FALL 2020
REFLECTIONS ON
2020
FORGING A PATH FORWARD PG 3
WILL THIS EVER END? PG 4
ACOEP’S COMMITTEE FOR WOMEN IN EMERGENCY MEDICINE UPDATE PG 5
The Pulse VOLUME XLIII No. 3
WE WERE MADE
FOR THIS
— OUR RESPONSE TO COVID-19 US Acute Care Solutions experienced the same sudden and unprecedented declines in hospital & ED volumes related to COVID-19 that everyone else did. How we reacted was different. We prioritized state-ofthe-art patient care
We prioritized the safety and needs of our clinicians
We prioritized the needs of our hospital partners
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We sourced our own national PPE backup supplies to mitigate local shortages.
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We developed a state-of-the-art N95 sterilization technique and shared this with our hospital partners.
We built surge ICU and hospital medicine processes and protocols, pre-ED triage tents, pop-up acute care settings, and even new hospital relationships.
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We supported telemedicine initiatives for hospitals, resulting in new patients being brought into the hospital system for appropriate care.
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We hosted webinars for hospital partners to coordinate an informed COVID response with best practices by leveraging our national footprint of 200+ acute care sites.
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We developed a clinical management tool to assign hospital observation, transfer, and inpatient admission.
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We created guidelines for a COVIDSafe Emergency Department, easing patient concerns about viral transmission and continuing to provide our trademark highquality care for serious acute conditions.
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We provided clinical updates three times a week to educate our clinicians on the latest evidence-based management techniques during a time of ultra-rapid knowledge development. We created our nationwide COVID Task Force to quickly disseminate best practices nationally.
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We created on-shift support for decontamination methods.
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We instituted frequent, clear, and concise communication to reduce information overload and to minimize misinformation.
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We created the first-in-the-industry quarantine fund to pay clinicians for lost time.
We created a clinical management tool to facilitate appropriate disposition for COVID patients.
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We maintained benefits (including our marquee 401k plan) for our clinicians and employees throughout.
We created a first-in-the-industry ventilator allocation guideline, leveraging our ethics expertise.
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We distributed wellness resources for our clinicians and their families.
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We created a communication aid for clinicians to facilitate travel to their hospitals without delays.
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We offered first-in-the-industry free antibody testing to all clinicians and employees.
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We provided educational points for clinicians to educate non-medical community members in their personal social media networks.
US Acute Care Solutions is different because we are majority physician-owned and are physician-led. We have the clinical, operational, and financial resources to weather the worst of a storm. COVID is case in point. We stepped up to face this crisis as a leader in our industry and an exceptional partner for our hospitals. We were made for this.
Interested in partnering with USACS?
Contact James Watson, Chief Development Officer, watsonj@usacs.com
Interested in a clinical career with USACS?
Contact Darrin Grella, VP of Recruiting, dgrella@usacs.com
EDITORIAL COMMITTEE Timothy Cheslock, DO, FACOEP, Chair Justin Grill, DO, FACOEP Christine Giesa, DO, FACOEP-D
TABLE OF CONTENTS 3
PRESIDENT’S REPORT Robert E. Suter, DO, MHA, FACOEP-D
The Pulse is a copyrighted quarterly publication distributed at no cost by ACOEP to its Members, Colleges of Osteopathic Medicine, sponsors, exhibitors, and liaison associations recognized by the national offices of ACOEP.
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THE ON-DECK CIRCLE G. Joseph Beirne, DO, FACOEP-D
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ACOEP’S COMMITTEE FOR WOMEN IN EMERGENCY MEDICINE UPDATE Nicole Vigh, DO, MPH
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WHAT WOULD YOU DO? ETHICS IN EMERGENCY MEDICINE Bernard Heilicser, DO, MS, FACOEP-D
The Pulse and ACOEP accept no responsibility for the statements made by authors, contributors, and/ or advertisers in this publication; nor do they accept responsibility for consequences or response to an advertisement. All articles and artwork remain the property of The Pulse and will not be returned. Display and print advertisements are accepted by the publication through ACOEP, 142 East Ontario Street, Chicago, IL 60611, (312) 587-3709, or electronically at marketing@acoep.org. Please contact ACOEP for the specific rates, due dates, and print specifications. Deadlines for the submission of articles are as follows: January issue due date is November 15; April issue due date is February 15; July issue due date is May 15; October issue due date is August 15. Advertisement due dates can be found by downloading ACOEP's media kit at www.acoep.org/advertising. ACOEP and the Editorial Board of The Pulse reserve the right to decline advertising and articles for any issue. ©ACOEP 2020 – All rights reserved. Articles may not be reproduced without the expressed, written approval of ACOEP and the author. ACOEP is a registered trademark of the American College of Osteopathic Emergency Physicians.
