SAEM Pulse July-August 2024 by Society for Academic Emergency Medicine

SAEM STAFF

Chief Executive Officer

Megan N. Schagrin, MBA, CAE, CFRE mschagrin@saem.org

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Doug Ray, MSA, dray@saem.org Manager, Accounting Edwina Zaccardo, ezaccardo@saem.org

Director, IT

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Director, Communications & Publications

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Sr. Manager, Communications & Publications

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Manager, Digital Marketing & Communications, Alison “Ali” Mistretta amistretta@saem.org

Specialist, Web and Digital Content Alex Gorny, agorny@saem.org

Sr. Director, Foundation and Business Development

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Sr. Manager, Development for the SAEM Foundation

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Kayla Belec Roseen, kroseen@saem.org Manager, Exhibits and Sponsorships

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Director, Membership & Meetings

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AEM Editor in Chief

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CONTACT US!

Monday - Thursday: 8 a.m. to 5 p.m. CT; Friday: 8 a.m. to 3 p.m. CT Phone: (847) 257-SAEM (7236) or email: saem@saem.org

2024–2025 BOARD OF DIRECTORS

Ali S. Raja, MD, DBA, MPH

President

Massachusetts General Hospital/ Harvard Medical School

Michelle D. Lall, MD, MHS

President-Elect Emory University

Pooja Agrawal, MD, MPH

Jody A. Vogel, MD, MSc, MSW Secretary-Treasurer Stanford University

Wendy C. Coates, MD Immediate Past President UCLA Department of Emergency Medicine, David Geffen School of Medicine at UCLA

Members at Large

Yale Department of Emergency Medicine

Jeffrey P. Druck, MD University of Utah School of Medicine

Ryan LaFollette, MD University of Cincinnati

3 President’s Comments

From Challenge to Triumph: Celebrating SAEM's Achievements and

Julianna J. Jung, MD , MEd Johns Hopkins University School of Medicine

Nicholas M. Mohr, MD, MS University of Iowa Carver College of Medicine Ava Pierce, MD UT Southwestern Medical Center, Dallas

PRESIDENT’S COMMENTS

“Your contributions have made SAEM what it is today, and I couldn't be prouder of all that you have achieved.”

Ali S. Raja, MD, DBA, MPH

Harvard Medical School/Massachusetts General Hospital 2024-2025 President, SAEM

From Challenge to Triumph: Celebrating SAEM's Achievements and Innovations

“Out of the frying pan and into the fire.” This phrase has echoed among our colleagues as we emerged from a pandemic into the most significant capacity and boarding crisis our specialty has ever faced. Despite these challenges, the care you give to our patients, the education and mentorship you provide for our learners, the scholarship and research discovery you perform to advance emergency care, and the volunteer service you donate to SAEM have been outstanding. As I write my inaugural column for SAEM Pulse, I am filled with gratitude and admiration for each of you who make SAEM the fantastic organization it is.

I am thrilled to spotlight the many individuals deserving of thanks and recognition. Most importantly, I want to thank all of you, our members: our faculty, residents, fellows, students, and leaders. Your contributions have made SAEM what it is today, and I couldn't be prouder of all that you have achieved. A special thanks to Megan Schagrin, our CEO, and our incredible SAEM staff, who have poured their heart and soul into this organization. Your exceptional work has propelled SAEM and our SAEM Foundation to new heights. We have over 9,300 members, our highest membership ever, and we witnessed our most significant annual member growth ever. Additionally, the SAEM Foundation awarded over $970,000 in grants last year, a record-breaking achievement!

Diverse teams are more innovative and successful, and I am proud of SAEM’s commitment to diversity and inclusion throughout all aspects of our organization. In addition, we offer a range of faculty development courses to support our members’ professional growth, from

the Advanced Research Methodology Evaluation and Design (ARMED) and Advanced Research Methodology Evaluation and Design: Medical Education (ARMED MedEd) courses to the Emerging Leader Development Program (eLEAD), Certificate in Academic Emergency Medicine Administration (CAEMA), and Chair Development Program (CDP) programs This past year, we also launched two new interest groups, AEMP (Academic Emergency Medicine Pharmacists) and Tactical and Law Enforcement, and we expanded the Informatics and Data Science Interest Group to include artificial intelligence. These initiatives are already making a significant impact, and I am excited to see their future accomplishments as integral parts of SAEM!

Our Journals — Academic Emergency Medicine and Academic Emergency Medicine Education and Training — have had banner years, with outstanding impact factors and the publication of two SAEM GRACE clinical guidelines. Finally, our SAEM Program Committee organized the largest SAEM annual meeting ever, with nearly 4,000 of us gathering in Phoenix, Ariz. in May to learn, connect, and have fun.

SAEM is shaping the future of emergency medicine science, education, and practice, and I am incredibly honored to be your president this year. Thank you for entrusting me with this incredible opportunity and responsibility.

ABOUT DR. RAJA: Ali Raja, MD, DBA, MPH, is a professor of emergency medicine at Harvard Medical School and the deputy chair of the department of emergency medicine at Massachusetts General Hospital.

SAEM BOARD CORNER

Ali S. Raja, MD, DBA, MPH

President, 2024-2025 SAEM Board of Directors

Deputy Chair and the Mooney-Reed Endowed Chair, Department of Emergency Medicine, Massachusetts General Hospital; Professor of Emergency Medicine and Radiology, Harvard Medical School

Dr. Raja is SAEM Board Liaison for the following SAEM groups:

Wilderness Medicine IG

Chair: Kevin Watkins, MD

Overview

The Wilderness Medicine Interest Group is a vibrant community of emergency physicians collaborating to address medicine’s unique challenges and practices in wilderness and austere environments. This group is a platform for research, education, and collaboration on a diverse range of topics, from outdoor injury management to environmental emergencies, all to enhance skills and knowledge in this specialized area of emergency care.

Updates/Status

The Wilderness Medicine Interest Group actively engages SAEM members with regular SAEM Pulse articles. They are also starting to brainstorm ideas for an exciting and educational outdoor activity for #SAEM25 in Philadelphia!

Bylaws

Committee

Chair: Ronny Otero, MD

Overview

The SAEM Bylaws Committee is one of two standing committees elected by the entire SAEM membership. Each

member serves a three-year term, with a new member added annually. SAEM is governed by officially ratified bylaws sanctioned by the voting members. The Bylaws Committee is responsible for thoroughly understanding these bylaws and reviewing them annually to ensure they remain current and accurate.

Updates/Status

When a modification or amendment is proposed, the Bylaws Committee examines its potential merits, possible drawbacks, and legal implications. They then provide their findings and recommendations to the SAEM Board for preliminary assessment before presenting them for formal consideration by the membership. If you see proposed Bylaws changes on any upcoming ballots, you can be confident that this dedicated group has thoroughly reviewed them before submitting them to the Board and, subsequently, to you for your vote! The committee may also propose bylaw amendments directly to the SAEM Board. This supportive and hard-working small group offers a unique perspective on the organization’s inner workings.

Telehealth IG

Chairs: Lulu Wang, MD and Shruti Chandra, MD, MEHP

Overview

The Telehealth Interest Group is working to ignite an exciting online information exchange and lively discussions amongst its members! They are dedicated to enhancing their online presence and sparking engaging conversation topics on their discussion boards. In addition, they are on the lookout for thrilling collaboration opportunities with other Interest Groups through joint conferences, meetings, and lectures.

Updates/Status

The TIG has been buzzing with regular meetings featuring fantastic speakers from top-notch academic medical centers with stellar telehealth programs. These sessions are designed to supercharge their members’ expertise! They have also excelled at connecting telehealth enthusiasts with phenomenal mentors nationwide. The level of engaged mentorship at their Phoenix meeting was nothing short of extraordinary!

Nicholas Mohr, MD, MS

Member-at-Large, 2024-2025 SAEM Board of Directors

Professor, University of Iowa Carver College of Medicine

@nicholas_mohr

Dr. Mohr is SAEM Board Liaison for the following SAEM Groups:

Program Committee

Chair: Patrick Maher, MD

Overview

The SAEM Program Committee is responsible for overall planning of the SAEM Annual Meeting. Each member participates in a subcommittee dedicated to abstracts, awards, didactics, events, innovations, junior faculty forum, medical student ambassadors, medical student symposium, photo exhibition, program directors, residency and fellowship fair, resident leadership forum, and/or social media. The Program Committee also has general oversight of SAEM Regional Meetings.

Monthly Meeting: Fourth Thursday of each month at 11 a.m. CT

Notable Accomplishments

• Successfully completed SAEM24 — the largest meeting of the Society to date

• Developed a process for asynchronous grading for presenter abstract awards

• Provided feedback for SAEM members grading didactics, with a plan to roll out similar structure for abstract grading in the upcoming year

• Organized a street medicine volunteer event at SAEM24 to provide an opportunity for SAEM members to provide local community service

Equity and Inclusion Committee

Chair: Emily Binstadt, MD, MPH Overview

The Equity and Inclusion Committee exists to help SAEM achieve the its organizational goal to improve gender and cultural competency and diversity among SAEM members and leaders. The committee is also charged with ensuring that all selected avenues to improve equity and inclusion are in alignment with the SAEM Board of Director’s strategic priorities.

Monthly Meeting: Third Friday of every month at 11 a.m. CT

Notable Accomplishments

• Hosted recent webinars for SAEM leaders on intersectionality and for SAEM members on caring for asylum seekers and migrant populations

• Created a Diversity, Equity, and Inclusion Curriculum available to all members as a resource to create educational content for all levels of learners

• Curated a DEI Resource Library with links to recent literature and created a Recruitment Module as a topic in the curriculum

• Submitted an annual scorecard to the Board of Directors reporting on SAEM diversity, equity, and inclusion metrics

Disaster Medicine Interest Group

Chairs: Samuel Sondheim, MD, MBA and Marta Rowh, MD, PhD, MPH

Overview

The Disaster Medicine Interest Group has as its mission to advance the science and practice of disaster medicine. The interest group encourages didactic and research presentations at the annual meeting, continued publication to advance the field, and sharing new knowledge.

Monthly Meeting: Fourth Thursday of every month at 12 noon CT

Notable Accomplishments

• Sponsored three abstracts at SAEM24

• Increased membership by 15% this year

• Developing a collaboration/ communication forum for Disaster Medicine fellows nationally

Evidence-Based Healthcare and Implementation Interest Group

Chair: Sangil Lee, MD, MS

Overview

The Evidence-Based Healthcare and Implementation Interest Group has as its mission merging health care professional expertise, research, and patient priorities/ circumstances via a process of finding, appraising, and using clinical science at the bedside. The interest group provides a network of expertise, which serves as a forum for research, education, and clinical practice.

Monthly Meeting: Second Monday of every month at 11 a.m. CT

Notable Accomplishments

• Proposed American Board of Emergency Medicine (ABEM) Key Advances articles, which have been chosen as peer-reviewed articles relevant to emergency medicine for the practicing physician

• Hosted didactics on peer reviewer training at the SAEM Annual Meeting and subsequently published a commentary on peer review training in AEM Education and Training journal.

• Selected annual Engineer Award for the best abstract on implementation science at SAEM24

Transmissible Infectious Diseases Interest Group

Chairs: Mike Waxman, MD and Mike Lyons, MD, MPH

Overview

The Transmissible Infectious Diseases Interest Group was created to facilitate networking, mentorship, training, and collaboration relevant to ED-based detection and response to transmissible infectious disease threats. This interest group intends to create a forum for academic exchange and collaboration related to best practices for ED program implementation for infectious diseases screening, research, and mentorship.

Monthly Meeting: Fourth Thursday of every month at 1 p.m. CT

Notable Accomplishments

• Changed name from EMTIDE Interest Group to the Transmissible Infectious Diseases Interest Group to reflect broader focus

• TID members presented several abstracts at SAEM24, which were very well-received

Simulation Academy

President: Suzanne Bentley, MD, MPH

Overview

The Simulation Academy is a national educational organization that focuses on the development and use of simulation in emergency medicine education, research, and patient care. The mission of the Simulation Academy is to serve as a unified voice for emergency medicine on issues of simulation.

Monthly Meeting: Third Tuesday of every month at 12 noon CT

Notable Accomplishments

• Launched new Mentorship Teams initiative to develop groups of senior, mid-career, and junior simulationists for career mentorship and professional connection

• Presented over 90 simulationfocused events, abstracts, lectures, and workshops at SAEM24, and members published 5 peer-reviewed manuscripts this year

• Developed the Diversity, Equity, and Inclusion Simulation Curriculum

• Presented 8 awards for exceptional work to Simulation Academy members at SAEM24

Advanced Research Methodology and Design (ARMED) Course

Chair: Danielle McCarthy, MD, MS

Overview

The Advanced Research Methodology Evaluation and Design (ARMED) is a course started in 2017 for junior faculty taught by leading experts in academic emergency medicine. The purpose of this course is to arm participants with the fundamental knowledge and skills to design a high-quality research project and grant proposal to jumpstart their research career.

Application deadline: August 1, 2024

Notable Accomplishments

• ARMED has trained over 190 emergency physician researchers since 2017

• ARMED is accepting applications for the 2024-25 ARMED course (due August 1, 2024)

• Participants ranked highly the ARMED Winter Workshop, a 2-day session at SAEM headquarters in Chicago in which participants receive feedback from faculty and peers on their specific aims and focus on in-person career development

• Recent ARMED participants have received funding through a dedicated SAEMF ARMED grant and funding from NIH

SPOTLIGHT

LEADING THE SAEM “FAMILY” IN TRAINING AND SUPPORTING THE FUTURE ACADEMIC EM WORKFORCE

An Interview with 2024-2025 SAEM President, Ali S. Raja, MD, DBA, MPH

Ali S. Raja, MD, DBA, MPH, is the deputy chair and the Mooney-Reed Endowed Chair in the Department of Emergency Medicine at Massachusetts General Hospital and a professor of emergency medicine and radiology at Harvard Medical School.

He received his MD and MBA degrees from Duke, his MPH from Harvard, and his DBA from Case Western. After training in emergency medicine at the University of Cincinnati, Dr. Raja completed a research fellowship at Brigham and Women's Hospital. He is board-certified in emergency medicine and clinical informatics.

Dr. Raja is an expert on managing critically ill patients in the emergency department and prehospital arenas. He has served as a Critical Care Air Transport Team commander for the U.S. Air Force, a civilian flight physician, a tactical physician for several local, state, and federal agencies, and a physician with MA-1 DMAT. The author of over 300 publications and book chapters, his research focuses on improving the appropriateness of resource utilization within the emergency department.

Dr. Raja has been an SAEM member for 22 years, serving in various capacities, including chair of the SAEM Program Committee, chair of the SAEM Trauma Interest Group, member of several SAEM committees, member of the SAEM Foundation Board of Trustees, and member of the SAEM Board of Directors. He currently serves as the 2024-2025 SAEM president.

Dr. Raja is also on the board of the Massachusetts Chapter of the American College of Healthcare Executives, where he serves as president, and the boards of Boston MedFlight and the Spaulding Rehabilitation Network. He was previously the editor-in-chief of the New England Journal of Medicine’s Journal Watch Emergency Medicine. Dr. Raja can be found on X/Twitter at @AliRaja_MD.

Congratulations on your election as the new president of SAEM. What are your primary goals for academic emergency medicine and SAEM during your term?

My primary goal is to work towards fulfilling the objectives of the strategic plan that the board and members of SAEM have worked to put together over the past many years. We’re going to continue to focus on medical education, research, and professional development, all in the context of the need to train and support the academic emergency medicine workforce of the future.

What are the most pressing issues facing academic emergency medicine today, and how do you plan to address them as SAEM President?

Many of the issues we’re now facing are similar to those we’ve faced more recently, especially as we reimagine our specialty post-pandemic. However, today’s issues are now layered onto the daily capacity challenges that we face in our emergency departments. Our emergency department at Mass General has between 45 and 100 boarding patients daily, and I plan to focus on developing ways to support our trainees and our educational and research missions within that context this year. Everything we do has to be reimagined in that context. It’s all possible, but our traditional strategies may no longer be as effective as they used to be.

You have held various leadership roles within SAEM. Which role has been your favorite, and why?

My favorite role, by far, was chair of the SAEM Program Committee. Not only did I get to know all the members

presenting at the annual meeting and leading our various groups, but I also got to organize a whole host of amazing social and networking events for the membership. It was the most intense and rewarding experience I’ve had within SAEM. I’m also glad it’s only a two-year position since it was pretty exhausting!

What has driven your long-term dedication to SAEM? What distinguishes our Society from other associations?

SAEM feels like a family. We’re all focused on furthering the academic mission of our specialty, but we have our particular spin on things. Yet no matter your specific interest, whether it’s space medicine or operations, you’ll find other like-minded members within SAEM who want to work together to build amazing things. That’s what makes us unique.

How has SAEM evolved as an organization during your nearly 22 years of membership?

The most obvious way is that it has grown enormously. With over 9,300 members and almost 4,000 of us attending the annual meeting, we’re much larger than we were a couple of decades ago. We’re also much more diverse in terms of our membership and leadership. It’s a little surprising to me that I’m the first South Asian president we’ve ever had, but I definitely won’t be the last, and it’s been great to see the varied backgrounds that the leaders throughout our organization have had.

Dr. Raja talking to a colleague.

The Rajas love dressing down.

The Rajas love dressing up!

Dr. Raja and family in Iceland, 2023.

Balancing your responsibilities as a chair, educator, clinician, researcher, and now SAEM President while maintaining a personal life can be challenging. How do you effectively manage these various roles and commitments?

The most important roles I get to have are those of a spouse and parent, and I try to remind the faculty I work with every day that their families matter more than anything else. The rest of it — the clinical work, research, education, and administrative roles — is much more complicated when juggling personal issues at home. Danielle and I try to carve out time for us and the family whenever possible, although it can sometimes be tricky.

What experiences outside of medicine have contributed to making you better at your work within the field of medicine?

My first jobs were as a waiter and a delivery driver for a florist. They both taught me a lot about customer service and how to connect with people, even those who are a little (or a lot) upset. I was also in the Air Force Reserve for a decade and while both stateside and while deployed I had the opportunity to work with outstanding teams with members who came from entirely different backgrounds but always pulled together for the sake of the mission. All those skills have translated directly into my clinical and administrative work and are useful daily in the department.

“We’re going to continue to focus on medical education, research, and professional development, all in the context of the need to train and support the academic emergency medicine workforce of the future.”

Up Close and Personal

Please complete the following three sentences:

1. In high school, I was voted most likely to…succeed, but a few years after me, Beyonce and Lizzo both went to my high school, so I feel like the school’s standards for success have gone up a lot since I left.

2. A song you’ll find me singing in the shower is…anything by Bon Jovi. I think I still have all the songs from Keep the Faith memorized.

3. A quote I live by is…“You miss 100% of the shots you don't take.” — Wayne Gretzky

What is your guiltiest pleasure (book, movie, music, show, food, etc.)?

I love fantasy movies and books. My kids and I are making our way through Lord of the Rings, and my wife Danielle and I are reading Sarah J. Maas and Ilona Andrews’ books. If I have downtime at the end of the night, you’ll always find me on my Kindle.

What tops your bucket list?

Making it to the Olympics has been on our bucket list for years, and this year, we’re finally going to get to go! We had to reserve the tickets almost two years ago, but we’re headed to Paris in August!

What's one thing few people know about you?

I’m always looking for things to do with my family, whether it’s dance lessons and krav maga with Danielle, or building a kit car with our sons, if they want to do something with me, I’ll generally try my hardest to make it happen.

Dr. Raja and his wife Danielle are fans of the Celtics.

A Record 3,904 Attendees Gather in Phoenix, Arizona for SAEM24

The 2024 SAEM Annual Meeting, held May 14-17 in Phoenix, Arizona, was truly historic! A record-breaking 3,904 attendees — the highest number in the Society's 35-year history — came together for four days of outstanding career development opportunities, cutting-edge education, groundbreaking original research, and innovations in academic emergency medicine presented by some of the foremost experts in the field. Our heartfelt gratitude to the SAEM Program Committee, moderators, presenters, and volunteers for their dedication and hard work in making SAEM24 an incredible success. Special thanks to all our attendees for bringing your energy, enthusiasm, and active participation. We look forward to seeing you in Philadelphia, May 13-16, 2025, for SAEM25!

SAEM24 Keynote Speakers: Leaders in Their Field

Dr. Peter Rosen Memorial Keynote

To kick off the event, Robert Neumar, MD, PhD, a leading advocate for federally funded research in emergency care and a distinguished researcher

with expertise in cardiac arrest resuscitation, delivered the SAEM24

Dr. Peter Rosen Memorial Keynote, "Emergency Medicine Research: Past, Present, and Future." Dr. Neumar, chair of emergency medicine at the University of Michigan, is well-regarded for his contributions and advocacy for federally funded research in emergency care. During his address, he reflected on the advancements in the field, explored the current research landscape, and envisioned the future of emergency medicine. Dr. Neumar's keynote was a pivotal moment for the emergency care community at SAEM24's opening session.

Education Keynote

On Thursday, Holly Caretta-Weyer, MD, MHPE, a leader in competency-based medical education, presented the SAEM24 Education Keynote, “PatientFocused and Learner-Centered: The Promise of Competency-Based Medical Education.” Dr. Caretta-Weyer

is the associate residency program director and director of evaluation and assessment for the Stanford University Emergency Medicine Residency Program. She also serves as the implementation lead for Entrustable Professional Activities/Competency-Based Medical Education at the Stanford University School of Medicine. Dr. Caretta-Weyer articulated a shared mental model of the fundamental elements of competency-based medical education.

Plenary Abstracts From the Brightest Minds in EM

Emergency medicine academicians in eight plenary abstract presentations explored a broad diversity of research relevant to the practice of emergency medicine during a special plenary sessions held following the SAEM24 keynote addresses on Wednesday and Thursday. The Plenary Sessions, which includes the top abstracts, chosen by the Annual Meeting Program Committee as the best from among more than 1,395 submissions, was a highlight of the annual meeting program.

Sign in with your user name and password at saem. org to view these eight plenaries, or see all SAEM24 accepted abstracts in the SAEM24 Annual Meeting Abstract Supplement

Opening Session Plenaries

1. Visualization of Occult Ventricular Fibrillation by Echocardiography During Cardiac Arrest: A Multicenter Trial

Romolo Gaspari, Josie Acuna, Jacob Baxter, Drew Clare, John DeAngelis, Timothy Gleeson, Powell Graham, John Hipskind, Ryan Joseph, Monica Kapoor, Tobias Kummer, Margaret Lewis, Stephanie Midgley, Robert Lindsay, Offdan Narvaez-Guerra, Jason Nomura, Mark Scheatzle, Nikolai Schnittke, Michael Secko, Trent She, Zachary Soucy, Jeffrey Stowell, Rebecca Theophanous, Jordan Tozer, Tyler Yates, Andrew Balk

2. Pharmacy Density As a Community Level Predictor of Heart Failure Medication Nonadherence: A Geospatial Analysis

Madeline Woodson, Matthew Durthaler, Karlee Waugh, Robert Ehrman, Nicholas Harrison

3. Implementation of Artificial Intelligence-Informed Risk-Driven Emergency Department Triage

Decreased Length of Stay for High-Risk Chest Pain

Jeremiah Hinson, Richard Taylor, Benjamin Steinhart, Christopher Chmura, Inessa Cohen, Haipeng Xue, Scott Levin

4. Emergency Department Utilization by Youth Before and After Firearm Injury

Samaa Kemal, Rebecca Cash, Kenneth Michelson, Elizabeth Alpern, Margaret Samuels-Kalow

Education Session Plenaries

5. Author Visibility in Video Presentations: Impact on Knowledge Retention and Satisfaction in Medical Education

Priya Patel

6. Resident Scholarly Activity and Productivity Outcomes Before and After Implementing a Structured Research Program

Sydney Krispin, Eric Kontowicz, Brett Faine, Michael Takacs, Karisa Harland, J. Priyanka Vakkalanka, Kelli Wallace, Andrew Nugent, Nicholas Mohr

7. Home vs. Away Rotation Differences in the Standardized Letters of Evaluation 2.0

Aman Pandey, Cullen Hegarty, Sharon Bord, Katarzyna Gore, Thomas Beardsley, Sara Krzyzaniak, Sandra Monteiro, Al'ai Alvarez, Teresa Davis, Melissa Parsons, Michael Gottlieb, Alexandra Mannix

8. Simulation-Based Mastery Learning Improves Resident Ability to Perform Emergency Cricothyrotomy

Elizabeth Stulpin, David Salzman

Dr. Ali Raja Installed as SAEM President; Presents $1 Million Gift to SAEMF

Ali S. Raja, MD, DBA, MPH, was installed on May 17 as SAEM’s 2024-2025 president. He will hold the president post for a one-year term. Dr. Raja is the deputy chair and the Mooney-Reed Endowed Chair in the Department of Emergency Medicine at Massachusetts General Hospital, as well as a professor of emergency medicine and radiology at Harvard Medical School. Dr. Raja succeeds Wendy Coates, MD, who became SAEM’s immediate past president.

continued on Page 12

Dr. Raja, in his first act as president, generously donated $1 million from SAEM to the SAEM Foundation (SAEMF), reaffirming the society's commitment to advancing emergency care research and education. Dr. Raja emphasized, "The SAEMF has been instrumental in nurturing emergency care

LOOKING AHEAD

Save the Date!

The SAEM Annual Meeting Program Committee, led by 2025-2026 Chair, Patrick Maher, is already hard at work to ensure SAEM25 is another stellar success. Join us in Philadelphia, PA, from May 13-16, 2025, at the Philadelphia Marriott Downtown. We look forward to seeing you there!

SAEM25 Submission Deadlines

The SAEM Annual Meeting is the premier event for presenting original, high-quality research and educational innovations in emergency care. Mark your calendar with the submission dates and start preparing to submit your work as soon as submissions open!

