, Jr., MD, MHSA Kennon Heard, MD Mary A. Hegenbarth, MD Mark C. Henry, MD Eric B. Herbert, MD Brian Hiestand, MD Benjamin Honigman, MD Debra Houry, MD, MPH David S. Howes, MD Gregg Husk, MD Charlene Babcock Irvin, MD Neil Jasani, MD David J. Karras, MD Harry D. Kerr, MD (continued on page 7)
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Research Fund Update (Continued) Stephen R. Knazik, DO Steven E. Krug, MD Nathan Kuppermann, MD, MPH Donation in Memory of Ken Graff Joseph LaMantia, MD Todd M. Larabee, MD Eric Legome, MD Christopher H. Linden, MD Robert A. Lowe, MD, MPH Donation in Memory of William Spivey Catherine A. Marco, MD Keith A. Marill, MD Tracy R. McCubbin, MD Francis Mencl, MD James J. Menegazzi, PhD Daniel C. Morris, MD Donation in Honor of Veterans of Foreign Wars Peter Moyer, MD William D. O'Riordan, MD Edward A. Panacek, MD Norman Paradis, MD
Frank S. Pettyjohn, MD Stephen R. Pitts, MD Michael S. Radeos, MD Donation in Memory of William Spivey Thomas J. Regan, MD James Richardson, MBA John C. Sakles, MD Sally Santen, MD Robert C. Satonik, MD Michael R. Sayre, MD Amy K. Schantz-Rontal, MD Lawrence R. Schwartz, MD David C. Seaberg, MD Richard D. Shih, MD Paul A. Silka, MD Marco Leonardo Sivilotti, MD, MSc John J Skiendzielewski, MD Vicken Y. Totten, MD, MS University Emergency Medical Services Phyllis Vallee, MD Marvin A. Wayne, MD Robert D. Welch, MD
Arlo Weltge, MD, MPH Robert A. Wiebe, MD James A. Wilde, MD Mildred Willy, MD Lance D. Wilson, MD Andrew G. Wilson, Jr., MD Kelly D. Young, MD Christopher Michael Ziebell, MD Frank L. Zwemer, Jr., MD, MBA Other Margaret Barron, MD Kevin Brown, MD Joseph J. Calabro, DO Kathryn Hall-Boyer, MD William G. Heegaard, MD, MPH Kaveh Ilkhanipour, MD Edward C. Jauch, MD Donation in Memory of Michael Spadafora Donald J. Kosiak, Jr., MD Thomas J. Regan, MD Richard Sinert, DO Edward P. Sloan, MD, MPH
Board of Directors Update The SAEM Board meets monthly, usually via conference call. This article includes the highlights of the December and January Board conference calls. The Board approved the final version of the Memorandum of Understanding (MOU) between SAEM and the Department of Health and Human Services. SAEM’s activities related to the MOU will be coordinated in the coming year by the SAEM Healthy People 2010 Task Force, which will be chaired by Carlos Camargo, MD. These activities will be in the following areas: access to quality health services, injury and violence prevention, respiratory diseases, and substance abuse. Specifics will be detailed in future issues of the Newsletter in the coming year. The Board appointed Worth Everett, MD, Nicki Peski, MD, and Matthew Sztajnkryer, MD, as the SAEM representatives to the AAEM/SAEM Smallpox Vaccine Working Group. The resulting report and position statement are published in this issue of the Newsletter. The Board approved a position statement entitled, “Optimizing Care of the Stroke Patient.” This position statement will be published in a future issue of
Academic Emergency Medicine and the May/June issue of the Newsletter. The Board approved an outline of a position statement on “Teaching on the Newly Dead.” The Board approved a request from CORD to work together to develop a joint task force on the issue of cultural awareness. CORD and SAEM will develop specific objectives, timelines, etc., in the coming months. The Board approved two amendments to the SAEM Constitution and Bylaws, as proposed by the Constitution and Bylaws Committee, chaired by Dr. Neumar. The amendments are published in this issue of the Newsletter. The Board approved the Consulting Service Guidebook developed by Glenn Hamilton, MD, the chair of the Consulting Service Task Force. The Board approved applications from the following five regional meetings: Southwestern, New England, MidAtlantic, Western, and New York. The Board will review the application of the Midwestern Regional Meeting in the coming months. The Board developed a letter to the Association of American Medical 7
Colleges (AAMC) regarding definitions for under-represented minorities. This letter was published in the January/February issue of the Newsletter. The Board submitted a nomination to the Institutional Review Committee of the Accreditation Council on Graduate Medical Education. The Board approved sponsorship of the National Alcohol Screening Day, and approved publication of an announcement in the January/February issue of the Newsletter. For many years, medical students have been offered two options regarding SAEM membership: receiving a subscription to AEM as a membership benefit, or choosing a less expensive dues payment and not receiving a subscription to AEM. The Board approved a proposal to amend medical student membership to match the other membership categories. Medical students members will no longer be given the option of paying a lesser dues amount and not receive a subscription of AEM. It was noted that most medical students did not take advantage of the less expensive dues.
Program Committee for the 2003 Meeting Jeffrey A. Kline, MD Carolinas Medical Center Chair, SAEM Scientific Subcommittee of the Program Committee On any given day when you walk into the emergency department to assume a shift, you are probably confronted with a mosaic of complaints and problems to solve, including the management of patients with headache, chest pain, asthma attack; a child with a fever, and an intoxicated elderly man with a thermal burn.You may have a message to call an administrator about the lack of beds in the hospital, and a new clinical triage policy in effect that has altered the flow of patient. The prehospital radio may be calling you to report on a patient being transported who was just in a car crash, and you may need to decide the level of service required to care for this patient. Such is a day in your life in the ED. When you see the contents of the research being presented at the 2003 Annual Meeting in Boston from May 28-June 1, you will see a mosiac of titles intended to reflect a day in your life in the ED. The Program Committee has endeavored to aggregate well-conceived and highly scored abstracts into chief complaint and disease-based oral and poster presentation modules. We hope that both your first glance, and your prolonged analysis, leave you with the conclusion that the research being done by the presenters addresses your needs as a practicing academic emergency physician. You will also notice several other changes, including most prominently two plenary sessions on the first and third mornings and unopposed poster sessions each afternoon. The decision for two plenary sessions reflects our maturation as a Society, and increased number of high quality submissions afforded to us each year. With further time, we hope to evolve into having a plenary session each day. Having two plenary sessions is a step in this direction. The decision to make the poster sessions unopposed evolved primarily out of requests from the membership. Frequently, the concern has been voiced that poster sessions are over-shadowed by other events. Having the poster sessions unopposed will ameliorate this problem. Within each of the daily poster venues, we will also continue to have two moderated poster sessions, which represent focused discussions on controversial or “hot� topics. We will be inviting guest moderators for certain sessions, in particular for those earmarked as discussion sessions. The unique feature of these oral discussion sections is an extra half-hour allocated to allow increased dialogue on the subject at hand. In the final count, there were 939 abstracts submitted, with 451 accepted. The decision to accept was based primarily on the abstract score, which was determined by independent review by at least 5 experts in the category of submission. Figure 1 shows histogram plots with overlying best-fit normal distribution curve for all valid abstract scores data. Figure 2 shows the histogram plot of the averages of 41 basic science abstracts. Summary descriptive data are provided for these figures. One reason for parsing out the basic science abstracts is to demonstrate a relatively small number of fundamental, mechanistic studies being submitted, and also to point out their tendency to have relatively higher scores than the general pool of abstracts. This permits one of several interpretations, including that the score or scoring system biases toward an artificially inflated score for basic science abstracts, or that the basic science quality is generally higher than the clinical science quality. Whether either or both of these explanations are at play, the Program Committee continues to
encourage the development of basic science in emergency medicine, and in future years we hope to have special sessions dedicated to encouragement of training and a forum for presentation of basic science work within the emergency medicine community. Histogram for Total Score 1200
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Figure 1. Histogram plot of all abstract scores for the 2003 Annual meeting. (Valid Data N= 5370, Mean11.36, SD 4.23, SEM 0.057, Lower 95% CL11.24, Upper 95% CL 11.47 Skewness -0.31, Kurtosis 2.54 Upper Quartile 15, Median 12, Lower Quartile 8) Histogram for Basic Science Scores 25
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Figure 2. Histogram plot of means of 41 basic science abstracts submitted to the 2003 meeting. (Valid Data N=41, Mean 14.5, SD 1.9, SEM 0.297, Lower 95% CL 13.91, Upper 95% CL 15.11, Skewness -0.89, Kurtosis 2.97, Upper Quartile 15.7, Median 15.2, Lower Quartile 13.75) The content of the abstracts accepted to the 2003 Annual Meeting will provide a compelling reason to travel to Boston this Spring. However, many other attractions of the meeting and the city will draw many of you. In addition, we will continue the tradition of having a high quality educational opportunity at the meeting, including 35 didactic sessions and 4 stateof-the-art sessions. These didactics were chosen from a total of 110 submissions - again reflecting the competitive and spir8
Report from Program Committee
First Working Session on Emergent Genomics
(Continued) ited nature of our Society and its members. We anticipate a highly attended and high-impact meeting. In conclusion, I would like to acknowledge and thank the SAEM members who donated their time and energy to review and score the submitted abstracts:
John Younger, MS, MD University of Michigan There is a revolution underway in the field of medical genomics; genetic variants associated with illness are being identified at a rapid and still accelerating pace. Underlying genetic variation no doubt affects the nature and severity of disease among patients cared for in Emergency Departments. It remains unclear, however, what role if any increased understanding of these unalterable patient characteristics might play in the actual delivery of emergent medical care. Fundamental hurdles abound, such as upon which diseases and genes focus should be placed and whether genetic information can ever realistically become available in clinically meaningful ‘real time.’ With this in mind, the University of Michigan and Carolinas Medical Center are excited to sponsor the First Working Session on Emergent Genomics during the SAEM Annual Meeting on May 30, 7:00-9:00 pm in Boston. This session will provide a forum for investigators to briefly present ideas, strategies, and preliminary data and to troubleshoot every aspect of this very challenging new endeavor. This will not be a didactic session! Rather, it will be an informal opportunity* for investigators and potential investigators to discuss their work, no matter how preliminary, in this area. We therefore extend an open invitation to anyone currently working in the area with experience in any of the following:
2003 Abstract Reviewers Jean Abbott, MD James Adams, MD Mark Angelos, MD Amado Baez, MD Chris Barton, MD Louis Binder, MD Michelle Biros, MS, MD Michael Blaivas, MD Michelle Blanda, MD Clifton Callaway, MD Carlos Camargo, MD Carey Chisholm, MD David Cone, MD Gregory Conners, MD Francis Counselman, MD Cathy Custalow, MD Rita Cydulka, MD Chris Decker, MD Daniel Dire, MD Amy Ernst, MD Brian Euerle, MD Sue Fish, PharmD, MPH John Flaherty, MD Howard Freed, MD Leonard Friedland, MD E. John Gallagher, MD Gregg Garra, MD Paul Gennis, MD Robert Gerhardt, MD Lowell Gerson, MD Lewis Goldfrank, MD Marc Gorelick, MD Diane Gorgas, MD Louis Graff, MD Steve Green, MD David Guss, MD Jerris Hedges, MD, MS Katherine Heilpern, MD Sean Henderson, MD Judd Hollander, MD Debra Houry, MD J. Stephan Huff, MD Raymond Jackson, MD
Sheldon Jacobson, MD Brantley T. Jolly, MD Alan Jones, MD Sharhabeel Jwayyed, MD Arthur Kellermann, MD John Kelly, MD Mark Kirk, MD Jeffrey Kline, MD David Lee, MD Roger Lewis, MD, PhD Bernard Lopez, MD Steve Lowenstein, MD Xin Ma, MD David Milzman, MD Robert Muelleman, MD Steve Meldon, MD Robert Neumar, MD Richard Nowak, MD Robert O’Connor, MD Brian O’Neil, MD James Olson, MD Diana Pancu, MD Susan Promes, MD James Reed, MD Philip Salen, MD Arthur Sanders, MD Terri Schmidtt, MD Phillip Scott, MD David Seaberg, MD Suzanne Shepard, MD Richard Shih, MD Robert Silbergleit, MD Richard Sinert, MD Susan Stern, MD Ian Stiell, MD Terry Vanden Hoek, MD Gary Vilke, MD Mary Jo Wagner, MD Ellen Weber, MD Stewart Wright, MD Michael Yaron, MD Donald Yealy, MD Robert Zalenski, MD
• Identifying which diseases warrant study • Selecting candidate genes • Choosing a detection technique (PCR, real-time PCR with fluorescent probes, gene sequencing, etc.) • Reliably collecting blood leukocyte, buccal scrape, or other tissue in the ED for DNA isolation • Using point-of-care DNA extraction systems and thermocyclers (including hand-held PCR devices) • Addressing consent and regulatory hurdles related to emergent collection of genetic material, including HIPPA. To sign up for a presentation or for more information contact: jyounger@umich.edu. The time available for individual presentations will be inversely proportional to the number of interested participants. This session has been approved to be held in conjunction with the SAEM Annual Meeting. Currently Scheduled Participants “Use of rapid screening methods to detect thrombophilic gene mutations as an adjunct to pretest probability assessment and risk stratification in venous thromboembolic disease in the ED setting,” Jeff Kline, MD, Carolinas Medical Center “Mannose binding lectin polymorphisms: a potential target for infectious and inflammatory disease characterization in the ED?,” John Younger, MS, MD, University of Michigan “Acute molecular triage for infectious disease in the ED,” Richard Rothman, MD, PhD, and Samuel Yang, MD, Johns Hopkins University Wine and beer will be provided. No jacket required.
