November-December 2001

S A E M

NEWSLETTER

Newsletter of the Society for Academic Emergency Medicine

PRESIDENT’S MESSAGE Half Time Assessment We are mid way through my term as SAEM president and in this message I provide you a halftime assessment of the progress in achieving objectives outlined earlier during the year. Before providing that assessment, I express concern and support of the many families, friends, and EMS personnel affected by the tragedies of September 11, 2001 and the ongoing acts of bio-terrorism.

Marcus Martin, MD This has been a trying past few months for Americans as we have experienced terrible acts upon citizens of our country. Our sense of security has been disrupted like no time before. Like many of you, I have developed a renewed sense of purpose in life and a deeper appreciation of my family, country and fellow Americans. It is painful to recall the events of September 11, 2001. On that day I was in the midst of my emergency department’s newly formed Emergency Medicine Center for Education, Research and Technology (EMCERT) Advisory Board meeting. This board, comprised of mostly community citizens (non-clinicians), was in shock as we viewed the live footage of the devastating loss of lives and the collapse of monumental structures before our eyes. Our meeting ended with sadness, bewilderment and helplessness. After making sure my department was poised to help potential victims of the Pentagon attack (we are located within two hours of Washington, DC), I then held the prescheduled SAEM Board teleconference that day. The Board’s resolve was to help in any way we could, beginning with a message to support our fellow EMS providers in New York, DC and Pennsylvania. The message we sent was as follows: "The SAEM Board of Directors held its conference call today and among the issues discussed was the tragedy of today’s events that shocked the world. We express deep concern for the victims and their families and offer our emotional support to all the healthcare workers so diligently working on the front lines to provide care."

During the ensuing 24 hours, we received responses from our membership. The following are a select few: "Dear colleagues: Thanks so much for your thoughts and concerns for all of us involved in this horrible tragedy. At times like these it helps to receive support from our friends. The lethality of the event was incredible with most victims dead at the scene, we are trying to go back to business as usual today but nothing will ever be the same. Thank you for your thoughts." Shelly Jacobson "From all the way on the other side of the world in Singapore, we watched in horror the unfolding of the terrible tragedy that is occurring in New York, Washington DC, and Pennsylvania. Our (continued on page 26)

901 North Washington Ave. Lansing, MI 48906-5137 (517) 485-5484 saem@saem.org www.saem.org

November/December 2001 Volume XIII, Number 6

Something New: Innovations in Emergency Medicine Education Exhibits Ellen Weber, MD Chair, SAEM Annual Meeting Program Committee University of California, San Francisco We’d like to call your attention to an important change in the submission process for Innovations in Emergency Medicine Education (IEME) Exhibits. In the past, those interested in describing or displaying such innovations submitted the concept as a scientific abstract, following the structured abstract format for all scientific papers. This worked well for those who had conducted scientific research or assessments on their inventions, but made it difficult for those who wished to display an innovative idea.

In addition, the Program Committee found these submissions inconsistent with the rest of the scientific abstracts and could not fairly judge them on the same criteria.

Therefore, we have created a separate submission process for the IEME exhibits. You will be asked to submit an application (not an abstract) describing an innovative new educational methodology or an innovative educational application of an existing product. The exhibit should not be used to display a commercial product that is already available and being used in its intended application.

Exhibits will be selected based on utility, originality, and applicability to the teaching setting. Commercial support is allowed, but must be disclosed on the application and at the exhibit.

Applications will be due on February 15, and will be judged by a review committee consisting of SAEM members who are knowledgeable in education and technology.

Decisions will be made on March 15. Exhibitors will be responsible for the costs of audiovisual or other equipment rental and computer internet connections.

If you have completed a well-designed scientific study evaluating a new educational methodology, we encourage you to submit a traditional scientific abstract for presentation. These are due on January 8, 2002. If you do submit a scientific abstract you will note that we have eliminated the IEME abstract category; instead you should now select the most appropriate subject category for the innovation (e.g. education, computer modeling, research methodology, cardiology, etc.)

I would like to thank Cathy Custalow, MD, and her subcommittee for putting together this new approach to the IEME Exhibits.

S A E M

Call for Submissions Innovations in Emergency Medicine Education Exhibits 2002 Annual Meeting Deadline: February 15, 2002

The Program Committee is accepting applications for review for the Innovations in Emergency Medicine Education (IEME) Exhibits at the 2002 SAEM Annual Meeting, May 19-22 in St. Louis. Submitters are invited to complete an application describing an innovative new educational methodology that they have designed, or an innovative educational application of an existing product. The exhibit should not be used to display a commercial product that is already available and being used in its intended application. Exhibits will be selected based on utility, originality, and applicability to the teaching setting.

Commercial support of innovations is permitted but must be disclosed. IEME exhibits will not be published in Academic Emergency Medicine with other abstracts, but will be listed in the on-site program. However, if submitters have conducted a research project on or using the innovation, the project may be written up as a scientific abstract and submitted for scientific review in the appropriate subject category by the January 8 deadline.

The deadline for submission of IEME Exhibit applications is Tuesday, February 15, 2002 at 5:00 pm Eastern Time and will be strictly enforced. Only electronic submission via email attachment to saem@saem.org will be accepted. The application form and instructions will be available on the SAEM web site at www.saem.org in November. For further information or questions, contact SAEM at saem@saem.org or 517-485-5484 or via fax at 517-485-0801.

Society for Academic Emergency Medicine • 901 North Washington Avenue • Lansing, MI 48906

Academic Emergency Medicine Website Brian O’Neil, MD Editorial Board, Academic Emergency Medicine Detroit Receiving Hospital I certainly do not view myself as a technocrat nor a computer jockey; however, I do enjoy things that help simplify my life and make me more efficient.

One of those things would be the Academic Emergency Medicine website found at www.aemj.org. This web site is free to all AEM subscribers and is maintained by Stanford Universities Libraries Highwire Press ™. Although this web site can make each of us significantly more efficient, it has been accessed by only a small percentage of the AEM subscribers. I am confident that the reason some of you have not accessed our site is that you have not been fully acquainted with the features of AEM online.

Computer neophytes need not be apprehensive when accessing the AEMJ homepage as the setup of site is absolutely unpretentious, extremely user-friendly, and seamless. The homepage is simple, uncluttered, and ergonomically split into the areas utilized the most. A small headline banner proclaims upcoming events and deadlines. Below this, a small area displays the headings View Future Titles, Select an Issue from the Archive, Search for

Articles and Collected Papers, as well as a picture of our current issue. On the left side, a quick reference banner allows access to information including the make-up of the editorial board, email alerts, positions available, help, tips, and feedback.

After the initial registration (very painless), the system stores a “cookie” that recognizes the subscriber upon return to the site, saving login time.

Many websites will let you search their database to the point where you can read the abstract, but when you wish to obtain the full text of the article, they require an ID, password, or money. To obtain the full text of an AEM article however, requires only a mouse click on the full text prompt.

One can search either archives of old issues or all available issues by citation, author, or keywords. Each of the subscreens allows you to quickly move back to either the home page or help page, provide feedback, obtain subscriptions, access the archives, or repeat the search, simply by clicking on one of the blue boxes on the header.

When searching the archives, the full text and abstracts are available back to January of 1999. The ability to pull up full text articles from the computer is a godsend to anyone who has spent time searching through old bound journals in the library catacombs, camped out in

front of copy machine sucking toner, or fed all their money to the copy card beast. Even if you subscribe to the paper journal, the on-line version saves you the time and aggravation of having to search through the pile of journals your kids have stacked into a fort to keep the dragons out. Being near to the old guard, I still prefer to read my articles on paper, and the PDF format allows me to quickly print out a high resolution article from the comfort of my office or home.

When you access an abstract, an options box at the top right allows you to get the full text of this article, reprint the PDF version of this article, or search similar articles through PubMed. When you click on the PubMed option, you are taken directly to The National Library of Medicine search page and it automatically searches for similar articles in its database. The speed of the transfer is actually quite good, even on my home computer with a 28K modem, with transfer and downloads times of less than one minute.

The web site can also make you more efficient by allowing you to download directly to your citation manager, in the EndNote, Reference Manager, ProCite, and Medlars formats. You also have the option, if your citation manager is not listed, to request that an additional format be added to this list. Another (continued on page 23)

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SAEM Membership Dues Increased Donald M. Yealy, MD SAEM Secretary/Treasurer Marcus Martin, MD SAEM President on behalf of the Board of Directors The major task of the SAEM Board of Directors is to lead the organization and fulfill its mission and goals. Toward that, the Board must manage the Society’s resources. At the most recent meeting on October 14, 2001, the Board voted to increase the dues for renewal and new applications for membership in the Society for calendar year 2002. The new yearly dues are $365 for active members and $350 for associate members. This increase is the first since 1995, representing an annualized increase of approximately 3%. We will not raise dues for the residents or students, the future of our organization. It is essential to share the thoughts behind this important decision with the SAEM members.

For the fiscal year ending December 31, 2001, the Society will have a small net positive balance on operations (income received minus expenses).

However, to fulfill the planned activities for the next year and beyond, an operating deficit would be realized without an increase in revenues. The Board weighed all options: reducing or eliminating programs and expenses; using reserves; or increasing revenues.

Currently, revenue comes mostly from membership dues, Annual Meeting registration fees, and investment income.

Given recent market conditions, the Board could not depend on enhanced revenue from investments. After careful deliberation, we chose to increase the membership dues while continuing efforts to operate more efficiently.

Our Society offers value to its members; our goal is to continue to provide and increase that value. For seven years, the Society has improved the member benefits while maintaining the same membership fee. These new or improved member benefits include: ● Ongoing and increased leadership in academic emergency medicine issues, with representation at the AAMC, AHRQ, NIH, NHLBI, and many other organizations; ● A strong voice in the communities of emergency medicine and medicine, working collaboratively with ACEP, ABEM, CORD, EMRA, AAEM, AACEM, AMA and other organizations;

● Development, alone or collaboratively, of position papers and commentary pieces that influence health care, from the training of providers through delivery of care to legislative advocacy; ● Growth of Academic Emergency Medicine, our Society’s well respected journal, now cited in Index Medicus, garnering a high impact factor within our field, and with electronic accessibility; ● Continuation of the premiere Annual Meeting for those interested in academic emergency medicine, which has grown in size, content, and diversity; ● Creation of focused conferences and published symposia on "Errors in Emergency Medicine" and "ED Overcrowding and The Unraveling Safety Net" – both current issues facing academic emergency physicians and the broader health care community ● The development and support for Regional Meetings to augment research and educational opportunities for all members, including trainees, junior faculty, and those who might not be able to attend the Annual Meeting; ● Expanded opportunities for Society involvement by members, including interest groups, task forces, and enhanced committee structures; ● The creation of research funding opportunities (alone or in collaboration) for members to develop the skills and knowledge to compete for governmental support. These include newer grants the Scholarly Sabbatical, Research Training, Institutional Training, and Neurosciences Research Fellowship to complement the pre-existing EMS Research Fellowship, Geriatric Awards, Innovations in Medical Education and Medical Student Awards (the latter two with the Emergency Medicine Foundation); ● A timely communication base using both traditional ‘hard copy’ - this Newsletter - and a growing electronic forum based on the SAEM Web page.

The Web page is a valuable tool, growing yearly in content and flexibility. It is the tool for abstract submission and meeting registration, easing this task for members. ● Development and distribution of new career materials and services in varied formats - the Academic Career Guide (2000) for junior faculty, the Virtual Advisor Program (2001) for medical students and the Faculty Development Website (2001) for junior

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to mid-career faculty. ● Expansion of programs for the increased number of medical student and resident members, including dedicated educational materials at the Annual Meeting, separate sections on the Web page, involvement in the SAEM committees, and a Resident Board member on the Board of Directors. ● Creation of the Research and Ethics Consulting Services, to augment the Residency Consulting Service. Each of these offers skilled insight for programs or academicians in need.

In planning for the future, we believe a dues increase is both necessary and the responsible thing to do for the organization. The people of SAEM are the most important resource – the members who donate their time, expertise, enthusiasm and support, together with a talented, hard-working professional staff. We need all of our resources – human and financial – to improve the return for every member. We value each SAEM member, and we look forward to your support and feedback.

Geriatric Emergency Medicine Resident/Fellow Grants Available SAEM, with sponsorship from the John A. Hartford Foundation and the American Geriatric Society, is pleased to announce the availability of grants to support resident/fellow research related to the emergency care of the older person. Investigations may focus on basic science research, clinical research, preventive medicine, epidemiology, or educational topics.

Awards may be up to $2,500 for each project.

Applications for the Geriatric Emergency Medicine Resident/ Fellow Grant may be obtained from the SAEM office or the website at saem.org. The deadline for receipt of a complete application at the SAEM office is March 4, 2002 with notification of selections by May 7 and funding awarded by July 1.

S A E M

2002-2003 SAEM Committee/Task Force Interest Form Deadline: February 1, 2002

Members interested in serving on an SAEM committee or task force in 2002-2003 should submit this form, along with a current curriculum vitae and a cover letter describing relevant experience or other qualifications, and likely contribution to the committee or task force. Completed forms submitted as e-mail attachments to saem@saem.org are preferred, however mail and fax copies are also acceptable. Members are encouraged to review the following materials, available on the home page at www.saem.org or upon request from the SAEM office: 1.

2.

3.

4.

Committee/task force orientation guidelines that detail the role and structure of SAEM's committees and task forces.

Current 2001-2002 committee/task force objectives.

SAEM mission and vision statement, and SAEM's five-year goals and objectives.

The article in the November/December Newsletter by Dr. Lewis, the current SAEM President-elect, regarding the committee/task force member selection process.

The following guidelines should be noted: 1. The completed interest form, CV, and letter must be received by February 1, 2002.

2. SAEM members, even if currently serving on a committee or task force, must submit a complete application to be considered for appointment or reappointment.

3. Due to the relatively small number of committees and task forces, preference will be given to those whose applications are thoughtful and focused.

4. Committee and task force appointments and reappointments will be made by the President-elect by April 15, 2002. The term of appointment is May 2002 to May 2003.

5. Committee and task force members are expected to attend all meetings and actively participate in the committee/task force activities. All committees and task forces meet at the SAEM Annual Meeting and many meet at the ACEP Scientific Assembly.

6. Individuals must be SAEM members to serve on a committee or task force.

7. In general, one resident will be appointed to each committee and task force.

1. Which description best characterizes you? ❒ EM resident, will complete residency in 20____. ❒ Faculty member without previous SAEM committee or task force experience. ❒ Faculty member with previous SAEM committee or task force experience. ❒ Other (e.g. fellow):_________________ 2. Is there a particular committee or task force in which you are interested? ❒ Yes ❒ No If so, which one(s): ______________________________________________________________________________ 3. Is there a particular objective on which you are interested in working? ❒ Yes ❒ No If so, which one(s): ______________________________________________________________________________ 4. What specific objectives or tasks do you think SAEM should pursue in the coming year? ________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ 5. Have you previously served on an SAEM committee or task force?

If yes, list name of committee/task force and time period served:

❒ Yes ❒ No

________________________________________________________________________________________________ ________________________________________________________________________________________________ ________________________________________________________________________________________________ Name: ____________________________________________________________________________________________ Institution: ________________________________________________________________________________________ E-mail address: ____________________________________________________________________________________ Fax number: ______________________________________________________________________________________ Return to SAEM at 901 N. Washington Ave., Lansing, MI 48906, fax (517) 485-0801, or e-mail at saem@saem.org

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Choosing Members for 2002-2003 Committees and Task Forces: The Selection Process and How to Apply Roger J. Lewis, MD, PhD SAEM President-elect Harbor-UCLA Medical Center In this issue of the SAEM Newsletter, a Committee Interest Form is included, so that all SAEM members may apply for positions on SAEM committees.

SAEM Committees are the "engine" which drives the organization. It is through the work of these committees that the mission of SAEM is advanced, the quality of our Annual Meeting maintained and improved, and in which many of the new ideas which strengthen our organization are developed and nurtured.

Being appointed to an SAEM committee is both an opportunity and a commitment. It is an opportunity to work to improve the world of academic emergency medicine and to influence the direction of the Society as a whole.

Because there are frequently more members who wish to serve on SAEM committees than available committee positions, it is expected that each member applying for a position is prepared to make a significant commitment towards completing the work of the committee.

One should only apply to become a member of an SAEM committee if you are willing and able to commit substantial time and energy.

It is important that potential committee members be aware that the goals and objectives of each committee are not set by the committees themselves, but are guided by the five-year goals and objectives of the Society and defined by the Board of Directors. Thus, committee members must be prepared

to put their efforts towards the completion of predefined goals and objectives.

As outlined below, however, there is significant opportunity to influence the goals and objectives of the committees through feedback to each committee chair or to the Board of Directors directly. The SAEM Board of Directors sets the Goals and Objectives for each committee and task force to help ensure a coordinated set of activities and to reduce duplicative efforts.

How are new Committee members selected? First, each committee chair is asked to evaluate the performance of each current committee member.

Committee members are evaluated in terms of their productivity, work effort, responsiveness to requests, and overall contribution to the function of the committee. Approximately one-third of each committee’s membership is rotated off each year, based on both the chair’s evaluation of each member’s performance, and based on the number of years each member has served on the committee. This rotation is extremely important to ensure that as many SAEM members as possible have an opportunity to participate in the Society’s efforts.

All prospective committee members, whether currently on an SAEM committee or with no prior experience, are required to submit a Committee Interest Form in order to be considered for new appointment or reappointment. The Committee Interest Form should be accompanied both by a current curriculum vitae, as well as a narrative statement outlining the applicant’s motivations for joining the committee, ideas

regarding areas in which they may contribute to the committee, and any other information the applicant deems relevant. In evaluating these applications, the President-elect looks for evidence of enthusiasm, focus, realism, new ideas, and commitment. Applications are generally much stronger if they demonstrate an understanding of SAEM’s mission, the five-year plan for the organization, and the current year’s goals and objectives for the individual committee (this information can be found at the SAEM website at www.saem.org). Please be aware that one-half or more of the goals and objectives for each committee are repeated each year. For example, one can anticipate that an objective for the Program Committee will always be to coordinate the Annual Meeting, to select abstracts for oral and poster presentation, and to select didactic presentations.

