Osteopathic Emergency Medicine Quarterly
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Presidential Viewpoints Page 4
A Primer on Bombings and Blast Injury Page 14
2013 Board Candidates Page 20
FOEM Foundation Focus Page 30
2013 SCIENTIFIC ASSEMBLY The Leader in Osteopathic Emergency Medicine
SAVE THE DATE OCTOBER 6â€“9, 2013 Hilton San Diego Bayfront San Diego, California
Editorial Committee Drew A. Koch, DO, FACOEP-D, Chair Timothy Cheslock, D.O., FACOEP, Vice Chair Julia Alpin, DO Kenneth Argo David Bohorquez, DO Gregory Christiansen, DO, M.Ed., FACOEP-D Anthony Jennings, DO, FACOEP Wayne Jones, D.O., FACOEP Peter J. Kaplan, Advertising Chair Andrew Little, D.O. Annette Mann, DO, FACOEP Matthew McCarthy, D.O., FACOEP Mark A. Mitchell, DO, FACOEP Todd Thomas Danielle Turrin, D.O. Thomas Baxter, Media & Technology Specialist Erin Sernoffsky, Communications Manager Brian Thommen, Media & Technology Director The PULSE is a copyrighted quarterly publication distributed at no cost by the ACOEP to its Members, Colleges of Osteopathic Medicine, sponsors, exhibitors and liaison associations recognized by the national offices of the ACOEP. 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 Norcom, Inc., Advertising/Production Department, PO Box 2566 Northbrook, IL 60065 ∙ 847-948-7762 or electronically at email@example.com. Please contact Norcom for the specific rates and print specifications for both color and black and white print ads. Deadlines for the submission of articles and advertisements are the first day of the month preceding the date of publication, i.e., December 1; March 1, June 1, and September 1. The ACOEP and the Editorial Board of The PULSE reserve the right to decline advertising and articles for any issue. ©ACOEP 2013 – All rights reserved. Articles may not be reproduced without the expressed, written approval of the ACOEP and the author.
Editorial Staff Drew A. Koch, DO, FACOEP-D, Editor Timothy Cheslock, D.O., FACOEP, Assistant Editor Gregory Christiansen, DO, M.Ed., FACOEP-D Mark A. Mitchell, DO, FACOEP Erin Sernoffsky, Communication Manager Janice Wachtler, Executive Director
Osteopathic Emergency Medicine Quarterly
Table of Contents
Presidential Viewpoints......................................................................................4 Gregory M. Christiansen, D.O., M.Ed., FACOEP-D The Editors's Desk..............................................................................................7 Drew A. Koch, DO, FACEOP-D Executive Director's Desk..................................................................................8 Janice Wachtler, BAE, CBA What Would You Do?.........................................................................................9 Bernard Heilicser, D.O., MS, FACEP, FACOEP Do We Run the Wrong Way?...........................................................................10 John C. Prestosh, D.O., FACOEP Healthcare in Crisis: Seek Solution................................................................11 Mark A. Mitchell, D.O., FACOEP, FACEP Correlation of Residency Program Maturity with Mean Scores................12 Michelino Mancini, DO A Primer on Bombings and Blast Injury.......................................................14 Stephen J. Vertrano, D.O., FACOEP, FACEP, EMT (I) Certification Update..........................................................................................16 Donald Phillips, D.O., FACOEP ACOEP is not AOBEM...................................................................................17 Janice Wachtler, BAE, CBA Finance Committee Report to the Membership...........................................18 David L. Levy, D.O., FACOEP, Janice Wachtler, BAE, CBA 2013 Board Candidates.....................................................................................20 Janice Wachtler, BAE, CBA ACOEP Congratulates 2013 Fellows and Distinguished Fellows.............29 Sonya Stephens FOEM Foundation Focus................................................................................30 Sherry D. Turner, D.O., FACOEP Resident Wrap Up..............................................................................................36 Megan McGrew Koenig, D.O., MBA, MS Residency Spotlight............................................................................................37 Call to Meeting...................................................................................................39
4 Presidential Viewpoints
Gregory M. Christiansen, D.O., M.Ed., FACOEP-D
Where’s the Emergency Department: An issue remembered from the Boston Bombing
e have talked about emergency department surge capacity; usually in the context of dealing with ‘green’ patients at the start of an impending influenza season. We have tolerated overcrowding for so long that we are numb to the issue of surge capacity. I typically expect 20 or 30 patients in the waiting room at the start of my shift. It’s a daily event at the trauma center. But now we have a more pressing issue, one which we’ve avoided since September 11, 2001 … and for that matter since 1993 with the first World Trade Center bombing. The issue of terrorism in context of mass casualties is likely to be a much more common occurrence. The Boston Marathon bombing quietly reintroduced the issue of surge capacity. It’s an issue we’ve ignored because it’s a function of economic policy and not a fixable medical service issue. The trouble is the problem of surge capacity is getting worse. The CDC is worried about our apathy to the problem. The agency called the terrorist attack a ‘predicted surprise’ and is concerned about our ability as emergency physicians to respond effectively. It outlined 6 characteristics learned from the Madrid bombing and other US-based attacks. One of the flawed characteristics within our control included the ‘natural tendency to maintain the status quo’. As I mentioned in my last article on the historical leaders who rose to the occasion,
‘vocal minorities subvert the actions of leaders’ when leaders knew there was problem, knew it would get worse and then failed to act to correct the problem. National media has highlighted the aftermath of the Boston Marathon bombing but largely ignored the immediate response of the area trauma centers to handle the influx of wounded patients. The response was taken for granted by the public and not analyzed by the media. However, the problem may already exist in many areas of the country. What would be the public outcry if there weren’t enough EMS personnel, emergency department facilities, trauma specialists, blood donors and the list goes on? Boston is unique as a medical community. It has 5 designated Level 1 trauma centers for the metro area of 4.6 million; three of the trauma centers specialized in pediatric trauma. Personal stories of physicians reflected on the ability of these facilities to ramp up. They were ready because they had prepared extra staff to meet the typical surge of patients associated with such a physically demanding large scale event – the marathon itself. Most running injuries associated with an event like a marathon are relatively minor, i.e., problems like dehydration, heat cramps, or overuse orthopedic injuries. So it was not an overwhelming situation to move the walking wounded from the ED beds. Boston has the capacity to staff for 150 patients stretched out across 5 hospitals. Additionally, the Boston health systems have remarkable capabilities with interoperability and sustainability not available in most other communities. Imagine if a resort area like metro Honolulu was attacked exposing its 1 million people to a catastrophic event. What if North Korea had a navigation failure of a missile test that struck a Hawaiian island? It has one Level 2 center for the whole island chain. How would they have fared in mounting a response to a mass casualty? It is 4 hours by plane to a Level 1 trauma center. In my state of Virginia there are only 2 designated Level 1 trauma centers. These centers did flex up to assist with injuries sustained in the September 11th attack on the Pentagon. There are many hospitals in Virginia’s metropolitan areas of almost 5 million, but few medical centers were capable of handling the type of injuries associated with the attack and the volume of patients
associated with mass casualties. Bottleneck areas identified in a mass casualty exercises proved correct and obstacles were overcome. However, mass casualties never really materialized in the Pentagon attack because of the large number of the mass fatalities. There were only 34 units of blood needed in the Pentagon event. Despite the experience, there is still a question if Virginia’s medical centers could handle a massive mass casualty event. The CDC has a remarkable publication that serves as a blue print to meet the demands of a mass casualty, titled “In a Moment’s Notice: Surge Capacity for Terrorist Bombings”. If you haven’t seen this publication before, then it’s worth reviewing to know what needs to be done in a disaster. If you want to get a sense of what can go wrong in a disaster, then take a gander at the Tokyo Saran gas attack video. You can watch taxis and buses clog EMS routes on their way to a packed ED waiting room where patients off load the Saran gas from their cloths into the hospital environment. (There are other training videos which are more revealing on errors in a civilian response to terrorism and here is just one example: https://www.youtube.com/ watch?v=QMWSGwtZslo ). Then there was the small town of West, Texas; it lost its entire cadre of EMS resources in the massive explosion that rocked the region at 8pm. Eleven firefighters from five departments were killed at the blast site destabilizing the prehospital response resource. Hillcrest Baptist Medical Center and Providence Healthcare Network had seen at least 179 patients by 3 am. In contrast to the Boston response interoperability between health systems was a real question. Just as concerning was the issue of sustainability. Could a community hospital with a limited staff continue to provide emergency service to hundreds of patients into the early morning hours? At the time of this article, officials were still piecing together how to manage the event. Distant facilities over 50 miles away from the sites like, Parkland Hospital in Dallas and McLane Children’s Hospital in Temple, eventually provided specialty services to lessen the burden at local facilities. As expected the call for blood donors was the next continued on page 6
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6 Presidential Viewpoints
Gregory M. Christiansen, D.O., M.Ed., FACOEP-D continued from page 4 pressing need. The West, Texas experience is more typical of resources available in most communities and highlights the concern. Those resources are shrinking under the pressure to maintain fiscal viability, especially in low income environments. In Boston patients arrived within 20 minutes of the event and had a full roster of services available. The CDC says these types of trauma centers reduce the risk of death from traumatic injury by 25%. In contrast it took much longer to service patients in West, Texas. From 1990 to 2005, 339 trauma centers have closed. The CBO expects 15% of hospitals will close under the Affordable Care Act. In the end, it all comes down to money. Dr. Renee Hsia – an EM doc and Yu-Chu Shen – an economist, have produced remarkable data on our emergency resources. They’ve found trauma centers are treating more people than ever. However, trauma centers have a higher level of uninsured and government insured patients. In a six-year study period, 16 million people had to travel further – at least 30 minutes more – to get to a trauma center that was still open. Medicaid patients were three times more likely than privately insured patients to visit the ED for complex problems. In review these patient did not have any other option for service, once again attesting to the ‘safety net’ concept emergency departments provide. Their data revealed for every 0.1 increase of African Americans in proportion to the population, the likelihood of the emergency department closing went up 41%. In California specifically, the higher the proportion of Medi-Cal patients the more likely the emergency department would close. Many of these disparities can be traced to behaviors and policies of the 1960 & 70’s. Employment based insurance graphically demonstrates the symptoms of failed economic policies which translates into declining health services. We now have a centralized system of health care that is bigger than any government health care program in the past. There is a raging debate if it will create stability or lead to more hospital closures. This is a history lesson relived for osteopathic physicians from the not so distant past. Unfortunately, closures have hit the osteopathic community hard with nearly all osteopathic hospitals having experienced closure or title transfer in the 1990’ and 2000’s. Why did osteopathic hospitals preferentially close? The reasons are multifactorial but can
be summed up when there was far too much apathy coupled with administrative policies that were ‘too little too late.’ Osteopathic facilities lacked flexibility and did not adjust the market place. They failed to recognize the impact capitation and government regulation would have on the operating budgets. It resulted in lower reimbursement and further reliance on government assistance which was insufficient to sustain viability. The overwhelming number of closures in the osteopathic community affirms the lack of understanding by its leaders and constituents on how the political environment affects the economic stability of a service or business. It is a history lesson not learned quickly enough. As government directed health care expansion continues, we need to be mindful of how we can meet the challenges of the future. Sitting idly by will certainly lead to our demise. We have seen this before. To further support the argument consider what is currently happening in the market place. It is a struggle for democrat groups to survive in this heavily regulated environment. Mega group staffing models have overtaken many markets in a consolidation effort to meet government mandates. The independent contractor is a shrinking entity and the small business model is forced into an employee position. The New York Times recognized this prediction in 2010 in its article titled ‘Doctors Are Giving Up Private Practice”. The operative word is ‘Giving Up’ and this undercurrent of behavior is followed by apathy. Since that observation 3 years ago, regional healthcare entities constructed to meet the Affordable Care Act payment system are creating even less surge capacity. One of the unintended consequences is becoming more evident. We may not have the resources or fortitude to meet the challenges of a predictable surprise. As physicians, we need to recognize our short comings in our strategic planning if we are to be ready for whatever comes through our doors. Just as an example of where we are in creating solutions for our profession, how many osteopathic residencies or university programs have the foresight to develop a health policy chair in their health system? How many of our members have a working relationship with their elected officials and know the issues which may close their emergency services to their patients? Dr. Hsia’s partnership with other disciplines demonstrates the power of knowledge to create solutions. Our organization desperately needs to have the membership engaged and educated on what we can do to save our emergency services when we are needed most. Historically,
the fundamentalist’s tactic of using terrorism inevitably increases the casualty count. We will see what happened in Boston happen again someplace else. The terrorist tactics will evolve into more insidious weapons and the predicted surprise becomes no surprise at all, except that we are not prepared for what is coming. If we accept the status quo of our current health care policy then we too are complicit in the apathy. There are smarter methods to create surge capacity in a lean system. Your involvement and contribution will move us in the right direction for solutions. References: 1. h ttp://www.independentsentinel. com/2013/01/extremists-arrested-ingreenwich-village-with-weapons-bombmaking-materials/ 2. Silverstein, Jason. The Decline of Emergency Care. The Atlantic April 26, 2013. http://www.theatlantic.com/health/ archive/2013/04/the-decline-of-emergencycare/275306/ 3.
http://www.nytimes.com/2012/11/14/ nyregion/fbi-had-greater-role-in-josepimentel-terrorism-case-documents-show. html?_r=0
4. Rivara FP, Nathens AB, Jurkovich GJ, Maier RV. Do trauma centers have the capacity to respond to disasters. J Trauma 2006 Oct 61 (4): 949-53 http://www.ncbi.nlm.nih.gov/ pubmed/17033567 5. h ttp://www.bt.cdc.gov/masscasualties/pdf/ cdc_surge-508.pdf 6. Sarin Gas Attack from KBRN / NBC 1995 https://www.youtube.com/ watch?v=QMWSGwtZslo 7. Frieden, Thomas, et. al. In a Moment’s Notice: Surge Capacity for Terrorist Bombings; Challenges and proposed Solutions. CDC – Dept of HHS http://www.bt.cdc.gov/masscasualties/pdf/ cdc_surge-508.pdf 8. h ttp://www.nytimes.com/2010/03/26/ health/policy/26docs. html?pagewanted=all&_r=0 More Doctors are giving up private practice. New York Times . March 25, 2010.