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Academic Emergency Medicine Journal Report 2002 Michelle Biros, MD, MS Hennepin County Medical Center Editor-in-Chief Jim Adams, MD and Dave Cone MD Senior Associate Editors The Editors of Academic Emergency Medicine (AEM) are pleased to provide you with this year-end report for 2002, which marks the 9th year of publication. Thanks to the energy and enthusiasm of our outstanding Editorial Board, the dedication and commitment of our peer reviewers and the steadfast support of our authors and readers, we have continued to provide you with excellent and relevant articles on the science, art and practice of our specialty. We thank you for your continued input regarding the workings of the journal and welcome your questions, comments and suggestions. Please feel free to contact any of our editors at any time. In 2002, AEM received 736 manuscripts for consideration for publication, including 597 original contributions that underwent peer review. As of this writing, decisions have been made on 706 of the total, with an overall acceptance rate of 39.5% and a turn around time of 39 days from receipt of the submission to the first decision. For revisions that we received, the turn around time was 13 days between the receipt of the revision and the final decision. Although our manuscript numbers have increased by almost 20 % from 2001 to 2002, the turn around times from receipt to first decision have remained the same (40 days in 2001). The on-line journal continues to be a success. From January to December 2002, the electronic version of full text articles in AEM was accessed almost 50,000 times. We have provided free access to over sixty developing countries, as defined by the World Health Organization, and readers from these nations have made good use of this service. This year we have added two additional features to our electronic journal. We now provide links from the articles we publish to their references, allowing readers to easily access useful resources. We have also added the data supplement, which allows us to electronically publish data collection vehicles, additional information that may be relevant to the readers of a particular article, and even raw data for some studies. The data supplements that we include are referred to in the paper journal for additional access as desired.
The reports we generate with the electronic journal allow us to get an overview of the interests of our readers. The most frequently accessed journal section this year was Clinical Investigations, followed by Clinical Practice and Special Contributions. By tracking the number of accesses we received this year, we have derived a list of the ten most frequently read AEM articles in 2002 (Table One). We also have determined the 10 articles from AEM that were most frequently cited in 2002 (Table Two). We believe these lists provide us with an interesting snapshot of the current research activities in our specialty and thus indirectly reflect the most important aspects of our clinical practice. The continued success of the journal is due in large part to our outstanding peer reviewers. This year, we have updated and refreshed the AEM reviewer database and have added many new reviewers to bring our current roster up to 303 reviewers. With each peer reviewed submission undergoing an average of three peer reviews each, we have obtained approximately 1800 reviews in 2002! We are still seeking new reviewers to keep our ranks current and expert. If you are interested in helping us maintain the quality of the literature by reviewing for AEM, and can provide us with timely evaluations of submitted articles, please let us know. In addition to expanding our reviewer database, we also have added to the ranks of our Editorial Board, and increased the number of Associate (decision) Editors who coordinate the selection of manuscripts for acceptance for publication. In 2002, Charlene Irvin, Gabe Kelen, Jeff Kline, and Catherine Marco became Associate Editors for AEM. Mike Blaivas, Rita Cydulka, and Brian Zink also joined the AEM Editorial Board. We look forward to working with these talented individuals and are very grateful for their efforts. We also most sincerely thank Judd Hollander, Ed Panacek, Chuck Cairns, Carlos Camargo, John Gallagher and Kathy Shaw, who rotated off the Editorial Board this year. Marc Shapiro and Pat Croskerry are also new to the Editorial Board, and are 10
editing a new journal section on “Profiles in Patient Safety”. This popular section developed through the efforts of the SAEM Patient Safety Task Force, coincided with the focus of the first AEM Consensus Conference, held in 2000, on Errors in Emergency Medicine. We followed this with an AEM Consensus Conference on the Unraveling Safety Net in 2001 and on Quality in Emergency Care in 2002. The 2002 AEM Consensus Conference was led by Art Sanders, and featured Ken Kizer and Helen Burstin as keynote speakers. The November AEM issue each year has subsequently been dedicated to publishing proceedings and original contributions related to the annual AEM Consensus Conferences. In 2002, the November issue also published proceedings and original contributions from another consensus conference, sponsored by the Council of Emergency Medicine Residency Directors (CORD) on the ACGME Core Competencies and Best Practices. Editors Felix Ankel, Deb Perina and Carey Chisholm provided the editorial oversight and coordination for the publications related to the CORD conference. The AEM consensus conferences have been so successful in bringing specialty and out of specialty attention to an important and timely patient centered topics that we have decided to continue this offering again in 2003. Our next AEM consensus conference, “Disparities in Emergency Health Care “ will be held on May 28, 2003. Keynote speakers are Jordan Cohen, MD (president of the AAMC) and Nicole Lurie, MD (Senior Program Officer, Division of Health Sciences Policy Analysis, RAND Corporation). Registration is limited, and available through the registration for the 2003 SAEM Annual Meeting. With this brief overview, we hope to convey to you the excitement and pride that we feel with every issue of AEM. We hope the Journal has continued to address your needs and that you will feel free to let us know how we can improve our service to you. It has been an honor to work with the AEM Editorial Board, our reviewers, authors and readers in 2002. We look forward to another year of continued growth and fruitful collaborations in 2003.
AEM Journal Report 2002 (Continued) Table One: Top 10 AEM Articles Accessed From January 2002 - December 2002
Table Two: Top 10 Most Frequently Cited AEM Articles in 2002 1. RW Derlet, JR Richards, RL Kravit Frequent Overcrowding in U.S. Emergency Departments Acad Emerg Med Feb 01, 2001 8: 151-155.
CLINICAL INVESTIGATIONS MK Kim, RT Strait, TT Sato, HM Hennes A Randomized Clinical Trial of Analgesia in Children with Acute Abdominal Pain Acad Emerg Med Apr 01, 2002 9: 281-287.
2. JE Hollander, RS Hoffman, P Gennis, P Fairweather, MJ DiSano, DA Schumb, JA Feldman, SS Fish, S Dyer, P Wax Prospective Multicenter Evaluation of cocaineAssociated chest Pain. Cocaine Associated Chest Pain (COCHHPA) Study Group Acad Emerg Med Jul 01, 1994 1: 330-339.
CLINICAL PRACTICE S Goodacre, T Locker, F Morris, S Campbell How Useful Are Clinical Features in the Diagnosis of Acute, Undifferentiated Chest Pain? Acad Emerg Med Mar 01, 2002 9: 203-208. SPECIAL CONTRIBUTIONS PE Mason, WP Kerns Gamma Hydroxybutyric Acid (GHB) Intoxication Acad Emerg Med Jul 01, 2002 9: 730-739.
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BASIC INVESTIGATIONS B Gilmer, J Kilkenny, C Tomaszewski, JA Watts Hyperbaric Oxygen Does Not Prevent Neurologic Sequelae after Carbon Monoxide Poisoning Acad Emerg Med Jan 01, 2002 9: 1-8.
JE Hollander, SM Valentine, GX Brogan Academic Associate Program: Integrating Clinical Emergency Medicine Research With Undergraduate Education Acad Emerg Med Mar 01, 1997 4: 225-230.
4. VS Tayal, RW Riggs, JA Marx, CA Tomaszewski, RE Schneider Rapid-Sequence Intubation at an Emergency Medicine Residency: Success Rate and Adverse Events During a Two-Year Period Acad Emerg Med Jan 01, 1999 6: 31-37.
BASIC INVESTIGATIONS SR Smith, JD Baty, D Hodge Validation of the Pulmonary Score: An Asthma Severity Score for Children Acad Emerg Med Feb 01, 2002 9: 99-104.
5. JF Tucker, RA Collins, AJ Anderson, J Hauser, J Kalas, FS Apple Early Diagnostic Efficiency of Cardiac Troponin I and Troponin T for Acute Myocardial Infarction Acad Emerg Med Jan 01, 1997 4: 13-21.
SPECIAL CONTRIBUTIONS S Schenkel Promoting Patient Safety and Preventing Medical Error in Emergency Departments Acad Emerg Med Nov 01, 2000 7: 1204-1222.
6. WD Rosamond, RA Gorton, AR Hinn, SM Hohenhaus, DL Morris Rapid Response to Stroke Symptoms: The Delay in Accessing Stroke Healthcare (DASH) Study Acad Emerg Med Jan 01, 1998 5: 45-51.
CLINICAL INVESTIGATIONS EG Marvez-Valls, A Stuckey, AA Ernst A Randomized Clinical Trial of Oral versus Intramuscular Delivery of Steroids in Acute Exudattive Pharyngitis Acad Emerg Med Jan 01, 2002 9: 9-14.
7. G Kovacs, P Croskerry Clinical Decision Making: An Emergency Medicine Perspective Acad Emerg Med Sep 01, 1999 6: 947-952.
CLINICAL PRACTICE SM Green, B Krauss Pulmonary Aspiration Risk during Emergency Department Procedural Sedation—An Examination of the Role of Fasting and Sedation Depth Acad Emerg Med Jan 01, 2002 9: 35-42.
8. KV Rhodes, JA Gordon, RA Lowe Preventive Care in the Emergency Department, Part I: Clinical Preventive Services—Are They Relevant to Emergency Medicine? Acad Emerg Med Sep 01, 2000 7: 1036-1041.
BASIC INVESTIGATIONS JF Holmes, JC Sakles, G Lewis, DH Wisner Effects of Delaying Fluid Resuscitation on an Injury to the Systemic Arterial Vasculature Acad Emerg Med Apr 01, 2002 9: 267-274.
9. RK Cydulka, CL Emerman, NJ Jouriles Evaluation of Resident Performance and Intensive Bedside Teaching During Direct Observation Acad Emerg Med Apr 01, 1996 3: 345-351.
CLINICAL PRACTICE JE Huizenga, BJ Zink, RF Maio, EM Hill Guidelines for the Management of Severe Head Injury: Are Emergency Physicians Following Them? Acad Emerg Med Aug 01, 2002 9: 806-812.