Among some SAEM members there is an unfortunate perception that being appointed to an SAEM committee requires being a member of some inner circle. On the contrary, each year the President-elect makes a concerted effort to appoint members who have not previously had an opportunity to serve, as part of an ongoing effort to develop new leadership talent in the Society.

Because the President-elect cannot know all members equally well, the information provided in the narrative statement and curriculum vitae is weighted heavily in the selection process. This helps to ensure fairness, opportunity, and a well-balanced committee and task force membership.

AEM Call for Papers “Assuring Quality” The Editors of Academic Emergency Medicine announce the next AEM Consensus Conference on “Assuring Quality” to be held on May 18 in St. Louis. The conference will aim to describe means of defining, assessing, measuring, and researching the delivery of quality emergency care in the clinical setting. We believe the conference is a logical progression in our consensus series, which has included “Errors in Emergency Medicine,” and “The

Unraveling Safety Net.” We therefore issue this call for papers related to the topic of Assuring Quality. Submitted manuscripts are due on March 1, 2002.

Accepted papers will be published in the late fall of 2002, along with Proceedings from the consensus conference.

Please submit eligible papers to the AEM editorial office in Lansing at aem@saem.org. Electronic submission of the original and a blinded copy are preferred. Submit also a cover letter 5

clearly indicating that your submission is for the Assuring Quality Consensus Conference. General instructions for authors appear at www.saem.org/ inform/journal.htm.

Any questions regarding this call for papers on the AEM Consensus Conference can be directed to Michelle Biros, MD, at biros001@maroon. tc.umn.edu or Jim Adams, MD, at: jadams@nmh.org.

S A E M

Call for Nominations SAEM Elected Positions Deadline: February 1, 2002

Nominations are sought for the SAEM elections which will be held in the spring of 2002 via mail or electronic ballot. The Nominating Committee will select a slate of nominees based on the following criteria: previous service to SAEM, leadership potential, interpersonal skills, and the ability to advance the broad interests of the membership and academic emergency medicine.

Interested members are encouraged to review the appropriate SAEM orientation guidelines (Board, Committee/Task Force or President-elect) to consider the responsibilities and expectations of an SAEM elected position. Orientation guidelines are available at www.saem.org or from the SAEM office.

The Nominating Committee wishes to consider as many candidates as possible and whenever possible will select more than one nominee for each position. Nominations may be submitted by the candidate or any SAEM member and should include the candidate's CV and a cover letter describing the candidate's qualifications and previous SAEM activities. Nominations are sought for the following positions: President-elect: The President-elect serves one year as President-elect, one year as President, and one year as Past President.

Candidates are usually members of the Board of Directors.

Secretary/Treasurer: The Secretary/Treasurer serves a three-year term on the Board. Candidates should have a track record of excellent service and leadership on SAEM committees and task forces and are usually members of the Board.

Board of Directors: Two members will be elected to three-year terms on the Board. Candidates should have a track record of excellent service and leadership on SAEM committees and task forces.

Resident Board Member: The resident member is elected to a one-year term and is a full voting member of the Board. Candidates must be a resident during the entire term on the Board (May 2002-May 2003) and should demonstrate evidence of strong interest and commitment to academic emergency medicine. Nominations should include a letter of support from the candidate's residency director.

Nominating Committee: One member will be elected to a two-year term. The Nominating Committee selects the recipients of the SAEM awards (Young Investigator, Academic Excellence, and Leadership) and develops the slate of nominees for the elected positions. Candidates should have considerable experience and leadership on SAEM committees and task forces.

Constitution and Bylaws Committee: One member will be elected to a three-year term, the final year as the chair of the Committee. The Committee reviews the Constitution and Bylaws and makes recommendations to the Board for amendments to be considered by the membership. Candidates should have considerable experience and leadership on SAEM committees and task forces.

Two New Residency Programs Approved During the September meeting of the Residency Review Committee for Emergency Medicine two new emergency medicine residency programs were approved: University of Alabama The University of Alabama at Birmingham program is a 2,3,4 program and was approved six residents per year. The residency director is James M. Leaming, MD, and the chair of the department is Thomas E. Terndrup.

The program includes the University of Alabama Hospital and Children’s Hospital of Alabama with a combined total of over 90,000 patient visits per year.

Maimonides Medical Center The residency program at Maimonides Medical Center in Brooklyn, New York has been approved for 9 residents per year and is a 1,2,3 program. Amy Church, MD, is the residency director and Steven J. Davidson, MD, is the chair of the department. The institution sees over 70,000 patient visits per year.

SAEM would like to congratulate the faculty and residents at these two new programs. There are now 124 approved emergency medicine residency programs in the U.S. Complete details on these programs can be found in the SAEM Residency Catalog at www.saem.org.

The 2001 Final CPC Competition was held October 15 during the ACEP Scientific Assembly. Mary Ryan, MD, from Lincoln Medical and Mental Health was selected as the Best Discussant and Michael Gisondi, MD, from Stanford-Kaiser was selected as the Best Presenter.

The 2002 Semi-Final Competition will be held on May 18 in St. Louis, the day before the SAEM Annual Meeting.

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Academic Announcements Michael Callaham, MD, has assumed the role of Editor of Annals of Emergency Medicine. Dr. Callaham is the Chief of the Division of Emergency Medicine at the Medical Center at the University of California, San Francisco and has served as Professor of Clinical Medicine since 1990. He has served as chair of the Ethics Committee of the World Association of Medical Editors and chair of the Editorial Policy Committee for the Council of Science Editors.

Sharon K. Griswold, MD, has been appointed the residency director of the emergency medicine residency program at Thomas Jefferson University.

She formerly served as assistant residency director.

Gwen Hoffman, MD, has assumed the presidency of the American Board of Emergency Medicine. She completed an EM residency at Butterworth Hospital in Grand Rapids, MI, and

served as residency director for 21 years. She is chair of the Emergency Medicine Department and presidentelect of the Medical Staff at Spectrum Health-Blodgett and Butterworth campuses in Grand Rapids.

During the ACEP Scientific Assembly in Chicago, Judd Hollander, MD, was presented with the ACEP Outstanding Contribution in Research Award. Dr. Hollander is Professor of Emergency Medicine at the University of Pennsylvania.

Bernard L. Lopez, MD, has been appointed Assistant Dean for Student Affairs at Jefferson Medical College at Thomas Jefferson University. Dr. Lopez also serves as the Director of Clinical Research in the Division of Emergency Medicine.

Donald Yealy, MD, was presented the Outstanding Contribution in Education Award during the recent ACEP Scientific

Assembly in Chicago. Dr. Yealy is Professor of Emergency Medicine at the University of Pittsburgh.

Blaine C. White, MD, has recently been appointed to the Institute of Medicine of the National Academy of Sciences. Dr. White is Professor of Emergency Medicine at Wayne State University.

Robert J. Zalenski, MD, MA, has been awarded a Certificate of Recognition from the National Heart Attack Alert Program for nearly a decade of service.

Dr. Zalenski served as the SAEM representative to the NHAAP Coordinating Committee from 1992-2001 and served in a variety of other roles.

SAEM members are encouraged to submit Academic Announcements on promotions, research funding, and other items of interest to the SAEM membership for publication in the Newsletter.

Submissions should be sent to saem@saem.org

Call for Nominations

S A E M

Deadline: February 1, 2002

Nominations are sought for the Hal Jayne Academic Excellence Award and the Leadership Award. These awards will be presented during the SAEM Annual Business Meeting in St. Louis. Nominations for honorary membership for those who have made exceptional contributions to emergency medicine are also sought. The Nominating Committee wishes to consider as many exceptional candidates as possible. Nominations may be submitted by the candidate or any SAEM member. Nominations should include a copy of the candidate’s CV and a cover letter describing his/her qualifications.

Nominations can be sent to saem@saem.org or 901 N. Washington Ave., Lansing, MI 48906. The awards and criteria are described below:

Academic Excellence Award

B. Other research publications (e.g., review articles, book chapters, editorials) C. Research support generated through grants and contracts D. Peer-reviewed research presentations E. Honors and awards

The Hal Jayne Academic Excellence Award is presented to a member of SAEM who has made outstanding contributions to emergency medicine through research, education, and scholarly accomplishments. Candidates will be evaluated on their accomplishments in emergency medicine, including: 1. Teaching A. Didactic/Bedside B. Development of new techniques of instruction or instructional materials C. Scholarly works D. Presentations E. Recognition or awards by students, residents, or peers 2. Research and Scholarly Accomplishments A. Original research in peer-reviewed journals

Leadership Award The Leadership Award is presented to a member of SAEM who has demonstrated exceptional leadership in academic emergency medicine. Candidates will be evaluated on their leadership contributions including: 1. Emergency medicine organizations and publications.

2. Emergency medicine academic productivity.

3. Growth of academic emergency medicine.

SAEM • 901 N. Washington Ave., Lansing, MI 48906 • www.saem.org

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2001 Healthy People Consortium Meeting

Nominations Requested for Resident Member of the SAEM Board of Directors

Carlos Camargo, MD, DrPH Chair, SAEM Public Health Task Force Massachusetts General Hospital The Healthy People Consortium Meeting, Creating Change with Healthy People 2010, was held October 19, 2001 in Atlanta.

The Healthy People Consortium is an alliance of more than 600 organizations (including SAEM) that are committed to making Americans healthier by supporting the goals and objectives of Healthy People 2010.

At the Consortium Meeting, approximately 400 people heard speakers discuss the greatest potential and the greatest challenge facing Healthy People 2010: How do we translate this national vision into local action … action that will make a real difference in the lives of the people of this Nation? The Plenary Session speakers provided specific examples of "Action in the Field" from a variety of perspectives: international, business, professional organization, region, and state. Conference attendees then participated in three breakout sessions, facilitated by national leaders, with work groups addressing all 28 Focus Areas of Healthy People 2010.

If SAEM members are interested in learning more about Healthy People 2010, I encourage you to browse: http://www.health.gov/healthypeople/. For news updates and announcements, you may want to join the Healthy People Listserve at: http://list.nih.gov/archives/healthypeople.html. Lastly, if you would like to help the SAEM Public Health Task Force with ED-based implementation of Healthy People 2010, please contact me at ccamargo@partners.org. We would welcome your assistance with several ongoing projects, and would gladly help you to implement your own ED-based programs/studies that support the goals of Healthy People 2010.

Faculty Development Conference: Navigating the Academic Waters March 2-4, 2002 – Washington, DC Faculty development continues to be one of the most carefully scrutinized areas by the RRC-EM. Due to the relative growth of our specialty, coupled with rapid growth of residency programs over the past 10 years, many younger faculty struggle to develop needed personal, management, teaching, and research skills required for successful career advancement.

CORD and AACEM have conjointly developed a seminar entitled: “Navigating the Academic Waters: Tools for Emergency medicine”. This conference was first held in November 1996 and received high praise from attendees. The conference is designed specifically for the unique needs of junior Emergency Medicine faculty and will address essential elements necessary for success in an academic environment including research development, grants, presentations skills, resident evaluation, mentoring and clinical teaching, as well as time and personal management. This course nicely augments the ongoing efforts made by SAEM in the area of faculty development. Young faculty or senior residents interested in an academic career should contact the CORD/AACEM office at 517-485-5484 or the CORD web site at www.cordem.org. Registration is limited to 125 people, so call today!

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Nominations are sought for the resident member of the SAEM Board of Directors. The resident Board member is elected to a one-year term and is a full voting member of the Board. The deadline for nominations is February 1, 2002.

Candidates must be a resident during the entire one year term on the Board (May 2002-May 2003) and be a member of SAEM. Candidates should demonstrate evidence of strong interest and commitment to academic emergency medicine. Nominations should include a letter of support from the candidate’s residency director, as well as the candidate’s CV and a cover letter.

Nominations should be sent to saem@saem.org or 901 N. Washington Ave., Lansing, MI 48906. Candidates are encouraged to review the Board of Directors orientation guidelines on the SAEM web site at www.saem.org or from the SAEM office.

The election will be held via mail ballot in the Spring of 2002 and the results will be announced during the Annual Business Meeting in St. Louis.

The resident member of the Board will attend four SAEM Board meetings; in the fall, in the winter, and in the spring (at the 2002 and 2003 SAEM Annual Meetings). The resident member will also participate in monthly Board conference calls.

CORD Best Practices Conference CORD is sponsoring a consensus conference, to be held on March 2-4, 2002 in Washington, DC, to present and discuss "best practice" models in emergency medicine residency education. The conference will highlight models to incorporate the six new ACGME core competencies into educational programs and will also explore "best practices" in other important areas of the emergency medicine residency curriculum. We will focus particularly on topics related to resident evaluation and assessment. The conference will include general discussion sessions as well as small group breakout sessions. We have invited educational leaders from the ACGME and other academic organizations to participate with us. We also plan to publish the results of the conference work in a special issue of Academic Emergency Medicine.

CORD is excited about the potential for emergency medicine, with this consensus conference, to provide a leadership role among the specialties in medicine in developing effective educational models for resident competency. The success of this conference, however, depends largely on the contributions of those in the academic emergency medicine community.

To that end, we invite members of CORD and SAEM to participate in this conference and to share your experience and ideas about these important and timely issues. Please set aside these dates in your calendar to attend this important conference.

For more information contact CORD at cord@cordem.org

Scholarly Sabbatical Grant Recipient Reports Scott Tadler, MD Medical College of Virginia As the recipient of the 2000-2001 SAEM Scholarly Sabbatical Award, I am writing to describe my experience. To give a bit of background, I graduated residency in 1997 from the University of Pittsburgh. While there, I became affiliated with Clifton Callaway, MD, PhD, and James Menegazzi, PhD. This relationship helped to kindle what was, at that time, a largely unexplored interest in research. I was fortunate enough to befriend Clif and his family and we spent many an evening brainstorming interesting ideas about cerebral resuscitation and the like. Some preliminary work with external cooling of swine during resuscitation from cardiac arrest was presented at a national meeting of the National Association for EMS Physicians (NAEMSP) where I won an award. I was also presented an award from the residency for my research.

Shortly after, I left for a faculty position at the new Department of Emergency Medicine at the Virginia Commonwealth University (where I am

currently practicing). Upon arrival, awareness of my own lack of expertise and independence was intensified. I spent a lot of time "spinning my wheels," so to speak. Upon the arrival of Kevin Ward, MD, a new mentoring relationship was established and I began to develop constructive research relationships and plans. In collaboration with Dr. Ward and Anthony Marmarou, PhD, I became the Department’s representative for the study of the use of Xenon CT for acute ischemic stroke and was introduced to the Marmarou laboratory.

It is my opinion that an inability to perform animal and basic science research limits one’s ability to explore fully any area of investigation. As a result it was my goal to become more proficient with laboratory techniques and more independent in developing workable hypotheses. Nevertheless, I was working in a very busy ED that, like many others, falls under tremendous financial pressures. It was difficult to find time to hone techniques and refine a specific hypothesis and research plan.

Fortunately, I was made aware of the SAEM scholarly sabbatical grant and

made a successful application.

As a result my clinical commitment was greatly reduced from June until December 2000. An ambiguous and poorly thought out research plan was revised and formalized and limited animal skills have broadened greatly. With further salary support in January and February, I submitted an application to the NIH, National Institute on Aging for the Mentored Clinical Scientist Development Award (K-08). For various reasons, I was unsuccessful with this attempt. My preliminary data was limited and my publication record not quite what was desired. Nevertheless, as a result of the SAEM grant I was able to, in large part independently, prepare and submit an application for research support that involved an important research question. With mentorship and guidance, I formulated an important hypothesis, collected and analyzed data and submitted the grant. For me, this represented both an important accomplishment and great experience.

My goal in writing this article is to bring an awareness to a large number of junior faculty the availability of a won(continued on page 23)

S A E M

Call for Nominations Young Investigator Award Deadline: December 15, 2001

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

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

3. Academic accomplishments which may include: a. postgraduate training/education: research fellowship, master’s program, doctoral program, etc. b. publications: abstracts, papers, review articles, chapters, case reports, etc. c. research grant awards d. presentations at national research meetings e. research awards/recognition The deadline for the submission of nominations is December 15, 2001. Nominations should include the candidate’s CV and a cover letter summarizing why the candidate merits consideration for this award. Candidates can nominate themselves or any SAEM member can nominate a deserving young investigator. Candidates may not be senior faculty (associate or full professor) nor be more than seven years beyond residency training at the time of application.

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

Send submissions to SAEM at saem@saem.org or 901 N. Washington Ave., Lansing, MI 48906

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Recollections of September 11 Sheldon Jacobson, MD Mt. Sinai Medical Center

bandaging and splinting. The Department of Medicine staffed a station that treated patient with respiratory and undifferentiated complaints. Our mental health professionals were on hand to speak with patients throughout their course. We completed registration in the area and support personnel were available to help the patient with communications and transportation needs.

This system functioned superbly and while providing expeditious care to our "minor patients" rapidly decompressed the ED and allowed our emergency physicians and surgeons to concentrate their resources on the major trauma cases and the acute and critical patients from our community that were brought in simultaneously.

Within our ED we were organized into treatment teams consisting of an emergency physician or a surgeon supported by a resident and a member of the ancillary staff. Once we were able to retriage the initial wave of patients to the auditorium, we were able to focus on the needs of our multisystem trauma patients. The Chief of Surgery was responsible for staging the movement of trauma patients to immediate operative intervention, delayed operative intervention or to an observation area. This area also functioned very smoothly given that our resources were never over taxed.

There were several areas of our response found to be less than adequate. Although our telephone system was intact, there were no open lines due to the massive number of calls being placed. We will need to create several back-up systems for both intramural and extramural communications. We do have an ambulance base-station in our ED and this was the mainstay of our communications during the first day of the event. Portable telephones, zones phones, would have been very helpful, as would have been portable radios that allowed communication with the major triage and treatment sites in our system.

We discovered that our HAZMAT and Bio-terrorism containment program has to be redesigned and reconfigured. We had relied on the HAZMAT services of our city Fire Department for decontamination of incoming victims. However, if they are overwhelmed at the scene of the disaster or if patients bypass EMS and present directly to the ED, there has to be a major decontamination, isolation and containment facility deployed outside of the confines of the ED or the Hospital.

