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OCTOBER 2018

ACOEP CELEBRATES 40 YEARS

PRESIDENTIAL VIEWPOINTS

PRESIDENTAL UPDATE PG 3

RESPONDING TO AN EMAC REQUEST PG 19

FOEM FOCUS PG 22


Have You Seen the FOEM Research Network? Calling all researchers and research sites! The FOEM Research Network is a state-of-the art, easy to use website connects researchers and research sites for easily accessibly multicenter studies! Users can search by research topic, location, and more to help get their finger on the pulse of the most cutting-edge research in EM.

Find us at frn.foem.org!


The Pulse VOLUME XL No. 4

EDITORIAL STAFF Timothy Cheslock, DO, FACOEP, Editor Wayne Jones, DO, FACOEP-D, Assistant Editor Tanner Gronowski, DO, Associate Editor Drew A. Koch, DO, MBA, FACOEP-D, Board Liaison John C. Prestosh, DO, FACOEP-D Christine F. Giesa, DO, FACOEP-D Erin Sernoffsky, Editor Janice Wachtler, Executive Director Gabi Crowley, Senior Digital Media Coordinator EDITORIAL COMMITTEE Timothy Cheslock, DO, FACOEP, Chair Drew A. Koch, DO, MBA, FACOEP-D, Board Liaison John C. Prestosh, DO, FACOEP-D Stephen Vetrano, DO, FACOEP Kaitlin Bowers, DO Tanner Gronowski, DO Dominic Williams, DO Erin Sernoffsky, Director, Media Services

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 ACOEP, 142 East Ontario Street, Chicago, IL 60611, (312) 587-3709 or electronically at marketing@acoep.org. Please contact ACOEP for the specific rates, due dates, and print specifications. Deadlines for the submission of articles are as follows: January issue due date is November 15; April issue due date is February 15; July issue due date is May 15; October issue due date is August 15. Advertisements due dates can be found by downloading ACOEP's media kit at www. acoep.org/advertising. The ACOEP and the Editorial Board of The Pulse reserve the right to decline advertising and articles for any issue. ©ACOEP 2018 – All rights reserved. Articles may not be reproduced without the expressed, written approval of the ACOEP and the author. ACOEP is a registered trademark of the American College of Osteopathic Emergency Physicians.

TABLE OF CONTENTS 3

PRESIDENTIAL VIEWPOINTS Christine Giesa, DO, FACOEP-D

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THE EDITOR'S DESK Timothy Cheslock, DO, FACOEP

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EXECUTIVE DIRECTOR’S DESK Janice Wachtler

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ON DECK CIRCLE Robert Suter, DO, MHA, FACOEP-D

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RESPONDING TO AN EMAC REQUEST Stephen J. Vetrano DO, FACOEP

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ACOEP CELEBRATES 40 YEARS

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ACOEP’S COMMITTEE FOR WOMEN IN EMERGENCY MEDICINE UPDATE Angie Carrick, DO, FACOEP

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THE LATEST FROM ACOEP’S NPIP RODNEY FULLMER DO MBS

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COMMITTEE CORNER

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ETHICS IN EMERGENCY MEDICINE: WHAT WOULD YOU DO? Bernard Heilicser, D.O., M.S., FACEP, FACOEP-D

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FOEM FOCUS


PRESIDENTIAL VIEWPOINTS

Christine Giesa, DO, FACOEP

PRESIDENTIAL UPDATE

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COEP and the Board of Directors conduct a strategic planning session every three to five years. Our current mission statement is as follows: “ACOEP promotes patient-centric holistic emergency care consistent with osteopathic philosophy by all emergency medical professionals.” The 2016 – 2018 Strategic Plan includes five goals to which the board is committed to advance the mission of the college. These goals include: member engagement and value, advocacy and influence, education and knowledge, increase awareness of osteopathic medicine, and college strength and sustainability. At the end of Spring Seminar, the Board held a mini-retreat to review our progress on the 2016-2018 Strategic Plan. Many of our objectives have been accomplished, but there are a few areas where we would like to focus. The New Physicians in Practice is a relatively new group of young physicians is the future of our college and we need to better support and help them advance their efforts. Our digital classroom is quickly growing, but the course offerings still need to be more robust, and possibly even include courses that meet state licensure requirements. Over the past six months, there has been a tremendous effort to increase awareness of ACOEP through communication blogs and the use of social media. Through the use of the ACOEP Newsroom and social media posts, we have been able to keep the membership better informed