The Editor's Desk
Drew A. Koch, DO, FACEOP-D
Code of Conduct
o the physicians, nurse practitioners and physician assistants in the Emergency Department practice medicine that is so egregious that every time a consult is called the ensuing phone call is unbearable? Proper phone etiquette is to initiate the call with a greeting, ‘How are you,’ followed with identification of the caller, and a statement of why you’re calling, preceded by an apology for interrupting the Consultant. Should the recipient of the phone call return the pleasantries that were afforded them or should the Consultant just proceed to engage in unruly and unprofessional behavior? One would hope the former behavior would be the norm and alternate behavior an occasional or rare occurrence. It is the exceptional Consultant who exchanges pleasantries and is accommodating whatever time of day they’re called. They are amiable and will avail themselves to assist the Emergency Medicine Provider (EMP) in patient care management or outpatient follow-up. The current norm is aggressive and unprofessional behavior from the medical staff. There is an epidemic of resentment and unwillingness of the medical staff, i.e., Consultants, to be civil on the phone let alone provide assistance to the Emergency Medicine Provider. The patients aren’t the focus of the conversation, but rather, a pawn of the Consultant, to convey their anger to the EMP.
There was always a lack of willingness or cooperation from a minority of the medical staff to provide the necessary care or follow-up to the emergency medicine patients. This lack of teamwork, cooperation and communication has spread and now encompasses the general medical staff. EMPs understand that Consultants don’t relish being on ED call and that ED call is the price of doing business; however, our medical staff brethren are convinced the EMP is incompetent and that you, personally, call them just to bother them. The only time the EMP is competent is when the EMP doesn’t call the Consultant or takes care of the Consultants’ family or friends. Some of our medical staff colleagues feel the only reason the EMP calls the Consultant during the night or on weekends is to annoy them and has nothing to do with patient care. It’s not uncommon to hear the Consultant ask why did you call, or say I just left the hospital and not coming back. This unruly behavior isn’t unique to the any specific hospital but is the norm everywhere. The only difference is the location and the physician’s name. Patient care and safety are placed in jeopardy. The EMPs don’t want confrontation and abuse when speaking with a medical colleague. The physicians, physician assistants and nurse practitioners will choose the path of least resistance when dealing with certain members of the medical staff. If feasible, the EMPs will address the patients’ care in the ED and discharge the patient to home without calling the specialist or PCP for follow-up. This allows the EMPs to avoid the negativism and unprofessional behavior afforded by the on-call doctor or PCP. However, in practice, this might not be in the patients’ best interest. Discharging the patient from the ED without discussing their care or worse, discharging them when they should have been admitted without proper follow-up is a dangerous alternative. There are other physicians who prefer to allow the on-call specialist to rant and rave when called before they present the patient to the on-call physician. These EMP feel that once the on-call doctors get their anger off their chest they are more apt to listen. The last option is to not allow the Consultant to engage in this behavior or give it right back to them. These communication techniques or lack of techniques don’t place patient care at the forefront of the physician –
physician communication. It’s inevitable that the EMP will need assistance with patients in the ED. The EMP doesn’t admit patients to the hospital, perform surgery, special procedures, or provide followup and outpatient work-ups. What the EMP does not need are the continual barriers to practicing medicine and roadblocks or hoops to jump through to provide care and follow-up arrangements patients require. So, what can EMPs do to eliminate this selfcentered angry behavior? We need to continue to be the patient advocate and insure patients are safe and obtain the care necessary. We need to be diligent in our perseverance of doing what is right for the patient. We should lead by example and provide positive exemplary behavior to our fellow members of the medical staff who continue to be the “poster children for bad behavior.” These unprofessional attitudes are learned behaviors. The culture of the medical staff must be changed. The medical staff should be working together to provide excellent care to our patients and place the interests of the patients above everything else. This change must start during the training years. Physicians in training must be taught how to work as a medical team, how to communicate with their peers and direct the focus of healthcare on the patient – where it belongs. The medical staff through its governing body should include a mission and vision statements that encompasses patient-centered care and clinical excellence. The governing body should adopt a code of conduct for its medical staff and provide a mechanism for enforcing that the medical staff adheres to its code of conduct and instills a culture of positive behavior.
8 Executive Director's Desk Janice Wachtler, BAE, CBA
When End of Life Decisions Don’t Come Easy individuals like this? How do you rationalize with someone who at this point has used all the family’s reserves to keep her mother ‘comfortable’? As a friend I have advised her for years her mother’s quality of life should outweigh the quantity of life and it’s all about that. For years she has chosen to ignore my advice and that of others who have advised her likewise. She has stubbornly maintained she cannot make the decision as she cannot assume blame for it.
nd of life decisions are always hard to make. No matter how prepared you are to make those decisions for family members, you are never truly ready. But what happens when you and your family member never discuss end of life decisions? I was recently faced with this situation as one of my friends, an only child, was tasked with making a decision on the end of life care for her mother. More than three years ago her mother broke her hip and obtained a nosocomial infection that left her in an induced coma during which she had a series of strokes. The situation is complicated by her own personal physical, mental health, and financial issues. The mother left a living will, stating not to use extraordinary means to extend her life, however, my friend feels the insertion of a feeding tube and utilization of multiple antibiotics do not amount to extraordinary means. Her mother is now in a vegetative state, muscles atrophied and non-reactive to pain, she feels hospice is a death sentence and, now, by pulling the feeding tube and removing medication is murdering her mother. As physicians what do you say to
Years ago, my family went through a similar situation with my father, the difference being is my family openly discussed death and dying and the wishes of everyone in the family. Most agreed they wanted no heroic actions taken they were not able to be viable mentally, as physical disabilities could be handled. All, with the exception of one, wanted to be cremated. So when we were faced with Dad being both mentally and physically impaired, plus a plethora of health-related problems, it was an easy decision that we spoke with him about, even though he was aphasic at
times. He acknowledged and agreed with two blinks of his eyes. We all must make decisions in our lives. It is extremely difficult when decisions involve the life and death of someone you love. But these are conversations that have to be done with children, parents, partners, friends and perhaps healthcare professionals. What would you do as a healthcare professional who is confronted with someone presenting to your emergency room in the obvious last stages of life? Their caregiver or guardian refuses to obey the patient’s request not to take extraordinary methods to keep them alive. Would you insert a feeding tube, IV, or antibiotic to counter an infection? Would you state the person has signed a living will that prevents you as a healthcare provide from taking these measures? How would you counsel this patient while doing the best for the patient?
Ethics in Emergency Medicine
Bernarnd Heilicser, D.O., M.S., FACEP, FACOEP
What Would You Do? This type of situation has, unfortunately, become more prevalent in our society. With the threats of terrorism, both foreign and domestic, and the increased availability of weapons, EMS providers are potentially in harm’s way on any given EMS run. Should they be allowed to wear body armor, and if so, should there be a policy for this?
n this issue of The Pulse, we will review the situation of whether paramedics should be permitted to selectively wear body armor on EMS calls. I posed this question in light of a recent event where one of the ambulances in my EMS System came under gunfire transporting a patient to our hospital.
With scene safety paramount in EMS response, EMS providers must be given every opportunity to protect themselves. When responding to a call with the indication there may be danger, appropriate precautions should be routine. Areas of potential violence are no exception. I would maintain that EMS providers be permitted to wear body armor. However, we must be careful not to make inappropriate assumptions that would lead to profiling.
respect. Protecting ourselves is essential, but this must be done in an ethical and professional manner. Specific provider policies should be written to emphasize the importance of objectivity, and to monitor for possible individual abuse. This is our obligation. If you have any cases that you would like to present or be reviewed in The Pulse, please fax them to us. Thank you.
Medical providers have a moral obligation to care for those who need us. We should treat every human being equally and with
We received the following response from Greg Conrad, D.O.: hen I was a medic I wore body armor as did W other members of my unit. We considered it as part of our personal protective equipment (PPE). We did not seek the approval of our town, our EMS System, or our employer. Therefore, we paid for the vests ourselves. I know of a number of medics who wear vests. But I don’t know who pays for them. t times when responding to calls at unsafe A scenes with no police availability, I was shot at 1 or 2 times. We also had numerous “unknown medicals”, where we reported to the scene of a violent crime. The body armor is designed for ballistic protection but also help protect the wearer during fights/blunt trauma and, to a point, some edged weapons. We thank Dr. Conrad for his thoughts.
10 The Board's Notebook
John C. Prestosh, D.O., FACOEP, Secretary
Do We Run the Wrong Way? just seen, a nurse popped in the charting room and asked if we heard about the Boston Marathon. There were four of us in the room, and I am not sure who was the quickest to pull the news up on the Internet. The headline stated there were two explosions at the finish line of the race, and numerous casualties. I immediately went into a vacant patient room and turned on the television to get more information. The pictures surely reinforced the adage of “a picture is worth a thousand words.” There was misery and shock seen in the eyes of many captured by the television cameras. Blood was everywhere. The cheers quickly
think strange; however, I did not find it strange or odd at all. I understood what I was watching. I saw many individuals running toward the devastation, toward the smoke, toward the crying, toward the unknown! Medical personnel, firefighters, paramedics were running the wrong way … they were running not from the disaster but into it. This did not surprise me. I expected it. As medical personnel and first responders, we have been trained for moments like this. While I admit we abhor when these situations arise, we have an adrenaline surge when they
"I will prescribe regimens for the good of my patients according to my ability and my judgment and never do harm to anyone." Excerpt from the Hippocratic Oath pril 15, 2013 … Tax Day … Patriot’s Day …. The day Boston was bombed …
I believe it was a fairly normal Monday for the majority of the people living in the United States. Many, like me, were at our work places, doing what we do. Others may have been working on their taxes to ensure they would beat the midnight filing deadline. Some may have had the day off and were just enjoying whatever they were doing. It was a special day in Boston, Massachusetts where more than 25,000 runners congregated for the annual marathon. Surely this was a day of anticipation and excitement for participating runners. Some, a select few, had aspirations of winning the race. Most had visions of doing a personal best time and still others were running on the behalf of charities and sponsors. Hundreds of people gathered near the finish line to congratulate those hearty runners as they crossed the finish line. Men, women, and children lined the streets cheering the runners during those last few yards. Cheers were heard, laughter was prevalent, and it was a good time with wonderful memories being made. A few minutes after 3PM, as I was completing a chart on a patient I had
turned to tears. The wonderful memories now replaced by scars that would never be erased. I am certain at that moment there were millions of eyes watching the horrible scene taking place on the screen before us. It was clear both runners and observers were injured; some worse than others and many emotions were displayed in front of viewers. Many people ran from this scene of devastation, running away as fast as they could to safety. But then I saw something else. I saw something many people would
do occur and our instinct and training take over. Disasters take place and when they do there are those unique individuals who will respond without thinking of their personal safety, instead they only have thoughts of the safety of others on their minds. This is the mentality of first responders, and I believe it is shared by any person who chooses this lifestyle as a vocation. I do not believe such a person thinks of what he or she does for a living as a job, but indeed a calling. See "Wrong Way" on page 26
The On-Deck Circle
Mark A. Mitchell, D.O., FACOEP, FACEP, President-Elect
Healthcare in Crisis: Seek Solutions expenditures and of that, the top 1% account for 30%. We know we spend a significant percentage of an individual’s total life-time expenditures in the final stages of life. As Emergency Physicians we seem to have a more tainted view of healthcare. We see patients who have no other resource than the Emergency Department as their “Medical Home.” We have to see patients even though they have governmental assistance, i.e. Medicaid, because they can’t get an appointment to assist with their chronic medical conditions such as asthma, hypertension, or diabetes. Yet, with all the total dollars spent in the United States on healthcare, there are still those who fall through the cracks and we are the safety net they rely on.
e are currently facing a situation in healthcare that we’ve seen coming for quite some time. The amount of our national resources directed to healthcare are significantly out of proportion to the rest of the world and when compared to other countries, our results are not statistically better. In 2010 healthcare spending in the United States was 17.6% of the GDP ranking second was the Netherlands at 12.0%. The average annual premium for family health insurance coverage increased from $5,791 in 1999 to $15,745 in 2012. During the same period (1999 to 2012) the following has been noted: Overall Inflation
Health Insurance Premiums
Workers’ Contribution to Premiums
Many measures are now being explored to attempt to ensure that there is value to accompany the escalating purchase price of healthcare. Consequently we are now seeing “value-based purchasing” in which reimbursement is tied to outcomes and metrics. This began in 2007 as Physician Quality Reporting Initiative (PQRI) that has now transformed to PQRS (System). In the early stages there were financial incentives to those providers who voluntarily participated in reporting these metrics on Medicare beneficiaries.
