The Pulse January 2014 by ACOEP

the

Pulse

January 2014

Osteopathic Emergency Medicine Quarterly

Mark A. Mitchell DO, FACOEP

ACOEP Welcomes New Board President By Erin Sernoffsky

t a ceremony at the 2013 EMERGE Scientific Assembly Mark Mitchell, D.O., FACOEP, FACEP assumed the position of President of the Board of Directors of ACOEP taking over the role from Gregory Christiansen, D.O., FACOEP, who worked tirelessly in the post for the past two years. “I am thrilled to work with Dr.Mitchell in this capacity,” says Jan Wachtler, ACOEP Executive Director. “His experience as a physician, board member, advocate, educator, and professional will certainly benefit members at every level and the entire continued on page 23

Presidential Viewpoints Page 4

Executive Director's Desk Page 6

Making Advocacy Work for You Page 16

FOEM Foundation Focus Page 28

Emergency Medical Associates has EXPANDED to PENNSYLVANIA

Seeking BC/BE EM Physicians for the Good Samaritan Health System Fast Track Opportunities for IM/FP Physicians in the ED Centrally located in scenic Lebanon Valley countryside with easy access to Hershey, Harrisburg, Lancaster and Philadelphia

Good Samaritan Health System • Lebanon, PA • • 54K volume ED • • 23-bed, newly renovated ED • Fast Track

172-bed acute care hospital Com ighly pe Wound Care and Hyperbaric Hou titive Medicine Center r Rat ly e Nationally Recognized Cardiac & Vascular Center with STEMI Lab near ED

Learn why EMA physicians stay with us for their entire career.

EMA Physicians Enjoy:

Unparalleled Support (i.e. Scribes & Physician Assistants)

Superior Compensation & Comprehensive Benefits

Stable, Long-Term Contracts

3 Equitable Scheduling 3 95% Physician Retention Rate 3 An Equal Voice in Everything We Do

3 An Equal Share in

Everything We Own

Contact Edie McDuffie, Recruiter

(973) 436-5547 • McDuffieE@ema.net • www.ema.net/for-providers Explore these positions, as well as exciting career opportunities in NJ, NY, PA, RI and NC. the PULSE | January 2014

The Pulse

VOLUME XXXVIII

Editorial Committee Drew A. Koch, DO, FACOEP-D, Chair Timothy Cheslock, DO, FACOEP, Vice Chair Kenneth Argo Gregory Christiansen, DO, M.Ed., FACOEP-D Joe Clark, DO Anthony Jennings, DO, FACOEP Wayne Jones, DO, FACOEP Peter J. Kaplan, Advertising Chair Lionel Lee, DO Andrew Little, DO Annette Mann, DO, FACOEP Mark A. Mitchell, DO, FACOEP Todd Thomas Danielle Turrin, DO Erin Sernoffsky, Communications Manager Thomas Baxter, Media & Technology Specialist 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 theteam@norcomdesign. 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.

Pulse

the

Editorial Staff Drew A. Koch, DO, FACOEP-D, Editor Timothy Cheslock, DO, FACOEP, Assistant Editor John C. Prestosh, DO, FACOEP Mark A. Mitchell, DO, FACOEP Erin Sernoffsky, Communications Manager Janice Wachtler, Executive Director

Osteopathic Emergency Medicine Quarterly

Table of Contents

ACOEP Welcomes it's New Board President: Dr. Mark Mitchell....................... 1 Erin Sernoffsky Presidential Viewpoints...............................................................................................4 Mark A. Mitchell, DO, FACOEP The Editor's Desk.........................................................................................................5 Drew A. Koch, DO, FACEOP-D Executive Director's Desk...........................................................................................6 Janice Wachtler, BAE, CBA What Would You Do?..................................................................................................7 Bernard Heilicser, DO, MS, FACEP, FACOEP A Voice Waiting to be Heard...................................................................................... 8 John C. Prestosh DO, FACOEP ACOEP New Speaker’s Forum 2014......................................................................10 Nilesh Patel, DO, FACOEP What is your Resolution?...........................................................................................13 Tim Cheslock, DO FACOEP A Close Call.................................................................................................................15 Tim Cheslock, DO FACOEP Making Advocacy Work for You..............................................................................16 Leann Fox AOBEM Update.........................................................................................................17 Donald Phillips, DO, FACOEP Fascial Distortion Model – A Remarkable Cure...................................................18 Juan F. Acosta, DO, MS, FACOEP-D Back to Basics..............................................................................................................22 James Hensel Double Vision.............................................................................................................24 Greg Christiansen, DO, M.Ed., FACOEP-D ACOEP Welcomes New Board Members..............................................................26 Erin Sernoffsky FOEM Foundation Focus.........................................................................................28 Sherry D. Turner, DO, FACOEP Resident Wrap Up.......................................................................................................39 Steve Brandon, DO Residency Spotlight.....................................................................................................40

the PULSE | January 2014

Presidential Viewpoints

Mark A. Mitchell, DO, FACOEP

Becoming Part of the Solution Despite all of these issues, the Emergency Departments in the US still provide access to care for everyone 24 hours a day, every day. During these times, each one of us needs to look in the mirror and ask ourselves, “What can I do to be part of the solution?” Yes, there are things each one of us can do on a national, regional, local level, or even for one patient at a time. We need to continue to reach out to our representatives in Congress and make sure we advocate for our patients. This can be done in many different ways including phone calls, letters, emails, or a personal visit. We have two emergency physicians currently serving in the US House of Representatives: Joe Heck, D.O. from Nevada and Raul Ruiz, M.D. from California. Having personally talked with each they are working hard to advocate for Emergency Medicine and the patients we serve. Even though they may not represent you geographically, rest assured they are representing Emergency Medicine.

t is truly a pleasure to have the opportunity to lead the ACOEP as President for the next two years. Never before in my career have I seen healthcare in such a time of uncertainty. We have many issues and changes we are all facing including Affordable Care Act (Obamacare), Accountable Care Organizations, electronic medical records, the still unresolved SGR, overcrowding in the ED, the continued effects of EMTALA on our departments, two midnight rule for admissions, increasing audits by payers, ICD 10, lack of adequate supply of boarded emergency physicians, telemedicine, free-standing emergency departments, and the growing number of urgent care centers.

We also have Student Chapters of ACOEP at each College of Osteopathic Medicine that need your mentorship. Each Student Chapter has one member of the ACOEP Board of Directors serving as a Board Mentor. However, we are in need of more members to engage with these students in any way you can. That could be having them shadow you in their first two years before they begin their clinical rotations. They are always seeking experienced emergency physicians to come to their meetings and talk with them. You don’t have to give some formal presentation as they enjoy just having the interaction and the ability to ask questions. If you would like to be equipped with a more

Have you seen the new ACOEP website? Visit www.ACOEP.org for the latest updates on news, conferences, CME opportunities, member benefits, careers and more! Our new design makes finding the information you need easier than ever. It's even mobile device friendly!

the PULSE | January 2014

formal presentation, reach out Jaclyn Ronovsky in the ACOEP office. During my term I will be focusing on several areas that include the following: • C ontinue to provide high quality CME via our conferences. • W ork with the CME Committee to provide additional offerings via electronic medium such as video, webex, or podcast. • W ork to establish an active Governmental Affairs Committee with Joseph Kuchinski, D.O. as its Chair. • E ngage with our Student and Resident Chapters to provide them with the Mentorship they needs and to assist them to become Active Members of the ACOEP. • C ontinue to work closely with the Federal Health Policy Taskforce of the Emergency Department Practice Management Association (EDPMA). • K eep in close communication with the AOA on important issues such as the ACGME standards, expansion of GME opportunities for our students, and the inspection process of existing programs. We have much work to do and the ACOEP Board of Directors and Staff need your involvement in order to continue to move our profession forward. I look forward to working with you over the next two years.

The Editor's Desk

Drew A. Koch, DO, FACEOP-D

Dilaudid Deficiency disappear from the emergency department happy.

ilaudid deficiency, or DD, is epidemic, and a common malady prevalent in emergency departments and communities. This condition is not unique to the emergency department where I work; it appears everywhere and affects all walks of life. This condition was not taught in medical school or learned during our emergency medicine residency and it has evolved over the years and has become more prevalent. What is diluadid deficiency and how is it readily recognized?

That scenario rarely occurs. The patient might leave voluntarily but usually comes back at a later time and date demanding more Dilaudid. The patient states that they need more than the amount given to them. They have a high tolerance and require a larger dose of Dilaudid. The patient wants the Dilaudid to be administered via an IV push and not in a mini-bag as a drip. They will refuse to take the Dilaudid orally. The patient refuses to leave when discharged. They claim their pain needs were not addressed. They will call the administrator on call to discuss their dissatisfaction. They will summon an ambulance from the waiting room or parking lot to take them to another hospital. These patients are professional patients and their job is score pain medication. They are better actors and actresses than anyone on the silver screen. The DD that presents covertly is often difficult to assess. These are the patients who present to the emergency department with what appears to be a non-painful complaint like syncope without trauma, weakness, dizziness, cough, psychiatric illness, or altered mental status. They present with a nonpainful complaint but request to have their dilaudid deficiency replenished while they are in the emergency department. The patient on occasion is barely conscious and does not appear to be in extreme pain but still requests

the DD addressed. As emergency medicine physicians, our ability to replenish the DD is compromised by the sparseness of information that is provided by our patients and the lack of accessibility to our patientâ&#x20AC;&#x2122;s medical records as an outpatient or at other facilities that are not part of our hospital network. The state where I practice has recently enacted a robust physician monitoring program that provides access to controlled substance prescriptions in real time (within 24 -48 hours), and this has proven to be a very valuable tool. The state has enacted a law that requires that all providers consult the PMP website before writing a controlled substance. Emergency medicine physicians are exempt from accessing the data base before writing a controlled prescription if the prescription is less than a five day supply. However, it is highly encouraged that each provider accesses the website on each patient before writing a controlled substance prescription. This website is a godsend and allows the EM provider to check the patients previous six month controlled substance history. It is an eye opener and sheds light on who the players really are. It is extremely difficult to assess if a patient has an acute medical problem, an acute exacerbation of a chronic problem, or if they are simply scamming you for Dilaudid. Dilaudid Deficiency is real and here to stay. It is up to us to decide how we are going to treat it.

It is anyone who presents to the emergency department who request dilaudid and appears to have a non-acute medical condition. It can present overtly or covertly. Overt is when the patient presents with subjective pain and demands pain medication. The patient states they are allergic to or intolerant to any other pain medications. They also state that the only thing that works or when they present to the ED that they are given that D worddddlaud-id. This is pretty straight forward. The patient comes in with a complaint and has a self-imposed solution to relieve the pain. The medical screening exam is performed and the patientâ&#x20AC;&#x2122;s chart is reviewed. Theoretically, the easy thing to do is acquiesce and provide the patient with the Dilaudid the patient requested. However, as we all know no good deed goes unpunished. One would hope that once the patient gets what they wanted they would

the PULSE | January 2014

Executive Director's Desk Janice Wachtler, BAE, CBA

This One’s For Me for a diagnostic ultrasound and diagnostic mammogram and went to the hospital within five days. It showed a 3cm lump, big yes, which required an ultrasound-guided needle biopsy. Twenty-two days after I found the lump, I was sitting in an oncologic breast surgeon’s office. He reviewed every test and palpated the now >5cm lump and did another needle biopsy. He told me I was ok to go to Convention and could wait until I got back to do surgery. “Whew,” I said, “what works for you?” He said, “How about Thursday?” “Sure what date?” He answered, “September 12th, does that work for you?”

uring the thirteen years I’ve authored Executive Director's Desk, the membership of ACOEP has lived through many of my experiences and observations. These experience include dealing with depression of my close friend, my experience as a hospitalized patient, the indecision of my friend in the disposition of her mother’s care, experience from the juror’s prospective in a malpractice case, and many other controversial topics. Now I will share a profoundly personal journey I am just beginning. There are several phrases you may hear during your life that you’ll remember forever. Some are wonderful, others not so much. But I’ve found the scariest phrase for me has been, ‘I’m sorry to tell you, but you have cancer.’ It can rock your world, I know it did mine. Those who know me well know I’m a bit of a control freak. I like being in charge of my world and my health. The only thing I’ve not been able to control is my sweet tooth, and that sometimes gets the best of me, but I’m someone who has gotten their physical exams, blood tests and even a colonoscopy (although it was a little later than prescribed). This diagnosis sent me into orbit. I had my last mammogram in early December 2012 and my physical exam in late July; but on August 17th, I discovered a lump, and it was big. I called my gynecologist, received orders

the PULSE | January 2014

Sitting down he said, “Jan, let’s be realistic, this thing has doubled in size since last Friday … it’s a T2 tumor and it needs to go. You okay with that?” Like duh, was I okay with it, you bet! And we made arrangements for surgery three days later. The day before the surgery he called, telling me the second biopsy showed I had cancer and it was ok for me to be angry, cry and be mad at him. He would make me cancer-free. I blinked back tears, saying, “I didn’t need your permission to be mad. And it was a large promise to cure me of cancer.” He said he was a good surgeon, and at best I’d need radiation and a pill a day for five years for chemotherapy. I hung up and cried harder than I ever did before. I went into the hospital the next day looking like a trainwreck and hoping I’d be fine. When I returned from Convention, the second shoe dropped when the Medical Oncologist informed me that I was 100% surgically cured but had two cancers not just one. One was ductal cancer which was now considered cured, the other, a large-celled genetic typed cancer with a high probability of recurrence in 10 years. Great, I muttered, what now. As I write this article, I have yet to learn the basis of the second cancer, but am in the midst of chemotherapy. I have had a PET scan that was clear and have visited a shrink to make sure I was stable and secure and I had a support mechanism as I begin this whole journey. I laughed saying I only really needed to see him because I’ve decided to undergo a prophylactic double mastectomy in the beginning of the year if warranted to remove all possibility of

recurrence. He concurred, but was there for continued support, which I appreciated more than I can verbalize. During the Convention, many physicians and spouses confided in me they did not go for routine mammograms or physicals. This was concerning to me. I’ve followed all the rules, done all the specifics for staying well and within 25 days, this all popped up (literally). So I urge you all not to disregard your health. You all are important parts of your family. If you feel disregarding your own health is fine, think about them, be there for them, be there for yourself. I will be fine. It will be a few months before I’m fully well and back to normal, but I’m not ready to throw in the towel or roll up in a ball. I’m sharing this not because I want your sympathy or support, but so many of you have shared your personal experiences with me and have confided in me and I need you there for the public, your families and me. The next time I see you all I may look different, have different hair, or be thinner (I can only wish) but I will be there. Until next time …

Ethics in Emergency Medicine

Bernarnd Heilicser, DO, M.S., FACEP, FACOEP

What Would You Do? alcohol consumption and demonstrates slurred speech. As you expect, she refuses medical treatment, and states her boyfriend made up the story and just wants her out of the house. EMS learns there is a possible history of drug OD in the past. As medical control, what would you do when EMS calls for direction? Should the patient be allowed to sign a refusal of transport, or be forced to be taken in for evaluation? Would you think differently if you further learn that the police are hesitant to assist in coerced transport? Additionally, what would be your approach when informed that the patient is the legal guardian of her 6 year-old grandchild who is in the house? What Would You Do?