Workshops - Aug. 12 – Sept. 17, 2024

Didactics - Aug. 15 – Oct. 2, 2024

Keynotes - Sep. 5 – Nov. 6, 2024

Abstracts - Nov. 1, 2024 – Jan. 3, 2025

Innovations - Nov. 1, 2024 – Jan. 8, 2025

IGNITE! - Nov. 1, 2024 – Jan. 8, 2025

scholars and educators. This contribution underscores our dedication to supporting the Foundation's mission and ensuring its enduring impact." SAEMF is grateful to SAEM for its unwavering dedication to emergency care research and education.

MEET PATRICK MAHER, MD

Your 2025-2026 Program Committee Chair!

Dr. Maher is an assistant professor of emergency medicine and critical care medicine at the Icahn School of Medicine at Mount Sinai. He practices emergency and critical care medicine at the Mount Sinai Hospital. His research interests include hemorrhagic shock and coagulopathy, critical care resuscitation, and emergency department-based laboratory testing. At Mount Sinai, Dr. Maher was supported through a T32 grant program during his research fellowship. He is a coinvestigator for the Prevention and Early Treatment of Acute Lung Injury (PETAL) studies at Mount Sinai. He has led funded studies investigating hypercoagulable states in various disease processes, including pregnancy, acute hemorrhage, and sepsis. He co-chairs the Mount Sinai Hospital CPR Committee and serves as co-director for the pulmonary and critical care medicine ultrasound education program. Before joining the faculty at Mount Sinai, Dr. Maher completed clinical training at the University of Washington in Seattle in emergency medicine and critical care medicine.

Dr. Patrick Maher

Meet Our SAEM24 Award Winners!

SAEM awards are given each year at the SAEM Annual Meeting in recognition of exceptional contributions to emergency medicine and patient care through leadership, research, education, and compassion. Congratulations to all of our 2024 award recipients!

John Marx Leadership Award

Nathan Kuppermann, MD, MPH

University of California, Davis

Honors an SAEM member who has made exceptional contributions to emergency medicine through leadership - locally, regionally, nationally or internationally, with priority given to those with demonstrated leadership within SAEM.

Hal Jayne Excellence in Education Award

Karen Jubanyik, MD

Yale New Haven Hospital and Yale University

Awarded to a member of SAEM who has made outstanding contributions to emergency medicine through the teaching of others and the improvement of pedagogy.

Marcus L. Martin Leadership in Diversity and Inclusion Award

Ugo Ezenkwele, MD

Mount Sinai Queens and Icahn School of Medicine at Mount Sinai

Honors an SAEM member who has made exceptional contributions to emergency medicine through advancing diversity and inclusion in emergency medicine.

Advancement of Women in Academic Emergency Medicine Award

Valerie Dobiesz, MD, MPH

Brigham and Women’s Hospital and Harvard Humanitarian Initiative

Recognizes an SAEM member who has made significant contributions to the advancement of women in academic emergency medicine.

Excellence in Research Award

James F. Holmes, MD, MPH

University of California, Davis

Presented to a member of SAEM who has made outstanding contributions to emergency medicine through the creation and sharing of new knowledge.

Organizational Advancement Award

Cherri D. Hobgood, MD

Indiana University

Michelle Blanda, MD Northeast Ohio Medical University

Gregory A. Volturo, MD University of Massachusetts Chan Medical School

Brian J. Zink, MD University of Michigan

Manish N. Shah, MD, MPH

University of Wisconsin-Madison

J. Scott VanEpps, MD, PhD University of Michigan

J. Adrian Tyndall, MD, MPH Morehouse School of Medicine

This year's award honored 7 of SAEM's past Foundation presidents for their ongoing contributions in advancing our organization and academic emergency medicine.

Arnold P. Gold Foundation Humanism in Medicine Award

Pavitra Parimala Krishnamani, MD, MS

University of Texas MD Anderson Cancer Center

Given to a practicing emergency medicine physician who exemplifies compassionate, patient-centered care.

FOAMed Excellence in Education Award

Mentor Award

Brian Gilberti, MD

NYU Langone Health

Honors an SAEM member who has made outstanding contributions to the online learning community of emergency medicine through innovative and engaging FOAMed content.

Public Health Leadership Award

Early Investigator Award

Rebecca Smith-Coggins, MD

Stanford University

Honors an SAEM member who has mentored the career advancement of other SAEM members.

Mid-Career Investigator Award

Early Educator Award

Danielle M. McCarthy, MD MS

Northwestern University, Feinberg School of Medicine

Kori Sauser Zachrison, MD, MSc

Harvard Medical School and Massachusetts General Hospital

Recognizes those SAEM members who have demonstrated commitment and achievement in research during the mid-stage of their academic career.

Thomas Jefferson University

Abra Fant, MD, MS

Northwestern University Feinberg School of Medicine

Ellen Duncan, MD, PhD

NYU Langone Health

Honors an SAEM member, within 8 years of their first faculty appointment who has made outstanding contributions to emergency medicine through the teaching of others.

Megan L. Ranney, MD, MPH

Yale School of Public Health and Yale School of Medicine

Honors an SAEM member who has made exceptional contributions to addressing public health challenges through interdisciplinary leadership in innovation.

University of Vermont Larner College of Medicine

Cameron J. Gettel, MD, MHS Yale University

Katherine H. Buck, MD, MPH The Ohio State University

Recognizes those SAEM members who have demonstrated commitment and achievement in research during the early stage of their academic career.

Fellows Awards

Pediatric EM

Christian

Pulcini, MD, MEd, MPH

Xiao Chi (Tony) Zhang, MD, MS

Imikomobong (Micky) Ibia, MD Boston Children’s Hospital

David Yang, MD, MHS Yale University

RAMS Leadership in Emergency Medicine Award

Cole Ettingoff, MPH

Trinity School of Medicine

Honors a medical student or practicing emergency medicine resident taking a leading role in their student interest group or residency program and making an impact on the local, regional, national, or international level through their efforts.

RAMS Excellence in Education Award

John Martindale, MD

Brown Emergency Medicine

Given annually to a senior emergency medicine resident who has demonstrated exceptional aptitude and passion for teaching during residency.

RAMS DEI Resident Education/Innovation Award

L. Tamara Wilson, MD

Baylor College of Medicine

Given to underrepresented medical students who demonstrate a strong commitment to and leadership skills in emergency medicine.

RAMS Excellence in Research Award

Marina Gaeta Gazzola, MD

NYU Grossman School of Medicine

Mohamad Ali Cheaito, MD University of Toledo

Awarded to annually to a senior emergency medicine resident or student who has demonstrated exceptional promise and early accomplishment in the creation of new knowledge.

Outstanding Department Award for Excellence and Innovation, Equity, and Inclusion

University of California San Francisco, Department of Emergency Medicine

In 2024, SAEM is recognizing seven of our past SAEM Foundation presidents for their ongoing contributions in advancing our organization and academic emergency medicine.

YOU ARE THE REASON FOR OUR SUCCESS. THANK YOU.

The SAEM Annual Meeting Program Committee, Board of Directors, and staff extend their heartfelt gratitude to the presenters and participants of our recent record-breaking annual meeting in Phoenix, Ariz. Your willingness to share your expertise, showcase groundbreaking research, contribute educational content, and give your time and effort elevated the quality of our event to new heights. Your contributions — whether large or small — enriched the academic emergency medicine community, setting new benchmarks, expanding our boundaries, and inspiring us all.

SAEM24 By the Numbers

• 3,904 participants

• 16 advanced EM workshops

• 1 Consensus Conference

• 141 didactics

• 227 e-poster abstracts

• 8 plenary abstracts

• 100 oral abstracts

• 450 lightning oral abstracts

These are the Champions!

SONOGAMES® CHAMPIONS

Harvard Affiliated Emergency Medicine Residency

SIMULATION ACADEMY SIMWARS CHAMPIONS

Washington University in St. Louis

DODGEBALL CHAMPIONS

UMass Chan Medical School

RAMS PHOENIX HUNT Team Songbirds

CLINICAL DIAGNOSIS WINNERS

Resident: Mahan Naeim. Medical Student: Soterios Stroud

Many Thanks to Our SAEM24 Exhibitors and Sponsors!

Exhibitors

• Abbott

• Abbvie

• ACEP Geriatric Emergency Department Accreditation

• AMBOSS

• American Medical Women's Association

• Apollo MD

• AstraZeneca Pharmaceuticals LP

• Auburn University, Physicians Executive MBA Program

• Beckman Coulter

• Bettinger, Stimler & Assocociates

• BTG Pharmaceuticals

Post-SAEM24 Need-to-Know

Claim Your SAEM24 CME or CPE

Mobile App Banner Ad

• Geisinger

Consensus Conference

• Univeristy of Michigan

• UC Davis

• Stanford University

RAMS Party VIP Tables

• Medical College of Wisconsin

• Mass General Brigham

• The Ohio State University

• Stanford University

• University of Indiana School of Medicine

The deadline is July 31 and July 13, respectively, to claim your SAEM24 continuing medical education (CME) and continuing pharmacy education (CPE). It's easy to claim CME or CPE! Just follow the simple instructions found on this webpage.

Access SAEM24 Content on SOAR Starting in August

Unable to attend SAEM24 in Phoenix or missed out on some sessions at the annual meeting? Starting in August, you'll have access to all the presentations from the annual meeting anytime, anywhere through our SAEM Online Academic Resources (SOAR) webpage. Enjoy convenient online and mobile viewing of SAEM24's Advanced EM Workshops, didactics, forums, abstracts, and more!

CLIMATE CHANGE & HEALTH

Climate Change and Emergency Medicine: Preparing for the Health Challenges Ahead

By Mary Bozsik, MD, on behalf of the SAEM the Wilderness Medicine Interest Group

There is a consensus within the scientific community that human activities have been the primary driver of climate change since the 1800s. Nearly all climate scientists agree that human actions are altering weather patterns, directly contributing to climate change and significantly impacting public health, particularly in emergency department utilization.

Climate change, often referred to as "global warming," has garnered increased attention as regions worldwide witness unprecedented weather phenomena. But what exactly constitutes climate change, and what factors are fueling it? Broadly, climate change denotes the long-term alteration in temperature and weather patterns

over 30 years or more. These shifts are largely attributed to escalating concentrations of atmospheric greenhouse gases. The four principal greenhouse gases known for their detrimental environmental impact are carbon dioxide, methane, nitrous oxide, and chlorofluorocarbons (CFCs).

Carbon dioxide emissions stem from both natural processes, such as volcanic eruptions and wildfires, and human activities, including fossil fuel combustion and deforestation. Methane emissions arise from sources such as plant matter decomposition, landfills, rice farming, and livestock digestion. Additionally, transportation contributes to methane emissions, primarily through the use of natural gas as fuel.

Nitrous oxide, a potent greenhouse gas, is released during the production and application of commercial and organic fertilizers. CFCs, exclusively human-made compounds, are found in refrigerants, solvents, and aerosol propellants and are recognized for their role in ozone depletion.

Despite overwhelming evidence linking human industrialization to environmental degradation, a subset of the population remains skeptical, attributing global warming to heightened solar activity. However, environmental scientists have demonstrated a decline in the average solar energy reaching Earth since 1750. Moreover, contrary to expectations of uniform atmospheric warming if solar radiation were the

“Nearly all climate scientists agree that human actions are altering weather patterns, directly contributing to climate change and significantly impacting public health, particularly in emergency department utilization.”

primary driver, observations indicate cooling in the upper atmospheric layers and warming near Earth's surface. This phenomenon, termed the "greenhouse effect," is attributed to greenhouse gases impeding heat dissipation from the lower atmosphere. According to the Intergovernmental Panel on Climate Change (IPCC), surpassing the threshold of a 1.5 degrees Celsius global temperature increase poses grave risks of exacerbating climate change-induced events such as droughts, heatwaves, and erratic precipitation patterns. Recent global temperature data underscores this urgency, with the years 2015 to 2021 ranking as the warmest on record, approximately 1.11 degrees Celsius above previous averages.

Climate change has numerous ramifications, one of which is rising sea levels. Most excess atmospheric energy generated by greenhouse gas emissions is absorbed by the oceans, leading to thermal expansion, sea level elevation, and accelerated ice melting. Concurrently, climate change has induced significant ocean acidification, as approximately 23% of annual anthropogenic carbon dioxide emissions are absorbed by seawater. While this absorption mitigates atmospheric carbon dioxide concentrations, it precipitates a chemical reaction that decreases oceanic pH levels, triggering adverse ecological effects such as coral reef degradation and biodiversity loss. Glacier melt is another consequence of escalating global and oceanic temperatures, with glacier mass loss accelerating from 53 gigatons per year in 2015-2019 to 100 gigatons per year in 2000-2004, thereby exacerbating sea level rise.

Greenhouse gases cause a plethora of adverse environmental effects, including ozone depletion, exemplified by the 2021 record expansion of the ozone hole spanning 24.8 million square kilometers, and heightened intensity of wildfires through prolonged droughts and increased flammable vegetation. Consequently, this amplifies carbon

dioxide emissions and compromises forests' ability to reduce atmospheric carbon dioxide concentrations.

While these impacts may seem distant from public health concerns, particularly emergency department visits, the link between climate change and human health is becoming increasingly apparent. Heatwaves are one of the most extensively studied consequences of climate change. Elevated temperatures are unequivocally associated with increased mortality, particularly among vulnerable populations susceptible to heat-related illnesses. High temperatures not only exacerbate acute heat-related ailments but also worsen chronic health conditions, leading to increased emergency department utilization.

Vector-borne diseases are another domain profoundly affected by environmental shifts. Temperature fluctuations significantly influence the life cycles and prevalence of disease vectors such as ticks and mosquitoes. For instance, rising temperatures extend the active period of ticks, increasing human exposure to Lyme disease. Similarly, the expanding range of Aedes aegypti mosquitoes, coupled with heightened vector capacity, portends a surge in mosquito-borne illnesses.

Waterborne diseases are another area of concern. Elevated sea temperatures foster the proliferation of waterborne pathogens, including harmful algal blooms and Vibrio parahaemolyticus. Additionally, episodic heavy rainfall events overwhelm sewage and water treatment infrastructures, increasing pathogen levels in drinking water and precipitating gastrointestinal disease outbreaks. Climate change has also significantly impacted pollen-producing plants, with elevated atmospheric carbon dioxide concentrations accelerating plant growth and exacerbating seasonal allergy symptoms.

The escalating concentration of anthropogenic greenhouse gases in the 21st century has led to cascading adverse

health effects and health care disruptions, resulting in surges in demand for emergency medical services. In the United States, emergency department visits have steadily increased over the past decade, currently averaging 139.8 million annually, accounting for approximately half of all medical care provision.

Although climate-related adverse health outcomes pose risks to all individuals, vulnerable and marginalized populations, including children, pregnant women, the elderly, low-income communities, communities of color, and the incarcerated, are disproportionately affected. Climate change strains various facets of the health care system, particularly emergency medicine, which is positioned at the frontline of acute care delivery nationwide. Emergency medicine is poised to bear a substantial burden of climate change-induced health repercussions, given its role as a safetynet provider for vulnerable populations and as a leader in disaster response.

Emergency medicine plays a crucial role in addressing the challenges of the climate crisis through disaster preparedness and response, clinical practice improvements, and climate change education. Emergency medicine practitioners can apply a climate lens to patient care, recognizing and addressing specific health impacts. By assessing vulnerabilities to climate-related disasters and integrating climate medicine into clinical practice education, providers can enhance their understanding and readiness to effectively address climaterelated health issues.

ABOUT THE AUTHOR

Dr. Bozsik is an emergency medicine resident at Cleveland Clinic Akron General. Outside of work, she enjoys running, hiking, and caring for her two rescue cats Toxoplasma and Henselae.

Multimodal Resuscitation: A New Paradigm in Sepsis Care or Just a Fad?

By Casey Carr, MD and Gregory P. Wu, MD, on behalf of the SAEM Critical Care Interest Group

A 66-year-old woman presents to the emergency department with a heart rate of 112, a respiratory rate of 32, an oxygen saturation of 88%, and a blood pressure of 70/30. She is quickly diagnosed with sepsis from pneumonia and is administered antibiotics and intravenous fluids. However, she remains hypotensive, prompting the initiation of a norepinephrine infusion. As the norepinephrine dose escalates, you wonder, “Is it time to start a second vasopressor?” But what if there is another approach to managing septic and vasodilatory shock?

Norepinephrine is the first-line vasopressor for sepsis-induced vasodilatory shock due to its strong evidentiary base and physiological rationale. However, doses exceeding

“Early addition of vasopressin reduces norepinephrine dose, the likelihood of developing tachydysrhythmia, and likely reduces mortality.”

1 mcg/kg/min are associated with worse survival rates. While there is considerable nuance in the discussion of high-dose norepinephrine, scientific support for non-catecholamine hemodynamic support is growing.

The principle of using medications that separately address the causes of vasoplegia — overproduction of nitric oxide, relative adrenal insufficiency,

and more — is appealing, though not strongly evidenced. This concept, often referred to as multimodal resuscitation, catecholamine-sparing resuscitation, or empiric vasopressor resuscitation, has gained popularity as supporting evidence mounts.

Vasopressin has traditionally been considered a second-line vasopressor for septic shock, after

randomized controlled trials showed no consistent benefit compared to norepinephrine. However, there appears to be an advantage to adding vasopressin alongside escalating norepinephrine doses. In fact, one observational trial found that delayed initiation of vasopressin was associated with increased odds of death. Early addition of vasopressin reduces norepinephrine dose, the likelihood of developing tachydysrhythmia, and likely reduces mortality. The author initiates a vasopressin infusion when the norepinephrine dose exceeds 0.1 mcg/ kg/min.

Nitric oxide inhibition has significant physiological appeal, as it addresses a core aspect of septic shock pathophysiology. Methylene blue, an inhibitor of nitric oxide synthase and guanylate cyclase, is one such agent. A randomized controlled trial showed that adding methylene blue in patients with sepsis and refractory vasodilatory shock reduced vasopressor dose, ICU length of stay, and hospital length of stay While methylene blue decreased the need for

norepinephrine, it did not significantly reduce mortality compared to routine care. The author initiates methylene blue when the norepinephrine dose exceeds 0.25 mcg/kg/min. Hydroxocobalamin has a similar effect through nitric oxide scavenging but is less well-studied in septic shock compared to methylene blue

Another tool in the catecholaminesparing regimen is glucocorticoids. Hydrocortisone is the best-studied, with mixed evidence regarding its addition in sepsis. However, the literature consistently shows that steroid use reduces the total dose of vasopressor therapy. The author initiates hydrocortisone when the norepinephrine dose exceeds 0.2 mcg/kg/min. Adding fludrocortisone at 50-100 mcg daily has been studied and retrospectively associated with improved survival compared to hydrocortisone alone, though the practice remains controversial

In conclusion, the practice of multimodal resuscitation in septic shock is a physiologically appealing strategy with low to moderate supporting

evidence. This strategy, also known as catecholamine-sparing resuscitation, represents a shift in the approach to sepsis-induced vasoplegia. Rather than relying on norepinephrine monotherapy, clinicians are beginning to incorporate noncatecholamine hemodynamic support early in the patient’s treatment.

ABOUT THE AUTHORS

Dr. Carr is an assistant professor of emergency medicine at the University of Florida–Jacksonville, where he practices as an emergency medicine intensivist.

Dr. Wu is an assistant professor of emergency medicine and internal medicine at Albany Medical College. He is an emergency physician and medical intensivist. He also is the clerkship director for Critical Care and the associate fellowship director for Resuscitation and Emergency Critical Care.

DIVERSITY, EQUITY, INCLUSION

Understanding Barriers in Pediatric Emergency Care Access for Communities of Color and Indigenous Peoples

By Zuag Paj and Maulik Lathiya, MBBS

In health care, children from communities of color and indigenous backgrounds often delay seeking medical care until their conditions become critical, requiring emergency attention. Despite medical advancements and the proliferation of health care facilities, systemic barriers and cultural factors obstruct timely access to care, leading to poorer health outcomes for these populations. Each delayed visit to the emergency room risks worsening an already precarious health condition. The reasons behind this phenomenon are multifaceted,

rooted in socioeconomic hardship, health care accessibility challenges, and cultural perceptions of illness.

Socioeconomic factors disproportionately burden communities of color and indigenous populations. Economic instability, lack of health insurance, and limited transportation access contribute to hesitancy in seeking timely medical attention. For many families, the decision to visit the emergency room involves not only medical considerations but also financial calculations, often resulting in delayed action until the situation becomes dire. Structural inequalities within the health care system exacerbate

the problem, with inadequate representation of diverse health care professionals, linguistic barriers, and cultural insensitivity creating alienation and distrust among marginalized communities, discouraging proactive engagement with health care services.

Cultural beliefs surrounding illness shape how individuals seek health care. Some cultural convictions and practices may exacerbate mistrust or skepticism of conventional medicine, leading families to avoid seeking medical care until conditions become severe. Traditional healing methods, passed down through generations, may still hold precedence over conventional

“Economic instability, lack of health insurance, and limited transportation access contribute to hesitancy in seeking timely medical attention.”

medicine, contributing to delays in treatment. Additionally, the responsibility of managing children’s medical needs typically lies with their caretakers or parents. Choices regarding pediatric health care are frequently shaped by ethical and political considerations, alongside the acknowledgment that children may lack the capacity to make such decisions due to their young age. Language and communication barriers, reliance on faith-based interventions due to religious beliefs, and cultural norms surrounding illness and health are among the obstacles that impede timely medical treatment, especially in emergent situations.

Limited health literacy, particularly prevalent in marginalized communities, hampers the ability to navigate the health care system and advocate for health needs effectively. Implementing health education programs geared toward empowering individuals — especially the younger population — with knowledge about preventative care, accessing health care services, and understanding insurance coverage is essential. These initiatives improve health literacy and encourage proactive health care utilization habits. Moreover, many underserved communities, especially those in rural or remote areas, face challenges accessing health care facilities due to limited transportation options and significant distances from medical centers. Investing in telemedicine and mobile health care units bridges this gap by delivering essential medical services directly to these underserved communities, ensuring equitable access to health care.

A multifaceted approach is necessary to improve access to primary care services for vulnerable populations, such as communities of color and indigenous peoples. Utilizing tactical measures is

imperative to dismantle the systemic barriers that hinder access to emergency care for children in marginalized communities. This includes investing in culturally competent health care providers, improving language access services, and fostering trust through interactive and meaningful community engagement initiatives. Furthermore, advocating for a tailored approach to early intervention that addresses the unique needs of these communities is crucial. This includes the integration of targeted outreach programs aimed at educating individuals on recognizing signs of medical emergencies. By understanding the root causes and enacting measures that cater to the distinctive needs of communities of color and indigenous peoples, timely access to medical care can be improved for their well-being and health.

ABOUT THE AUTHORS

Zuag Paj is a third-year medical student at the University of Minnesota Medical School, Twin Cities. She is public relations chair of the Global Health Student Advocacy Board and advocacy chair for Representation, Inclusivity, Support, & Empowerment at the University of Minnesota Medical School.

Dr. Lathiya is a research fellow in the Department of Neurology and Emergency Medicine at the University of Minnesota. He is an international graduate medical student, a U.S. emergency medicine residency applicant, and a member of the SAEM Wellness Committee and SAEM Membership Committee.

Training Residents to Effectively Care for Patients With Limited English Proficiency

By Onyoo Park, MD and Michael J. Zdradzinski, MD on behalf of the SAEM Education Committee

Introduction

As the U.S. population becomes more diverse, emergency department patients increasingly reflect that diversity. Emergency physicians are seeing more patients with limited English proficiency (LEP). These patients face disadvantages due to communication difficulties with providers, resulting in worse outcomes, unnecessary testing, increased emergency department (ED) utilization, and higher rates of loss to follow-up. Using medical interpreters has been shown to improve patient outcomes and satisfaction. Despite this, studies indicate low interpreter utilization and continued use of untrained, self-

identified bilingual speakers, leading to persistent communication errors and differential outcomes.

Importance of Formal Education

The health disparities experienced by LEP patients are complex, involving individual, interpersonal, and systemic factors. One approach to addressing these disparities is through formal training in pre-graduate and postgraduate medical education. Many medical schools and residency programs lack formal training in interpreter use, relying instead on informal “on-the-job” learning. This informal training can perpetuate biases

and poor communication habits, placing the burden on trainees to acquire these skills independently, leading to significant variation in their knowledge and abilities. Formal training has been shown to reduce frustration when working with LEP patients and increase knowledge and self-efficacy in using medical interpreters. Formal training, especially before clinical years, supports learners in developing lifelong, effective communication habits.

Curriculum Design

Several curricula have been developed to train medical students and residents in using medical interpreters. While methods may vary based on specific

“Formal training has been shown to reduce frustration when working with LEP patients and increase knowledge and self-efficacy in using medical interpreters.”

school or program needs, successful interpreter curricula share key components:

Collaboration With Interpreter Services

Medical interpreters should be integrated into the medical care team. They facilitate communication between providers and LEP patients and help navigate cultural barriers that may affect understanding and care. Curriculum design and implementation should involve interpreters for their expertise and feedback on learners’ communication skills and interpreter use.

Time-Efficiency

Trainees and medical students have demanding schedules. Training must be time-efficient and fit within existing didactic schedules and curricula.

Practicality

Learners are inundated with a wide range of didactic content; thus, the proposed curriculum must be highly applicable and clearly beneficial to learners’ current practice for it to be of value.

Hands-on Practice

A hands-on practice component is essential, whether through roleplaying, Objective Structured Clinical Examinations (OSCEs), or simulations, as working with an interpreter is a communication skill.

Curriculum Components

Below is a list of important curriculum components, with examples of topics for each:

Definitions and Commonly Mistaken Terms

Start with definitions such as:

• Interpreter vs. translator

• Consecutive vs. simultaneous interpretation

• Qualified interpreter vs. Ad-hoc vs. approved bilingual provider

Interpreter Scope

Discuss the training and roles of interpreters to understand their workflow, strengths, and limitations.