THE ON-DECK CIRCLE
G. Joseph Beirne, DO, FACOEP-D
PRESIDENT’S REPORT
Robert E. Suter, DO, MHA, FACOEP-D
WILL THIS EVER END?
FORGING A PATH FORWARD
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t is an understatement to say that 2020 has been a very stressful and challenging time for all humankind, let alone all of us as healthcare workers. What most of you may not know are the additional stresses that ACOEP has been under as an organization and how our staff and leadership has had to shoulder this additional burden, along with those burdens shared by all during this pandemic. Over time, organizations are supposed to prepare themselves for hard times. As our current Board and Officers were elected in 2017, we learned that ACOEP was overextended financially. This was something that had not previously been transparent to anyone. We immediately set about rectifying this situation, initiating new expectations, reorganizing, and cutting expenses wherever possible. Unfortunately, in some cases the actions we wanted to take immediately were not possible due to long-term contracts, leases with horrific penalty clauses, and other legal issues, all of which were very frustrating. The process of getting ACOEP back to a good place, including effective strategic planning based on an accurate understanding of our position, was well on its way, but not complete, when the COVID crisis hit. As a board and staff, we were then forced to make more sobering and painful decisions, including
furloughing much of our staff from May to July and suspending the hiring of a new executive director after a very well-run search led by our own Megan Koenig, DO. I am certain that these decisions made many feel that, as an organization, we were drifting and not sailing. At times, I thought that myself. The truth, though, was that we were doing what any sailor has to do in a rough storm: put the
We know that, even though you probably understand these decisions, you don’t like them. Us too. We really wanted to get the ACOEP family together in person. We miss the community and togetherness. That said, we need you, our loyal members, to continue to support us so we are positioned for the future. Renew your membership. Register for the phenomenal Scientific Assembly put together by Chris
TO REACH A PORT, WE MUST SET SAIL – SAIL, NOT TIE AT ANCHOR; SAIL, NOT DRIFT” – FDR sails down and keep a firm hand on the rudder to keep from going down until the worst passes. We are now putting the sails back up, but, to move ahead rapidly, we need you to be our wind. We need your loyalty and dedication to ACOEP to provide us the ability to get moving on a strong course. If you go to our website, you will see that our strategic plan emphasizes community and recognizes that we are a “high-touch community.” We have therefore been especially hard hit by the COVID restrictions keeping us from gathering together. First the Spring Seminar and now our Scientific Assembly were forced to go 100% virtual: necessary, but an especially unfortunate development for a hightouch community.
Colbert, DO, the CME Committee, and our incredible staff. We know that it may not be as easy to get excited about these things right now when you can’t be together in-person with your fellow members, but, in order to sustain the best possible post-COVID future of our community, we need your support now. ACOEP has always been about you, and for you, in advocacy for our community. Now, we need you to be there for us. Be the wind in our sails, and we will go far together. With your support, we will be ready to gather together as soon as it is possible. If we all work together to sustain our community in these tough times, our best days are ahead of us. –•–
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s I write this article for The Pulse, I have recently returned from a much-needed vacation to the boundary waters in Minnesota. We have been going there on our annual summer trek every year, going on 30 years. It is an environment that takes you away from the chaos of everyday life, allows you to relax and spend time with your thoughts, and truly appreciate the beauty of a pristine wilderness. Every year when we travel there, I spend time thinking about my life, my career, my family, my friends, and how fortunate I am to have all of this. During that time, I thought about how our lives have changed because of COVID. I remember our first case in Missouri and how this disease spread all over the country. I remember the first COVID patient I treated and how I hardly slept that night wondering if I had protected myself enough. As the months progressed, every patient I saw was marked “yellow” in our department (symptoms concerning for COVID). Donning an isolation gown, two pairs of gloves, and a fullface shield respirator with N95 filters became the norm. I watched as our numbers grew and as worry about each case was replaced with a sense of helplessness and weariness. Will this ever end?