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HOPE TO SEE ALL OF YOU IN CHICAGO TO HELP CELEBRATE THE 40TH ANNIVERSARY OF ACOEP.” regarding advocacy action items that ACOEP has supported. Remember to check the Newsroom on the ACOEP homepage for updates. Every year in July, the President and President-elect attend AOA Board of Trustees and House of Delegates annual business meeting. The most notable announcement is that the AOA revised its Constitution and Bylaws to allow MDs to become full members of the AOA. Previously MDs were relegated to an associate member category along with dentists and podiatrists. ACOEP is in the process of renewing their agreement with WestJEM. A key area has been the addition of an ACOEP section editor to assist with papers submitted through the ACOEP Research Review portal. The addition of this editor will be a great educational support for physicians that are new to getting published or who need to publish to meet criteria for scholarly activity. The ACEOP editor will review the article and provide feedback on writing, methodology and statistical analysis, and presentation so that the papers are of sufficient quality to successfully pass the peer-review process. If a paper is ultimately rejected, the editor will give additional feedback regarding the changes that are required for the paper to be successfully submitted to another journal for publication. Please note that merely being a member of ACOEP does not guarantee that your paper will be published.

Rather it will ensure that your paper will be academically reviewed and the author will be given the best recommendations on how to potentially get published. As witnessed in the article by Sandra Scott Simmons, MD in the August EM News, the lack of physician rights to due process is a real and growing problem. Due process is a fair hearing with the right of appeal in front of peers from the medical staff prior to restriction or termination of privileges to practice medicine in a hospital. Physicians employed by a hospital have a right to due process; however, physicians employed by staffing companies are frequently forced to waive their right to due process as part of their employment contract. AAEM took initiative and wrote a letter to the Centers for Medicare and Medicaid speaking out against the denial of physician due process rights. ACOEP joined with AAEM and cosigned the letter along with seven other major emergency medicine organizations. Congressman Chris Collins (NY-27) and Congressman Raul Ruiz (CA -36) submitted legislation to protect physician rights to due process. Physician due process is important to patient safety. Physicians who elect due process are less likely to raise patient safety or quality of care concerns for fear of losing their job. These are just a few of my summer endeavors. Hope to see all of you in Chicago to help celebrate the 40th anniversary of ACOEP.


THE EDITOR’S DESK

Timothy Cheslock, DO, FACOEP

ACOEP CELEBRATES 40 YEARS OF OUTSTANDING SERVICE!

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appy Anniversary ACOEP! It’s hard to believe that it has been 40 years since the inception of the college. While it is difficult for me to give you a full perspective of how far we have come over that time, so many of our members have been here since the beginning and I’m sure their thoughts and tributes can do much more justice to this celebration. What I can say over my comparatively short time as a member of the College is that it has by far exceeded my expectations. I feel like my own involvement and success within the College has been a collective accomplishment. One that was brought about by the encouragement and mentorship of so many people and groups within the college. I became a student member of ACOEP while attending medical school at LECOM- Erie. As a member of the student chapter, I was always made to feel welcome at the Scientific Assembly and Spring Seminar. Members of the Board and many members of the College went out of their way to make me feel welcome, in what was at that time a brand-new experience and challenging time in my education and career. I quickly realized that ACOEP was a special organization. One that wanted me as a member and one that had a lot to offer me both in guidance, mentorship and friendship as I pursued my Osteopathic degree. I quickly became involved in the student chapter activities and made it a point to attend as many activities and seminars that I was able. During my time as a student and then as a resident, both groups

began to explode in growth. The breadth of activities continued to expand and soon the student and resident activities were a large part of the conference activities. The encouragement by then presidents, Dr. Willoughby DeJesus and Dr. Bell to the Student and Resident Chapter leadership gave us the drive to succeed and grow the student and resident chapters. I was honored to serve as the Resident Chapter president and hold a position on the Board of Directors under Dr. Brabson. Following graduation from residency I continued my involvement with the College thanks to the encouragement of Dr. Christiansen and Dr. Wayne Jones. I became a member of the

to fulfill my first term on the Board. Currently serving as the Treasurer for the College and a member of the Executive Committee, I am thankful and elated to have been able to come this far in my career. The tide has come full circle where I now find myself as the one mentoring students and residents and encouraging their active participation in the organization and serving the membership from a position of leadership. Over the last 15 years I have made so many friends in the college who have been there for me. I cherish my relationships with those in the College with whom I have become close and look forward to making more acquaintances as time goes by. I am

I NOW FIND MYSELF AS THE ONE MENTORING STUDENTS AND RESIDENTS AND ENCOURAGING THEIR ACTIVE PARTICIPATION IN THE ORGANIZATION AND SERVING THE MEMBERSHIP FROM A POSITION OF LEADERSHIP.” Communications Committee and not long after was offered to serve as chair. It has been a great honor to be the editor of The Pulse and share my thoughts with the membership on a regular basis as well as help to communicate our goals, mission and accomplishments to the membership and the larger EM community. I was also fortunate to be a member of the EMS Committee and CME committees as well. I was honored to be asked by Dr. Mitchell to consider running for a position on the Board of Directors. Thanks to the membership and your trust in me, I have been able

sure each of you can think back to friends you met as a result of being a member of our group. Each of you can probably share similar stories of friendship, success and belonging because of your membership. I encourage you to remember these stories and help us share the excitement of our college with others. There is so much talent, skill and energy within our College! Here is to a happy anniversary to ACOEP and many more years of success and growth!