Our patient is a 45 year-old female with a questionable history of an antihypertensive overdose. Her live-in boyfriend called EMS stating the patient took an unknown amount of pills. When EMS arrives, they find the patient denying any overdose. However, there is an empty vial of pills, and the patient admits to

Please send your thoughts and ideas to WhatWouldYouDo@acoep.org. Every attempt will be made to publish them when we review this dilemma in the next Pulse. If you have any cases that you would like to present or be reviewed in The Pulse, please email them to us at WhatWouldYouDo@acoep.org. Thank you.

EMERGENCY Intensive on Immersi ce Experien

2014 dates March 14 - 16, Orlando April 4 - 6 , Las Vegas May 2 - 4 , Boston May 30 - June 1, Dallas Sept. 12 - 14, Baltimore Nov. 14 - 16, San Diego Focusing on the difficult and failed airway

the PULSE | January 2014

The On-Deck Circle

John C. Prestosh DO, FACOEP, President-Elect

A Voice Waiting to be Heard have a platform from which you are able to shout out your cares along with thousands of others. The American College of Osteopathic Emergency Physicians is that platform to represent those voices. The college functions to represent and advocate for the thoughts and concerns of individual physicians as well as the entire membership. The ACOEP shares common interests with many national organizations involved in emergency medicine. We work collegially with the American College of Emergency Physicians (ACEP), the Council of Residency Directors (CORD), and the American Academy of Emergency Physicians (AAEM). ACOEP has and will continue to partner with these groups to promote excellence in the delivery of care to all patients while listening to the needs of emergency medicine physicians.

Dr. Leap never visited my department, but it struck true that his emergency department was the same as mine, and yours! Coincidence, I doubt it. We all have stories that ring identical for every emergency department in the country. Having said everything to this point brings me to the crux of my message. The ACOEP represents more than 4,000 emergency medicine physicians and partners with other organizations that have memberships in the thousands. The ACOEP wants to hear your voice, your concern, your needs. The Board of Directors has always and will continue to work

" Our opinions do not really blossom into fruition until we have expressed them to someone else."

solitary voice cries out in a rural county, but no one hears that plea. An identical lone voice echoes its need amidst an inner city room but goes unheard. Would that voice be heard if it was doubled, tripled or even magnified a hundred times? Should that voice be heard? What is the concern that voice wants to share with those who will listen? As an emergency medicine physician, do you ever feel that you are that voice that no one hears? Do you believe you have something important to express that should be heard? Your individual concern, I believe, is not unique. I wholeheartedly feel that your disquiet is shared by a thousand other minds, perhaps even more. The perplexities of daily practice that face each emergency medicine specialist need to be expressed by the massive number of voices that share those concerns. These concerns are varied and partially include: boarding patients in the emergency department, demands to meet timelines, performance paid care, utilization and costs of tests, and one that I personally find most offensive, considering our patients to be consumers. Of course there are more issues we face; you know them, the list is extensive. I believe every emergency department in the United States is confronted with many of the same challenges, whether it is situated in a rural county that has 8,000 patient visits a year or in a large academic center with greater than 100,000 patient encounters. Your voice should not cry out alone.

the PULSE | January 2014

You

ACOEP had the privilege of having Edwin Leap M.D. speak at our recent Scientific Assembly in San Diego. He was informative, interesting, and humorous. I felt compelled to speak with him after his presentation as to how

he knew “my” emergency department so well. After all, he obviously did not mention patient names, but he described so many of those that I treat that I believed he must have visited our emergency department at some time. Of course, I realized that

– Mark Twain

on behalf of our patients and members of the college. The Board is keenly aware of the myriad of issues that confront each emergency medicine specialist on a daily basis. However, the scope of medicine is changing quickly, and I am sure there are issues that you may have and need to be brought to the forefront of awareness. Please contact us so we can hear YOUR voice. We will listen to your concern and do what is necessary to ensure that your need is addressed. I cannot promise the solution will be immediate (or if a solution even exists

at this time). However, be assured the Board of Directors will stand behind you and offer whatever assistance may be possible to remedy your concern. I believe there is a voice waiting to be heard. Is it yours? If it is, please contact us and know that your solitary concern will be heard by many and soon your lone voice will be echoed by thousands!

ACOEP BRINGS YOU TO

ACOEP is proud to unveil the new brand of our educational conferences:

– The Edge – • We will give you an edge to overcome new challenges. • We embrace the cutting edge of new technologies, opportunities and advancement. • We journey together to the edge, generating creative thoughts, solutions and lasting advancement.

JOIN US FOR OUR 2014 EDGE CONFERENCES! ACOEP Presents

INTENSE REVIEW

ACOEP Presents

SPRING SEMINAR

ACOEP Presents

SCIENTIFIC ASSEMBLY

‘14 ‘14 ‘14

TO FIND OUT MORE VISIT: www.acoep.org/edge the PULSE | January 2014

ACOEP New Speaker’s Forum 2014 Nilesh Patel, DO, FACOEP

n an effort to secure new speakers for the College’s major CME conferences, ACOEP is proud to sponsor a New Speaker’s Forum. This opportunity is open to members of the college to display their speaking skills and become involved with lecturing on a national level. The second annual competition will take place at ACOEP’s upcoming The Edge Spring Seminar, which will be held April 22-26, 2014 at the Westin Kierland Resort and Spa in Scottsdale, Arizona. Candidates must submit the following by Monday, March 10, 2014: 1) Faculty Profile 2) CV 3) Proposed Title of Presentation 4) (3) Learning Objectives

the PULSE | January 2014

The Faculty Profile form can be found on the ACOEP website (www.acoep.org/speakers) Please submit the above items to Lorelei Crabb at lcrabb@acoep.org by March 10. The ACOEP CME Committee will conduct a CV review to select the most qualified candidates. You will be contacted by email if you are selected for the competition. No submissions will be accepted past this deadline. Also, speaker slots are awarded on a first come, first serve basis per your application. Speakers must give a 12-minute power point based lecture before a panel of judges from the ACOEP CME Committee on a topic relevant to Emergency Medicine. This time allotment is strict, speakers running over the 12-minute time period will be stopped. There will be a 2-minute period for questions following the presentation. Speakers are required to bring their

presentations to the audition. Presentations must be preloaded onto the ACOEP laptop in advance. You will not be allowed to use your own computer for presentation. Your presentation must be compatible with the college’s computer as their will be no time to switch computer’s between presentations. ACOEP will provide a wireless microphone and laser pointer with slide advancer for the speakers. Speakers must be registered for the Spring Seminar and are responsible for their own travel arrangements and expenses. Judges will select one winner from the speakers. The winner will be offered the opportunity to lecture either at the 2015 The Edge - Spring Seminar or Scientific Assembly.

ACOEP Presents

INTENSE REVIEW

â&#x20AC;&#x2DC;14

Hurry, Registration is Filling Up Fast!

The Edge - Intense Review 2014 The Westin River North Chicago, Illinois

January 16 - 20, 2014 Oral Board Review

January 14, 2014 The January 15th Oral Board Review is SOLD OUT!

ACOEP Presents

SPRING SEMINAR

ACOEP Presents

SCIENTIFIC ASSEMBLY

ACOEP Presents

INTENSE REVIEW

‘14 ‘14 ‘14

Save the Date The Edge - Spring Seminar 2014 The Westin Kierland Resort & Spa Scottsdale, Arizona

April 22 - 26, 2014 For More Information Visit: www.acoep.org/edge

What is your Resolution? Tim Cheslock, DO FACOEP

t’s hard to believe that we are beginning another new year! New Year’s traditionally motivates people to resolve to make some substantial change for the upcoming year. This may be related to becoming more fit, eating healthier, or spending more time with family. Everyone has a renewed vigor to make this the best year ever. In addition to making a personal resolution this year, I would like to challenge each of you to make a professional resolution as well. What can you do to advance osteopathic emergency medicine? It may be as simple as committing to serve as a preceptor for an osteopathic medical student or becoming a mentor through the ACOEP mentoring program. Maybe it will be attending The Edge Spring Seminar in order to get a leg up on completing your CME requirements. DO day on the Hill is

what we can accomplish this year "Imagine if we get everyone involved in some facet

of advancing our field, our college and our profession.

rapidly approaching, we could use some new advocates to meet with elected leaders to move our agenda forward. For those who are really motivated, maybe you would like to serve the college and participate in one of the many ACOEP committees. Energy and motivation are contagious! Go public with your resolutions and encourage your colleagues to do the same. Imagine what we can accomplish this year if we get everyone involved in some facet of advancing our field,

our college and our profession. I would be interested in hearing from our membership as to what their professional resolution will be for 2014. You can email me at tim.cheslock@gmail.com. Some of these will be shared in our next issue and on our website. Happy New Year! Let’s make it a successful and fulfilling one!

the PULSE | January 2014

ACOEP Presents

SCIENTIFIC ASSEMBLY

ACOEP Presents

INTENSE REVIEW

‘14 ‘14

Save the Date The Edge - Scientific Assembly 2014 Caesars Palace Las Vegas, Nevada

October 12 - 15, 2014 For More Information Visit: www.acoep.org/edge

A Close Call Tim Cheslock, DO FACOEP

very now and then a patient comes in that rattles you to some degree. These are patients that really leave an impression in your mind that is not soon forgotten. I wanted to share one such experience because there are some valuable lessons that we can all benefit from. It was a typical, busy shift when a forty some year old woman presented with symptoms of angioedema. This is by no means something we see frequently, but is something that will raise a chill considering how quickly someone with angioedema can deteriorate. This particular patient, to her credit, was more knowledgeable than most about her condition. This both helped and hindered her in this case. She had hereditary angioedema and was followed by allergy and immunology. Up until this presentation she had never had any issues with edema above the chest, all of her prior episodes had been abdominal in nature. She was involved with a support group and knew what worked and what didn’t in cases such as her's. She began to feel symptoms about 6-8 hours prior to her presentation to the ED. It started with some tingling of her upper lip and shortly thereafter some visible edema to the cheek and side of the neck. She delayed her presentation to the ED because a family member was giving birth at the hospital and she wanted to be there for her. However, she did contact the facility to inquire whether or not they had medication available in case the symptoms became worse. Apparently she talked to someone in the pharmacy and they told her they did have Kalbitor (ecallantide) in house. Kalbitor is one of only a few medications that are available to help treat angioedema. The clincher is that the medicine costs about $50,000 per dose, per patient and pharmacist. I could not verify that but have no reason to doubt the information they provided. The patient, with this knowledge, continued to delay her presentation feeling reassured that she had prompt access to medication. When the birth was complete she then proceeded to the ED to seek care. By this time it had been almost eight hours since her first indication that something was wrong. At the time of patient contact she was awake, alert with no obvious respiratory

clincher is that the medicine (Kalbitor) "The costs about $50,000 per dose, per patient and pharmacist. " distress, but visible moderate edema of her upper lip, left cheek and submandibular area, and what she described as a funny feeling in her throat that did not cause any dysphagia or respiratory distress. The patient was anxious and relayed to me the information she obtained from the pharmacy earlier in the day. As in all situations of this nature, the concern for her airway was paramount. All the routine processes and procedures were in place. IV access, O2, monitor, airway cart to the bedside. I explained to the patient that I would order the Kalbitor from pharmacy but it would take some time. In the interim, I had attempted to administer the routine second line medications to bide time. Knowing they would not likely work, but maybe, just maybe, slow progression of what sounded to be an impending airway event. This is where things began to unravel. The patient, in her knowledge of her disease process, declined the Benadryl, steroids and other treatments, stating that they would not help her situation and would wait for the Kalbitor. I called the pharmacy directly and inquired about the availability of the medication. Being told it was available, I promptly entered the order and expected it to arrive within minutes. It never came. A second call to the pharmacy revealed that the medication in stock was prepurchased by two other patients that have HAE and could not be used for my patient because it was not hers. Even after explaining the situation and the possibility of impending airway

compromise the pharmacist still would not release the medication. Now my anxiety began to increase. I relayed the information to the patient and she became irate. She stated, “they told me they had the medicine and that’s why I waited, because I knew it was here!” Apparently they didn’t know that she was not one of the patients for whom the medication was intended. She then proceeded to tell me about a hotline number that would assist in locating medication for her. All the while I’m thinking to myself, this patient does not have time for this. She is going to need airway protection sooner rather than later if we cannot provide her with the therapy needed. I called the hotline while at the same time, I quickly located the same information on their website (www.haea.org) which gave me a toll free number to a patient advocate that took some basic information, my location, and promised a call back shortly with some information. Simultaneously, I had paged the house supervisor to determine if there was any way to over-ride the pharmacist and get the medication to prevent this situation from becoming a life-threatening. Knowing time was becoming short, I re-evaluated my patient. I did not see "Close Call" continued on page 19

the PULSE | January 2014

Making Advocacy Work for You Leann Fox

eople ask why advocacy is important in many different ways. Does anyone really read my letters? Why should I bother? They already know how we feel. They’ll hear from someone else, they won’t listen because they’re a Democrat or Republican. Questions and statements like these are uttered by voters every day. What these questions say is that as overall political issues increase amongst the general public, the more complicated and partisan - and ultimately frustrating - it can become. However, as health care remains at the forefront of the national political conversation, it is more important than ever for physicians and the patients they treat, to engage in advocacy. A survey of the national political landscape would tell you that only three percent of Congress truly understands what a physician’s day-to-day life is really like – of the 535 Members of Congress, only 20 have ever practiced medicine. While lobbyists are well armed with the knowledge and details of health policy, the most powerful tool in a lobbyist’s arsenal is you, your story and how these policies affect voters in a state or district. Truthfully, the efficacy of advocacy depends on a number of factors - at least two of which you cannot control, the elected official you are trying to influence and the quality of the opponent and their message. Persuasion is a complicated art and in politics, where both sides can be right and truthful at the same time, delivering a compelling message is everything. In order to deliver the most convincing message, you have to start with the basics and that means knowing your audience. Each elected official maintains a webpage outlining their position on key issues—so-called “hot button” issues. Your “target” legislator, and by extension their policy staff, have a voting record which will give you a blueprint for mapping out the type of message you need to deliver. It may not provide the entire picture; however, the congressional record and votes on specific bills provide important background. While your elected official may support a particular issue, they may not co-sponsor a bill or vote in favor of passage because of some underlying reason - for example, how a measure is paid for. This is where expert sources, such as your state or

the PULSE | January 2014

more than ever, physicians must push "Now past frustrations behind them and engage in advocating for their practices and patients. " national professional organization, can help you sort through why someone who appears to support an issue you care for voted against it. Being armed with the issues and motivations of an elected official gives you the knowledge you need, however you still need to develop a relationship with the office – specifically the staff covering health care issues. This individual spends every day working on the issues that affect you and a solid relationship with them will provide you the access you need when important legislation comes up. Beginning a relationship is not a difficult proposition, it requires reaching out to the office regularly –

both to ask for support or opposition, and to thank them for their stance on an issue. You should also offer to be a resource to the office on health care issues, attend local events the legislator holds - such as town hall meetings, and send letters to the editor in support of votes and work a legislator has done. You will not always agree with the positions of your legislators, but a cordial working relationship with them is a necessary part of advocacy. Now more than ever, physicians must push past frustrations behind them and engage in advocating for their practices and patients. If you don’t do it, who will?