However, in 2015 the program will also apply a payment adjustment (decrease) to those providers who do not satisfactorily report on quality measures. Additionally, hospitals were faced with reporting Core Measures as a determining factor in their reimbursement for services rendered. Now we are faced with even more “Value-Based Purchasing” issues including: * Episodes of care and bundled payments *Hospital readmissions *Accountable Care Organizations (ACO). The environment will continue to get more complex as government and commercial payers develop measures to contain cost and maintain or increase value from the healthcare system. As such we must understand these changes and be prepared to make changes, where needed. As Emergency Physician, I personally feel that we are in a great position in these ever-changing times. We have the most valuable commodity in all of this … the patients. Patients continue to seek out our care in record numbers. Approximately 70% of all hospital admissions in the US See "Healthcare" on page 26
Source: Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 1999 – 2012.
It is also interesting to note that 20% of individuals with insurance don’t use any healthcare allocations in a given year, and 70% account for only 10% of the total expenditures. This results in 30% of people accounting for 90% of the
Correlation of Residency Program Maturity with Mean Scores Michelino Mancini, DO
bstract Context: Hospital educators seeking to implement an osteopathic emergency medicine residency program require the support of hospital administration. When designing a residency program, educators and administrators encounter a multitude of unknowns. One question often encountered is: at what point can a new program expect to see applicants who meet the same level of quality as established programs? At present, the most commonly used quantifiable measure of applicant quality is the Comprehensive Osteopathic Medical Licensing ExaminationUSA (COMLEX-USA) score. Objective: To highlight COMLEX-USA scores as supportive data for hospitals considering the implementation of an Osteopathic Emergency Medicine residency. Methods: COMLEX-USA scores of Emergency Medicine resident applicants to a newly established Emergency Medicine Residency program at Lakeland HealthCare in Saint Joseph, Michigan were gathered from the Electronic Residency Application Services (ERAS) from 2011 through 2013. These applicant scores were compared to those published by the American Association of Colleges of Osteopathic Medicine (AACOM) in their 2011 Match report. Results: In 2011, the Lakeland applicants’ mean COMLEX-USA Level 1 and 2 scores were 481.95 and 484.91 respectively. In 2012, the mean COMLEX-USA Level 1 and 2 scores were 476.08 and 489.28. Finally, the 2013 applicants’ mean COMLEX-USA Level 1 and 2 scores were 501.04 and 504.29.
To highlight COMLEX-USA scores "Objective: as supportive data for hospitals considering the
implementation of an Osteopathic Emergency Medicine residency.
Of statistical significance, Lakeland’s 2013 applicants ranked at the 50th percentile on both COMLEX-USA Level 1 and 2 when compared to applicant data published in the AACOM report. Conclusion: At the newly established Emergency Medicine residency program, the mean COMLEX-USA scores generally trended upward from the inaugural year to the 3rd year of the application cycle. In addition, the new program’s 2013 applicants’ mean COMLEX–USA Level 1 and 2 scores compared favorably with those scores published by the AACOM. Introduction A newly established Emergency Medicine residency program experiences many unknowns. When preparing to begin a new Emergency Medicine residency program, program directors often want to know how long it will take to obtain high caliber applicants who “measure up” to applicants at more established residency programs? Not only do program directors desire high caliber applicants in order to increase the possibility of selecting competent students into residency; they may need reliable data to garner support from hospital administrators to begin a residency program. Most resident selection processes entail reviewing medical student applications
through the Electronic Residency Application Service (ERAS). ERAS serves as a central hub for applicants to reach numerous programs and programs to reach numerous applicants. Upon receipt of applications through ERAS, residency programs usually perform a screening process to determine which applicants will be interviewed. ERAS candidate applications contain an abundance of information. Most of this information is subjective, such as letters of recommendation and personal statements. Only two specific areas of the ERAS application offer quantifiable objective forms of data available to program directors for screening applicants. These forms of data are medical school transcripts and COMLEX-USA Level 1 and Level 2 scores. Often times, program directors utilize the COMLEX-USA score as a measure of applicant quality – the higher the score, the stronger the applicant. In October 2012, the American Association of Colleges of Osteopathic Medicine (AACOM) published its second and most current GME Match Report, entitled the Osteopathic GME Match Report for the 2011 Match1. The first AACOM report regarding Match results, the Osteopathic GME Match Report 2009, was published in September 2011. These reports were developed with the cooperation of the American Osteopathic Association (AOA) and the National Board of Osteopathic
13 Medical Examiners (NBOME) and were intended to support osteopathic medical students during their osteopathic graduate medical education match selection process. There are numerous data elements provided within the AACOM report, including nontest performance measurements such as number of publications, number of research experiences, specialty of first choice match and more. Additional elements pertaining to testing performance are included, such as, first score attained from COMLEX-USA Level 1 and 2. Although the AACOM does not promote the use of its report as reference material, the information can be useful for osteopathic graduate medical education programs seeking additional insight into applicant data. Many of the above mentioned elements are utilized by residency programs to determine the caliber of a medical student’s application for entrance into post-graduate education, but the COMLEX-USA score appears to be one of the most often utilized quantifiable measures of applicant quality. The validity of tests, such as COMLEXUSA and the United States Medical Licensing Exam (USMLE), has come into question. Some studies, as produced by Cavaleri2 et al. and Sevensma3 et al., demonstrate a direct correlation between future clinical medical knowledge and COMLEX-USA scores. While other studies, as illustrated by McGaghie5 et al., purport a lack of significant association between USMLE scores and resident clinical success. Nonetheless, without reproducible validity, these standardized tests remain one of the primary objective benchmarks for program directors during the interview selection process. A recent comprehensive survey by the Accreditation Council for Graduate Medical Education (ACGME) Program Directors’ residency selection criteria reported by Green4 et al. in Academic Medicine in 2009, exemplified objective data measurements as being most regarded. With regard to applicant interview selection criteria, the following elements were identified in descending order of importance: grades in required clerkships; USMLE step 1 scores; grades in senior electives in specialty; number of “honor” grades; and USMLE step 2 scores. In addition, The National Resident Matching Program (NRMP) produced the Results of the 2012 NRMP Program Director Survey6 where they illustrated that 82% and 71% of all residency programs utilize USMLE/COMLEX-USA Level 1
510 505 500 495 490 Level 1
480 475 470 465 460 2011
Figure 1. COMLEX-USA Scores of applicants into Lakeland HealthCare’s Emergency Medicine Residency Program
and USMLE /COMLEX-USA Level 2 as factors in selecting applicants to interview. Although multiple factors are likely used in the selection process, this paper focuses on COMLEX-USA scores as related to a newly established osteopathic Emergency Medicine residency at Lakeland HealthCare.
data pool included: applications that did not provide both COMLEX-USA Level 1 and 2 scores and applicants with previous graduate residency training. The final inclusion number for each Lakeland applicant cycle was the following: 136 of 155 for 2011, 170 of 204 for 2012 and 189 of 236 for 2013.
The purpose of this study is to determine the amount of time expected to observe the applicant pool of a new Emergency Medicine residency program to reach the same caliber of candidates as the applicant pool of established programs, using COMLEX-USA scores as a quantifiable measure of quality. It is the assumption that as newly established residency programs progress yearly, they begin to capture the quality of applicants interviewing at fully-developed residency programs.
Lakeland’s annual mean COMLEX-USA Level 1 and 2 scores were calculated and a Z score with percentile rank was created by utilizing the “normal values” provided by the 2011 AACOM report.
Methods In the beginning of 2013, COMLEXUSA scores were collected retrospectively for all applicants to Lakeland HealthCare’s Emergency Medicine residency program. Data was acquired from ERAS for the 2011, 2012 and 2013 applicant cycles. In order to conform to data acquisition provided by the Osteopathic GME Match Report for the 2011 Match, only 1st attempt COMLEX-USA scores were used for applicants matching into one of the 46 accredited osteopathic emergency medicine residency programs. To our knowledge, only 2 of the 46 accredited osteopathic emergency medicine residency programs were newly established in 2011. Additional exclusions from the Lakeland
The NBOME issues COMLEX-USA results as both a two and three digit numeric standard score. For the purposes of this study the three digit numeric standard score was used. The NBOME attempts to acquire a mean COMLEX-USA score of 500 for both Level 1 and 2. Also, a passing COMLEXUSA score is considered 400 and above for both Level 1 and 2. Results In 2011, Lakeland’s mean COMLEXUSA Level 1 and 2 scores were 481.95 and 484.91 respectively. The mean 2012 applicant COMLEX-USA Level 1 and 2 scores were 476.08 and 489.28. Finally, the 2013 mean COMLEX-USA Level 1 and 2 scores were 501.04 and 504.29. Figure 1 illustrates Lakeland HealthCare’s applicant COMLEX-USA score trends. The 2011 AACOM report illustrates "Correlation" continued on page 24
A Primer on Bombings and Blast Injury Stephen J. Vertrano, D.O., FACOEP, FACEP, EMT (I) Vice Chair, EMS Committee
n light of the recent tragedy at the Boston Marathon, it seems wise to provide some general information regarding the care of blast injuries. Bombing incidents have plagued society since the dawn of explosives and will continue because of the relative ease to assemble and cheap cost of production. Our servicemen and women fighting in the Global War on Terror have endured first-hand the effects of blast injury, and unknowingly advanced its treatment, particularly for head trauma. However, that is only a small piece of the story. First, you must recognize there are two types of explosives events: low-order explosives and high-order explosives. Loworder explosives are typically made with gunpowder, black powder, or smokeless powder. High-order explosives are military grade explosives: C4, Semtex, Plastique, Ammonium Nitrate and Fuel Oil (ANFO), Nitroglycerin, TNT. Low-order explosives like black powder and similar products, burn more than they explode. When black powder explodes, it usually results from rapid combustion of the product inside a vessel. The pressure inside the vessel increases to a point that it surpasses the vesselâ€™s ability to contain the pressure, resulting in the explosion (e.g., pipe bomb, pressure cooker bomb). High-order explosives are so volatile that they expand very rapidly, converting the solid or liquid into a gaseous state nearly instantly. This results in a unique injury pattern seen only in high-order explosives.
bombing event is a mass casualty "Any incident. Your facilityâ€™s disaster plans will need to be utilized. Accurate triage is needed to assure maximal survival.
Blast injury can be categorized into five types: Primary, Secondary, Tertiary, Quaternary, and Quinary. Primary blast injury occurs from the blast wave or blast wind as the explosion displaces the atmosphere around it and matter is transformed from solid to gas. Primary blast injury is unique to highorder explosives. Patients suffering primary blast injuries involve organs with an air or fluid interface, particularly hollow air-filled organs. Tympanic membrane rupture is very common, but cannot be used as a marker for other primary blast injuries, only as a marker for primary blast exposure (i.e. high-order explosive usage). Pulmonary injury including pneumothorax commonly occurs, as does hollow viscous rupture in the abdomen. Traumatic brain injury occurs without direct impact of the head on a solid object. This has been discovered through the examination of minor wounded soldiers from IED blasts in the Global War on Terror having concussive or postconcussion syndrome signs in the days after the blast. Secondary and tertiary blast injuries produce similar effects but by different mechanisms. Secondary blast injury is the result of shrapnel or debris being thrown by the blast and striking the patient. Tertiary blast injury is the result of the patient being
thrown by the blast and striking something. Penetrating and blunt trauma is the result, with secondary blast injury favoring more penetrating than blunt, and tertiary favoring much more blunt than penetrating. In particular, traumatic amputations are highest in the tertiary blast injury group.
If you observed some of the video of the Boston Marathon bombing, you’ll notice there is a blast wind that occurs. This is related to the explosion of the low-order black powder in the pressure cooker, and is an effect of combustion under pressure. If you examined injury reports, they were virtually all secondary and tertiary blast injury effects.
Any bombing event is a mass casualty incident (MCI). Your facility’s disaster plans will need to be utilized. Accurate triage is needed to assure maximal survival. Comfort care will be needed for the expectant injuries. The good news is in most bombings, the majority are not critically injured. The critically injured, however often have multidisciplinary injuries.
Quaternary blast injury is a conglomeration of other injuries such as burns, crush injury, eye irritation, and exacerbation of chronic diseases such as COPD/asthma or heart disease.