In the last 3 weeks we all have had to come to grips with the reality of the World Trade Center and Pentagon tragedies.

Needless to say, we have had to shift our priorities, both professional and personal to come to grips with the impact these unspeakably terrible events have had on us, our families, friends, and co-workers. Then there are the more universal issues for our Nation, our safety, and the response of our government to terrorism and the possibility of additional acts of terrorism.

The answer really is that there is no way to make sense of these events. That 19 terrorists would commit suicide in order to annihilate almost 6000 innocent human beings is totally incomprehensible. However, we are all looking for ways to help each other through this tragedy and find a way to contribute, to have something positive come out of this situation no matter how modest. It is from this view point that we have asked a number of our colleagues who responded to the disaster at the scene or within their institutions in New York City to summarize the local or regional responses to the event and to delineate which programs and systems worked and which did not. We surmise that the lessons learned here also apply to the attack at the Pentagon, however there was no time to incorporate comments from our colleagues in Washington, DC. We have all learned a good deal about disaster preparedness and response from this event and much of it is universally applicable and well worth sharing.

Rick Nierenberg MD, Director, Jersey City Medical Center Emergency Department, Assistant Professor of Emergency Medicine Jersey City Medical Center (JCMC) is a level II trauma center located directly across the Hudson River from the World Trade Center. We are an inner city teaching hospital with an ED volume of 60,000 visits per year. Because of our location we received an initial influx of 150 patients over a very short time via ferry with little or no prior notification. Most of these were minor trauma patients although we did receive 12 patients who were admitted with serious injuries. Unfortunately due to the lethality of the event very few additional casualties were seen subsequently although we maintained our disaster deployment mode for the next 2 days.

Dr. Stephen Menlove, Chair Disaster Committee Bellevue Hospital Center and Assistant Professor of Emergency Medicine in Surgery During the first 24 hours of the disaster we treated approximately 186 patients from the site. There was one death, 10 patients required surgical intervention, 25 patients were admitted and 150 patients were treated and released. Some of our residents and faculty went to ground zero but the medical needs at the site were minor as all of the victims were rapidly removed to neighboring hospitals.

In general our response was very effective and our resources were never inadequate to meet the influx of patients. One of our problems was crowd control as so many of our medical professionals gravitated to the ED to observe and to offer their services. The telephones were constantly busy and communications became a significant problem. We will need to institute several back-up systems. Registration bottlenecks were anticipated by using blocks of preregistered disaster charts, but there were still delays in inputting patients into the system.

Given that this was a medically compensatable event for us at JCMC, our deployment and operational status was gratifyingly smooth and rapid. The hospitals and the community were galvanized into a highly effective rescue force that could have treated a great many additional patients had they survived to reached us.

The separation and treatment of the "walking wounded" from the critical ill and injured patient was accomplished by a remarkable effort to set up separate but contiguous facilities.

Our auditorium was set up to serve as an expanded fast track where our minor cases were sent from triage. Through prior planning and ad hoc decision-making we deployed a series of "stations� in the auditorium. Thus we set up an eye station staffed by senior ophthalmologists and residents that was supplied with slit lamps and miscellaneous ophthalmic medications and equipment. Our orthopedic personnel staffed a minor skeletal trauma station that was appropriately equipped for

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Resident Group Discount Membership Participation Donald M. Yealy, MD University of Pittsburgh SAEM Secretary/Treasurer On behalf of the Board of Directors, I would like to thank the residency programs that have elected to participate in the resident group discount membership. These 66 programs bring 1807 resident members to the Society. This program provides residents with invaluable exposure to all facets of academic emergency medicine. Each resident member receives subscriptions to Academic Emergency Medicine and the SAEM Newsletter, plus a discounted registration fee to attend the Annual Meeting. The participating programs are: Albany Medical College Albert Einstein Medical Center Program Allegheny General Hospital Beth Israel Deaconess Medical Center/Harvard Affiliated Carolinas Medical Center Case Western Reserve University/MetroHealth Medical Center Christ Hospital Christiana Care Health System Clarian - Methodist Hospital Cooper Hospital/University Medical Center Detroit Receiving Hospital East Carolina University Emory University George Washington University Hennepin County Medical Center Henry Ford Hospital Howard University Indiana University Long Island Jewish Medical Center Louisiana State University - Charity Hospital Louisiana State University - Baton Rouge M.S. Hershey Medical Center Maricopa Medical Center

Mayo Clinic Medical College of Virginia Medical College of Wisconsin Michigan State University Kalamazoo Center Mount Sinai Medical Center/Elmhurst Hospital Center North Shore University Hospital Northwestern University Oregon Health Sciences University Palmetto Richland Memorial Hospital Regions Hospital Resurrection Medical Center Saginaw Cooperative Hospitals, Inc./MSU Spectrum Health St. Luke's-Roosevelt Hospital Center St. Vincent Mercy Medical Center Stanford University/Kaiser Permanente State University of New York at Buffalo State University of New York at Stony Brook State University of New York Health Science Center at Syracuse State University of New York Health Sciences Center at Brooklyn Texas Tech University Thomas Jefferson University Hospital University of California, San Diego

UMDNJ-Robert Wood Johnson University of Arizona University of Arkansas University of Chicago Hospitals/Lutheran General Hospital University of Cincinnati Medical Center University of Connecticut University of Louisville University of Michigan/St. Joseph Mercy Hospital University of New Mexico University of Pennsylvania University of Pittsburgh University of Texas Medical School at Houston University of Virginia Health Sciences Center Wake Forest University Baptist Medical Center Wayne State University/Sinai-Grace Hospital Wayne State University/Detroit Medical Center West Virginia University William Beaumont Hospital Yale-New Haven Medical Center York Hospital/Pennsylvania State University

Sign Up to Be a Medical Student Virtual Advisor Wendy C. Coates, MD Co-Chair, SAEM Undergraduate Education Committee Harbor-UCLA Medical Center The Virtual Advisor Program was developed by the Undergraduate Education Committee in an attempt to provide high quality advice to students who attend medical schools without an associated EM residency program. Others may be looking for specific advice from someone in the geographic region in which they wish to train. The academic faculty of emergency medicine are in the best position to provide the most valuable advice to these students. If you already registered at the Annual Meeting in Atlanta, you have already heard about your new advisee(s) soon. If not, please visit the SAEM

website at www.saem.org where you can access the Virtual Advisor home page. Please take a few minutes to complete the "Application to become an Advisor" and begin to share your experiences with a future member of our specialty. Be sure to list your areas of expertise, as someone may be looking for a mentor who shares the same interests. The future of our specialty depends on our ability to attract bright students from all medical schools. With your help, students can receive excellent career planning advice and be introduced early to academic emergency medicine.

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Medicare Education and Regulatory Fairness Act Published below is the text of a letter developed by the SAEM National Affairs Task Force, chaired by James Hoekstra, MD, that was sent to members of Congress on September 24 to comment on the Medicare Education and Regulatory Fairness Act. The Society for Academic Emergency Medicine (SAEM) represents approximately 5500 academic emergency physicians practicing emergency medicine in academic medical centers and teaching hospitals throughout the U.S. SAEM welcomes the opportunity to support the "Medicare Education and Regulatory Fairness Act of 2001 (MERFA)." These principles set forth in this Act are essential to ensure that effective regulatory relief occurs and that physicians and providers can exercise due process rights when faced with contractor overpayment investigations.

Emergency physicians and other providers are subject to more than 132,000 pages of complex Medicare rules and regulations that are continuously changing. Under current law, Medicare providers must complete claim forms, advance beneficiary notices, certify medical necessity, file enrollment forms, and comply with complex evaluation and management code documentation guidelines. In teaching institutions, the effects of these documentation requirements are especially burdensome, interfering with our ability to teach effectively as we spend more and more time in the redundant and often irrelevant documentation of services in order to meet Medicare coding guidelines. These requirements can erode a physician’s ability to care for patients and educate emergency physicians in training. SAEM is hopeful that MERFA will provide some modest reforms to relieve us of these burdens.

The Medicare documentation and regulatory burdens have been exacerbated by an audit system that assumes guilt for all physicians perceived to have failed to follow Medicare guidelines.

Physicians who make honest mistakes often are treated as though they have committed crimes under the current practice. Specifically, MERFA will provide modest reforms of the audit practices of the Center for Medicare and Medicaid Services and provide education for medical providers on the complexities of Medicare billing. The bill also will prohibit collection of alleged Medicare overpayments until after a physician’s appeal is heard. SAEM supports this effort.

Evaluation and Management (E&M) Documentation Guidelines E&M documentation guidelines have an extremely broad impact on physicians as they govern how physicians must document for office visits in order to receive Medicare reimbursement. To date, the Center for Medicare and Medicaid Services (CMS) has not been able to set forth E&M guidelines to accurately reflect the services provided during an emergency department visit. The E&M coding system does not accurately reflect the decision making process in emergency situations. It rewards completeness of documentation, not appropriateness of rapid and critical intervention, which is so crucial to the practice of emergency medicine.

SAEM has offered its opinions in the past regarding the E&M coding practice, recommending a coding system based on chief complaints, not final diagnoses or E&M documentation of complete histories and physicals. We welcome a chance to revisit this concept and discuss other options with CMS at any time.

CMS is currently reexamining the documentation requirements.

We believe that pilot tests are needed to ensure that proposed new guidelines accurately reflect physician visits, and that documentation requirements should not be implemented as national policy before pilot tests have been completed. In addition, physicians participating in a pilot test of any new guidelines should not have the claims that are part of the pilot test subject to being downcoded by the contractor or used as the basis for audits. Protection during their participation in the pilot projects is especially important as the purpose of the pilot tests will be for both physicians and carriers to learn whether the documentation guidelines are appropriate.

This limited protection is the only way to ensure physician participation and accurate documentation/coding in the pilot projects.

Documentation of Physician Participation in Educational Settings In teaching institutions, E & M coding requirements force redundancy in documentation between attending physicians and residents or students. Emergency physicians are on duty in the emergency department 24 hours a day, supervising

residents and students in the appropriate application of patient care.

Residents and students are constantly observed and closely monitored.

Unfortunately, the documentation of that presence by dictating or re-documenting what the residents or students have already done reduces our ability to educate residents and medical students and take care of our patients.

Redundant documentation of the "key" portions of those patient encounters or clinical procedures robs the student and resident of valuable time that could be spent teaching, or in further patient care. In addition, it adds to inefficiency in the academic ED and increases patient lengths of stay, decreasing our ability to provide care to patients in need of our attention.

Due Process During Appeals We strongly urge Congress to establish a set of due process protections for physicians and providers faced with contractor post-payment audits. It must be emphasized that these audits are to recover alleged overpayments - not to proceed against suspected fraudulent behavior – and that physicians and providers in these situations should not be required to waive their due process rights. We believe that the following elements are essential to safeguard due process rights: Fair Repayment Plans Exhaustion of Appeals – Physicians/ providers should not be forced to pay contractors for alleged overpayments (which can be hundreds of thousands of dollars because of extrapolation) before they have exhausted their administrative appeals. The length of time it takes to complete the appeals and the high percentage of reversals of contractors’ overpayment allegations illustrate the inequity of these repayment demands.

If they choose to appeal, physicians and providers should pay interest on the overpayment allegations if their appeals are unsuccessful. Quite simply, we believe that physicians and providers should have the opportunity to exercise their due process rights before assuming financial liability.

Repayment Plans – Physicians/ providers should be entitled to repayment plans if their overpayments (continued on next page)

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Medicare Education (Continued) exceed a certain threshold that would severely impact the financial well-being of the practice or provider. Contractors currently give physicians and providers 30 days to repay overpayments in full (which can be hundreds of thousands of dollars because of extrapolation).

Unless the physician or provider has demonstrated in some manner that it is not a reliable source of repayment, they should be given flexibility in repaying overpayment amounts.

Extrapolation We are very concerned about the contractors’ use of extrapolation from probe samples. Contractors conduct these probe samples on 15-40 claims over a one to two year period and then use the alleged overpayment to extrapolate to all claims submitted during that one to two year period. Using 15-40 claims in a probe sample over such a long time period is not a valid method to determine an alleged overpayment for the rest of the claims. Contractor errors regarding payment in the probe sample, which are often overturned through administrative appeal, can result in enormous extrapolated overpayment allegations. Even more egregious, often the first notice that physicians and providers receive regarding alleged overpayments is a letter demanding this extrapolated overpayment amount. We strongly urge the Congress to ensure that extrapolation does not occur unless the contractor has provided prior, documented education to the physician or provider.

Reliable Pathways for Questions One of the principal problems with today’s Medicare system is that physicians and providers cannot obtain reliable information about their questions relating to complex and confusing Medicare program guidances, program memoranda, and regulations. The contractors will often not provide written confirmation of conversations nor will contractor personnel even release their own names. Thus, physicians and providers have nothing to rely upon if they are later audited for alleged overpayments. We strongly believe that physicians and providers must have a route to obtain information from their contractors upon which they can rely.

Congress should create a mechanism to obtain this type of information about conflicting and confusing policies, while ensuring that those who ask questions are not targeted for audits solely as a result of their inquiries.

Voluntary Repayment Physicians and providers who receive mistaken overpayments currently return these payments with the fear that they will be audited by contractors simply for having returned the overpayment. These repayments, if they occur before they are noticed by the contractors, should be encouraged. Physicians and providers should not have to fear that they will be audited for being good actors.

Currently, contractors have complete discretion regarding how to structure and implement these random audits, and we believe that physicians and providers should have guideposts with the general conditions under which these audits may occur.

Application to All Providers, Physicians and Suppliers We urge the Committee to ensure that these reforms apply to all providers, physicians, and suppliers. All groups are entitled to the same level of due process protections and education regarding Medicare’s complex rules and regulations.

In closing, we very much appreciate the Committee devoting so much consideration to this issue. As you know, these problems have an impact on the vast majority of physicians and providers – especially those with high Medicare patient populations. We urge you to ensure that the legislation emerging from your Committee contains the principles listed above, and we look forward to working closely with you on this and other issues in the coming months.

SAEM thanks you for the opportunity to express our views. We welcome the opportunity to discuss this issue with you at any time.

Random Prepayment Audits We strongly urge Congress to direct the Secretary to establish uniform standards for random prepayment audits.

Newsletter Submissions Welcomed

Residency Vacancy Service

David C. Cone, MD Editor, SAEM Newsletter Yale University

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.

SAEM invites submissions to the Newsletter pertaining to academic emergency medicine I the following areas: 1) clinical practice; 2) education of EM residents, off-service residents, medical students, and fellows; 3) faculty 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 electronically, preferably by e-mail to saem@saem.org. 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.

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Yale University to Study ED Interventions for Hazardous Drinking Clifton Callaway, MD, PhD SAEM Research Committee University of Pittsburgh

Substance Abuse Prevention (CSAP) fellowship, reports Dr. D’Onofrio. That experience helped introduce her to the network of investigators with similar interests and to the methodologies central to this field. Similar experience may not have been available without stepping outside the boundaries of Emergency Medicine.

Close collaboration with specialists in other areas will be central to the success of this project. The brief intervention has been adapted from interventions previously described (for example, Acad Emerg Med 1998; 5:1210-1217 ). The input of two collaborating internists and a psychologist have helped with that development. Statistical refinement was accomplished with the help of a senior biostatistician at Yale with special interest in substance abuse. This team of investigators meets regularly to share their particular expertise and to keep the clinical trial on track.

Receipt of this funding will allow the research endeavor in the section of Emergency Medicine to grow in several ways. A full time project director and five research associates will be hired specifically for this project. In addition, funding will help protect some of the academic time for Dr. D’Onofrio and Dr. Degutis. Such protection will be critical for balancing clinical, teaching and administrative duties with the investigative responsibility.

Yale University has received a three-year $2.3 million grant from the National Institute on Alcohol Abuse and Alcoholism (NIAAA) entitled "Emergency Physician Brief Interventions for Alcohol." Gail D’Onofrio, MD, an Associate Professor in the Section of Emergency Medicine, continues her career-long interest in the impact of alcohol on ED patients as the Principal Investigator for this award. Linda Degutis, DrPH, also an Associate Professor in the Section of Emergency Medicine, is a co-investigator on the project.

At the beginning of this project, emergency physicians and physician assistants at Yale will be taught a structured 5-7 minute brief intervention for patients with hazardous or harmful drinking. During a subsequent intervention phase of the study, ED patients will be screened for excessive alcohol consumption using a survey. Once a patient with hazardous or harmful drinking has been identified and consented to the study, that subject will be randomly assigned to receive the brief intervention from the physician or to receive standard discharge instructions and referrals. These subjects will receive telephone follow-up at 1, 6 and 12 months to assess the status of their drinking behavior, and their use of health-related services. The study will test the hypothesis that the intervention can reduce total alcohol consumption, reduce the frequency of binge drinking and increase utilization of primary care related services. The investigators will also begin to examine whether the intervention can reduce subsequent ED visits and hospitalizations for the subjects.

This project is the culmination of a series of investigations focusing on the role of alcohol in ED patients. Dr. D’Onofrio studied alcohol-related seizures in Boston, receiving some support from a Boston University Biomedical Research Grant.

That work led to a track record of publication in the area of alcohol effects on health, including a high-profile article in the New England Journal of Medicine (1999; 340:915-919).

Further background for this project derived from a Center for

Information Sought on Federally Funded Projects If you are a Principal or Co-Investigator for a current program or project grant supported by NIH, AHRQ, CDC or other federal funding, we invite you to notify the Research Committee of your project on an ongoing basis. The Research Committee activity will try to publicize new projects in Emergency Medicine research to acknowledge success in achieving funding, and to point out resources for members seeking expertise in particular fields.

Send information to Clifton Callaway, MD, PhD at callawaycw@msx.upmc.edu.