AOBEM Update Donald Phillips, DO, FACOEP AOBEM Secretary

xaminers and Item Writers: AOBEM welcomes submissions for qualified diplomats to participate with the board as item writers and oral board examiners. Item writers may be DOs or MDs and must be board certified by AOBEM or ABEM. Item writers are required to complete the online NBOME item writer course and submit the certificate of completion. Item writers for Certificate of Added Qualification (CAQ) exams are also welcomed. These item writers must hold the CAQ for which they wish to write. Currently, we have CAQs in EMS and Toxicology. AOBEM also is a conjoint sponsor for Sports Medicine. Oral board examiners must be DOs holding current certification by AOBEM or ABEM for at least the previous three years. Oral board examiners are also expected to participate as item writers.

OCC for Cognitive Assessment: Diplomats that took the cognitive assessment (formerly the Formal Recertification Examination or FRCE) in September 2013 must complete the Component 4 Practice Performance Improvement (PPI) before December 31, 2013. In order to be credentialed for the cognitive assessment in 2014, those diplomats must submit their application by February 01, 2014 and have completed their PPI by September 01, 2014 in order to be credentialed to take the cognitive assessment. Beginning in 2015, diplomats applying for the cognitive assessment will be required to have completed component 4 prior to the February 01 application deadline. Undersea and Hyperbaric Medicine CAQ: AOBEM will be jointing this conjoint

CAQ board. Error correction: At the fall ACOEP membership meeting I had reported erroneously that the AOA Board of Trustees had approved a change that would not allow diplomats to sit for CAQs not sponsored by their primary board. This change applies only to CONJOINT CAQs. I apologize for the error and any concerns this may have inflicted. Appeal Policy: I would point out a significant change to the AOBEM appeal policy. The full policy is on the website. The change is that appeals must be filed within 24 hrs of completion of an examination. Please read the full policy on the website. Respectfully, Donald Phillips, DO, FACOEP Secretary

the PULSE | January 2014

Fascial Distortion Model – A Remarkable Cure Juan F. Acosta, DO, MS, FACOEP-D

s Osteopathic physicians we have many tools in our treatment repertoire that help patients in time of need and, in many cases, urgently. Although Osteopathic Manipulative Treatment (OMT) may not be used by most osteopathic physicians in an emergency department, we still use our osteopathic principles and practice when we treat our patients. Many factors such as a patient’s acuity and the increase in patients being seen in the ER, limits the amount of time one can spend performing such procedures as OMT. Fascial Distortion Model (FDM) is a treatment developed by the late Stephen Typaldos, DO; a Family Medicine physician who worked in emergency medicine, as well as, manipulative medicine. Fascia is a living tissue, thus needing all the nutrients and oxygen in order to sustain itself and the body it supports (Typaldos, S., 2002). It is a very effective treatment but three out of the six distortions are very painful to treat. FDM is a manual treatment based on six different fascial distortions in which the patient has specific body languages to describe the pain they are experiencing. The six distortions include Triggerbands, Continuum Distortion (CD), Herniated Trigger Point (HTP), Folding Distortion, Tectonic Distortion and Cylinder Distortion. Each one of these distortions has a specific body language. This concept of body language is important in making the correct diagnosis. Triggerband – a sweeping finger along the painful linear pathway. Herniated Trigger Point (HTP) – pushing fingers, thumb or knuckles, into the protruding tissue. Continuum Distortion (CD) – pointing with one finger to the spot of pain. Folding Distortion – for the extremities there is a “cupping of the joint with hand”; for the back – placing the dorsum of hand or fist on the spine.

the PULSE | January 2014

is a manual treatment based on six "FDM different fascial distortions in which the patient

has specific body languages to describe the pain they are experiencing.

Cylinder Distortion – respectively squeezing the soft tissues or broad sweeping motion of palm along a wide area of discomfort.

quick treatment on patients that is “objective, obvious, measurable and immediate” (Typaldos, S. 2002).

Tectonic Fixation – shoulder – anterior rotation with abduction; hip – placing hands on iliac crest; low back – repetitively twisting torso. Inability of the fascial surfaces to glide

There are presently three certified instructors in the United Sates; Dr. Todd Capistrant (Alaska), Dr. Byron Perkins (Alaska) and Dr. Gene Lenard (California).

I was introduced to the Fascial Distortion Model (FDM) in 2010 and have used it ever since. There are three modules used to instruct the FDM. Although the treatments are painful, it is very rewarding to be able to perform a

eference: Typaldos, Stephen, (2002), Clinical and R theoretical Applications of the Fascial Distortion Model (FDM) within the Practice of Medicine and Surgery, Typaldos Publishing Co.

19 "Close Call" continued from page 15 any outward signs of worsening and her vitals all remained stable. I had the conversation that we may need to electively intubate her should the medication not be available in order to prevent an airway crisis. She was painfully aware and this furthered her anxiety and desperation. Within 30 minutes I had received a call back from the advocate that there was a similar medication called Berinert available at my facility that would work. I called my pharmacy and inquired. They did in fact have it and promptly sent it to the ED. The house supervisor returned the call, but by now the alternative therapy was en-route so political jockeying was no longer needed. The patient promptly received the dose of medication and within 30 minutes was showing signs of decreased edema and the throat irritation she had experienced earlier was resolved. She remained in the ED for observation and was later discharged home. The patient thankfully had a good outcome, but the situation could have easily turned into calamity or at the very least a much more procedure intense visit that could have been prevented. So what are the lessons to be learned? First, for a condition like HAE there are only four medications available that have been proven to reduce the symptoms caused by the condition. Kalbitor, Berinert, Cinryze, and Firazyr are the brand names for those medications. They are all C1- Inhibitors. You

should determine which medications may be in your hospitalâ&#x20AC;&#x2122;s pharmacy. You also need to determine their policy for use. In this situation when an airway is involved, there should have been some type of emergency release of this medication available to treat the patient. This is something I will bring up to our P & T committee to look into. No one should be denied a life-saving medication because of policy or paperwork issues. The cost, risk, and potential complication from having to electively intubate and maintain the patient on a ventilator far outweighs the cost of this medication. Second, when I inquired with the pharmacist initially what alternative medication was available they never made mention of the Berinert. Either they themselves did not know it was a substitute, or were unaware they had it. It took a phone call from a patient advocate at HAEA to make them realize it was there. How did someone outside the facility know better than the pharmacist what was in their pharmacy? The hospital pharmacist should know what is in their pharmacy especially when a therapeutic alternative was available. This would have saved precious minutes in delivering the care needed. Third, the patient was educated thoroughly that her delay in presentation could have been life threatening and was urged to promptly seek care at the first onset of symptoms. She also stated that she never pursued her own supply

of Kalbitor because she never experienced an airway issue. The unpredictable nature of HAE does not guarantee anything in regards to which areas of the body may be involved in the next flare. She will now make certain that she has a personal supply of this life-saving medication available to her in the future. In conclusion, HAE is a potentially fatal disease if the airway rapidly deteriorates and the appropriate therapy is not readily available. Early airway protection is a must but does not resolve the underlying process. Know what medications your pharmacy has. Have a plan when something you want is not available. Address logistical issues related to medication use before a crisis to avoid the situation from escalating. Use resources available to assist in treating your patients. In this case, the patientâ&#x20AC;&#x2122;s insistence that I call the haea.org advocate proved life-saving because it guided us to a solution that we were unaware of right in our own facility. Listen to your patients! The other interesting factoid is that the peripheral brains we all rely upon did not list the potential alternative meds in their pathways either. The medications were found on individual medication searches, but not in the treatment section for angioedema. Moments of crisis should not have us searching google and ancillary websites for treatments. Preparation is key. This is one case that will stick in my mind for quite some time. It has been a great learning experience.

We Want to Hear from You! ER Physicians do incredible things every day and we want your stories! From Dr. Cheslock's close call, to Dr. Acosta's information on Fascial Distortion, 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.

the PULSE | January 2014

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 Executive Director Janice Wachtler, BAE, CBA 312.445.5705 janwachtler@acoep.org

Administrative Assistant, FOEM & Member Services Gina Schmidt 312.445.5701 gschmidt@acoep.org Meetings and Conventions

Development Director Stephanie Whitmer 312.445.5712 swhitmer@acoep.org

Manager of Meetings and Conventions Adam Levy 312.445.5710 alevy@acoep.org

Executive Assistant Geri Phifer 312.445.5700 gphifer@acoep.org Manager of Education Services Kristen Kennedy, M.Ed. 312.445.5708 kkennedy@acoep.org

Senior Meetings Coordinator Lorelei Crabb 312.445.5707 lcrabb@acoep.org

Sr. Coordinator of Member Services Jaclyn Ronovsky 312.445.5702 jronovsky@acoep.org Media and Technology Communication Manager Erin Sernoffsky 312.445.5709 esernoffsky@acoep.org Media Technology Specialist Tom Baxter 312.445.5713 tbaxter@acoep.org

Member Services Director of Member Services Sonya Stephens 312.445.5704 sstephens@acoep.org

Medicine Management Mentoring Mission

Multiple ASSISTANT DIRECTORSHIP positions available in NORTHEAST OHIO We are now looking for board certified emergency physicians with excellent leadership skills to join our well-established stable group at the following locations: UH Richmond Medical Center

UH Geauga Medical Center

Richmond Heights, OH

Chardon, OH

Annual Volume 21,000

Annual Volume 19,000

Annual Volume 43,000

UH Bedford Medical Center

UH Twinsburg Medical Center

Bedford, OH

Twinsburg, OH

UH Ahuja Medical Center

Annual Volume 21,000

Annual Volume 16,000

St. Elizabethâ&#x20AC;&#x2122;s Health Center Boardman, OH

Beachwood, OH Annual Volume 22,000

4M Emergency Systems offers an extremely competitive compensation and benefit package including an incentive plan, paid health plan, 401K, malpractice, life & long/short-term disability. Sign on bonus! To learn more about joining our practice, please contact Erin Waggoner or Jeff Mirelli at (888) 758-3999 or via email at EWaggoner@4Mdocs.com or JMirelli@4Mdocs.com

APPEARANCE: ACOEPâ&#x20AC;&#x2122;s The Pulse DATES: January, April, July, October 2014 SIZE: Half-Page (no bleed) 4/Color

Norcom, Inc. 847-948-7762 theteam@norcomdesign.com

the PULSE | January 2014

Back to Basics James Hensel This article was originally published in The Fast Track, ACOEP’s Student and Resident Chapter Quarterly Publication.