10. JA Kline, S Meek, D Boudrow, D Warner, S Colucciello Use of the Alveolar Dead Space Fraction (Vd/Vt) and Plasma D-Dimers to Exclude Acute Pulmonary Embolism in Ambulatory Patients Acad Emerg Med Sep 01, 1997 4: 856-863. 11
Report on the NINDS Conference Brian O’Neil, MD William Beaumont Hospital/Detroit Receiving Hospital SAEM Representative to the NINDS Conference I had the pleasure of representing SAEM at the recent National Institute of Neurological Disorders and Stroke (NINDS) meeting entitled “Improving the Chain of Recovery for Acute Stroke in Your Community.” The meeting had wide representation, including PM&R, nursing, interventional radiology, and extended care facilities. This broad representation was a direct attempt by the NINDS to involve all potential players in the treatment of stroke, whether in the acute or the extended care setting. EM was well represented at this conference, as the two co-chairs were Dr. William Barsan and Dr. Paul Pepe. The primary goal of this conference was to produce a document that would address six main stroke issues: public recognition, choosing the level of care, professional education, a template for organizing stroke triage, incentives for stroke care, and provider support systems. The early morning session on the first day was dedicated to presentation of the previous stroke trials, and subanalyses of old data. In addition, data was presented showing that all successful therapeutic stroke trials incorporated a stroke team or stroke unit. It was noted that stroke teams and units are labor and time intensive, and require a commitment from doctors, administrators, and other health care sources. The emphasis was not on tPA-eligible patients, but rather on the care of the other 98% of patients. Dr. Andy Jagoda noted that many emergency physicians still question the validity of the data, as only one thrombolytic stroke trial has reported positive results. Dr. Jagoda further noted the difficulties associated with instant access to CT scanners and consultants. Next, multiple models of stroke systems were presented. Dr. Arthur Pancioli addressed audience comments regarding the ACEP policy statement regarding tPA in stroke. The ACEP policy states that there is insufficient evidence to endorse the use of IV tPA when systems are not in place to insure that the inclusion criteria of the NINDS guidelines are followed. Therefore, the decision to use IV tPA in the ED should begin at the institutional level, with commitments from hospital administration, the ED, neurology, neurosurgery, radiol-
ogy, and laboratory services to ensure that the systems necessary for the safe use of thrombolytic agents are in place. During the breakout sessions, questions were raised regarding obtaining informed consent from these patients. The issue of informed consent boiled down to whether or not your institution considered this as “use of the standard of care.” We ultimately agreed that if your institution considers tPA as part of the stroke guidelines, then it would not necessarily require you to get informed consent. If, however it is not considered a standard under the guidelines of your institution, then informed consent would be needed. The patient or patient’s family then needs explicit information regarding a ten-fold increase in intracerebral bleeds (although even with increased bleeds there was no increase in mortality) and the 12 to 13% of patients who will have less disability at three months. It was felt the decision on informed consent was best left within each institution. Public Recognition of Stroke The committee noted that public recognition of stroke symptoms is inadequate, and the urgency of the disease is not stressed enough. A goal was set of 70% of patients presenting to hospitals in less than three hours from symptom onset. The education process itself will need to move on multiple fronts and multiple levels of knowledge, targeted at the whole population, but tailored to special populations. Research needs to be done in stroke education, looking specifically for cost-effective education in stroke care. Choosing the Level of Care It was felt that each institution needs to choose its level of care, from basic care to a stroke center to a comprehensive stroke center. (The definition for the comprehensive stroke center, which is the highest level of care, will be established by the Brain Attack Coalition. The concept of credentialing was also supported.) Institutions and physicians should examine both the resources in the facility and the resources around them, from EMS to extended care facilities. Once chosen and achieved, an institution’s stroke designation should
be clearly stated. The committee felt that these levels of care should define whether patients will be admitted or transferred to another facility. The data support the use of guidelines for improving care and also a multidisciplinary approach with the inclusion of neurology, primary care medicine, PMR, nursing, OT, and PT. Professional Education This task force felt that physicians need to have an active learning base, feedback, and targeted and focused instruction. Education needs to be presented on multiple levels, as multiple providers are involved. It was also felt that there needs to be performance assessment for the teacher and the student. Organizing Stroke Triage This group was charged with developing “how to” guides on getting patients to the hospital, and starting the process. Their recommendations included defining and finding a “champion,” and getting both physician buy-in to staff a stroke team and administration support of that stroke team. Networks, which include EMS, medical societies, and hospital councils, are needed, along with the involvement of the community and politicians. Incentives for Stroke Care The committee noted that currently there is no reimbursement for full consultations or review of CT’s, which are obviously necessary if these consultants are going to be the primary providers of tPA infusion for stroke. It was noted that support from third party payers in general, and the Medicare system in particular, was critical. It has been noted that CMS has dropped the stroke quality indicator. Incentives need to be improved for consultant support for neurology and radiology, and if these services are not available, modalities such as tele-medicine should be investigated. Provider Support System A provider support system is defined as the human and material resources necessary to solve a clinical problem. No mechanisms are available through (continued on page 17)
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A New Era for Funding Research in Pediatric Emergency Medicine Isabelle Melese-d’Hospital, PhD, Research Specialist EMSC National Resource Center Harold K. Simon, MD Emory University/Children’s Healthcare of Atlanta SAEM Research Committee A previous SAEM newsletter article (Jan/Feb 2002) outlined funding opportunities available for researchers in pediatric emergency medicine (PEM) through the American Academy of Pediatrics such as the PEM-CRC’s Ken Graff Young Investigator Award. Other opportunities for funding were through various pediatric academic societies (Ambulatory Pediatric Association, American Pediatric Society, and the Society for Pediatric Research (www.aps-spr.org)). This article focuses on federal opportunities and developments of interest to PEM researchers. Researchers in PEM now have more potential funding opportunities than ever before. This is in part due to the Health Resources and Services Administration’s Maternal and Child Health Bureau (MCHB) and its federal and private partnerships. In 2001 and 2002, the MCHB’s Research Bureau (mchb.hrsa.gov/grants) and EMS for Children Program awarded cooperative agreements named the Network Demonstration Development Project (NDDP) and the Center for Data Management Coordinating Center (CDMCC). The competitive award recipients consisted of five university centers, who together form the basic infrastructure for the first federally funded Pediatric Emergency Care Applied Research Network (PECARN). Furthermore, the EMSC program has been sponsoring and working closely with other U.S. government entities which fund research through the federal Interagency Committee on EMSC Research (ICER). ICER partnerships with agencies across the DHHS are responsible for a significant increase in awareness of existing funding opportunities. The EMSC program also provides a monthly updated “Grants Alert!” section through its website at (www.ems-c.org). The “Grants Alert!” lists federal agencies as well as private professional organizations and foundations that recognize the importance of improved research in PEM. PECARN The goal of the PECARN is to conduct high priority multi-institutional
research on the prevention and management of acute illnesses and injuries in children. It is comprised of four regional multi-institutional nodes and a coordinating data center. Each node works collaboratively with the others and with MCHB/HRSA to initiate, implement, and administer network research. Specific research projects, however, require extramural research funding. The four Regional Nodal Centers (RNCs) and their 25 Hospital Emergency Department Affiliates (HEDAs) in the PECARN network serve approximately 840,000 acutely ill and injured children every year. These HEDAs represent academic, community, urban, rural, general, and children’s hospitals. The PECARN offers investigators both within the network and outside (who have a sound research hypothesis related to the emergency care of children) an opportunity to submit a proposal and to access large sample sizes through the network’s 25 hospital ED sites across the country. The successful proposal will enable the PI to enjoy collaboration with an experienced network of PEM researchers and will potentially enhance the chance of future funding at the R01 level. This collaborative network serves as a resource for the country in advancing research in pediatric emergency care, translating research into practice, and providing training to health care providers in pediatric emergency medical and nursing research, as well as prehospital EMS research. National EMS Research Agenda In December 2001, the National EMS Research Agenda (www.nhtsa. dot.gov) supported by the EMSC program and administered by NHTSA, was completed and disseminated. The document provides a template and excellent resources for EMS and EMSC researchers interested in studying prehospital care. The Agenda can also be used to educate funding agencies at the local, state, and national level along with policymakers, state EMS directors, EMS educators, and other members of the EMS community about the importance of supporting EMS research for children 13
and adults. Interagency Committee on EMSC Research (ICER) A milestone was achieved in January 2001 with the release of the “Research on Emergency Medical Services for Children” research announcement PA01-044, in the NIH Guide to Grants and Contracts. The EMSC program guided eight federal agencies from its Interagency Committee on EMSC Research (ICER) in collaborating together to craft this important announcement. These eight are: Human Resources and Services Administration as the lead agency; Agency for Healthcare Research and Quality (AHRQ), The Center for Disease Control and Prevention’s National Institute for Occupational Safety and Health (CDC/NIOSH); the National Heart, Lung and Blood Institute (NHLBI), National Institute for Child Health and Human Development (NICHD), National Institute on Drug Abuse (NIDA), National Institute of Mental Health (NIMH) and National Institute for Nursing Research (NINR). The program announcement can be found on all of the partners’ websites, as well as www.ems-c.org and the NIH Guide to Grants and Contracts at grants1.nih.gov/grants/guide/index.html. The EMSC program is currently working with these existing partners towards an extension of this historic interagency achievement, which currently expires in 2004. Another goal for 2003 is to craft a new joint request for proposals in the area of EMSC research, with dedicated funding from each participating agency. New members have been recruited to join the ICER in these productive interagency meetings, where federal program staff can share information and strategies to improve the flow and quality of research, with an emphasis on EMS and children. Furthermore, since terrorism has become a top priority, members have been updating each other on resulting changes in their agencies, such as the increased emphasis on bio-defense, trauma, and emergency-related research, with research funding spikes most notable at the NIH (continued on page 16)
ACADEMIC RESIDENT News and Information for Residents Interested in Academic Emergency Medicine Edited by the SAEM GME Committee
The General Competencies: What EM Residents Need to Know Steven H. Bowman, MD Rush Medical College/Cook County Hospital Eric Legome, MD New York University/Bellevue Hospital Peter Shearer, MD Mount Sinai School of Medicine/Elmhurst Hospital Center SAEM Graduate Medical Education Committee The General Competencies have finally arrived at an emergency medicine residency near you. Like a trailer for a movie with no release date, the competencies have been hovering on the horizon for a few years now. Why is knowledge of the competencies important to the residents reading this section of the SAEM Newsletter? If you are a new junior resident, a graduating senior who will be working with EM residents, or somewhere in between, the General Competencies will serve as the basis for all resident evaluations. In addition to the competencies, several new evaluation tools will also be arriving in various forms in programs nationwide. The following is an overview of what’s going on and how some of these changes will affect you as an EM resident. In one of the broadest reaching changes in post-graduate medical education, the Accreditation Council for Graduate Medical Education (ACGME) has redefined the criteria by which we teach and evaluate residents. The ACGME has undertaken an extensive “outcomes project.” This is a longterm initiative by which the ACGME is increasing emphasis on educational outcome assessment in the accreditation process. The aim is to fulfill a long-term goal of improving the quality of graduate medical education. Previously, a residency programs was judged on its potential to educate by focusing on the structure and process components of its curriculum. The new standard is to judge programs based on their actual outcomes. Residency programs will soon be required to identify specific learning objectives related to the ACGME’s general competencies, develop objective tools to measure resident performance, and use the derived data to provide continuous improvement. In a previous newsletter (May/June 2001), the specific competencies were addressed. We will address several questions surrounding the competencies in this edition. We will look at the evolution of the competencies to become the new standards for evaluation and their plan for implementation. We will review some of the common assessment methodologies and tools currently in place. We will also discuss the problems with and possible solutions to validating these tools and measurement devices. In its own words, the ACGME has been “playing catch up” with other accrediting bodies in the health professions, education, and business that have focused on educational outcomes since the 1980s. At that time, the U.S. Department of Education mandated the greater use of outcome assessment in the accreditation process. As a result, many of these 14