In April 2020, my mother-in-law died of COVID. She had been in assisted living for about a month and had been living with stage 4 breast cancer for almost two years. The last time we physically got to see her was early March. After that, her facility went on lockdown, and we began doing Skype with her every week. She became ill on April 4 and died on April 10. Because of COVID, there was no visitation, no funeral. Her husband died three years ago and is buried at Jefferson Barracks National Cemetery in St. Louis. She was buried there, and, a week later, my wife and I visited the grave. It was a beautiful, sunny day. As we sat by the headstone and talked, my wife looked up and saw two birds flying. They flew towards each other, circled over us, and then flew away. We looked at each other and smiled. It was almost as if the spirit of her parents were there looking down on us. A few weeks later, I had a patient in the ED who was brought in with altered mental status. He turned up positive for COVID. I admitted him, and the hospitalist called me a few days later when I was on my next shift and told me that the patient had died. His wife was in our ED about a week later, and I also took care of her. She was positive for COVID, but survived.
WHAT GREW OUT OF OUR HELPLESSNESS...HOPE!”
Her children talked with me outside of the room and told me they were still in shock about their father. I shared the story about my mother-in-law with them and about the difficulty of not having a formal visitation or funeral. We talked for a long time, shared stories, and ended up sharing tears as well. One of her children asked me, “Doc, do you think this will ever end?”My answer was, “I hope so.” I thought about this encounter one day on vacation while I was in our kayak and paddling up the lake. It seemed surreal that this started in our country back in February; the last six months of this feels more like six years. Being away from all of this, in the pristine wilderness, gave me pause to think about where we started, where we are, and where we are going. This pandemic is truly the plague of our generation – our “1918 Influenza” so to speak. We feel helpless against it, we have no magic bullet, no vaccine (yet), and have watched patients of all ages succumb to it. However, what grew out of our helplessness? Hope. All our colleagues around the country shared their experiences when treating these patients. We used our technology to spread the word about what works, what doesn’t, and new therapies that emerge. We did not run and hide, we stood up and took the lead. Our specialty is on the
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ACOEP’s Committee for Women in Emergency Medicine Update By Nicole Vigh, DO, MPH
THE MEDICAL COMMUNITY AS A WHOLE HAS NEEDED TO LEARN TO QUICKLY ADAPT TO AN EVER-CHANGING ENVIRONMENT.”
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A GLOBAL VIEW OF WOMEN’S EXPERIENCE DURING THE CORONAVIRUS PANDEMIC
K. Kay Moody, DO, MPH
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he ACOEP’s Committee for Women in Emergency Medicine is excited to continue our participation in ACOEP’s Scientific Assembly! Given the current pandemic, the medical community as a whole has needed to learn to quickly acclimatize to an ever-changing conditions. We have shouldered the constantly evolving protocols of how to treat the novel coronavirus, learning to adapt in a resourcescarce environment, including changes to our home lives with children attending school virtually and, not least of all, socially distancing from our family and friends. The academic community has also needed to adapt to the new norm of virtual learning in order to keep physicians all over the world educated on the latest medical advances. We are excited that ACOEP’s Scientific Assembly will take place virtually this year and we are proud to be a part of such a resilient community.