At any MCI, EMS triage will initially be limited. Patients who can self extricate will do so, often to the closest health care facility. The majority will be transported not by EMS. The Boston Marathon Bombing was an outlier because the marathon, and other events in which large crowds of spectators and participants are expected, require the prepositioning of medical assets. These assets simply responded to the injured. The CDC has a predictor tool for estimating the total number of injured patients to expect. After the arrival of the first patient, in one hour, half of the total number of patients is expected to arrive. The second half will
Quinary blast injury effects have been postulated by the military. This involves the body’s reaction to “post-detonation environmental contaminants” such as bacteria, hazardous chemicals, metals, and radiologic material. The care of injured patients in a bombing is rooted in trauma care. Communication may be difficult due to ruptured tympanic membranes, and decontamination may be needed prior to care because of the bombing material or concern for quinary blast injury.
arrive over the next five to six hours. Thus, multiplying the number of patients seen related to the incident in the first hour by two will give a rough estimate of total to expect, and the facility can start to plan for additional staff and resources needed. Of note, remember the regular 911 system will still be in place, and non-MCI patients will still be seeking evaluation for their problems. In summary, conventional bombings will still be the main weapon of mass destruction favored by terrorists due to the ease of obtaining materials. Explosions result in injury across five types of mechanism resulting in multidisciplinary injuries and complex injury patterns requiring innovated multidisciplinary approach. Reference: Bombings: Injury Patterns and Care, version 2.0. CDC, ACEP, and US Department of Health and Human Services, 2009
ABC's always take precedence; however, exsanguinating hemorrhage should be treated above all other injury. Use of tourniquets is of paramount importance here. Assessment of the ABC's will help to uncover blast lung injuries. Secondary assessment will uncover head, abdomen, and extremity injuries. Patients will often present with a combination of blast injury effects and will require a multidimensional approach to care.
Certification Update Donald Phillips, D.O., FACOEP Secretary, American Osteopathic Board of Emergency Medicine
reetings from the American Osteopathic Board of Emergency Medicine! I would like to take a moment to bring the ACOEP membership up-to-date with information on recent changes in board certification and maintenance of certification. If you have a current application pending with the American Osteopathic Board of Emergency Medicine (AOBEM) all rules in effect when you applied are still and will remain in effect. Please remember that some rules discussed below, are in the process of being approved and will not take effect until they are approved by the Bureau of Osteopathic Specialists (BOS) and the AOA Board of Trustees (BOT). Osteopathic Continuous Certification (OCC) Osteopathic Continuous Certification (OCC) is the process in which board certified osteopathic physicians can maintain dominance and demonstrate competency in their specialty area. The cycle for Emergency Medicine OCC is ten (10) years. AOBEM has updated information on the website (www.aobem.org) to reflect the most current AOA regulations. Most notably, Component 4 must now be met by completing the online form electronically via the website. Please note the following changes: If you are currently within 5 years of your certification expiring, you must submit one Component 4 (Practice Performance Assessment and Improvement) project before recertifying. For those expiring in 6-10 years,
a project must be submitted during years 1-5 and another project in years 6-10 of certification. THIS APPLIES TO 2013-2018 ONLY! You must review at least ten of your own charts for each of the pre and post intervention assessments. If your initial assessment of your ten or more charts reveals that your performance is satisfactory (see the criteria on the web form), a post intervention assessment does not need to be performed. If you decide to submit this project for PQRS, you must do a post intervention assessment even if you are already satisfactory. The AOA will award one CME credit per chart pulled for the initial assessment to a maximum of ten credits. Useful information on OCC can be accessed by using this link http://www.aobem.org/ OCC_main.html Continuing Osteopathic Learning Assessments (COLAs) Beginning with COLA 2014, registration will be all online. This will allow nearly instant access to the exam following registration. Registration for all COLAs before 2014 will utilize the current application procedure. COLAs are accessible for three years currently. In the near future, all COLAs will remain accessible. To encourage timely completion of the modules (within three years
of posting), the following fee structure will be established. • During years 1-3 - $105 per COLA • Years 4 and older - $210 per COLA Formal Recertification Examination (FRCE) The BOS requested that all boards standardize their terminology. As a result, the FRCE will now be known as Cognitive Assessment. 1. Diplomates will have three years before their certification expires in which they may recertify. 2. Diplomates will also have three years after their certification expires to “catch up” and recertify. This is the reason AOBEM is putting the expired COLAs back online. Primary Certification AOBEM is currently developing alterations of its regulations that will eliminate Part III Clinical Examination. This is not in effect at this time and all candidates must remember that rules in effect when they apply are the rules they will be under throughout their eligibility. Physician Quality Reporting System (PQRS) Please review the website for submission directions. Note that if you are submitting your OCC Component 4 data as your PQRS you must always do a post intervention evaluation using at least ten of your own charts.
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http://www.acoep.org/pulse the PULSE
ACOEP ≠ AOBEM Janice Wachtler, BAE, CBA Executive Director
ver the course of many years, the American College of Osteopathic Emergency Medicine has tried to inform its members of its purpose. This has been done through various mechanisms; we’ve printed articles, hosted lectures and even had face-to-face chats and it doesn’t appear to work. We still get complaints and questions about the board certification process.
The American Osteopathic Board of Emergency Medicine (AOBEM) is the group that certifies physicians. It develops certification tests, develops mechanism for maintenance of certification. The Board is an extension of the AOA developed specifically to provide certification for osteopathic emergency physicians, toxicologists, pediatric emergency medicine physicians and EMS physicians.
The College is a non-profit organization established to serve the needs of the osteopathic emergency medicine physician. It is service organization formed to advocate for the emergency medicine physician, provide educational credentialing for residents and continuing medical education pertinent to emergency medicine and its subspecialties. The part the College plays only a small part in initial certification by declaring residents program complete. For physicians recertifying we provide required CME courses and accredit participation in the COLA modules. That’s it.
The Board is held accountable to the public for the guarantee that emergency medicine physicians (and subspecialists) meet a certain standard of care. This standard of care is reported to governmental officials and the public. While the College understands some of the frustration its members are encountering meeting the various steps in certification, we cannot oppose the rulings demanded by the American Public. We know that new rulings are upsetting to physicians who must now take not only continuous certification modules and now charting
assessments during their 10 year active certification but we have no influence in this area. Our officers have met on a personal and professional basis with members of the AOBEM and AOA’s Bureau of Osteopathic Specialists to express our concerns, but these agencies are being driven by outside agencies to meet the demand of the public. Each year we get numerous threatening comments from members that they’ve had it with our demands and requirements for certification. They threaten to drop membership, stop coming to meetings, complain to AOA, and such. In reality that won’t help you. AOA and AOBEM are agencies directly related with certification; the ACOEP is not. We can advocate and be your voice in the process, but the process is driven solely by the public and government; not the college. So next time you have complaints about the certification process, we can listen and forward them to the AOBEM and AOA, but we can’t change them.
We Want to Hear from You! ER Physicians do incredible things every day and we want your stories! From Dr. Prestosh’s experience with the Boston bombings, to Dr. Vetrano’s look at how to treat victims of bombings, we know that our members have thoughts to share. Send your story ideas to ThePulse@acoep.org, we would love to share your experience with our members. We also encourage you to email ThePulse@acoep.org to share your thoughts on specific articles that you read here. We want to keep the conversation rolling, whether you agree or disagree with a point of view represented in our articles, we want to highlight various perspectives from our diverse membership.
Finance Committee Report to the Membership David L. Levy, D.O., FACOEP, Treasurer Janice Wachtler, BAE, CBA Executive Director
t is the responsibility of the Finance Committee to report the status of the College’s financial position its membership twice annually at the General Membership Meeting. Fiscal Year-end Audit – The audit of the Fiscal Year October 1, 2011 through September 30, 2012 was conducted by the independent auditing branch of Dugan and Lopatka in December 2012 with the results made available to the Treasurer in early January, 2013. The findings of the Audit were that there the College’s net assets increased by $140,418 during the last fiscal year when compared to the previous fiscal year findings. Its liabilities increased by approximately $39,700 during that same period of time. The increase in assets was generated by increases in membership dues and
program fees, as well as increases in the return on the College’s investments which were increased by approximately $164,000, which increased the total revenue for the fiscal year by $491,857 over that of the previous fiscal year. With growth in its product (CME Meetings), the expenses to support these events increased by almost $150,000 (15.2%). Administration of the College also increased from the previous year about $175,650 (14%). During the fiscal year of October 1, 2011 and September 30, 2012, the ACOEP increased its staff to serve the College by 1.5 FTE which added to the salary and benefit line of the budget from the previous year. As for the current year it appears that we will show similar growth and expenditures going forward. At this time the College’s
income is $2,235,535. The expenditures are $1,632,040 through March 15, 2013. This does not include much of the expected expenditure from the Spring Seminar which should be in the area of $200,000 or the remaining six months of expenses for the College. The College has undergone expansion of its physical space to accommodate anticipated growth between now and 2017. We anticipate growth in the GME area as well as membership and administration. To contain costs the office will be assuming some of the design work it has traditionally outsourced with employment of staff in the IT Department with different skill sets than a previous employee. We anticipate this to save approximately $60,000 over the 2013-14 fiscal year. We thank you for your continued support.
AMERICAN COLLEGE OF OSTOEPATHIC EMERGENCY PHYSICIANS STATEMENT OF FINANCIAL POSITION SEPTEMBER 30, 2012 AND 2011 ASSETS ASSETS:
Accrued interest receivable
Due (to) Foundation for Osteopathic Emergency Medicine
Due from the Federation of Osteopathic Specialty Organizations $2,469
Prepaid expenses and other assets
Furniture, equipment and leasehold improvement, net
Cash and cash equivalents
LIABILITIES AND NET ASSETS LIABILITIES:
Line of Credit
Total Liabilities and Net Assets
2013 Board Candidates Janice Wachtler, BAE, CBA Executive Director
he ACOEP is pleased to announce the candidates for the four available positions on its Board. Elections will take place online as they have in the previous three years with voting being available to members who have paid 2013-2014 dues after August 15th. As explained in another article, members will receive a key after their dues have been processed by which they can cast their ballots. Voting will also be available on-site in San Diego until 90 minutes prior to the Membership Meeting. Juan Acosta, D.O., M.S., Ph.D., FACOEP, FACEP Dr. Acosta is a 1997 graduate of the New York College of Osteopathic Medicine. After a residency in Emergency Medicine at St. Barnabas Hospital, Bronx, NY, he received a Masters in Clinical Investigation from Weill Cornell Medical College and is currently in the process of obtaining a Doctorate Degree in Health Education from AT Still University. Dr. Acosta currently serves as Assistant Dean of Postgraduate Medical Education/Director of Medical Education and an Associate Professor at Pacific Northwest University in Yakima, Washington. He is also the Medical Program Director - Yakima County Department of EMS and the Chief of Staff at Toppenish Community Hospital. In addition to his above roles, Dr. Acosta is actively involved in the Washington Disaster Medical Assistance Team (DMAT) and a reviewer for CECBEMS and Western Journal of Emergency Medicine. He is involved with the Yakima County Medical Society and currently serves as its President-elect. As President of FOEM, he worked with and mentored medical students and residents to embrace research as part of their education.
Anita Eisenhart, D.O., FACOEP As a 20-year member of ACOEP, Dr. Eisenhart has stated that it is her honor “to have served, and to be nominated to continue to serve our College” as a Board Member. In addition to serving two terms on the Board, she has been an active member of the CME Committee, including Chair of the Committee. As such, Dr. Eisenhart served as Chair of the Scientific Assembly for several years and a frequent contributor and speaker at meeting venues of the College. She continues to work with this important group and currently serves as the Chair of Spring Seminar. Under the leadership of Past President Vic Scali, DO, she served an integral role in developing a pediatric presence within our College, including basic standards for pediatric emergency medicine and the impetus for a SIG in this area. Dr. Eisenhart is a proud Alumnus of the Philadelphia College of Osteopathic Medicine, who completed an osteopathic internship and Emergency Medicine residency at St. Barnabas Hospital, Bronx, NY. She then completed a Pediatric Emergency Medicine fellowship at Maimonides Medical Center, Brooklyn, NY. Dr. Eisenhart currently holds a community hospital position at John C. Lincoln - Deer Valley Hospital in the Pediatric Emergency Department, Phoenix, AZ. In the past she held teaching positions in both osteopathic and allopathic Emergency Medicine residency programs and can appreciate the practical differences between teaching hospitals and the community setting. Dr. Eisenhart lives in Scottsdale, AZ with her family. She enjoys raising her very energetic 5-year-old son, Max, and is currently studying Krav Maga between shifts and Little League games. She expresses her sincerest hopes
to continue to serve the members of the College and believes that by continuing her service for a last term on the Board. She believes the continuity of having three-term Board members is paramount to continuing the hard work we do. Thomas E. Green, D.O., MPH, FACOEP, FACEP Dr. Green graduated from Nova Southeastern University – College of Osteopathic Medicine in 1998 and did his emergency medicine residency at OUCOM/Doctors Hospital in Columbus, Ohio (where he served as chief resident) finishing in 2002. He is board certified through AOBEM (since 2003) and currently works in a community hospital emergency department (Palos Community Hospital in Palos Heights, IL). His previous positions include: work in a teaching hospital (Saint James Hospital and Saint Margaret Mercy) as well as having been the first associate program director for the MWU/CCOM Emergency Medicine Residency. He is also very involved in academic medicine through Midwestern University – CCOM. He is currently an associate professor in emergency medicine and the clinical curriculum director (which oversees the 1st and 2nd year medical school clinical curriculum). Dr. Green has been a member of the CME committee since 2003 and served on the Spring Seminar subcommittee and currently is the Vice Chair of the Scientific Assembly subcommittee. He was Co-Chair of the Scientific Assembly for 2012 and is Program Chair for the Scientific Assembly 2013. Dr. Green has significant leadership experience in various roles which have given him a unique perspective to serve on the ACOEP Board. He has served as a member of the Board of Directors of Ohio-ACEP (in 2003-2004), assistant medical director and medical director of an emergency department, associate residency director, and
21 faculty senator for MWU-CCOM. He has also been an editorial advisory board member for Emergency Physicians Monthly (20082011). Dr. Green states that he is seeking election to the Board for one primary reason, to bring new thoughts and ideas to the Board and College. He believes the current and previous Board and leadership of the College has done a tremendous job and the College has come a long way in just the past several years, however, we still have work to be done. Dr. Green is not afraid to be a contrarian voice, if that voice is speaking for the good of the membership and college. If elected, he states that his goal is to represent you, the physician member. He is seeking to the Board because he believes in the College, the greatness of osteopathic emergency medicine physicians, and that we can have a specialty college that we are all proud of and will take us to that next level. David L. Levy, D.O., FACOEP David Levy, DO is currently serving a three-year term on the ACOEP Board of Directors where he also holds the position of ACOEP Treasurer. Service to the College and the ACOEP membership has been an honor for Dr. Levy who is seeking election for a second term. Certified in the specialty of Emergency Medicine by AOBEM and ABEM since 1999, with current re-certifications in 2008, Dr. Levy has been a career-long member of the ACOEP, since 1993. Following his 1994 graduation from the New York College of Osteopathic Medicine, Dr. Levy completed his residency in Emergency Medicine and held the position of Chief Resident at Long Island Jewish Medical Center in New Hyde Park, NY. Today, he is a full-time attending physician with the Department of Emergency Medicine at Good Samaritan Hospital Medical Center in West Islip, NY, a Level II Area Trauma Center with an annual census approaching 100,000 patients. He also established the Emergency Medicine Residency Program and has served as its Program Director since 2004.