Report on Task Force on Weapons of Mass Destruction Edward J. Otten, MD SAEM Representative, Task Force on Weapons of Mass Destruction University of Cincinnati The Task Force on Weapons of Mass Destruction (WMD) was formed in response to a perceived need of the United States Government that the medical community might not be prepared to respond to terrorist attacks on the US population. In 1996-97 the Congress passed the Defense Against Weapons of Mass Destruction Act along with the Nunn-Lugar-Domenici amendment that authorized $10 billion dollars to remedy this problem. As happens in these cases hundreds of “experts” in

WMD vied for those funds. Unable to sort the wheat from the chaff, the Office of Emergency Preparedness asked the American College of Emergency Physicians (ACEP) to assemble a task force to look at the various programs, courses, training materials and curricula to determine the optimal program for training EMS personnel, physicians and nurses in how to respond to WMD incidents. Fourteen national organizations representing police, fire, rescue, physicians, toxicologists, nurses and administrators and guided by the Office of Emergency Preparedness and ACEP took on this task. Although I belonged to three of the organizations, I represented SAEM on the Task Force. We met eight 14

times over two years and produced a 140 pages document entitled “Developing objectives, content and competencies for the training of emergency medical technicians, emergency physicians, and emergency nurses to care for casualties resulting from nuclear, biological, or chemical (NBC) incidents’. This document collects, summarizes and expands on the entire field of WMD training in the US and gives educators a “go by” to evaluate various training programs and eventually will become the gold standard for all such programs. SAEM should continue to participate in projects such as these in the future since our input and expertise are needed.

Academic Pathways and Research Funding Opportunities for EM T. Paul Tran, MD SAEM Research Committee University of Nebraska Medical Center

als in basic research to improve cardiopulmonary and neurological outcomes following resuscitation from cardiopulmonary arrest (http://grants.nih.gov/grants/guide/rfa-files/RFA-HL-02003.html). The letter of intent receipt date is January 10, 2002 and the application receipt date is February 12, 2002.

The Emergency Medicine Foundation (EMF), the education and research arm of ACEP, also provides grant support for individuals. These include: 1) The Creativity and Innovation in Emergency Medicine grant ($5K) designed to provide support for time relief or minor equipment purchase for new/seasoned investigators with an innovative research idea. The next deadline is December 12, 2001, 2) The EMF Research Fellowship grant ($35K) which provides support for EM residency graduates who wish to spend one year to pursue further training in research methodology. The next deadline is January 11, 2002, and 3) The EMF career development grant ($50K). This provides seed money for investigators at the instructor or assistant professor level on their way to becoming independent researchers. The next deadline is January 11, 2002. More web resources for EMF programs can be found at http://www.acep.org/2,1628,0.html The Society for Academic Emergency Medicine (SAEM) also administers a number of grants. The SAEM Scholarly Sabbatical Grant (http://www.saem.org/awards/sabbatic.htm) provides support up to $10,000/month for 6 months to EM faculty at the assistant professor level or higher for release time to develop skills for career advancement. The SAEM Research Training Grant, formerly known as the Resident Research Year Award (http://www.saem.org/awards/research.htm), is a twoyear grant that provides $75,000 per year. Other SAEM research grants are the Neuroscience Research Fellowship Grant ($50K) sponsored by AstraZeneca (http://www.saem. org/awards/neurores.htm), and the EMS Fellowship ($60K), sponsored by Medtronic Physio Control (http://www.saem.org/ awards/02ems.htm). The deadline for all these applications is November 1, 2001.

The American Heart Association (AHA) is an important source of funding for investigators in cardiovascular research.

The research area broadly covers cardiovascular function and disease, stroke, or related basic science, clinical, bioengineering/biotechnology, and public health problems. Two AHA levels of support are available: affiliate and national. Investigators can apply to both during the same cycle. Web resources for AHA programs can be found at: http://www.americanheart. org/research/app/appintro.htm At the national level of the AHA are two important grants for beginning investigators. First is the "National Scientist Development Grant," which provides support for investigators on their way to being independent investigators. Application deadlines are January 14, 2002 and July 15, 2002. Second is the "National Fellow to Faculty Transition Award," which provides support for the faculty in the early years of their first faculty position. The application deadline is January 14, 2002.

Independent investigators can apply for the "National Established Investigator Grant" or "National Grant-in-Aid." At the affiliate level, young investigators can apply for the "Beginning Grant-in-Aid" designed to help beginning scientists to reach independent status. For independent investigators, the "Affiliate Grant-in-Aid," provides support for the most meritorious research projects. Investigators should apply to the appropriate local AHA affiliate office.

As articulated by recent SAEM presidents, academic emergency medicine needs a cadre of young academicians dedicated to the exploration of fundamental physiological and pathological processes that will ultimately lead to improved emergency care. These young emergency academicians may face major barriers in their academic journeys, not the least of which is getting funding support.

There are generally three ways to progress in academics: the clinician pathway, the educator pathway, and the research pathway. While any of these is equally viable, the "rules of the game" for academic advancement still require research grants and publications. Time and again, obtaining effective mentorship, defining a focused area of interest, finding a supportive environment, developing time management skills, and obtaining grants are some of the most critical ingredients for success.

In an environment of continuing fiscal constraint and competing clinical demands, obtaining initial grant support can be a tremendous motivation in this long journey but requires careful planning.

The gold standard of biomedical grant funding is extramural support from the NIH. Clinically oriented scientists can apply for the Mentored Patient-Oriented Research Career Development Award (K23). This award supports the development of investigators who wish to conduct patient-based research. The research can be in mechanisms of disease, therapy, clinical trials, or development of new technologies.

Funding support ranges up to $75K/yr (plus fringe benefits) for 3-5 years; however, applicants must be prepared to spend 75% of their time on the research effort. Mentorship is imperative. Applicants must work with a mentor who has extensive research experience and a proven track record in the area of research.

Laboratory-oriented scientists can apply for the Mentored Clinical Scientist Development Award (K08). This award supports development of clinically trained investigators to perform laboratory or field based research. Again, mentorship is critical. It is expected that at the end of the grant period, investigators will be able to perform independent research. Eligibility requirements and support vary among the 15 NIH institutes.

Generally support ranges to $75K/yr (plus fringe benefits) for 3-5 years. Again, applicants must spend 75% of their time on the research effort. More web resources for both the K08 and K23 awards can be found at www.nih.gov and the supporting institutes. Application forms can be obtained on line at http://www.grants.nih.gov/grants/forms.htm#training and are accepted February 1, June 1, and October 1.

Two RFA’s (Requests for Applications) that may be of interest to researchers in EM were released by the NIH in September 2001. The first is RFA-AA-02-004 from the National Institute on Alcohol Abuse and Alcoholism requesting proposals in basic research for the development of pharmacotherapeutic agents for alcoholism, alcohol abuse, and alcohol-related medical consequences (http://grants.nih.gov/grants/ guide/rfa-files/RFA-AA-02-004.html). The letter of intent receipt date is December 28, 2001 and the application receipt date is January 23, 2002. The second is RFA-HL-02-003 from the National Heart, Lung, and Blood Institute requests propos-

15

Summary of the Successful Researchers Project Jeffrey A. Kline, MD Carolinas Medical Center Craig D. Newgard, MD, MPH Harbor-UCLA on behalf of the SAEM Research Committee As the specialty of emergency medicine (EM) grows, our research efforts begin to have a larger impact on society at large. This impact is only possible through the efforts of individual researchers. Each year, more young graduates in the field of EM seek to make a difference through contributions in research, and as their ranks grow, so does the competition to become recognized as EM academicians.

Many young researchers have questions about how successful contemporary EM investigators reached their current status and the path that led them there. While it is self-evident that the process of achieving academic success is a complex process that cannot be quantified by a mathematical model, we hypothesize that certain components to training, access to knowledge, technical skill, funding, motivation, and communication skills are required for a researcher to achieve high merit. The purpose of this project was to investigate which factors and traits are shared by a group of successful researchers, and the extent to which these factors have contributed to research success for these individuals. To achieve this goal we conducted a structured interview with a sample of 10 successful researchers in the field of EM. Those interviewed included: Lance B. Becker MD, University of Chicago Michael Callaham, MD, University of California at San Francisco Carlos Camargo, Jr., MD, DrPh, Massachusetts General Hospital E. John Gallagher, MD, Albert Einstein Medical Center Jerris R. Hedges, MD, MS, Oregon Health Sciences University Jerome R. Hoffman, MD, UCLA Emergency Medicine Center Gabor D. Kelen, MD, Johns Hopkins University Arthur Kellerman, MD, Emory University Roger J. Lewis, MD, PhD, HarborUCLA Medical Center Each investigator was asked a series of 10 questions, shown in Table 1. Table

2 summarizes the results of these interviews, with the ten subjects numbered randomly.

Among the ten investigators interviewed, five are current Chairs or Chiefs of their departments/divisions and all hold at least the appointment of Associate Professor. The mean age was 49Âą10 years, and the investigators have been practicing EM for a mean 12Âą6 years.

The interview process demonstrated that among the 10 successful EM researchers, there was no predominant self-perception as to what actually constituted "a most important research accomplishment." Several of the investigators identified objective achievements such as the development of study consortiums, publications, or positions held. However, they also indicated that intangible contributions to our specialty are extremely important. This finding suggests that one of the keys to internal and external validation regarding a successful career in EM research lies in individual values, rather than accomplishing specific goals such as publishing a high-profile article, or being awarded a large grant.

The aggregated responses also suggest that researchers require a long time to reach the research goals that instill satisfaction. The mean requirement was 7.9 years Âą 3.2 (SD) years, with a range of 3 to 12 years. Most of the investigators were hesitant to define a specific endpoint in their research and all indicated that their research was an ongoing effort. Again, we interpret these responses as evidence that satisfaction from a career in research grows more from the process of learning than from any specific endpoint.

Another clear message was the importance of mentoring. Five of ten respondents ranked mentoring as the single most important aspect to their training. With respect to the optimal qualification of a mentor, the majority of respondents felt that the most important aspect of mentoring was mutual respect and the overall relationship between the mentor and the mentee. It was evident from these interviews that the mentor must have adequate time in order to make an important contribution to a young researcher's development. As for fellowship training, the investigators felt that pursuing a fellowship was always helpful, however only a minority indicat16

ed that fellowship was a mandatory requirement for success in EM research. This finding implies that the relationship between an established researcher and a researcher-in-training may be more important than the context and formal description of that relationship. Interestingly, when posed with the question of what could have been done differently in their research careers, four of ten would have sought fellowship training or mentoring earlier in their career.

The majority of these established investigators derived their initial funding from industry. However, it should be noted that many of these researchers started out in the late 1980's, and since that time, EM has made great strides with many more researchers receiving federal funding. It was evident from the responses that all of the sampled investigators now consider federal funding to be one of their most important sources of research funding. While the investigators sampled suggested that industry was likely to be a primary source of funding for up and coming researchers in the next 5 to 10 years, all felt that high quality EM research would continue to be federally funded.

There was no consensus as to what SAEM should be doing differently to improve the development of researchers. However, potential areas to further develop are the availability of research funding, enhancing the exposure of EM researchers to the NIH, and improving communication between established researchers and young investigators.

Half of the investigators expressed concern over the process of promotion and tenure and its effect on publication record. Specifically, there was concern that the process of promotion often forces young investigators to publish too many small papers, which have little impact. This finding raises the question of whether promotion should be linked to the impact of the research effort on better understanding mechanisms of disease or patient outcomes, rather than simply to quantitative productivity, the latter of which is often the case.

It should be noted that the list of the successful investigators was derived arbitrarily, based on specific criteria, consensus of members of the Research Committee, and availability for interview.

This list is only a sampling of successful investigators, is not meant to be com(continued on next page)

Summary of the Successful Researchers Project (Continued) prehensive, and is not meant to indicate that these researchers are in anyway the ten "best" EM researchers. Surely, our specialty has growing numbers of prominent investigators and academicians that deserve to be recognized, but are not included in this sample. We regret that there were no women included in the list, and that few researchers who perform basic science were included. We hope that future work may focus on and recognize these individuals as well.

In summary, this project suggests that successful researchers do not necessarily perceive their specific public accomplishments to be their highest honor. Many indicated intangible aspects to the process of learning and teaching to be equally or more important than grants, positions or publications. The majority of successful investigators in this sample indicated that mentoring was the most important element to success in EM research and that the young investigator should conduct a vigorous search for the ideal mentor.

Table 1. Survey questions.

1. What do you consider to be your highest research accomplishment?

2. How long did it take from the time you first had this goal, to the time you reached it?

3. Please rank these issues in order of importance for reaching your research goal: mentoring, seed money, protected time, collaborative support, your personality, fellowship training, writing skills, luck, intelligence. Elaborate on what you think is most important and why.

4. Please elaborate on the second most important factor that allowed you to reach your accomplishment.

5. What advice would you give a young researcher looking for a mentor?

How do you decide who is a good mentor?

6. Has fellowship training become a necessity for a young researcher to become successful in EM research?

7. Where have you derived most of your research funding?

8. Where do you think the majority of funding for young investigators involved in EM research will come from in 10 years?

Foundations, Industry, or Federal?

9. If you had a time machine, what decision would you change, or what would you have done differently about your research career?

10. What should SAEM be doing to help young researchers?

Table 2. Tabulated responses from the 10 investigators.

TEN SUCCESSFUL INVESTIGATORS (in random order) Question 1 2 1. Highest accomplishment 5 3 2. Time to reach, (years) 6.5 10 3. Most important factor mentoring mentoring 4. Second most important motivation collaboration 5. Mentor: via national self-initiate a. method to find meeting contact b. qualifications 1 2 6. Fellowship required?

1 1 7. Funding source 1,3 1,3,4 8. Future funding 1 1,2 9. What would do over committed epidemiology differently on speaking degree 10. What should SAEM do? sponsor enhance sabbatical connections

KEY Accomplishment 1=methodology 2=study group or consortium 3=position held 4=funding OR publication 5=mentoring

Fellowship 0=low importance 1=helpful 2=almost required 3=mandatory

3

4

5

6

7

8

9

10

2

2

4

1

2

5

4

4

5

10

12

2.5

3

8

10

10

mentoring motivation self-initiate contact 3 3 1,4 1,2 fellowship

colleagues protected time via fellowship contacts 1 2 4 3 fellowship

enhance mentoring

smaller meetings

motivation writing skills self-initiate contact 3 1 1 1 find mentor sooner enhance connections

mentoring protected time self-initiate contact 3 2 2,3 3 more first authorship enhance connections

motivation collaboration self-initiate contact 1 3 1,2,3 1 fewer small projects sponsor research

Funding source 1=industry 2=foundation 3=NIH 4=other federal

mentoring fellowship training protected time protected time luck mentoring self-initiate self-initiate self-initiate contact contact contact 1 1 3 2 3 2 4 4 2 1,2,3 3,4 3,4 additional grad nothing fewer small projects courses sponsor target federal enhance research funding connections

Mentor qualifications 1=mutual respect, good relationship, likable, availability 2=shared interest and passion for a topic 3=publication history, expertise, and name recognition

17

ACADEMIC RESIDENT News and Information for Residents Interested in Academic Emergency Medicine Edited by the SAEM GME Committee

WHAT

IS THE

EMERGENCY MEDICINE SCHOLARLY ACTIVITY REQUIREMENT?

Adapted from a presentation by William Cordell, MD Indiana University

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We are sensitive to the many demands placed on resident physicians during their post-graduate training. Why then to we require the completion of a scholarly project during the residency?

First, it is required by the Residency Review Committee (RRC). The RRC residency requirements state: "The curriculum should include resident experience in scholarly activity prior to completion of the program. Some examples of suitable resident scholarly activities are the preparation of a scholarly paper such as a collective review or case report, active participation in a research project or formulation and implementation of an original research project. Residents must be taught an understanding of basic research methodologies, statistical analysis and critical analysis of current medical literature."

More importantly, we strongly believe there are important skills a resident should acquire during post-graduate training.

These include tools for life-long learning, an understanding of how to use medical research and basic research concepts, an awareness of the importance of information management in healthcare, and the application of evidence-based medicine (EBM) skills. These EBM skills include formulating questions, searching for answers, critically analyzing research to weigh the evidence, and applying the evidence to the care of patients or populations.

Scholarly Activity Options To fulfill the Scholarly Activity requirement, each resident must participate in or complete one of the following by the end of his or her residency: ● Original research project: The resident serves as principal investigator, co-investigator, or a sub-investigator on a project. It is important to define the exact role you will play in the project. If you are joining a project as a sub-investigator, be certain that this will meet graduation requirements from your Program Director. ● Evidence-based Medicine Critically Appraised Topic ("CAT"): The resident chooses a clinical question, searches the literature for pertinent articles, and writes approximately 10 one-page critiques in the style of ACP Journal Club. These articles and reviews are assembled in a notebook and filed for future use by the training program. ● Product invention/development: The resident designs a medical product/device. A written description and prototype or product are required. In addition, the resident will review the patent process and protection of intellectual properties. ● Computer project: The resident designs a computer program or educational project. A written description and completed prototype or product are expected end points.

The resident reviews the process for protecting intellectual 18

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properties.

Practice guidelines: Using evidence based medicine skills, the resident investigates a clinical question, searches for pertinent articles and/or previously-written guidelines, assesses their validity, and develops a departmental practice guideline. Example: "What are the indications for prescribing antibiotics to patients with acute bronchitis?"

Case report: A publication-ready manuscript is normally required.

Collective review: The resident identifies a topic, performs a literature search, and prepares a manuscript following the style of the major EM journals.

General Instructions ● All projects should have a faculty sponsor/mentor (Emergency Medicine, Trauma, Radiology, etc.). Try to pair up with a faculty member who is initiating a project or one who shares an interest in your topic of research. ●

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●

●

●

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There should be contacts (e.g. research director) within your residency faculty who can assist in pairing your interests with appropriate faculty from EM or other disciplines, as well as biostatisticians to help formulate the project and assist with the mechanics.

Collaboration with other EM residents (especially those who will graduate after you) or residents from other departments should be considered. This helps spreads the work load and promotes continuity (e.g. if data collection takes longer than anticipated, your project will not wither on the vine after you graduate). The down side is that you have little leverage with a peer or colleague from another discipline if they fail to do their work.

Keep the project simple and doable. The first step is formulating an answerable question. This is perhaps the most frequent mistake made by novice researchers! Your goal is to contribute a small piece of information to the medical community, not win the Nobel Prize.

Focus your energies. Pick one topic you’re interested in and complete it. The tendency is to be interested in numerous topics and getting none really going.