his year, my soon to be OMS-III medical school class had the pleasure of taking Basic Life Saving and Advanced Cardiac Life Saving two weeks after the spring semester wrapped up. Which means, we got to use two precious board studying days to take those classes. Needless to say, the general attitude about the classes’ scheduling was less than excited. Yet, when does any medical student find themself thinking “Oh, perfect timing!” when a BLS/ACLS class is scheduled? I was kind of excited about ACLS because I had never taken it before. However, I had taken BLS a few times. I will openly admit that in the few times I have taken BLS classes, I have not had the most eager attitude during the whole ordeal. My mind would often drift, as I thought about what I would rather be doing; only being sure to grasp the “important details” of what seemed to be easy and straight forward material. I may be sticking my neck out on this one, but I don’t think I'm the only medical student who has ever felt this way. The performance exam of the BLS class involved, as you all know, responding to a person who has been found down on the ground in a public setting. As testing proceeded, small groups of students would run through the motions eager to get out of class. I remember hearing someone say, “This isn’t how we are going to find our patients…” Again shamefully, this is a sentiment I shared until a couple of weeks ago. I was four days away from taking my Step One COMLEX, and I was searching for a new study spot to keep me going with a change in scenery. My wife and I live just outside “Small Town, USA” and have driven by a “Coffee and Antiques” that I thought I would check out that day. Upon walking into the shop I quickly became aware it was more an antique’s shop, than a coffee shop. I almost turned right around and walked out, but I decided to take a lap around what appeared to be a vacant antique shop. Still having hopes of finding a cup of coffee, I carefully looked around the front counter hoping to see coffee shop equipment I could

the PULSE | January 2014

a few eternal seconds of frozen disbelief, I "After went into an autopilot mode I didn’t know I had. " wait on. As I was about to dejectedly head back home, coffeeless, I took one more glance behind the counter and froze in my tracks. On the ground, was an elderly woman lying motionless; not sleeping. After a few eternal seconds of frozen disbelief, I went into an autopilot mode I didn’t know I had. I flew open the gate of the counter and tried waking this poor woman, who was already gray in color and whose hands were cool to the touch. I confirmed a lack of breathing a pulse, and with one locked arm and my core strength began chest compression cycles while calling 911 with my other hand (I was completely alone in this store). While on the phone with the dispatcher, I remember being surprisingly collected. I reported I was with a woman who I found not breathing without a pulse. I explained exactly where I was, even though it was my first time to set foot in that store. Within minutes the professionals were on the scene, and took over. They seemed grateful that, one – someone had been there, and two – had started basic lifesaving. While waiting to talk to the police and investigators who invariably showed up, I watched carefully hoping to see I had unknowingly found this woman in ventricular fibrillation, and that a good “shock” would bring her back to life. Sadly, she had no rhythm that could be defibrillated, and after a few cycles of CPR and rhythm analysis, she was whisked away to the hospital down the road. After speaking with the police and letting them know I was just a passerby who happened to find this woman (who could have easily gone unseen by someone not desperate for coffee) and who happened to be a medical student who knew basic lifesaving, I went home and called my parents. That’s what you should do if/after you find a person on the ground like that, call your parents. While speaking with my dad, he

explained to me it wasn’t only a good thing that someone (me) discovered the woman, but it was significant that I, a trained medical student, discovered this woman. Someone else with no clue of what to do beyond yell for help and call 911 in a panic could have been the first on scene. Yet, it was me, who had just jadedly sat through a BLS class, who provided this lady a shot at survival. Later that day, I was able to find out the woman did not pull through. I was saddened, but not too surprised. It would have been easy to feel that my and others’ efforts were all in vain, but I thought about something my mom told me (now you see why you should call your parents). If anything, my actions provided comfort to the woman's family by letting them know that as soon as she was found someone took action to save the life of their mom, wife, sister, etc. They can know she was not just found and declared dead at the scene. When I take a step back and think about it, it is kind of odd so many of us (me included) can have a jaded attitude about a class whose title literally describes why we want to become doctors. My experience that day opened my eyes. For one, I became very thankful for the training I have received and will receive, especially the previously groaned about BLS class. When I was able to think back to what happened during that 15 minute blur, I realized it was the BLS class that provided me the “emergency autopilot mode” I had that day. The events of that day also showed me that we as medical students are not just going to be doctors in hospitals and clinics. We will be doctors wherever we go. This means that even simple things, like BLS classes, should be taken seriously. We very well may be called upon when we least expect to be.

23 "Welcome Dr. Mitchell" continued from page 1 staff is looking forward to working with him.” Dr. Mitchell was born and raised in Jackson, MS and attended WVSOM for medical school. It was during an Internal Medicine Residency that he began moonlighting in the ED. He soon fell in love with the rapid pace, new and interesting cases, and the lifestyle of the ED, and completed his Emergency Department Residency at Midwestern. “I’m a workaholic,” Dr.Mitchell said. “I work all the time. As an internist you can’t turn it off. You are thinking about your patients constantly. The ED appealed to me originally because of the shift work. I could work hard, see my patients, and then leave at the end of the day.” Of course it didn’t work. “I still work too many hours and too many jobs!” he laughs. In addition to the Board President of ACOEP, some of these jobs include, Senior Vice President of Provider Services with Schumacher Group, and Medical Director at Wheaton Franciscan Healthcare. He is the recipient of the ACOEP Meritorious Award and of the Benjamin Field Mentor of the Year Award. He has served two terms on the ACOEP Board and is a frequent speaker at educational events. It’s an exciting time,” he said. “With advances in technology, radiology is dramatically changing to the point of hand-held ultrasound machines. Point of care testing is intriguing. Telemedicine will open up a lot of doors of opportunity and more access to specialized patient care.” When asked about his goals, Dr. Mitchell laughs and said, “survive!” He then quickly adds a list of ambitious goals, including increase

In addition to the Board President of ACOEP, some of Dr. Mitchell's other jobs include: • Senior Vice President of Provider Services with Schumacher Group • Medical Director at Wheaton Franciscan Healthcare. He is also the recipient of the following awards: • ACOEP Meritorious Award • Benjamin Field Mentor of the Year Award. He has also served two terms on the ACOEP Board and is a frequent speaker at educational events.

Dr. Mitchell poses for pictures with students from WCUCOM in Hattiesburg, MS the participation of membership at every level, including working more closely with the Student and Resident Chapters. He would like to foster closer relationships with EDPMA and other organizations; serve as a strong advocate for our members; ensure that our ED programs are state

of the art; and help to build ACOEP’s impact with new technologies and outreach. Dr. Mitchell has already begun work on these goals, and the next two years look to be ones of great change and growth under his leadership.

Come Home to Your Osteopathic Military Colleagues

AMOPS Annual Meeting May 1–4, 2014 at CCOM

• Sessions on Battlefield Medicine and Medicine in Austere Environments, Psychiatric and Psychological Medicine and Operational Medicine along with many other great talks • Presidential Gala Banquet • National Student Conference will be held in conjunction with AMOPS Annual Meeting

Stephanie Wilson (908) 387-1750 phone Wilson@amops.org email ASSOCIATION OF MILITARY OSTEOPATHIC PHYSICIANS AND SURGEONS ACOEP1163_AMOPS_QtrPgAdFINAL.indd 1

12/9/13 9:03 AM

the PULSE | January 2014

Double Vision Greg Christiansen, DO, M.Ed., FACOEP-D Immediate Past President

e are witnessing a surreal event in history as political forces falter in fundamentally changing the health care industry. The headlines came to a head on November 14th when the President’s vision of the Affordable Care Act came face to face with reality. After over three years of ‘Obamacares’ implementation, the public’s starry eyes got a clearer look of the President’s vision of his signature domestic achievement. Like having double vision, the picture painted of Obamacare did not align with view of reality. The President admitted he was aware that patients would lose insurance coverage. This admission provided credence to the sharp criticism of his adversaries. The means by which the law was passed and then promoted was deemed deceitful by a majority surveyed in a recent pole. A larger majority of the public surveyed still do not support the implementation of the law. As a result the issue remains very contentious. The President apologized for the failings of the law which overlooked details relating to the website performance and the insurance cancelation process. However, these issues are only a small part of the overall reform. They are likely to change as more money is poured into the system. Despite the headlines, there is another real concern that blind-sided the public from the real view of Obamacare. The real vision of the designers and strategists of Obamacare was to craft a process to limit physician and insurer’s input and communication to the public. That role would be supplanted by a government entity which could make rules on issues like national practice rights and care directives. On a macro level they intentionally changed the doctor/ patient relationship because it was tied to a vote – the patient – and thus had power. If you notice in the debate over how the reform should proceed, the physician groups have been largely marginalized. Consensus from national groups did not get press in national reporting. Physician groups are not leading the reform even today. Congress is keenly aware of this observation and questions why physicians are not more proactive in shaping the health system reform they will have to enact.

the PULSE | January 2014

the rest of the ‘medical homeless’ many "Like patients will not have a doctor so the ED becomes the default care center. " The lack of transparency is evident in other areas of the law. The law itself placed restrictions on insurer’s communication way back in 2010. Senator Mitch McConnell was criticized for his comments revealing this accusation. His comments on the gag order were initially labeled by PolitiFact.com as false. However, PolitiFact reversed its initial assessment in May of 2013 once it discovered the letters from Kathleen Sebelius’ HHS post. The letters revealed she in fact did threaten regulatory action against insurance companies in 2010. Fact checkers found the threats were aimed at any insured who did not comply with her demands or attempted to criticized Obamacare. The stress of the public outcry over Obamacare in an election season brought forward other pieces of information that had been previous hidden or dismissed as inaccurate. We learned from these same policy designers and strategists that the intent of Obamacare was indeed for a single payer government controlled system. This fact had been previous disputed in the debates leading up to the passage of Obamacare. The President himself admitted this was a 100 year old goal. These strategists lamented their regret in not forcing insurers to sell the insurance product the administration demanded. This error

resulted in insurers opting out of the market or cancelling policies. Insurers thus provided limited coverage to a restricted geographical area. Rural regions in particular would not have any opportunity at competitive pricing. As the system unfolded, a majority of cancelled policy holders would experience significantly increased pricing. The critics of the plan site the misunderstanding of President Obama who failed to recognize the difference between having insurance coverage and having physician care. He lost site of the fact that having insurance doesn’t mean having a doctor to provide care. Let us remember, Obamacare was supposed to insure 44 million uninsured Americans (ObamacareFacts.com). Economists believe only 11 million uninsured could be covered under the Obamacare plan. Once the roll out began it was clearly evident the administration was ill prepared. Millions of covered patients lost their current insurance and had to pay for more expensive policies or face losing coverage while also having to pay a fine. Experts say tens of millions more will see the same fate when the employer based coverage experiences the same financial stress as seen in the individual mandate. This is the vision many now have of our country’s future. The numbers are projected to be 11 million will have gained

coverage while 50 - 90 million will have lost their coverage. The newly uninsured will be forced into the exchange system or pay the fine. Additionally, wealth redistribution will continue to have an impact on jobs and the economy with more people having lost their insurance than have gained by the year 2015. Government economic statics now show there are 108 million Americans receiving some form of government assistance while only 101 million Americans are paying into the system. The criticism is historically a lop-sided system of payers to users is not sustainable and threatens to destabilize the markets. This is very important to emergency medicine because if employers cannot afford medical services then they move the operation to more affordable sites. Michelin tire moved many of its operations to South Carolina for this very reason and have publically stated they will move overseas if medical costs impair the operations. What can we envision in emergency medicine as it relates to the changes from Obamacare? In the immediate future you are likely to have an increased volume due to the insurance market upheaval. January 2014 will usher in those who have lost insurance and have not been reissued new coverage. March will be followed by those who failed to sign up for coverage. As the year progresses the employer mandate will begin to take shape. Patients who have lost coverage will go to the ED. Patients who are not buying coverage will go to the ED as well. Like the rest of the ‘medical homeless’ many patients will not have a doctor so the ED becomes the default care center. Insidiously, there are additional unintended consequences. Patients who have a primary care doctor or already have coverage are also going to the ED. Primary care doctors report thin margins force their hand at sending complicated patients to the ED. Those same market forces are sending patients to the ED if they need testing, radiographs, diagnostics or consultations. Insiders also warn of a little known ‘fix’ for the physician shortage as well. The expanded Medicare and Medicaid market has been voluntary to participating

primary care physicians to date, but many believe primary care will be mandated to see these patients, just like emergency physicians are mandate to screen all comers to the ED. The primary care doctors report costs from the Medicaid and Medicare population exceed payment levels. These patients will also be sent to the ED. The result of such a mandate would be a mass exodus of primary care doctors the physician labor pool.

candidate from having the life-saving surgery. These changes under Obamacare severely strain the concept held in the Hippocratic Oath. In serving the employer and the government mandates, the employed physician may come into conflict with patient centered care. The Independent Payment Advisory Board is an Obamacare institution which by its very design is destined to challenge the employee – patient relationship.

By way of anecdote, I asked a GYN doctor why a post-operative patient was sent to the ED for evaluation from his office. The GYN said he use to collect $1800 for a hysterectomy, but now only get 1/3 of that payment. The $600 isn’t enough to cover his costs. So in essence he is cost shifting to make up for the deficit.

It’s now clear the vision of Obamacare is myopic, and prudent physician experience is required to focus on principles which serve the patient. Centralization results in losing the patient in the big picture. The Hippocratic Oath should not be lost in this transformation of healthcare. Transparency in policy and in pricing is the honest way to make change. Physicians need to step forward and inject their foresight into the process. We have a common goal to meet our patients’ needs. It is time to put forward a clearer vision of our nation’s health care future.

There are a number of changes you might not see unless you were actually looking for the results. As I mentioned previously, the doctor patient relationship will be forced to change under Obamacare. On a micro level this fact makes utilization of the ED all the more easier and is an unintended consequence. Why would an on-call physician take the chance and have the patient wait until the morning to be seen? The on-call physician will have no more of a relationship than the ED doctor so he might as well have the patient go to the ED too. Lastly, I want to point out the economics of the Obamacare system moves the physician work force into an employee model. This has to happen in the larger scheme of Obamacare. A universal system controls the work force with an employee model thereby making compliance with regulations and payment systems easier. You may have noticed some of these regulations if you are already an employee. Annual compliance tests are increasingly burdensome and prolific. You will also see innovation decline over time as the incentives are lacking in employee models. Labor pools also tend to organize as frustration builds with unresponsive management authorities. UCLA Medical Center made national news in November because its labor force was on strike. The strike prevented a renal transplant

References: 1. http://www.cbsnews.com/8301-250_16257605968/ Nearly 9 in 10 Displeased with Washington poll says Oct 3 2013. 2. http://www.youtube.com/watch?v=hV05TLiiLU You have to pass the bill to find out what’s in it. March 9, 2010. 3. http://blog.heritage.org/2010/01/29/ congress%E2%80%99-new-secret-planto-pass-obamacare-%E2%80%93-thenuclear-option/ Congrss’ New Secret Plan to Pass ObamaCare – the Nuclear Option January 29, 2010. 4. http://www.ino.com/blog/2013/08/10reasons-why-obamacare-is-going-to-ruinyour-medical-care-and-your-life/ August 3, 2013. 5. http://finance.townhall.com/columnists/ michaelschaus/2013/11/15/obamacare"Double" continued on page 27

the PULSE | January 2014

ACOEP Welcomes New Board Members Erin Sernoffsky

t the 2013 EMERGE Scientific Assembly, four new members stepped in to leadership roles as Board Members. Juan Acosta, D.O., FACOEP-D and Tom Green, DO, FACOEP became the newest members to the ACOEP Board of Directors while Steve Brandon, DO became the president of the Resident Chapter and Kaitlin Fries became the president of the Student Chapter. Dr. Brandon and Student Dr. Fries also sit on the Board as full, voting members representing their constituent groups. Dr. Acosta, a graduate of NYCOM, has long been the face of the Foundation serving for many years as its President and long-time educator and researcher. Dr. Acosta is currently the Assistant Dean for Postdoctoral Education and the Pacific Northwest University of Health Sciences in Yakima, Washington. Dr. Acosta also currently serves as the Medical Program Director of the Yakima County Department of EMS and Chief of Staff at Toppenish Community Hospital. He is interested in bringing research and mentorship of students and residents to the forefront and providing continuous education for them as they work their way through the various phases of the medical education and emergency medicine careers. Dr. Green, a graduate of Nova Southeastern University-COM, is known by many of our members as the Chair of the Scientific Assembly. As such he is deeply involved in providing worldclass CME opportunities to ACOEP members. Continued improvement and growth will be at the heart of his three-year term on the Board. He said, “I think one of the greatest values of ACOEP to its members is their dedication to their membership and always striving to become better and seeks way to serve its membership.” Dr. Green is also committed to the training he received as a DO. “I have been trained to evaluate a person with the understanding that the body has an inherent ability to heal itself and that I have been taught an extra modality in which I can relieve pain and help diagnose my patients. It also allows me to appreciate how any illness and/or disorder can and does effect the rest of the body and when approaching treatment of a person to encompass that thought-process and ideal.”