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EXECUTIVE DIRECTOR’S DESK

Janice Wachtler, BAE, CBA

BECAUSE OF THEM...

“B

ecause of them we can” was emblazoned on the shirt of a young man sitting in front of me at an event I attended. “Hmm,” I thought, “that’s a very heavy statement.” But it got me thinking about ACOEP and the request I received to write about the 40th anniversary of it being recognized as a specialty college and, by that emergency medicine being recognized as a specialty within the osteopathic profession. Prior to this, I wrote two articles that regurgitated College history, which were quickly scrapped, and I pondered how best to write about this anniversary without being boring or maudlin, so that statement gave me pause and I began to think about the sacrifices made to establish our specialty. Emergency medicine was not recognized, at all, before the late 1960’s and even then, emergency rooms were the playground of hotshot doctors wanting to make a name for themselves or interns, residents and other physicians looking to earn extra money. Emergency rooms were relegated to a basement location, usually next to the morgue, in some subterranean world in the hospital. It was supplied with old, scuzzy, equipment, and only those brought into the hospital by some major tragedy were seen there. In the 1960’s and early 1970’s patients were mostly admitting by physicians, if you could wait for a bed to open, then the

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patient reported for admission. By the mid-1970’s hospitals had designated street-level rooms for emergency rooms, and usually patients were sent there by family doctors and met by them or a resident prior to admission. But even then, most of the staff was made up of interns and residents, and no one was classified as an emergency physician. In our case a group of physicians met in the kitchen of Bruce Horton, DO

Now over time, many of the early members and officers of ACOEP have been forgotten, but these physicians fought battles we will never fully know about to get programs in hospitals, to build freestanding Departments of Emergency Medicine, instead of divisions under surgery or internal medicine, and to build credible and awesome training programs in hospitals inside and outside the osteopathic network.

EMERGENCY MEDICINE WAS NOT RECOGNIZED, AT ALL, BEFORE THE LATE 1960’S AND EVEN THEN, EMERGENCY ROOMS WERE THE PLAYGROUND OF HOT-SHOT DOCTORS WANTING TO MAKE A NAME FOR THEMSELVES OR INTERNS, RESIDENTS AND OTHER PHYSICIANS LOOKING TO EARN EXTRA MONEY.” in Toledo, Ohio to begin to formulate the College. A letter of intent was written to the AOA, that stated the intention to establish emergency medicine as a specialty in the osteopathic profession. On October 5, 1975 they elected a President and Officers and set about gathering 50 people who would become charter members. Getting the 50 members took eighteen months, but in July 1978 the AOA chartered the ACOEP as a specialty organization and the era of the osteopathic physician in emergency medicine began.

So, because of them, we can practice emergency medicine. Let’s take our hats off to these pioneers, say thanks to them for starting the movement regardless of how they did it; we owe them, and every member of every Board and every program director since.


THE ON-DECK CIRCLE

Robert Suter, DO, MHA, FACOEP-D

A TRADITION OF EFFECTIVE ADVOCACY

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hile most famous for his scientific advances in pathology, Rudolf Virchow was also ahead of his time in understanding the need for physicians to be advocates politically. Over the past 40 years ACOEP has taken this important organizational function seriously, with many accomplishments to advance the success and wellbeing of our osteopathic emergency physician members and our patients. While not necessarily top of mind with many of our members, one of these has been ACOEP’s role in advocacy at the state, federal, and even international levels. Just in the past two years we have promoted osteopathic emergency physician practice rights in other countries, legislation and regulation to protect your due process rights, took multiple efforts including supporting lawsuits to protect the Prudent Layperson Standard for payment ED visits, lobbied for continued physician supervision of NPs, and the protection of ABEM/AOBEM as the recognized emergency medicine boards. You didn’t know? Perhaps the main reason that you may not realize all ACOEP does in advocacy is because of how we do it. As you might guess, advocacy efforts to protect and promote all of our interests could be overwhelming. Even if we just focused on federal initiatives, to try to effectively do advocacy by ourselves would easily consume all of our resources. Luckily, we learned a long time ago to “work smarter not harder” by identifying