The promotion of Osteopathic Emergency Medicine and Medical Education is a keen interest of Dr. Levy’s and as a member of the Board of Directors and Residency Program Director, he is actively involved with the academic pursuits, growth, and fostering interest in emergency medicine among medical students, professionals and the public. Dr. Levy has advocated for osteopathic emergency medicine and: Has been a Delegate to the AOA’s House of Delegates for over seven years; Has chaired the Resident In-service Examination Committee for the last three years with the goal of refining and advancing the exam to new levels; Is a committee member on the Emergency Medicine Residency Program Director’s Committee, has been Board Liaison to the Undergraduate Medical Education Committee, Research Committee, CME committee, FOEM, and has academic appointments at several medical schools; Traveled to medical schools around the country to promote Osteopathic emergency medicine and has both organized and participated in workshops for students and residents on both the regional and national stage; Has served for over five years with the Department of Homeland Security as Medical Officer for the Disaster Medical Assistance Team, NY-2; Has enjoyed participating on numerous institutional committees and has organized a multitude of community-focused campaigns; By listening to the voice of ACOEP members and taking action with our best interest in mind, Dr. Levy is committed to continuing to serve the college as a member of the Board of Directors. As a nominee for ACOEP Board of Director in October 2010, he was voted in by the ACOEP membership in San Francisco in 2010. He has served as Board Liaison to the EMS Committee. He has been newly appointed as Board Liaison to the Constitution and Bylaws Committee by the President of ACOEP. He continues to serve
on the Program Directors Committee as well. At both the ACOEP Spring Conferences and the Fall Scientific Seminar, he continued to be very active with the osteopathic students in leadership, educational and mentoring programs. With osteopathic residents, he continued to be active with research competitions and mentoring as well. For the membership, he has been accessible in making sure concerns were addressed through the Board of Directors. Brandon J. Lewis, D.O., FACOEP Dr Lewis is a graduate of Texas A&M University and the University of North Texas Health Science Center-Texas College of Osteopathic Medicine. He completed his Emergency Medicine residency at Lehigh Valley Health Network in Allentown, PA. He served in the U.S. Air National Guard for 10 years as a flight surgeon and was activated several times including a deployment to Iraq in 2007. Dr. Lewis is a partner and member of the Board of Managers at Emergency Service Partners, LP, a physician owned Emergency Medicine partnership group which staffs twenty five emergency departments across the state of Texas. Dr Lewis currently practices at St Joseph Regional Health Center, a 300 bed community hospital in Bryan, TX. He is Medical Director and Chair of the Emergency Services Department which sees 60,000 patients per year. Under his direction, the Emergency Department, in cooperation with other departments, earned the hospital national recognition five consecutive years for excellence in stroke and cardiac care. The facility was designated as a certified stroke center and selected by CMS to serve as a test site for Comprehensive Stroke designation criteria for community hospitals. His facility achieved Cycle III and IV Chest Pain Center accreditation, and increased its trauma designation from Level III to Level II. He also oversaw the consolidation of regional EMS services under a single medical director for better standardization and cooperation and implemented a successful clinical research program in the Emergency Department. He has received awards from Trauma Region-N Regional Area Council and St Joseph Regional for his service and achievements. Most recently he was
Dr Lewis has been an active member of the ACOEP since joining as a student in 1998. He served in several leadership positions during medical school and residency including President of both the Student and Resident Chapters. One of his more notable achievement during that period was authoring a resolution that eventually led to the AOBEM changing their rules to allow 4th year residents the opportunity to sit for Step 1 of their Emergency Medicine Boards. He is currently a member of the Graduate Medical Education Committee, the Members Services Committee, and is the current and founding Chair of the Young Physicians Special Interest Group. He has also been a speaker on several occasions for the Student Chapter at the annual Scientific Assembly. He is active with the Emergency Medicine Practice Management Association, a conglomerate of Emergency Medicine organizations which advocate on behalf of the specialty on legislative and regulatory issues. Dr Lewis has also been very active in his state medical society, the Texas Osteopathic Medical Association having served on several committees and three terms, as a student, a Young Physician, and as a regular elected member on its Board of Directors. Having served previously as both a student and resident, Dr Lewis feels very honored to have been nominated for a position on the ACOEP Board of Directors. If elected, he would bring the viewpoint of an experienced physician working in a community hospital, who is actively engaged with the residents and newer members of the College. He would relish the opportunity to offer his experience and proven leadership skills in continued service to the College as a member of the Board of Directors. J.D. Polk, DO, MS, MMM, CPE, FACOEP Dr. J.D. Polk is the Principal Deputy Assistant Secretary for Health Affairs and Deputy Chief Medical Officer of the Department of Homeland Security
(DHS). He began serving in this position in November of 2011. Prior to his work at DHS, Dr. Polk was the Deputy Chief Medical Officer and Chief of Space Medicine for the National Aeronautics and Space Administration’s (NASA) Johnson Space Center and an Assistant Professor in the Departments of Preventive Medicine and Emergency Medicine at the University of Texas Medical Branch. He is the former State Emergency Medical Services Medical Director for the State of Ohio, and former Chief of Metro Life Flight in Cleveland, Ohio. He was previously a member of the State Trauma Committee for the State of Ohio. He has been active in the local, state, and federal emergency services and preparedness planning throughout his career. In addition, he is a member of the American Osteopathic Association’s Commission on Osteopathic College Accreditation, a Fellow of the American College of Osteopathic Emergency Physicians, and an Associate Fellow of the Aerospace Medicine Association. Dr. Polk received his degree in Osteopathic Medicine from the A.T. Still University in Kirksville, Missouri. He completed his residency in emergency medicine with the Mt. Sinai hospitals and the Ohio University system and is board certified in emergency medicine. Dr. Polk holds a Master’s in Science in Space Studies with a concentration in human factors from the American Military University, and a Masters in Medical Management from the University of Southern California’s Marshall School of Business. Dr. Polk has published extensively in the areas of emergency medicine, austere medicine, disaster response, air transport, aerospace medicine and medical management. He is an attending emergency physician with the Emergency Medicine Associates group as well as a Clinical Associate Professor of Emergency Medicine at the Edward Via College of Osteopathic Medicine. He is also an Affiliate Associate Professor and Senior Fellow in the School of Public Policy at the George Mason University. He has received numerous awards and commendations including citations from the Federal Bureau of Investigations, White House Medical Unit, Association of Air Medical Services, U.S. Air Force, and has received the NASA Center Director’s Commendation, the NASA Exceptional Service Medal, the National Security and International Affairs Medal and
the NASA Exceptional Achievement Medal. Otto F Sabando, DO, FACOEP, Board of Director ACOEP 2010-2013 As a nominee for ACOEP Board of Director in October 2010, he was voted in by the ACOEP membership in San Francisco in 2010. He has served as Board Liaison to the EMS Committee. He has been newly appointed as Board Liaison to the Constitution and Bylaws Committee by the President of ACOEP. He continues to serve on the Program Directors Committee as well. At both the ACOEP Spring Conferences and the Fall Scientific Seminar, he continued to be very active with the osteopathic students in leadership, educational and mentoring programs. With osteopathic residents, he continued to be active with research competitions and mentoring as well. For the membership, he has been accessible in making sure concerns were addressed through the Board of Directors.
appointed Vice President of Medical Affairs for the St Joseph Health System. Dr Lewis began his administrative career serving in a Medical Director role at a 7000 volume rural hospital E.D. and later, at a hospital affiliated freestanding E.D seeing 12,000 patients per year.
Dr Sabando was born and raised in Queens NY. He is the son of Ecuadorean immigrants. After graduating Brooklyn Technical High School, he enlisted in the Navy and was a Navy Hospital Corpsman. He also trained in Camp Johnson for Field Medicine after which he served with the Marines. After 2 years of active duty, he remained in the reserves until 1994. Dr Sabando earned his Baccalaureate of Arts in Biology in 1992 in Queens College. After working as a medical microbiologist, he graduated from NYCOM in 1998. He continued on and completed his Osteopathic Internship and Residency in Emergency Medicine in 2002 at St. Barnabas Hospital in the Bronx. Dr Sabando began his career at NY United Hospital as a faculty attending for the new Osteopathic Emergency Medicine. Shortly thereafter, he was Interim ODME and Interim Program Director. He also served on the medical board of the hospital. In April of 2005, Dr Sabando began as the Program Director for the new Osteopathic Emergency Medicine Residency at St. Joseph’s Regional Medical Center, Paterson NJ. From the residency program, fellowships
23 in EMS/Disaster, Emergency Ultrasound and Osteopathic Pediatric Emergency Medicine Fellowships were formed. Dr Sabando serves on the ED Executive, CAP, STEMI, CHF, GME and Sepsis Committees of the hospital. He has served as Vice Chair of the Osteopathic EM Program Directors Committee at ACOEP and serves on the board of directors and is Secretary for NJOAPS and is a delegate for the AOA. He has attended several AOA Delegate meetings in Chicago and has also participated several times at DO Day on the Hill. Stephen Vetrano, D.O., FACOEP Dr. Vetrano likes to describe himself as being Jersey born, Jersey raised, and Jersey educated. He received his DO degree from the University of Medicine and Dentistry of NJ-School of Osteopathic Medicine in 1998 and completed a one year traditional rotating internship at Union Hospital, Union, NJ before going to an emergency medicine residency at Newark Beth Israel Medical Center, Newark NJ. He is a diplomate of the AOBEM and is board eligible for ABEM. In addition, He is also NJ State Certified EMT for over 20 years. Dr. Vetrano has been an attending ED physician at Capital Health System, Trenton NJ for ten years where he served as an assistant department director and EMS Medical Director. He represented Capital at the NJ State Department of Health Mobile Intensive Care Unit Advisory Council, the state Paramedic Advisory Council. He also became the chair of its Basic Life Support Subcommittee, a position he still hold today. He also sat on another advisory council independent from Capital, the State Advisory Council for Basic and Intermediate Life Support (aka, the EMT Training Fund Advisory Council) and is now serving his second term as chair, and represents that group to the EMS Advisory Council of NJ. Most recently, Dr. Vetrano is an emergency medicine physician at Our Lady of Lourdes Medical Center in Camden NJ; working for a doc we all know, Al Sacchetti. Dr. Vetrano’s reputation as a medical command physician among field providers has led him to become medical director for multiple BLS agencies in Central NJ.
He is also active in prehospital education throughout NJ. Last year, Dr. Vetrano ran and was elected to the Board of Chosen Fire Commissioners of Hamilton Township Fire District #2. This Board is responsible for the governance of the district and employs 17 career firefighters and a career chief to provide fire suppression, EMS, incident rehab, and rescue services to the citizens and visitors to the district as well as the rest of Hamilton Township. He became active in the ACOEP when he joined its EMS Committee in 2009 and is currently its Vice Chair. The Committee has been instrumental in affiliating ACOEP with the World Association of Disaster
and Emergency Medicine (WADEM), an international professional disaster and emergency medicine society. The Committee has reviewed and endorsed the position papers of the National Association of EMS Physicians, and continues to work on a hybrid EMS fellowship program to give osteopathic EM physicians the opportunity to become certified in EMS. Dr. Vetrano feels honored and humbled by being given the opportunity to serve the College thus far and is equally humbled and honored to have received a nomination to the Board of Directors. He looks forward to continuing his service to the College in that role, or any other role that awaits him.