Set a time table early. Projects almost invariably take longer than anticipated (usually twice as long as anticipated…three times for research projects since they must go through the IRB/animal use committee). Good scholarly activity projects cannot be started and completed by "pulling an all-nighter."

Initiation and completion of the project is the responsibility of the resident and is a requirement for graduation. Your program director should have established guidelines about what is and isn’t acceptable…incorporate this into your planning.

Consider taking an Emergency Medicine Research elective. At least three weeks of the month must be allocated for project completion.

My Two Cents on Scholarly Activity Rita K. Cydulka, MD, MS MetroHealth Medical Center The other day I received by e-mail a survey from a resident who was completing his scholarly project requirement. The survey asked a number of personal questions and questions about my medical history. The survey was not accompanied by a cover letter explaining the purpose of the survey, a copy of IRB approval to query physicians across the internet about very personal information, a section that details the privacy and confidentiality issues, or what prior research has revealed about this particular issue. Unfortunately, the survey was typical of many surveys that I receive from residents in an effort to complete their required scholarly activity. The surveys are frequently hastily compiled, not reviewed by a survey methodologist, and not approved by the hospital’s IRB. According to the Program Requirements for Residency Education in Emergency Medicine, put forth by the Accreditation Council for Graduate Medical Education, emergency medicine residency must include "…provision of support for resident participation in scholarly activities. The curriculum should include resident experience in scholarly activity prior to completion of the program. Some examples of suitable resident scholarly activities are the preparation of a scholarly paper such as a collective review or case report, active participation in a research project, or formulation and implementation of an original research project."

In my experience, the most common ways that residents attempted to fulfill this requirement were by writing literature reviews, case reports, or conducting surveys. In my eight years as a co-residency director and residency director, I went from being very enthusiastic about the scholarly activity requirement as an opportunity for emergency medicine residents to see if academia was the right choice for a future career, to realizing that rigors of residency training barely allow enough time for one to become a skilled clinician, read at least one emergency medicine textbook cover-to-cover, and keep up with the medical literature, while trying to maintain some type of balance outside of residency. I also realized that the length of most programs (3 years) allows for few electives and even less time for dedicated research months. As a result, most of the scholarly activity performed is squeezed in during "days off" and hastily completed.

Although some residency programs are able to implement a successful research program and consistently recruit residents who are able to complete high quality projects during their training, I have found this to be the exception, rather than the rule.

The purpose of this discussion is not to offer my opinion on this requirement and whether it serves the purpose it seeks to accomplish, but to provide helpful suggestions for those trying to fulfill the requirement. Therefore, this discussion will be aimed at offering helpful suggestions for those residents choosing to write literature reviews, case reports, or conduct surveys in fulfillment of the requirement. A discussion of observational trials and experimental trials is beyond the scope of this discussion.

The Literature Review The two types of literature review that I have seen published by residents are literature reviews for peer review journals which cite hundreds of articles pertaining to a single subject, and the clinically based literature review, such as those found in loosely reviewed – but practical – resources, such as computer based texts, etc. that are clinically oriented and designed for use in the emergency department. Performing either type of review forces the resident to obtain a deep fund of knowledge on the subject

about which he/she is writing but neither of these forces the resident to critically review the articles for methodological quality, content, and relevance to emergency medicine practice.

A systematic literature review, on the other hand, is a literature review in which evidence from scientific studies is located, evaluated and put together using a well defined scientific design.

In fact, the design by which the literature for a systematic literature review has been selected must be reported in the paper itself. The aim of a systematic literature review is to provide a comprehensive and unbiased manuscript that can be used for important decisions in the delivery of health care. Systematic literature reviews include studies that have not been published but which may have an important effect on the conclusions that are drawn, as well as published studies. This means that the resident must be familiar with the field of study and contact experts in the field to discuss unpublished data. A well done systematic literature review will take a resident about a year to complete with proper guidance from a faculty member who is trained in this methodology.

The following stages should be followed in completing a systematic literature review: ● Identify a subject of interest and a question that you wish to answer. ● Make sure that a systematic review on the subject has not been recently published. ● Determine how you are going to review each article. ● Decide the requirements to include an article in your literature review. ● Do a literature search and retrieve all relevant articles. ● Read all the articles and assess them for inclusion in your review based on: ● Relevance to your question/subject. ● Your inclusion criteria. ● Study validity. ● Extract the data from each study for inclusion in your data tables. ● Analyze the data using meta-analysis approach ● You will need someone trained in this area to help you here. ● Write up the manuscript. ● Have a faculty member who is trained in this area review the manuscript. ● Edit the manuscript ● Repeat above two steps until both the resident and faculty member are satisfied with the manuscript. ● Submit the manuscript.

Case Reports Case reports are usually derived from an interesting and unusual clinical observation. They tend to describe the presenting signs and symptoms of a disease, its progress, or its response to therapy and may contribute to the identification of new diseases, outcomes of treatment, and recognition of previously unrecognized associations and causes of rare diseases.

In fact, case reports are frequently the means by which adverse reactions to drugs are first identified.

The advantages of doing a case report are: they are easy to do and, on rare occasions, may disprove an accepted hypothesis if the case report involves the exception to a previous rule.

The weakness of case reports are that they commonly focus on cases which are unusual, which means that the finding may have little practical importance and may not be generalizable.

Case reports are definitely not a method for answering research questions and should always be considered as a preliminary 19

(continued on next page)

My Two Cents (Continued) observation.

In order to develop a case report, the case must be interesting and have at least one novel element that is previously unreported. This unusual feature might be the ultimate diagnosis, the method of diagnosis, the treatment, or the complications of the treatment. After you have selected your case, further research is necessary. Begin with a literature search on the subject. Read through all the relevant literature before you start to write. As you read, take notes on relevant points of the literature including study methodology, conclusion, relevance to your case, and quality of the study. The discussion should include relevant features of the case and how you place these findings in the context of the published literature. As you work through your case, compare each fact of your case to previously published data. If the findings match those previously described, state this. If the case you are describing is unusual, try to provide a logical explanation of why and how the management of the case was altered. This should also be done for each abnormal clinical finding or laboratory result. The discussion should also include a few paragraphs explaining the "who cares" aspect of the case. In other words, explain to the reader why you are reporting this case, why they should be interested and how it is relevant to their clinical practice.

Surveys Surveys in health care have been used to determine knowledge and experience of physicians, activities that physicians perform, educational needs, need for patient services, health beliefs and behaviors, training and experience of staff, as well as a myriad of other questions. According to the Section on Survey Research Methods of the American Statistical Association, the following steps should be taken when designing a survey: ● Determine very clearly what it is you want to measure. ● Generate an item pool using literature review, focused group discussions, expert reviewers, and validation items. ● Determine the format that you are going to measure the responses ● What type of scale are you going to use? ● Have the initial items reviewed by experts. ● Consider including validation items in your questionnaire. ● Pilot the items in a development sample to a small number of people. ● Evaluate the items that you have piloted.

A well planned, newly developed survey will take well over a year to complete. Before beginning a survey, decide who your group of interest is. It is very important that the participants in your survey are representative of this broad group of interest.

Next, a list of possible participants must be obtained. If the list of participants is too large for everybody to be studied, a sample should be taken from this list. It is very important that there is an accurate list from which the sample is drawn so that: 1) people aren’t forgotten; 2) all people have an equal chance of being included in the sample. The most common methods of choosing a sample are 1) convenience sampling, which consists of selecting those participants that tend to be easy to include; 2) simple random sampling, which means every possible participant will have an equal chance of being selected for the sample; 3) systematic sampling, which means determining a systematic way of choosing participants, i.e. selecting every 20th person on a list to participate.

Surveys are not immune to proper research methodology. A sample size must be decided. It is best to ask a statistician or someone familiar with calculating sample sizes in order to col-

lect a proper number of responses.

Next, the method of sampling must be decided: will it be electronic surveying, telephone surveying, mail survey, in-person interviewing? Self-administered questionnaires are more economical than interviews and more easily standardized. Closeended questions are usually easier to answer and easier to analyze. The instrument should be simple and easy to read. All questions should be proceeded by clear instructions and examples. The answers to close-ended questions should be coded in advance and the codes and score should be organized on the form in a way that would make data entry simple and efficient.

Residents should make an effort to use existing tools that are known to produce accurate and reliable results. Remember to put sensitive questions later in the survey so those respondents are not immediately put off by your questions. The instruments should be pre-tested before being used in the study. The pretest will help refine the actual survey.

Once the survey has been pilot tested and is ready to mail, residents should plan on a way to track responses. Several mailings and/or calls are usually needed in order to achieve an acceptable response rate to their survey.

The data must be entered in a systematic fashion and must be checked to ensure that all forms are completed. Missing data or inappropriate answers should be followed up on. An experienced analyst should analyze the data. Of course, no project is complete until it is published so that the knowledge gained can be shared with others. Manuscript preparation for surveys is similar to that described above.

Common problems in survey studies include the following: poorly defined research questions and too many items on the survey. It is essential to refine the research question and focus it. A survey that is too long, unfocused, and poorly written will have a poor response rate. Remember, the persons who you are surveying are busy and will only respond if they feel that the information they are providing to you is meaningful.

Final Thoughts Scholarly projects that are well done contribute significantly to the medical literature. They are intended to introduce residents to research methodology and allow residents to experience first hand the excitement of completing a project from idea to publication. Ways to increase the likelihood of conducting a successful project include the following: studying something that people care about, developing a focused project, proper planning, sound methodology, a pilot trial, support from your faculty advisor / mentor and the persons whom you are involving in the study, and adequate resources and expertise to complete the project. On occasion, performance of a successful research project is career altering as the process excites persons who may never have considered a research career to pursue one. I know that this was certainly the case with me.

References 1. http://www.acgme.org/index.htm 2. Crombie IK, Davies HTO: Research and Health Care Design, Conduct and Interpretation of Health Services Research.

John Wiley and Sons, New York, 1997.

3. Hulley SB, Cummings SR: Designing Clinical Research: An Epidemiologic Approach. Williams & Wilkins, Baltimore, 1998.

4. ASA Series: What is a Survey? Section on Survey Research Methods. American Statistical Association. Alexandria, 1997.

5. Cydulka R, Davison R, Grammer L et al: The use of epinephrine in the treatment of older adult asthmatics. Ann Emerg Med. 1988: 17 (4): 322 – 6.

20

Resident Work Hours: An EM Resident's Perspective Jill A. Grant, MD SAEM National Affairs Task Force University of Virginia What is it about human nature that drives us to succeed, to push ourselves to the furthest physical and mental limits? Is it the fear of failure? Is it embarrassment that we won’t stand up to our peers? Is it the push we receive from our parents or mentors? Or is it simply an inherent drive to achieve that which we hold deep in our hearts? No matter what the focus point for success on the path to becoming a physician, including medical school, internship, and residency, it is impossible to avoid the physical and mental strain caused by the stresses of a new environment, new situations, long work hours, and immense new responsibilities. Residency is a learning environment, and ongoing reading and research are critical for making us better physicians. It is over a short period of time in this environment however, that a resident’s mental and physical stamina are pushed to the limit.

Mental and physical fatigue settle in, decision trees are limited, and residents are frequently left with instinct, something which has not been given ample time to develop. Patients are now at risk of harm or death based on residentadministered treatment. This scenario illustrates why SAEM must address the need for limits on resident work hours to ensure not only quality patient care but also a productive educational work environment and physician well being.

Residency training should balance work with education to produce competent and caring physicians. Sleepy, overworked residents are more prone to making medical errors. In fact, one study cited in JAMA in 1991 found that "41% of 145 residents surveyed cited fatigue as a cause of most of their most serious mistakes." And even more worrisome is that in nearly one-third of these cases, patients died as a result of the error. Unfortunate as this is, the patient is not the only one placed at risk, so is the resident. Studies have shown that sleep-deprived physicians-in-training are at increased risk of being in an auto crash, suffering from depression, or giving birth to premature infants.

Being overworked is also not conducive to medical education. With such a busy work schedule it is difficult to find time to read without falling asleep. Additionally,

some of the best learning occurs while at work, on rounds, and through conferences and lectures, but again fatigue and overwork frequently interfere with reception and retention of the information. Not only are residents cheated of their education by being overworked, but so are the medical students, because residents supervise a large portion of their clinical experience and provide a significant percentage of their teaching.

Eventually, residents’ depressed physical and mental states trickles down to their personal and family life. Family relationships and quality of life suffer secondary to resident mental and physical fatigue, depression, and resentment with work schedules.

The need for limitations on resident work hours became apparent at a national level in 1984 when an 18-yearold female, Libby Zion, was admitted to Cornell Medical Center and died shortly after admission to an inpatient unit allegedly due to negligence by overworked and fatigued residents. There were numerous complaints regarding the care she received, primarily by residents, which precipitated a review by the New York County grand jury. It was determined that "the number of hours that interns and residents were required to work was counterproductive to providing quality medical care." As a result, an Ad Hoc Advisory Committee was established which adopted regulations to protect patient welfare and safety. In 1987, New York became the only state with regulations mandating work hour limits on residents. However, follow-up investigations in 1997 indicated widespread noncompliance with resident regulations, noting that 37% of all residents exceeded 85 hours per week, 20% exceeded 95 hours per week and 60% of surgical residents exceeded 95 hours per week.

As a result of similar situations nationwide, the ACGME within the past decade created standards to be followed by voluntary compliance. They unfortunately have also been ineffective.

In fact more than 10% of residency programs surveyed by ACGME in 1999 violated work hour compliance standards.

Citations for these violations were infrequent and removal of accreditation for repeat offenders has yet to occur. To help enforce decent working conditions for residents, the American Medical Student Association (AMSA), in May of

2001, petitioned OSHA to limit resident work hours. The proposal included the following highlights: 1. Limit work hours to 80 hour work week 2. Limit shifts to 24 hour maximum consecutive hours 3. Limit on call shifts to every third night 4. Require a minimum of 10 hours off between shifts and 5. Require at least one 24 hour off duty period per week OSHA declined to intervene. AMSA has responded by beginning to gather support for legislation in favor of limitations on resident work hours.

But are federal mandates what EM physicians really want and need? Does the ACGME need more empowerment to enforce voluntary compliance and wield the punishment of removing accreditation or levying fines? The U.S. federal government already regulates and places stipulations on the amount of hours worked and the amount of sleep required for truck drivers and airline pilots so that the general public is not placed in harms way. Studies in these populations have clearly demonstrated that there is impairment after long hours of work without sleep. So why should a physician be put in a position to place their patients or themselves in jeopardy because of prolonged work hours?

Granted, there are several inherent problems with the governmental imposition of resident work hours and what duties and activities should be included in the standards. The particulars are probably best left to be decided by a multi-partisan panel of experts consisting of residents, faculty, and department heads, all of whom have different goals, needs, and expectations. Standards developed must include and apply to all forms of academic and clinical duties.

This includes shift work, call, conferences, and moonlighting.

Ongoing research in the field of physician impairment secondary to sleep deprivation is in the preliminary stages. In October 2001 the AMA and the American Academy of Sleep Medicine will hold a conference to discuss "the possible link between sleep deprivation, physician performance and medical errors." They will also be developing guidelines "to alleviate the nega(continued on next page)

21

Tales . . . . . . Jolly Ole Man and Eight Tiny Reindeer someone coming. Not knowing whether Santa had returned or whether my kids had gotten up early, I quickly ran into the utility room and hid. My kids were coming down the steps. Now what! There was only one way out of the utility room and it led directly to the family room where the kids were waiting. When I came out of the utility room my kids looked at me and said "Dad, what are you doing?" I said, "I thought it was ok to come down and see what Santa had left and when I heard footsteps I thought he had returned. So I hid in the utility room." I spent a few minutes with the kids playing with their toys. Since it was around 5:00 am, I went back upstairs and went to bed. What a night! Thank goodness I did not have to work in the ED that day. After about 2 hours of sleep, and at the coaxing of my kids, I got up from the bed and played with the toys, enjoyed a nice breakfast cooked by mom and gave thanks and praise for the true meaning of Christmas.

I hope you have had Christmas experiences as vivid as mine. Happy Holidays to you and your immediate and extended families for this upcoming Thanksgiving and Christmas. I am also looking forward to the upcoming New Year. Don’t forget to get your SAEM abstract in before the deadline of January 8, 2002, 3:00 pm Eastern Time. On Brian, on Roger, on Don and Carey, on Judd, on Debra, on Glenn and Jim, on Sue and Mary Ann too. Well, I guess that makes me Rudolph!

But who is Santa?

There is probably a little Santa in each of you.

Thanks SAEM for a great 2001!

Marcus Martin, MD SAEM President University of Virginia This is another tale from the crib (home). You may want to read this before your kids do.

A family tradition has been to attend Christmas Eve service, come home and enjoy each other's company and go to sleep to wait for Santa Claus to make his visit. One early Christmas morning I went downstairs to check to make sure Santa had left everything in good shape and there was no further work to be done. Sometimes Santa will leave a bike, stereo set, dollhouse, or some other toy under the tree without completely assembling them. As I proceeded to check things out, not a creature was stirring, not even a mouse! While looking around to make sure everything was properly assembled I heard a noise. I quickly ran up the stairs and looked outside.

There was a cloud passing over the moon and a vague silhouette of a sled, eight tiny reindeer and an obese bearded person on a sleigh. I ran and got my video camera and recorded the whole thing. I came back in and looked around for some evidence, went into the kitchen and found some broken cookies and a partially consumed glass of milk on the table. I was careful on Christmas Eve night not to make a fire in the fireplace in case Santa elected to come down the chimney. I noticed the fireplace screen had been moved to the side, so I assumed Santa actually came down the chimney. I went back downstairs to check on the tree and toys and suddenly heard

AEM Call for Papers “Best Practices” The Council of Emergency Medicine Residency Directors (CORD) is sponsoring a Consensus Conference to present and discuss “best practice” models in emergency medicine, residency education.

The conference will be held March 2-4, 2002 in Washington, DC. This conference will highlight models to incorporate the six new ACGME core competencies into educational programs, and will also explore “best practices” in other important areas of the emergency medicine curriculum. In addition, topics related to evaluation and assessment of the effectiveness of educational curricula will be discussed.