Laws and Hospital Policies

Educate residents and medical students

about the legal requirements for using interpreters, mandated under Title VI of the Civil Rights Act and affirmed by the Affordable Care Act. Discuss statespecific laws and hospital policies, including available interpretation resources and how to access them.

Different Modalities of Interpretation

Cover all available interpretation mediums, including new technologies like video interpreting.

Proper Techniques

Demonstrate proper techniques for using an interpreter, such as the following examples:

• Pre-interview discussion with the interpreter to explain the context

• Proper positioning

• Speaking in short, clear sentences

• Speaking directly to the patient in first person

Troubleshooting Communication Failures

Provide content for honing communication skills to be more timeefficient and effective when working with an interpreter.

Feedback

Include real-time feedback from physician educators, interpreters, and standardized patients to assess and improve learners’ communication skills.

Conclusion

Proper use of medical interpreters is a complex communication skill requiring navigation of linguistic and cultural differences while working as a team with the interpreter. The medical education community must intentionally provide training in interpreter use to address the significant consequences of communication failures in highstakes environments like the emergency department. A formal curriculum underscores the importance of addressing disparities experienced by LEP patients.

ABOUT THE AUTHORS

Dr. Park is a first-year emergency resident at Boston Medical Center in Boston, Massachusetts. She is interested in improving access and care of immigrant patients in the emergency department.

Dr. Zdradzinski is an assistant professor at Emory University School of Medicine. One of his primary interests is in curricular development, and he serves in several educational and physician wellness leadership roles.

Understanding GDF15's Role in Hypothermia During Cosmetic Procedures in Emergency Settings

By Kingsley Essel Arthur

Cosmetic surgery has surged in popularity, offering individuals avenues for aesthetic enhancement. However, beneath the allure of beauty lurks a concealed peril — fluctuations in Growth Differentiation Factor 15 (GDF15) levels. This pivotal protein, renowned for its role in heat generation, poses a significant risk of hypothermia during surgical procedures. Understanding the interplay between GDF15, cosmetic surgery, and body temperature regulation is paramount for ensuring favorable surgical outcomes.

GDF15: The Guardian of Body Heat

Functioning as a custodian of our internal furnace, GDF15 influences energy utilization and inflammatory

responses. Studies elucidate its crucial role in regulating brown and beige fat cells, pivotal for heat production to maintain body warmth.

Disruption of GDF15 Balance by Cosmetic Surgery

Cosmetic procedures have the potential to disrupt GDF15 levels through various means. For instance, diabetic patients prescribed metformin may experience altered GDF15 expression due to the drug’s suppressive effects. Furthermore, the utilization of nonsteroidal antiinflammatory drugs (NSAIDs) before, during, or after surgery can impede the NAG-1 pathway (an alternative denomination for GDF15), potentially leading to complications

It is also interesting to note that current studies probe the correlation

between GDF15 levels and heart surgery outcomes, hinting at its potential as a prognostic marker. Understanding the ramifications of GDF15 alterations on cosmetic surgery patients, especially those with body dysmorphic disorder or perfectionism, is crucial for optimizing patient care and outcomes (Lai et al., 2010; Heyes, 2009).

Maintaining Normal Body Temperature is Imperative

The American Society of Plastic Surgeons (ASPS) underscores the significance of maintaining normothermia during surgery. Their guidelines advocate for active warming strategies to stave off hypothermia and its adverse effects on patient outcomes, such as heightened infections and impaired wound healing.

“Functioning as a custodian of our internal furnace, GDF15 influences energy utilization and inflammatory responses, playing a crucial role in regulating brown and beige fat cells pivotal for heat production to maintain body warmth.”

GDF15 Assessment: A Promising Tool

The potential influence of GDF15 on thermoregulation mandates a comprehensive approach in emergency medicine. Assessing GDF15 levels in patients with a history of cosmetic procedures, particularly those with risk factors like diabetes or NSAID use, could furnish invaluable insights for emergency physicians managing potential hypothermia.

GDF15: A Potential Gamechanger in Emergency Medicine

Incorporating GDF15 assessment into the perioperative care plan for patients undergoing cosmetic surgery holds promise as a game-changer. By discerning a patient’s GDF15 levels, emergency medicine teams can anticipate and manage the risk of hypothermia more effectively, thereby optimizing patient care and ensuring smoother recovery.

The Road Ahead: Unveiling the Full Potential

Further research is indispensable to fully comprehend the role of GDF15 in cosmetic surgery outcomes, its impact on patient safety and recovery, and the potential utility of GDF15 as a biomarker

during surgery. Additionally, standardizing GDF15 measurement protocols will be pivotal for its efficacious clinical application.

Conclusion

While cosmetic surgery offers avenues for aesthetic enhancement, the potential disruption of GDF15 and the ensuing risk of hypothermia necessitate cautious consideration. By delving deeper into the connection between GDF15 and cosmetic surgery, we can mitigate these potential risks and ensure a safer journey for individuals seeking cosmetic enhancements.

ABOUT THE AUTHOR

Kingsley Essel Arthur is a pharmacist and graduate student at Kwame Nkrumah University of Science and Technology, Ghana. Specializing in Pharmacology and Advanced Toxicology, his focus on post-cosmetic surgery complications fuels his passion for Emergency Medicine. He contributes actively as a member of Academic Emergency Medicine Pharmacists (AEMP) membership committee. @kofiessel_35

“The American Society of Plastic Surgeons underscores the significance of maintaining normothermia during surgery, advocating for active warming strategies to stave off hypothermia and its adverse effects on patient outcomes, such as heightened infections and impaired wound healing.”

VOICES & VIEWPOINTS

EMTALA’s “Unborn Child” Clause: What to Know as the U.S. Supreme Court Rules in Idaho and Moyle, et al. v. United States

By Joel Rowe, MD

The U.S. Supreme Court heard oral arguments in April in Idaho and Moyle, et al. v. United States, and a decision is either forthcoming by the time of this publication or has just been announced. This precedent-setting case examines whether emergency abortions are protected under the Emergency Medicine Treatment and Active Labor Act (EMTALA) in states where trigger laws otherwise make them illegal outside the context of maternal medical extremis. The case is likely to have a profound impact on reproductive emergency medicine practice for large swaths of the country. Understanding what’s at stake requires a brief summary

of how this case came before the court, as well as central features of the Idaho law and its resulting friction with EMTALA. Differing interpretations of the term “unborn child” are central to the debate and may impact how the Supreme Court’s decision affects emergency medicine clinicians.

State of the Debate

On June 24, 2022 the U.S. Supreme Court overturned Roe v. Wade in its decision on Dobbs v. Jackson Women’s Health Organization. The ruling swiftly generated a heated debate over the abortion-prohibitive “trigger laws” that then went into immediate effect in over a dozen states. Whether (and to what extent) these trigger laws conflict with the legal mandates for emergency

medical treatment outlined in EMTALA is central to the case before the court.

Idaho Law

Besides extremely narrow exceptions for rape or incest, Idaho’s Defense of Life Act only permits abortions “deemed necessary to prevent the death of the pregnant woman.” Abortion is otherwise a felony, punishable by 2-5 years in prison, as well as suspension/revocation of medical licensure. The law defines abortion as, “the use of any means to terminate the pregnancy of a woman with knowledge that the termination will, with reasonable likelihood, cause the death of the unborn child.” Importantly, “unborn child” is defined in Idaho law as “an individual organism of the species homo sapiens from fertilization until live

“Emergency providers in many states will continue to be faced with such decisions if the court rules in favor of the Idaho law.”

birth.” A specific exception is made for ectopic pregnancies, but not for other non-viable conditions.

EMTALA

The legal bedrock of modern emergency medicine practice, EMTALA, ensures that all patients who present to emergency departments receive a screening medical examination for emergency conditions, and that these conditions are treated and stabilized (prior to transfer for definitive management, if necessary).

EMTALA defines a medical condition as an emergency if, “the absence of immediate medical attention could reasonably be expected to result in placing the health of the individual (or, with respect to a pregnant woman, the health of the woman or her unborn child) in serious jeopardy.” Under EMTALA, such conditions must be stabilized before a patient’s condition worsens towards

clinical decompensation. By contrast, the Idaho statute has been interpreted as requiring the woman’s life to already be in jeopardy before an abortion can be performed to save the life of the mother.

Why This Case?

Shortly after the decision in Dobbs v. Jackson and the enactment of abortion trigger laws that followed, the Biden administration issued a letter via the Department of Health and Human Services that reinforced the obligation of emergency departments to comply with EMTALA and the intention of the federal government to exact penalties to hospitals and individual clinicians for failures to comply. These include tens to hundreds of thousands of dollars of punitive fees, in addition to the potential termination of a hospital’s provider agreement with Medicaid and Medicare (which for the majority of institutions would result in financial insolvency).

The Biden administration went on to bring a formal suit against the state of Idaho (and Texas) for ostensibly violating the statutes set forth by EMTALA by passing their abortion trigger laws. In August, 2022, a district court in Idaho ruled in favor of the Biden administration. An order to enjoin (prohibit) enforcement of Idaho’s “Defense of Life Act” was subsequently administered, effectively banning the criminal prosecution of providers in Idaho who perform abortions deemed necessary to avoid, “placing the health of a pregnant patient in serious jeopardy,” or where, “serious impairment or dysfunction to the bodily functions of the pregnant patient” may arise. Whether this order blocking the “Defense of Life Act” should prevail is presently at issue before the US Supreme Court.

continued from Page 29

Legal Conflict

The degree to which a pregnant patient must be clinically decompensated in order for an abortion to be permissible in Idaho and other states with similarly worded laws may differ greatly from the point at which a clinician might believe that a medically stabilizing abortion is legally indicated vis a vis EMTALA. While EMTALA does not mention any specific modality of emergency medical treatment, abortion remains the stabilizing treatment for a multitude of serious pregnancy complications, including some cases of preterm premature rupture of membranes, maternal hemorrhage or infection (due to spontaneous or elective pregnancy termination), and preterm hypertensive emergencies. Once such a condition is identified, EMTALA mandates that a provider take action before a patient’s condition worsens, while Idaho law mandates just the opposite: that a clinician acts only to save their patient from death.

Unborn Child Clause

The legal appeals that have brought the case to the Supreme Court additionally cite the “unborn child” clause in EMTALA as conferring equal protection to both the presenting pregnant mother as to the fetus. As outlined above, this phrase has been interpreted in states like Idaho as applicable to a gestating fetus at all stages of development. As some have argued, this might problematize the performance of an abortion–even a medically stabilizing one for the mother–if doing so runs counter to the potential interests of the gestating fetus. However, as complications of pregnancy that are sufficiently severe as to require an abortion for medical stabilization often inherently render the fetus non-viable, this raises questions about the appropriate applications of terms like “abortion” and “unborn child” in such cases, just as the termination of an ectopic pregnancy falls outside of the definition of an abortion as outlined by the Centers for Disease Control.

Historical Context

Whether lawmakers in the 1980s in fact had the protection of a newly fertilized embryo in mind when EMTALA and its “unborn child” clause were constructed has been called into question. In addition to mandating the provision of emergency medical care for all presenting patients and prohibiting the transfer medically unstable

uninsured patients from private facilities to public ones, EMTALA was originally intended to stymie the dangerous refusal of labor and delivery care that was common in emergency department practice through the 1970-1980s. Prior to EMTALA, preceding case law allowed for patients to be turned away from care based on hospital policies. Famously, in Campbell v. Mincey, a patient in active labor was turned away from care and forced to deliver in a parking lot. In such egregious cases, patients were also denied subsequent admission for post-natal care.

Impact for Emergency Clinicians Patient Outcomes

Examples abound of patients (in Idaho and elsewhere) for which the withholding of emergency abortion treatment has resulted in demonstrable harm and delays in care. During oral arguments to the US Supreme Court in April, lawyers for the federal government cited examples of women transferred via helicopter to surrounding states to receive stabilizing medical treatment. Justice Elena Kagan commented, “It can’t be the right standard of care to force someone onto a helicopter.” Emergency providers in many states will continue to be faced with such decisions if the court rules in favor of the Idaho law.

Scope of Practice

The care environment for OB/GYN providers in states like Idaho has caused many doctors to flee the state. A resulting question remains for emergency doctors: who will be left to stabilize sick pregnant patients, and how might a consultation desert impact emergency medicine’s scope of practice in reproductive care in these areas?

The views and opinions expressed in this article are those of the author and do not necessarily reflect the official policies, positions, opinions, or views of the Society for Academic Emergency Medicine or its members.

ABOUT THE AUTHOR

Dr. Rowe is a clinical instructor in the Department of Emergency Medicine at the Icahn School of Medicine at Mount Sinai and master’s degree candidate in the Mount Sinai/Clarkson University bioethics program. He has previously published work in bioethics and emergency reproductive care in The Atlantic magazine and Academic Emergency Medicine journal. @jrowemd

Best Practices for Research Consent in Persons with Cognitive Impairment and Their Care Partners in ED Settings

By James Galske; Tonya Chera; and Cameron Gettel MD, MHS, on behalf of the SAEM Academy of Geriatric Emergency Medicine

Introduction

More than 6.5 million older adults in the United States are living with dementia, with projections nearly doubling by 2050. Engaging persons living with dementia (PLWD) in research is essential for providing person-centered, evidence-based care tailored to patients' needs and desired outcomes. Recruiting PLWD and their care partners for research studies in the emergency department (ED) poses significant challenges for investigators. In addition to the acute and chronic illnesses that brought the PLWD to the ED, their cognitive impairment may also affect their decisional capacity, complicating

their participation in research.

Conducting research with PLWD may require adjustments to enrollment materials, additional capacity measuring tools, and possibly the involvement of legally authorized representatives. Based on our experience enrolling PLWD in our research, we have developed best practices for engaging this population in research studies.

Tailoring Enrollment Materials

For studies involving both PLWD and their care partners as dyads, it is ideal to create two distinct information sheets. Simplifying language, using visual aids, and structuring information to highlight the most crucial details (e.g., roles,

risks, benefits) can contribute to a better understanding of the study. Additionally, tailoring recruitment guides and scripts for scenarios in which PLWD are unaccompanied in the ED is essential to providing sufficient instruction without the aid of care partners.

Contextual Gathering Before Approaching Patients

The patient’s care team and chart can provide helpful contextual information for research staff to adjust their enrollment procedures and determine the best time to approach the patient. Care team members can provide insights into the PLWD's ability to communicate, which may not be fully

“For studies involving both persons living with dementia and their care partners as dyads, it is ideal to create two distinct information sheets.”

captured in the chart, and offer a general timeframe of the patient’s course in the ED. Approaching patients while they are waiting for imaging scans, lab testing, or results can prevent disruptions and repetition during the enrollment process. (Figure 1) The chart can also indicate if the patient is accompanied by a visitor, the visitor’s relationship to the PLWD, and whether the visitor can provide consent by proxy when applicable.

Managing the Consent Process

One of the primary ethical concerns of involving PLWD in research is obtaining informed consent. Therefore, it is crucial to carefully select questions or an assessment tool that is both valid and minimizes the burden on respondents. The consent process begins with explaining the research study and answering any questions the PLWD or their care partner may have before assessing the patient’s ability to consent. Tools like the University of California, San Diego Brief Assessment of Capacity to Consent (UBACC) can assess decisional capacity. Key factors include ensuring the older adult can understand the study information, recognize how the study will impact them, and make an unbiased, consistent choice about participation.

It is essential to include PLWD at all stages (mild, moderate, and severe) in research, as their concerns, experiences, and care needs may differ at each stage. In situations where patients are unable to provide consent, research staff can assess assent (verbal yes, head nod, or similar indication of agreement) and obtain proxy consent from a care partner, such as a legally authorized representative or surrogate decisionmaker, reflecting the patient’s values and preferences for research participation. However, patients lacking capacity should

still be included in discussions about study information and involvement.

Cognitive Assessment

Approximately 1 out of 10 older adults in the emergency department (ED) have delirium. Although delirium is a type of cognitive impairment, it involves acute changes in cognition, unlike the chronic decline seen in dementia. Using screening tools like the 4-AT or AD8 can help identify participants with dementia more accurately. Since dementia is often underdiagnosed, particularly among ethnic and racial minority groups, incorporating cognitive testing into recruitment protocols can help include those with undiagnosed cognitive impairment, resulting in a more diverse study sample.

Communication With Care Partners and Patients

As a research subject, the care partner can guide research staff through the recruitment process. For instance, the care partner can rephrase questions to improve the PLWD’s understanding. Additionally, the care partner may have preferences regarding which questions or data collection methods (procedures, tests, etc.) are presented to the PLWD. Even if the patient is willing, the care partner might disagree. Therefore, providing a brief description of each instrument’s content, length, and purpose, and confirming with both

continued on Page 35

Figure 1

“The consent process begins with explaining the research study and answering any questions the persons living with dementia or their care partner may have before assessing the patient’s ability to consent.”

GERIATRIC EM

continued from Page 33

the patient and care partner before proceeding, allows care partners to express their preferences.

Utilizing Resources for Alternative Recruitment

One of the main challenges of conducting research with PLWD and their care partners in the ED is enrolling enough participants to meet study and grant deadlines. However, adapting enrollment procedures and identifying alternative recruitment streams can help increase enrollment rates. Collaborating with multidisciplinary team members can help identify prospective subjects and facilitate smoother introductions to the study through a "warm handoff" from clinicians. For example, our research staff have benefited from meeting with geriatric advanced practice providers after their consultations with PLWD and care partners, as well as follow-up nurses who contact patients after an ED visit and can propose the study to eligible individuals.

Additionally, electronic reports generated from the electronic health record can be automatically filtered with inclusion and exclusion criteria to identify patients, even when research staff are not present in the ED. This method helps expand outreach to participants after they leave the ED and provides a more accurate count of potential subjects, aiding in the establishment of recruitment goals.

Maintaining a Positive Research Experience

Research staff and investigators should always prioritize ensuring that all subjects, including prospective ones, have positive experiences with the study and interactions with the study team. Advancing research among PLWD and their care partners is crucial, and establishing trust can encourage these communities to participate in future studies. Sometimes, care partners and PLWD may express interest in

participating but decline due to timing, stating it’s a “bad time,” there are “too many things going on,” or they “need to care for the patient.” If the study allows and the context is appropriate, research staff can offer flexibility by leaving contact information with patients or care partners to follow up at a more suitable time.

Conclusion

In summary, it is crucial to include patients living with cognitive impairment or dementia in research to develop evidencebased, goal-concordant care. Obtaining informed consent is a critical aspect of conducting research with PLWD, achievable through screening tools such as UBACC, 4AT, and AD8. Collaboration with the patients themselves, their family members, and their care team can enhance the recruitment process in the ED. Future work involving all stages of dementia or cognitive impairment will further improve the care provided to PLWD in the future.

ABOUT THE AUTHORS

Dr. Gettel is an assistant professor in the department of emergency medicine at Yale School of Medicine, a clinical investigator at the Yale Center for Outcomes Research and Evaluation, and the co-director of the Yale Emergency Scholars (YES) Fellowship Program. @CameronGettel

James Galske is currently a second-year medical student at the University of Connecticut School of Medicine.

Read More, Learn More

• Optimal Emergency Department Care Practices for Persons Living With Dementia: A Scoping Review

• Challenges in Involving People with Dementia as Study Participants in Research on Care and Services

• Tailoring Research Recruitment for Acute Care Settings Recommendations from People with Dementia and their Caregivers

• A New Brief Instrument for Assessing Decisional Capacity for Clinical Research

• The Delirium Screening Tool 4AT in Routine Clinical Practice: Prediction of Mortality, Sensitivity, and Specificity

Tonya Chera is a student in the postbaccalaureate pre-medical program at Temple University.

• The Six-Item Screener and AD8 for the Detection of Cognitive Impairment in Geriatric Emergency Department Patients

Navigating Emerging Threats of Old Diseases: Lessons from Emergency Medicine Practice in Bolivia

By Eduardo Saadi Neto; Sofia Susana Aliss Sabath; and Rebecca Leff, MD on behalf of the SAEM Global Emergency Medicine Academy

A 63-year-old man with a history of alcoholic cirrhosis presented to the emergency department resuscitation bay after a syncopal episode. His initial blood pressure was 80/50 mm Hg, and his heart rate was 110 bpm. He was obtunded. The family reported a 48hour progression of illness, beginning with fever, myalgias, and arthralgias. After staying home and self-medicating with acetaminophen and ibuprofen, he developed melena and syncope, prompting the family to call EMS. He received a fluid bolus, and basic labs revealed a hemoglobin of 10.2 g/dL and platelets of 88,000/μL. He was started on epinephrine and transferred to the intensive care unit. His NS1 antigen test

for dengue returned positive.

A 78-year-old man with a history of Chagas disease presented to the emergency department with syncope. He reported nausea and lightheadedness before losing consciousness. The family reported the initial event lasted approximately 20-30 seconds, followed by two subsequent events on the way to the hospital. He arrived with a heart rate of 38 bpm. An ECG showed a right bundle branch block (RBBB) and a third-degree AV nodal block, characteristic of Chagasrelated heart disease. Cardiology was consulted, and he was urgently taken to the operating room for pacemaker placement.

In the absence of an established preexisting diagnosis, “kissing bugs” and Aedes mosquito-borne illnesses may not be on the differential diagnosis for emergency clinicians evaluating patients in U.S. emergency departments. However, we may need to change our mindset. Cases of dengue are surging globally, even in regions once considered once off-limits to Aedes aegypti and Aedes albopictus. In 2023, the Centers for Disease Control and Prevention reported the highest number of travel-associated dengue cases since the disease became reportable in the United States in 2010,

“In 2023, the Centers for Disease Control and Prevention reported the highest number of travel-associated dengue cases since the disease became reportable in the United States in 2010, reflecting increasing trends internationally.”

reflecting increasing trends internationally. Additionally, local transmission increased, with several hundred cases reported collectively in California, Texas, Florida, Arizona, and Hawaii. Similarly, Chagas disease is becoming a rising public health threat in the U.S., ranking seventh highest in prevalence of Chagas infections in the Western Hemisphere. It is estimated that more than 300,000 individuals in the U.S. are infected with Chagas, with the highest prevalence in regions heavily populated by Latin American immigrants and asylum seekers. Of these, roughly 30,000 to 45,000 are expected to develop Chagas heart disease.

While increasing numbers of unfamiliar illnesses may challenge emergency medicine physicians in North America,

these illnesses are well-known to our colleagues in Bolivia. Bolivia has the highest prevalence of Chagas globally (6.1%), with the disease endemic in 60% of the country due to vectors present in seven of the nine states. It is estimated that 607,186 individuals in Bolivia have Chagas disease, with an additional 586,434 people at risk and 8,700 new cases annually. Dengue is also highly prevalent in Bolivia, with cases increasing from 15,000 in 2022 to 156,774 cases in 2023. In 2023, Bolivia ranked fifth in South America for severe dengue cases, with 640 reported. Thus far in 2024, Bolivia has reported over 25,000 dengue cases, with the highest prevalence in Santa Cruz, Cochabamba, and La Paz The latter two regions indicate the

adaptation of the vector to colder and higher-altitude areas, with altitudes of 2,558 and 3,640 meters, respectively.

Dengue Overview and Management: Insights and Guidelines

Dengue is an acute febrile illness caused by infection from one of four subtypes of a single-stranded RNA Flavivirus (DENV1–4). Transmission typically occurs through the bite of infected Aedes aegypti and Aedes albopictus mosquitoes. Dengue is endemic in over 100 countries worldwide, with high risk in Central and South America, East Africa, and Southeast Asia.

Clinical suspicion for dengue is challenging due to its varying and unpredictable clinical course, with most cases lasting 7-10 days. Symptoms usually develop after an incubation period of about 5-7 days. Most patients experience a 72-hour febrile phase followed by a recovery phase. However, some, especially those with a second serotype infection, may progress to a critical phase on days 3-7 of illness, characterized by systemic vascular leak syndrome and shock lasting 24-48 hours The febrile phase typically occurs over the first 72 hours with nonspecific symptoms such as fever, headache, myalgias, anorexia, nausea, vomiting, and retro-orbital pain.

The World Health Organization (WHO) has identified criteria for early case identification (first 72 hours) including fever accompanied by at least two of the following signs and symptoms: rash, arthralgias, nausea/vomiting, positive tourniquet test, and/or leukopenia. To perform the tourniquet test, inflate a blood pressure cuff to 80 mm Hg for 5 minutes and examine the arm for petechiae (10 petechiae per square inch is considered a positive test). These criteria have been prospectively validated with high sensitivity (95%) but low specificity (<40%).

The critical phase often correlates with defervescence followed by increased vascular permeability, with third spacing into the pleural space and abdomen causing rising hematocrit. A common mistake is to discharge the patient whose fever is resolving without a follow-up plan or search for dengue warning signs, as patients may return in severe shock. Warning signs include abdominal pain/tenderness, persistent vomiting, clinical fluid accumulation (ascites, pleural effusion), mucosal bleeding, lethargy, restlessness, postural hypotension, liver enlargement >2 cm, and progressive increase in hematocrit. Narrow pulse pressure may indicate compensated shock. These patients, and all pregnant patients, should be admitted for observation. Severe criteria include shock or respiratory distress due to plasma leakage, severe bleeding, and severe organ involvement (myocarditis, hepatitis, encephalitis, acute kidney injury). Liver function tests may be GLOBAL

“Emergency medicine in Bolivia was recognized as a specialty in 2004 and is still growing, with multiple recent successful conferences in Cochabamba and Santa Cruz in collaboration with the Mayo Clinic, Mano a Mano Bolivia, and Universidad del Valle.”

elevated due to hepatocellular necrosis Thrombocytopenia increases the risk of hemorrhage, resulting in hematemesis, melena, or menorrhagia. Confirmatory testing for dengue is unlikely to return in the emergency department but should be obtained. During the febrile phase, viral PCR or antigen testing can be used. However, in the critical phase after viremia wanes, IgM testing should be obtained. Suspected cases without warning signs that are discharged need close follow-up. Management of dengue is supportive with judicious fluid administration. Non-steroidal anti-inflammatory drugs (NSAIDs) are contraindicated. Hematocrit is often used as a benchmark to help determine the need for further fluid resuscitation if elevated and the need for blood transfusion if decreasing. Electrolyte levels should also be monitored hyponatrmia may be present While the use of crystalloids has been proven safe in severe dengue, many recommend the use of colloid bolus for pulse pressure <10 mm Hg, though this may affect coagulation.