MEDICINE IS A SOCIAL SCIENCE AND POLITICS IS NOTHING ELSE BUT MEDICINE ON A LARGE SCALE.” RUDOLF VIRCHOW 1821-1902 and collaborating with like-minded organizations on most issues. ACOEP enjoys good relations with a number of organizations involved in healthcare advocacy, enabling us to collaborate on issues of importance to our members. These include the AOA, ACEP, AAEM, EDPMA, SAEM, and others. We work with all of them to efficiently and effectively advocate on your behalf. Our collaboration and leveraging of these relationships ensures that your ACOEP membership makes a difference impacting issues of importance to you. This collaboration is accomplished by a combination of informal and formal agreements. Often, advocacy needs are identified by other organizations and reported to us by our ACOEP liaisons. In some cases, we identify issues and bring them to the other organizations for support. In all cases, we aspire to be part of as broad based a coalition as possible and are usually content to let the organization best positioned to be successful or with the most resources to take the lead and most of the credit. While our fingerprints are always there, usually that is not us.

One of our more formal relationships is our membership in the Emergency Medicine Action Fund-EMAF. The EM Action Fund pools limited resources to be a compelling force that can impact the emergency medicine practice environment. ACOEP pays dues to this collaborative entity and in turn get a Board seat and vote. The EMAF, with our participation, has been particularly active and aggressive in advocating for emergency care access for our patients and your financial interests. By our membership in EMAF we coordinate federal regulatory, advocacy, and legal strategies across the specialty, making use of largescale resources to make us more effective as changes in health care financing and delivery continue. Since its inception, through the EMAF our College has helped to advance the needs of emergency medicine by addressing crucial federal regulatory issues, especially those that were issued under the Affordable Care Act, and has also focused on many other important issues and challenges to the profession, some at the state level, some involving litigation at the federal level, and others involving sophisticated policy analysis and public affairs/advocacy strategies. CONTINUED ON PG 7

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CONTINUED FROM PG 6

Our current projects in conjunction with EMAF include funding a public affairs campaign to improve the perception of emergency care by the public and lawmakers; support enforcement of prudent layperson standards and fight back through PR, advocacy, legal, and regulatory tactics against efforts by both public and private insurers like Anthem trying to erode it with new policies that aim at scaring patients away from seeking emergency care; identify and evaluate policies and programs that reflect the administration’s health policy themes and messaging; continue to support access to emergency medical services as a covered essential health benefit for any insurance plan in a post-ACA replacement environment; promote and fund efforts related to the impact of MACRA and alternative payment; ensure fair and accurate valuation of emergency services codes; work with other EMAF stakeholders on implementing constructive state legislation on fair

and transparent benefit coverage, network adequacy, and fair out-ofnetwork payment standards, block or reverse balance billing prohibitions, and secure the use of appropriate physician charge benchmarking tools and standards; and continue financial support for retained consultants and legal counsel needed to monitor and advise us on federal regulatory issues impacting acute care and develop advocacy strategies to address them. Of course, as an Osteopathic organization we are emergency medicine’s point organization on any issues unique to DOs or the AOA. While independent from the AOA’s perspective we are officially recognized as an AOA Affiliate Organization. This allows us advocate for you on AOA issues or to promote the adoption of emergency medicine advocacy positions by the AOA, since the AOA’s support cannot always be assumed do to the occasional conflict of our issues with those of

primary care. In these cases we have to respectfully remind the AOA to at least show some restraint if the primary care agenda harms specialists in any way. In these cases when our interests are more in line with the body of emergency physicians regardless of degree or training we throw our lot in with our usual emergency medicine partners. Of course the AOA is our partnerin-arms in promoting osteopathic recognition and around the world and in protecting our practice rights in those (now thankfully rare) times when others seemingly forget we exist. Whether initiated by us, or more likely by the AOA directly, we benefit greatly from these types of AOA efforts and are very thankful for them. So you see, your ACOEP has a rich 40-year tradition and a bright future in advocacy on behalf of you and your patients. Virchow would be proud of ACOEP.

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RESPONDING TO AN EMAC REQUEST

A MEDICAL DIRECTOR’S PERSPECTIVE

By Stephen J. Vetrano DO, FACOEP

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y home state of New Jersey has seen its fair share of natural disasters—Hurricane Irene and Superstorm Sandy immediately come to mind, received a lot of external assistance through the Emergency Management Assistance Compact, an agreement between states and territories to request, send and receive assistance to each other in times of need.

What equipment would we need to bring? Operationally, how long would this deployment last? Who should go? Who could go? How would New Jersey EMS personnel operate so far away? This was a particularly interesting question for New Jersey’s ALS providers who are required to contact a hospital base station. And, of course, how would we pay for all of this?