the PULSE | January 2014

Joining Dr. Acosta and Dr. Green on the Board is Resident Chapter President, Steve Brandon, DO. Dr. Brandon, currently a resident at St. Mary Mercy in Livonia, MI and graduate of Western University of Health Sciences says that being an Osteopath is a journey of “being able to spend my life caring for others.” The main goals for his presidency include continuing to foster a strong relationship between the Resident Chapter and the membership of ACOEP. “ACOEP provides a close-knit community,” Dr. Brandon says. “as well as represent the interests of DO physicians nationally.” Dr. Brandon will be a strong ally over his next two years on the board and for a landscape in healthcare that he sees as an uncertain medical environment and possible threats to professional stability. Working closely with Dr. Brandon and the Resident Chapter is Kaitlin Fries, the newly appointed Student Chapter President who will also serve a two-year term. Fries, currently a third year student at Ohio University Heritage College of Osteopathic Medicine chose to become an Osteopathic physician due in large part to the value system of the discipline. “I have learned the importance of taking the time to listen to my patients while using my hands to diagnose, manipulate, perform a procedure, or just provide comfort.” Fries plans to take both a large-scale and local approach to her presidency, “As a board member my main goal is to work closely with the resident chapter and physicians to provide students with all the resources needed to get the most out of their education and ultimately the best residency for each individual,” she says. “A more specific focus of mine this upcoming year is to revamp the current mentorship program into a regional based system that will better support each local chapter’s needs while further promoting the ACOEP.” Each new member joins a Board fully committed to ACOEP and its mission, as well as advocating on behalf of the work of Osteopaths across the country, providing world-class care to patients.

Current ACOEP Board Members

Current ACOEP President Mark A. Mitchell, DO, FACOEP

ACOEP President-Elect John C. Prestosh, DO, FACOEP

Immediate Past President Gregory Christiansen, DO, M.Ed., FACOEP-D

Secretary David L. Levy, DO, FACOEP

Treasurer Mark Rosenberg, DO, FACOEP-D • Juan F. Acosta, D.O., MS, FACOEP-D • Michael Steven Brandon, DO, ACOEP-RC President • Anita W. Eisenhart, DO, FACOEP • Kaitlin Fries, MBA, ACOEP-SC President • Christine Giesa, DO, FACOEP-D • Thomas E. Green, DO, FACOEP • Drew A. Koch, DO, FACOEP-D • Beth A. Longenecker, DO, FACOEP • Duane Siberski, DO, FACOEP • Robert E. Suter, DO, MHA, FACOEP-D • Janice Wachtler, Executive Director

27 "Double" continued from page 25 architect-blames-cancelled-policies-ongreedy-consumers-n1747043/ Nov 15, 2013. 6. http://www.dailymail.co.uk/news/ article-2509715/Obama-flubs-healthcare-conference-community-organizersMore-100-million-Americans-successfullyenrolled.html Nov 18, 2013. 7. http://www.cbsnews.com/8301-250_16257612670/gop-obama-knew-keep-yourplan-promise-was-deceitful/ Nov 16, 2013. 8. http://www.csmonitor.com/USA/ DC-Decoder/2013/1117/Smokinggun-Critics-cite-evidence-Obama-knewAmericans-would-lose-coverage-video Nov 17, 2013. 9. http://www.forbes.com/sites/ scottgottlieb/2013/10/28/obamacarefaces-a-death-spiral-but-it-turns-on-thedeclining-participation-of-health-plansand-not-just-their-rising-premiums/ Oct 28, 2013. 10. http://www.realclearpolitics.com/ video/2013/11/13/fireworks_megyn_ kelly_takes_on_ezekiel_emanuel_over_ obamacare_again.html Nov 13, 2013. 11. http://video.foxnews. com/v/2800556045001/obamacaresrocky-rollout-a-sign-of-things-to-come/ Nov 3, 2013. 12. http://www.whitehouse.gov/ blog/2013/11/14/president-obamaannounces-new-steps-help-americansreceiving-insurance-cancellation- Nov 14, 2013. 13. http://www.theihcc.com/en/ communities/policy_legislation/the-newhealth-law-bad-for-doctors-awful-forpatie_gn17y01k.html Jason Fodeman, MD. Galen Institute 2013 Institute for Healthcare Consumerism 14. http://www.rasmussenreports.com/ public_content/politics/current_events/ healthcare/health_care_law Nov 18, 2013. 15. http://www.cnn.com/2013/11/07/ politics/obama-obamacare-apology/ Nov 7, 2013. 16. http://www.whitehouse.gov/ blog/2013/11/14/president-obamaannounces-new-steps-help-americans-

receiving-insurance-cancellation- Nov 14, 2013. 17. http://obamacarefacts.com/obamacarepros-and-cons.php Nov 15, 2013. 18. http://www.nytimes.com/2013/10/24/ business/health-law-fails-to-keep-priceslow-in-rural-areas.html?_r=0 Oct 24,2013. 19. http://www.cnn.com/2013/10/29/ health/obamacare-doctors-limited/ Oct 29, 2013. 20. http://video.foxnews. com/v/2545096179001/sen-johnbarrasso-calls-for-a-permanent-delay-of-obamacare/ July 14, 2013. 21. http://www.barrasso.senate.gov/public/ index.cfm?FuseAction=PressOffice. Speeches&ContentRecord_id=252c6914dd45-0f91-b1b0-3eb0f978e0a2 Barrasso: under Obamacare Many Americans Lose Coverage, Doctor. Nov 4, 2013. 22. http://www.barrasso.senate.gov/public/ index.cfm?FuseAction=PressOffice. PressReleases&ContentRecord_ id=aaae167b-d060-55c3-5aa83a37c0ed392fl Jan, 21, 2011. 23. http://www.ijreview.com/2013/09/81619busted-obama-refers-affordable-care-actuniversal-coverage/ Sept25, 2013. 24. http://cnsnews.com/news/article/ terence-p-jeffrey/census-bureau-meanstested-govt-benefit-recipients-outnumberfull Oct 24, 2013. 25. http://www.foxnews.com/ politics/2009/03/18/universal-healthcare-cost-trillion/ March 18, 2009. 26. http://www.politifact.com/truth-ometer/statements/2013/may/28/mitchmcconnell/mitch-mcconnell-says-hhs-putgag-order-insurers-ab/ May 28, 2013. 27. http://www.forbes.com/sites/ theapothecary/2013/11/12/theobamacare-exchange-scorecard-around100000-enrollees-and-five-millioncancellations/ Nov 12, 2013. 28. http://online.wsj.com/news/articles/SB1 00014240527023045877045773356022009 37084 Tire Makers New Home Michelin, Bridgestone, Continental Shift Tire Industry Locus to South Carolina. April 16, 2012. Comments Made by Congressman Shockey of IL. March 14, 2013.

29. http://online.wsj.com/news/articles/SB1 00014241278873246007045784027841233 34550 When Your Boss Makes you Pay for Being Fat. April 5, 2013. 30. http://www.forbes.com/sites/ theapothecary/2013/10/31/obamaofficials-in-2010-93-million-americanswill-be-unable-to-keep-their-health-plansunder-obamacare/ Oct 31, 2013. 31. http://www.reviewjournal.com/opinion/ editorial-obamacares-broken-promisescancellations-only-beginning Nov 6, 2013. 32. http://masonconservative.typepad.com/ the_mason_conservative/2013/11/ virginia-democrat-calls-for-forcingdoctors-to-accept-medicare-and-medicaidpatients.html Nov 2, 2013. 33. http://abcnews.go.com/blogs/ health/2013/11/14/long-awaited-kidneytransplant-canceled-over-hospital-strike/ Nov 14, 2013. 34. http://en.wikipedia.org/wiki/Patient_ Protection_and_Affordable_Care_Act 35. http://www.weeklystandard.com/blogs/ cbo-uninsured-under-obamacare-neverfalls-below-30-million_733740.html June 4, 2013. 36. http://communities.washingtontimes. com/neighborhood/obamacarewatch/2013/nov/17/obamacaremedicare-fallout-unitedhealth-cuts-docto/ Nov 17, 2013. 37. http://www.theblaze.com/ stories/2013/11/15/this-could-be-oneof-the-best-cases-ever-made-againstcommon-core-no-one-expected-it-tocome-from-a-high-school-student/ Nov 15, 2013. 38. http://www.youtube.com/ watch?feature=player_ detailpage&v=RPEwO47khEM Ethen Yong on Common Core Education. 39. http://online.wsj.com/news/articles/SB1 00014240527023035595045792001906145 01838 UnitedHealth Culls Doctors from Medicare Advantage Plans. Nov 16, 2013. 40. http://www.forbes.com/sites/ paulhsieh/2013/11/17/the-onlyobamacare-fix-is-for-obama-to-legalizereal-health-insurance/ Nov 17, 2013.

the PULSE | January 2014

FOEM | BEACON

masthead_Layout 1 4/18/13 10:24 AM Page 1

• A FOUNDATION DEDICATED TO RESEARCH IN OSTEOPATHIC EMERGENCY MEDICINE

Foundation Focus Sherry D. Turner, DO, FACOEP President

n October 7, the Foundation for Osteopathic Emergency Medicine hosted its third annual Legacy Gala Dinner & Awards Ceremony presented by TeamHealth. The festive evening consisted of recognizing the top donors and researchers of the American College of Osteopathic

Emergency Physicians and The Foundation for Osteopathic Emergency Medicine. The attendees enjoyed a live band and emcee, professional photo booth, an elegant dining experience, and fun on the dance floor that continued well into the night. To top it all off, the guests recognized the Foundation’s

charitable mission by contributing an outstanding amount of over $34,000.00 in just one night! Thank you so much to all that attended, supported FOEM at the 2013 Legacy Gala. We look forward to seeing you all again in 2014!

A Grateful Legacy

2013 Legacy Gala Dinner and Awards Ceremony

Presenting Corporate Sponsor:

Friends:

Thank you for your generous donations. We couldn’t have done it without you! the PULSE | January 2014

FOEM | BEACON To see all the pictures of the 2013 FOEM Legacy Gala, check out FOEM on Facebook!

Special thanks to table 12 for raising the most money per table at the 2013 Legacy Gala!

The photo booth came with plenty of props to keep our guests occupied!

2013 FOEM Legacy Gala Honorees

FOEM Pinnacle Award: Presented to donors achieving lifetime donation level of $25,000 and above. • Sherry Turner, D.O., FACOEP and James Turner, D.O., FACOEP

FOEM President’s Circle Award: Presented to donors achieving lifetime donation level of $10,000 - $24,999. • Peter J. Kaplan • Douglas Webster, D.O., FACOEP-D

FOEM Foundation Pillar Award: Presented to donors achieving lifetime donation level of $5,000 - $9,999. • Gary Bonfante, D.O., FACOEP • Joseph Calabro, D.O., FACOEP-D • Mark Damon, D.O., and Shelly Zimmerman-Damon, D.O., FACOEP, FACEP • Bruce Whitman, D.O., MHA, FACOEP

100% Program Challenge Award: Presented to the ACOEP Residency Program that has raised the most funds per resident in 2013. To qualify, 100% of the residents must contribute at least $5.00. • 1st Place: Good Samaritan Hospital Medical Center in West Islip, NY • 2nd Place: Ohio Valley Medical Center in Wheeling, WV • 3rd Place: ROWAN School of Osteopathic Emergency Medicine in Stratford, NJ • 4th Place: Marietta Memorial Hospital in Marietta, OH

the PULSE | January 2014

FOEM | BEACON 2013 FOEM Legacy Gala Honorees (continued)

3rd Place – Sofia Farooqi, D.O. of St. Barnabas Hospital for her paper Comparison of Hemoglobin Concentration in the Complete Blood Count and the Venous Blood Gas in Adult Patients with Acute Gastrointestinal Bleeding

Winning Abstracts

FOEM Research Flame Award: Presented to the ACOEP Residency Program that has achieved the highest average score for Senior Research Papers in 2013. Scores are determined by the ACOEP Research Committee. • Lehigh Valley Health Network in Allentown, PA