organizations began to expand their use of outcome measures in accreditation. In addition to competency in clinical care, multiple studies had shown that patients’ satisfaction depended heavily on an empathetic, caring physician with good listening and communication skills. The ability to demonstrate educational outcomes as the achievement of competency-based learning objectives will theoretically address these issues. Residents are evaluated at the end of each monthly rotation by faculty. The challenge has been to define a uniform set of qualities, skills, or behaviors that make a good doctor and to objectively evaluate a resident on each of these qualities. If done well this would allow a program director to tell a resident, for example, “Your medical knowledge is at the expected level, but you need to work on your interpersonal skills.” The Outcomes Project Advisory Group has accomplished this task by defining the six general competencies that encompass medical practice, i.e. qualities, skills, and behaviors that make a good doctor. The Outcomes Project Advisory Group is an 11 member consultative body funded by a Robert Wood Johnson Foundation grant. The members have expertise in different areas central to the outcomes project. They were responsible for crafting the general competencies, developing assessment methods, and recommending that emphasis is placed on outcomes in graduate medical education. The competencies were developed through a research and collaborative review process that began in January 1998 and lasted a year. It involved literature reviews, examination of curriculum documents, surveys, interviews, and focus groups. The process used input from multiple sources which included medical professionals, residents, medical educators, physician employers, patients, the U.S. government, health care quality monitors, community health providers, and society-at-large as typified by a private foundation. Executives representing nurses, physician assistants, and allied health professionals were also queried. The Outcome Project Advisory Group distilled all of this information to provide the ACGME with six General Competencies: 1. Patient Care 2. Medical Knowledge 3. Practice-Based Learning and Improvement 4. Interpersonal and Communication Skills 5. Professionalism 6. Systems-Based Practice
These General Competencies are applicable to all the disciplines of medical practice and are not particular to any one specialty. It is the task of each specialty to determine how the general competencies apply to it. The outcomes project advisory group has also reviewed and refined a planned timeline in which the competencies need to be introduced, focused, fully integrated, tested, and eventually shown to be appropriate. The initial step began in July of 2001 as they were launched to the residency programs, and many programs began initial steps to introduce them to their residents and faculty. Over the next four years, programs and specialties are charged with focusing and redefining the competencies. This includes applying and testing new evaluation methods, and then publishing and sharing their experiences with other programs. Ultimately the Residency Review Committee (RRC) for each specialty will want to see evidence of a program’s experiences with the competencies. The third phase is slated to begin in July of 2006. At this time the programs will move to full integration of the competencies in their residencies. This means that they will be able to provide evidence of learning and assessment of all six competencies and show how the long-term outcome of their residents, including practice patterns and clinical outcomes, is related to the competencies. The last phase, although not fully developed, includes identifying “best practices” and adapting and generalizing the best programs. It also includes community involvement in the GME process. Currently, when the RRC visits programs, they expect to see that the programs are using more dependable methods to evaluate the competencies. They must show continued improvement in their methods of evaluation. In the future, the ACGME has yet to determine exactly which tools they will use to assess and make accreditation decisions. Measurement tools are a way for faculty to evaluate an individual’s performance. They are now going to be based upon the competencies. It is surprisingly difficult to get a clear and objective assessment of residents and their strengths and weaknesses. Asking various faculty members what they think of a resident is a common method, but obviously filled with difficulties. Perhaps more charismatic or more attractive residents get evaluated more favorably? Other tools have been developed such as asking other people in the department (nurses, transport personnel, patients, etc.) to evaluate a resident, or staging observed clinical scenarios. These also have their weak points. To learn what works well and accurately it becomes necessary to evaluate the measurement tools in order to assess the utility and efficacy of the outcome measurements. There is a need to show that the assessment approach provides
valid data. This is similar to phase 3 testing of a new medication, when the drug is put through a clinical trial to see if it actually does what everyone expects it to do. Validity may be inferred when the approach predicts performance in actual practice (i.e. performing better after an instructional intervention) or when there is a strong relationship between the data and external indicators. The assessment tool must be shown to yield data that are reliable. This means it yields the same result for the same item or case assessed regardless of who is using it or when they do so. This includes equivalent results across tests, individual assessors, situations, or items. The approach must be feasible. While hiring professional educators to come into every residency program and design specific tests would be useful, it would clearly be time- and cost-prohibitive. However, the test or evaluations must be designed with the ability to be used in the specific circumstances that they are applied. This means that tests used for evaluating pathology residents in the laboratory may not be applicable to emergency medicine residents in the ED. Multiple tools are currently being tested or have been shown to be useful. In each competency, there are multiple approaches to assessment. Some of the assessment tools that the ACGME proposes my be familiar. These include written and oral examinations, procedure logs, and global rating forms (“superior, satisfactory, unsatisfactory”). Some of the newer tools that are becoming increasingly prevalent in residency programs include: 360-degree evaluations: A survey-based evaluation method in which the evaluators may consist of superiors, peers, subordinates, and patients and their families. Objective Structured Clinical Examination (OSCE): Residents participate in short standardized patient encounters. Residents may be asked to interpret data, provide a diagnosis, initiate therapy, or demonstrate a technical skill. Patient surveys: Patients complete satisfaction surveys on care received. Portfolios: Residents assemble written (usually) documentation as evidence of learning. As an example: a literature review to answer a clinical question that could not have been answered in the clinical setting in a timely manner. Simulations and models: Computer, mannequin, or virtual reality based scenarios that attempt to replicate real-life scenarios. Useful for practice with critical patients without the risk of life-threatening errors. The General Competencies are here. The next several years will prove to be an exciting time for residency training overall. If you would like additional information on the general competencies or the assessment tools check out the ACGME’s website at: www.acgme.org.
AAMC and Sallie Mae offer new MEDLOANS Consolidation Loan The AAMC and Sallie Mae, a federally guaranteed student loan provider, have introduced “MEDLOANS Consolidation Loan,” a federal consolidation loan program. The new product allows eligible borrowers to lower their monthly student loan payments by up to
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loan with one monthly payment. The loan may be repaid with terms up to 30 years, based on their total education loan indebtedness. For more information, contact: http://www.aamc.org/medloans
Funding Research in Pediatric Emergency Medicine (Continued) and the Department of Defense. The EMSC program continues to foster these important and fruitful relationships with its federal partners to continue to improve the field of EMSC research. Below is a list of the participating agencies, along with other ICER agencies which fund research related to EMSC or who, like the FDA and CDC’s NCHS, support researchers in other ways by providing data, databases, and consultation services. For more information on any aspect of the federal EMSC Program, contact: Daniel Kavanaugh, MSW Director EMSC Program Injury and EMS Branch Division of Child, Adolescent, and Family Health Maternal and Child Health Bureau Health Resources and Services Administration 5600 Fishers Lane, RM 18A-38 Rockville, MD 20857 Phone: (301) 443-1321 Fax: (301) 443-1296 Email: dkavanaugh@hrsa.gov EMSC National Resource Center Staff: Jane Ball, RN, DrPH Executive Director EMSC National Resource Center 8737 Colesville Road, Suite 400 Silver Spring, MD 20910
Phone: (202) 884-6866 Fax: (202) 884-6845 Email: jball@emscnrc.com Isabelle Melese-d’Hospital, PhD [ICER COORDINATOR] Research Specialist EMSC National Resource Center 8737 Colesville Road, Suite 400 Silver Spring, MD 20910 Phone: (202) 884-6859 Fax: (202) 884-6845 Email: imelese@emscnrc.com For more information on the MCHB’s Division of Research, Training and Education, contact: Kishena Wadhwani, PhD Chief Research Branch Division of Research, Training and Education Maternal and Child Health Bureau 5600 Fishers Lane RM 18A-55 Rockville, MD 20857 Phone: (301) 443-2927 Fax: (301) 443-4842 Email: kwadhwan@hrsa.gov PECARN Contacts NDDP and CDMCC Principal Investigators to contact with relevant research ideas: Chair of the network, Dr. Nate Kuppermann University of California, Davis (nkuppermann@ucdavis.edu)
Vice-Chair, Dr. Jim Chamberlain Children’s Research Institute (Washington, DC) (jchamber@cnmc.org) Dr. Ronald Maio University of Michigan (ron.maio@umich.med.edu) Dr. Nadine Levick Columbia University (New York, NY) (nadine.levick@columbia.edu) CDMCC Director, Dr. J. Michael Dean University of Utah (mike.dean@hsc.utah.edu). Research Funding Resources The EMSC program has a researcher listserv that can be joined by going to www.nedarc.org and clicking on EMSC Researcher Listserv. The National EMSC Data and Analysis Resource Center (NEDARC) is also a good source of information about research and obtaining research funding in EMS/C. Tour their website after subscribing to the listserv. PRIVATE FOUNDATIONS: The Foundation Center – www.fdncenter.org Robert Wood Johnson Foundation (RWJF) - www.rwjf.org Johnson & Johnson - www.jnj.com The David and Lucile Packard Foundation - www.packard.org
SAEM Sponsors National Alcohol Screening Day SAEM will sponsor the fifth annual National Alcohol Screening Day (NASD) held on April 10, 2003. SAEM members will receive, at no charge, materials to screen patients for alcohol problems, as well as educate patients about alcohol’s effect on medical conditions and drug interactions. Addressing a range of alcohol problems from at-risk drinking to alcohol dependence, the materials are geared at helping ED staff identify and manage patients with existing or developing alcohol problems. NASD is a program of Screening for Mental Health, a nonprofit organization, in partnership with the National Institute on Alcohol Abuse and Alcoholism (NIAAA) and the Substance Abuse and Mental Health Services Administration. The program is free to all health care providers. Registered providers receive a kit of ready-to-use education and screening materials, including brochures, educational flyers, videotape and screening
forms. Sites also receive step-by-step instructions for planning and conducting a screening event and a publicity guide. The materials are designed to be used either of two ways. Clinicians are invited to conduct a special outreach event on National Alcohol Screening Day, or incorporate the screenings into their day-to-day ED procedures and screen regularly scheduled patients. As many as 30% of ED patients present with alcohol related problems, and patients from racial and ethnic minorities and those who lack access to other health services are over-represented in this group. Hospital EDs offer a concentrated opportunity not available elsewhere for alcohol abuse screening, brief counseling and referral, a teachable moment for contemplating change in behavior. The ED is an ideal setting to meet people with harmful or hazardous drinking with a targeted intervention. By participating in National Alcohol Screening Day, clinicians can help 16
improve overall patient care in ED settings. Since 1999, NASD has provided thousands of health care facilities, treatment centers, mental health clinics, colleges, and primary and specialty care providers with a ready-made, easy-touse program for conducting free, voluntary alcohol screenings with referrals for individual evaluation and treatment. Over the last four years, NASD has attracted over 150,000 people to the event, screening some 100,000 individuals and educating friends and family about signs, symptoms, available treatments, and where to seek counseling and help. Sites can register online by going to www.nationalalcoholscreeningday.org or by calling the NASD office at (800) 253-7658. To receive a registration form or for more information, contact One Washington Street, Suite 304, Wellesley Hills, MA 02481, or call (800) 253-7658, or fax (781) 431-7447.