Board Election FAQs Each fall ACOEP holds elections for available positions on Board of Directors. Here are some frequently asked questions to remind you of how the process works… Who’s eligible to Vote? All categories of Active, Retired, and Life members of ACOEP are eligible to participate in the election process for the Board of Directors. The following membership categories are considered Active members categories: Active First Year
Active Second Year
Active Third Year
Life Charter Member
Distinguished Fellow Member When does voting begin? Voting is open the day after dues notices are mailed to members in early August. Can I vote on that day? Voting can be done only when eligible members pay their dues. The earlier you pay your dues, the earlier you can vote. Voting remains open until 3:30 p.m. PST on Sunday, October 6, 2013. How will I know when I’m eligible to vote? As dues payments are received and entered, Sonya Stephens, Member Service Director, will send paid members an email containing their specific voter key and a link to the election page. Can I vote at the Scientific Seminar? Yes, Voting will remain open until 90 minutes prior to the General Membership Meeting at the 2013 Scientific Assembly in San Diego (on Sunday October 6, 2013, 5-7 PM). At the conference, voting kiosks will be available on the day of the Membership Meeting. Eligible Members, who have not already done so, may vote on-site using computers at these kiosks or your own laptop or tablet.
24 "Correlation" continued from page 13 applicants’ mean COMLEX-USA Level 1 and 2 scores of 500.96 and 505.21 respectively. These AACOM scores also help to demonstrate an upward trend of Lakeland’s yearly applicant percentile ranks (see Table 1). The 2011 Lakeland applicant class ranked at the 37th and 39th percentile on COMLEX-USA Level 1 and 2 respectfully. The 2012 Lakeland applicant class ranked at the 34th and 41th percentile on COMLEXUSA Level 1 and 2 respectfully. The 2013 Lakeland applicant class ranked at the 50th percentile on both COMLEX-USA Level 1 and 2. Comment The findings in this study demonstrate multiple patterns. First, the mean COMLEXUSA scores trended upward from the inaugural year to the 3rd year of the residency program’s existence. One outlier was seen in the COMLEX-USA Level 1 scores for the 2012 applicants. Also, Lakeland’s 2013 applicants compared favorably with those applicants in the Osteopathic GME Match Report for the 2011 Match achieving COMLEX-USA scores at the 50th percentile. There are currently no articles published illustrating these correlations. The data acquisition for this research is not without limitations. First, the effect of excluding applicants who did not submit both COMLEX-USA Level 1 and 2 scores and/or had previous graduate residency training is unknown. AACOM’s most current Osteopathic GME Match Report for the 2011 Match directly correlates only with the 2011 Lakeland applicant group. A report providing data on the 2012 and 2013 ERAS applicants and their mean COMLEX-USA Level 1 and Level 2 scores has not be published . Future data collection to compare these years and
provide more accurate percentile ranks is anticipated. Another limitation of this study is the sample size. This study and the AACOM’s match report is limited to graduates of colleges of osteopathic medicine who elected to continue osteopathic graduate medical education training in AOAaccredited residency training programs. A larger number of applicants could be incorporated with the inclusion of graduates of osteopathic medicine who entered ACGME-accredited residency training programs. Also, sample size is small due to limiting research to one institution and its emergency medicine residency program. This specific restriction adds specialty bias which limits generalization of study findings to other specialties and institutions. We have begun exploring collaborative studies to compare our initial results with other newly established residency programs, both AOA and ACGME accredited. Additional studies would be significantly important for novice institutions who are interested in establishing future residency programs. Conclusion The mean COMLEX-USA scores among applicants into Lakeland HealthCare’s Emergency Medicine Residency program generally trended upward from its inaugural year to the 3rd year of the application cycle. Also, Lakeland 2013 applicants’ scores compared favorably with those published in the Osteopathic GME Match Report for the 2011 Match. As such, applicant COMLEX-USA scores in a newly established osteopathic Emergency Medicine residency program should trend upward and reach and/or closely approach the mean of established programs. For hospitals that are considering the institution of an osteopathic emergency
Table 1. Applicant Statistics for the Comprehensive Osteopathic Medical Licensing Examination-USA Level 1 (L1) and Level 2 (L2)
Examination OGME Match Report 2011 (L1) OGME Match Report 2011 (L2) Lakeland 2011 (L1) Lakeland 2011 (L2) Lakeland 2012 (L1) Lakeland 2012 (L2) Lakeland 2013 (L1) Lakeland 2013 (L2)
N 209 209 136 136 170 170 189 189
Mean (SD) 500.96 (58.6) 505.21 (70.9) 481.95 (63.4) 484.91 (87.9) 476.08 (61.9) 489.48 (72.6) 501.04 (68.6) 504.29 (77.5)
Z Score — — -0.32 -0.29 -0.42 -0.22 0 -0.01
Percentile — — 37 39 34 41 50 50
medicine residency, data supporting program implementation is essential. In addition, hospitals with or without an existing graduate medical education program, require the support of hospital administration in order to create new residency programs. Information demonstrating the length of time expected for a new program to attract the same level of quality candidates as more mature programs assists future program directors and directors of medical education with their long term strategic plans, and provides useful data to aide in garnering support from hospital administrators. Graduate medical education programs would benefit from additional studies on a larger scale than represented in this single study. Finally, it is important to note that Lakeland HealthCare does not exclusively use or advocate using COMLEX-USA scores as the sole method for the interview selection process of new residents. The utilization of standardized tests such as COMLEX-USA and USMLE for the residency selection process will continue to be debated, as there is no single tool in use at this time to predict quality of resident clinical skills. Therefore, the limitation of comparing only COMLEXUSA scores should be recognized. Acknowledgements The author thanks Jerome Thayer, PhD, at Andrews University for assistance with the statistical analysis used in this study and Lorraine Kelly, ADME at Lakeland HealthCare, for assistance in editing and submission of this article. References: 1. Osteopathic GME Match Report for the 2011 Match. Chevy Chase, MD: American Association of Colleges of Osteopathic Medicine; 2012. Available at http://data. aacom.org/aacomas/do_gme_match_ report2011.aspCOM 2. Cavaleri TA, Shen L, Slick G. Predictive validity of osteopathic medical licensing examinations for osteopathic medical knowledge measured by graduate written examinations. J Am Osteopathic Assoc. 2003;103:337-342. Available at http:// www.jaoa.org/cgi/reprint/103/7/337. 3. Sevensma S, Navare G, Richards RK, COMLEX-USA and In-service Examination Scores: Tools for Evaluating Medical Knowledge Among Residents. J
25 Am Osteopathic Assoc. 2008;108:713-716. Available at http://www.jaoa.org/cgi/ reprint/108/12/713.pdf 4. Green M, Jones P, Thomas J, Selection Criteria for Residency: Results of a National Program Director’s Survey. Acad Medicine. Mar 2009;84:362-367. Available at http:// journals.lww.com/academicmedicine/ Fulltext/2009/03000/Selection_Criteria_ for_Residency__Results_of_a.24.aspx 5. McGaghie W, Cohen E, Wayne D, Are United States Medical Licensing Exam Step 1 and 2 Scores Valid Measures for Postgraduate Medical Residency Selection Decisions? Acad Medicine. Jan 2011;86:4852. Available at http://journals.lww.com/ academicmedicine/Fulltext/2011/01000/ Are_United_States_Medical_Licensing_ Exam_Step_1.20.aspx 6. Results of the 2012 NRMP Program Director Survey. National Resident Matching Program; Aug 2012. Available at http://www.nr mp.org/data/ programresultsbyspecialty2012.pdf
Committed Physicians Interested in Serving on College Committees The annual appointment for physicians seeking committee positions on ACOEP Committees will begin during the last quarter of 2013. Physicians seeking appointment to any committee should send his or her CV with a letter naming the committee they would like to be appointed to and why. All applications must be received by December 1st and will be assigned based on availability. Terms are 3 years beginning January 1 and ending on December 31st. Committees are open to any physician and we encourage interested physicians to sit in on meetings of Committees that you are interested in being appointed to. Appointees must attend 66% of all meetings, conference calls and must participate in the activities of the Committee. Failure to do so will cause the appointee to be removed from the committee. Send your information to: Jan Wachtler, Executive Director, ACOEP, 142 E. Ontario St., Suite 1500, Chicago, IL 60611
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26 "Wrong Way" continued from page 10 To help another human being is a noble effort of the highest calling. To put the welfare of another individual above your own personal safety cannot be taught, it must be deeply imbedded in one’s heart. Those of us who are involved in emergency medicine aspire to the same high standard. We have been trained to think quickly when faced with life-threatening situations. Most of the time when faced with an emergent patient we do not have the luxury of looking up an answer in a textbook or conferring with a consultant. I have heard emergency medicine physicians called “a jack of all trades but a master of none.” I believe the phrase should be” having knowledge of all trades and the master of many.” We have chosen this particular specialty of medicine because we enjoy the fast pace, the varied presentation of patients, and even the fact that a patient may come through our doors with something we have only read about but have never actually seen or treated. Yes, we truly abhor when disasters or tragedies happen. However, when they do occur, we stand ready to run toward the problem and not away from it. Do we run the wrong way? I think not. We are actually running in the direction that we deeply feel in our hearts, the direction that we have been trained for: the direction that our patients desperately need. We can be very proud of what we have seen and heard about the first responders and the medical personnel at the receiving hospitals regarding this despicable act which took place in Boston. We know all too well, that we could easily substitute the names of our towns and cities: New York, Seattle, Los Angeles and even Nazareth, PA, where devastating tragedies could also occur. None of us ever want to be an eye witness to such an event, however, should a situation such as that we just experienced in Boston occur in “our” locale, I know that every emergency medicine physician would initially seem to be running the wrong way. When faced with a disaster, they would be seen running toward the problem. Do we run the wrong way? No, we are running in the right direction. We are running in the direction where our patients are and where we belong!
"Healthcare" continued from page 11 originate from the Emergency Department. The most expensive decision in healthcare is the decision to admit a patient to the hospital or not … and we make the majority of those decisions. Accountable Care Organizations will be seeking to prevent unnecessary hospital admissions and or that reason, a smart ACO’s will partner with emergency providers to create alternatives to admissions and readmissions. We need to understand and take advantage of these changing times. When patients present to the Emergency Department there is essentially two disposition alternatives we have, either admit or discharge. For our low acuity patients we can rapidly assess, treat, and discharge them. For our high acuity patients, admission is sometimes obvious within minutes of our evaluation. However, we spend most of our time and mental energy sorting through those that
it is just not clear. At the end of many of these evaluations we know for certain that some can be discharged home if timely and proper follow-up was assured. However, since this is not always available we do the best for the patient and admit them or place them in observation. If we only had the available resources to insure proper followup we could safely send them home. Those facilities that will lead the pack in this new era of healthcare will quickly recognize the value of supporting the emergency department and provide the resources we need to ensure good outcomes. It will be the most economical decision as well as the best for the patient. I encourage each of you to continue to lobby for your patients; demand resources you need to deliver high quality, compassionate care in a timely manner; and don’t hesitate to stand up for your patients, your staff, and yourself.
ACOEP Staffing Updates
Already 2013 has been a year of incredible changes! We have welcomed two new staff members as well as developed new departments to better accommodate our ever-growing membership. Below is an updated list of ACOEP staff along with their contact information. Feel free to call or email our staff with any questions, concerns, or needs that you may have. Executive Director Janice Wachtler 312.445.5705 firstname.lastname@example.org
Sr. Coordinator of Meetings and Conventions Lorelei Crabb 312.445.5707 email@example.com
Director of Development Stephanie Whitmer 312.445.5712 firstname.lastname@example.org
Executive Assistant Geri Phifer 312.445.5700 email@example.com Executive Assistant for GME Kristen Kennedy 312.445.5708 firstname.lastname@example.org Administrative Assistant for FOEM Gina Schmidt 312.445.5701 email@example.com Meetings and Conventions Manager of Meetings and Conventions Adam Levy 312.445.5710 firstname.lastname@example.org
Director of Member Services Sonya Stephens 312.445.5704 email@example.com Sr. Coordinator of Member Services Jaclyn Ronovsky 312.445.5702 firstname.lastname@example.org Media and Technology Director of Media and Technology Brian Thommen 312.445.5703 email@example.com Communication Manager Erin Sernoffsky 312.445.5709 firstname.lastname@example.org Media Technology Specialist Tom Baxter 312.445.5713 email@example.com
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ACOEP Congratulates 2013 Fellows and Distinguished Fellows The American College of Osteopathic Emergency Physicians is pleased to announce the 2013 class of physicians receiving the honorary titles of Distinguished Fellows and Fellows of the College. Distinguished Fellow titles have been granted to: Juan F. Acosta, D.O., MS, Ph.D., FACOEP, Yakima, Washington Anthony Affatato, D.O., FACOEP, Clinton Township, Michigan Gregory M. Christiansen, D.O., M.Ed., FAOCEP, Chesterfield, Virginia Kevin Loeb, D.O., FACOEP, Terre Haute, Indiana The title of Fellow have been granted to: Cindy Armstead, D.O., Hattiesburg, Mississippi Stacey Barnes, D.O., Hoboken, New Jersey Frank C. Biondolillo, D.O., Sarasota, Florida April Brill, D.O., Lemont, Illinois Curt Cackovic, D.O., Swedesboro, New Jersey Jacqueline Cappiello Dziedzic, D.O., Arlington Heights, Illinois Timothy Cheslock, D.O., Moscow, Pennsylvania Michael T. Cicero, D.O., Downers Grove, Illinois John S. Current, D.O., Massillon, Ohio Stuart Friedman, D.O., Holland, Pennsylvania Mark A. Grant, D.O., Brighton, Michigan Kristopher K. Hart, D.O., Edmond, Oklahoma Leo Huynh, D.O., Miami, Florida Donald G. Jones, D.O., Mountain Township, Pennsylvania Tavi Madden-LeDuc, D.O., Mason City, Iowa Michelino Mancini, D.O., New Buffalo, Michigan John Mathew, D.O., West Islip, New Jersey Nilesh N. Patel, D.O., North Caldwell, New Jersey Christine M. Perry, D.O., Bremerton, Washington Shawn M. Quinn, D.O., Allentown, Pennsylvania Steven Schwartz, D.O., Tampa, Florida Jeremy Kent Selley, D.O., Morehead City, North Carolina Victoria Hutto Selley, D.O., Morehead City, North Carolina Bruce St. Amour, D.O., Des Moines, Iowa Michael Traktman, D.O., Marquette, Michigan Sherry D. Turner, D.O., Hattiesburg, Mississippi Eric Vinson, D.O., Clarion, Pennsylvania Kevin R. Weaver, D.O., Walnutport, Pennsylvania. Fellowships are awarded to physicians who have completed a variety of tasks in their professional lives that serve the profession of emergency medicine on a national, regional, or local basis. Distinguished Fellowship are granted to physicians who have held the title of Fellow for ten or more years and have distinguished themselves in the profession above and beyond the requirements to gain fellowship. Applications for these two honorary titles are accepted throughout the year and may be found on-line at www.acoep.org in the Member Service section under the heading, Level of Membership. Each nomination period ends on March 1st and any applications received after that date are automatically placed in a queue for the following year. ACOEP congratulates each of the above-named physicians for their professional and personal accomplishments that have allowed them to achieve this prestigious acknowledgement of their peers.