With Hurricanes Irma and Maria hitting the western Caribbean, emergency management officials found themselves facing another EMAC request, but this time it was to send resources. The US Virgin Islands Office of Emergency Management sent an EMAC request to for specialized EMS resources. Specifically, they were requesting Alternative Support Apparatus (ASAPs) and crews to man them, plus a management team, all from the New Jersey EMS Task Force.

Four key agencies were involved in the initial decisions: the New Jersey EMS Task Force Advisory Board, the New Jersey Department of Health Office of EMS and the Office of Emergency Preparedness, and the New Jersey Office of Emergency Management, Division of State Police. Several questions were answered through the EMAC request itself and subsequent conversations with the Government of the USVI and the key agencies.

ASAPs are six foot by six foot enclosed “gator” type vehicles that are fully equipped with basic life support ambulances. Like all New Jersey EMSTF assets, ASAPs are maintained and used by host agencies that belong to the task force. When there is a task force deployment, these assets are brought together. ASAPs have proven themselves highly useful in countless snowstorms, fairgrounds, and any other remote area that a conventional ambulance has a hard time reaching. The EMAC request received caused a lot of questions. Logistically, how would we get there?

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The mission was for New Jersey EMS providers to integrate into the USVI EMS for additional manpower and apparatus. This solved some issues right away: with New Jersey providers embedding into USVI EMS, New Jersey EMS regulations would not apply. The mission duration was for two weeks. In addition to medical supplies for a two week period, the team also had to be essentially selfsufficient for that time: food, water, and shelter. For approximately one month, the leadership of the New Jersey EMS Task Force and the key agencies worked on solving these problems.


Force have a baseline physical exam upon joining the team, physicians also conducted a medical review of history and obtained vital signs prior to deployment. The team used FEMA guidelines for vital signs for deployment.

Fortunately, food and water were relatively easy. The Task Force has a cache of both bottled water and Meals Ready to Eat (MREs). There was much discussion on shelter for the team, centering around housing provided by USVI, versus using the Western Shelter tent system maintained by the task force. Ultimately, the tent system made the better choice. The biggest hurdle had to be getting the team and equipment there. The key agencies, particularly the New Jersey Office of Emergency Management and Division of the State Police, worked with the New Jersey Air National Guard on this issue. A total of five C-5A aircraft were used to transport the team, supplies, and vehicles. The key agencies worked with New Jersey Air National Guard and US Air Force loadmasters to ensure proper fit and balance. As the mission became more a reality, new issues crept in, most notably team wellness and operational security. There was a significant issue in team wellness, particularly in the realm of travel medicine. There was much discussion regarding vaccinations. Travelling to the tropical environment of the Caribbean indicated certain vaccination recommendations. The EMS Task Force leadership, EMS Task

Force physicians, the Office of EMS Medical Director, and even the New Jersey State Police medical director held lengthy discussions on the topic and placed considerable emphasis on standard vaccinations of tetanus and Hepatitis B. Additional vaccinations for diseases such as Typhoid were an option, but the time frame for vaccination was too short to allow for inoculation and for immunity development. And even if time allowed, getting the vaccines proved nearly impossible. All but one of the team physicians are emergency physicians with no ability to secure vaccines. The one internal medicine physician had just started a new job at a new hospital and had not yet navigated the hospital landscape to secure vaccines. Ultimately, it was left to the individual members to ensure vaccination for tetanus and Hepatitis B; and emphasis shifted to proper hygiene and personal protective equipment. As the appropriate PPE for a mosquito-rich environment would be long sleeve shirts and pants, additional water was added to the supply package. Eventually, it came time to determine who was going through a medical screening to ensure fitness for duty. While all members of the EMS Task

In addition to the New Jersey EMS Task Force members, a unit of the New Jersey State Police came to provide team security, and the newest addition to the New Jersey Department of Health, the Disaster Terrorism Branch of the Office of Mental Health Services, sent six counsellors to help the team debrief and aid the citizens of the USVI. New Jersey EMS Task Force personnel operated on St. Thomas and St. John with USVI EMS. USVI EMS greatly appreciated the personnel and equipment brought to ease the burden on their service. The mission was highly successful, with the initial deployment being extended for an extra week. Approximately one month later, a second team was sent on a second two week deployment. This team had the opportunity to work with nurses from New Jersey, who came as part of a request from the New Jersey Hospital Association to support the hospitals in the USVI. A third group recently returned from another two week deployment at the end of April. I rapidly became an expert in travel medicine thanks to this experience. I also gained experience in team wellness and medical clearance. I also experienced disaster medicine more from a public health and public policy perspective. It is an experience I have come to enjoy and one that I hope benefits our team in the future.