NINDS Conference (Continued) the ACEP policy to actually address these system issues. Support is needed from ancillary services like laboratory and radiology. Support is also needed for protocol development. When transfers occur, all measures need to be in place with guidelines and standing orders. The system, once in place, needs to be analyzed via focus groups, check lists for research, and mock stroke codes. The committee also felt
that provider support should incorporate educational support, including credentialing of physicians and institutions. In summary, EM was well represented and was recognized as a key player in the acute treatment of stroke. The committee felt we needed to be on board, we need to be convinced of the data, and we need to have provider support if in fact we are going to be giving thrombolytic therapy. The issues facing
EM were well delineated and concerns that current data were inadequate to support the widespread use of tPA in the ED for stroke were presented and understood by the committee. The slides and the audio from this symposium are available on the FERNE website, (www.ferne.org), and the final written statements for the group will be posted at www.strokesymposium.org
Under-Represented Member Research Mentoring Task Force Glenn C. Hamilton, MD Wright State University Chair, SAEM Under-Represented Member Research Mentoring Task Force This is the mid-point of the second year of this task-force. Most of these “goal directed� groups have a finite life-span of two years and our official charge is planned to end in May of 2003. The mid-point is a good time to review the status of our performance on current objectives.
tural competency. This topic has not progressed to a significant degree. The group has been focused on the other objectives and this one will need to be pursued in the future. Complete the focus group project on addressing the question of under-graduate medical student minority interest in emergency medicine as a career. With the support of a limited grant from SAEM, we have been able to move forward effectively in this area. We currently have ten sites that are working through their IRB and planning focus group sessions to discuss the perceptions of minority medical students regarding emergency medicine as a future career choice. We view this as an important research to assist the specialty in better determining how it may collectively and with individual program directors work toward improving recruitment of under represented minorities into the specialty. At the time of publication we anticipate six of the ten programs to have held their focus groups. Analysis is planned through the services of a consultant hired at the University of New Mexico. Once this analysis is complete, we will generate a scholarly paper, plan a presentation and most importantly develop a monograph to aid training programs in their recruitment efforts. We have also held discussions with the SAEM Diversity Interest Group suggesting this monograph may serve as the template for diversity oriented consultations to be sponsored by the group.
Provide research and academic mentoring to under-represented minorities in medical schools. One of our first activities was to tally under-represented minorities who were actively being mentored in either research or career choices by members of the task force. Listed below is a sampling of this active mentorship role. The task force was clearly able to demonstrate under-represented minority mentorship is active in emergency medicine. It needs to be continually addressed, and expanded as an important faculty role for our future. Medical School Long Island Jewish Hospital Case Western Reserve Wright State University Allegheny General Hospital Johns Hopkins University University of Virginia Emory University Mt. Sinai Medical Center New York University Bellevue
Student Mentored 2001-2002 Gina Pulido Robin Lowman, Rahabu Rajan Courtney Holland, Charity Witt Ruth Perez-Sanchez, Ademola Adowale Theresa WU, Derek Mitchell Alfa Diallo, Tokunbon Shosan Shelise Henry, Toihunta Stubbs Latoya Maynard, Celine Hamilton Russell Flood, Khana Ennis
Develop and suggest future mentoring initiatives. As mentioned above, our current future recommendation relates to developing the cultural competency curriculum. Emergency medicine represents the ultimate medical melting pot, and must effectively educate itself about these important issues. Also, it may serve as a nidus for expanding this topic into undergraduate medical curricula. This will hopefully be a significant focus of SAEM in the near future.
Develop a case based cultural competency curriculum. This project has turned out to be much larger in scope than anticipated. Currently, we have approximately twenty five cases developed by each of the sites represented on the committee. As we have delved deeper into the project, it is obvious that a considerable amount of introductory material must be developed to properly frame these cases and make them effective teaching points. Currently, we have placed a proposal before the incoming president recommending this specific activity be the focus of the next diversity oriented task force running for an additional two years. That response is pending, but we are hopeful we can continue to work on this important educational aspect of our charge. Importantly, the Society has had recent discussions with CORD about potentially pursuing this as a joint venture.
In closing, one can always observe that we never travel quite as far as we plan, but the plans do allow us to make significant gains. Diversity and cultural competency issues will remain significant for emergency medicine and the Society at large. Whatever we can do to expand understanding and awareness in these important relationship areas will be of benefit to us all. It has been a privilege to serve as the Chair of this task force for the last two years and I look forward to continued contributions of the membership in educating others about the benefits of mentoring under-represented minorities as well as medically serving the populations they represent.
Develop and implement research proposals regarding cul17
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 April 1, 2003 to be included in the May/June issue. Steve Bowman, MD, has been named director of the emergency medicine residency program at Cook County Hospital. Jeffrey Coben, MD, has been appointed the residency director at Mount Sinai Mary Ann Cooper, MD, has been elected a Fellow of the Council of the American Meteorological Society. Election to Fellow serves as a recognition of outstanding contributions to the atmospheric or related oceanic or hydrologic sciences, or their applications, during a substantial period of years. Linda Degutis, MD, was elected to the Executive Board of the American Public Health Association (APHA). Dr. Degutis is Associate Professor of Emergency Medicine and Public Health at Yale University. Theodore R. Delbridge, MD, MPH, received the Keith Neely Award given during the National Association of EMS Physicians 2003 Annual Meeting. Dr. Delbridge is assistant professor of emergency medicine at the University of Pittsburgh School of Medicine and director of emergency services at UPMC Presbyterian. Gabor Kelen, MD, has been named Director of the newly created Johns Hopkins Office of Critical Event Preparedness and Response (CEPAR). CEPAR is responsible for integrating and coordinating an enterprise-wide response to critical events in the Baltimore region. Dr. Kelen is chair of the Department of Emergency Medicine at the Johns Hopkins University.
Roger J. Lewis, MD, PhD, has been named a member of the Health Research Dissemination and Implementation (HRDI) Study Section of the Agency for Healthcare Research and Quality (AHRQ). This expert committee reviews applications requesting support for dissemination and implementation of health research findings and products by health care practitioners and administrators, policy makers and consumers. Douglas Lowery, MD, has been promoted to Associate Professor of Emergency Medicine at Emory University School of Medicine. He also serves as Vice Chair for Clinical Affairs/Emory Healthcare, Department of Emergency Medicine. He was also awarded an Emory University School of Medicine Dean's Teaching Award for medical student education. Thomas A. Mayer, MD, was awarded the First Annual Public Health Hero Award on November 10, 2002 at the Annual Meeting of the American Public Health Association. The award was in recognition of his leadership in creating a system to care for the inhalational anthrax patients seen in the National Capital Region. Dr. Mayer has also been named as Medical Director for the NFL Players Association, overseeing the medical care to over 1,900 NFL players. In January, Harvey W. Meislin, MD, was selected chair of the Department of Emergency Medicine at the University of Arizona. Dr. Meislin has served as Interim Chair since the Department was established in 2001. John E. Prescott, MD, has been appointed Senior Associate Dean for the West Virginia School of Medicine. He will also continue his responsibilities as Clinical Associate Dean and President/Chief Executive Officer of the physician practice plan.
Raymond F. Regan, MD, Associate Professor in the Department of Emergency Medicine at Thomas Jefferson University is the principal investigator of a four-year, $1.19 million grant from the NIH (National Institute Neurological Diseases and Stroke) to investigate hemorrhagic central nervous system injury. The title of the study is "Effect of Inducible Antioxidants on Hemoglobin Toxicity" and funding began on December 1. Robert E. Suter, DO, MHA, was reelected to the ACEP Board of Directors during the ACEP Scientific Assembly in Seattle. He is an Associate Professor of Emergency Medicine at the Medical College of Georgia and Clinical Associate Professor of Emergency Medicine at the University of TexasSouthwestern. The American Board of Emergency Medicine has announced the re-election of Lynnette Doan-Wiggins, MD, to a four-year term on the American Board of Emergency Medicine. Dr. Doan-Wiggins is an Assistant Professor of Surgery at Loyola University. ABEM has also announced the election of Joel M. Geiderman, MD, Debra G. Perina, MD, and Mark T. Steele, MD to four-year terms on ABEM. Dr. Geiderman is the co-chair of the Department of Emergency Medicine at Cedars-Sinari Medical Center. Dr. Perina is an Associate Professor in the Department of Emergency Medicine at the University of Virginia and is also the President of the Council of Emergency Medicine Residency Directors. Dr. Steele is a Professor in the Department of Emergency Medicine at Truman Medical Center/University of Missouri-Kansas City.
Newsletter Submissions Welcomed David C. Cone, MD Yale University Editor, SAEM Newsletter SAEM invites submissions to the Newsletter pertaining to academic emergency medicine in the following areas: 1) clinical practice; 2) education of EM residents, off-service residents, medical students, and fellows; 3) facul-
ty development; 4) politics and economics as they pertain to the academic environment; 5) general announcements and notices; and 6) other pertinent topics. Materials should be submitted by e-mail to saem@saem.org.
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Be sure to include the names and affiliations of authors and a means of contact. All submissions are subject to review and editing. Queries can be sent to the SAEM office or directly to the Editor at david.cone@yale.edu.
President’s Message (Continued) Task Forces are most effective when they can pursue goals and objectives suggested by their own members. Unlike Committees and Task Forces, whose goals and objectives are approved by the Board, SAEM’s Interest Groups choose their own objectives each year. Because of this, Interest Groups are an ideal setting for members to establish collaborations in order to pursue their own interests. Virtually the only limitations are that the activities be consistent with the mission of the Society, and that allocation of SAEM funds to support Interest Group activities requires the submission of a defined project on a project proposal form [http://www.saem.org/inform/projpro.htm ] and approval by the Board. While the initiative of individual members is almost always a good thing, occasionally the activities proposed by members conflict with other SAEM activities or with the priorities of the Board. For example, sometimes other SAEM members, Committees, or Task Forces are already working on a similar project and additional activity would reduce our focus, be redundant, or lead to confusion. Sometimes activities proposed would obligate the Society to collaborations, to participate in meetings, or to support position statements even before they are written. Projects and activities that propose inter-organizational collaborations require particular care, since many organizations assume that when SAEM sends a representative to a meeting that SAEM will officially endorse the end product of that collaboration. This cannot be assumed, since the sending of a representative does not guarantee that the final product will be consistent with SAEM’s mission or the interests of academic emergency medicine. Finally, because SAEM works with a limited budget and strives to be most effective in furthering academic emergency medicine given its resources, it is important that SAEM’s activities not suf-
fer from “mission drift.” In other words, our activities and programs should be tightly focused on our mission “to improve patient care by advancing research and education in emergency medicine.” Occasionally activities are suggested which, while obviously valuable and related to emergency medicine in general, are not specific to academic emergency medicine (e.g., clinical practice and billing issues). In general, the Board believes such issues should be tackled by other emergency medicine organizations, such as ACEP and AAEM, acknowledging that there is tremendous overlap in the membership of all emergency medicine organizations. With these considerations in mind, it is the role of the Board of Directors to maximize the effectiveness of our members in furthering the mission of the Society by avoiding redundant efforts, unnecessary or unproductive obligations to other organizations, and “mission drift” while, simultaneously, not stifling the creativity and productivity of our members, many of whom work best as individuals. To be most effective, the Board shouldn’t lead as much as it guides. Having discussed some of the pitfalls to be avoided when proposing and/or pursuing new activities within SAEM, I would like to finish by emphasizing the benefits, both to the individual and to the Society, of working within the Society. In other words, why should you become involved in SAEM? While this may sound naíve, I believe the most important reason is a desire to further the specialty of academic emergency medicine. Academic emergency medicine is still a relatively young specialty, and it requires the efforts of many academicians working together to make progress scientifically, academically, administratively, and politically. Gains in all of these areas are important to ensure the quality of our own academic
life, and the quality of care delivered to patients in academic emergency departments. A second reason is the desire to become part of something “bigger” than one’s own department or institution. It is exciting and intellectually stimulating to be part of a discussion with academic colleagues from all areas of the country, and to make progress on projects that transcend institutional and geographic boundaries. Third, SAEM provides the best opportunity to network—to find colleagues with similar interests from across the country, develop friendships and collaborations, and pursue joint activities. Although difficult to measure, an opportunity to network is one of the most important products provided by SAEM to its members. This is well understood by the Program Committee and, over the last several years, many changes have been made in the format of the program to encourage networking. Lastly, involvement in SAEM is an excellent way to gain recognition outside of one’s own institution for academic talents and contributions. Achieving recognition and a reputation that extends beyond one’s own institution is a key step in career development which is important to university promotion and tenure committees. In summary, the individuality and career aspirations of our members are the primary strengths of SAEM. Occasionally, however, they are also occasionally a liability and it is the role of the President and the Board to help our members avoid academic, political, or financial pitfalls. When individual initiative is combined with teamwork, however, emergency physicians make great strides (e.g., consider the NEXUS study). As the President of the Society, and as a member of the Board, it is a privilege to be cat herder. [For a more humorous look at cat herding please see http://www.eds.com/advertising/ ads/tv/catherding.mpg]
Erratum In the November/December 2002 Newsletter one of the medical student recipients of the Emergency Medicine Medical Student Interest Group Grant for the University of California, Los Angeles was incorrect. The correct name of the recipient is Sai-Hung Joshua Hui. SAEM regrets the error and once again congratulates the UCLA Medical Student Interest Group for its successful grant application.