Chagas Disease: An Overview

Chagas disease is caused by the protozoan parasite Trypanosoma cruzi, transmitted by triatomine insects through their stool, which is rubbed into bite wounds or mucous membranes. There are over 130 species of triatomine insects in the Americas, several of which can transmit T. cruzi. In Bolivia, the primary vector is Triatoma insects Poor-quality housing made of adobe is a significant risk factor for infection in rural settings, usually during childhood Approximately 70-80% of infected individuals will remain asymptomatic throughout their lives In Santa Cruz, Bolivia, T. cruzi infection is detected in 15-20% of asymptomatic pregnant women at the time of delivery Chagas is the most common cause of nonischemic cardiomyopathy in Latin America.

Acute infection, occurring 1-2 weeks after inoculation, is most commonly asymptomatic but may present with skin lesions called chagomas at the infected site, unilateral periorbital swelling at the inoculation site (Romaña’s sign), fever, adenopathy, myocarditis, and hepatosplenomegaly. Benznidazole (first-line therapy) and nifurtimox are the only drugs with proven efficacy against Chagas disease and are recommended in all cases of acute infection. However, use in the United States requires consultation with the CDC

Chronic disease causes disordered esophageal or colonic motility, leading to achalasia or severe megaesophagus, and Chagas heart disease, characterized by cardiomegaly, ventricular wall thinning, pericardial effusion, regional wall motion abnormalities, and ventricular aneurysms. Patients typically present with dyspnea, palpitations, syncope, chest pain, ventricular arrhythmias, sinus node dysfunction, and apical aneurysms. Right bundle branch block, with or without left anterior hemiblock, typically marks the transition to chronic cardiac Chagas disease. As Chagas disease most commonly causes conduction interference below the bundle of His, the use of adenosine for acute arrhythmias is unlikely to be effective. Sudden cardiac death, from ventricular arrhythmias or complete AV nodal block, is the leading cause of death in patients with Chagas disease, often precipitated by exercise. The definitive treatment is a permanent pacemaker Intracardiac mural thrombosis should be considered in these patients as up to 50% of patients with cardiomyopathy had evidence of embolic events in autopsy studies. During the chronic phase, management with trypanocidal therapy still varies in practice but is typically indicated in children, adolescents, recent infections, and women of childbearing age.

Emergency medicine in Bolivia was recognized as a specialty in 2004 and is still growing, with multiple recent successful conferences in Cochabamba and Santa Cruz in collaboration with the Mayo Clinic, Mano a Mano Bolivia, and Universidad del Valle. Through shared collaboration with emergency medicine physicians and trainees worldwide, we grow as a specialty and improve the care we give to our patients.

ABOUT THE AUTHORS

Eduardo Saadi Neto is in his final year of medical school at Universidad Privada Del Valle in Bolivia and completed his intern year at Hospital Univalle. He has participated in his school's research program. Eduardo is passionate about pursuing a future in emergency medicine and served as an interpreter at emergency medicine conferences in Bolivia.

Sofia Susana Aliss Sabath is in her final year of medical school at Universidad Privada del Valle in Bolivia, participating in research throughout her medical training. She is an advocate for women in medicine and recently started an initiative called Mujeres en Medicina to support women pursuing careers in medicine. She is planning to pursue a career in emergency medicine.

Dr. Leff is an emergency medicine resident at the Mayo Clinic and incoming pediatric emergency medicine and global health fellow at Boston Children’s. She co-chairs the pediatrics and humanitarian sections of SAEM GEMA. She has presented at several emergency medicine conferences in Bolivia and studies pediatric emergency medicine development in low- and middle-income countries.

Strengthening Pediatric Emergency Care: Implementing Pediatric Advanced Life Support Training in Nepal

By Morgan Bowling, DO; Samantha Langer, MD; and Christine Saracino, DO

Medical literature supports that much of childhood morbidity and mortality is preventable or reversible with proper care, highlighting the critical importance of the first 24 hours after hospital presentation. Despite this evidence, pediatric emergency medicine (PEM) remains underdeveloped in low- and middle-income countries. Certifying a group of providers in Pediatric Advanced Life support (PALS), the gold standard for assessing and treating critically ill pediatric patients, is an important initiative to fundamentally improve pediatric emergency skills and training worldwide.

Since 2019, the Arnhold Institute for Global Health at the Icahn School

of Medicine at Mount Sinai, Dhulikhel Hospital in Dhulikhel, Nepal, and Kathmandu University of Medical Sciences have collaborated to advance activities improving the health and well-being of vulnerable people in Nepal and worldwide. Together, they aim to replicate the Academic Model Providing Access to Healthcare (AMPATH).

Dhulikhel Hospital is a teaching hospital in the Bagmati province of Nepal, approximately 30 kilometers from Kathmandu. Each month, more than 200 pediatric patients are treated in the emergency department, presenting with a wide range of acute and chronic issues, including neonatal concerns, respiratory distress, seizures, trauma,

and poisonings. Compared to patients in U.S. emergency departments, Dhulikhel Hospital patients have significantly higher acuity. Dhulikhel Hospital has a 90% admission rate, with more than 40% of children requiring specialized care in either the pediatric intensive care unit (PICU) or high dependency unit (HDU). None of the providers at Dhulikhel Hospital previously held PALS certification.

In 2023, our team received a grant as part of AMPATH Nepal’s pilot program to strengthen collaboration between Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, Dhulikhel Hospital, and Kathmandu University of Medical Sciences,

Dr. Samantha Langer facilitating discussion during PALS course

offering opportunities for future iterations and continued collaboration. A key component of our project was certifying a pilot group of local providers at Dhulikhel Hospital in PALS. Based on our work in Nepal, the following steps are required to bring this essential training to a lowresource international setting:

Identify a PALS instructor. At least one team member must be a certified PALS instructor. The number of instructors determines the quantity of participants that can be trained in a session.

Communicate with the American Heart Association (AHA).

To ensure quality control and adherence to AHA guidelines, notify an AHA representative early to register your international setting. Certain additional administrative steps may be required, such as confirming payment for course materials (e.g., provider manuals, provider cards) and documenting the course through pictures.

Conduct a needs assessment. The team must determine what equipment is needed versus what is available locally for successful completion of the PALS course (e.g., CPR feedback device, intubatable mannikin, intraosseous trainer).

Procure necessary equipment. Basic Life Support (BLS) and Advanced Cardiac Life Support (ACLS) equipment may be available in the local facility. Remaining gaps can be donated, borrowed, or purchased specifically for the course. Our team used grant funds to purchase necessary equipment and then donated them to Dhulikhel Hospital for future trainings.

Identify participants.

In collaboration with the local team, determine who would most benefit from the course. Our team elected to include interns, medical officers, and residents from the departments of general practice/ emergency medicine and pediatrics.

Conduct the PALS course. Before starting the PALS course, participants must take and pass a free online pretest.

The PALS course combines educational videos with skills stations. In areas with unreliable Wi-Fi, it is recommended to download required

course videos in advance. It's also crucial to develop a clear lesson plan, especially with multiple instructors. For efficient logistics, consider setting up skills stations in separate rooms so that the next set of videos can be loaded while participants practice skills on procedural trainers.

Participants are required to pass a final exam with a score of 84% or higher. It's important that students have an opportunity to review any questions they missed and, if necessary, take a second version of the exam to achieve a passing score.

Distribute PALS cards.

Upon successful completion of the course and the final exam, students will receive their PALS cards by email.

Ensure program sustainability. PALS certification expires every 2 years. It is critical to train and certify a local PALS instructor to ensure continuity for future trainings and recertifications.

PALS is at the cornerstone of pediatric emergency medicine. Certifying a pilot group of providers in PALS at Dhulikhel Hospital is an important step in strengthening the hospital’s ability to care for acutely ill and injured children. Expanding PEM’s influence is essential, and we encourage other teams to consider teaching these certification courses in low-resource settings, both locally and globally.

In Nepal, medical education differs from that in the United States. Medical school lasts 5 years, followed by a

1-year internship. After passing a general licensing exam, candidates work as medical officers for 1-2 years before taking an additional board exam. Following board certification, they can apply to and complete a specialtyspecific 3-year residency program.

ABOUT THE AUTHORS

Dr. Bowling is an assistant professor of emergency medicine and pediatrics at the Icahn School of Medicine at Mount Sinai and a pediatric emergency medicine attending. Before graduating from the West Virginia School of Osteopathic Medicine, Dr. Bowling taught first grade in Baltimore City through Teach For America.

Dr. Langer is a first-year pediatric emergency medicine fellow in the department of emergency medicine at Mount Sinai in New York City. She completed her pediatric residency at NewYorkPresbyterian/Weill Cornell Medical College in June 2023. Dr. Langer has an interest in global health, simulation, and medical education.

Dr. Saracino is an assistant professor of emergency medicine and pediatrics, as well as simulation faculty at the Icahn School of Medicine at Mount Sinai. She completed a pediatrics residency and chief residency, as well as fellowships in both pediatric emergency medicine and simulation at Maimonides Medical Center.

Dr. Christine Saracino providing CPR feedback during PALS course

Drs. Morgan Bowling, Chrisitne Saracino, Rose House and Samantha Langer outside DH

INFORMATICS, DATA SCIENCE, & AI

Entering a New Era of Risk: Understanding AI-Driven Probabilities

By Arwen Declan, MD, PhD; Mack Sheraton, MD, MS, MHA; Moira Smith, MD, MPH; Robert Doerning, MD, MBA, MS; and Christian Rose, MD, on behalf of the SAEM Informatics, Data Sciences, and Artificial Intelligence Interest Group

The emerging opportunities to apply artificial intelligence (AI) in medicine also introduce new uncertainties or risks. Although the mathematical notion of risk, defined as the known probability of an outcome, may make us uncomfortable, we emergency physicians (EPs) have an intimate relationship with risk. We use Bayesian decision-making to decrease radiation exposure (e.g., d-dimer, PERC, Wells) and rely on statistical analyses like logistic regression for tools such as MDCalc's PSI/PORT. We hone our internal “spidey sense” to recognize rare or unusual situations and are reassured by a less than or equal to 2 percent risk for most major adverse events. We combine our estimations of risk with

insights from cognitive psychology to share decisions with our patients.

As EPs, we tend to focus on negative outcomes. Whether determining the need for advanced imaging after trauma, discussing a procedure’s risks and benefits, or assessing the likelihood of major adverse cardiac events, we constantly assess the probability of negative outcomes for patients or the system. Ultimately, we integrate evidence, standards of care, and clinical experience to help patients understand risks and make informed decisions.

Entering the age of AI introduces new risks. Terms like hallucination, model drift, and bias reflect potential sources of error in AI systems, leading

to inaccurate or misleading output. Hallucination refers to AI models generating plausible but incorrect outputs. Model drift describes performance degradation over time due to changes in input data characteristics or disease patterns. Bias can arise if a population is underrepresented in the training data, if sensitive attributes are associated with specific groups, or if models are trained on physician notes with subtle inaccuracies. These biases can lead to unfair and unreliable outcomes in the AI system. These distortions introduce new risks, potentially more subversive than our cognitive biases, partly because we perceive computer output as intrinsically trustworthy. To responsibly integrate

“As we enter the age of AI, we must consider a new set of risks such as hallucination, model drift, and bias, which can lead to inaccurate or misleading outputs.”

AI into our practice, we must evaluate the trustworthiness and accuracy of the information presented.

Since AI introduces new, often opaque methods of synthesizing data to produce decisions, our understanding of risk must fundamentally change as we develop and implement generative AI in clinical practice. We must develop three key cognitive strategies to address these new types of risk:

1. Recognize and Categorize Changes in Probabilistic Risk: We must identify, describe, and categorize AI-introduced risks like hallucination, drift, and bias transparently and clearly. Each represents a category of error with an associated risk of harm. As we explore

and implement AI, further types of errors must be recognized, defined, and communicated to end users.

2. Quantify Measurable Risks: We must seek to understand the harms associated with each type of risk. Risk technically refers to known probabilities; until we can define and quantify the risks associated with AI, we cannot understand the likelihood of harm inherent in specific AI applications. AI algorithms must be audited and tested for specific error modes. To quantify generalizability and limitations, model performance, calibration, value, and risks must be validated independently across diverse datasets, patient populations, and clinical settings.

3. Define Standards, Policies, and Regulations: Early use-casespecific guidelines, such as those developed by professional societies, can help avoid harm in early AI implementations. Ongoing review and revision will support policy clarification and generalization as AI develops and actual risks become evident. Multidisciplinary collaboration between EPs, AI experts, ethicists, and policymakers will be essential. We must employ a meticulous approach to manage and mitigate potential risks as AI integrates into

“By leveraging AI’s ability to rapidly analyze large quantities of data, we could more quickly evaluate clinical questions, develop new insights, and speed the incorporation of new perspectives.”

INFORMATICS

continued from Page 43

health care. Regulatory due diligence will be crucial to ensure AI models meet standards for analytic and clinical validity. Shared governance and risk strategies should include guardrails limiting known risks. Extensive quality assurance testing will be essential to optimize performance and prevent implementation mishaps. Independent validation on diverse data will enhance model accuracy and generalizability before deployment. AI tools should be implemented in phases, targeting initial deployments to low-risk areas such as data aggregation and summarization. This strategy minimizes potential harms and builds opportunities to identify unanticipated risks.

Additional risk-mitigation strategies during initial deployment include automatically generated links to source material to detect and address hallucinations and bias. Techniques like Retrieval Augmented Generation (RAG) may address bias by incorporating recent, external data beyond the model’s initial training data. Continuous quality monitoring should compare input data to pre-deployment data to prevent model drift. Output guardrails should ensure clinicians can override model decisions with mechanisms like uncertainty estimates and human-in-the-loop reviews. Continued post-deployment surveillance should track population-level performance, fairness, and value delivery over time.

Clinician involvement is crucial for risk mitigation and regulatory approval throughout AI integration, from design and deployment guidance to risk interpretation and communication with patients. Even self-improving “agentic” AI will need human-guided guardrails. EPs should plan to regularly review model performance and enhance their own education to effectively integrate AI into clinical workflows. Combining clinical acumen with AI models can reduce risk broadly by rapidly analyzing large data sets, developing new insights, and accelerating the incorporation of new perspectives. Collaborating with statisticians to implement techniques like target trial emulation can simulate clinical trials years before RCTs are completed, defining high-probability new information and decreasing risks of harm. EPs must monitor, minimize, and communicate AI risks while seeking opportunities to improve care and decrease risk with AI.

Studying AI risks will have wider implications. Prior advances in our statistical understanding of risk have revolutionized our societal and technological capabilities. Detailed attention to AI model risks may result in an even greater paradigm shift. The progressive development of qualitative and quantitative risks associated with AI may revolutionize our understanding of probabilistic risk. Exploring creative and useful ways to use AI may uncover the next sociotechnological paradigm shift. As risk-aware EPs explore AI’s risks, benefits, and impact in emergency medicine, we anticipate parallel growth in our broader understanding of probabilistic risk.

“To responsibly integrate AI into our practice, we must evaluate the trustworthiness and accuracy of the information presented.”

ABOUT THE AUTHORS

Dr. Declan is the assistant research director at Prisma Health Upstate and clinical assistant professor at the University of South Carolina School of Medicine - Greenville and Clemson University. She applies informatics methods to improve patient care and support the clinician workforce.

Dr. Sheraton is an assistant professor of emergency medicine at UT Houston Health Science Center, focusing on the responsible use of generative AI in medical education and the automation of healthcare administration through digitalization.

Dr. Smith is a clinical informatics fellow at the University of Virginia. After her fellowship, she will be the assistant emergency medicine informatics director at UVA. Her work focuses on data analytics and reporting, quality improvement, electronic health record usability and workflow, and clinical decision support.

Dr. Doerning is an acting assistant professor of emergency medicine and specialty CCIO and associate director of data science and clinical informatics for the University of Washington. He is dual-boarded in emergency medicine and clinical informatics. His work is in operations data analytics and reporting, AI and LLM applications, and electronic health record implementation.

Dr. Rose is an assistant professor of emergency medicine at Stanford University, focusing on the intersection of clinical practice and informatics to elevate patient care and promote a human-centered approach.

Dual-boarded in emergency medicine and clinical informatics, his work leverages technology within healthcare to transform health outcomes through information systems..

INNOVATION IN EM

Empowering Emergency Medicine: Leveraging Design Thinking to Address Challenges and Drive Solutions

By Leonardo Garcia; Zaid Altawil, MD; Jonathan Oskvarek, MD, MBA; and Nicholas Stark, MD, MBA on behalf of the SAEM Innovation Interest Group

Presented at SAEM24 in Phoenix, Arizona, the SAEM Innovation Interest Group and the Emergency Medicine Innovation Collaborative hosted a problem-solving workshop titled "Solving the ED Psych Crisis: An Interactive Session." Dr. Michael Wilson, chair of the Coalition on Psychiatric Emergencies, opened the workshop. Participants applied design thinking practices to tackle a growing challenge in emergency medicine (EM): the significant increase in behavioral health emergencies faced by emergency departments (EDs) in recent years. In this context, this article explores design thinking and its role in fostering innovation within EM.

Design Thinking Defined

In 2008, Tim Brown, CEO of IDEO, defined design thinking as a framework for promoting human-centered design in business. He described it as using the "designer’s sensibility and methods" to meet people’s needs within technological and business constraints (Brown 2008). Design thinking involves empathetically approaching problems, focusing on the end-user, and implementing iterative solutions to address their needs.

Unlike traditional linear approaches, each step in design thinking is iterative and interconnected, leading to multiple

cycles of innovation at each stage. By developing frameworks for design thinking, the success rate of solutions is increased by systematically and preemptively addressing common pitfalls of failed innovations. Its practices are universal and have been utilized within EM to foster innovation for some of the field’s toughest issues.

For example, as shared by Dr. Wilson, suicide rates are at their highest levels in 80 years, and patients with psychiatric emergencies are increasingly arriving in the ED. Dr. Wilson noted the gap in educational tools for facilitating better management of these patients. Utilizing

“Design thinking involves empathetically approaching problems, focusing on the end-user, and implementing iterative solutions to address their needs.”

design thinking, Dr. Wilson helped create iCar2e, a digital tool for emergency physicians to better identify and manage patients experiencing suicidality. This is one of countless examples of how design thinking has been translated to health care to foster novel solutions that harness the power of technology, various perspectives, and iterative improvement.

The 5 Steps of Design Thinking

Emergency physicians can apply design thinking to every part of the acute care environment, from the waiting room to disposition. The central framework of design thinking consists of five interconnected and nonlinear steps, allowing for movement back and forth between stages as needed. As defined by Stanford’s Hasso Plattner Institute of Design, the five key steps of design thinking are:

1. Empathize: Understand the perspectives of everyone involved, including patients, triage staff, nurses, physicians, first responders, and essential staff. Observations, interviews, and working groups help bring these perspectives to the forefront, allowing for the identification of pressure points and effective troubleshooting.

2. Define: Frame the problem holistically through various perspectives. Defining not only what the problem is, but also why it exists, and reflect empathetically on who enables the problem and who is most affected to uncover the root of the problem and its nuances more easily.

3. Ideate: Brainstorm and generate ideas to address the defined problem. In EM, this means brainstorming potential solutions to improve patient care, streamline processes, or enhance communication. Logistics are not considered at this stage; instead, physicians are encouraged to dream big and think of diverse and unconventional ideas.

4. Prototype: Build tangible solutions from the ideas generated, considering the logistical and material limits within the acute care environment. Organize prototypes by feasibility and impact to identify which to test. Design thinking encourages returning to previous stages to drive forward innovation.

5. Test: Implement prototypes within the ED and gather data and feedback on their sustainability and effectiveness. Return to empathizing to consider the

differing perspectives on the success of the solution depending on the individual.

Applying Design Thinking to EM

By establishing a framework for innovation, emergency physicians can confidently design and implement efficient solutions to some of the most challenging issues faced by patients and staff. For example, Dr. Wilson presented the problem of extended duration of stay, limitations to proper treatment, and barriers in disposition for patients with primary psychiatric illnesses setting the stage for empathizing and defining the issue. The SAEM24 session defined the specific problem as "improving ED psychiatric care in terms of length of stay and/or disposition."

The session then broke into small groups to dive deep into the ideation and prototyping phases of the design thinking process. Ideas ranged from a medical-psychiatric inpatient unit, interdisciplinary rounds, standardized treatment workflows for physicians, to a telehealth system. Ultimately, one idea

Figure 1: Design Thinking Framework

“Design thinking provides a framework to innovate with empathy and intentionality, ensuring that endeavors are more effective in meeting the true needs of the end-users— physicians, staff, and patients.”

INNOVATION

continued from Page 47

the groups decided to prototype was a telehealth medical consult system to allow patients with primary psychiatric illness and secondary medical issues to be admitted to psychiatric units with support from telehealth medical providers in managing their secondary issues. This would expedite disposition to the proper environment, improving patient care and reducing the patient burden within the ED. While prototyping this solution, it became clear that the perspective of mental health providers was missing, prompting the need to return to the empathize step to refine the prototype and better predict its effectiveness.

This problem and the proposed solution are just one example of what design thinking can achieve. It can be used to identify barriers and design approaches to address extended wait times, frequently returning patients, common medical errors, and more. Its human-centric approach has limitless applications in addressing issues faced by all individuals who interact with the ED.

Design thinking is a dynamic and iterative approach that emphasizes empathy, holistic problem framing, creative ideation, tangible prototyping, and rigorous testing. Its principles are highly beneficial in emergency medicine, addressing complex issues such as improving patient care, enhancing process efficiency, and improving communication. With advancements in technology, such as artificial intelligence, design thinking provides a framework to innovate with empathy and intentionality, ensuring that endeavors are more effective in meeting the true needs of the end users— physicians, staff, and patients

ABOUT THE AUTHORS

Leonardo Garcia is beginning his fourth year of medical school at the University of California San Francisco (UCSF). At UCSF, he is a member of the Acute Care Innovation Collaborative, spearheading project development and research in artificial intelligence and immigrant health digital resources. He is applying into emergency medicine this year.

Dr. Altawil is an emergency medicine attending physician at Lawrence General Hospital in Massachusetts. He is co-founder of the Emergency Medicine Innovation Collaborative, a group of emergency medicine physicians working to cultivate collaborations, share resources, and inspire innovative change.

Dr. Oskvarek is an emergency physician with US Acute Care Solutions and research co-director at Summa Health in Akron, Ohio. He has received grants to evaluate a pilot emergency department advanced alternative payment model. Dr. Oskvarek also conducts research in clinician performance improvement and works with entrepreneurs.

Dr. Stark is an emergency physician who works clinically at the University of California San Francisco (UCSF) and is the vice chair of emergency medicine and director of operations and quality at Mercy Medical Center. He is the co-founder of the national nonprofit EM Innovation Collaborative and the assistant director of the UCSF Acute Care Innovation Center. @NickStarkMD

Persistent Hypoglycemia in Opioid Overdoses: Emerging Challenges and Management Strategies

By Brigid Garrity, DO, MPH; Bri Marschke, MD; Matthew Bui, MD; Jessica Lin, MD, MPH; and Andrew Mittelman, MD

Opioid overdoses are increasingly common in emergency departments, with the Centers for Disease Control and Prevention reporting 107,941 opioid overdose deaths in 2022. Initial management of opioid overdose in patients with respiratory depression often involves naloxone, a shortacting opioid antagonist that can be administered intranasally by bystanders and EMS or intravenously in the emergency department. The goal of naloxone administration is to achieve adequate ventilation rather than improve mental status, a common misconception among both bystanders and medical professionals. Repeat doses of naloxone may be required, though excessive dosing can precipitate

“The goal of naloxone administration is to achieve adequate ventilation rather than improve mental status, a common misconception among both bystanders and medical professionals.”

withdrawal. Supportive measures and the initiation of medication-assisted treatment (MAT) for opioid use disorder, such as methadone and buprenorphine, may also be included in the standard care management of opioid overdose.

While polysubstance use, such as combining opioids, methamphetamines, and cocaine, has become increasingly common, there has also been a substantial rise in additives within the opioid drug supply. Non-opioid additives

“In recent months, our emergency department has observed a rise in persistent hypoglycemia following opioid overdoses, signaling a potential trend in increasing opioid contamination.”

are typically used to increase drug volume and are often substances that are readily available to individuals producing the opioids. A common co-ingestion is synthetic benzodiazepine-laced opioids, often referred to as “benzodope,” which has significantly contributed to increased opioid-related morbidity and mortality. Concomitant use of fentanyl and nonpharmaceutical fentanyl (NPF) is also very common. Additionally, several nonfentanyl groups of new synthetic opioids are being incorporated into the opioid supply, including MT-45, benzamide, and 2-phenylacetamide opioids The presence of these substances adds complexity to a typical opioid overdose presentation.

In recent months, our emergency department has observed a rise in persistent hypoglycemia following opioid overdoses. As the highest volume Level 1 trauma center in New England and one of the busiest emergency departments in the country, we are concerned this may signal an increasing trend in opioid contamination. Many of our patients use both opioids and benzodiazepines. Since sulfonylurea tablets physically resemble Valium, patients may mistakenly take sulfonylureas or another additive, believing they are consuming benzodiazepines. These patients often present diaphoretic, weak, and with respiratory depression, which is treated with naloxone by EMS or bystanders before arrival at the emergency department. Initial hypoglycemia in these patients is potentially multifactorial, attributable to poor nutritional intake, concomitant alcohol use, or hypothermia. However, we have noted recurrent cases of refractory hypoglycemia, many of which have not responded to treatment with glucose or dextrose for 24 hours after presentation. After evaluating six months of pharmacy data from our emergency department, we observed an increase in octreotide utilization for patients experiencing opioid overdoses. Subsequent interdisciplinary discussions between emergency medicine pharmacists, addiction medicine

clinicians, and individuals working in harm reduction centers led us to hypothesize that the opioid supply used by many of our patients may be laced with sulfonylureas.