Manuscripts relevant to these topics are being solicited for consideration of publication in Academic Emergency Medicine. The deadline for receipt of manuscripts is December 15, 2001. Instructions for authors appear on the website at www.saem.org/inform/journal.htm. Send manuscripts, including one blinded copy, one original copy, and an author copyright and disclosure form to AEM (preferably electronic to aem@saem.org). Be sure to specify that the manuscript is for the Best Practices issue. Any questions can be directed to Michelle Biros, MD, at biros001@maroon.tc.umn.edu.

Resident Work Hours (Continued) tive impact resident work hours may have on patient safety, resident education and lifestyle issues." At the same time Congress is delving into the relationship between sleep deprivation and medical errors after last year’s Institute of Medicine report.

The issue of resident work hours is a complex problem with no simple solutions. The medical community, including SAEM, needs to band together so that physicians are making the policies regarding physicians, not the government. It is in the patients’ and physicians’ best interest to have a multi-partisan panel of experts who will work to develop effective resident work hour guidelines to ensure the continuity of care for patients and an effective educational environment for residents. More importantly, it is the enforcement of these guidelines that will make more caring and competent physicians.

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ABEM Philosophy of Combined Training Programs and Review Process At the 2001 SAEM Annual Meeting in Atlanta, the ABEM report included a discussion of combined training programs in Emergency Medicine and other primary specialties. This information came out of the ABEM Board meeting on February 2, 2001.

Currently, the Board has approved Emergency Medicine combined training programs with Pediatrics, Internal Medicine, and Internal Medicine/Critical Care Medicine. It clarified that proposals for new combined training options should support an established career path that a significant number of individuals have already pursued, rather than seek to establish a new career path to attract individuals. The Board identified several areas of information that are important to have in place when considering a proposed combined training program. Institutions interested in starting a combined training program should contact ABEM.

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Information Required For Proposed Combined Training Programs What is the name of the specialty to be combined with EM training?

What is the origin of the request to consider a combined training program?

What are the basic objectives of a combined training program in EM and the other specialty?

How would a combined training option in EM and the other specialty improve patient care?

How many institutions have accredited programs in both specialties?

Include a written commitment from at least six training programs that support the proposed combined program.

What is the anticipated career path of graduates of such a combined program? In addition, would there be a reasonable demand for the graduates of such a program?

How many practicing physicians are currently dual-boarded in EM and the other specialty?

Include statements from physicians who have pursued this career path.

Include a template of a proposed curriculum clearly showing and describing the overlap that is possible between the two specialties.

How would the combined program be funded?

How would diplomates certified through the combined program recertify or maintain certification in both specialty areas?

Include a letter of endorsement from the director or other appropriate individual of the residency program of the specialty with which the combined program would be developed.

Has there been contact with the other specialty board? If so, what was the response?

Academic Emergency Medicine Website (Continued) handy feature is a direct link to the author’s email if you have questions or comments regarding the article you have read.

If you choose the search command in the archives section, again one can search by citation, author or key words and across multiple journals. If the author you are looking for is not available on AEM, it allows you with the click of the button to try to search another journal available from a drop down list.

Another nice advantage of this search engine is it allows you to search for keywords anywhere in the article instead of the only the abstract and title which is more customary.

When you pull up the full text of the article, you are able to quickly move

through the main sub-headings with the click of a mouse. No more scrolling until you get vertigo. The tables and figures can be viewed either within a small window, blown up in a separate window, or at an even higher resolution (36K).

One of the most useful features is the ability to directly access the abstract or in some cases the full text of the literature referenced simply by clicking on the blue highlighted text at the end of the reference. If “full text� is displayed, there are links to other Highwire journal sites that share articles between subscribers. AEM plans to expand the access to full text by subscribing to a consortium of over 70 publications in 3800 other journals. This feature will be particularly helpful to those subscribers

without institutional affiliation or whose institutions do not subscribe to a large number of journals.

In summary, the AEM website is an extremely resourceful tool that will greatly increase your efficiency, saving you searching time both electronic and bipedal. So please, if you have not utilized it already, it behooves you to access your AEM journal account at www.aemj.org.

Once you have accessed this site, bookmark it, because I guarantee that you will utilize it repeatedly. If you have any feedback about the site, send it by clicking the feedback button, as it is our wish to make this site as easy as possible to access.

Scholarly Sabbatical Grant Recipient Reports (Continued) derful opportunity to grow and learn, and perhaps make future contributions.

I am not fellowship trained and graduated residency without any particular research expertise. Nevertheless, the award allowed for important growth.

One blessing that evolves from the relative youth of our specialty, is the fact that considerable funding is available to even very inexperienced faculty such as myself. Not all of us have completed or contemplated fellowship training. While 23

not a substitute, this grant makes possible training that for me would have been very difficult to obtain otherwise.

September 11th (Continued) made that will be helpful in future planning. The decision to locate the emergency management command post at the WTC was clearly an unfortunate one. What is needed is a secure and safe low profile location. There was no organized backup incident command center and this function will have to be added to the City’s plan. The initial wave of casualties were all dispersed to the three closest hospitals which were transiently overwhelmed. Had there been a second wave of patients there could have been a delay in management of unstable patients. The transportation decisions were hampered by the lack of onsite command and communications systems. There was a massive turnout of volunteers. Crowd control, initial supervision, and organization of the volunteer rescuers, as well as their safety were unanticipated problems.

There were inadequate supplies of dust masks and eye protection during the early phase of response of the rescuers. The media descended on the perimeter of the site and interviewed a number of the physicians and volunteers as they exited the perimeter. There were a few interviewees who transmitted erroneous information. Thus, systems of crowd control and media access and control will have to be reconfigured. Finally in approaching multi-casualty situations in high rise buildings there will have to be a rethinking of the locations of the patient collection stations, as well as the location of the perimeter beyond which access to the site by men and equipment has to be limited and controlled.

Kevin Chason, DO, Co-Director, Division of EMS and Disaster Preparedness, Department of Emergency Medicine, Mount Sinai School of Medicine When notified of the disaster at the World Trade Center (WTC) at the Mount Sinai Hospital we immediately activated our disaster plan. We were able to clear out the Emergency Department and admit the patients already waiting for beds in one hour. We identified and organized the triage and treatment teams and operating rooms and ICU beds were readied. We established a staffing pool and received O negative blood, antibiotics and prepared for trauma and burn injuries. Then we waited for patients to arrive, but few came. We treated 20 minor trauma patients during the first 8 hours and then over the next 3 days waited to receive patients as they were extricated from the debris. We were overwhelmed with feelings of sorrow and frustration at our inability to provide meaningful medical assistance. A natural response that must be addressed in disaster planning with timely debriefing.

Our disaster operations were thus never really challenged by a large numbers of victims, but we were ready. There was a communications breakdown between the City’s disaster operations and the hospitals so we were in the dark as to what was coming our way or if we were still needed or could stand down from our deployment. We received much of our information early on by Internet and television broadcast. The City of New York’s Emergency Operations Center was in the WTC so its coordinating and communication functions were lost for a period of several hours while an alternate site was being set up.

Our phone system was very unreliable and using radios at key posts was very helpful. Because of the lack of communications we were also uncertain of the decontamination and containment needs of our patients. Our external decontamination shower was deployed, but never put into action. While there are reports at other sites, patients covered in dust and debris were decontaminated.

The problem of overcrowding and the lack of inpatient beds are facts of life for us at Mount Sinai. However when the disaster plan was activated, suddenly 160 inpatients could be discharged and the patients in the ED waiting for beds left the Department in a very short period of time. Similar scenarios were played out in a number of our neighboring hospitals as well. This phenomenon provides a very important window into the problems of length of stay, ED overcrowding and the admission and discharge processes in our institutions.

James Pruden, MD, Director of Emergency Services, St. Joseph’s Hospital, Paterson, NJ, Assistant Clinical Professor, Emergency Medicine, Mount Sinai School Medicine In the first few hours after the attacks, there were scores of physicians and nurses that went to the area of the fallen buildings to offer their services. In light of the devastating impact this event had on the leadership in the Fire Department of New York (FDNY), as well as the loss of significant communication capabilities (cell phone broadcasting sites and satellite sites were located at the top of the World Trade Center), effective radio and telephone communication was temporarily lost. It was impossible to learn if we were needed or specifically what was needed.

As an emergency physician, trained in Urban Search and Rescue, I too responded directly to the area, thereby violating one of the standard principles of this kind of work. That principle is to "avoid freelancing". Freelancing is acting independently outside of an organizational structure. Freelancing also makes it hard to maximize rescuer safety, working without some kind of reporting structure or buddy system and a command structure. Nonetheless, that seemed to be what the situation called for at the time, and I am sure that others felt that way as well. I did make it my goal to try to network with other resources in the area. With the help of an Army Ranger Captain, and some volunteer Office of Emergency Medicine Services people, we established a triage area. The goal was to direct the walking wounded further away from the area of ongoing danger. and to do some initial sorting of others that came through. After establishing a process and leaving someone else in charge, another EMS worker and I sought to identify and quantify available medical resources, and establish ambulance transport points. Much of those early hours, was spent also spent in attempting to make connections that maximized our joint functions, and then letting other groups know what was available and where.

Neill Oster, MD, Co-director of the Division of EMS/Disaster Preparedness, Mount Sinai Department of Emergency Medicine Our Departmental Disaster plan at Elmhurst City Hospital was rapidly deployed and we unfortunately did not receive significant numbers of casualties. As I am involved in the Mayor’s Antiterrorism Task Force and the Office of Emergency Management, I was able to participate and learned more about the response and the issues at ground zero. The human carnage that occurred and the massiveness of the destruction were very difficult to comprehend, let alone respond to in an organized way. However the dedication and selflessness of the uniformed services and the volunteers were monumental and their efforts truly mitigated the loss of life.

While an official critique of the response is yet to come, there are a number of observations that I and others have

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Ethics Consultation Service Every day emergency physicians are faced with countless ethical dilemmas. In our practice, our teaching, our research and our administrative duties, we make choices based not only on our knowledge but also on our personal beliefs and value systems.

For the most part, these decisions are made in typical emergency medicine style--- we think, we decide, we act, and we move on. We feel confident that we have acted appropriately, based on a reasoned assessment of the circumstances and the strengths of our convictions. We act in good faith, and hope that we have acted wisely and justly.

Occasionally, an ethical issue arises that is outside our world view or consideration, or a situation confronts us that makes us uncomfortable. We may lack the knowledge that we need to make a reasonable choice, we may be faced with something totally out of our experience, or we feel at a loss because we cannot determine the possible options. We may witness an ethically questionable act, may observe unprofessional and possibly harmful actions, may disagree about the correctness of another’s decision, or may feel we ourselves are being subjected to exploitation, abuse, or other unethical behavior. Such situations are frightening; it is difficult to distinguish reality from perception, to know who can be approached for advice, or where resources can be found to assist in developing an appropriate response.

Some institutions have committees or other authoritative bodies designed to examine grievances, allegations of scientific misconduct or specific ethical dilemmas in clinical practice.

The advice of these groups, however, may have limited applicability to emergency medicine; they may not include emergency physicians, or

September 11th (Continued)

have the expertise to relate to the unique aspects of the ethics of emergency medicine. In addition, these groups are charged with developing a response to a particular crisis that has arisen locally. They are goal directed and not necessarily able to provide a thoughtful method to educate beyond the concrete response to the problem at hand.

For these reasons, the SAEM Board charged the Ethics Committee to develop an Ethics Consultation Service. As the title implies, the Ethics Consultation Service is available to assist SAEM members with their questions concerning ethical issues or decisions they must make during the course of their clinical, academic or administrative responsibilities.

Opinions from the Ethics Consultation Service will be offered to SAEM members in a timely manner; requests from nonmembers will be considered on a case by case basis.

The opinions rendered are not meant to be part of an ‘appeal process.’ This service is offered to SAEM members who may need advice or assistance when faced with a difficult ethical decision.

All communications with the Ethics Consultation Service will be anonymous and confidential. However, because many ethical issues confronting practicing emergency physicians are universal in their scope, and others may learn from the issue presented, we hope to develop a series of articles for publication for the Society, assuming that confidentiality can be maintained.

All requests, inquires, or correspondence should be directed to the Ethics Consultation Service at SAEM, 901 North Washington Avenue, Lansing, MI 48906 or saem@saem.org.

Password Required to Receive AEM Online SAEM members must now use a password to access their online subscription to Academic Emergency Medicine. All SAEM members are entitled to receive a free subscription of both the print copy and online version of AEM. To activate your subscription go to the website: www.aemj.org, Click on the subscriptions button. Click on the link “activate your member subscription.”

Enter your membership number (which is printed above your name on the mailing label of this Newsletter) and click the submit button. You will then be asked to select a user name and password. If you need assistance or do not have a member number, send an email to saem@saem.org or call 517-485-5484.

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There was, as it turned out, a superabundance of physicians at the scene. Most of them were not trained in Emergency Medicine or prehospital care. There were certainly issues of training, liability, safety and adequate personal protection.

Because we did not know the extent of the casualties we would be triaging and managing we made the decision to find functions for these uninitiated providers and keep them at the site. Besides, you could not have gotten most of those people away from that site with a stick of dynamite. Their fervent need to help, to participate, to DO SOMETHING was that strong.

Ultimately, there were MASH capabilities established at Chelsea pier, (about 1.5 miles from ground zero) there were 15 to 20 physicians at or near the new triage area. We relocated our original triage area to this site when it became clear that Building Seven near our post was going to go down, and it was also becoming clear that there was not going to be a sudden influx of overwhelming numbers of patients in a second wave of casualties.

On the positive side, our actions seemed to coordinate the available resources placing the volunteers into an operational team that approximated a patient triage and collection station.

Triage was ultimately set up in close proximity to transport capabilities and people in the area were informed as to where the medical resources were being concentrated.

We did not sustain significant injuries among the rescuers in my group but this was an ever-present danger. I was absent for the first few hours during the mobilization of the New Jersey Emergency Response Task Force in which I play a leadership role. However, they seemed to perform splendidly in my absence. I am still ruminating about the appropriateness of my actions as a freelance organizer at the site of the disaster.

And so it goes, our world turned up side down on September 11 and we are ruminatively replaying the event in our minds. We have learned a number of very painful lessons that will change how we prepare and respond to disaster and other multi-casualty events should we be called upon to serve once again. As we continue to work on our response capabilities and operational readiness our immediate response as emergency physicians is to redouble our standing commitments to our families patients, trainees and country.

President’s Message (Continued) prayers are with you all and with our fellow emergency workers in these areas who are trying their utmost to cope with this situation." V. Anantharaman "It was a difficult day for all of us and I fear the worse is yet to come. All our faculty, residents and staff are safe as are myself and family but we have several individuals in our department who have family members who are still missing. And all of us have lost friends amongst the hundreds of emergency personnel who were killed at the scene when the World Trade Center collapsed.

I am proud of the way emergency physicians around the city met the challenge of preparing for thousands of casualties.

Unfortunately, very few victims survived to have need of our care. It is likely that those thousands are buried in the rubble and the agonizing process of returning their bodies would take months.

Thank you for your concern and support. We will continue to draw comfort in them in days ahead."

Lynne Richardson "It is very hard for us to see you working hard in this treachery attack, instead of being there and helping you.

I wish this will be the last violence in your country and all over the world. We all are ready for any kind of support to help you. Our hearts and prayers are with you especially the emergency staff who are lost in the wreckage of buildings and all American people." Sedat Yanturali (Turkey) In this Newsletter, Dr. Sheldon Jacobson and others provide an account of September 11, 2001.

Although we have experienced great change in our lives with the indelible events of September 11 and the reality of bioterrorism, we must continue our daily lives and Societal activities with fervency. I am happy to report to the SAEM membership on the activities of our committees and task forces at this time.

The SAEM committees and task forces have made steady progress towards accomplishing their objectives.

The Emergency Care Center Categorization Committee has streamlined the application process and continues to work to improve upon the application and make it easier for our members to apply.

The Ethics Committee has worked on ethical case studies and submitted course proposals for the annual meeting. The Ethics

Committee is also developing a teaching module for emergency medicine residency programs and developed guidelines for filming of patients in academic emergency departments. The Board of Directors has also developed a position statement on filming of patients in the ED. The Faculty Development Committee has developed the faculty development section of the SAEM website and has made tremendous progress towards the completion of the Faculty Development Academic Handbook. The Graduate Medical Education Committee is developing a fellowship catalogue and developed a skeleton curriculum of a teaching module for residents interested in an academic career. The resident section of the website has been revised and additional articles have been posted for residents interested in an academic career.

The Grants Committee has been coordinating the application process and will be recommending recipients to the Board for the medical student interest group, scholarly sabbatical, research training, neuroscience fellowship, EMF/SAEM innovations in emergency medicine education, EMS research fellowship, EMF/SAEM medical student, and institutional research training grants. We established the institutional research training grant this year and expanded funding for the research training grant. These additions will provide more opportunities for members of our organization to achieve necessary research skills and further position SAEM and members to advance our mission of improving patient care through research and education.

The National Affairs Task Force has been active in representing SAEM at the AAMC and AMA and has submitted periodic reports, positions papers and articles. In collaboration with the Association of Academic Chairs, the National Affairs Task Force has scheduled a conference at the AAMC meeting in Washington, DC on November 4, 2001. At that meeting, a report on the Safety Net Consensus Conference held at SAEM in May 2001 will be delivered

by Lynne Richardson and Jim Gordon and AAMC staffer Richard Knapp is to attend. The NATF wrote a letter of support for the Medicare Education and Regulatory Fairness Act (MERFA), which was sent to Congress (the text of the letter is in this Newsletter). The bill (S452) provides added protection to

physicians undergoing an audit, establishes an education program for care givers to help them with paperwork and regulations and streamlines some regulations reducing the amount of time spent on paperwork. SAEM expressed concern for the amount of time emergency physicians spend documenting on charts which takes time away from patient care.

The NATF also wrote a letter to CMS in regards to the Medicare program’s 5year review of RVU’s stating SAEM’s concerns about uncompensated care for patients who are "admitted and boarded in the ED." SAEM asked for a critical analysis of ED boarding of patients who are kept in the emergency department while waiting for an inpatient bed. Jill Grant the resident member of the NATF wrote an article in this Newsletter on resident work hours.