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Solicitation of Reading for ABEM Future Lifelong Learning and Self-Assessment Tests System Disorders and Toxicologic Disorders. ABEM will select 50% of the readings for the 2005 LLSA test from these two designated areas, while the remaining 50% of test content will be drawn from the remaining content areas of the EM Model “Listing of Conditions.”
A cornerstone of ABEM’s new EMCC program is the concept of Lifelong Learning and Self-Assessment (LLSA). The primary goal of LLSA is to promote continuous learning on the part of ABEM diplomates. ABEM will facilitate this learning within the context of LLSA by identifying an annual set of readings to guide diplomates in self-study of recent Emergency Medicine (EM) literature. ABEM has sought to involve the EM community-at-large in the LLSA process by inviting EM organizations and ABEM diplomates to make suggestions for readings to the ABEM Board of Directors. For the 2004 LLSA test currently under development, the Board received over 100 suggestions collectively from the ACEP, SAEM, CORD, AAEM and a number of individual ABEM diplomates.
How to Submit Recommendations for LLSA Readings For each reference submitted, ABEM must receive the following two items: 1. Complete an LLSA Form for each reference that you recommend to the Board. Be sure to provide all requested information for each reference, including the article title completely written out, the journal name, etc. Do not use abbreviations. Do not alter the form in any way, except to add the requested information in the space provided. The LLSA Reference Form is available from ABEM and may also be downloaded as an MS Word document from the ABEM website. The form can be computer-printed or typewritten.
Submission Criteria for LLSA Readings The Board has determined that readings used for the LLSA tests should meet the following criteria: 1. Focus on recent advances or current clinical knowledge in Emergency Medicine; 2. Be clinically oriented in content; 3. Be drawn from peer-reviewed EM journals, peer-reviewed journals from related primary specialty fields, textbook chapters, or updated practice guidelines; 4. Be published in printed or electronic form within the immediate five years preceding the LLSA test in which it will be used; 5. Relate to either the designated content areas for a given year (50%), or to the remaining content areas (50%) of the EM Model “Listing of Conditions.”
2. Provide one paper copy of the article, chapter or other text for which you have submitted a reference must be mailed or faxed to ABEM in order to be considered for inclusion. Electronic copies of references cannot be accepted due to copyright restrictions. References received by June 1, 2003, will be considered for inclusion in the 2005 LLSA module. Materials submitted after that date may be considered for future LLSA tests. Recommendations may be submitted via fax to (517) 3323943 or mail to LLSA References, American Board of Emergency Medicine, 3000 Coolidge Road, East Lansing, MI 48823. If you have specific questions or comments contact Timothy J. Dalton, Examination and Evaluation Project Specialist, at (517) 332-4800.
Content of LLSA Test in 2005 Although readings for the first LLSA test in 2004 have already been selected, the Board welcomes reference suggestions for future LLSA tests from the larger EM community on an ongoing basis. Currently, ABEM is soliciting readings for the 2005 LLSA test, for which the designated content areas will be Nervous
3rd Annual New York State Regional SAEM Meeting
6th Annual SAEM Western Regional Meeting
April 9, 2003 Metropolitan Hospital Center
April 5 & 6, 2003 Mayo Clinic Scottsdale Scottsdale, AZ
Location: Metropolitan Hospital Center, 1901 First Avenue, New York, NY 7:30 am – 4:30 pm. Registration fees: Faculty - $55; Residents/Nurses - $35, Medical Students - free. Registration deadline is March 26, 2003. Make checks payable to: New York Medical College. Mail to: Metropolitan Hospital Center, 1901 First Avenue, Rm. 2A20, New York, NY 10029. Keynote Speaker: Carlos A. Camarago, Jr, MD, DrPH, Director, EMNet Coordinating Center, Massachusetts General Hospital, will speak on the topic of Asthma Research in Emergency Medicine. Contact: Hazel Hunt, administrative coordinator, New York Medical College (Metropolitan) Emergency Medicine, 212423-6684, fax: 212-423-6383, hazel_hunt@nymc.edu
The 2003 meeting will include lectures by renowned speakers, oral and poster presentations and a special clinical and basic research breakout track sessions. Hotel reservations can be made at the Courtyard MarriottMayo Clinic in Scottsdale ($99/night, phone 1-480-8604000) and transportation from the airport may be arranged. Contact: Marie Kirkendolph or Christopher Lipinski, MD, Department of Emergency Medicine, Maricopa Medical Center, 2601 East Roosevelt Street, Phoenix, AZ, 85008; phone (602-344-5418) or email: Marie.Kirkendolph@hcs.maricopa.gov. The deadline for conference registration is March 14, 2003.
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6th Annual SAEM Mid-Atlantic Regional Meeting
Southeastern Regional SAEM Meeting
March 15, 2003 George Washington University Hospital Washington DC
April 11-13, 2003 Jacksonville, FL
All accepted papers will be presented orally, giving researchers at all levels a special opportunity to share their work and findings. In addition, there will be round table discussions with leaders in academic emergency medicine, medical student sessions, and a unique forum to meet with representatives of the National Highway Traffic Safety Administration and discuss research opportunities. Hotel reservations can be made at One Washington Circle, across the road from the conference site (202466-1868). Please mention the meeting to obtain the discounted rate. For information contact: Jeremy Brown MD or Dave Milzman MD, Dept of Emergency Medicine, George Washington University, 2150 Pennsylvania Ave NW, Suite 2B-417 Washington, DC 20037. 202-741-2911 or jbrown@mfa.gwu.edu. Registration Fees: Faculty-$75; Residents/Nurses-$35; Medical Students/Physician Assistants-$25; EMTs/paramedics-$10. Deadline for conference registration is February 28, 2003.
There will be oral and poster research presentations, round table discussions with leaders in academic emergency medicine, keynote presentations by nationally recognized emergency physicians, and hands on educational sessions, all in a relaxed atmosphere in sight of the Atlantic Ocean! Registration: medical students and residents are particularly encouraged to attend, and receive a discounted registration fee of $50 (medical students) and $75 (residents). Registration for attending physicians is $110. To register, contact: Ms. Everlena Owens • phone: (904) 244-4106 • fax: (904) 244-4508 • email everlena. owens@jax.ufl.edu Rooms have been reserved at the host hotel, the Sea Turtle Inn http://www.seaturtle.com/ • phone (800) 8746000 or (904) 249-7402, for $140 – $180 per night. Mention the SE SAEM conference to receive the discounted rates. Spouses and children are welcome. The beach is the main attraction.
Medical Student Excellence in Emergency Medicine Award Established in 1990, the SAEM Medical Student Excellence in Emergency Medicine Award is offered annually to each medical school in the United States and Canada. It is awarded to the senior medical student at each school (one recipient per medical school) who best exemplifies the qualities of an excellent emergency physician, as manifested by excellent clinical, interpersonal, and manual skills, and a dedication to continued professional
development leading to outstanding performance on emergency rotations. The award, presented at graduation, conveys a one-year membership in SAEM, which includes subscriptions to the SAEM monthly Journal, Academic Emergency Medicine, the SAEM Newsletter and an award certificate. Announcements describing the program and applications have been sent to the Dean's Office at each medical school. Coordinators of emergency
medicine student rotations then select an appropriate student based on the student's intramural and extramural performance in emergency medicine. The list of recipients will be published in the SAEM Newsletter. Over 100 medical schools currently participate. Please contact the SAEM office if your school is not presently participating.
SAEM/ACMT Michael P. Spadafora Medical Toxicology Scholarship Dr. Michael P. Spadafora was an academic emergency physician and medical toxicologist who was a member of SAEM and the American College of Medical Toxicology (ACMT) and was dedicated to resident education. After his death in October 1999, donations were directed to SAEM for the establishment of a scholarship fund to encourage Emergency Medicine residents to pursue Medical Toxicology fellowship training. ACMT has graciously agreed to donate matching funds. Two recipients will be chosen to attend the North American Congress of
Clinical Toxicology (NACCT), which will be held September 4-9, 2003 in Chicago. Each award of $1250 will provide funds for travel, meeting registration, meals, and lodging. Any PGY-1 or 2 (or PGY-3 in a 4 year program) in an RRC-EM or AOA approved residency program is eligible for the award. The deadline for application is May 1, 2003. Scholarship recipients will be announced at the annual SAEM and NACCT meetings. Each recipient will also be required to submit a summary of the ACMT scientific symposium and the ACMT practice symposium for publica21
tion in the SAEM Newsletter and the Internet Journal of Medical Toxicology. Applications must be submitted electronically to saem@saem.org and include: 1. Curriculum Vitae of applicant 2. Verification of employment and letter of support from the applicant’s program director 3. Letter of nomination from an active member of SAEM and/or ACMT 4. 1-2 page essay describing the applicant’s interest and background in Medical Toxicology
Call for Abstracts 13th Annual Midwest Regional SAEM Meeting
7th Annual New England Regional SAEM Meeting
September 19, 2003 Saginaw Cooperative Hospitals, Inc. Saginaw, MI
April 9, 2003 Shrewsbury, Massachusetts
The Program Committee is now accepting abstracts for review for oral and interactive poster presentations. The meeting will take place September 19, 2003, 8:00 am – 5:00 pm, at Curtis Hall on the campus of Saginaw Valley State University, Saginaw, Michigan. The deadline for abstract submission is Monday, July 14, 2003, by 3:00 p.m. EDT. Only electronic submissions via the SAEM online abstract submission form at www.saem.org will be accepted. Acceptance notifications will be sent in late July. Registration forms are available from Melinda Wardin, Department of Emergency Medicine, Saginaw Cooperative Hospitals, Inc., 1000 Houghton Avenue, Saginaw, MI 48602. E-mail contact is mwardin@schi.org Registration Fees: Faculty--$75; Residents/Nurses--$30; EMTs/Students—No Charge. Late fee after September 12, 2003: add $25. Visit our website for updated information: www.schi.org
Keynote Speaker: Peter Rosen, MD, FACS, FACEP The meeting will take place April 9, 2003, 8:00 am-4:00 pm, at the Hoagland-Pincus Conference Center in Shrewsbury, MA; www.umassmed.edu/conferencecenter/ Send registration forms to: Tania Strout, RN, BSN, Department of Emergency Medicine, Maine Medical Center, 47 Bramhall Street, Portland, ME 04102. E-mail contact is strout@mmc.org Registration Fees: Faculty-$100; Residents/Nurses-$50; EMTs/Students-$25. Late fee after March 21, 2003: add $25. Make checks payable to Maine Medical Center Department of Emergency Medicine.
The Top 5 Most-Frequently-Read Contents of AEM – January 2003 Most-read rankings are recalculated at the beginning of the month. Rankings are based on hits received by articles archived on AEMJ.org.