While isolated case reports of sulfonylureas mixed with opioids and benzodiazepines have been documented over the past two decades, establishing causality of refractory hypoglycemia remains challenging. To address this concern, emergency medicine clinicians can attempt to evaluate insulin and c-peptide levels, although these tests are not routinely performed in the emergency department and have limited utility due to their extended result time. In adults, hypoglycemia following sulfonylurea ingestion usually occurs rapidly, although delayed onset has been reported, and post-sulfonylurea hypoglycemia typically lasts less than 24 hours after initial ingestion.

Sulfonylureas have a narrow therapeutic window, so any unintentional or excessive use can lead to lifethreatening hypoglycemia. Treatment of sulfonylurea poisoning consists of IV dextrose and octreotide (starting dose of 50 μg bolus, followed by an infusion of 25 μg). While octreotide is often administered for refractory hypoglycemia after initial treatment with dextrose, it may be more beneficial to administer octreotide after the first episode of hypoglycemia if sulfonylureas are suspected to be the cause. Treatment of opioid overdose remains the same in these patients.

In patients presenting with opioid overdose who experience two or more episodes of hypoglycemia, emergency medicine clinicians should consider the possibility of occult sulfonylurea contamination. Octreotide and dextrose may be given for hypoglycemia in the setting of suspected sulfonylurea coingestion. These patients should be observed until persistent euglycemia is achieved and may need to be admitted to inpatient or observation units. Patients should be counseled on the dangers

of hypoglycemia and using opioids that may be laced with diabetic medications. Future harm reduction efforts may involve distributing test strips for more than just fentanyl to test for additional substances, such as sulfonylureas and other oral diabetic medications, in the opioid supply.

ABOUT THE AUTHORS

Dr. Garrity is an emergency medicine resident at Boston Medical Center. Her academic interests include health services research, health policy, and substance use. brigid.garrity@bmc.org

Dr. Marschke is an emergency medicine resident at Boston Medical Center. Her academic interests include social emergency medicine, health equity, health policy, and substance use disorders. brianna.marschke@bmc.org

Dr. Bui is an emergency medicine resident at Boston Medical Center. His academic interests include high efficiency resuscitation teams, cardiac arrest in drowning, and emergency point-of-care ultrasound. matthew.bui@bmc.org

Dr. Lin is an emergency medicine resident at Boston Medical Center. Her academic interests include social emergency medicine, prehospital care, and palliative care. jessica.lin@bmc.org

Dr. Mittelman is an attending physician at Boston Medical Center where he also serves as residency assistant program director. He is interested in psychosocial factors of resuscitation teams and transition points in resident development. andrew.mittelman@bmc.org

& GENDER IN

Rising Syphilis Rates: Demographic Shifts and Critical Public Health Implications

By Meg Hayslip, MD, on behalf of the SAEM Sex & Gender in Emergency Medicine Interest Group

The incidence of syphilis reached its lowest point in 2000 and has been rising ever since. Historically, syphilis has predominantly affected men, particularly men who have sex with men (MSM). However, in the last decade, there has been a notable uptick in the number of women and men who have sex with women (MSW) affected by syphilis. Ten years ago, over 90% of primary and secondary syphilis cases occurred in men. Since then, the incidence among women has increased 866.7% (from 0.9 to 8.7 per 100,000) while the rate among men has increased 162.7% (from 10.2 to 26.8 per 100,000) In 2014, 83% of syphilis cases were in

“From 2013 to 2022, the rate of syphilis among women of childbearing age increased by over 800%, and the number of congenital syphilis cases rose by over 900%.”

MSM. By 2022 that number dropped to 29% as the incidence in women, MSW, and men with unknown sex of sex partners (MSU) surpassed the case rate in MSM.

Syphilis can have a tremendous impact on women of childbearing age, as congenital syphilis has devastating effects. From 2013 to 2022, the rate of syphilis among women of childbearing

“CDC data suggests that 40% of those giving birth to a baby with congenital syphilis in 2022 did not receive any prenatal care. Timely testing and treatment during pregnancy could have prevented almost 9 in 10 cases.”

age increased by over 800%, and the number of congenital syphilis cases rose by over 900% (from 362 to 3,755). This rise has had tragic outcomes, as congenital syphilis, which is preventable if caught and treated, can cause severe health issues. Between 2018 and 2022, there was an almost 200% increase in congenital syphilis-related deaths (from 96 to 282) and a 225% increase in congenital syphilis-related symptoms in newborns, such as deformed bones, neurological problems, severe anemia, and enlarged liver and spleen. Centers for Disease Control and Prevention data suggests that 40% of those giving birth to a baby with congenital syphilis in 2022 did not receive any prenatal care. Timely testing and treatment during pregnancy could have prevented almost 9 in 10 cases

The drastic increase in syphilis cases, especially among MSW and women, is thought to be due to several factors, including funding cuts affecting sexually transmitted infection (STI) prevention and treatment programs and an increase in the number of persons who inject

drugs (PWID), a group disproportionately impacted by syphilis. Between 2013 and 2017, the use of methamphetamines, heroin, and injection drugs increased by more than 100% among MSW and women with syphilis, but decreased among MSM. This indicates a significant proportion of heterosexual syphilis transmission among those who use injection drugs. Stigma around drug use and other social determinants of health may also lead to less access to health care and difficulties in locating sex partners for exposure notification.

As more individuals, including pregnant persons, rely on the emergency department (ED) for primary care, the potential impact of syphilis screening is important to consider. From an ED perspective, timely identification and treatment of syphilis is crucial to prevent severe consequences. With late syphilis on the rise (28% increase from 2021 to 2022), symptoms may not align with typical STI presentations. While EDs often screen for gonorrhea and chlamydia in symptomatic patients, syphilis testing is

frequently overlooked. Some institutions are beginning to implement focused or routine opt-out syphilis screening programs, similar to those previously modeled for hepatitis C and HIV. Early detection is vital to prevent adverse outcomes, and these programs have the potential to significantly impact syphilis incidence and outcomes. Given the shifting demographic profile of syphilis, especially among women, incorporating routine syphilis testing into STI testing protocols in the ED is a solid first step; expanded screening should also be considered.

ABOUT THE AUTHOR

Meg Hayslip will be a PGY-1 Resident at Carolinas Medical Center.

Affordable Reusable Simulation for Priapism Aspiration Training: Enhancing Emergency Medicine Education

By Rahul Gupta, MD; Logan O’Keefe, DO; Cortney Owoc, DO; and Alison Southern, MD

Priapism is defined as a persistent erection of the penis, lasting at least four hours, that is not associated with sexual stimulation or desire. It can occur in all age groups and is classified as ischemic or nonischemic. Ischemic priapism is a urologic emergency. Failure of detumescence is related to impaired relaxation and paralysis of cavernosal smooth muscle, resulting in compartment syndrome with increasing hypoxia and acidosis in the cavernous tissue. Rapid detumescence is required to avoid long-term sequelae. Although primarily managed by urologists, emergency medicine clinicians are often the first-line providers and should be capable of managing priapism through

aspiration and irrigation. (UpToDate, 28 Jan. 20)

Priapism aspiration is a high-acuity, low-opportunity (HALO) procedure encountered in emergency medicine. Due to its infrequent occurrence, many emergency medicine residents feel inadequately prepared to perform this limb-saving procedure confidently.

While not a high-index procedure mandated by the Accreditation Council for Graduate Medical Education, ischemic priapism is an emergency that warrants rapid treatment. Priapism is a rare condition that requires practice in a simulated scenario. Our team constructed a low-cost, reusable

simulation model for this specific pathology and its treatment.

Drawing on our background knowledge of priapism and multiple online sources, we created several lowcost, reusable models. To make these models, we used a male genitalia mold, silicone, male barrier contraceptives, and a wooden dowel. We purchased molds and silicone from Amazon, male barrier contraceptives from a pharmacy, and wooden dowels from a craft store. Silicone was poured into the mold and the wooden dowel was inserted. Once dry, a fluid-filled male barrier contraceptive was inserted into the void left by the wooden dowel.

“Ischemic priapism is a urologic emergency. Failure of detumescence is related to impaired relaxation and paralysis of cavernosal smooth muscle, resulting in compartment syndrome with increasing hypoxia and acidosis in the cavernous tissue.”

These models enable residents to familiarize themselves with relevant anatomy and the process of aspiration and irrigation, as well as the necessary equipment. During the simulation, learners insert a needle into the appropriate area of the contraceptive and aspirate the fluid. Learners also practice other aspects of the procedure, including dorsal penile nerve block. In addition to the hands-on model, the team created a short presentation covering all relevant knowledge on priapism, including indications and contraindications.

This approach highlights the importance of simulation-based training in the education curriculum for emergency

medicine residents. It allows residents to prepare for procedures of any difficulty and rarity. We acknowledge limitations in our model and have identified areas for improvement to enhance learning and hands-on practice. We are exploring different mediums that will allow the model to detumesce as the fluid is removed. Once we perfect the medium and molding procedure, we aim to add multiple areas of fluid to simulate the urethra and cavernosa, aiding residents in understanding the anatomy comprehensively.

The response to our model has been positive, but the team is committed to further improving resident education.

ABOUT THE AUTHORS

Dr. Logan O’Keefe is a rising third-year emergency medicine resident at Aultman Hospital in Canton, Ohio.

Dr. Rahul Gupta is a graduating third-year emergency medicine resident at Aultman Hospital in Canton, Ohio. He has accepted an attending physician position in the state of New York.

Dr. Cortney Owoc is the pediatric emergency medicine director for Aultman Emergency Medicine in Canton, Ohio, and an assistant professor of emergency medicine for Northeast Ohio Medical University.

Dr. Alison Southern is the program director for Aultman Emergency Medicine in Canton, Ohio, and a professor of emergency medicine for Northeast Ohio Medical University.

@Aultman_EM and @AultmanEM

Five Essential Tips for Writing a Compelling Grant Application

By Asit Misra, MD and Diana Yan, MD, MEd on behalf of the SAEM Simulation Academy

The article below was adapted from a Mentor Hour hosted by the Education Subcommittee of the SAEM Simulation Academy on March 19, 2024.

Successful grant writing is challenging. In 2023, only 21% of NIH grant applications were funded. Here are five tips to make your grant proposal compelling and secure support.

Tip 1: Have a Project Idea Ready Before Seeking Funding Opportunities

Grants are awarded to fresh ideas grounded in up-to-date literature. Generating strong research ideas is challenging and needs continuous effort. Familiarity with current trends in your field of study, attending professional meetings, and building

collaborations helps to develop and refine novel directions of inquiry. Having a strong idea allows you to pursue grant opportunities as they arise

Tip 2: Letters of Intent Are as Important as Grant Applications

The letter of intent (LOI) screens your grant application. A lackluster LOI means the agency won't invite you to submit a full application. The LOI includes a brief background and problem statement, research design/ methodology, analysis approach, team details, project relevance to the agency's mission, general funding needs, total amount requested, team expertise, and project completion capabilities. Close your LOI by

expressing appreciation for the opportunity provided.

Tip 3: Title and Abstract to Impress

Use a creative title covering the condition, study design, and participants of your project. The abstract concisely describes the identified problem and proposed solution — an 'elevator pitch' for your grant proposal. Include problem statement/need, research design/ methods, and anticipated outcomes/ implications.

Tip 4: Use Tables and Charts

A picture is worth a thousand words; it explains processes and data visually, helping reviewers understand complex concepts more easily. Tables are useful for explaining your budget, line

items, and costs, and they also enhance comprehension of project timelines. An excellent way to demonstrate your project timeline is by using a Gantt Chart (see Figure 1).

Tip 5: Follow the Rules

Funding bodies will reject applications that don’t follow guidelines. Don't let your

DOS

Check if the proposal meets the eligibility requirement

Check if the project fits into the budget

Check for project dates (realistic for your project) and deadline

Read the Request for Proposal (RPF) carefully

Follow the instructions carefully

Ensure the evaluation plan matches the objectives

Gather information from funded proposals by the agency in the past

Table 1: The DOs and DON’Ts of Writing a Grant Proposal.

hard work be eliminated by formatting or page count errors. Have your mentors and institutional grant office review your application before submission. Grant offices usually require at least two weeks for review, so plan accordingly. Contact the grant administrator with questions. Funding agencies are willing to provide funding, but they require the right grant

DON’TS

Forget to ensure consistent and correct formatting of the proposal

Use a writing style that is not persuasive

Forget to establish the need for the program early in the proposal

Forget to include preliminary data or local data

Forget to use SMART (Specific, Measurable, Achievable, Realistic, Time-bound) objectives

Forget to check for any mismatch between activities and the budget

Submit a proposal that is not innovative

proposal. Review our list of Dos and Don’ts (Table 1).

Writing a robust grant application is a necessary skill for any simulation educator’s professional toolbox. While developing strong simulation curricula is important, learning to sell your work to secure funding is equally crucial.

ABOUT THE AUTHORS

Dr. Misra is an assistant professor of emergency medicine/surgery at the University of Miami Miller School of Medicine and assistant director of the Prehospital and Emergency Training Division of the Gordon Center for Simulation and Innovation in Medical Education.

Dr. Yan is an assistant professor of emergency medicine, pediatrics, and medical education at Icahn School of Medicine at Mount Sinai and the lead for graduate medical education at Mount Sinai Beth Israel.

Figure 1: An example of a Gantt Chart showing the project timeline.

SOCIAL EM & POPULATION HEALTH

Bridging Language Barriers in the ED: Resident Approaches to Caring for Patients With Non-English Language Preference

By Elaine Hsiang, MD and Katrin Jaradeh, MD on behalf of the SAEM Social Emergency Medicine and Population Health Interest Group

It is well established that language barriers contribute to health care disparities for patients with non-English language preference (NELP). In the emergency department (ED), patients with NELP experience increased rates of diagnostic testing, admission, and unplanned ED revisits within 72 hours Data on patient satisfaction among ED patients with NELP is mixed, as studies combine patients regardless of interpreter use or type, but suggest decreased satisfaction and less willingness to return to the same ED. The use of certified interpreters is cost-effective and can mitigate some of these health care disparities. In one randomized controlled trial, inperson interpretation increased both patient and provider satisfaction with

communication during ED visits Certified interpreter use has also been linked to clearer discharge communication and caregiver understanding

Language equity is an important issue in emergency medicine, as a significant proportion of patients in our EDs speak languages other than English and may use the ED as an entryway into the medical system or rely on the ED for health care. In this article, we share some resident perspectives on caring for NELP patients in the ED, as well as best practices to improve the care for this important population.

Challenges in ED Care of Patients With NELP

With growing patient volumes and wait

times, the ED is fast-paced and often rewards speed and efficiency. Unless you are fluent and certified to provide care in a language other than English, you will likely need an interpreter for some of your patients. The use of an interpreter can add significant time to your patient encounter and can come with additional issues, such as patient or provider frustration when the interpreter experience is less than ideal. A qualitative study of resident physicians revealed the tendency to “get by” without interpreters due to time constraints, despite recognition that NELP patients receive worse care

Access to interpretation is a major barrier. Although hospitals are required by federal law to provide language assistance to patients who need it, a

“Even in high-acuity situations where the patient may be communicative, use interpreters; their Glasgow Coma Scale can noticeably change with appropriate interpreter use.”

2016 study found that one-quarter to one-third of hospitals in the United States do not provide appropriate interpreter services. A recent scoping review suggests that seven in ten ED patients with NELP are not receiving languageappropriate services. In-person, video, and phone interpretation capabilities vary dramatically across EDs, and not all EDs have interpreter services around the clock.

Logistical barriers to languageconcordant care for ED patients with NELP abound. Interpreter or provider devices may be broken or frequently malfunction, especially after frequent wiping with bleach or alcohol. Audio and video quality can vary depending on WiFi or phone signals on either the hospital or interpreter side. Access to sign language interpretation is extremely limited in hospitals without video or in-person interpretation. For departments without ED-based in-person interpretation, paging and waiting for an in-person interpreter may not be feasible, particularly in highacuity trauma or medical resuscitations. These issues compound and lead to a higher likelihood that certified interpreters may not be used during all encounters for patients with NELP, and commonly, interpreters are not being used at each touch point (e.g. during reassessments or upon patient discharge).

What Residents Can Do: On-shift

Use certified interpreters for all NELP encounters.

In-person interpretation is ideal, but video or phone interpreters may be more readily available in EDs. Approach fluent medical staff only if certified interpreter services are inaccessible, mindful of the extra workload they may take on. Avoid asking family members to interpret, except when it is the patient’s strong preference. Never use children to perform interpretation services. Even in high-acuity situations where the patient may be interviewable, use interpreters; their Glasgow Coma Scale (GCS) can noticeably change with appropriate interpreter use.

Be an upstander.

Encourage your colleagues — medical students, co-residents, attendings, consultants, nursing, or any other patient-facing staff — to use certified interpreters when interacting with NELP patients. Remind colleagues of a patient’s preferred language and the necessity of using an interpreter. For those in teaching roles, modeling this yourself can be a powerful way to increase interpreter use.

Check and update preferred written and spoken language(s) in patient charts. Many electronic medical records prominently display preferred languages in patient charts to facilitate appropriate interpreter use. If there are none listed or if languages are incorrect, feel empowered to update your patient’s chart (or notify registration staff to do so).

Provide discharge paperwork in the patient’s preferred language, as well as in English. Technology such as Google Translate, DeepL, and ChatGPT can translate discharge instructions into a patient’s preferred language, but be cautious of potential errors. If using precreated patient discharge instructions, make every effort to use attachments offered in your patient’s preferred language. It is still important to review discharge instructions verbally with your patient with the help of a certified interpreter.

What Residents Can Do: Outside of Shift

Advocate for improved access to interpreter services.

Assess your hospital’s interpreter capabilities: Is there 24-hour interpretation available? Which languages are accessible through in-person, video, and phone interpretation? Is signage across the ED posted in multiple languages? How would you access a sign language interpreter? Are tablets, phones, or other devices available department-wide for interpreter use, and are computers in rooms equipped with interpretation software? Ensure the interpreter services number is easy for providers and staff to locate and is posted in patient care

spaces. Implementing even minor system changes to lower barriers to using certified interpreters can significantly impact patient care.

Get certified as a bilingual (or multilingual) provider.

Some hospitals, like ours, offer a certification process and a monthly stipend to residents who can provide care in an additional language. For those learning languages and striving for fluency, phone-based applications, tutors, elective time, and immersion programs are invaluable tools. Utilize department or program education funds, if available, to access quality learning materials.

Learn more about language equity in medicine.

There is a growing number of resources available to enhance skills and considerations in providing care for NELP patients, such as this MedEdPortal collection.

Participate in efforts to diversify emergency medicine.

Language-concordant care is the gold standard in caring for NELP patients. Recruiting and retaining emergency providers who speak other languages is critical to improving the accessibility, quality, and inclusivity of our emergency departments

ABOUT THE AUTHORS

Dr. Jaradeh is an emergency medicine intern at the University of California San Francisco.

Dr. Hsiang is chief resident in emergency medicine at the University of California San Francisco. She is an incoming social emergency medicine fellow at Stanford. @egnaish

ABC Versus CAB: Rethinking Approaches to Trauma Resuscitation Training

By Michael Cusumano, PharmD; Cole Ettingoff, MPH; Michael Jones, MD; and Kaushal Shah, MD on behalf of SAEM Trauma Interest Group

Resuscitation training has long employed the ABC mnemonic — airway, breathing, and circulation — to help learners prioritize critical actions. The Advanced Trauma Life Support (ATLS) program, designed for non-trauma experts, adopted this straightforward approach. However, the optimal sequence varies by clinical context.

In 2010, the American Heart Association updated its guidelines for managing non-traumatic cardiac arrest, retiring ABC and replacing it with CAB (circulation, airway, breathing), emphasizing that chest compressions should precede airway

management and rescue breaths. This shift has sparked debate about the ABC sequence's appropriateness in trauma care, especially when "airway" implies endotracheal intubation before addressing hemorrhagic shock.

Several training programs now prioritize managing life-threatening bleeding before intubation, as shown in Table 1. Nevertheless, the American College of Surgeons (ACS) maintained the ABC sequence in its 10th Edition of the ATLS course in 2018, stating that “no evidence-based data were identified that justified a modification to this approach in the care of civilian patients.”

This article examines the value of CAB vs. ABC in severe trauma management, relevant to all emergency physicians.

There are compelling arguments for switching to a CAB sequence in trauma resuscitation. One key point, acknowledged in the ATLS 10th Edition Student Course Manual, is that "hemorrhage is the predominant cause of preventable deaths after injury." Additionally, endotracheal intubation can precipitate cardiac arrest in hypotensive patients by reducing venous return from spontaneous inspiration. A 2022 meta-analysis found that pre-intubation hypotension was associated with

“In 2010, the American Heart Association updated its guidelines for managing nontraumatic cardiac arrest, retiring ABC and replacing it with CAB (circulation, airway, breathing), emphasizing that chest compressions should precede airway management and rescue breaths.”

an adjusted odds ratio of 5.2 for periintubation cardiac arrest.

Evidence directly comparing the ABC and CAB approaches in trauma has only recently emerged. A 2023 review identified two studies comparing these approaches in hypotensive trauma patients undergoing intubation. Both observational studies, published in 2018 by Ferrada et al., defined "CAB" as initiating blood product transfusion before intubation. One multicenter study found no difference in survival between the ABC and CAB approaches. The other, a single-center study, reported a significant increase in survival with the CAB approach (78% vs. 50%, p < 0.05, n = 66).

In 2024, Ferrada et al. conducted a similarly-designed prospective, multicenter study approved by the Eastern Association for the Surgery of Trauma (EAST) Multicenter Trials

Committee. This study reported significantly increased survival with the CAB approach (88.9% vs. 30.8%, p < 0.001, n = 278). It defined CAB as “delaying intubation until blood products were started and/or bleeding control was performed.”

Although ATLS continues to teach intubation before hemodynamic resuscitation, Ferrada's studies indicate that many United States trauma centers have already adopted the CAB sequence. The ACS has recognized Ferrada’s findings, noting in a press release "better outcomes" with a "paradigm shift" to CAB in a press release. With no strong physiological rationale for the ABC sequence in managing massive hemorrhage and emerging evidence favoring CAB for patient survival, the next ATLS edition could justifiably adopt a CAB approach. Until then, consider using CAB for hemorrhagic trauma patients needing resuscitation.

ABOUT THE AUTHORS

Dr. Jones is a professor, vice chair for education, and residency director for emergency medicine at Jacobi-Montefiore Emergency Medicine Residency Program of the Albert Einstein College of Medicine, where he was chief resident. He completed medical school at Albert Einstein and his undergraduate studies at Columbia University. He is the chair of the SAEM Trauma Interest Group and a founding member of the All NYC EM, Inc. education consortium.

Michael Cusumano worked as an emergency medicine pharmacist at HSHS St. John's Hospital in Springfield, Illinois, before returning to school at Saint Louis University School of Medicine. He is passionate about interprofessional collaboration and the elegant use of medications in emergency medicine.

Dr. Shah is a professor and vice chair of education for the Emergency Medicine Department at Weill Cornell Medicine. His areas of interest are trauma, medical education, and mentorship. He was the former chair of the SAEM Trauma Interest Group. @kshah74

Cole Ettingoff is a current third-year medical student at Trinity School of Medicine. He is passionate about all things related to social EM, EMS, and public health.

6th Ed

7Ps sequence for RSI: Preparation, Preoxygenation, Physiologic optimization, Paralysis with induction, Positioning, Placement, Postintubation

Table 1. Mnemonics for sequence of initial interventions applicable to trauma patients requiring airway management. ITLS

A Novel DIY Phantom for UltrasoundGuided Arthrocentesis Practice in the Suprapatellar Space

By Sara Schulwolf and Trent She, MD, on behalf of the SAEM Academy of Emergency Ultrasound

Knee pain is a common presenting complaint in the emergency department and is often associated with effusion. Causes of the effusion can vary and include gout, Lyme arthritis, inflammatory arthritis, or, most concerningly, septic arthritis. Obtaining a sample of synovial fluid for testing is crucial for diagnosis, making proficiency in bedside arthrocentesis valuable across multiple disciplines, not just in emergency medicine. Point-of-care ultrasound (POCUS) can improve the success and accuracy of arthrocentesis by identifying the largest fluid pocket

and providing direct visualization of anatomical landmarks and needle movement.

Currently, options for practicing ultrasound-guided knee arthrocentesis are limited. Cadaveric models offer highfidelity simulation but are not always accessible. Commercial phantoms, while available, can be expensive and may exceed the budgets of many departments and medical schools. Therefore, a realistic, low-cost, do-ityourself (DIY) phantom for ultrasoundguided knee arthrocentesis would be beneficial for many learners.