2013 FOEM Competition Winners FOEM Research Study Poster Competition 1st Place – Elizabeth Gannon, D.O. of St. Vincent Health System for her study Comparison of Intubation Modalities in Simulated Cardiac Arrest with Uninterrupted Chest Compressions 2nd Place – Christopher Komurek, D.O. of Aria Health for his study Are Emergency Physicians Too Aggressive with Empiric Treatment of Gonorrhea and Chlamydia in the Face of Rising Resistance? 3rd Place – Andrew Keri, D.O. of McLaren Oakland Hospital for his study Initial Antibiotic Therapy in Healthcare Associated Pneumonia FOEM Clinical Pathological Case Competition Sponsored by Schumacher Group 1st Place Faculty – Aaditya Desai, D.O. from St Joseph’s Regional Medical Center 1st Place Resident – Xandus Chen, D.O. from Aria Health 2nd Place Faculty – Nicole Maguire, D.O. from Newark Beth Israel 2nd Place Resident – Kristen Knowles, D.O. from St Luke’s Hospital 3rd Place Faculty – Anaheita Kalantari, D.O. from Aria Health 3rd Place Resident – Tie – Ryan Misek, D.O. from Midwestern and Justin McNamee from St. Joseph’s Regional Medical Center FOEM Oral Abstract Competition Sponsored by EmCare 1st Place – Sarah Vitello, D.O. of Good Samaritan Hospital Medical Center for her study Epidemiology of Nursemaid’s Elbow 2nd Place – Natasha Powell, D.O. of Newark Beth Israel Medical Center for her study A Retrospective Review of the Use of Prenatal Sedation for Acute Agitation or Intoxication in the Emergency Department, an Evaluation of Safety. 3rd Place – Sean Baskin, OMSIII of Lake Erie College of Osteopathic Medicine for his study Osteopathic Emergency Medicine Programs Infrequently Publish in High Impact Emergency Medicine Journals FOEM Research Study Paper Competition 1st Place – Ryan Misek, D.O. of Midwestern University for his paper Predictors of Psychiatric Boarding in the Emergency Department 2nd Place – Patrick Hughes, D.O. of POH Regional Medical Center for his paper Relation of Electrocardiographic Changes in Pulmonary Embolism to Right Ventricular Enlargement

the PULSE | January 2014

Research Study Poster Competition Comparison of Intubation Modalities in a Simulated Cardiac Arrest with Uninterrupted Chest Compressions Navin Tandon, DO1 Matthew McCarthy DO1,2 Brett Forehand MD, PHD1,2 Jestin N. Carlson MD, MSc 1,2 1) Department of Medicine, Division of Emergency Medicine, Saint Vincent Health System, Erie, PA 2) Department of Medicine, Division of Emergency Medicine, Lake Erie College of Osteopathic Medicine, Erie, PA Abstract Background: Interruptions in chest compressions during cardiopulmonary resuscitation (CPR) can negatively impact survival. Several new endotracheal intubation (ETI) techniques including video laryngoscopy may allow for ETI with minimal or no interruptions in chest compressions. We sought to determine the impact of three different ETI techniques upon Time To Intubation (TTI) in a simulated cardiac arrest during uninterrupted chest compression. Methods: We performed a randomized crossover study with a convenience sample of Emergency physicians using three different ETI techniques: direct laryngoscopy (DL), GlideScope video laryngoscopy (GVL), and GlideScope video laryngoscopy with bougie (GVL- B). Providers performed ETI on a mannequin on a hospital bed with concurrent chest compressions. Our primary outcome, TTI, was defined as the time from insertion of the laryngoscope blade until first breath. Given the correlated nature of the data, we used the paired t-test to assess the differences in mean TTI's between GVL minus DL and GVL-B minus DL. We also ran the analysis stratified by provider experience. Results: We enrolled 20 providers with a median TTI (IQR) by device of: DL 27seconds (20.3, 35.4), GVL 20.6 seconds (17.7, 27.1), and GVL-B seconds 60.1 (39.1, 99). The mean GVL – DL difference was -10.1 seconds (-17.9 – -2.3) while the mean GVL-B – DL difference was 45.6 seconds (19.8-71.4) (p<0.001). The GVL-B required the greatest TTI across providers of varying experience levels. Conclusion: In this simulated model of cardiac arrest with uninterrupted chest compressions, TTl was shorter for GVL than DL while use of the GVL with bougie resulted in longer TTL Oral Abstract Competition Sponsored by EmCare Epidemiology of Nursemaid’s Elbow Sarah Vitello DO, Ronald Dvorkin MD, David Levy DO, Lyncean Ung DO, Steven Sattler, DO Abstract Objective: To provide an epidemiological description of radial head subluxation, also known as nursemaid’s elbow, from a database of emergency department visits. Methods: We conducted a retrospective medical record review of patients six years of age and younger, who presented to the emergency department

FOEM | BEACON between January 1, 2005 and December 31, 2012 and were diagnosed with nursemaid’s elbow. Inclusion criteria consisted of chart information including date, unique account number, medical record number, weight, age, sex, and arm affected. Exclusion criteria included any charts with missing or incomplete data. Results: There were 1,228 charts that met inclusion criteria. The majority of patients were female (60%) The mean age was 28.6 months (± 12.6). The left arm was affected 60% of the time. Most of the included patients were over the 75th percentile for weight and more than one quarter were over the 95th percentile in each gender. Conclusion: The average age of children presenting with nursemaid’s elbow was 28.6 months. Females were affected more than males, and the left arm was predominately affected. Most patients were above the 75th percentile for weight and more than one quarter were over the 95th percentile for weight. Research Paper Competition Predictors of Psychiatric Boarding in the Emergency Department Ryan Misek DO, Ashley DeBarba DO & April Brill, DO, FACOEP Franciscan St. James Health System, Olympia Fields, IL Midwestern University, Downers Grove, IL Abstract Emergency psychiatric care is extremely limited in the United States. Numerous budget cuts at the federal and state level may further hamper an already overburdened system. Patients experiencing psychiatric emergencies often require resources not available at the hospital to which they present and frequently require transfer to an appropriate psychiatric facility. This typically involves being held in the Emergency Department (ED) until a psychiatric bed is available. Boarding of psychiatric patients, defined as a length of stay greater than four hours after medical clearance, is ubiquitous throughout emergency departments nationwide.1 The boarding of patients is recognized as a major cause of ambulance diversions and ED crowding and has a significant impact on health care providers, patient satisfaction, and hospital costs.2 We hope to identify differences between patients who boarded versus patients who did not board, with length of stay less than four hours after disposition in the ED, to identify factors which are amenable to change and identify possible interventions which then could lead to decrease in overall psychiatric patient length of stay and improve patient care. We performed a retrospective multicenter cohort study of all patients assessed to require inpatient psychiatric hospitalization at two community EDs from July 1, 2010 through June 30, 2012. Six hundred seventy one patients were identified and insurance status, sex, age, time of arrival, time of disposition and time of transfer were collected. There was a statistically significant difference in the insurance status between the cohort of patients boarding in the ED compared to nonboarders prior to inpatient psychiatric admission. Our study identified 95.4% of uninsured patients were boarded in the ED, compared to 71.8% of Medicare/ Medicaid patients and 78.3% of patients with private insurance (χ2=50.6, df=2, p<0.001). In addition, we found the length of stay to be longer for patients transferred to publicly funded psychiatric facilities when compared to those transferred to private facilities, with a mean time spent in the ED of 1661 minutes and 705 minutes, respectively (p<0.001). Secondary outcomes identified that patients with Medicare/Medicaid were nearly twice as likely to return to the ED for psychiatric emergencies than self pay and privately insured patients, requiring repeat inpatient psychiatric admission (estimate=0.649, p=0.035, OR=1.914). This study identifies an underserved population of psychiatric patients who requires more frequent inpatient psychiatric admission. We hope to bring attention to the need for increased psychiatric services for this group as well as improve emergency room efficiency and allocation of resources for psychiatric patient placement.

The Foundation for Osteopathic Emergency Medicine (FOEM) thanks its lifetime donors for making the legacy of improving patient care through research and education possible. *In an effort to conserve space, this list accommodates only one designation (D.O.) per name.

Pinnacle Level - $25,000 and above ACOEP Joseph Kuchinski, D.O. James and Sherry Turner, D.O. President’s Circle Level - $10,000 $24,999 Juan Acosta, D.O. Paula DeJesus, D.O. Anita Eisenhart, D.O. Peter Kaplan, NORCOM, Inc Beth Longenecker, D.O. Douglas P. Webster, D.O. Pillar Level - $5,000 - $9,999 John Becher, D.O. Gary Bonfante, D.O. Joseph J. Calabro, D.O. Mark A. Foppe, D.O. Victor J. Scali, D.O. Robert E. Suter, D.O. Janice Wachtler Bruce S. Whitman, D.O. Mark Damon, D.O. & Shelly Zimmerman-Damon, D.O. $500 - $4,999 Anthony Affatato, D.O. Fahim Shan Ahmed, D.O. Michael Allswede, D.O. Victor M. Almeida, D.O. Anonymous AOBEM Larry Bachle, D.O. Gaiti Bakhsh, D.O. Jerry Balentine, D.O. Gregory J. Beirne, D.O. Peter A. Bell, D.O. Nancy Bellemare, D.O. Sheldon Bender, D.O. Rudolph D. Bescherer, D.O. Donald G. Beyer, D.O. Brian S. Blaustein, D.O. David Bohorquez, D.O. James M. Bonner, D.O. Thomas Brabson, D.O. Bernadette P. Brandon, D.O.

Wallace M. Broadbent, D.O. Donald J. Brock, D.O. Howard Brown, D.O. Denise M. Buruse, D.O. Curt Cackovic, D.O. Timothy J. Cheslock, D.O. Ben H. Chlapek, D.O. Gregory M. Christiansen, D.O. Mark E. Cichon, D.O. Duane J. Corsi, D.O. John S. Current, D.O. Mark A. Cynar, D.O. Mario D'Alessandro, D.O. Glenn A. DeLong, D.O. Lisa J. DeWitt, D.O. William DiCindio, D.O. Doctors of EM of IL Kenneth K. Doroski, D.O. Joseph Dougherty, D.O. John E. Everett, D.O. Mark L. Fennema, D.O. Benjamin S. Field, D.O. Jack B. Field, D.O. Clifford J. Fields, D.O. Donald Findlay, D.O. Bryan T. Fitzgerald, D.O. Gregory R. Frailey, D.O. J. Gregory Frappier, D.O. William R. Fraser, D.O. Howard Friedland, D.O. Calixto Garcia, D.O. Christine F. Giesa, D.O. Jeffrey A. Giese, D.O. Bernadette B. Gniadecki, D.O. Edward E. Goetten, D.O. Michael Goodyear, D.O. John W. Graneto, D.O. Gregory H. Gray, D.O. Kyle W. Groom, D.O. Anthony Guarracino, D.O. Dennis M. Guest, D.O. E. Rodrigo Guzman, D.O. William B. Halacoglu, D.O. Regina Hammock, D.O. Robert Lee Harding, D.O. Bernard J. Heilicser, D.O. Douglas M. Hill, D.O.

the PULSE | January 2014

FOEM | BEACON Susan M. Horling, D.O. Ira Brady Husky, D.O. Alan R. Janssen, D.O. Michael P. Jarzabek, D.O. Anthony W. Jennings, D.O. Julie Johns, D.O. Bobby Jr Johnson, D.O. Wayne T. Jones, D.O. B. Bryan Jordan, D.O. George M. Kaiser, D.O. Stephen G. Kaiser, D.O. Risty T. Kalivas, D.O. Dmitry Katkovsky, D.O. Raymond P. Kelly, D.O. Gregg Kling, D.O. Judith M. Knoll, D.O. Drew A. Koch, D.O. William M. Kokx, D.O. Anthony C. Korvas, D.O. Daniel R. Kowalzyk, D.O. Christ Kyriakedes, D.O. David Lang, D.O. Paula C. Lange, D.O. Gary A. LaPolla, D.O. Francis L. Levin, D.O. David Lawrence Levy, D.O. Brandon Lewis, D.O. George P. Librandi, D.O. David A. Ligor, D.O. Wesley C. Lockhart, D.O. Freda Lozanoff, D.O. William Lynch Ned A. Magen, D.O. David T. Malicke, D.O. Christopher Martella, D.O. Manjushree Matadial, D.O. Douglas McGee, D.O. David A. McKelway, D.O. Robert B. McManus, D.O. James L. McMullen, D.O. George J. Miller III, D.O. David E. Miller, D.O. Daniel A. Miller, D.O. James M. Mitchell, D.O. Mark A. Mitchell, D.O. Gary L. Moorman, D.O. Michael A. Morgenstern, D.O. Robert L. Morris, D.O. E.Scott Morrison, D.O. Arlene Frances Mrozowski, D.O. Thomas J. Mucci, D.O. National Hotel Sales Joe A. Nelson, D.O. Joseph O. Obebe, D.O. Thomas H. O'Hare, D.O. Eugene A. Oliveri, D.O. Michael H. Oster, D.O. Steven J. Parrillo, D.O. Nilesh N. Patel, D.O. Jon Pierre Pazevic, D.O. Donald G. Phillips, D.O. Katherine J. Pitus, D.O. Christopher M. Posey, D.O. John C. Prestosh, D.O.