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ACOEP CELEBRATES WHAT I REMEMBER MOST ABOUT MY FIRST CONFERENCE IS... The overwhelming sense of family. Meeting so many attendings and residents who were truly interested in helping me become the best emergency physician I can be. – AS H L E Y G U T H RI E

As a newly graduated emergency physician, meeting other osteopathic physicians from across the country and feeling accepted by them. – ,WI L LIA M KO KX

Sense of unity, the ability to learn from others’ experiences that confirm that you are not alone. – ST E P H E N M I FS U D

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40 YEARS! How welcomed [I was]. I knew nobody and was introduced to all the Board members at the time. This kept me well-informed and retained my attendance at Spring Seminar which followed. – H OWA RD D . K ES S L E R

How easy it was to meet the leaders within ACOEP and how friendly they were to a second year resident. – K E L LY K LO C E K

Coming to realize the great specialty society I am part of, how it works for me and how I can work for it. – ST E P H E N V E T R A N O

Hurricane Wilma was there during the conference and I met my now husband there! – A P RI L B RI L L

The genuine feeling of belonging to an organization which cared about its members. – J O H N P RESTOS H

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MY FAVORITE PART OF ACOEP IS... Associating with other physicians who share my philosophy. Giving back to an organization that enabled me to achieve board certification and providing an independent means to maintain it. – M I C H A E L A P P L E W H IT E

The feeling of having a family of friends and teachers working with me and supporting me as I become an EM physician. – J O E SO RBO R

Being a part of an organization that makes a difference in someone’s life, and a better place to practice emergency care. – B RIA N T R A N

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The wide variety of information and education I gain and bring back to my faculty. The impact on my practice has been enormous.

Networking in an organization that is large enough to have an impact but small enough to not forget about people.

– H OWA RD K ES S L E R

– M I C H A E L G U T T E N B E RG

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Knowing we are all pulling in the same direction, as one family. – LI O N E L L E E

Ability to continually gain insight into new treatment modalities, compare and contrast treatments with others from across the country, to be a part of a dynamic progressive group. – JAC K B . FI E L D

The ability to get involved on all levels of the college and how easy it is to access the past and present leaders one-on-one. – K E L LY K LO C E K

Being part of a family that focuses on the patient. – RO B E RT S U T E R

Connection. Being a member of ACOEP has kept me connected. Connected to other practicing emergency physicians. Connected to the reason I am an osteopathic emergency physician. Connected to knowledge and the practice of emergency medicine. Connected to the evolution to the multitude of administrative, political, and legal aspects of emergency medicine. – ST E P H A N I E DAVI S

The friendship and family that has been created by being in the ACOEP is priceless and timeless. – FA H I M S H A N A H M E D

How much they do for students! – TI M B I K M A N

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BEING A DO MEANS Being able to relate to patients, with more than just pharmaceuticals. – H A L A SA B RY

A holistic approach to modern, science-based medicine. DOs are known to be very personable, kind, and caring as well as providing excellent care. – K E VI N J O H N SO N

Family tradition. Starting with my father, and now myself and all my brothers. – J O N DAVI D FI N C H

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I AM A MEMBER OF ACOEP BECAUSE… It is my support structure in the medical profession. – GA RY BO N FA N T E

This organization has supported me from the time I was a student and I want to support it now. Thank you to all of the great leaders who have built and maintained the ACOEP. It has been a invaluable resource in supporting thousands of Osteopathic Emergency Physicians. May it continue to thrive for another 40 years! – B R A N D O N L E WI S

The camraderie. From the general student members to the Board of Trustees, everyone is approachable and easy to talk to and work with.

It gives credibility as well as helps keep me current. ACOEP seminars are excellent. ACOEP has developed into an outstanding organization, promoting and modeling through its membership both scientific and human medicine in an extraordinary manner. – R A N DY K E L L E N B E RG E R

– ST E V E V E T R A N O

It offers great opportunities for the profession in education, leadership, advocacy and so much more! Happy Anniversary to ACOEP! Let’s see what we can do to make it an exciting year!

It has helped me stay up to date, advised me regarding board certification, and kept me in touch with people I did residency with.