Several potential templates for knee task trainers exist in simulation literature; however, each presents complications that may limit their utility for practicing ultrasound-guided arthrocentesis. Garrett et al developed a task trainer using a prefabricated knee model purchased on Amazon, with a water balloon under the quadriceps tendon to simulate effusion and ballistics gel “skin” on top. While effective for practicing injection via palpation of anatomical landmarks, this model is less applicable to POCUS due to potential air accumulation in the joint space from the

MATERIAL COST

PlayOn Rawhide Bone, 8”

Play-Doh 3-pack

Latex balloons

Boneless pork tenderloin

Big Y premium applewood smoked bacon, 12 oz

Round, flat-ish rock

Rubber band or covered elastic

Yarn, twine, or other string (optional)

Saran wrap or other cling wrap

$6.99 from Pet Supplies Plus, West Hartford CT

$2.99 from Target, West Hartford CT

$1.25 from dollar general

$4.89/lb from Big Y Supermarket, West Hartford CT

$7.68 from Big Y Supermarket, West Hartford CT

Free from Outdoors, West Hartford CT

Free from my bedside table (see also, medical school admissions office), West Hartford/Farmington, CT

Free from my bedside table, West Hartford CT; available for purchase from most craft stores, pharmacies, or supermarkets depending on string type

Free from my parents’ kitchen but available for purchase at most supermarkets, dollar stores, or pharmacies (~$1.25-$4.49)

“Obtaining a sample of synovial fluid for testing is crucial for diagnosis, making proficiency in bedside arthrocentesis valuable across multiple disciplines, not just in emergency medicine.”

loosely covered ballistics gel. McDermott et al. created a scannable knee phantom using a tide pod placed between PVC pipes to create a joint space, covered by strips of bacon to represent overlying musculature and tendons (5). This model produced decent sonographic images but lacked a patella simulator and could not effectively simulate the suprapatellar space or an effusion.

The basis for our novel knee model included an 8-inch rawhide dog bone, Play-Doh, a flat rock, one latex balloon, two strips of thick-cut bacon, and one pork tenderloin. A detailed list of materials is presented in Table 1, with the total cost of one model approximately $2025. Images of the completed model with and without the overlying pork tenderloin are shown in Figures 1 and 2. When scanned longitudinally from distal to proximal with the probe marker directed cephalad, the operator can visualize the curved, hyperechoic patella anteriorly with posterior acoustic shadowing, the quadriceps tendon attaching to its

proximal edge, the linear, hyperechoic femur with posterior acoustic shadowing, and an anechoic region between the patella, quadriceps tendon, and femur representing joint space effusion. Rotating the probe to transverse orientation with the marker to the patient’s right allows visualization of an axial cut of the suprapatellar space, with an effusion lying between the distal femur and patella. A labeled still image of the model in the long axis can be seen in Figure 3. A largegauge, hyperechoic needle can be easily visualized moving through the layers of the model with its movement tracked under ultrasound guidance. A transverse image demonstrating needle tracking within this model is demonstrated in Figure 4.

Two of these models were created and used at a medical student simulation night, attended by approximately 20 students. Both knee models remained intact for the duration of the event, withstanding at least 10 arthrocentesis attempts each. The water balloon effusion

did not require replacement and was found feasible for reinjection after each aspiration.

The primary limitation of this model is its limited shelf-life, requiring refrigeration and personal protective equipment for handling raw meat. Plastic wrap was used to cover the entire model to prevent direct contact with raw materials. Ballistics gel was considered for creating an acoustic window, but the striations within the pork tenderloin and its relative malleability provided optimal fidelity to a human knee. A future version could integrate a thin layer of ballistics gel “skin” over the pork tenderloin to avoid contact with raw meat. Initial concerns about the structural integrity of the rawhide bones were unfounded, as the models held up well and scanned effectively five days after construction. For future iterations, a plastic bone may be considered for the femur. Adding food coloring to the

Table 1: Materials Used to Construct Model and Associated Costs

ULTRASOUND

continued from Page 63

water balloon or using a more viscous liquid such as a cornstarch slurry, olive oil, or pudding could simulate different types of effusion. Alternatively, adding small pebbles or rice granules could potentially simulate a crystalline effusion.

Figure 1: Knee Arthrocentesis Model (labeled) w/o Overlying Pork Tenderloin. KEY: A = rawhide bone; B = Play Doh; C = rock; D = latex balloon filled awaiting assembly

Figure 2: Fully assembled knee arthrocentesis model (unlabeled)

Figure 3: Model viewed on ultrasound in long axis. KEY: C = quadriceps tendon; D = quadriceps muscle; E =

A realistic model of a suprapatellar effusion can be created with pork, dog bones, Play-Doh, and other household items to practice ultrasound-guided knee arthrocentesis. This model can be assembled quickly, stored for several days with proper refrigeration, and used multiple times while maintaining structural integrity. The entire model cost less

than $25 to assemble and required less than an hour to set up.

Instructions for Model Assembly

1. Mold Play-Doh to one of the rounded edges of the dog bone to simulate the meniscus at the distal edge of the femur.

2. Place the rounded rock on top of the Play-Doh to represent the patella.

3. Fill one latex balloon approximately two-thirds full with water. Tie the end of the balloon tightly to prevent air accumulation. Place the balloon on top of the shaft of the bone, just proximal to the rock. This will represent the effusion. The balloon and the rock should be in contact, with the rock resting slightly on top of the balloon if desired.

4. Use ultrasound gel to fill any air spaces remaining between the balloon, rock, bone, and Play-Doh. Additional Play-Doh can also be used to fill gaps.

5. Place two strips of thick-cut bacon longitudinally along the shaft of the dog bone, covering the rock and the water balloon. This will represent the quadriceps tendon. Tuck the edges under the distal aspect of the bone. Secure the proximal edge with a rubber band.

6. Cut a 4- to 5-inch segment of pork tenderloin longitudinally to create a wider piece. Wrap this around the other model components so that

the balloon-rock-bacon apparatus is covered, and the proximal end of the bone is visible. This will simulate the quadriceps muscle and provide an acoustic window. Note: for anatomical correctness, the quadriceps muscle would be placed under the quadriceps tendon; however, for creating an adequate acoustic window and simulating muscle tissue, the model works better if the pork tenderloin is placed over the top of the bacon. Secure tenderloin with a rubber band or piece of yarn.

7. Optional but encouraged: Cover the raw meat components of the model with a layer of plastic cling wrap.

ABOUT THE AUTHORS

Sara Schulwolf is a fourth-year medical and MPH student at the University of Connecticut School of Medicine in Farmington, Connecticut. She is co-president of UConn’s Ultrasound Interest Group and is currently serving as the SAEM RAMS medical student representative. Dr. She is the ultrasound director and ultrasound fellowship director at Hartford Hospital in Hartford, Connecticut. He is an assistant professor at the University of Connecticut School of Medicine.

filled with water; E= bacon; F: pork tenderloin

KEY: A = patella; B = femur; = effusion

Figure 4: Needle tracking through effusion viewed on ultrasound in short axis. KEY: A = femur; B = quadriceps tendon; C = needle (in plane); D = quadriceps muscle; E = effusi

Navigating the Evolving Landscape of Diversity, Equity, and Inclusion

By Adedoyin Adesina, MD, MEd and Cassandra Bradby, MD, on behalf of the SAEM Academy for Diversity, Inclusion, and Equity in Emergency Medicine

The landscape of diversity, equity, and inclusion (DEI) in the United States has undergone dramatic changes over the last few years. The COVID-19 pandemic and the social upheavals following the murder of George Floyd marked a watershed moment for DEI efforts. These crises exposed deep-seated inequities and galvanized widespread support for DEI initiatives. Yet today, we observe a troubling reversal, as numerous legislative actions aim to dismantle the frameworks designed to address these disparities. We have experienced a transition from robust support to resistance against DEI efforts.

“The COVID-19 pandemic and the social upheavals following the murder of George Floyd marked a watershed moment for DEI efforts.”

The onset of the COVID-19 pandemic exposed stark inequalities in health, employment, and education that disproportionately affected minority and underserved populations. While these disparities were not new, the global

scale of the pandemic, its undeniable data, and the prominence of social media — highlighted by cases such as the death of Dr. Susan Moore — made these inequalities impossible to ignore. Institutions across sectors pledged

“It becomes essential to engage in dialogue that bridges ideological divides and fosters an understanding of DEI’s critical role in achieving a just society.”

to address these systemic failings through enhanced DEI initiatives. This led to the creation of DEI positions, the development of curricula on topics such as implicit bias, and the implementation of mandatory DEI-related training. The public's demand for justice and equity reached unprecedented levels, compelling organizations, educational institutions, and businesses to reevaluate their roles in perpetuating systemic biases. Consequently, commitments to DEI became more pronounced as entities sought to rebuild trust and foster inclusive environments.

However, this period of seemingly progressive momentum has now met substantial resistance. In recent times, several state legislatures have proposed or enacted laws that restrict or ban the teaching of critical race theory, limit discussions of gender and sexuality, and curtail various DEI initiatives in education and corporate settings. Many of the jobs created to focus on these endeavors have been abolished, repurposed, or folded into other roles.

This pivot in the DEI discourse from broad institutional support to legislative

suppression reflects deeper societal divisions. The shift underscores a fundamental misunderstanding or dismissal of DEI efforts and what they seek to achieve: creating fair opportunities for all individuals by recognizing and addressing systemic barriers. Furthermore, diversity in representation within the medical community is instrumental to equitable care. The reduction of DEI efforts to politically charged topics, rather than universally beneficial reforms, suggests a troubling departure from a commitment to justice and equity.

As we reflect on this transition, it calls for a deeper exploration of our collective values and the kind of future we wish to build. It becomes essential to engage in dialogue that bridges ideological divides and fosters an understanding of DEI’s critical role in achieving a just society. It is crucial for us to find new strategies to communicate the importance and benefits of DEI initiatives, not only for marginalized groups but for our collective society. We look to a future where the principles of DEI are recognized as foundational to a healthy, thriving society

with widespread policies that ensure these efforts are sustainable and resilient to political and cultural shifts. The work must continue, and the battles must still be fought despite the crashing tide. The views and opinions expressed in this article are those of the author and do not necessarily reflect the official policies, positions, opinions, or views of the Society for Academic Emergency Medicine or its members.

ABOUT THE AUTHORS

Dr. Adesina is an assistant professor of emergency medicine at Baylor College of Medicine and holds the role of associate clerkship director.

Dr. Bradby is the immediate past president of ADIEM and the residency program director at East Carolina University.

July Transitions and Their Impact on Mental Health: A Critical Look at Suicide Risk Among Medical Interns

By Amanda Ritchie, MD; Juliet Jacobson, MD; Joselyn Miller, DO; Vytas Karalius, MD; Rita Manfredi, MD; Amanda Deutsch, MD on behalf of the SAEM Wellness Committee

On July 1, after many years of schooling, 3,026 new interns will introduce themselves as doctors in our specialty for the first time. This new title brings a range of emotions, including anxiety and imposter syndrome. Despite thorough preparation in medical school, the transition remains challenging, and the steep learning curve can feel insurmountable.

Medical training involves several overwhelming transitions: from medical student to resident to fellow to new attending. Recognizing these transitions is crucial for supporting our colleagues.

During the first three months of internship, suicidal ideation increases at least fourfold among interns. By acknowledging and discussing these high-risk periods, we can break through the stigma surrounding mental health, normalize the conversation, and support our interns.

The ACGME conducted an in-depth review from 2000-2014 on the causes of death in residents, revealing that suicide is the second leading cause of death. For male residents, suicide is the leading cause of death, and for female residents, it is second after malignancy.

Seventy-four percent of resident suicides occurred in the first two years of training. Not easy statistics to read. The ACGME review found that 35% of resident suicides occurred between July and September; a previous study found that thoughts of suicidal ideation increased 370% during this period.

Many myths about suicide prevent open discussion, particularly the myth that talking about suicide increases the risk. This concern, known as the Werther effect, contrasts with the Papageno effect, where responsible and purposeful discussions about suicide

“During the first three months of internship, suicidal ideation increases at least fourfold among interns.”

can decrease rates by promoting hope and recovery. Other myths suggest that people who die by suicide are selfish or weak or that someone with a seemingly perfect life isn’t at risk. Unfortunately, it is difficult to identify those contemplating suicide.

As physicians, we are inherently at risk of dying by suicide. The Joiner Theory explains this with three overlapping factors: thwarted belongingness, perceived burdensomeness, and the capacity to carry out the action. Fostering belongingness can help prevent suicide among our colleagues. Identifying trainees who may not show obvious signs of distress is critical to uncovering those in the early stages of suicidal ideation, preventing the worst-case scenario: physician suicide.

During the first few months of intern year, senior residents, program

leadership, and attendings must prioritize supporting new interns and those who have recently taken on new roles and responsibilities. During these transition periods, it is not surprising that interns experience feelings of insecurity, selfdoubt, and imposter syndrome. Some residents may turn to alcohol use to cope. This is a critical time when support from program leadership and coworkers can save lives.

Strategies Program Leadership

During orientation, include information about mental health and available resources. Openly discuss the increased risk of suicide during the first three months of intern year, which remains a risk throughout their careers. Consider an open-door policy to reduce the stigma of mental health issues. Implement an opt-out counseling program in the

curriculum and develop a peer support team of residents. These initiatives, along with a supportive leadership culture, show that discussing these topics is safe, acceptable, and normal.

Attendings

Recognize an intern’s effort, compassion, and dedication to learning new skills to foster a safe learning environment. Provide positive feedback alongside constructive criticism to nurture a safe, supportive, and rewarding learning environment. As an attending, model the behavior you wish to pass on. Normalize speaking up, discussing challenging cases, and addressing the emotions tied to our careers.

PGY2-4s

Regularly check in with junior residents

“Fostering belongingness is one way to help prevent suicide in our colleagues.”

WELLNESS

continued from Page 69

and interns. Use the “double tap” method when asking how they’re doing; it’s easy for them to say, “I’m okay.” However, asking again—“No, really, how are you doing?”—and truly listening to their response can foster connection and reveal deeper issues. If there isn’t a formal peer mentorship program, consider developing one with the chief residents or program leadership to ensure all interns have someone to turn to. Some programs have residency families for informal mentorship.

PGY-1s

Check in with your new coworkers. No one understands what you’re going through better than someone going through it with you. Your senior residents remember being interns and are great resources. As an intern, you are not alone. Reach out to the many available resources at the program or national level if needed.

Takeaways

• Stop the stigma of mental health and suicide through open discussion.

• July is a critical time for transitions, with the first three months of intern year posing a higher risk of suicide

National Resources

Dr. Lorna Breen Heroes Foundation

Established in memory of Dr. Lorna Breen, a former emergency medicine physician who died by suicide during the COVID-19 pandemic. The foundation advises on wellness initiatives, raises awareness to combat mental health stigma, and funds research and programs aimed at reducing physician burnout and improving well-being.

988 Suicide and Crisis Hotline: Available 24/7 in the U.S. by calling 988 or visiting their website.

National Suicide Prevention Hotline

A 24/7 confidential crisis hotline available in the U.S. by calling 1-800-273-TALK (8255).

Physician Support Line

A confidential, free peer support line staffed by volunteer psychiatrists. Stop the Stigma EM

An initiative by emergency medicine organizations to educate, normalize, and challenge the mental health stigma faced by EM physicians. Participate in the third Stop the Stigma EM month in October.

• Provide resources in common areas such as break rooms, resident rooms, or even on desktops, and ensure they are routinely updated.

• Develop programs like opt-out counseling built into the curriculum to ensure a longitudinal practice of wellbeing and support.

ABOUT THE AUTHORS

Dr. Ritchie is an internal/ emergency medicine resident at Louisiana State University in New Orleans

Dr. Jacobson is an emergency medicine resident at New York Presbyterian-Cornell/Columbia and a member-at-large on the SAEM Resident and Medical Student (RAMS) Board

Dr. Miller is an emergency medicine resident at The University of Connecticut

Dr. Karalius, is a medical education fellow and clinical instructor at Stanford University. @VytasKaralius

Dr. Manfredi is a professor of clinical emergency medicine at The George Washington University of Medicine and Health Sciences. She is coeditor of “From Self to System: Being Well in Emergency Medicine.”

Dr. Deutsch is director of well-being at Thomas Jefferson Emergency Medicine. @amandajdeutsch

WILDERNESS & SPORTS MEDICINE

Ultramarathons: Testing Human Limits – The Sport, Its Risks, and Medical Ethics

By Eric Macaluso, DO, on behalf of the SAEM Wilderness Medicine Interest Group

What is an Ultramarathon?

An ultramarathon is any footrace longer than a marathon (26.2 miles or 42.195 km).

Who Runs Ultramarathons?

Thanks to social media, websites like ultrasignup.com, and a society increasingly drawn to extreme sporting events, more people than ever are participating in ultramarathons. Participants range from experienced runners and sponsored athletes to individuals with little or no running experience seeking a new challenge. In 2018, over 600,000 people ran an ultramarathon, representing a 1,676% increase in participation since the late 1990s. This number has only continued to grow.

What Happens When Ultramarathons Go Wrong?

In May 2021, the Gansu Ultramarathon disaster in Gansu, resulted in the deaths of 21 runners (12% of the total field) from hypothermia, with another eight hospitalized during the 62-mile (100 km) race in a remote mountain region. These were not inexperienced athletes; participants had to have previously completed another ultramarathon or finished two marathons. Multiple highlevel and well-known Chinese distance runners perished during this race.

The cause of the deaths is debated, but most attribute it to a combination of poor planning by local organizers, atypical weather for the season, too few aid stations and monitors, underdressed

runners, and slow medical response time due to the race’s remoteness. While the Gansu Ultramarathon was unique in its scale of tragedy, it is not the only deadly ultramarathon. Deaths have increased during ultras due to the growing number of participants and the inclusion of less experienced athletes, with sudden cardiac arrest being the most predominant cause of death.

Are There Any International Regulations Governing Ultramarathons?

No. Unlike other organized marathons or Olympic running, there is no centralized set of rules or governing body overseeing all ultramarathons. The primary global governing body for

“In 2018, over 600,000 people ran an ultramarathon, representing a 1,676% increase in participation since the late 1990s.”

ultramarathon running is the International Association of Ultrarunners (IAU), which operates under World Athletics (formerly known as the IAAF). They set the rules and regulations for various types of ultramarathon events, including road races, trail races, and track races. However, many races still operate with their own set of rules and regulations.

This lack of uniformity can lead to events that seem to place safety as an afterthought, purposely pushing human physiology to its limits. For instance, the Badwater Ultramarathon, a 135-mile (217 km) race, takes place in mid-July in Death Valley, one of the hottest places on earth, with temperatures reaching as high as 127°F (53°C) during races

Are There Any Accepted Universal Medical Guidelines for Ultramarathons?

There are no specific or universal standards of medical care for ultraendurance foot races due to the vast differences in weather, available resources for emergency transportation, distance to definitive care, number of participants, and number of spectators, among other variables. Dr. Martin Hoffman and his team addressed the coverage of these events in their paper, “Medical Services at Ultra-Endurance Foot Races in Remote Environments: Medical Issues and Consensus Guidelines.” They discuss common ailments that can occur during an ultramarathon, such as hyponatremia, heat stroke, and acute kidney injury (AKI), and provide guidance on recognizing and treating these conditions.

Ethically, Should Physicians Be Volunteering or Working at Ultramarathons?

Ultramarathons are inherently dangerous, even under perfect weather conditions and with proper training, due to the

extreme stress they place on the human body. Given the nature of these races and the fact that medical professionals take the Hippocratic or Osteopathic Oath, pledging to do no harm and to preserve the health of their patients, ethical questions arise regarding the participation of medical professionals.

Does a physician’s or medical personnel’s presence encourage participation in extreme sporting events that might otherwise be avoided?

Possibly. While no specific peer-reviewed studies seem to address this question directly, it is conceivable that the presence of medical personnel could enhance participants’ perception of safety and encourage their participation if they were previously unsure.

Would runners participate in ultramarathons without medical personnel present?

Yes, people engage in extreme sports regularly without the presence of physicians or medical providers. Does having medical providers at extreme sporting events save lives? Yes. Rapid medical intervention at sporting events can be life-saving, for instance, quickly recognizing and treating heat stroke

Do medical professionals overall cause more good than harm by being at an ultramarathon?

I would argue yes. I’ve spoken with sports medicine physicians who believe that attending certain sports events, such as nonsanctioned mixed martial arts fights, is unethical or falls into a gray zone because their presence might validate and encourage participation in these dangerous activities. Could the same reasoning apply to ultramarathon races like the Badwater 135, which takes place in Death Valley in the summer, or the Habanero Hundred, which purposely occurs at high noon in August in Texas? One could argue yes; however, the potential encouragement is outweighed by the crucial help medical providers offer as humans continue to push their limits.

ABOUT THE AUTHOR

Dr. Macaluso will be a first-year resident in the Crozer Health Family Medicine Residency Program. He has a special interest in wilderness and sports medicine. Email: emacaluso98@gmail.com

David Goggins running Badwater Ultramarathon in 2007. Photo Credits: US NAVY- Mass Communication Specialist Seaman Brandon Rogers

SAEM Foundation and Its Donors: Transforming Emergency Care Together

SAEM Foundation (SAEMF) is the largest private foundation for research and research training in emergency medicine. Established in 2008, our net assets are over $12 million. This is why we are able to boldly invest nearly $1 million in the best and brightest academic emergency medicine researchers and educators each year. Our grants, fully supported through generous Annual Alliance donors, have a career-defining impact on aspiring researchers by funding their work at a critical stage that prepares them to compete for funding. A donation to SAEMF is a truly transformational investment in emergency care:

• Each $1 donated leads to $3 in subsequent funding from federal and other sources.

• One hundred percent of annual fund gifts received are directed to clinical, translational, and education research with a singular mission focus and an efficient operation and network supported by SAEM.

• Together, SAEM and SAEMF have awarded nearly $13.5 million in grants to more than 570 academicians.

Learn how SAEMF is investing in the science, innovation, and future leaders that emergency medicine needs.

Watch SAEM Foundation's new video and discover the power of investing in the future of emergency medicine. From driving groundbreaking research to nurturing the next generation of academic emergency medicine research and education leaders, SAEMF and its donors make a truly transformative impact. Let's take the next steps to transform emergency care together. Donate

SAEMF is grateful to the donors below for their support through the Annual Alliance. These visionary donors make it possible for SAEMF to invest close to $1 million each year in emergency medicine’s future researchers and leaders. To join them, visit www.saem.org/alliance for details, then donate or email us at foundation@saem.org

Thank You! 2024 Annual Alliance Donors

Enduring Donors

Sustaining Donors

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Dickson,

Advocate Donors

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— In honor of William G. Baxt, MD

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Mentor Donors

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Your support is not only a donation, it is an investment in the future of emergency care. Check out our Donor Guide to learn more about how your donation makes a transformational impact.

Robert Eisenstein, MD

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Young Professionals

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Ray Fowler, MD

Caroline Freiermuth, MD, MHS

Fiona E. Gallahue, MD

Stephanie C. Garbern, MD, MPH

— In honor of Beatrice Garbern

Romolo J. Gaspari, MD

Michael A. Gisondi, MD

Elizabeth M. Goldberg, MD, ScM

Lewis R. Goldfrank, MD

Joshua Goldstein, MD

Chris Goode, MD

Kelly Goodsell, MD

Colin F. Greineder, MD, PhD

Shayne Gue, MD, MSMEd

Nick Hartman, MD, MPH

Braden Hexom, MD

Katherine Hunold Buck, MD, MPH

Meagan Hunt, MD

Laura Iavicoli, MD

Andy S. Jagoda, MD

Laura Janneck, MD, MPH

Annahieta (AK) Kalantari, DO, MEd

Matthew T. Keadey, MD

Diann M. Krywko, MD

Nancy Kwon, MD, MPA

— In memory of my brother, John S. Kwon

Ryan LaFollette, MD

Eve D. Losman, MD, MHSA

Joshua Lupton, MD, MPH, MPhil

Alex F. Manini, MD

Dan Mayer, MD

Anthony S. Mazzeo, MD

Danielle M. McCarthy, MD, MS

Anne M. Messman, MD, MHPE

Cori McClure Poffenberger, MD

Jonathan McCoy, MD

Jolion McGreevy, MD, MBE, MPH

Colleen McQuown, MD

Sudave Daniel Mendiratta, MD

Philip A. Mudd, MD, PhD

Jessie G. Nelson, MD

Kat Ogle, MD

Ronny Otero, MD, MSHA

Scott Pasichow, MD

Ryan Pedigo, MD, MHPE

Heather Marie Prendergast, MD, MS, MPH

Christian D. Pulcini, MD, MEd, MPH

Yanina Purim-Shem-Tov, MD

Elaine Rabin, MD

Neha Raukar, MD, MS

Michael Redlener, MD

Lynne D. Richardson, MD

Anthony Russell Rosania, III, MD

Carlo Rosen, MD

Amber Sabbatini, MD, MPH

Basmah Safdar, MD, MSc

Rama A. Salhi, MD, MHS, MSc

Kinjal Nanavati Sethuraman, MD, MPH

Jeff Siegelman, MD

Matthew Strehlow, MD

Stacy A. Trent, MD, MPH

Andrej Urumov, MD

Laura Walker, MD MBA

Mary Jo Wagner, MD

Bjorn C. Westgard, MD, MA

Dustin Blake Williams, MD

Stephanie Williford

Ashlea Danielle Winfield, MD

Brian Yun, MD, MBA, MPH

Milana Zaurova, MD

Wesley Zeger, DO

Xiao Chi Zhang, MD, MS

Residents

Anonymous (1)

Alison Bonner, MD

Emily Cloessner, MD, MSPH

Aaron D'Amore, MD

John Dickens, MD, MBA

Hart Edmonson, MD

Juliet Jacobson, MD

Daniel N. Jourdan, MD

Daniel Keyes, MD, MPH

Mit Patel, MD

Genevieve Pentecost, MD

Giovanni Rodriguez, MD

Medical Students

Stephanie Balint

Sara Schulwolf

As of June 28, 2024

We are also grateful to our Additional Donors and staff who contributed this year. See the full Annual Alliance Donor list online. If your name was omitted from this list, or, if it is incorrectly listed, we apologize and ask that you contact jwolfe@saem.org.

Who will win the 2024 Academy, Committee, Interest Group Challenge?

The annual SAEM Foundation (SAEMF) Challenge is underway! YOUR gift or pledge to SAEMF by August 31 will help your Academy, Committee, or Interest Group rise to the top.

Donate!

saem.org/donate

Winning groups will receive:

Bragging rights for a year!