The Patient Safety Task Force is in the process of developing a teaching module on patient safety. Didactic proposals have been submitted for the Annual Meeting. A Newsletter article on research opportunities related to patient safety is in progress. Members of the Patient Safety Task Force were able to obtain multi-site funding through the National Patient Safety Foundation.

The Program Committee has been working steadily on developing and coordinating the 2002 Annual Meeting.

The Program Committee is on schedule with review of didactic proposals of which there were 94 submitted this year.

They are assigning abstract reviewers and generally progressing well. IEME exhibits will continue with a separate application progress from the abstract submission.

The Public Health Task Force has been developing a teaching module directed towards residents to explain HP 2010 and its objectives. Public Health Task Force members have initiated several projects of direct relevance to HP 2010 objectives. Some projects under development include ED overcrowding, diabetes screening, falls in the elderly, ED alert network, alcohol screening and smoking sensation.

Project specific action plans will be submitted to the Board for approval.

The Research Committee has submitted didactic proposals including sessions focusing on NIH and other sources of federal funding.

The Research Committee is also well on its way in accomplishing other objectives (continued on next page)

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President’s Message (Continued) such as SAEM newsletter articles profiling EM researchers, development of a program by which the Research Committee can provide mentorship for junior researchers and identifying organizations that SAEM can interact with and exchange information.

The Salary Survey Task Force has disseminated the salary survey and completed surveys are steadily returning. The Undergraduate Education Committee has developed the virtual advisor program, which has already become successful. The medical student section of the website has been revised and enhances SAEM’s visibility to medical students. With outstanding cooperation of SAEM staff, computer consultants and members of the subcommittee, the actual web page was added to the SAEM home page in time to be used for the 2001-2002 application cycle. The AAMC accepted the virtual advisor project as an exhibit for the November AAMC meeting and was written up in the September issue of the AAMC newsletter in the "web watch section". The Undergraduate Education Committee organized various slide presentations that should prove to be useful to faculty who are conducting meetings for medical students about the specialty of emergency medicine. A complete power point presentation on topics such as how to structure the 4th year medical school, how to apply to residency, and career options in emergency medicine is available on the SAEM web page. For the future, the Undergraduate Committee will work to develop a question and answer bank (shelf exam for medical student evaluation).

The Under Represented Member Research Mentoring Task Force has progressed well under the leadership of one of our new Board members, Glenn

Hamilton. The focus of this task force is to provide mentoring to under represented members of SAEM and address cultural competency issues, to develop a teaching module on cultural competency and to develop a monograph to encourage under represented minority medical students to consider emergency medicine as a specialty. More than 20 sites are involved and focus groups are being developed to ultimately serve as a basis for the development of the medical student monograph.

Development of a teaching module with many cultural competency cases should prove to be valuable to emergency medicine.

The new PR Committee was formed this year and initiated an annual announcement of the incoming SAEM president with a brief overview of objectives that were sent to the president’s hometown paper, institution and several national papers and magazines for publication. SAEM and the president become better known through this process. The PR Committee met in Chicago and discussed additional public relation efforts including advertising the annual meeting to other organizations.

During the SAEM Board meeting in Chicago in October, the Board voted to raise the dues for 2002. The dues have not changed since 1995. Considering budgetary projections for SAEM, it is evident that a dues increase is needed.

It is important to maintain financial stability to continue our mission and benefits. In this edition of the SAEM Newsletter, reasons for dues increase are further elaborated.

I appointed several Board members to a subcommittee on SAEM Research Funds and Finances. It is crucial that we further develop the SAEM Research

Fund and secure SAEM’s future financially. This Board subcommittee is working on an SAEM Research Fund strategic plan that includes ways to enhance finances available for current and future training grants, fellowships and sabbaticals. At the Board’s long range planning meeting in March 2002, we will consider projections for the future including the SAEM Research Fund.

As we go forward, the Nominating Committee will be considering nominations for Leadership, Academic Excellence and Young Investigators Awards and developing a slate of candidates for the elected positions.

This past year, SAEM held for the first time a mail ballot election that was very successful. Your response by voting in the 2002 mail ballot will be crucial in setting the stage for SAEM for years to come. We look forward to your participation in the election process. We look forward to your submission of abstracts for the Annual Meeting and we look forward to seeing you in St. Louis in May 2002.

All in all, I feel that SAEM’s progress this year has been significant. We are living in times like no other and I am privileged to be an SAEM member and the current president. Regarding the second half of this year’s presidency, I feel confident that we will continue the progress and stay ahead of the game as we have done in the first half.

I wish you, your family and friends a blessed holiday season and I look forward to communicating with you again the first of the New Year.

Marcus L. Martin, MD University of Virginia

The Top 5 Most-Frequently-Read Contents of AEM During the Month of September 2001 Most-read rankings are recalculated at the beginning of the month. Rankings are based on hits received by articles archived on AEMJ.org.

Droperidol vs. Prochlorperazine for Benign Headaches in the Emergency Department Acad Emerg Med Sep 01, 2001 8: 873-879. (In "CLINICAL INVESTIGATIONS") Bench to Bedside: Resuscitation from Prolonged Ventricular Fibrillation Acad Emerg Med Sep 01, 2001 8: 909-924. (In "SPECIAL CONTRIBUTIONS") Utility of an Initial D-dimer Assay in Screening for Traumatic or Spontaneous Intracranial Hemorrhage Acad Emerg Med Sep 01, 2001 8: 859-865. (In "BASIC INVESTIGATIONS") Epidemiology of Thoracolumbar Spine Injury in Blunt Trauma Acad Emerg Med Sep 01, 2001 8: 866-872. (In "CLINICAL INVESTIGATIONS") Are Emergency Department Patients at Risk for Herb-Drug Interactions?

Acad Emerg Med Sep 01, 2001 8: 932-934. (In "BRIEF REPORTS")

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FACULTY POSITIONS

University of Cincinnati Medical Center

ALBANY MEDICAL COLLEGE – CHAIR POSITION: The Albany Medical College Department of Emergency Medicine is seeking a residency trained, Board Certified emergency physician for the position of Chairperson. The Chair’s responsibilities will include overseeing clinical operations, the research program, and the educational missions of the Department. The Albany Medical College, Department of Emergency Medicine, the first academic department in New York State, evaluates and treats 65,000 patients annually and serves as the primary teaching site for a fully accredited emergency medicine residency program. The Department faculty provide medical direction for the hospital based air medical program, ground EMS agencies, and a variety of advanced life support training programs. The Department has a history of excellence in patient care, academic productivity and administrative leadership and seeks an individual who will enhance these core missions. The Albany Medical College is an equal opportunity/affirmative action employer.

Send CV to Kevin Roberts, MD, Chairman, Emergency Medicine Search Committee, Albany Medical College, MC-131, 47 New Scotland Avenue, Albany, NY 12208, 518-262-4305; Fax 518-262-4736 or robertk@mail.amc.edu.

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

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

ANN ARBOR, MICHIGAN – FACULTY/CLINICAL STAFF and RESEARCH DIRECTOR (ACADEMIC SETTING): Seeking BC/BP EM physicians to join St. Joseph Mercy Hospital. Clinical research experience required for Directorship. Level II Trauma Center with on-site Medflight air ambulance service that sees 92,000 patients annually between the ED, adult and pediatric ambulatory care centers, and chest pain observation unit.

Approved EM Residency program sponsored by the hospital and U of M Medical Center. Employed positions offer excellent remuneration, faculty stipend, paid malpractice, relocation allowance, cafeteria-style benefits, 401(K), long term disability, flexible scheduling and more. Director position offers dedicated protected time. Contact Nancy Ely at 800-4663764, ext. 337; nely@epmgpc.com; or visit us at EPMGPC.com

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

INDIANA UNIVERSITY SCHOOL OF MEDICINE: Department of Emergency Medicine is recruiting clinician teachers to provide care at the public hospital emergency department located on the medical center campus. Wishard Hospital is a Level I Trauma Center, base for one of the country’s busiest pre-hospital emergency transport services, and regional burn center. The ED recorded 105,000 visits in 2000. Wishard complements Methodist in providing clinical experiences for IUSM EM residents. Enthusiasm for medical education, facilitation of clinical research, and excitement for patient care in a busy public hospital ED are expectations. Residency training, certification in EM are required. Rank and tenure status are dependent upon interests and qualifications. Apply to Jamie Jones MD (jhjones@iupui.edu) or Rolly McGrath, MD (rmcgrath@iupui.edu), FAX (317) 656-4216. IU is an EEO/AA Employer, M/F/D.

RESIDENT EMS COORDINATOR

JACKSON MEMORIAL HOSPITAL, MIAMI, FL – ASSOCIATE MEDICAL DIRECTOR EMERGENCY CARE CENTER: Main teaching hospital for the University of Miami School of Medicine. Hospital has level one Trauma Center, >100,000 patients per visit per year. We are looking for a candidate with administrative and education experience. Minimum requirement: EM Boarded and 4 years of experience. EM/IM boards certified a plus. Excellent salary & benefits. Ample protected time for teaching and administrative duties. Florida license required. Contact: Abdul Memon, MD, Medical Director, Emergency Care Services, office: (305) 585-6913, email: Amemon@med.miami.edu.

The Division of Emergency Medicine at Duke University Medical Center is working to develop an Emergency Medicine Residency Program.

We are currently seeking a faculty member with a strong interest in EMS. This position offers opportunities for community EMS involvement, clinical practice in the ED, teaching, and research. Residency training and BC in EM required. Duke University Medical Center Emergency Department is a Level I Trauma Center in Durham, North Carolina, with an annual volume of 65,000 patient visits.

Competitive salary and benefits.

Faculty with EMS fellowship training are especially invited to apply.

OHIO STATE UNIVERSITY: Assistant/Associate or Full Professor.

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

OREGON: The Oregon Health Sciences University Department of Emergency Medicine is conducting an ongoing recruitment of talented entry-level clinical faculty members at the assistant professor level.

Preference is given to those with fellowship training, experience in collaborative clinical research, and writing skills, Please submit a letter of interest, CV, and the names and phone numbers of three references to: Jerris Hedges, MD, MS, Professor & Chair, OHSU Department of Emergency Medicine, 3181 SW Sam. Jackson Park Road, UHN-52, Portland OR 97201-3098.

Please contact: Kathleen J. Clem, MD, FACEP Chief, Division of Emergency Medicine DUMC 3096, Durham, NC 27710 email: clem002@mc.duke.edu

PENNSYLVANIA: We’re adding two positions to assure triple coverage – one available now and one this summer. Seeking BC/BE EM-trained

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physicians to join cohesive faculty of 30 BC physicians evaluating 100,000 patients at 700-bed Lehigh Valley Hospital’s three sites. LVH is academic, tertiary hospital with EM Residency, Level I trauma, 9-bed Burn Center and 10 residency programs. Member of the prestigious Council of Teaching Hospitals (COTH). Faculty appointment at Penn State/Hershey.

Opportunity for resident teaching and clinical research. Allentown has great public schools, safe neighborhoods, moderate cost of living, 10 colleges and universities, and is 60 miles North of Philadelphia and 80 miles West of Manhattan. Email CV c/o Michael Weinstock MD, Chair EM, to carol.voorhees@lvh.com. Fax (610) 402-7014. Phone (610) 4027008.

Faculty Development Fellowship The Wright State University School of Medicine, Department of Emergency Medicine is pleased to announce the second year of its new Faculty Development Fellowship. Must have completed Emergency Medicine Residency and be Board Prepared. Starting dates are flexible. The Fellowship has an 18 hour / week clinical commitment at one of our several practice sites (30,000 to 95,000 patient visits.) There are planned instructional sessions in didactic and clinical teaching, curriculum design, research project planning, grantsmanship, writing and publishing in the medical literature, use of media, administrative skills, international emergency medicine and several other topics. Each segment is linked to the expertise of a specific faculty members, combined with written materials. A portion of the program can be tailored to the needs and interests of each fellow. Stipend is $50,000 plus generous benefits and travel support. We are currently accepting applications for 2002. Please include a CV, letter of interest and two letters of reference. If you have an interest in academic emergency medicine and would enjoy a year of focused training in the skills necessary to establish your career, contact: Glenn C. Hamilton, MD, MSM Department of Emergency Medicine 3525 Southern Blvd., Kettering, OH 45429 Phone: (937) 296-7839 • Fax: (937) 296-4287 email: glenn.hamilton@wright.edu Consideration of applications begins September 15, 2001 and will continue until the positions are filled. Wright State University is an AAEO Employer.

UCLA EMERGENCY MEDICINE CENTER: Announces the availability of a fellowship in emergency medicine for graduates of EM residency program. The two year research fellowship is integrated with the Robert Wood Johnson Clinical Scholars Program and the UCLA School of Public Health. Candidates may obtain with an MPH or PhD degree. Contact Larry J. Baraff, MD, UCLA Emergency Medicine Center, 924 Westwood Blvd, Suite 300, Los Angeles, CA 90024-1777, or lbaraff@ucla.edu.

THE UNIVERSITY OF CALIFORNIA, DAVIS, SCHOOL OF MEDICINE: Recruiting for a full-time faculty at the Assistant, Associate or Full Professor level, in the Division of Emergency Medicine and Clinical Toxicology. A residency training program in emergency medicine began over 10 years ago and currently has 29 residents. The UCDMC Emergency Department provides comprehensive emergency service as a Level I Trauma Center, as well as a paramedic base station and training center.

Candidates for this position must be board certified or eligible in emergency medicine and be eligible for licensure in California. Open until filled, but no later than 1/31/02. For consideration, a letter outlining interests and experience, and curriculum vitae should be sent to: Robert Derlet, MD, Chair, Emergency Medicine Search Committee #3053, University of California, Davis Medical Center, 2315 Stockton Blvd., PSSB 2100, Sacramento, CA 95817. The University of California is an affirmative action/equal opportunity employer.

UNIVERSITY OF MICHIGAN: The Department of Emergency Medicine at the University of Michigan is seeking a Residency Program Director for the Emergency Medicine Residency Program. The residency program is a joint program between the University of Michigan and St. Joseph Mercy Hospital both located in Ann Arbor. The residency program is a four-year program with 56 approved residents. Candidates at the Associate Professor level (either clinical or tenure track) preferred. Excellent fringe benefit package. If interested, please send curriculum vitae to: William G. Barsan, MD, Professor and Chair, Department of Emergency Medicine, UMHS, 1500 East Medical Center Drive, Ann Arbor, MI 48109-0303. The University of Michigan is an equal opportunity affirmative action employer.

We are increasing our faculty again! These are all new openings. The Brody School of Medicine at East Carolina University has immediate openings available for emergency physicians at the rank of assistant professor or above, depending upon the candidate’s qualifications. Physicians must have emergency medicine residency training or ABEM/AOBEM certification. The emergency medicine residency program has been fully accredited since 1982.

Many faculty are extensively involved in state and national activities. Pitt County Memorial Hospital is a 740-bed Level I trauma center, with 55,000 ED visits per year and a new Urgent Care facility will open in the fall of 2001. Our residency has 12 positions per year. Greenville has the benefits of being a very family-oriented community and a college town.

Compensation is competitive and commensurate with qualifications; an excellent fringe benefits program is provided.

Screening begins summer of 2001 and will remain open until filled. This is an excellent opportunity to join a rapidly-growing emergency department in the coastal plains of eastern North Carolina, just ninety minutes from the Atlantic Ocean.

UNIVERSITY OF NEBRASKA MEDICAL CENTER: Section of Emergency Medicine, seeks an ABEM board eligible or -certified individual for a fulltime academic position. This is an exceptional opportunity to be a part of a young, dynamic group in an outstanding tertiary referral environment.

Generous salary, benefits and CME. Respond in confidence to: Robert M. Muelleman, M.D., Professor, Director of Emergency Medicine, University of Nebraska Medical Center, 1150 UNMC, Omaha, NE 68198-1150.

(402-559-6705) The University of Nebraska is an affirmative action/equal opportunity employer. Minorities and women are encouraged to apply.

UNIVERSITY OF NORTH CAROLINA AT CHAPEL HILL: 2 openings for either full-time academically qualified Emergency Medicine, tenure-track physicians or for full-time clinical track physicians at the Clinical Instructor or Clinical Assistant Professor level. Successful tenure-track candidates will be Board Certified/Board Prepared in Emergency Medicine with an interest in clinical cardiology or neurosciences research. Clinical track faculty are expected to do clinical work only.

UNC Hospitals is a 665-bed Level I Trauma Center. The Emergency Department sees upward of 40,000 high acuity patients per year, is active in regional EMS, ACLS/ATLS/BTLS education and has an aeromedical service. Send CV to Edward Jackem, MBA, Department of Emergency Medicine, CB #7594, Chapel Hill, NC 27599-7594. (919) 966-5943. FAX (919) 966-3049. UNC is an Equal Opportunity/ADA Employer. Women and minorities are encouraged to apply.

Please submit letter of interest and curriculum vitae to: Nicholas Benson, MD, MBA Professor and Chair Department of Emergency Medicine The Brody School of Medicine at East Carolina University 600 Moye Boulevard Greenville, North Carolina, 27858-4354 Phone 252-816-4757; Fax 252-816-5014 ECU is an EEO/AA employer and accommodated individuals with disabilities. Applicants must comply with the Immigration Reform and Control Act. Proper documentation of identity and employability required at the time of employment. Current references must be provided upon request.

www.ecu.edu/med

VANDERBILT UNIVERSITY: Research Position — The Department of Emergency Medicine at Vanderbilt University is seeking a researchoriented faculty member for a tenure track position. This position will be customized to meet a junior or senior level faculty member’s training and experience. This exciting position is based in the Department of Emergency Medicine in collaboration with The Vanderbilt Center for Health Services Research. The individual to be recruited will have

www.uhseast.com

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completed training in an Emergency Medicine Residency Program. He or she should have a strong interest, or record, in an academic career and a desire to focus on outcomes research. If appropriate, the selected investigator will be allowed sufficient non-clinical time to complete the Vanderbilt MPH program during his or her two years. This position will have up to 80% protected time and start-up funding. Secretarial, research nurse, and statistical support will be provided, along with a premium discretionary research package. Appointments will be commensurate with the individuals level of achievement. Excellent salary and benefits in a great community. Please reply to Corey M. Slovis, MD, Chairman, Department of Emergency Medicine, Vanderbilt University, Room 703, Oxford House, Nashville, TN 37232-4700, E-mail: corey.slovis@mcmail.vanderbilt.edu.