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DF Salo, R Lavery, V Varma, J Goldberg, T Shapiro, A Kenwood A Randomized, Clinical Trial Comparing Oral Celecoxib 200 mg, Celecoxib 400 mg, and Ibuprofen 600 mg for Acute Pain Acad Emerg Med Jan 01, 2003 10: 22-30. (In “CLINICAL INVESTIGATIONS”)
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D Donaldson, D Poleski, E Knipple, K Filips, L Reetz, RG Pascual, RE Jackson Intramuscular versus Oral Dexamethasone for the Treatment of Moderate-to-severe Croup: A Randomized, Double-blind Trial Acad Emerg Med Jan 01, 2003 10: 16-21. (In “CLINICAL INVESTIGATIONS”)
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SSW Chan Emergency Bedside Ultrasound to Detect Pneumothorax Acad Emerg Med Jan 01, 2003 10: 91-94. (In “BRIEF REPORTS”)
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J Stein, MA Levitt A Randomized, Controlled Double-blind Trial of Usual-dose versus High-dose Albuterol via Continuous Nebulization in Patients with Acute Bronchospasm Acad Emerg Med Jan 01, 2003 10: 31-36. (In “CLINICAL INVESTIGATIONS”) RS Naunheim, A Ryden, J Standeven, G Genin, L Lewis, P Thompson, P Bayly Does Soccer Headgear Attenuate the Impact When Heading a Soccer Ball? Acad Emerg Med Jan 01, 2003 10: 85-90. (In “BRIEF REPORTS”)
Log onto www.aemj.org and start taking advantage today! 22
FACULTY POSITIONS MINNESOTA: Academic Emergency Medicine Faculty - Excellent opportunity for EM residency-trained, BC/BE Emergency Medicine faculty to join our progressive academic EM group at Regions Hospital, a Level I Trauma and Burn Center in St. Paul. Numerous opportunities in clinical research, health services research, EMS, Informatics, Toxicology, and education. Established 3year emergency medicine residency. ED volume: 65,000. Must have or be eligible to attain Minnesota and Wisconsin medical licensure. Forward CV to: HealthPartners Medical Group, Attn: Sandy Lachman, Physician Recruitment Coordinator, Mail Code 21110Q, P.O. Box 1309, Minneapolis, MN 554401309. Fax (952) 883-5395. For more information, email sandy.j.lachman@healthpartners.com or call 800-472-4695. EO Employer.
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.
NEW JERSEY, UMDNJ (Newark) - Come in on the ground floor at a major medical school and university hospital. We’re planning to start an EM Residency and have faculty opportunities for Emergency Physicians at ALL LEVELS, including Residency Director, EMS Director and Director of Clinical Operations. The ED has an annual volume of 72,000, including 2,700 level I trauma patients. Competitive compensation and benefits package including on-site fitness and child care centers. For information please contact Ronald Low, MD, MS, at 973-972-7882. UMDNJ-University Hospital is an AA/EOE, M/F/D/V. Visit us on the web at www.TheUniversityHospital.com. 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, 169 Means Hall, 1654 Upham Drive, Columbus, OH 43210 or call (614) 2938176. Affirmative Action/Equal Opportunity Employer.
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/
OREGON: The Oregon Health & Science University, Department of Emergency Medicine is conducting an ongoing recruitment campaign for talented faculty members. Entry-level clinical faculty members at the instructor and assistant professor level. Preference given to those with fellowship training (especially in pediatric emergency medicine) or equivalent experience. Knowledge of emergency medicine as a faculty discipline is expected. 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, CDW -EM, Portland, OR 97239-3098. PENNSYLVANIA – TWO NEW POSITIONS available for EM Residency-trained physicians to join cohesive faculty of 31 BC physicians evaluating more than 100,000 patients at the three sites of Lehigh Valley Hospital. EM residency program. LVH is academic, tertiary hospital with Level I trauma center, 9-bed Burn Center. Eligibility for faculty appointment at Penn State/Hershey. Opportunity for resident teaching and clinical research. LVH is located in the beautiful Lehigh Valley, with 700,000 people, good schools, safe neighborhoods, etc. Email CV c/o Michael Weinstock MD, Chair EM, to katherine.adams@lvh.com Fax (610) 402-7014. Phone (610) 402-7008.
Yale University School of Medicine New Haven, Connecticut
Ultrasound Fellowship The Section of Emergency Medicine fellowship in Emergency Ultrasound is a one-year program that will prepare graduates to lead an academic and/or community emergency ultrasound program. Experience will be sufficient to fulfill the recommendations of all major societies for the interpretation of emergency ultrasound as well as RDMS/RDCS/RVT certification and exposure to aspects of program development and quality assurance. The program consists of structured time in the emergency department performing bedside examinations, examination QA and review, research into new applications, and education both in the academic and community arenas. Clinical experiences outside of the emergency department in echocardiography and gynecologic applications are available.
UNIVERSITY OF KENTUCKY: The Department of Emergency Medicine at the University of Kentucky is recruiting full-time faculty members at the assistant or associate professor level. The desired individual must be BP/BC in emergency medicine. Academic tenure track and clinical non-tenure track positions available. The EM residency has full accreditation. The Emergency Department at the UK Hospital is a level I trauma center with 40,000 annual visits. The department has nine full-time faculty. Contact: J. Stephan Stapczynski, MD, Department of Emergency Medicine, UKMC, 800 Rose Street, Room M-53, Lexington, KY 40536-0298, Phone: (859) 323-5908, Fax: (859) 323-8056, or Email: jsstap01@uky.edu. We are an EOAAE.
The SAEM Newsletter is mailed every other month to the 5,500 members of SAEM. Advertising is limited to fellowship and academic faculty positions. Deadline for receipt: April 1 (May/June), June 1 (July/August), August 1 (September/October), October 1 (November/December), December 1 (January/February), and February 1 (March/April). Ads received after the deadline can often be inserted on a space available basis. 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 To place an advertisement, e-mail or fax 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: Carrie Barber at carrie@saem.org, via fax at (517) 485-0801. For more information or questions, call (517) 485-5484.
For further information, contact the fellowship director: Chris Moore, MD, RDMS, RDCS phone: 203-785-3843 email: chris.moore@yale.edu This Fellowship offers an appointment as a Clinical Instructor to the faculty of the Section of Emergency Medicine at Yale University School of Medicine Yale University and Yale-New Haven Hospital are affirmative action, equal opportunity employers and women and members of minority groups are encouraged to apply.
All ads posted on the SAEM web site at no additional charge.
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Emergency Medical Services/ Emergency Ultrasound Fellowships The State University of New York at Buffalo, Department of Emergency Medicine, is seeking applicants for a one or two-year Emergency Medical Services / Emergency Ultrasound Fellowships. Clinical experience in our busy level-one trauma center, research, administrative, and academic experiences in conjunction with our emergency medicine residency program will be tailored to the fellow’s goals. The fellow will serve in a leadership role for our Specialized Medical Assistance Response Team (SMART), which is responsible for supporting law enforcement, fire department, EMS providers and other public safety agencies. SMART provides on-scene patient care, triage and other disaster and public health actions. The Emergency Ultrasound Fellowship experience will be adapted to meet the fellow’s objectives under the instruction of nationally recognized experts in the field. Applicants must be Board Eligible in Emergency Medicine. A letter of interest and Curriculum Vitae should be submitted to: Anthony Billittier, IV, MD or Dietrich Jehle, MD Department of Emergency Medicine 462 Grider Street Buffalo, NY 14215 email: craczka@ecmc.edu
Yale University School of Medicine New Haven, Connecticut
EMS Fellowship The Division of EMS, Section of Emergency Medicine, offers a one- or two-year fellowship program that is credentialed by the Society for Academic Emergency Medicine to host the SAEM/Medtronic Physio-Control Fellow in EMS through 2006. The program, which has trained a fellow each year since its inception in 2000, provides training in all aspects of EMS, including academics, administration, medical oversight, research, teaching, and clinical components. The program also focuses on operational EMS, with the fellow actively participating in the system's physician response team, and all fellows offered training to the Firefighter I or II level. The fellowship graduate will be prepared for a career in academic EMS and/or medical direction of a local or regional EMS system. The program's SAEM credentialing application is available for review at the Division's web site: yalesurgery.med.yale.edu/ surgery/sections/emergency/div_ems.htm.
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 Emergency Medicine residency training program in 1970. The Center for Emergency Care evaluates and treats 86,000 patients per year and has 44 residents involved in a four year curriculum. Our department has a long history of academic productivity, with outstanding institutional support. Please send Curriculum Vitae to:
For further information, contact the fellowship director: David Cone, MD phone: 203-785-4710 email: david.cone@yale.edu
W. Brian Gibler, MD Chairman, Department of Emergency Medicine University of Cincinnati Medical Center 231 Albert Sabin Way Cincinnati, OH 45267-0769
This Fellowship offers an appointment as a Clinical Instructor to the faculty of the Section of Emergency Medicine at Yale University School of Medicine. Yale University and Yale-New Haven Hospital are affirmative action, equal opportunity employers and women and members of minority groups are encouraged to apply.
Phone: (513) 558-8086 Fax: (513) 558-4599 E-mail: Diane.Shoemaker@uc.edu
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Louisiana State University Health Sciences Center Shreveport, Louisiana
Residency Program Director / Associate Program Director
The Department of Emergency Medicine at the University of Michigan is seeking one – two faculty members in the Instructional or Tenure Track. We are looking for individuals committed to developing an academic and research career in emergency medicine. Prior research experience desired but not required. We are particularly interested in attracting candidates who are women or members of underrepresented minorities, although we are certainly interested in attracting the most qualified candidates. The recruited faculty member will be provided with appropriate senior mentorship as well as research start-up funds and will have adequate protected time to develop a research program. Interested candidates should contact Dr. William Barsan, Chair, Department of Emergency Medicine at wbarsan@umich.edu or by phone (734) 936-6020. The University of Michigan is an equal opportunity employer.
The Department of Emergency Medicine at Louisiana State University Health Sciences Center is developing a Residency Training Program in Emergency Medicine and is seeking fulltime faculty to serve as Residency Program Director or Associate Program Director determined by experience and qualifications. LSUHSC is the tertiary referral center for the entire region with an annual selected volume of 60,000 and serves as the only Level I Trauma Center in the area. The department faculty is involved in all levels of graduate medical education and operates in a progressive environment with total digital radiography, computerized charting and a stat lab located within the ED. Clinical and basic science research opportunities are available with proven investigators along with protected time and educational benefits provided. This is a great opportunity for involvement in resident training from the very beginning. LSUHSC is an Equal Opportunity/Affirmative Action employer. Interested applicants are encouraged to contact: Thomas C. Arnold, M.D. Chairman, Department of Emergency Medicine LSUHSC-Shreveport 1501 Kings Highway P.O. Box 33932 Shreveport, LA 71130-3932 (318) 675-6885 or fax (318) 675-6878
Louisiana State University Health Sciences Center
Department of Emergency Medicine
Shreveport, Louisiana
Faculty / Open Rank
University of Florida/Jacksonville
The Department of Emergency Medicine at Louisiana State University Health Sciences Center is developing a Residency Training Program in Emergency Medicine and is seeking fulltime faculty to complete the complement of core faculty necessary to achieve excellence. LSUHSC is the tertiary referral center for the entire region with an annual selected volume of 60,000 and serves as the only Level I Trauma Center in the area. The department faculty is involved in all levels of graduate medical education and operates in a progressive environment with total digital radiography, computerized charting and a stat lab located within the ED. Clinical and basic science research opportunities are available with proven investigators along with protected time and educational benefits provided. Several opportunities are available for energetic applicants with residency training and ABMS board status. Rank and position commensurate with experience and qualifications. LSUHSC is an Equal Opportunity/Affirmative Action employer.