Stephen Pulley, D.O. Abdulrahman Qabazard, D.O. Carol Rahter, D.O. Fred A. Rawlins II, D.O. Craig A. Reynolds, D.O. Riverside Brian J. Robb, D.O. Alexander Rosenau, D.O. Mark S. Rosenberg, D.O. Otto F. Sabando, D.O. Sandra L. Schwemmer, D.O. John R. Scranton, D.O. Donald J. Sefcik, D.O. Monte Sellers, D.O. Michael E. Sheehy, D.O. Duane D. Siberski, D.O. Steven A. Smith, D.O. Theodore A. Spevack, D.O. Bruce St.Amour, D.O. Bryan D. Staffin, D.O. Joseph W. Stella, D.O. Ronald K. Sterrenberg, D.O. Murry B. Sturkie, D.O. John F. Sullivan Jr., D.O. Michael P. Torosian John A. Tyrell, D.O. John L. Urbanek Jr., D.O. John Viteritti, D.O. James S. Walker, D.O. Michael D. Ward, D.O. Lisa M. Ward, D.O. John D. Weilbacker, D.O. Fred G. (Kip) Wenger, D.O. Stephanie Whitmer, D.O. Anthony D. Wilko, D.O. Gary L. Willyerd, D.O. Jennifer Bantley Wilson, D.O. Jennifer A. Yorke, D.O. Thomas J. Ziemba, D.O. $100 - $499 Brian Acunto, D.O. Jamie Adamski, D.O. John Agee, D.O. Rohit K. Agrawal, D.O. Kevin J. Aister, D.O. Steven Aks, D.O. David G Alexander, D.O. Andrew C. Allison, D.O. Louis Allocco, D.O. Sean Al-Salman, D.O. Leonardo Altamirano, D.O. Dario Altamirano, D.O. Ruben Altamirano, D.O. Larry Anderson, D.O. Kelly R. Anderson, D.O. Daniel Angeli, D.O. Adam Ankrum, D.O. Eric Appelbaum, D.O. Michael Applewhite, D.O. Robert D. Aranosian Arash Armin, D.O. Justin Arnold, D.O. Paul Arnold, D.O.

the PULSE | January 2014

Amy Arnold, D.O. Richard Arriviello, D.O. Harry M. Arters, D.O. Mary Arvanitis, D.O. Gerard Ashbeck, D.O. Dale Askins, D.O. Stephen Backman, D.O. Fred Bailor Jr., D.O. James Bajo, D.O. Michael L. Baker, D.O. Richard Balbin, D.O. Lisa Baldridge, D.O. Mark Banas, D.O. Tracy Chandler Barber, D.O. Stacey Barnes, D.O. William Barone, D.O. Steven B. Bashor, D.O. Andrew Basile, D.O. Levente Batizy, D.O. Julianna Batizy-Morley, D.O. Robert Bazuro, D.O. Gary Beasley, D.O. Bryan Beck, D.O. Darryl Beehler, D.O. S. Addison Beeson, D.O. John Belk, D.O. Thomas Bell, D.O. Donna M. Bell, D.O. David Berg, D.O. Robert M. Biernbaum, D.O. Frank C. Biondolillo, D.O. Spence R. Bisbing, D.O. Ronald M. Bishop, D.O. Craig Scott Black, D.O. Charles D. Black, D.O. Paul A. Blackburn, D.O. Brad A. Blaker, D.O. Janice Blau, D.O. Gregory P. Bloxdorf, D.O. Richard M. Blubaugh, D.O. Kris M. Bly, D.O. Susan M. Lessner Boesler, D.O. Suzana Bogdanovska, D.O. William Bograkos, D.O. Daniel L. Bommelje, D.O. Charles M. Boothby, D.O. Allyson Borgstedte, D.O. Thomas Borgstedte, D.O. Gregory L. Boris, D.O. George W. Borrelli, D.O. Daniel G. Bosso, D.O. Melinda L. Boye-Nolan, D.O. Christine D. Boyko, D.O. Thomas A. Boyle, D.O. Alvin Jay Bradford, D.O. Mary Louise Brawn, D.O. Matthew S. Brice, D.O. April Brill, D.O. Donald L. Brizendine, D.O. Glen H. Brookshire, D.O. Willie C. Bruce, D.O. Billy R. Bryan, D.O. Kathryn Bulgrin, D.O. Timothy P. Bumann, D.O.

Kyland I. Burden, D.O. Russell E. Burkett, D.O. Barry Burton, D.O. Jeffrey D. Butler, D.O. Richard A. Buzard, D.O. Edward J. Byrnes, D.O. Ronald M. Cable, D.O. Christina M. Cabott, D.O. George Sarkis Caleel, D.O. Arthur G. Calise, D.O. Brett A. Call, D.O. Victoria A. Camba, D.O. Carla Cameron, D.O. Christina Campbell, D.O. Jacqueline M. Cappiello-Dziedzic, D.O. Chad Carman, D.O. Michael B. Carney, D.O. Terry L. Carr, D.O. Cesar Walter Carralero, D.O. Dale M. Carrison, D.O. Terry K. Carstensen, D.O. Thomas E. Carter, D.O. Melissa L. Carter, D.O. Raymond P. Cascarino, D.O. Christopher J. Case, D.O. David Castle, D.O. Anthony Catapano, D.O. Barbara A. Celestina, D.O. Charles Celestina, D.O. Joseph Charais, D.O. Jason Everett Cheatham, D.O. Steve Cheche, D.O. Sybil K. Cheng, D.O. Lawrence Cherish, D.O. Allen W. Cherson, D.O. Fang-Chin Chiang, D.O. James P. Chiavaras, D.O. Bernard Cieniawa, D.O. Kevin R. Clark, D.O. Bevin Clayton, D.O. Kelly A. Clifford, D.O. David Coffey, D.O. Jeffrey Cohan, D.O. Andrew N. Cohen, D.O. Ronald S. Cohen, D.O. Justin Cole Michael H. Coleman, D.O. Samuel T. Coleridge, D.O. Gregory B. Collins, D.O. Brian C. Collins, D.O. Grant D. Comnick, D.O. Jonathan L. Conard, D.O. Michael S. Cone, D.O. John F. Conlon, D.O. Mario Anthony Cosenza, D.O. Roger Jeffrey Cotner, D.O. Lonnie D. Couch, D.O. Jeffrey W. Couturier, D.O. Rodney Cox, D.O. Michelle Cranick-Kuster, D.O. Kevin Cranmer, D.O. Joseph Crum, D.O. Eric J. Csernyik, D.O. Andrew Culver, D.O.

FOEM | BEACON Thomas M. Culver, D.O. Nicholas A. Cunicella III, D.O. Jeff Curnes, D.O. Melissa A. Cusumano, D.O. Thomas J. Czelatdko, D.O. Christopher P. Daisy, D.O. Kenneth M. Dale, D.O. Michael D'Ambrosio, D.O. Paul A. D'Amico, D.O. Michael David Dargay, D.O. Stephanie L. Davis, D.O. Kimberly M. Davis Waaso, D.O. James T. DeAngelis, D.O. Steven L. Decker, D.O. Daniel Scott DeFeo, D.O. DeKalb Physicians Clinic Philippe DeKerillis, D.O. Amy DeLorie, D.O. Joseph A. DeLucia, D.O. Louis J. DeMicco, D.O. Michael R. Denney, D.O. Stephen L. DeWitt, D.O. Adrian Dews, D.O. Daniel Dickriede, D.O. David R. Didur, D.O. Matthew S. Dikin, D.O. Robert G. Dinwoodie, D.O. Anthony J. DiPasquale, D.O. Scott Patrick Dishaw, D.O. Freya J. Dittrich, D.O. Thanh M. Do, D.O. Jean Emmanuel Dorce, D.O. Michael Q. Doyle, D.O. Joseph Drasba, D.O. Nathaniel J. Drexler, D.O. Paul Dubiel, D.O. Stephen P. Dubos, D.O. Craig Dues, D.O. John J. Dunlop, D.O. Julie Dunlop, D.O. Martin Dunsky, D.O. Ronald Dupler, D.O. Kevin R. Durell, D.O. Robert M. Duvoisin, D.O. Nana Dwomoh, D.O. Michael C. Eastman, D.O. Francis Eaton, D.O. K. Donaldson Edwards, D.O. Mark Edwin, D.O. Mark James Elder, D.O. Trudie J. Ellenberger, D.O. Jeremiah F. Ellias, D.O. Ronald Ellis, D.O. Harry J. Emmerich, D.O. James Espinosa, D.O. Robert Mike Esposito, D.O. Armand Eusanio, D.O. James C. Eutzler, D.O. Jeffrey C. Evans, D.O. Robert I. Faber, D.O. Daniel P. Fagnant, D.O. David Farcy, M.D. Andrew D. Felsted, D.O. Curt Fenkl, D.O.

Carter P. Fenton, D.O. Michael Ferraro, D.O. Michael Filart, D.O. Charles A. Finch Jr., D.O. James A. Fish, D.O. James M. Fitzgerald, D.O. Patrick Michael Flaherty, D.O. Frank Flores, D.O. James J. Flowers, D.O. William S. Folley, D.O. Matthew Font, D.O. Apiwat W. Ford, D.O. Iris M.W. Ford, D.O. William C. Forsythe, D.O. Michele Marie Fowler, D.O. C.H. Fowlkes, D.O. Jean-Claude Frank, D.O. Kevin T. Franks, D.O. Alice Anne Frazier, D.O. Nathan Fredrick, D.O. Michael E. Fritsche, D.O. Joseph M. Frontino, D.O. Michael Gable, D.O. Steven Gable, D.O. Thomas Gable, D.O. Joan M. Gable, D.O. Theodore J. Gaeta, D.O. Howard H. Galarneau Jr., D.O. Joseph L. Galkowski, D.O. C. Wayne Gallops, D.O. James R. Galloway, D.O. Patrick G. Gannon, D.O. Roger Garcia, D.O. Raul J. Garcia-Rodriguez, D.O. Barry Gardenhire, D.O. Tressa K. Gardner, D.O. Michelle P. Gebhard, D.O. George L. Geisler, D.O. Timothy D. Genetta, D.O. GFK Custom Research Mark A. Giese, D.O. James R. Giesen, D.O. David R. Gilchrist, D.O. Jon R Gildea, D.O. Richard C. Giovannini, D.O. Mark S. Gittings, D.O. Tara E. Gleeson, D.O. Keischa L. Glenn, D.O. Eric Gloss, D.O. William A. Gluckman, D.O. Robert Goddard, D.O. David Goff, D.O. Thomas S. Goldsborough, D.O. Antonio Gonzales, D.O. Christopher Michael Gooch, D.O. Stephanie Goodwin, D.O. Sheryl L. Gottlieb Siar, D.O. Patrick K. Gray, D.O. Thomas E. Green, D.O. Brett S. Greenfield, D.O. Jeffry D. Greenlee, D.O. Raymond K. Griffith, D.O. David T. Grinbergs, D.O. Angela C. Gruesen Wright, D.O.

Alan Gruning, D.O. Joseph R. Guarnaccia, D.O. Stephen J. Gunn, D.O. Patricia Guntern, D.O. Michael Guttenberg, D.O. Ronald P. Guzas Jr., D.O. Richard Haering, D.O. Gregory J. Hall, D.O. Gary W. Hamlin, D.O. Gregory Hammons, D.O. Linda M. Hanekamp, D.O. Karl Harnish, D.O. M. Franklin Harrison, D.O. Janice L. Hart, D.O. Valerie Hart, D.O. John Havlick, D.O. John C. Hayden, D.O. Oliver W. Hayes, D.O. Joseph J. Heck, D.O. Melvin Hecker, D.O. Todd Helfman, D.O. R. Steven Hemby, D.O. Lisa C. Henning Low, D.O. John Herrick, D.O. Daniel L. Herriman, M.D. Ralph C. Hess, D.O. David Vern Hess, D.O. Gregory Higbee, D.O. James R. Hildebrandt, D.O. Bradley S. Hiles, D.O. John B. Hinckley, D.O. Edwin M. Hinton IV, D.O. Joseph O. Hoffman, D.O. Bradford V. Hoffman, D.O. Steven D. Hollosi, D.O. Timothy M. Holt, D.O. David W. Homer, D.O. Andrea E. Horvath, D.O. Evan A. Houck, D.O. Darrin F. Houston, D.O. Roger A. Howell, D.O. Randall A. Howell, D.O. Philip B. Howren, D.O. Lisa D. Hrutkay, D.O. Donald G. Hudson, D.O. Raymond G. Hughes, D.O. Joseph C. Hummel, D.O. Robert L. Hunter, D.O. Kenneth Hurst, D.O. Timothy J. Huschke, D.O. Anwer Hussain, D.O. George Hutchins, D.O. Sarah Iosovich, D.O. Kimberly Irvin, D.O. Iscovich Foundation Louis H. Issacson, D.O. Raymond A. James, D.O. Kristin James, D.O. Stephen G. Jaskowiak, D.O. David D. Jensen, D.O. Jody Johnsen, D.O. Heath A. Jolliff, D.O. Scott D. Jolly, D.O. Gregory D. Jones, D.O.

Grace Dizon-Retiro Jones, D.O. Donald Gregory Jones, D.O. Travis Kain, D.O. Mark D. Kalna, D.O. Andrew F. Kalnow, D.O. Scott B. Kanagy, D.O. Bryan Kane, M.D. Jonathon Karol, D.O. Joseph F. Karre, D.O. Jessica Kasirsky, D.O. Laura Kasper, D.O. Elizabeth D. T. Kassapidis, D.O. Sophie Kay, D.O. Gloria D. Kayfan, D.O. Randy Kellenberger, D.O. Kenneth R. Keller, D.O. Michael Lee Kelley, D.O. Sara Kelly, D.O. Jay Kernus, D.O. Lenard M. Kerr, D.O. Howard D. Kessler, D.O. Thomas C. Kickham, D.O. Tamara Lynn Kile, D.O. Jeffrey J. Kinyon, D.O. Rebecca Kirsch, D.O. Wendy Anne Kissinger, D.O. Joe Kissinger Michael Kitto, D.O. Thomas E. Klie, D.O. Kelly Klocek, D.O. Marc D. Knudsen, D.O. Shahrokh Kohanim, D.O. MaryAnne Kolar, D.O. Andrew J. Kolp, D.O. Rajesh S. Kothari, D.O. Kevin Kramer, D.O. Matthew Kramp, D.O. David A. Kraus, D.O. Arnold S. Kremer, D.O. Jay Kugler, D.O. John C. Kulin, D.O. Kyla Kutch, D.O. Randall L. Labaki, D.O. Helene Labonte, D.O. Sheera Lall, D.O. David S. Lambie, D.O. James C. Lambros, D.O. Henry Landsgaard, M.D. Catherine J. Langston, D.O. Michael LaRochelle, D.O. Matthew Daniel Larrew, D.O. Richard Jake Lartey, D.O. Joseph M Leahy, D.O. Ronald Joe Leckie, D.O. James J. Lee, D.O. Lionel Lee, D.O. Sang Lee, D.O. Shi-Wen Lee, D.O. Gordon D. Leingang, D.O. Joseph D. Lemmons, D.O. Jaime C. Lent, D.O. James Patrick Leonard, D.O. Johanna R. Leuchter, D.O. Robert W. Linkenheimer, D.O.

the PULSE | January 2014

FOEM | BEACON James T. Little, D.O. Jean Liu, D.O. Liubusy Inc., D.O. James E. Lively, D.O. Rezarta Lloyd, D.O. Kevin J. Loeb, D.O. Michael Anthony LoGuidice, D.O. Daniel Lombardi, D.O. Carrie L. Lotenero, D.O. Ralph Wayne Love, D.O. Aaron Love, D.O. Sean Ludlow, D.O. Fredric B. Ludwin, D.O. James Lundy, D.O. Khoa C. Luong, D.O. Rose Mack, D.O. Dominic J. Maga, D.O. Mary Lynn Magarelli, D.O. Mary E. Malcom, D.O. Gerald E. Maloney, D.O. Raymond J. Malta, D.O. Michelino Mancini, D.O. Eric D. Mann, D.O. Annette M. Mann, D.O. David Manno, D.O. Fanny J. Mantilla, D.O. Lori A. Marasovich, D.O. Thomas E. Marchiondo, D.O. Gene Marino, D.O. Melissa J. Marker, D.O. Brian Marshall, D.O. Paul G. Martin, D.O. Bruce A. Marts, D.O. Carmen Massey, D.O. Donald F. Massey, D.O. James T. Massimilian, D.O. Gregory J. Massoud, D.O. Paul Mastrokyriakos, D.O. Mihaela-Elena Matei, D.O. Robert W. Mathews, D.O. Daniel J. Matricia, D.O. Michael D. Matthews, D.O. Michael J. Mattingly, D.O. Jennifer B. Matzner-Abrams, D.O. Bruce E. Maulbetsch, D.O. Michelle M. Maureau, D.O. Dennis Mays, D.O. Lawrence Mazur, D.O. Ronald L. McAdam, D.O. Marty D. McBee, D.O. Raymond A. McCarthy, D.O. Maureen McCarville, D.O. Gerald W. McClallen, D.O. William E. McConnell, D.O. James W. McCorry, D.O. Eric McDonald, M.D. Eric McDowell, D.O. Michelle A. McGinn-Kearney, D.O. Cathleen McGovern, D.O. Charles McIntosh, D.O. Robert V. McJennet, D.O. Kay E. McMillan, D.O. Jacklyn McParlane, D.O. James Peter Mead, D.O.