University of Cincinnati Medical Center

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

VIRGINIA COMMONWEALTH UNIVERSITY HEALTH SYSTEM: The Department of Emergency Medicine at MCV Hospitals and Physicians of Virginia Commonwealth University Health System seeks physicians BC in Emergency Medicine to fill key faculty positions as the Vice Chairman of Academic Affairs, as well as a Toxicologist to serve as the Medical Director of the VA. Poison Control Center (ABMT and/or ABEM subspecialty examination required). In addition, we seek BC/BP EM physicians to fill clinical teaching positions. All positions include an excellent compensation package. Forward CV to: Joseph Ornato, MD, FACC, FACEP, Professor & Chairman, Emergency Medicine, MCVH&P/VCU, Box 980401, Richmond, VA 23298-0401; 804-8284859, fax: 804-828-4686, www.vcu.edu/mcved. MCVH&P/VCU is an EEO/AA Employer. Women, minorities and persons with disabilities are encouraged to apply.

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

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

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

Academic Emergency Medicine The Department of Emergency Medicine, Wright State University School of Medicine seeks a faculty member at the Instructor, Assistant or Associate Professor level. Faculty rank and salary are commensurate with the candidate’s professional qualifications and School of Medicine standards. Faculty activities include medical education at all levels, curriculum coordination, administration and patient care. An interest and ability in clinical and classroom education are preferred. Requirements for appointees include: Instructor, Board prepared; Assistant, Board Certified; Associate, board Certified and 5 years Emergency Medicine experience. All must be graduates of Emergency Medicine Residency and eligible for Ohio license. Applicants should send curriculum vitae and names of three references to: Glenn C. Hamilton, MD, MSM Department of Emergency Medicine 3525 Southern Blvd., Kettering, OH 45429 Phone: (937) 296-7839 • Fax: (937) 296-4287 email: glenn.hamilton@wright.edu Consideration of applications begins September 15, 2001 and will continue until the positions are filled. Wright State University is an AAEO Employer.

Deadline for receipt: December 1 (Jan/Feb issue), March 1 (March/April), May 25 (May/June issue), June 15 (July/Aug issue), August 1 (Sept/Oct issue), and October 15 (Nov/Dec issue). 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, fax or mail the ad, along with contact person for future correspondence, telephone and fax numbers, billing address, ad size, and Newsletter issues in which the ad is to appear to: Jennifer Mastrovito at jmastrovito@saem.org, via fax at (517) 4850801 or mail to 901 N. Washington Avenue, Lansing, MI 48906. For more information or questions, call (517) 485-5484 or jmastrovito@saem.org.

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

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FACULTY POSITION The Division of Emergency Medicine at Duke University Medical Center is working to develop an Emergency Medicine Residency Program. We are currently seeking full-time academic faculty members. These positions offer a variety of opportunities for clinical practice, teaching, and research.

Residency training and BC in EM required.

Duke University Medical Center Emergency Department is a Level I Trauma Center in Durham, North Carolina, with an annual volume of 65,000 patient visits. Competitive salary and benefits. Faculty at all academic levels are invited to apply.

Please contact: Kathleen J. Clem, MD, FACEP Chief, Division of Emergency Medicine DUMC 3096, Durham, NC 27710 email: clem002@mc.duke.edu

WEST VIRGINIA UNIVERSITY Department of Emergency Medicine Open Rank: The Department of Emergency Medicine at West Virginia University has a full-time physician faculty position available. The qualified emergency physician will have patient care and teaching responsibilities. The WVU Hospital System includes a Level 1 Trauma Center with 38,000 annual patient visits, a well-established Emergency Medicine residency and an active aeromedical transport program. The Department has eighteen EM residents involved in a 1, 2, 3 program and twenty-six Physician Assistants from throughout the country enrolled in a graduate program in Emergency Medicine.

Duties include direct patient care and the supervision of medical students, physician assistants, and residents. Significant research opportunities with an emphasis on injury control are available through the affiliated Center for Rural Emergency Medicine.

Morgantown offers both scenic beauty and low cost of living that is within commuting distance of Pittsburgh, PA. The area offers lakes, hiking trails, skiing, whitewater sports, and numerous other outdoor activities. Preferred candidates will be residency trained in emergency medicine and board certified/eligible. Salary and rank commensurate with accomplishments and experience. This position will remain active until filled. Applicants should forward a letter of interest, curriculum vitae, and names and addresses of three professional references to Ann S. Chinnis, M.D., Chair, Department of Emergency Medicine, Robert C. Byrd Health Sciences Center, P.O. Box 9149, West Virginia University, Morgantown, WV 26506-9149.

West Virginia University is an Affirmative Action/Equal Employment Opportunity Employer.

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FACULTY POSITIONS Department of Emergency Medicine Tufts University School of Medicine Baystate Medical Center Springfield, MA 01199 www.baystatehealth.com Emergency Medicine Researcher: Seeking an emergency medicine researcher with experience in clinical research and grant writing. The position includes significant protected time; minimal clinical and administrative responsibilities; competitive salary (AAMC Standards) not based on grant support; departmental research staff including a clinical nurse researcher, a data manager, a team of EM research faculty; office space and secretarial support; an academic appointment with Tufts University School of Medicine consistent with experience and publications.

Pediatric Emergency Medicine: Seeking BC/BE physician in Pediatric Emergency Medicine and Emergency Medicine to join a regional trauma center with a fully accredited Emergency Medicine Residency Training Program and a Children’s Hospital. Opportunities include a full unencumbered medical school academic appointment, participation in a Pediatric Emergency Medicine fellowship being developed, and an active clinical research program. You will serve as an attending physician in the Pediatric and Main ED. Baystate Medical Center is a Level 1 Trauma Center, 500-bed hospital with an annual ED census of 98,000 in Western Massachusetts. Baystate Medical Center has a PGY13 emergency medicine residency with 12 residents per year and was recently named one of the top 15 major teaching hospitals in the United Sates for clinical excellence and efficient delivery of care (HCIA and The Health Network).

Springfield is located in the beautiful Connecticut River valley at the foothills of the Berkshires with convenient access to coastal New England, Vermont and metropolitan Boston and New York. The area also supports a rich network of academic institutions including the University of Massachusetts and Amherst, Smith, Hampshire and Mount Holyoke Colleges.

Please send your letter of interest with curriculum vitae to: Phil Henneman, MD, Professor and Chair Department of Emergency Medicine Tufts University School of Medicine c/o Don Rainwater, Baystate Medical Center 759 Chestnut Street, S-1578, Springfield, MA 01199 Tel: (800) 767-6612, Fax: (413) 794-5059 E-mail: Don.Rainwater@bhs.org Baystate Health System is an Equal Opportunity Employer

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Emergency Medicine Foundation Research Grant Program Overview All funding periods are July 1, 2002-June 30, 2003 unless otherwise noted. Contact EMF at 800-798-1822 or www.acep.org.

EMF Career Development Grant Description: A maximum of $50,000 to emergency medicine faculty at the instructor or assistant professor level who needs seed money or release time to begin a promising research project.

Deadline: January 11, 2002 Notification: March 20, 2002 EMF Creativity and Innovation in Emergency Medicine Grant Description: A maximum of $5,000 to support small pilot projects that are new and innovative. It is intended to provide release time or provide equipment and supplies for new investigators or for experienced investigators who have a novel idea.

Deadline: December 12, 2001 Notification: March 20, 2002 EMF Research Fellowship Grant Description: A maximum of $35,000 to emergency medicine residency graduates who will spend another year acquiring specific basic or clinical research skills and further didactic training in research methodology.

Deadline: January 11, 2002 Notification: March 20, 2002 EMF Resident Research Grant Description: A maximum of $5,000 to a junior or senior resident to stimulate research at the graduate level.

Deadline: December 12, 2001 Notification: March 20, 2002 Riggs Family/EMF Health Policy Research Grant Description: Between $25,000 and $50,000 for research projects in health policy or health services research topics.

Applicants may apply for up to $50,000 of the funds, for a one- or two-year period. The grants are awarded to researchers in the health policy or health services area, who have the experience to conduct research on critical health policy issues in emergency medicine.

Deadline: December 5, 2001 Notification: March 20, 2002 EMF/FERNE Neurological Emergencies Grant Description: This grant program is sponsored by EMF and the Foundation for Education and Research in Neurological Emergencies (FERNE). The goal of this directed grant program is to fund research based towards acute disorders of the neurological system, such as the identification and treatment of diseases and injury to the brain, spinal cord and nerves. $50,000 will be awarded in this program annually.

Deadline: January 16, 2001 Notification: March 20, 2002 EMF/SAEM Medical Student Research Grant Description: This grant program is sponsored by EMF and SAEM. A maximum of $2,400 over 3 months for a medical student to encourage research in emergency medicine.

Deadline: January 18, 2002 Notification: March 20, 2002 EMF/SAEM Innovation in Medical Education Research Description: This grant program is sponsored by EMF and SAEM. A maximum of $5,000 to support projects related to educational techniques pertinent to emergency medicine training.

Deadline: November 14, 2001 Notification: March 20, 2002 EMF Directed Research Cardiac Arrest Survival Award Description: This grant program is sponsored by the EMF and Wyeth-Ayerst. The goal of this directed grant program is to fund research proposals specifically targeting research that is designed to improve the outcome of patients who suffer cardiac arrest.

Potential proposals can include basic science, translational or clinical science investigations. A maximum of $100,000 over 2 years (July 1, 2002-June 30, 2004) will be awarded in this program.

Deadline: November 21, 2001 Notification: March 20, 2002 EMF/ENAF Team Grant Description: A maximum of $10,000 to be used for physician and nurse researchers to combine their expertise in order to develop, plan and implement clinical research in the specialty of emergency care.

Deadline: January 11, 2002 Notification: March 20, 2002 EMF Established Investigator Award Description: A maximum of $50,000 to established researchers.

Deadline: December 19, 2001 Notification: 33

March 20, 2002

S A E M

Call for Abstracts 6th Annual New England Regional SAEM Meeting April 3, 2002 Hoagland-Pincus Conference Center Shrewsbury, Massachusetts

Keynote Speaker: Ian Stiell, MD, MSc, FRCPC The Program Committee is now accepting abstracts for review for both oral and poster presentations at the New England Regional SAEM Meeting. The meeting will take place April 3, 2002, 9:00 am-4:00 pm, at the Hoagland-Pincus Conference Center in Shrewsbury, MA; www.umassmed.edu/conferencecenter/ The deadline for abstract submission is Tuesday, January 8, 2002 at 3:00 pm Eastern Time and will be strictly enforced.

Only electronic submission via the SAEM online abstract submission form will be accepted. Go to www.saem.org for more information. Acceptance notifications will be sent in late February 2002.

Send registration forms to: Kathleen Shea, Department of Emergency Medicine Research, 1BMC Place, Dowling 1S - Room #1332, Boston, MA 02118-2393; www.kashea@bmc.org Registration fees: Faculty - $100; Resident/Nurses - $50; EMTs/Students - $25. Late fee after March 20: add $25. Checks payable to Boston Emergency Physicians Fund.

S A E M

Call for Photographs Deadline for receipt: February 15, 2002

Original photographs are invited for presentation at the SAEM 2002 Annual Meeting in St. Louis. Photographs of patients, pathology specimens, gram stains, EKG’s, and radiographic studies or other visual data may be submitted. Submissions should depict findings that are pathognomonic for a particular diagnosis relevant to the practice of emergency medicine or findings of unusual interest that have educational value. Accepted submissions will be mounted by SAEM and presented in the "Clinical Pearls" session and/or the "Visual Diagnosis" medical student/resident contest.

No more than three different photos should be submitted for any one case. Submit one glossy photo (5 x 7, 8 x 10, 11 x 14, or 16 x 20) or a digital copy in JPEG or TIFF format on a disk or by email attachment (resolution at least 640 x 480). Radiographs should be submitted as glossy photos, not as x-rays. For EKG’s, send an original and a digital image. The back of each photo should contain the contributor’s name, address, hospital or program, and an arrow indicating the top. Submissions should be shipped in an envelope with cardboard but should not be mounted.

Photo submissions must be accompanied by a case history written as an "unknown" in the following format: 1. Chief complaint 2. History of present illness 3. Pertinent physical exam 4. Pertinent laboratory data 5. One or two questions asking the viewer to identify the diagnosis or pertinent finding.

6. Answer(s) and brief discussion of the case, including an explanation of the findings in the photo.

7. One to three bulleted take home points or "pearls" The case history must be 250 words or less with at least one blank line between sections. The case history MUST be submitted as an email attachment to saem@saem.org. If accepted for display SAEM reserves the right to edit the submitted case history.

Submissions will be selected based on their educational merit, relevance to emergency medicine, quality of the photograph, the case history, and appropriateness for public display. Contributors will be acknowledged and photos will be returned after the meeting.

Photographs must not appear in a refereed journal prior to the Annual Meeting. Patients should be appropriately masked. Written consent is required for all submissions except for isolated diagnostic studies such as EKGs, radiographs, gram stains, etc. Written consent and release of responsibility, where necessary, must accompany submissions.

All submissions will be considered for publication in Academic Emergency Medicine. In addition, SAEM reserves the right to post selected images and case histories on the SAEM website for teaching purposes. Submitters will be acknowledged. SAEM will retain the rights to use submitted photographs in future educational projects, with full credit given for the contribution.

Send submissions to SAEM at 901 North Washington Avenue, Lansing, MI 48906 or saem@saem.org.

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S A E M

Call for Abstracts 5th Annual SAEM Mid-Atlantic Regional Meeting

S A E M

April 11 & 12, 2002 First USA Riverfront Arts Center Wilmington, DE

Call for Abstracts SAEM Western Regional Research Forum San Diego, CA April 6-7, 2002

Keynote Speakers: Marcus Martin, MD, and Charles Pollack, Jr, MA, MD Special presentation: Joseph Lex, Jr., MD Other highlights include: oral paper and poster scientific presentations, renowned speakers, convenient location.

The deadline for abstract submission is February 1, 2002 via the SAEM online abstract submission form at www.saem.org.

Hotel reservations can be made at the Sheraton Suites Hotel in Wilmington, DE and transportation will be provided to the meeting site.

For information contact: Patty McGraw, RN, MS or Brian Burgess, MD, Department of Emergency Medicine, Christiana Care Health Services, 4755 Ogletown-Stanton Road, Room L877, Newark, DE 19718; phone: 302-7334166; fax: 302-733-1625; e-mail: pmcgraw@christianacare.org. The deadline for conference registration is March 8, 2002.

S A E M

Location: The beautiful Holiday Inn on the Bay Conference Center overlooking San Diego Harbor Deadline for abstract submission: January 15, 2002, electronic submission preferred via abstract submission process for national SAEM Annual Meeting. All regions invited to submit abstracts.

Special EM resident and medical student tracks.

Come and enjoy the sun and surf in San Diego!

Hosted by the University of California, San Diego Emergency Medicine Residency

Call for Abstracts Southeastern Regional SAEM Meeting April 12-14, 2002 Jacksonville, FL

The 2002 Southeastern Regional SAEM Meeting will be held at the beach in Jacksonville, Florida on April 12 – 14, 2002.

The program committee is now accepting abstracts for oral and poster presentations. Abstracts may be submitted electronically via the SAEM web site at www.saem@saem.org or by email to se.saem@jax.ufl.edu until January 8, 2002. Please use the SAEM submission form http://www.saem.org/meetings/regabst.htm if submitting by email.

There will be oral and poster research presentations, round table discussions with leaders in Academic Emergency Medicine, keynote presentations by world famous emergency physicians, and hands on educational sessions including: - difficult airway management / alternative airway devices - resuscitation using an advanced patient simulator - emergency ultrasonography 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 Hotel: Rooms have been reserved at the host hotel, the Sea Turtle Inn http://www.seaturtle.com/ • phone (800) 874-6000 or (904) 249-7402, for $140 – $180 per night. Mention the SE SAEM conference to receive the discounted rates.

Other Activities: Spouses and children are welcome. The beach is the main attraction. Transportation will be provided for those who would like to take a day trip to historic downtown St. Augustine on Saturday.

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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 Marcus Martin, MD President Roger Lewis, MD, PhD President-Elect Donald Yealy,MD Secretary-Treasurer Brian Zink, MD Past President James Adams, MD Felix Ankel, MD Carey Chisholm, MD Glenn Hamilton, MD Judd Hollander, MD Debra Houry, MD, MPH Susan Stern, MD

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

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

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

SAEM regional meeting Calls for Abstracts in this Newsletter

S A E M

CALL FOR ABSTRACTS 2002 Annual Meeting May 19-22 — St. Louis, Missouri

The Program Committee is accepting abstracts for review for oral and poster presentation at the 2002 SAEM Annual Meeting. Authors are invited to submit original research in all aspects of Emergency Medicine including, but not limited to: abdominal/gastrointestinal/genitourinary pathology, administrative/health care policy, airway/anesthesia/analgesia, CPR, cardiovascular (non-CPR), clinical decision guidelines, computer technologies, diagnostic technologies/radiology, disease/injury prevention, education/professional development, EMS/out-of-hospital, ethics, geriatrics, infectious disease, ischemia/reperfusion, neurology, obstetrics/gynecology, pediatrics, psychiatry/social issues, research design/methodology/statistics, respiratory/ENT disorders, shock/critical care, toxicology/environmental injury, trauma, and wounds/burns/orthopedics.

The deadline for submission of abstracts is Tuesday, January 8, 2002 at 3:00 pm Eastern Time and will be strictly enforced. Only electronic submissions via the SAEM online abstract submission form will be accepted. The abstract submission form and instruction will be available on the SAEM web site at www.saem.org in November. For further information or questions, contact SAEM at saem@saem.org or 517-485-5484 or via fax at 517-485-0801.

Only reports of original research may be submitted. The data must not have been published in manuscript or abstract form or presented at a national medical scientific meeting prior to the 2002 SAEM Annual Meeting. Original abstracts presented at other national meetings within 30 days prior to the 2002 Annual Meeting will be considered.

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