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Karen Greenberg, DO
Our Committee for Women in EM Virtual Luncheon and educational track will take place on Tuesday, October 13th, from 12:50 - 2:50 pm CT. We will begin with an update on our committee happenings and will present the Willoughby Award to this year’s recipient. We will then present our educational track and are honored to have some prestigious guest speakers. Beginning at 1:05 pm CT, K. Kay Moody, DO, MPH, will be joining us to discuss physician wellness during the pandemic. She currently serves as the President of the Tennessee ACEP and Emergency Department Medical Director at Indian Path Medical Center in Kingsport, Tennessee. Additionally, Dr. Moody is the founder of Physician Wellness, an organization that aims to prevent physician burnout by encouraging sustainable professional satisfaction. Physician wellness is an extremely important topic to discuss right now given our current situation and
Judith Eisenberg, MD, MS
Sally Henin, MD
we are looking forward to having Dr. Moody join us! At 1:35 pm CT, we will then have Karen Greenberg, DO, joining us to discuss the topic of stroke in women. She serves as the director of the Neurologic Emergency Department at Crozer-Chester Medical Center in Upland, Pennsylvania. Dr. Greenberg is widely published on the subject of neurologic emergencies, especially stroke, and her innovations were critical to the creation of the first neurologic emergency department in the country. Dr. Greenberg will be joining us to discuss the topic of stroke in women. Lastly, beginning at 2:05 pm CT, we will be having a panel discussion on alternative careers in emergency medicine. For this panel discussion we have three extremely interesting physicians. Judith Eisenberg, MD, MS, works at the CDC with Occupational Medicine and Workplace Hazard Prevention. At the CDC, she serves as the Acting Lead of the Firefighter Fatality Investigation
Thomas Lukens, MD
and Prevention Program (FFFIPP) Medical Team, administered by the National Institute for Occupational Safety and Health (NIOSH). Sally Henin, MD, is joining us from Memorial Hermann Health System in Texas where she works in Forensic Medicine, overseeing forensic nurses who care for sexual assault patients. Lastly, Thomas Lukens, MD, will discuss his experience working in cruise ship medicine with National Geographic. We are looking forward to hearing about all their very interesting alternative careers in emergency medicine! Everyone is encouraged to join us for our lecture track and virtual luncheon! The event is free for all those attending the conference and lectures will be accredited with CME. We appreciate your continued support and we look forward to “seeing” you all at our virtual luncheon and educational track at ACOEP’s Scientific Assembly on Tuesday, October 13th! –•–
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front lines of this pandemic, and we will not back down. We have shared laughter, tears, and joy with our patients, our colleagues, and our families as we go in to work every day and do what we were trained to do. Every day in the trenches of the ED, we learn more about this virus, its effect on the body, and how to treat it. Every day we inch closer to success. Every day we make a difference in the lives of our patients. Every day, at the
end of my shift, I think about what difference I made for someone. That “juice” is what keeps me going and provides me with a sense of pride for continuing to make that difference every single day. Will this ever end? Will we ever return to some sense of normalcy? Only time will tell. As I suit up each day in the department, I vow to myself to never give up, not allow this virus to beat us, to fight back, and to win this battle. During these incredibly
challenging times, I think about the famous quote from Jimmy Valvano, the former head coach of North Carolina State University, who gave his speech at the 1993 ESPY awards after receiving the Arthur Ashe Courage Award. “Don’t give up, don’t ever give up.” The ED has always been the front door of the hospital. We, as ED doctors, will be there waiting for you to join the battle and fight with us.
What Would You Do?
Ethics in Emergency Medicine Bernard Heilicser, DO, MS, FACOEP-D
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In this issue of The Pulse, we will review the dilemma presented in the July (Summer) issue regarding the patient refused transport to a clinic for a termination of pregnancy procedure because the paramedic felt this violated her religious beliefs. This situation necessitated a second ambulance be dispatched and the refusing paramedic was terminated by the private ambulance company involved. If you were the medical director for the ambulance company, how would you approach this situation? Without getting into the corporate legal aspects, would you support the company or would you accept the paramedic’s denial of the patient care based on her religious principles?
WHAT WOULD YOU DO? This dilemma is not unique. We have seen many situations where legal, religious, political, and ethical beliefs collide. Unfortunately, patient care is often in the middle. From an ethical perspective, wwe all have right of conscience, and this should be honored in the appropriate setting. However, when a legally indicated situation exists, patient care must not be jeopardized. The paramedic should have made her beliefs known in advance and, if at all possible, accommodated. However, no political or religious statements should be made at a patient’s expense. Essentially, any human being with an appropriate and legal claim to medical treatment should be treated with respect and dignity. –•–
Thank you to everyone who attended our virtual Scientific Assembly! Didn’t have the chance to join us? The lectures will become available for purchase! STAY TU NE D FOR MORE I NFORMATI ON
If you have any cases that you would like to present or be reviewed in The Pulse, please email them to us at esernoffsky@ acoep.org. Thank you.
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