A special treat at your group meeting during SAEM25

Recognition as the 2024 Challenge champions in SAEM communications

Challenge donors will also be recognized as Annual Alliance Donors

Thanks to generous SAEM members, many of whom are Challenge donors, SAEMF invested close to $1 million in the research and career development of its 2024-25 research and education grantees. Let’s take the next step to transform emergency care together – become an SAEMF Challenge donor today at saem.org/donate.

“I am so grateful for the grant I received from SAEMF. It allowed me to help jumpstart my research looking at the clinician workforce. Since my initial pilot award from SAEMF, I’ve subsequently gone onto obtain two separate R01 grants from NIH related to clinician psychological and cardiovascular health. The funding allowed me to work with a number of mentees and other trainees passionate about this area. I am grateful for the support from SAEMF and its supporters!”

Bernard P. Chang, MD, PhD Columbia University Medical Center, Associate Dean of Faculty Health and Research Career Development Vice Chair of Research, Tushar Shah and Sara Zion Associate Professor of Emergency Medicine

BRIEFS & BULLET POINTS

SAEM NEWS & INFO

Announcing the Winners of the SAEM24 FOAMed Showcase!

During the SAEM24 FOAMed Showcase this past May in Phoenix, social media innovators and Free OpenAccess Medical Education (FOAMed) content creators presented their most groundbreaking work from the past year. Two participants stood out, impressing both the audience and a panel of judges. We are excited to announce the winners of the SAEM24 FOAMed Showcase:

Overall Winner: UPAndo Latinoamérica

UPAndo Latinoamérica, a collaborative project, has been recognized as the overall winner for their exceptional work in producing open-access educational materials in Spanish. These resources cover various aspects of point-of-care ultrasound (POCUS) for emergency medicine, primary care, and prehospital settings. Their efforts are instrumental in promoting the integration of POCUS into medical practice across Latin America, ensuring just and dignified health care for all.

To celebrate their well-deserved victory in our social media competition, the UPAndo Latinoamérica team will take over the SAEM X/Twitter channel on Saturday, July 20, 2024. Join us to explore their impressive resources and learn more about their impactful work. Don’t miss this exciting event!

Contributors:

• Mandeep Dhillon, MD

• Reyna Huerta Sanchez, MD

• Eva Tovar Hirashima, MD, MPH

Live Event Winner: Continuing Medical Education on Stick (CMES)

Developed by Techies Without Borders, Continuing Medical Education on Stick (CMES) won the Live Event category for their innovative approach to delivering free, high-quality continuing medical education in low-resource settings. By overcoming internet and electricity barriers through a low-cost information technology solution, CMES is leveling the playing field in knowledge accessibility, making a significant difference in medical education.

Contributors:

• Jessica Pelletier, DO

• Manoj Thomas, PhD, MBA, MS

• Yan Li, PhD

• Emily Cloessner, MD, MSPH

• Nicholas Maxwell, MD

• Vera Sistenich, MA, MPH

• Bethel Mwenze, EMT-P

• Deb Stoner, MD

Explore the New and Improved SAEM

Community!

The new and improved SAEM Community offers a more engaging, userfriendly experience with features like a central social feed and easy links to post messages, access directories, and join groups. Navigate effortlessly with our new menu and quick tools, making it simple to find resources and stay updated. The same features you love, like email notifications, are still here. Visit the “About SAEM Communities” page for FAQs, and contact us at saem@saem.org for more info. Explore and collaborate with your EM peers today.

Join an

Academy or Interest Group and Connect With Others Who Share Your Interests

SAEM members who wish to explore a specific specialty area are encouraged to join one or more SAEM academies or interest groups. SAEM academies provide a forum for members to network, exchange information, collaborate on educational initiatives, develop policy, perform research, and provide faculty development pertaining to their area of special interest or expertise. SAEM interest groups provide a mechanism for members interested in a specific topic or specialty area to meet, share ideas and network in an unstructured and informal fashion. Membership in SAEM academies and interest groups is 100% free!

Join SAEM in Embracing Diversity: Update Your

Member Profile

Today! At SAEM, we champion diversity, recognizing its profound value in shaping our organization, enriching patient care, and advancing academic emergency medicine. In 2019, we launched the SAEM Equity and Inclusion Scorecard, a vital tool ensuring our commitment to diversity remains steadfast. To ensure the scorecard accurately reflects results and progress, we need your help! Check your inbox for a personalized link to complete your confidential demographic form. Have questions? Contact us at governance@ saem.org. Your input fuels our progress as we strive to enhance membership, leadership, volunteerism, and recognition across all demographics. Thank you in advance for your participation.

FOR RAMS

RAMS! Join Us for the Virtual Residency & Fellowship Fair

There's still time to sign up for the 2024 Virtual Residency & Fellowship Fair (RFF), to be held July 22-25, 2024. Meet online with representatives from top residency and fellowship programs from around the country — all waiting to talk to you about their programs and give you advice to help you with the application process. The RFF is free for residents and medical students, so take advantage of the

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opportunity to sign up and visit with as many programs as your time allows.

Program directors! There’s still time to maximize your recruitment efforts with this streamlined, cost-effective program. Don’t miss out — register your program today!!

REGIONAL MEETINGS

Register for Free for the July 13

Southeastern Regional

There’s still time to register for the SAEM Southeastern Regional Meeting, to be held Saturday, July 13, 2024, at the University of Central Florida Student Union in Orlando, Fla. The meeting will provide emergency medicine residents and faculty the opportunity to present their research and scholarly activity in a forum that will foster development and productivity within emergency medicine. The meeting will feature a variety of e-poster sessions, an “EM Madness” competition, top abstracts presentation, and a keynote address from SAEM Board Member Julianna Jung, MD, MEd. Registration is free! (Information on hotel accommodations coming soon!)

SAEM JOURNALS

Special Issue of AEM E&T: Proceedings From the SAEM 2023 Annual Meeting

A special issue of AEM Education and Training (AEM E&T) highlighting proceedings from SAEM23 in Austin, Texas, is now available. The issue

includes conceptually based white papers from SAEM academy, committee, and interest group members that share cutting-edge ideas and concepts relevant to education and training. (Note that SAEM member login is required to access journal content.)

Call for submissions! AEM E&T invites submissions from SAEM academies, committees, and interest groups for a special SAEM24 proceedings issue, to publish in early 2025.

SAEM Publishes Guideline for Treatment of Nonopioid Use Disorders in the Emergency Department

Published in the May issue of Academic Emergency Medicine journal, Guidelines for Reasonable and Appropriate Care in the Emergency Department (GRACE-4): Alcohol Use Disorder and Cannabinoid Hyperemesis Syndrome Management in the Emergency Department focus on alcohol withdrawal syndrome, alcohol use disorder, and cannabinoid hyperemesis syndrome. With rising ED visits due to heavy drinking and cannabis use, the guidelines offer evidencebased, patient-centric approaches for evaluation and management. Despite limited evidence, SAEM’s diverse panel used Grading of Recommendations Assessment Development and Evaluation (GRADE) methodology to formulate recommendations. Addressing a critical gap in nonopioid use disorder treatment, SAEM GRACE-4 joins the series of SAEM GRACE guidelines.

SAEM EDUCATIONAL COURSES

3 Courses to Enhance Your Skills and Leadership in EM

Whether you’re focused on research, department leadership, or administration, these opportunities will equip you with the knowledge and mentorship needed to excel in your career.

• Advanced Research Methodology Evaluation and Design (ARMED): For junior faculty, fellows, and senior residents, ARMED provides essential skills in designing research projects and grant proposals, with workshops and

monthly webinars on research design, grant writing, and career development. Scholarships available. Application deadline: July 31

• Chair Development Program (CDP): Open to new and aspiring academic EM department chairs, CDP offers leadership training through in-person and virtual sessions led by experienced professionals. Attend all sessions for an AACEM certificate. Scholarships available. Application deadline: July 31

• Certificate in Academic Emergency Medicine Administration (CAEMA): The CAEMA program educates professionals in academic EM administration, covering academics, human capital, personal development, and practice operations. Email caema@ saem.org for details.

Opening August 1!

• Advanced Research Methodology Evaluation and Design: Medical Education (ARMED MedEd)

• Emerging Leader Development Program (eLEAD)

SAEM WEBINARS

Add These Webinars to Your Watch List!

SAEM offers live and recorded webinars covering a variety of emergency medicine topics, providing an excellent opportunity to stay current and learn from your colleagues. Register soon for these upcoming webinars and check back frequently for updates:

• Biostats Made Simple: Session 1, July 16

• SAEM RAMS Mentorship Opportunities, July 18

SAEM FOUNDATION (SAEMF)

Accepting Applications for SAEMF Grants

The SAEM Foundation (SAEMF), in partnership with SAEM, provides grants to national and international universities and medical schools to help fund innovative research and education initiatives in the field of emergency medicine. In order for a project to be eligible for funding, it must fit into the scope of one of the grant categories listed below and must support the mission of SAEM and the SAEMF. The application deadline is 5 p.m. CT on August 1, 2024:

• Research Training Grant (RTG)$300,000

• Research Large Project Grant (LPG)$150,000

• Education Research Training Grant (ERG) - $100,000

• SAEMF Emerging Infectious Disease and Preparedness Grant - Up to $100,000

• SAEMF/ED Benchmarking Alliance Clinical Operations Research Grant$50,000

• SAEMF ARMED Pilot Grant - $25,000

• SAEMF ARMED MedEd Pilot Grant$25,000

• Education Project Grant (EPG)$20,000

• Geriatric Emergency Medicine Research Catalyst Grant, Supported by Michelle Blanda, MD - $10,000

• SAEMF/Clerkship Directors in Emergency Medicine (CDEM) Innovations in Undergraduate Emergency Medicine Education Grant - $5,000

• MTF/SAEMF Toxicology Research Grant - $20,000

• SAEMF/Academy of Emergency Ultrasound (AEUS) Research Grant$10,000

• SAEMF/Global Emergency Medicine Academy (GEMA) Research Pilot Grant - $10,000

• SAEMF/Academy for Women in Academic Emergency Medicine (AWAEM) Research Grant - $10,000

• SAEMF/Simulation Academy Novice Research Grant - $5,000

• SAEMF/Academy for Diversity and Inclusion in Emergency Medicine (ADIEM) Research Grant - $6,000

• SAEMF/Resident and Medical Students (RAMS) Research Grant - $2,500$5,000

For more information visit What We Fund.

Congratulations to the 2024-25 SAEMF Grants Committee Resident Reviewers

The Resident Reviewer Program (RRP) is an indispensable way for residents to gain insight into the grant review process. RRP participate in the grant review process,

receive mentorship on evaluating and scoring grants, and have the opportunity to participate in other SAEM Grants Committee meetings and objectives. SAEMF is pleased to announce the 202425 SAEMF Resident Reviewers of the SAEM Grants Committee:

• Manoj Arra, MD

• Brigid Garrity, MD

• Thomas Hagerman, MD

• Patricia Hernandez, MD

• Brunda Lakshmish Kumar, MD

• Mustfa Manzur, MD

• Matthew Matlock, MD, PhD

• Cora Ormseth, MD

• Sarah Oworinawe, MD

• Caroline Raymond-King, MD

• Aria Shi, MD

Interested in participating on the Grants Committee as a Resident Reviewer?

Mark your calendar to apply at SAEMFoundation.org in early February 2025.

Apply for NIDA Mentor-Facilitated Training Award

The SAEMF-sponsored NIDA MentorFacilitated Training Award offers a $10,000 stipend for awardees and a $2,000 stipend for mentors. This program supports early career investigators in substance use disorder (SUD) research, particularly opioid use disorder (OUD), through a mentorsupervised project. Learn more and apply by September 30, 2024

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SAEM MEMBER RESOURCES

Announcing the SAEM EM Mentorship and Pathway Program Directory

The SAEM EM Mentorship and Pathway Program Directory is a comprehensive resource aimed at strengthening the emergency medicine pipeline. Curated by the All Emergency Medicine Diversity, Equity, and Inclusion (DEI) Task Force, the directory supports underrepresented minority students with clinical training, mentorship, career webinars, hands-on experience, and networking. Programs range from virtual workshops to innovative e-mentoring and partnerships, offering continuous support from elementary school to medical school. These initiatives aim to eliminate health care disparities and foster the next generation of diverse health care professionals. Submit your program for inclusion today!

The SAEM Career Roadmap Helps You Navigate Your Academic EM Career

The SAEM Career Roadmap is your

essential companion for navigating the diverse landscape of academic emergency medicine careers. Tailored for individuals at every stage of their professional journey — from chairs and faculty to administrators, fellows, residents, and medical students — this comprehensive guide illuminates the array of tools and resources SAEM offers. From leadership opportunities and specialized courses to networking events, grants, scholarships, and prestigious awards, the roadmap equips you with invaluable insights and connections to propel your career forward.

Introducing Neuro-EM Scholars: A Career Development Program for EM Research in the Neurological Sciences

Created in collaboration with the National Institute of Neurological Disorders and Stroke (NINDS) at the National Institutes of Health (NIH), this innovative K12 program, developed by the Office of Training and Workforce Development, aims to recruit, mentor, and train early-career emergency

medicine faculty in neurological disorder research. Additionally, the Neuro-EM Scholars Pipeline Program supports early career investigators, promoting diversity and enhancing participation from underrepresented backgrounds. SAEM’s proactive approach and strategic alliances in achieving this milestone marks a pivotal moment in EM research, ensuring progress and innovation in the field. Visit the NeuroEM Scholars website for additional details and to subscribe to program updates.

An Essential Guide for New Emergency Medicine Researchers

The Roadmap to Emergency Medicine Research Funding, developed by the SAEM Research Committee, simplifies the process of applying for research funding, specifically designed for new researchers. Explore opportunities from departmental and institutional sources, foundational funding in emergency medicine, National Institutes of Health (NIH) grants, and other federal funding beyond NIH. Empower your research journey with this comprehensive resource.

SAEM CONSULTATION SERVICES

Call on our expert consultants to help improve your practice

SAEM Academy Executive Committees 2024-2025

SAEM is pleased to announce your academy executive committees for 2024-2025. Congratulations to these newly elected academy leaders who were installed at SAEM24 in Phoenix, Ariz. in May.

Academy of Administrators in Academic Emergency Medicine (AAAEM)

• President: Becky McGowan, MBA

• President-Elect: Jennifer Patton Muir, EdD, MBA

• Treasurer: Stephen G. Maxwell, MSM

• Secretary: Brendan Russell, MBA

• Immediate Past President: David Christiansen, MBA

• Member-at-Large: Diane C. Lee, DBA, MBA

• Member-at-Large: Kashwayne Williams, MBA, MHA Academy for Diversity and Inclusion in Emergency Medicine (ADIEM)

• President: Katrina A. Gipson, MD, MPH

• President-Elect: Sreeja (Sree) Natesan, MD

• Secretary-Treasurer: Ryan Ellis Tsuchida

• Immediate Past President: Cassandra Kim Bradby, MD

• Members-at-Large: Eliot Blum, MD; Moises Gallegos, MD, MPH; Tiffany Mitchell, MD

• Development Officer: Melanie F. Molina, MD, MAS Academy of Emergency Ultrasound (AEUS)

• President: Petra Duran-Gehring, MD

• President-Elect: Meera Muruganandan, MD

• Treasurer: Andrew Goldsmith, MD, MBA

• Secretary: Maya Lin, MD

• Immediate Past President: Christopher Thom, MD

• Research Officer: Youyou Duanmu, MD, MPH

• Education Officer: Jason Arthur, MD, MPH Academy of Geriatric Emergency Medicine (AGEM)

• President: Katie Hunold Buck, MD

• President-Elect: Kei Ouchi, MD, MPH

• Treasurer: Fernanda Bellolio, MD, MS

• Secretary: Surriya Colleen Ahmad, MD

• Immediate Past President: Elizabeth M. Goldberg, MD, ScM

• Members-at-Large: Anita N. Chary, MD, PhD; Angel Li, MD; Cameron Gettel, MD, MHS; Rachel Michelle Skains, MD, MSPH

• Resident Representative: Lily Berrin, MD

• Medical Student Representative: Erin Hunt Academy for Women in Academic Emergency Medicine (AWAEM)

• President: Amy Zeidan, MD

• President-Elect: Margaret Samuels-Kalow MD, MPhil, MSHP

• Treasurer: Amy F. Hildreth, MD, MHPE

• Secretary: Laura Walker, MD, MBA

• Immediate Past President: Kathleen “Kat” Ogle, MD

• Vice-President of Membership: Taylor Stavely, MD

• Vice-President of Education: Jennifer Love, MD

• Vice-President of Communications: To be Appointed by the AWAEM Executive Committee

• Vice-President of Corporate Development: Ynhi Thomas, MD, MPH, MSc

• Resident Member: Kellie LeVine, MD

Clerkship Directors in Emergency Medicine (CDEM)

• President: Keme Carter, MD

• President-Elect: Amy Cutright, MD

• Treasurer: Alejandro Palma, M

• Secretary: Bradley S. Hernandez, MD

• Immediate Past President: Joseph B. House, MD

• Members-at-Large: Jennifer Carey, MD; David Tillman, MD; Navdeep Sekhon, MD; Jose V. Nable, MD

Global Emergency Medicine Academy (GEMA)

• President: Stephanie Chow Garbern, MD, MPH, DTM&H

• President-Elect: Megan Rybarczyk, MD, MPH

• Treasurer: John Austin Lee, MD, MPH

• Secretary: Torben “Tom” Becker, MD, PhD

• Immediate Past President: Naz Karim, MD, MHA, MPH

• Members-at-Large: Sonya Naganathan, MD, MPH; Katie Wells, MD, MPH

• Medical Student/Resident Representative: Kaitlin Rose

• Development & Grants Officer: Florian Schmitzberger, MD, MS

• IT Chair: Vinay Kampalath, MD, DTM&H

• Program Committee Liaison: Emma Cortes, DO

Simulation

• President: Suzanne (Suzi) Bentley, MD, MPH

• President-Elect: Tiffany Moadel, MD

• Treasurer: Michael S. Hrdy, MD

• Secretary: Tina Chen, MD

• Immediate Past President: Sara M. Hock, MD

• Vice President of Membership: Stephanie Cohen, DO

• Vice President of Research/Scholarship: Stephanie N. Stapleton, MD

• Vice President of Social Media & Communication: Aga De Castro, MD, MPH

• Vice President of Education: Julie Rice, MD

• Fellows: Andrew Melendez, DO; Salil Phadnis, MD

SAEM REPORTS

ACADEMIES

Academy of Emergency Ultrasound

Updates and Insights From AEUS Innovation Competition Winners

The Academy of Emergency Ultrasound (AEUS) called for entries in the fall of 2023 for its AEUS Innovation Competition. AEUS members were invited to submit cutting-edge advancements in emergency ultrasound. Awardees receive a scholarship based on demonstrated need to help cover the initial costs of implementing their ideas. The aim of these projects is to promote emergency ultrasound education, showcase innovation, foster collaboration and professional development among ultrasound educators, and support research in point-ofcare ultrasound (POCUS) innovation. This year, AEUS awarded four individuals for their innovative ideas. We caught up with them to see the progress of their projects six months later. We hope these innovative ideas inspire you to consider how to advance education and research in the field of ultrasound.

Development of a POCUS Social Media Platform

Gabriel Siegel, MD, resident at Denver Health

“Our vision was to build the first ultrasound social media platform and utilize the images in our library for image-based machine learning. With the generous funding from AEUS, we have completed multiple stages of development. We hired a logo designer and created the Probe logo. We planned the functionality of the Probe application as a social media platform. Additionally, we hired a user interface (UI), user experience (UX) designer, and a front-end developer to design the user interface of the Probe mobile application. We have completed the initial UI/UX design and are now seeking additional funding to finalize the UI/UX design and development of the Probe mobile app.”

3D Printed Ultrasound Guided Central Line Trainer

Michael Fareri, MD, Ultrasound Fellow at Thomas Jefferson University Hospital

“Our end goal is to use 3D printed silicone to create a higher fidelity, reproducible central venous access training model. Our first iteration was a model made entirely of the new silicone material. However, this proved too dense to transmit the ultrasound waves adequately, so we pivoted to using the 3D printed silicone to form the vessels and a “skin.” We conducted several rounds of testing different poured materials around the vessels to find the combination that looked the best under ultrasound. Our most recent step was transitioning from straight “veins” to a model that had an anatomically accurate common carotid artery and internal jugular vein. The Jefferson Health Design Lab modeled the vasculature based on their previous work with the department of Otolaryngology, using CT scans of the neck. Despite the need to slightly change the direction of our project, our original goal is still within reach. With the material specifications now optimized, the Design Lab can print different

model variations to simulate anatomic variation and patient size differences. Future directions may include other central access sites, such as the subclavian vein which could include a 3D-printed clavicle. Additionally, the silicone provides a slight tactile resistance with needle entry that recreates the feel of puncturing skin and vessel wall in a more accurate way compared to many commercially available trainers.”

AI-enhanced Needle Tip Tracking in Ultrasound-Guided Intravenous Access

David Chu, MD, Ultrasound Fellow at Harvard Massachusetts General Brigham

“My project involves developing a deep learning (DL) algorithm to aid in ultrasoundguided peripheral IV (USIV) placement by automatically localizing and tracking the needle tip and secondary subcutaneous tissue deformation in short-axis view POCUS clips. Initially, we planned to use animal tissue simulation models, such as pork models, to gather, process, and annotate USIV placement clips for training the algorithm. However, due to inadequate anatomical similarity between pork models and human tissue, we transitioned to using Blue Phantom gel blocks.

We gathered 742 clips showing needles entering gel blocks of various gauges and depths. Currently, we are using a YOLOv8 model and have tested it on about 13,000 annotated images extracted from these gel block clips. In parallel, we are developing an auto-labeling feature to optimize the efficiency of the remaining deep learning (DL) training process. Following this, we will assess the DL algorithm’s performance on a separate set of gel block clips that were previously unseen by the algorithm, comparing its ability to detect the needle tip and track subcutaneous tissue movement against the performance of human providers.

The final step involves testing this DL algorithm on real clips of ultrasound-guided intravenous placement in patients undergoing routine clinical procedures.”

POCUS Best Practices in the Street Medicine Setting

Jack Spartz, MD, resident at Denver Health

“For my project, I am assessing the potential impact of point-of-care ultrasound (POCUS) on the practice of street medicine. While some street medicine programs utilize ultrasound, there are currently no formal recommendations regarding its scope of practice in this setting. Furthermore, there are no established best practices for sustainable implementation of ultrasound in street medicine programs.

Our initial project phase involved evaluating the utility of POCUS for clinical decision making and addressing challenges around performing POCUS on the street and in the outdoor elements. I have been using POCUS during street medicine outreach with a team from Stout Street Health Center in Denver. We receive real-time quality assurance from an attending physician at Denver Health through our Butterfly cloud system. Notable challenges identified include limited visibility on small phone screens, especially under sunlight, patient discomfort due to cold temperatures, and difficulties in positioning patients.

Dr. Gabriel Siegel

Dr. David Chu

Dr. Jack Spartz

Dr. Michael Fareri

Currently, we are pursuing obtaining IRB approval for research aimed at assessing the adoptability and clinical utility of POCUS in diagnosing skin and soft-tissue infections within the street medicine context, which is particularly relevant to our patient population. Our study aims to determine the willingness of street medicine providers to integrate POCUS into their practice and evaluate the potential benefits for patients.”

Submitted by E. Liang Liu, MD, associate professor and the director of the Emergency Ultrasound Fellowship in the Department of Emergency Medicine at Emory University.

“How

the AEUS ARMED MedEd Scholarship Transformed My Medical Education Research”

Sometimes the hardest part of research is putting the ideas onto paper, hashing them out, and breaking them down into realistic pieces that can be executed in a reasonable amount of time. Although there’s nothing wrong with shooting for the stars, you still need to get off the ground. After completing my master’s degree in health professions education, I applied for a grant, got rejected, and was left wondering what to do next. My department chair saw an announcement for the Advanced Research Methodology Evaluation and Design: Medical Education (ARMED MedEd) course and encouraged me to apply. It turned out to be a great experience, and I was fortunate to receive the Academy of Emergency Ultrasound (AEUS) scholarship and the support of our emergency ultrasound community.

In emergency medicine, we need researchers in medical education to continuously improve our programs. Our field lacked a network of medical education researchers with a plan for helping new faculty get started, and the ARMED MedEd course fills that gap. This course provided a logical route that not only helped refine my ideas but also divided the grant application process into digestible portions. We tackled a new section while continuously refining the project, resulting in a well-designed, feasible research question and the opportunity to apply for a designated grant. The course designers provided guidance on time management, expert panels on medical education methodologies, including qualitative and mixedmethods, and how to select the best one for your question. The talks from successful medical education researchers, who not only discussed their wins but also their failures and the pathways leading there, were encouraging because research isn’t a linear process. Taking and integrating the feedback, results in a better project.

The greatest benefit of the program was the connections made with mentors and peers. Being matched with mentors who understood medical education research, and in my case, ultrasound, was critical to creating a project that worked. Feedback from both the experts and peers helped us craft a good question (if you can explain it à la the Richard Feynman method, you know you’ve got it down!) I received tremendous guidance on my ideas, and the connections I made resulted in the chance to more easily design multisite research studies. The monthly Zoom meetings helped keep me on track while accountability partners helped me manage my time. Mentors were approachable outside of the monthly meetings if new questions or roadblocks emerged.

Many of us landed in academic medicine because we love learning, want to become better educators, and help the next generation of physicians reach new heights. We overflow with ideas but sometimes don’t know where to begin. Some of us have experience via a fellowship or working with colleagues but aren’t sure how to take it to the next level. AEUS and the ARMED Med Ed course connected me to the mentorship and resources I needed to move forward. I highly recommend ARMED MedEd if you are looking for mentorship and guidance on medical education research and the grant writing process.

Submitted by Elizabeth Yetter, recipient of the AEUS the ARMED MedEd Scholarship. Dr. Yetter is an assistant professor of emergency medicine and serves as the ultrasound division director at Mount Sinai Morningside and Mount Sinai West in New York City.