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• A FOUNDATION DEDICATED TO RESEARCH IN OSTEOPATHIC EMERGENCY MEDICINE
Foundation Focus Sherry D. Turner, D.O., FACOEP President
n April 3, 2013, the Foundation’s Board of Trustees elected new Board members and officers. As the new President of the Foundation for Osteopathic Emergency Medicine, I am honored to introduce the 2013 Board of Trustees.
2013 FOEM Board of Trustees Sherry D. Turner, D.O., FACOEP – President Dr. Turner has been a member of FOEM Board since 2008. She is a graduate of NOVA Southeastern College of Osteopathic Medicine and completed her residency at Charleston Area Medical Center in Charleston, West Virginia. She is currently a practicing Emergency Physician at Wesley Medical Center in Hattiesburg, Mississippi. During her residency she completed the Training in Health Policy Fellowship from New York College of Osteopathic Medicine/AOA. Prior to completing medical school, she received her Master’s degree in Nursing and participated in research in many venues. She is currently enrolled in a Master’s of Public Health program at University of Southern Mississippi. She brings a background in fundraising and leadership for multiple charitable organizations.
Juan Acosta, D.O., M.S., FACOEP, FACEP – Immediate Past President Dr. Acosta is a 1997 graduate of the New York College of Osteopathic Medicine. After a residency in Emergency Medicine at St. Barnabas Hospital, Bronx, NY, he received a Masters in Clinical Investigation from Weill Cornell Medical College and is currently in the process of obtaining a Doctorate Degree in Health Education from A.T. Still University. Dr. Acosta currently serves as Assistant Dean of Postgraduate Medical Education/ Director of Medical Education and an Associate Professor at Pacific Northwest University in Yakima, Washington. He is also the Medical Program Director - Yakima County Department of EMS and the Chief of Staff at Toppenish Community Hospital. Dr. Acosta is actively involved in the Washington Disaster Medical Assistance Team (DMAT), a reviewer for CECBEMS and Western Journal of Emergency Medicine. He is involved with the Yakima County Medical Society and currently serves as its President-elect. As President of FOEM, he worked with and mentored medical students and residents to embrace research as part of their education.
Peter Kaplan – President-Elect Peter Kaplan is the Secretary of the Foundation. He is President and Chief Executive Officer of Norcom Incorporated, a multifaceted marketing and communications firm specializing in healthcare. Among his philanthropic endeavors, he serves on the United Way of Lake County, IL Board of Directors and has chaired numerous UWLC committees. Peter’s other volunteer leadership roles include the Alzheimer’s Association, Center on Deafness, Illinois Holocaust Museum and Education Center, Vista Health Foundation and the American Cancer Society. Douglas P. Webster D.O., FACEP, FACOEP-D – Treasurer Dr. Webster is currently Executive Vice President of the Pacific West Region of EmCare. He previously served as Regional Chief Executive Officer of EmCare’s Midwest Region. A board certified and residency trained emergency physician, Dr. Webster has practiced in and served as Emergency Department Medical Director at numerous facilities, from small rural hospitals to Level I Trauma Centers. He has also held the positions of Chair and Associate Professor of Emergency Medicine at Midwestern University, Chair and Member of the
FOEM | BEACON 31 Medical Disciplinary Board of the Illinois department of Professional Regulation, Lecturer in Bioethics, Professionalism and Justice at Loyola Stritch School of Medicine and Associate Clinical Coordinator for the Crescent Counties Foundation for medical Care (PRO). He is the author of numerous publications in basic science and medicine, and a board member for several charitable organizations. His business interests include management of medicolegal and regulatory risk, statistical and numerical analysis, electronic medical record implementation and corporate mergers and acquisitions. William Lynch, Jr. – Secretary Armed with more than two decades of experience in the hotel and incentive travel industries, Bill Lynch launched NHS Global Events in 2000. His goal was to create a company that offered a higher level of service, a niche that Bill knew needed filling. “I didn’t want to start just another company-the objective was to create a place where relationships come first. I think we’ve done that, and that’s been our formula for success from the beginning.” NHS has grown from dream to reality, now servicing dozens of happy clients with a broad range of essential services. The company tagline of “site selection, meeting planning and consulting” summarizes the menu of offerings. “These are services that, traditionally, would have been secured through a number of different providers. Now you can find it all under one umbrella.” Beyond providing services, NHS has always been a place where clients come to solve problems. “Focusing on relationships opened the door to consulting opportunities,” Bill explains. “And that’s what I enjoy most about this business-we have the tools and the expertise to take the process one step further. Anyone can provide services-we prefer to educate and collaborate with our clients and actually solve problems.” Coupled with speed, efficiency, volume buying and insider knowledge, the NHS team is a powerful ally to have at your side. “We analyze every situation for opportunities to keep the advantage on our client’s side. Concessions, upgrades, better contract terms-nothing is off limits when NHS negotiates on your behalf.”
Focusing on relationships and problem solving has earned NHS a special place in the industry. “We have a great reputation, and as an owner, that’s something you protect and nurture every chance you get,” Bill concludes. A graduate of the University of Missouri, Bill hones his relationship skills with his wife of twenty years and their three children. Janice Wachtler – Executive Director (Non-Voting) Janice Wachtler is the Executive Director of the Foundation, serving in this capacity for more than 10 years. She is also the Executive Director of American College of Osteopathic Emergency Physicians where she has been employed for over 18 years. Ms. Wachtler has a strong osteopathic background working with the American Osteopathic Association as the Administrator of the Division of Postdoctoral Training in the Department of Education for 13 years prior to moving to the ACOEP. She has a degree in education and a Certificate of Business Administration from the University of Illinois at Chicago. Ms. Wachtler is also a member of the Society of osteopathic specialty Executives (SOSE) and was a major force in developing this organization to train and represent directors of osteopathic specialty organizations on a national level. Ms. Wachtler has been active in her community holding the offices of Vice President (1990-1992) and Secretary (1985-1990 and 1999-2005) to the RANCH Triangle Neighborhood Association where she served on its elective Board from 19821992 and 1998-2005. She has also been the Secretary to the Federation of Osteopathic Specialty Organizations (1992-1995 and 1998-2007). Stephanie Whitmer – Assistant Executive Director (Non-Voting) Stephanie Whitmer began working for the American College of Osteopathic Emergency Physicians in September of 2010, but had worked there previously from 20052006. She was awarded the Presidential Scholarship for Academic Achievement from DePaul University and earned her
Bachelor’s Degree in Psychology in 2007. She is currently completing her Master’s Degree in Nonprofit Administration at North Park University and looks forward to serving the ACOEP and FOEM for many years to come. Michael P. Allswede, DO Dr. Allswede is Director of the Strategic Medical Intelligence (SMI) initiative, which is a forensic epidemiology program he developed in 1999. This program was developed in Pittsburgh and employs locally accessible volunteer doctors to improve early warning and detection of bioterrorism so as to prevent its occurrence and improve the medical community’s response if it occurs. The field of forensic epidemiology integrates public safety concerns with individual rights to privacy. As an academic leader in this field, Dr. Allswede serves as a lecturer at the Marshall Institute “Preventing Terrorism Security Studies” course where he trains international students. Dr. Allswede is also a subject matter expert for the INTERPOL bioterrorism unit and a co-author of the INTERPOL “Bioterrorism Incident PrePlanning and Response Guide”. Dr. Allswede has trained experts from over 155 nations through these endeavors. Dr. Allswede is currently the founder and Program Director of the Residency in Emergency Medicine at Conemaugh Memorial Medical Center located in Johnstown PA. This program combines excellence in training at a Level I Trauma Center with disaster medicine training to specifically address the national need for better trained medical leadership in terrorism and disaster events. Dr. Allswede is a co-author of the first accredited disaster medicine fellowship curriculum designed for physicians. This fellowship curriculum is directed at training physicians to improve deficits noted in the 2006 Institute of Medicine’s report on the Future of Emergency Care and the 2007 Presidential Decision Directive 21. Rudolph Bescherer, Jr. D.O., FACOEP (No picture or bio available)
32 FOEM | BEACON Steve Hollosi, DO, MS Dr. Hollosi has been a member of the FOEM board since 2012. A graduate of Emory University (BA), the New York Institute of Technology (MS) and their College of Osteopathic Medicine (DO) is Core Faculty and the Research Director of the Emergency Medicine Residency at Charleston Area Medical Center. He conducts and participates in research activities that include Graduate Medical Education, Research Development, Translational Clinical Research and Professional Development. He completed specialized research training within the American College of Emergency Medicine and is uniquely suited to supervise investigators and establish physician collaboration. He has published work in the field of microbiology, medical education, research development and biostatistics. Joe Kissinger, CASE Joe Kissinger has been a hospitality industry professional for more than 20 years. He started his career with Marriott Hotels in 1989, directing meeting and catering departments in convention hotels throughout the US. He left Marriott in 2001 to open a regional office in Chicago for the Sacramento Convention and Visitors Bureau, focusing on bringing association meetings to the destination. Since joining the Las Vegas Convention and Visitors Authority in 2004, Joe is now the Director of Regional Sales for the LVCVA’s Midwest Regional team, who help generate more than $300,000,000 of group business for Las Vegas annually. He is an active member in the meeting planning community, and has held board positions with the Professional Convention Management Association (2009-2011), the Association Forum (2007-2009), and was Board Chair for the Chicago Area Convention Bureau Satellite Offices (20032005). Joe earned his CASE designation (Certified Association Sales Executive) in 2009, and also currently sits on the Advisory Board for The Hybrid Group.
Victor J. Scali, D.O., FACOEP-D Dr. Scali graduated from PCOM ‘s HPSP program in 1980 , receiving Flack Award for Excellence in Internal Medicine, interned at Malcolm Grow USAF Med Center then served 3 years as Medical officer and Commander for the 6943rd ESS at National Security Agency receiving the Defense Meritorious Service Medal upon separation for outstanding service at The National Security Agency. He then served as Chief Resident at PCOM’s EMR from 1984-1986 then was part of original founding faculty of AEMC EM residency in 1989, and still holds rank of Associate Professor at PCOM and Assistant Professor at UMDNJ/SOM where he is currently Co- Director of the Em and IM/EM residencies. He was Past President of ACOEP and Past President of FOEM. He has been Coordinator of COMLEX 2 testing and entire test construction process and AOBEM examiner for parts 2, 3. He helped advance research initiatives for residents and created PEM Committee; member of Emergency Medical Services for Children Stakeholders Group in Washington, DC, and grant contributor to International Center to Heal our Children‘s PETT program at CNMC; appointed member of National Academies of Practice as distinguished practitioner; speaker at national and local academic venues; author of several scientific articles including bench research. Recipient of multiple awards including ACOEP Mentor of the Year Benjamin A. Field Award, ACOEP Meritorious Service Award, UMDNJ’s Dean’s Recognition Award, PCOM Alumni Award Certificate of Merit. He is listed in Marquis’ Who’s Who in healthcare as well the Contemporary Who’s Who. He was founder of PCOM/ AEMC and UMDNJ’s EM Student Clubs; and provides medical direction/ QA and education to several EMS squads. Currently a key participating grantee in developing a competency based Geriatric Emergency Medicine Residency Curriculum and virtual teaching simulation through a 4 year Reynolds Grant awarded to UMDNJ/ SOM’s New Jersey Institute for Successful Aging. In September 2009, Dr. Scali was awarded the title of Distinguished Fellow in the American College of Osteopathic Emergency Physicians.