– TI M C H ES LO C K

– E L L E N K RO O N

The organization has kept its focus on providing leadership & changes that were required to adjust to the ebbs & tides of health care. – B E RN A RD C I E N IAWA

It is my professional college and they provide me with networking, high quality CME, and professional development opportunities. – J U STI N G RI L L

The people that I meet. There is a camaraderie that is prevalent within the members of ACOEP. It’s like a family of cousins. I do not get that warmth when I attend conferences offered by other organizations. – C H RI STI N E G I ESA


ACOEP’S COMMITTEE FOR

WOMEN IN EMERGENCY MEDICINE UPDATE By Angie Carrick, DO, FACOEP

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e want to introduce everyone to the official ACOEP Committee for Women in Emergency Medicine! The former “Women’s Council” was voted to become a formal ACOEP committee in 2018. Our mission statement is, “to bring to light any gender disparities present within the field of emergency medicine and to provide a support network that cultivates leadership and resources, as well as develops policies to represent the female emergency medicine physician.” All those interested are encouraged to attend our events—including men! The committee meets in person twice a year at Scientific Assembly and Spring Seminar and welcomes all members’ input and ideas.

physician-related issues. Four impactful female physicians will speak on powerful and relevant topics we are facing in emergency medicine. The Women’s Track will take place Sunday, October 21st from 1:00-5:00 p.m. and features the following talks: “Gender Disparities and Sexual Harassment in the Workplace,” “Resilience in a Stressful Work Environment,” “Effective Communication Strategies,” and “EmpowHER: The Brain Science of EmpowHERing Women Leaders.” This series of lectures will give insight and tools to approach the challenges female physicians face which is the purpose of the Women’s Committee. The fall Women’s Committee meeting will take place just prior to this lecture track.

Innovative changes are happening beginning this fall at Scientific Assembly. For the first time in the history of Scientific Assembly there will be an entire lecture track designed around female

Then on Wednesday, October 24th from 12:302:00 p.m. the hugely popular annual women’s luncheon will take place. This year’s theme is “Networking and Empowerment.” The luncheon brings together physicians from across the country and provides the opportunity to get to know each other, network and share stories. This year a panel of influential female physicians will open up about their firsthand accounts of struggles and overcoming challenges in leadership positions. The lectures, the luncheon and the committee meeting itself are meant to be educational as well as a place to build a community of physicians to support females in emergency medicine. The events are appealing and inclusive to a wide range of ACOEP members including students, residents, and even ACOEP’s current president Christine Giesa, DO! Women like Dr. Giesa are paving the way of the future of emergency medicine. So come and see for yourself how useful and inspiring the Women’s Committee really is.

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THE LATEST FROM

ACOEP’S NPIP By Rodney Fullmer, DO MBS NPIP Chair

A

s a medical student pursuing a career in emergency medicine, I was often told that the American College of Osteopathic Emergency Physicians was a family. At the time, I wasn’t sure what that meant. Fast forward almost a decade and I now understand more clearly the comparison and how the college continues to care for its members, embodying the concept of an extended family. As the College reflects on 40 years, I am grateful to be part of this family. As with any professional organization, the College has been through many challenges and has had to adapt to the ever-changing landscape of modern healthcare; specifically, emergency medicine. As the chair of the New Physicians in Practice group, I have personally witnessed the adaptation of the college for its members. The New Physicians in Practice group was developed by ACOEP to help foster our young physicians in their new career. A new physician in practice is defined as any physician in the final year of residency training through their first five years in practice. The group’s focus is to support the new physician as they navigate through difficult job selection decisions, help manage their new work-life balance, and provide opportunities to dialogue with experts in the fields of contract negotiations, financial guidance and more, both remotely and in person. Furthermore, NPIP, in conjunction with ACOEP, has created an education track especially for new attending physicians held annually at ACOEP’s Scientific Assembly. Topics presented vary and are directed at new attending physician needs. Consistently high interest has now made this one of the most popularly attended tracks. As a member of NPIP and the ACOEP family, I can assure you that you will reap the benefits of having all the tools of success right at your fingertips. As chair, I am proud of what NPIP has become and am excited about its future potential. I urge you to join us in Chicago this fall.

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COMMITTEE CORNER A COEP’s Committees are the beating heart of the College and an incredible way to affect change at a higher level. From the EMS committee’s commitment to safer prehospital care and mass casualty training, to the CME committee’s work to bring the highest standard in medical education. Two newer committees have already become part of the fabric of ACOEP, the New Physicians in Practice Committee and the Committee for Women in Emergency Medicine.

New Physicians in Practice exists to support physicians in their first five years of practice, helping to ease the difficult transition from resident to attending physicians. Not only does this dynamic group offer resources for new physicians, they also plan lecture tracks with incredible speakers at conferences. At the 2018 Scientific Assembly the track will include lectures on contract negotiations, Board certification, an in-depth look at the IC versus employment model, and navigating social media as a physician. Not only do these CME-qualified lectures prepare new physicians for their careers, social gatherings such as happy hours and poolside parties help to foster a sense of community and bring people together.