INTEREST GROUPS

Social

Emergency Medicine & Population Health

Introducing SEMINAR: A New Research Network to Advance Social Emergency Medicine

Interest in social needs screenings and interventions in the emergency department (ED) is growing, as are valuable conversations about identifying effective, sustainable, and equitable practices. Research in this field has expanded significantly in recent years and must continue to do so. This summer, the SAEM Social Emergency Medicine & Population Health Interest Group is launching a new research network to address health-related social needs in the ED: The Social Emergency Medicine Integrated Network for Advancing Research (SEMINAR).

SEMINAR is poised to transform promising concepts from individual sites into scalable, multisite initiatives. By sharing findings and collaborating across institutions, SEMINAR aims to accelerate the identification of novel strategies, attract funding for multisite trials, and lay the groundwork for future evidencebased guidelines.

Vision

Evidence-based practices guide sustainable social emergency medicine screenings and interventions that meaningfully improve patient health.

Mission

To serve as a hub for exploring effective social emergency medicine practices and a platform to establish or expand trials across multiple sites.

SEMINAR will host quarterly “shop talk” sessions to discuss current and potential projects and seek collaboration opportunities. Discussions are already underway on several potential projects related to social emergency medicine data practices and screening methods for unmet social needs. Although SEMINAR is in its early stages, it is well-positioned to adapt to the interests of researchers. Join us and help shape the future of social emergency medicine.

Submitted by Cole Ettingoff, a current third-year medical student at Trinity School of Medicine and member of the SAEM Social Emergency Medicine & Population Health Interest Group.

SAEM Reports continued on Page 86

Dr. Elizabeth Yetter

SAEM REPORTS

continued from Page 85

Informatics, Data Science, and Artificial Intelligence

Study Published in JAMA Network Open Reveals Growing Patient Portal Use in U.S. EDs

The results of a collaborative study from members of the SAEM Informatics, Data Science, and Artificial Intelligence Interest Group was recently published in JAMA Network Open. The manuscript, entitled “Real-Time Electronic Patient Portal Use Among Emergency Department Patients,” evaluated real-time patient portal usage in emergency departments (EDs) across the U.S. Examining data from over one million adult patients across 36 EDs from 8 different health systems in the U.S., the authors found that 17% of patients accessed their patient portal while in the ED with rates increasing over time. Despite this increase in usage, disparities were observed, with lower odds of access among patient who are male, Black, and uninsured. These findings underscore the importance of promoting patient engagement in portal use during ED visits, especially considering the ED’s role in caring for medically underserved populations. Addressing disparities in portal access represents an opportunity for EDs to enhance patient-centered care and support long-term health management beyond the ED encounter.

Submitted by Rob Turer, MD, MSE, on behalf of the SAEM Informatics, Data Science, and Artificial Intelligence Interest Group. Robert.Turer@UTSouthwestern.edu

Educational Research

Celebrating SAEM24 Successes

The revamped Educational Research Interest Group made a significant impact at SAEM24, proudly sponsoring four highly attended didactic sessions focusing on cutting-edge educational research topics. In addition, our annual in-person meeting provided a valuable platform for networking, celebrating this year’s achievements, and strategizing for the year ahead.

While in Phoenix, we successfully balanced work and camaraderie, hosting a vibrant Happy Hour on Wednesday afternoon at the Sheraton lobby bar that fostered in-person connections and strengthened the virtual relationships we’ve cultivated over the past year.

Looking ahead, we are excited about the upcoming year and our commitment to developing evidence-based practices that

empower our learners to achieve their full potential. Our research projects continue to expand, and we are actively working towards establishing a structured mentorship program within our extensive network of over 600 educational researchers.

Join us for our monthly virtual meetings to engage in networking, project development, and collaborative learning among your peers. All educational researchers, regardless of experience level or background, are welcome.

Submitted by Rebekah Cole, PhD, MEd, on behalf of the SAEM Educational Research Interest Group. rebekah.cole@usuhs.edu

Academic Emergency Medicine Pharmacists

The Emergency Medicine Pharmacists Have Arrived: Highlights From the Inaugural AEMP

Conference

The Academic EM Pharmacists (AEMP) interest group successfully hosted its inaugural conference in conjunction with the 2024 SAEM Annual Meeting. With over 160 participants in attendance, this day-long event covered a diverse array of topics focused on evidence-based practices in EM pharmacotherapy. The conference fostered multidisciplinary collaboration, provided a platform for networking among peers nationwide, and contributed to advancing the field of EM pharmacy.

The program featured speaking opportunities for residents, new practitioners, and various content experts. Beyond enriching educational sessions, attendees enjoyed engaging in social activities such as the AEMP happy hour and cheering for our dodgeball team, the Keta-meanies! The warm reception from our physician colleagues was overwhelming, and we look forward to expanding our involvement in SAEM activities beyond AEMP.

AEMP has ambitious plans to advance EM pharmacy practice in partnership with SAEM and we invite you to join us in this endeavor! EM physicians who champion EM pharmacists are encouraged to join our interest group and encourage your local EM pharmacists to participate.

We have several exciting opportunities for you to take part in. Whether you have a passion for a specific area of practice, seek leadership roles, or merely wish to get more involved, we invite you to join one or more of our committees as we continue our mission of advancing EM pharmacy practice. Our committees include:

• Program Committee

• Career Development Committee

• Communications Committee

• Membership Committee

• Steering Committee

• (NEW) Education Committee

Please feel free to reach out any time with questions, concerns, or to share new ideas for our group.

Submitted by Megan Rech, PharmD, MS, inaugural chair of the AEMP Interest Group. megan.a.rech@gmail.com

SAEM JOURNALS

Peer Review Perspectives: Insights From the 2023-2024 AEM E&T Fellow Editors In Training

Behind the Scenes of Academic Publishing: My Editorial Fellowship Journey

Carl Preiksaitis, MD 2023-2024 AEM Education

and Training Fellow

Editor-in-Training

This past year, I had the opportunity to dive deep into medical education research through an editor-in-training fellowship with Academic Emergency Medicine Education and Training (AEM E&T) journal. As I began my residency, focusing on research was far from my mind. However, as I ventured deeper, the importance of evidence-based education became clear. Just as evidence guides every move in the emergency department to ensure optimal patient care, educators similarly strive to base their teachings on solid evidence to set up learners for success.

Medical education research is fascinatingly complex. Unlike biomedical research, this field involves a rich tapestry of disciplines, methodologies, and discussions, from conceptual frameworks and qualitative techniques to ontological debates. Before this fellowship, terms like these felt foreign. Now, they are part of my daily vocabulary and, importantly, they make sense.

One of the most valuable aspects of this experience was learning directly from experts. The fellowship was not just about observation; it was about “doing” — cultivating personal and professional relationships, refining research skills, and engaging in peer review. Peer review, I learned, is not solely about ensuring publication quality. It is a two-way process that offers as much learning to the reviewer as to the author. Critiquing papers helped me sharpen my research and writing skills, teaching me what makes a study stand out and how to effectively convey findings.

In an era where AI tools are increasingly prevalent in academia and research, the value of human feedback in peer review has become more pronounced. The nuanced understanding, critical thinking, and contextual judgment that human reviewers contribute are irreplaceable, particularly in the dynamic, multifaceted field of medical education. This human element preserves and respects the essence of research: exploring new ideas, challenging old ones, and rigorously evaluating methodologies. Engaging in peer review thus emerges not only as a scientific service but also as a safeguard, maintaining human insight amid advancing automation.

Yet, one of the most enlightening aspects was getting a glimpse behind the scenes of how a journal operates. The journey from submission to publication always seemed shrouded in mystery, and uncovering this process was immensely rewarding. Listening in on editorial board discussions offered a sneak peek into the future of medical education, revealing where leaders are steering the field.

Reflecting on this journey, the fellowship has been an exceptional experience. It has opened my eyes to the nuances of medical education research, improved my abilities as a researcher, and expanded my understanding of academic publishing. As I advance in my career, the lessons learned, and connections forged during this time will undoubtedly be invaluable as I continue my quest to contribute to medical education.

Dr. Preiksaitis is a clinical instructor and Medical Education Fellow in the Department of Emergency Medicine at Stanford. His scholarly interests include artificial intelligence in education, reproductive health care in the emergency department, and human factors in health care delivery. cpreiksaitis@stanford.edu, @CMPreik

Pulling Back the Curtain on the Peer Review Process

Michelle Suh, MD 2023-2024 AEM Education and Training Fellow Editor-in-Training

In residency, I often felt like Dorothy struggling to stay on the yellow brick road as I explored the world of research, from conceptualization to publication. There were twists and turns, and the occasional flying monkey. Mentors would appear to offer guidance when I hit a roadblock, such as navigating the Institutional Review Board or writing a discussion section. When I finally produced a manuscript, I felt like I was knocking on the doors to the Emerald City. But once I hit “submit” in the editorial manager, the manuscript seemed to disappear into an unknowable black hole, where the wizard would eventually email me a final decision. Through the Academic Emergency Medicine Education and Training (AEM E&T) Fellow Editor-in-Training program, the curtain was pulled back, allowing me to understand the wizard’s process.

Completing peer reviews under the expert guidance of Dr. Esther Chen enabled me to see and apply the rubric that peer reviewers use to evaluate manuscripts. Thinking critically about theoretical frameworks, research questions, and the rigor of analysis from the other side of the peer review process has clarified my own scholarship. As I conduct my own projects and write manuscripts, I can now critique my work proactively from an editor’s perspective.

The fellowship also offered a chance to meet the emergency medicine medical education research community at large, both with my co-fellow editor, Dr. Carl Preiksaitis, and the AEM E&T editorial board. Through editorial board meetings, I witnessed the tireless efforts of editors to disseminate meaningful scholarship and reduce decision times for submissions. I also gained insight into the actual publishing process, and now I can finally say I have met Taylor Bowen, AEM E&T peer review coordinator!

Although my term as a fellow editor-in-training is ending, I’ll carry these experiences and learning with me throughout my career. Not only do I feel empowered to serve as a peer reviewer, but I also recognize the need for all of us to step up and continue the work of scholarship and publishing. Furthermore, seeing the breadth of medical education research submitted to the journal makes me appreciate the immense challenge of learning how to practice EM, as well as our collective creativity and hard work. I am grateful and honored to be part of the community of medical educators and researchers who not only practice emergency medicine but also tirelessly teach learners to provide high-quality care to patients. There truly is no place like EM.

Michelle Suh, MD is a clinical associate and MedEd fellow at at University of Chicago Emergency Medicine. She completed her emergency medicine residency at Baylor College of Medicine Her interests include race and gender, carceral health, and medical education. @MSuh25

Dr. Carl Preiksaitis

Dr. Michelle Suh

ACADEMIC ANNOUNCEMENTS

Dr.

Jason Wilson Named Chair of the New Department of Emergency Medicine at USF

Morsani College of Medicine

Jason W. Wilson, MD, PhD, has been appointed chair of the newly established Department of Emergency Medicine at the University of South Florida (USF) Morsani College of Medicine. Previously, emergency medicine operations at USF were integrated within Tampa General Hospital's department and functioned as a division within the USF Health Department of Internal Medicine. In April, USF elevated its Division of Emergency Medicine to an independent department, at which point Dr. Wilson immediately moved from division chief to department chair. This transition grants USF Emergency Medicine independent status, aligning it with the organizational structure and faculty standards of other esteemed academic medical centers. The Society for Academic Emergency Medicine (SAEM) provided crucial support through its Consultation Services, which were instrumental in guiding the proposal team through the complexities of this significant reorganization.

Mount Sinai’s Dr. Rachel Solnick Awarded a K23

Career Development Award From the NIMH

Rachel Solnick, MD, MSc, was awarded a K23 career development award from the National Institute of Mental Health (NIMH). Her research project, “Telephone Initiated PreP Post-ED Discharge (TIPPED),” will develop and test a protocol and persuasive health communication for HIV PrEP initiation after emergency department discharge for patients with laboratory-confirmed sexually transmitted infections. Dr. Solnick is an assistant professor of emergency medicine and population health science and policy, Icahn School of Medicine at Mount Sinai. She is an emergency medicine attending physician at The Mount Sinai Hospital.

UPenn’s

the US

Dr. Jeanmarie

Perrone Testifies Before

Senate Finance Committee About the Fentanyl Crisis

Jeanmarie Perrone, MD, senior fellow, Leonard Davis Institute of Health Economics at the University of Pennsylvania, testified in May before the U.S. Senate Committee on Finance about the dangers of fentanyl in the street drug supply, and the expansion of telehealth to reach more substance users in need of treatment. Dr. Perrone, a professor of Emergency Medicine at the Perelman School of Medicine and director of the Penn Center for Addiction Medicine and Policy, is one of the country’s foremost experts in the field of opioid dependence treatment.

Mount

Sinai’s Dr.

Utsha Khatri Receives a K23 Career Development Award From the NIDA

Utsha Khatri, MD, MSHP, received a K23 Career Development Award from the National Institute on Drug Abuse (NIDA) for her project, "Telehealth to Improve Post-Incarceration Treatment for OUD Patients (TIPTOP): An Acceptability and Feasibility Trial." Her project focuses on improving access to buprenorphine for those released from jail. The grant allows Dr. Khatri to further develop skills and expertise as a physician-scientist. Dr. Khatri is an assistant professor of emergency medicine and population health science and policy, in the Department of Emergency Medicine and the Institute for Health Equity Research at the Icahn School of Medicine at Mount Sinai. She is an emergency medicine attending physician at The Mount Sinai Hospital and Elmhurst Hospital.

IU School of Medicine Welcomes Dr. Seema Patel as Assistant Program Director, Combined Emergency Medicine/Pediatrics Residency

Seema Patel, MD has been appointed as an assistant program director for the combined Emergency Medicine/Pediatrics Residency at Indiana University School of Medicine. Dr. Patel, an assistant professor of clinical emergency medicine, will start this role in July. In this role, Dr. Patel will contribute to leading the combined residency program, furthering Indiana University’s commitment to innovation and clinical excellence. She brings a wealth of knowledge into the advocacy and primary care space the program and residents will benefit from.

Dr. Paul Musey is Named Eskenazi Health Foundation Chair and Scholar of Emergency Medicine at IU

Paul Musey, MD, associate professor of emergency medicine at Indiana University School of Medicine has been appointed the Eskenazi Health Foundation chair and scholar of emergency medicine. Dr. Musey will also hold a new title within the Department of Emergency Medicine: vice chair of research and innovation. Dr. Musey has built a clinical research program focusing on disparities in emergent care and psychological contributors to symptom complexes such as low risk chest pain in the emergency department. Dr. Musey is currently the medical director for the Indiana University Health Enterprise Clinical Research Organization, overseeing clinical research across the entirety of Indiana University Health. He serves on the SAEM Foundation Board of Trustees.

Dr. Jason W. Wilson

Dr. Utsha Khatri

Dr. Seema Patel

Dr. Paul Musey

Dr. Rachel Solnick

Dr. Jeanmarie Perrone

Michael P. Jones, MD Is Promoted to Professor of EM at the Albert Einstein College of Medicine

Michael P. Jones, MD has been promoted to professor of emergency medicine at the Albert Einstein College of Medicine, Bronx, New York. Dr. Jones is vice chair for education and Residency director for emergency medicine at Albert Einstein/ Jacobi + Montefiore, overseeing one of the largest residency programs in the country along with the department’s student, fellowship, and faculty development programs. Dr. Jones is also the chair of the SAEM Trauma Interest Group and founding member of All NYC EM, an educational collaborative of the region’s 25-plus training programs.

Mount Sinai’s Dr. Ethan Abbott Is Awarded an American Heart Association Grant

Ethan Abbott, DO, has been awarded a grant from the American Heart Association to support his research titled "The Impact of Safety-Net Hospital Status on In-Hospital Cardiac Arrest Care and Outcomes in the United States." This project utilizes the American Heart Association's Get With The Guidelines dataset. Dr. Abbott is an assistant professor of emergency medicine at the Icahn School of Medicine at Mount Sinai and serves as an attending emergency medicine physician at The Mount Sinai Hospital.

Dr. Michael P. Jones

Dr. Ethan Abbott

POST YOUR OPEN JOBS IN FRONT OF OUR QUALIFIED CANDIDATES!

Accepting ads for our “Now Hiring” section!

Deadline for the next issue of SAEM Pulse is August 1.

For specs and pricing, visit the SAEM Pulse advertising webpage.

DIRECTOR OF QUALITY IMPROVEMENT EMERGENCY MEDICINE FACULTY

The University of California San Francisco, Department of Emergency Medicine is recruiting for a full-time faculty member at the Associate Professor or Professor level to serve as the Director of Quality Improvement at our UCSF Hellen Diller Medical Center at Parnassus Heights campus. We seek individuals who meet the following criteria: emergency medicine faculty with a track record of successfully developing and maintaining rigorous, data-driven quality and safety programs, establishing a culture of safety, improving the identification and review of cases, and ultimately, optimizing the quality of patient care. Rank, step and series will be commensurate with qualifications.

The Department of Emergency Medicine provides comprehensive emergency services to a large local and referral population at multiple academic hospitals across the San Francisco Bay Area, including UCSF Hellen Diller Medical Center, Zuckerberg San Francisco General Hospital and Trauma Center, and the UCSF Benioff Children’s Hospitals in San Francsico and Oakland. The Department of Emergency Medicine hosts a fully accredited 4-year Emergency Medicine residency program and multiple fellowship programs. There are opportunities for leadership and growth within the Department and UCSF School of Medicine.

Board certification in Emergency Medicine is required. All applicants should excel in bedside teaching and have a strong ethic of service to their patients and profession.

The University of California, San Francisco (UCSF) is one of the nation’s top five medical schools and demonstrates excellence in basic science and clinical research, global health sciences, policy, advocacy, and medical education scholarship. The San Francisco Bay Area is well-known for its great food, mild climate, beautiful scenery, vibrant cultural environment, and its outdoor recreational activities.

PLEASE APPLY ONLINE AT: https://aprecruit.ucsf.edu/apply/JPF05030

Applicants’ materials must list current and/or pending qualifications upon submission. The posted UC salary scales set the minimum pay determined by rank and step at appointment. See [Table 5] (https://www.ucop.edu/academic-personnel-programs/_files/2023-24/oct-2023-acad-salary-scales/t5-summary.pdf). The minimum base salary range for this position is $177,100-$377,200. This position includes membership in the [health sciences compensation plan] (https://ucop.edu/academic-personnelprograms/_files/apm/apm-670.pdf) which provides for eligibility for additional compensation.

UCSF seeks candidates whose experience, teaching, research, and community service has prepared them to contribute to our commitment to diversity and excellence. UCSF is an Equal Opportunity/Affirmative Action Employer. The University undertakes affirmative action to assure equal employment opportunity for underrepresented minorities and women, for persons with disabilities, and for covered veterans. All qualified applicants are encouraged to apply, including minorities and women. For additional information, please visit our website at http://emergency.ucsf.edu/

Penn State Health Emergency Medicine

About Us:

Penn State Health is a multi-hospital health system serving patients and communities across central Pennsylvania. We are the only medical facility in Pennsylvania to be accredited as a Level I pediatric trauma center and Level I adult trauma center. The system includes Penn State Health Milton S. Hershey Medical Center, Penn State Health Children’s Hospital and Penn State Cancer Institute based in Hershey, Pa.; Penn State Health Hampden Medical Center in Enola, Pa.; Penn State Health Holy Spirit Medical Center in Camp Hill, Pa.; Penn State Health Lancaster Medical Center in Lancaster, Pa.; Penn State Health St. Joseph Medical Center in Reading, Pa.; Pennsylvania Psychiatric Institute, a specialty provider of inpatient and outpatient behavioral health services, in Harrisburg, Pa.; and 2,450+ physicians and direct care providers at 225 outpatient practices. Additionally, the system jointly operates various healthcare providers, including Penn State Health Rehabilitation Hospital, Hershey Outpatient Surgery Center and Hershey Endoscopy Center.

We foster a collaborative environment rich with diversity, share a passion for patient care, and have a space for those who share our spark of innovative research interests. Our health system is expanding and we have opportunities in both academic hospital as well community hospital settings.

Benefit highlights include:

• Competitive salary with sign-on bonus

• Comprehensive benefits and retirement package

• Relocation assistance & CME allowance

• Attractive neighborhoods in scenic central Pa.

Pursue Your Passion in Emergency Medicine

Whether you are interested in research, mentoring new physicians or growing into a leadership role, we can match you with your ideal position. Our physician-led practices provide unmatched opportunities for professional development.

We offer leadership and staff positions at academic medical centers, freestanding EDs and pediatric, community, rural and teaching hospitals nationwide.

FEATURED EM OPPORTUNITIES

Check out some of our featured openings.

EM PHYSICIAN

Morristown Medical Center

Morristown, New Jersey

Fellowship trained in Critical Care, Sports Medicine or Research

+ JEFFREY S. RABRICH, DO, FACEP, FAEMS SVP Emergency and Hospital Medicine Contact our experienced recruiters

PEM PHYSICIAN

Medical City Dallas Dallas, Texas

Fellowship Trained

EMS PHYSICIAN

Trinity Health Ann Arbor Hospital Ypsilanti, Michigan

Fellowship Trained

Talk with our clinical leaders and experienced recruiters at ACEP24 Scientific Assembly

ACEP24 | Booth 4610 Sept. 29-Oct. 1 | Las Vegas

F E L L O W S H I P S

Continue your academic training at the University of Wisconsin School of Medicine and Public Health, a recognized international, national, and statewide leader in medical education, research, and service Located in Wisconsin' s capital and second largest city, the BerbeeWalsh Department of Emergency Medicine sponsors several advanced training programs for early career physicians several

Our primary emergency department at UW Health's flagship hospital:

#1 hospital in Wisconsin for more than a decade

ACS-certified, Level 1 adult and pediatric trauma and burn center

One of the nation’ s first certified comprehensive stroke centers

ACGME accredited Anesthesia Criti

The multidisciplinary EM-ACCM fellowship advances skills in medical, surgical, and cardiothoracic critical care, including extracorporeal device support (ECMO) Fellows benefit from a team of EM/CC Intensivists dedicated to developing them as leaders, with opportunities to work with prehospital, quality, and ECPR teams, teach residents, and conduct research

ACGME accredited Emergency Medical Services

This EMS fellowship trains physicians to provide exceptional medical direction and education to prehospital agencies with advanced competencies in EMS & HEMS operations, clinical care, and education This one-year program combines ground, aeromedical, and tactical EMS exposure with administrative, advocacy, research, QA/QI, and leadership responsiblities

Research

This two-year, SAEM-certified fellowship trains physicians to become independent physician-scientists and leaders in emergency care research, setting them on a pathway to achieve NIH funding in clinical or health services research Fellows are supported to pursue an MSCI or other advanced degree at UW–Madison’ s world-renowned research enterprise

University Hospital ED:

70,000+ adult and pediatric patient visits annually

uality, and Leadership

Develop the analytical and management skills to pursue leadership roles in administration, quality, patient safety, and operations within an ED, hospital, or healthcare system Fellows work directly with faculty leaders in ED operations, gaining a complete view of patient safety, cost-effectiveness, efficient flow principles, patient experience, and change management

Global Emergency Medicine

This SAEM-certified fellowship offers the opportunity to advance emergency medicine in low resource settings through 2+ months of fieldwork abroad, teaching, developing curricula, research, and graduate-level coursework at UW Prior fellows have engaged in global health projects and research in Uganda, Rwanda, and Kenya, and with local NGOs and the UNDP

Medical Simulation

Develop expertise in creating and administering clinical and non-clinical, simulation-based learning experiences in this oneyear, mentored program Fellows utilize UW Health' s state-ofthe-art simulation facilities and are provided with extensive interdisciplinary training opportunities with subspecialty areas, including Critical Care, EMS, Med Flight, and Ultrasound

Chair, Department of Emergency Medicine

The George Washington University School of Medicine and Health Sciences and the Medical Faculty Associates are pleased to announce a national search for the Chair of the Department of Emergency Medicine. This is a full-time, non-tenure track, faculty position that provides a remarkable opportunity to lead an exceptional academic and clinical department known nationally for providing outstanding patient care, fostering the medical and biomedical education of the next generation, and pursuing innovative clinical and translational research.

The Chair will serve in the senior leadership group of the faculty practice organization, the GW Medical Faculty Associates, to ensure the delivery of high-quality clinical care, achievement of program objectives, and departmental and faculty engagement to support efficiency and financial goals. The Chair, through their leadership position within GW School of Medicine and Health Sciences, is responsible for faculty development and mentoring toward academic advancement through impactful research and scholarship. Additionally, the chair will actively foster a robust culture that supports learning for physicians, advanced practitioners, students, residents, and fellows, and stimulates team performance and innovation, while ensuring ongoing attention to quality and accreditation standards.

Applicants must be nationally recognized physicians with an outstanding record of accomplishments in leadership, clinical care, education, and scholarship. An M.D. degree, or equivalent; board certification in Emergency Medicine or comparable credentials; and possession of, or eligibility for, a medical license in the District of Columbia, are required.

Applicants possessing the appropriate qualifications and experience to be appointed at the academic rank of Professor of Emergency Medicine are invited to apply. The School of Medicine & Health Sciences is committed to building a culturally diverse faculty and strongly encourages applications from candidates from backgrounds underrepresented in medicine.

For more details on the position and to apply, visit https://www.gwu.jobs/postings/110718. Review of applications by the search committee will begin on June 17, 2024, and will continue until the position is filled. Only complete applications will be considered. Employment offers are contingent on the satisfactory outcome of a standard background screening.

The George Washington University School of Medicine and Health Sciences is an Equal Employment Opportunity/Affirmative Action employer that does not unlawfully discriminate in any of its programs or activities on the basis of race, color, religion, sex, national origin, age, disability, veteran status, sexual orientation, gender identity or expression, or on any other basis prohibited by applicable law.

May 13-16, 2025 | Philadelphia Marriott Downtown