Robert E. Suter, D.O., MHA, FACEP, FIFEM Dr. Robert E. Suter, Past president of the American College of Emergency Physicians and the International Federation for Emergency Medicine graduated from Washington University in St. Louis, and received his DO and MHA degrees from Des Moines University in Des Moines, Iowa. Dr. Suter did his residency training in emergency medicine at Brooke Army-Wilford Hall USAF Medical Centers in San Antonio, Texas and is board certified by the American Board of Emergency Medicine and the American Osteopathic Board of Emergency Medicine with a CAQ in Emergency Medical Services. Dr. Suter has a long history of service to emergency medicine on a state, national, and international level. As a student, he was a founding member of the Student Chapter of ACOEP, During residency he was president of EMRA in 1991-1992, the Treasurer of the American Association of Osteopathic Postgraduate Physicians and a founding member of the Resident Chapter of ACOEP. During this time he was also elected to the Board of the Government Services Chapter of ACEP, participated in numerous state and national committees, and served as ACEP liaison to several organizations. Immediately following residency, he was the physician co-chair of the federal project EMS Agenda for the Future. In 1998 Dr. Suter was given the Wackerle Founders Award, EMRA’s highest recognition of service to emergency medicine and emergency medicine residents, and in 2000 he was given the highest award of the Continuing Education Coordinating Board for EMS for his many years of contributions to advancement of EMS education. Dr. Suter served as a member of the ACEP Council from 1991 through 1999 when he was elected to ACEP Board of Directors for the first of two terms. He was the first osteopathic physician to serve in an officer position in the ACEP, serving as secretarytreasurer, and President in 2004-05. He was also the first osteopathic physician on the Board of the International Federation for Emergency Medicine, and served as its President in 2006. He continues to serve on or chair a number of important committees
FOEM | BEACON 33 and task forces for ACEP and IFEM, and was awarded the Order of the IFEM in 2008, and in 2009 the John G. Wiegenstien Leadership Award, ACEPs most coveted honor. Dr. Suter is a full-time Professor of Emergency Medicine at the University of Texas-Southwestern where he leads efforts in Academic Development, Practice Management, Health Policy, and International Emergency Medicine Education He also holds appointments as a Professor at the Medical College of Georgia, Des Moines University, and the Uniformed Services University of the Health Sciences. In addition to his decades of academic service, he has had experience practicing emergency medicine in nearly every imaginable practice setting, including the U.S. military, where he serves as a Colonel in the U.S. Army Reserve who has served in Iraq. Dr. Suter has a long-term commitment to clinical excellence, teaching, and research in emergency medicine and a passion for sharing the specialty and osteopathic medicine with physician colleagues around the world. Dr. Suter is the author of numerous studies, papers, and textbook chapters in emergency medicine, and has given hundreds of presentations worldwide. He is particularly recognized as an integrative scholar, especially in the areas of Evidenced-Based Practice, EMS, Practice Management, and Health Policy and is currently working on a text entitled “The Global History of Emergency Medicine.”
A person who
never made a
mistake never tried
Quality people. Quality care. Quality of LIFE. Emergency Medicine Opportunities Available at the Following Osteopathic Hospitals! • Aria Health System Frankford Campus Torresdale Campus Bucks County Campus • Wheeling Hospital Wheeling, West Virginia • Grandview Medical Center Dayton, Ohio • Southview Medical Center Dayton, OH
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FOEM 1087 (4M_EmerSyst)NewLogo_Layout 1 5/20/13 2:59 PM Page 1
EM Residency Program Director
Physician owned and operated, 4M Emergency Systems has over 15 years of experience management and staffing emergency departments and urgent care centers. We are now looking for qualified physicians at the following locations: Cleveland, Ohio: 4M Emergency Systems has an excellent opportunity for a BC Osteopathic Emergency Medicine Practitioner to join the UH Regional Hospital EM Residency Program, as the Program Director. Candidates are expected to demonstrate aptitude with both clinical leadership and medical education leadership experiences. Prior administrative experience in Emergency Medicine residency leadership roles is required. Candidates must have completed an accredited osteopathic emergency medicine training program and must be ABOEM board certified. Outstanding compensation and benefits program including an incentive plan, stipend, paid health plan, 401K, malpractice, life & long/short-term disability and much more. For more information about this position, contact Erin Waggoner, 4M Emergency Systems, telephone 888-758-3999; or email email@example.com.
– Albert Einstein
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100% Program Challenge Who will win in 2013? The 100% Program Challenge is an annual competition that pits residency programs against each other to determine which program can raise the most money per resident for the Foundation for Osteopathic Emergency Medicine (FOEM).
Congratulations and thank you to the winners of the 2012 100% Program Challenge Good Samaritan Hospital Medical Center in West Islip, NY!
The competition will run from July 1, 2013 – October 1, 2013. Contributions received after the deadline will not be counted. In order to qualify, the residency program must have 100% participation – that means every single resident in the program must contribute at least $5.00 to the challenge. Checks must specify “100% Program Challenge” on the memo line in order to be counted for the competition. A list of current residents that have contributed must be included with the check. If a list is not included that accounts for all residents in a program, 100% participation cannot be determined and the program will not be eligible to win. In order to make this competition fair to residency programs of all sizes, the winner will be determined by the average donation per resident. This number will be determined by dividing the total donation from the residency program by the number of residents in that program. It is not the total amount that counts, but the average per resident. ($500 from a program with 20 residents = $25/resident > $500 from a program with 25 residents = $20/resident). This is a fun competition that encourages first time donors to get involved with the Foundation’s mission. For more information, please contact Stephanie Whitmer at (312) 445-5712 or at email@example.com.
Resident Wrap Up
Megan McGrew Koenig D.O., MBA, MS President
Our incredible team of Resident Chapter Officers and Committee Members have been hard at work creating many exciting things on the horizon: FALL CONFERENCE: October 5th-9th, 2013 in San Diego, California Events: Annual Jeopardy Competition, Ever-Popular Career Panel and Career Fair, Advanced Airway Clinic, and your annual chance to run for a National Leadership Position RESEARCH COMPETITIONS: The deadline for the annual Fall FOEM Competitions is rapidly approaching July 31st. So whether you have a research paper or poster, get it polished up and ready for submission! CHIEFS COLLEGE: For the first time ever, residents who are either already chiefs or aspire to one day become one, will have an amazing opportunity to attend a special leadership track of lectures at our Fall Conference. If you have any interest in becoming involved in the Resident Chapter, please donâ€™t hesitate to contact me (firstname.lastname@example.org). As always, we greatly appreciate the support of The College, The Board of Directors, and our many sponsors, and thank them for all of their encouragement.
Residency Spotlight Program: Charleston Area Medical Center Address: 501 Morris Street, General Division City/State/Zip: Charleston, WV 25301 Hospital Information: Type (Community, rural, urban): Community Trauma Level: I Number of Hospital Beds: 838 Number of ED Beds: 55 EM Program Information: Phone: 304-388-7170 Website: http://camc.wvu.edu/ Total Number of EM Residents: 16 Residents to Attending Ratio Working Clinically: 1:1 Accepts Medical Student Rotations? Yes EM Program Curriculum: PGY 1: EM, Peds EM, Anesthesia, Cardiology, General Surgery, Inpatient Medicine, Inpatient Family Practice, Orthopedics, OB/GYN PGY 2: EM, Peds EM, Trauma Surgery, ICU, Admin/Research, Selective PGY 3: EM, Peds EM, ICU, EMS/Air Ambulance, Elective PGY 4: EM, Peds EM, ICU, Elective EM Program Application Information: Dates applications are accepted: July 1 Interview Dates: September - December Number of Letters of Recommendations and who can write the letters: 3, with at least one from an Emergency Medicine physician Program: McLaren Macomb Address: 1000 Harrington Blvd. City/State/Zip: Mt. Clemens, MI 48043 Hospital Information: Type (Community, rural, urban): Community Trauma Level: II Number of Hospital Beds: 288 Number of ED Beds: 35 EM Program Information: Phone: 586.493.8195 Website: www.mclaren.org/macomb Total Number of EM Residents: 17 Residents to Attending Ratio Working Clinically: 1-2:1 Accepts Medical Student Rotations? 4th year medical students
EM Program Curriculum: PGY 1: Internal Medicine, Cardiology, MICU, General Surgery, Orthopedics, OG/GYN, Peds EM, EM PGY 2: Trauma Surgery, Pediatric ICU, Research, Anesthesiology, EM PGY 3: Toxicology, Radiology/Ultrasound, SICU, MICU, EM PGY 4: Electives, EMS, Administrative, EM EM Program Application Information: Dates applications are accepted: July 1st Prefers COMLEX Scores of: No specific score Interview Dates: November Number of Letters of Recommendations and who can write the letters: 2-3 letters of recommendations Program: INTEGRIS Southwest Medical Center Emergency Medicine Residency Program Address: 4200 S. Douglas, Suite 306 City/State/Zip: Oklahoma City, Oklahoma 73109 Hospital Information: Type (Community, rural, urban): Community Trauma Level: Level 2 Number of Hospital Beds: 377 Number of ED Beds: 32 EM Program Information: Phone: 405-636-7195 Website: http://integrisok.com/emergency-residency Total Number of EM Residents: 36 Residents to Attending Ratio Working Clinically: 1:1 Accepts Medical Student Rotations? Yes EM Program Curriculum: PGY1: E R, Peds ER, House Officer, General Surgery, Infectious disease, IM, ICU, OB/GYN PGY2: Adult ER, Peds ER, Radiology, ICU, Ortho, Anesthesia, Vacation PGY3: Adult ER, Neurology, Cardiology, Trauma, Peds ICU, Tox, Transplant ICU nights PGY4: Adult ER, Administration, Transplant ICU Nnights, Elective, Attending, Vacation, Ophthalmology/ENT EM Program Application Information: - INTEGRIS Southwest Emergency Medicine Program participates in ERAs Dates applications are accepted: July 1st Interview Dates: October through December
Check out the Student's and Resident's recently redesigned online publication
The Fast Track dicine Publication An Emergency Me
e 07 Summer 2013 - Issu
3 Fall Conference 201
San Diego Awaits!
The new version of The Fast Track is more robust, with a combination of both anecdotal experiences, thought provoking articles, and peer reviewed research articles that will propel ACOEP to the next level in the student and resident publication arena. Here are some articles featured in the July issue: • New Pediatric Pearls "Pediatric Procedural Sedation" • Dear Graduates
ue! New Features this Iss arls Pediatric Pe kids in the ED e; when it comes to Be on your gam to stay smart. use these helpful tips
e Review y Medicin EmergencBoa azing rds? Check out the am Studying for EM by Rosh Review EM review questions
e Trade for improving Tricks of thues and methods Discover techniq ning your mind. your skills and sharpe
• Advice to Interns From a Recent Graduate • New "Emergency Medicine Review by Rosh Review" • New "Tricks of the Trade"
You can view The Fast Track online by going to the Student Members page at:
www.acoepsc.org the PULSE
CARE IS WHO WE ARE. We care about what matters to our partners. EPMG offers exceptional compensation, family health benefits, 401(k) employer contribution, a new Partnership Program, CME, and much more. EPMG rewards colleague referrals! EPMG offers opportunities in Delaware, Illinois, Indiana, Iowa, Michigan, Ohio, Pennsylvania, and Virginia. Looking for alternate staffing options? We support locum tenens, moonlighting, and Travel Team opportunities, call today to learn more!
MEDICAL DIRECTOR OPPORTUNITY
39 CHELSEA COMMUNITY HOSPITAL New state-of-the-art facility 18,500 patient volume Member of the Trinity Health System Member of the EM Control Authority Located 15 minutes west of Ann Arbor Chelsea is a vibrant community Competitive administrative stipend Two years of leadership experience required Contact NANCY ELY 734.686.6337 email@example.com www.epmg.com
We care about more than staffing shifts. We care about shifting expectations.
Call to Meeting At the request of the Secretary, John C. Prestosh, D.O., FACOEP, a meeting of the membership of the American College of Osteopathic Emergency Physicians has been arranged for October 6, 2013 at 5:00 p.m. at the Hilton San Diego Bayfront Hotel in San Diego, California. This event will be followed immediately by the Welcome Reception for the Collegeâ€™s 2013 Scientific Assembly. Voting for Board Members will once again take place online and will be available to Active, Fellow, Distinguished, Retired and Life Membership between August 7th and 4:30 p.m. on October 6th. Please watch for voting keys that will be emailed to any eligible members on August 6th.
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142 E. Ontario Street Suite 1500 Chicago, Illinios 60611
We are passionate EM physicians who love owning and managing our own business, because ownership gives us power.
EMP Leadership Forum Social in Las Vegas with over 160 present.
Power to create a culture we love. Power to put patient care first. Power to do business and life on our terms. At EMP, weâ€™re looking for EM residents who want to own the future.
Visit us at booth 915
or call Ann Benson at 800-828-0898. Opportunities from New York to Hawaii.
AZ, CA, CT, HI, IL, MI, NV, NY, NC, OH, OK, PA, RI, WV