We are actively recruiting 9 Board Certified or Board Eligible Emergency Medicine Physicians in an exciting opportunity to expand our Department at a community-based hospital in the greater OrlandoTampa area. Newly renovated 24,000 square foot emergency department, 33 patient care bays including a 7 bed minor care area, 3 x-ray suites, a radiology viewing area, ample work space, and a large waiting area, that serves a growing volume of 45,000 patient visits per year. In addition to a salary line of approx. $120 per hour, we offer the full range of University of Florida state benefits that include health, life, disability insurance, vacation & sick leave, 403B retirement plan with immediate vesting, and sovereign immunity occurrence medical liability insurance. Individuals will be appointed at the rank of Clinical Assistant Professor or Clinical Associate Professor. Interested? Mail your letter of interest and CV to Dr. Kelly Gray-Eurom, Dept. of Emergency Medicine, University of Florida Health Sciences Center, 655 W. 8th Street, Jacksonville, Florida 32209. Application deadline is 6/1/03 with anticipated start date of 7/1/03. EOE/AA Employer.
Interested applicants are encouraged to contact: Thomas C. Arnold, M.D. Chairman, Department of Emergency Medicine LSUHSC-Shreveport 1501 Kings Highway P.O. Box 33932 Shreveport, LA 71130-3932 (318) 675-6885 or fax (318) 675-6878
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Brigham and Women’s Hospital/Harvard Medical School
PROGRAM DIRECTOR
Full-time academic faculty position
The Department of Emergency Medicine at the University of Texas Houston Medical School is soliciting applications for the position of program director. Applicants must be residency trained and board certified in emergency medicine and should have a portfolio of scholarly accomplishments and a strong interest in education.
Includes excellent academic support, appointment at Harvard Medical School, unparalleled research opportunities, competitive salary, and an outstanding comprehensive benefit package. Brigham and Women’s Hospital is a major Harvard affiliated teaching hospital, level I trauma center, and the base hospital for the four-year ACGME accredited Brigham and Women’s Hospital/Massachusetts General Hospital Harvard Affiliated Emergency Medicine Residency Program. The Department of Emergency Medicine cares for over 55,000 ED patients per year and includes a state-of-the-art 9 bed ED Observation Unit. The department has a robust International Emergency Medicine Program and offers international EM fellowships. The successful candidate must have successfully completed a four year residency training program in emergency medicine or a three year program followed by a fellowship, and be board prepared or board certified in emergency medicine. Interest and proven ability in Emergency Medicine research and teaching are essential. Please send inquiries and CV to Ron M. Walls, MD, FACEP, Chairman Department of Emergency Medicine Brigham and Women’s Hospital 75 Francis Street, Room PBB-100 Boston, Massachusetts 02115. Email rwalls@partners.org
The emergency medicine residency training program at The University of Texas Houston Medical School is a three-year program with 10 residents per class. The program has just received full accreditation for the next three years. Our primary teaching hospital is Memorial Hermann Hospital. The emergency department has an annual volume of approximately 55,000 patients and is one of the nation’s busiest level I trauma centers. Duties of the program director include oversight of the residency program and of other departmental educational activities. Interested applicants should send a curriculum vitae and a list of professional references to Dr. Brent King, Chairman, Department of Emergency Medicine, The University of Texas Houston Medical School, 6431 Fannin St. MSB. 6.264, Houston, TX 77030.
The University of Texas is an Equal Opportunity, Affirmative Action Employer. Minorities and women are strongly encouraged to apply. This is a security-sensitive position and thereby subject to Texas Education code §51.215.
CHAIR EMERGENCY MEDICINE
ATLANTA, GA
Phoenix, Arizona
DEPARTMENT OF EMERGENCY MEDICINE Due to continued growth, we anticipate openings for fulltime academic emergency physicians in both research and clinician-educator tracks. Emory offers a dynamic and professional environment with special strengths in patient care, teaching, community service, EMS, toxicology, clinical and laboratory research, and public health. Excellent salary and benefits. Applicants must be residency trained and/or board certified in EM. Emory is an equal opportunity/affirmative action employer. Women and minorities are encouraged to apply. For further information visit our web site at http://www.emory.edu/em or contact:
Maricopa Integrated Health System (MIHS), a 550-bed hospital with a Level I Trauma Center, a Level I Burn Center and a Level III OB Unit is seeking a Department Chair for Emergency Medicine. The successful candidate will have experience in graduate medical education, research and administration. MIHS serves the largest county in Arizona. It is the second largest teaching hospital in the state of Arizona with eight residency programs including 30+ emergency medicine residents. MIHS is affiliated with the University of Arizona Health Sciences Center and the Mayo Graduate School of Medicine.
Arthur Kellermann, MD, MPH, Professor and Chair Department of Emergency Medicine 1365 Clifton Rd., Suite B-6200 Atlanta, GA 30322 Phone: (404) 778-2600 Fax: (404)778-2630 Email: Paula Bokros - pbokros@emory.edu
For consideration, send a current CV to: Chris Carey, M.D. Chair, Department of OB/GYN Chair, Emergency Medicine Search Committee Maricopa Integrated Health System 2601 E. Roosevelt, Phoenix, Arizona 85008 or email to: chris_carey@medprodoctors.com
Emory is an equal opportunity/affirmative action employer
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Fellowship Opportunity
The University of Washington Medical Center (UWMC)
Emergency Medicine/Neurology The Department of Emergency Medicine and the Department of Neurology Stroke Program at The University of Texas-Houston Medical School are jointly offering a two-year fellowship to Emergency Medicine Residency graduates. This is part of an NIH-funded fellowship training program to develop clinicianscientists who are expert in the acute care of stroke patents. During the twoyear training period, the trainee will work as part of a multidisciplinary Stroke Team in evaluating and treating acute stroke patients at four regional Emergency Centers, and will participate in ongoing clinical activities that include prehospital care, emergency treatment, acute brain imaging, neurosonology, endovascular therapy, neuro-critical care and outcomes assessment. Participation in ongoing clinical research protocols is and important part of the program, and the development of new research initiatives by the trainee will be encouraged through enrollment in a specialized program in clinical research training. Clinical duties will also include a limited number of ED shifts each month. Positions are available starting either July 1st, 2003 or July 1st, 2004.
Division of Emergency Medicine The University of Washington seeks a physician to join its faculty in the Division of Emergency Medicine in the Department of Medicine at the University of Washington Medical Center. This full-time position requires direct patient care, teaching and supervision of medical students and housestaff, and the expectation for engagement in scholarly activities. The applicant must be board certified in emergency medicine. The successful candidate will be appointed as full-time faculty member; at the rank of assistant or associate professor in the clinician/teacher (patient care/teaching emphasis) pathway; or physician/scientist (research emphasis) pathway.
Send a letter of interest, curriculum vitae, and three letters of reference to: David J. Robinson, MD, MS, FACEP, University of Houston Health Science Center at Houston, Department of Emergency Medicine, 6431 Fannin, Suite JJL 433, Houston, TX 77030. Office: (713) 500-7875, Fax: (713) 500-7884, Email: David.J.Robinson@uth.tmc.edu.
Applicants should submit a curriculum vitae and statement of career goals to: Judy Prentice, Division Administrator, U.W.M.C., Box 356123, Seattle, WA 98195-6123. The University of Washington is building a culturally diverse faculty and strongly encourages applications from female and minority candidates. The University is an Equal Opportunity/Affirmative Action employer. Deadline for inquiries is April 30, 2003.
The University of Texas is an Equal Opportunity, Affirmative Action Employer. Minorities and women are strongly encouraged to apply. This is a security-sensitive position and thereby subject to Texas Education code §51.215.
Faculty Opportunity
Advertising Positions Available at Annual Meeting
Department of Emergency Medicine The University of Texas Houston Health Science Center is seeking candidates for a full-time faculty position immediately available in the Department of Emergency Medicine. The department has responsibility for two emergency centers. Memorial Hermann Hospital is located within the Texas Medical Center. This emergency department has an annual census of 55,000 patient visits and is one of only two Level I trauma centers in Houston. Additionally, Memorial Hermann is a regional burn center, a nationally recognized stroke center, and a comprehensive cardiac care center. The Lyndon Banes Johnson Hospital has an annual census of 85,000 visits and is a Level III trauma center. Qualified applicants will be board certified/prepared in EM and possess interest/expertise in the clinical teaching of emergency medicine. Excellent salary and comprehensive benefits package, including relocation assistance.
SAEM is again offering an opportunity to advertise in the on-site program. The Annual Meeting will be held May 29-June 1 in Boston and will attract approximately 1,800 academic emergency physicians. A limited amount of space is being set aside for the position available section and only academic positions available will be accepted. The deadline for receipt of ads at the SAEM office is May 1. The following ad requirements and prices are available for the on-site program: Classified line ads (100 words maximum): $100 (contact SAEM member) or $125 (non-SAEM member)
Please forward your CV to: Dr. Brent R. King University of Houston Health Science Center at Houston Department of Emergency Medicine P.O. Box 20708 Houston, TX 77030
Quarter page ads: 31⁄2” wide x 43⁄4” deep Half page ads: 71⁄2” wide x 43⁄4” deep or 31⁄2” wide x 93⁄4” deep Full page ads: 71⁄2” wide x 93⁄4” deep
$300 $350 $450
A typesetting fee ($25-$50) will be charged if the quarter, half, or full page ads are not camera-ready.
The University of Texas is an Equal Opportunity, Affirmative Action Employer. Minorities and women are strongly encouraged to apply. This is a security-sensitive position and thereby subject to Texas Education code §51.215.
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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 Susan Stern, MD
Editor David Cone, MD David.Cone@yale.edu Executive Director/Managing Editor Mary Ann Schropp mschropp@saem.org Advertising Coordinator Carrie Barber Carrie@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.
AEM Consensus Conference 2003; Disparities in Emergency Health Care Michelle H. Biros, MS, MD Hennepin County Medical Center Editor In Chief, Academic Emergency Medicine The editors of Academic Emergency Medicine are firmly committed to the advancement of patient care through research, teaching and clinical practice. While the medical literature holds the key to improved clinical practice, there are many aspects of health care that are influenced by forces outside of our specialty. These areas may not be amenable to typical research methodologies, are rapidly changing and politically charged, and are essential to understand and to study in order to remain patient centered in an increasingly difficult practice and teaching environment. Accordingly, AEM has developed a series of Consensus Conferences, held immediately before the SAEM Annual Meeting, with the goals of summarizing existing relevant knowledge, establishing a research agenda, setting a specialty action plan, and increasing specialty and out of specialty awareness regarding these challenging topics. The 2003 AEM Consensus Conference will examine “ Disparities in Emergency Health Care.” We will attempt to critically evaluate the presence, causes, and outcomes related to disparities and determine if these arise
from within or outside of the specialty. We will evaluate existing research methodologies to find the most appropriate means of defining, assessing, and measuring emergency care disparities. We will also scrutinize our emergency medical education, and determine whether it promotes, lessens, or addresses disparities. By the end of the day, we will set a research agenda to further study this complex problem. We also hope to challenge the specialty to confront this issue as appropriate, and develop a specialty action plan to translate relevant research findings into clinical practice. The conference will be held on May 28, 2003, at the Marriott Copley Plaza Hotel in Boston. Dr. Jordan Cohen, the President of the Association of American Medical Colleges, will provide a general overview of health care disparities. Dr. Nicole Lurie, the Senior Program Officer in the Division of Health Sciences Policy Analysis at RAND Corporation, will speak on the Healthy People 2010 initiative and the development of research priorities for emergency medicine related to health care disparities. Panels of noted emergency medicine clinicians, educators and
researchers will discuss health care disparities in emergency care delivery and their implications, the strengths and weaknesses of existing research methods, systems and administration issues that promote or lessen disparities, and the residency educational gaps related to disparities that challenge clinical educators. This conference is open to all interested, but pre-registration and a $50 registration fee (which includes lunch) will be required. The proceedings of the conference will be published in the November 2003 issue of AEM. In addition original contributions have been solicited for peer review in a general call for papers related to emergency health care disparities. Paper submitted for consideration for this special issue must be received by March 1, 2003; decisions on acceptance are expected by mid June. The preliminary agenda and details regarding the consensus conference will soon be available on the SAEM website. Further questions may be addressed to the AEM editorial office at aem@saem.org.