Visit the Member Center at www.acoep.org to learn more about the New Physicians in Practice Committee and how to get involved and support this group.

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ACOEP’s newest, and fastest-growing, committee is the newly formed Committee for Women in Emergency Medicine. The group began as a council, providing women in emergency medicine a space to collaborate, learn, support each other, and advance their careers. It’s incredible popularity soon made it clear that this council should become a committee. Women in emergency medicine face a unique set of challenges, different from their male counterparts and this committee addresses those issues head-on, giving members the tools and support needed to climb past these barriers. At Scientific Assembly the Committee for Women in EM will host a networking and empowerment luncheon featuring trailblazing speakers such as Karen Greenberg, DO, FACOEP Alexis LaPietra, DO, FACOEP Karen Nichols, DO Paula Dejesus, DO, FACOEP-D, MHPE. For the fist time, the Committee will also host a breakout lecture track focusing on gender disparities and sexual harassment in the workplace, effective communication strategies, and the brain science behind empowering women leaders. In a short amount of time both of these committees have become integral parts of the ACOEP machine, and only continue to grow and bring more exceptional learning opportunities and chances to be a part of a truly exceptional community.


Bernard Heilicser, DO, MS, FACEP, FACOEP-D

What Would You Do? Ethics in Emergency Medicine

The following ethical dilemma was referred to us by a local fire chief. “We have an elderly patient who has dementia. On occasions she wanders off from her condominium. The patient’s daughter had placed into our 911 CAD system if the patient is found wandering around she is to be transported to the ED for a medical evaluation if we are unable to contact any family members. The patient’s daughter also had put into the CAD she has medical power of attorney for her mother. “Recently the patient had wandered off. The patient had contact with a police officer. An ambulance was dispatched to the scene. Upon arrival patient was conscious and oriented. Patient refused any type of services. The police officer transported the patient back to her condominium building where she stayed with a neighbor. “I received a call from our police Commander, who relayed to me that the family was upset that the patient was not transported to the ED as was instructed to do by our CAD system. I explained to the Commander if the patient refuses transport and is conscious and oriented, I do not believe we can justify arbitrarily transporting the patient to the ED without the person who has power of attorney either present on the scene, or we were able to contact via cell phone to verify the information is correct and up to date. “This is a unique situation. I am looking for some guidance so if the situation should arise again we handle the call correctly. Thank you.” This type of situation is not uncommon. We certainly have patients who wander, and we have concerned families. We also have Power of Attorney for Health Care documents that are incorrectly filled out, or misinterpreted. Did this fire chief have an appropriate understanding of this advance directive? Does patient autonomy have any standing in this situation? What guidance would you offer? What would you do? Please visit www.acoep.org/newsroom and share your thoughts on this case.

If you have any cases that you would like to present or be reviewed in The Pulse, please email them to us at esernoffsky@acoep.org. Thank you.

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SAVE THE DATE TUESDAY, OCTOBER 23RD 2018

Celebrate FOEM’s 20th Anniversary at the FOEM Legacy Gala: Dinner and Awards Show!

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FOEM FOCUS T

here is more going on with your Foundation than ever before, with the Board and staff working continuously to bring you the research opportunities, support, funding, competitions and more. From the upcoming FOEM Legacy Gala, to the newly-launched FOEM Research Network, there is much to celebrate. FOEM Competitions – all five FOEM Competitions at Scientific Assembly are now open to attending physicians, not just students and residents! We are looking forward to how this expansion changes the landscape of these competitions in Chicago at Scientific Assembly. FOEM Research Network – the FOEM Research Network is live! The site consists of three sections: researchers can search the site to find multicenter research opportunities nationwide; research sites (hospitals and universities) can update their dashboard to include up-to-date demographics and information as well as research opportunities; and clinical research organizations (device manufacturers or pharma) can search the site for attractive research sites to pilot their products. Visit www.foem.frn.org to see the new, state-of-the-art platform for yourself.

Grant-funded research – FOEM funds research projects annually and is currently funding Dr. Mike Allswede’ s ACOEP-ACGME Paradigm Research Project. The goals of the project are to capture the costs, satisfaction, and quality associated with adopting a new accreditation paradigm. The project will soon be recruiting workgroup members to analyze the results, which is eligible for scholarly activity as well as monetary funding. If interested, contact Stephanie Welter at swhitmer@foem.org.

Research Review Resource – Each year, the ACOEP Research Committee reviews research papers submitted via the online portal. Papers are primarily submitted by senior residents, but the portal is now open to all researchers looking to have their work reviewed. There are two ways to get involved for scholarly activity—submit a paper for detailed feedback which boosts your chance of publication dramatically or volunteer as a paper-reviewer.

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