Roger G. Meadows, D.O. Derek S. Meeks, D.O. Michael Mendola, D.O. Andrew Mersky, D.O. Scott T. Miekley, D.O. Stephen D. Mifsud, D.O. Jonathan Mihok, D.O. Daniel P. Miller, D.O. Brian F. Miller, D.O. Anna Milman, D.O. Thomas F. Minahan, D.O. Shawn Minor, D.O. Sarah K. Minor, D.O. Eric D. Mohr, D.O. Melissa Lin Monte, D.O. Jane Siehl Moore, D.O. Javier Morales, D.O. Alicia A. Morales, D.O. Jimmy D. Morgan, D.O. James B. Morosco, D.O. Andrew E. Morrison, D.O. Anthony V. Mosca, D.O. Robert A. Mott, D.O. Jittin T. Muljibhai, D.O. Robert D. Mullins, D.O. Michael T. Murphy, D.O. Darlene Myles, D.O. Michelle M. Naegele, D.O. Katia Nakahodo, D.O. Samuel A. Namey, D.O. Craig A. Nattkempter, D.O. Kevin P. Neenan, D.O. Lisa A. Nelson, D.O. Brian A. Nester, D.O. Mark C. Netzel, D.O. Karen Nichols, D.O. Matthew K. Nickerson, D.O. Joseph B. Nienaltowski, D.O. David J. Niles, D.O. Jessica Normile, D.O. Bradley North, D.O. Paul Numsen, D.O. Daniel E. Oberdick Sr., D.O. Julia Ann O'Brien, D.O. Moira Ellen O'Brien-Bruce, D.O. Kevin J. O'Gara, D.O. J.Michael O'Hargan, D.O. Jerry Oliaro, D.O. Daniel J. Olsson, D.O. Price Paul Omondi, D.O. Robert Ormanoski, D.O. Gary L. Osborn, D.O. William E. Osborn, D.O. Margie D. Ott, D.O. Taryn Papandria, D.O. Diane M. Paratore, D.O. Neelesh V. Parikh, D.O. Malsuk Park, D.O. Dana F. Parsons, D.O. Benjamin N. Paschkes, D.O. Rebecca Pasdon, D.O. Michael D. Passafaro, D.O. Edmond Pasternak, D.O. Ernest F. Patti, D.O.

the PULSE | January 2014

Celine Paulus, D.O. Susan L. Payson, D.O. Arthur Steven Pecora, D.O. Dwight Pentzien, D.O. Christine M. Perry Ockerman, D.O. Narendralall Persaud, D.O. Nicole Phillips, D.O. Deborah L. Pierce, D.O. David E. Pierce, D.O. Scott Plasner, D.O. Amy Poholski, D.O. Catherine Polera, D.O. James D. Polk, D.O. Valerie A. Pollard, D.O. Arnis Pone, D.O. James A. Poplawsky, D.O. James L. Portzer, D.O. James L. Preddy, D.O. Robert J. Prodinger, D.O. Jeffrey C. Proudfoot, D.O. Stuart L. Pyatt, D.O. Shawn M. Quinn, D.O. Sean P. Quinn, D.O. Abdulrahman Raja, D.O. P Rao, D.O. Narasinga Rao, D.O. Jason A. Ravanzo, D.O. Marshall L. Rea, D.O. Leonard Reiffe, D.O. Michael J. Reihart, D.O. Gregory W. Reinhold, D.O. Jay Reynolds, D.O. Karen H. Rickert, D.O. Saul F. Rigau, D.O. Martina Riley, D.O. Vincent Rimanelli, D.O. Alexander Riss, D.O. J.Jennifer Roberts, D.O. Samuel Robles, D.O. Alexander E. Rodi, D.O. J. Allen Roseberry, D.O. Stephen A. Roskam, D.O. William D. Ross, D.O. Jennifer Ross, D.O. Charles S. Ross, D.O. Timothy Rossi, D.O. Brian Roy, D.O. John W. Rubin, D.O. David P. Ruby, D.O. Michael P. Ruggiero, D.O. Brandon Aaron Russell, D.O. Matthew Rutman, D.O. Mariusz Rybaltowski, D.O. Richard A. Saalborn, D.O. Fred E. Sabol, D.O. Alfred Sacchetti, D.O. Thaddeus R. Salmon, D.O. Brian S. Saracino, D.O. William O. Sargeant, D.O. David D. Sarkarati, D.O. Ronald Scheer, D.O. Frank Schell, D.O. David Scheraga, D.O. Michael Schiesel, D.O.

Scott H. Schleifer, D.O. Cary N. Schneider, D.O. Marie Schreiber, D.O. Henry R. Schuitema, D.O. Donna M. Schutzman-Bober, D.O. Adam Schwartz, D.O. Steven Schwartz, D.O. Jeffrey M. Scott, D.O. Jeremy Kent Selley, D.O. Jeffrey A. Sendi, D.O. Jane Sennett, D.O. Shane A. Serfling, D.O. Regina Sexton, D.O. Martha Shadel, D.O. Neena M. Shah, D.O. Thomas L. Sharp, D.O. George J. Shervanick, D.O. Ashwin K. Shetty, D.O. Jeffrey Shipkey, D.O. Mikhail Shpak, D.O. Merlin LeRoy Shriner, D.O. James B. Shuler, D.O. Iqbal Siddiqui, D.O. Robert M. Sidwa, D.O. John I. Siekierka, D.O. John J. Sillery, D.O. Brian S. Silverman, D.O. Walter Simmons, D.O. Purabi Mehta Simon, D.O. George R. Simons Jr., D.O. Robert Sing, D.O. Eileen M. Singer, D.O. James R. Skinner, D.O. Gregory J. Smolin, D.O. Jerald Solot, D.O. Mark Sombat, D.O. Jessica Lynn Sop, D.O. Joseph Sorber, D.O. Carlos Augusto Sotelo, D.O. Janene C. Sparks, D.O. John E. Sparks, D.O. Julius Keith Speed, D.O. Kenyon W. Sprankle, D.O. Nick Stavridis, D.O. Robyn Steenstra, D.O. John Stepanek, D.O. Sonya Stephens Douglas D. Stern, D.O. Jennifer Stevenson, D.O. Jay Alan Stiefel, D.O. Virginia Ann Stoll-Tyrrell, D.O. Robert G. Stone, D.O. Rosa Stone, D.O. Jeffrey J. Stuart, D.O. Glenn F. Suacillo, D.O. Italo Subbarao, D.O. Aisha Subhani, D.O. Patrick Sullivan, D.O. Daniel Sullivan, M.D. Michael Scott Summerfield, D.O. Cynthia Susedik, D.O. Matthew D. Swayze, D.O. Edith Szabo, D.O. Mark Tang, D.O.

FOEM | BEACON Ben Tapper, D.O. H. Sprague Taveau, D.O. Michael W. Tawney, D.O. Marcus Teng, D.O. James H. Thomas, D.O. James Thomas, D.O. Scott A. Thomas, D.O. Brandon T. Thomas, D.O. Timothy M. Thompson, D.O. David A. Tilles, D.O. Michael F. Todd, D.O. Charles W. Tolan, D.O. Julia Yanoviak Toledo, D.O. Harrison Tong, D.O. Jeffrey Trager, D.O. Michael Traktman, D.O. Gerald Traktman Dong Trieu Trang, D.O. Despina Melissa Trigenis, D.O. Vince Truong, D.O. Hal R. Tucker, D.O. Craig Steven Turner, D.O. Erwina Ungos, D.O. Remus Ungur, D.O. Matthew VanderWoude, D.O. Suzanna L. Vass, D.O. Dinesh K. Verma, D.O. Stephen J. Vetrano, D.O. Michael D. Vickery, D.O. Sanford J. Vieder, D.O. Jason N. Vieder, D.O. Darrel Vlachos, D.O. Benjamin Von Fischer, D.O. S. Robin Von Haven, D.O. Stevan A. Vuckovic, D.O. Bernice Vulich, D.O. Peter S. Wachtel, D.O. Rona Wadle, D.O. Brett D. Wagner, D.O. Donald J. Wagner, D.O. Harold Wagner, D.O. David A. Wald, D.O. Christy L. Walter, D.O. Pamela A.C. Walters, D.O. Milo N. Warner, D.O. Matthew Warpinski, D.O. Joseph Warren, D.O. Wayne Warrington, D.O. Aimee Washington, D.O. Susan S. Watson, D.O. Thomas J. Watts, D.O. Jennifer L. Waxler, D.O. William H. Weaver, D.O. David R. Weaver, D.O. Kevin R. Weaver, D.O. John Palmer Weddle, D.O. Vivian Weinberger, D.O. David C. Welch, D.O. Ronald J. Weller, D.O. John D. Wells, D.O. Eric S. Wernsman, D.O. Tonya L. West, D.O. Thomas Westenberger, D.O. Michael W. Westfall, D.O.

Thomas Wetjen, D.O. Jeffrey Wheeler, D.O. Lisa L. Wheeler-Lewis, D.O. Susan Whitaker, D.O. Erik D. White, D.O. Brian K. Wiboon, D.O. Thomas Wigboldy, D.O. Elaine Lombardi Wilk, D.O. Michael Williams, D.O. Adrienne Brooks Williams, D.O. Stacy J. Williams, D.O. John E. Williamson, D.O. Courtney Willner, D.O. Thomas M. Wills, D.O. Cathy Wilson, D.O. Elizabeth Wilson, D.O. Melissa Winger, D.O. Yvette A. Wirta-Clarke, D.O. Robert J. Wise, D.O. Maury Witkoff, D.O. William L. Wixom, D.O. Lara M. Wiziecki, D.O. Thomas Woltanski, D.O. Valerie Woodmansee, D.O. Charles Worrilow, M.D. Jody Wozniak, D.O. Michael H. Yangouyian, D.O. John Zambito, D.O. Christina Zhang, D.O. Michael E. Zielinski, D.O. Jocko R. Zifferblatt, D.O. Roger Zionitz, D.O. Carolynn L. Zonia, D.O. $99 and below Mikhael Abourjeily, D.O. Steven Adamczyk, D.O. Lajon Addison, D.O. David Adinaro, M.D. Mehvish Ahmed, D.O. Amarachi Akujobi, D.O. Andrew Alaimo, D.O. Siddhartha Al-Hashimi, D.O. Andrea Allman, D.O. Rachel Amsterburg, D.O. Daniel Anderson, D.O. Eric Anderson, D.O. Richard Anderson, D.O. Verna Arcedo, D.O. Alwin Arendse, D.O. Cindy Armstead, D.O. Brent Arnold, D.O. Sarah Arzt, D.O. Lexi D. Ash Linda Assaf Brian Ault, D.O. Jennifer Axelband, D.O. Allison N. Ayotte, D.O. R. Scott Baeder, D.O. Jacob Bair, D.O. Nick Bair James F. Baird, D.O. James G. Baldwin, D.O. Raj Baman, D.O.

Kimberly A. Banfield, D.O. Clyde Banner , D.O. Jane Barnes, D.O. Jeremy Barnes, D.O. D. Gary Batten, D.O. Jeffrey M. Beard Robert Beight, D.O. Jason K. Benn, D.O. Jessica Bennett, D.O. Scott Bennion, D.O. John Benson, D.O. David P. Berg, D.O. James Berry, D.O. Elizabeth Berry, D.O. Luke Bertorelli, D.O. Besrkshire Health System Gust W. Bills, D.O. Black Canyon Mallory Blakeslee, D.O. Dennis Blankenship, D.O. Jason Blasenak, D.O. Blessing Hospital Wojciech Bober, D.O. Brian T. Bonner, D.O. James Botti, D.O. Katay Bouttamy, D.O. Matthew E. Boyer, D.O. Joseph Boyle, D.O. Joshua Bozek, D.O. Tecla Brabazon, D.O. Teresa K. Braden, D.O. Thomas Brandon, D.O. Ryan W. Brennessel, D.O. Brentwood Emergency Physicians Todd Britt, D.O. Lauren Courtney Brown, D.O. Christopher Bruner, D.O. Steven J. Brunetti, D.O. Christine Brunner, D.O. Sharla D. Bryan, D.O. Holly Ann Bryant, D.O. Terry Lynn Bucan, D.O. Alyssa Buchheister, D.O. Suzy M. Buckmaster, D.O. Jory C. Bulkley, D.O. Steven R. Burkholz, D.O. David Burmeister, D.O. Gregory K. Burnette, D.O. Kristie Busch, D.O. Joseph D. Bushek, D.O. Nikolai Butki, D.O. Michele Butler, D.O. Keith Butvilas, D.O. Kenneth Byerly, D.O. Terrence M. Callahan, D.O. Bradley Caloia, D.O. John M. Caltry, D.O. Lynn A. Campbell, D.O. Bradley J. Campbell, D.O. Nicholas J. Cardinal, D.O. Angela Carrick, D.O. Craig T. Carter, D.O. Carroll Cartwright Kevin Michael Casey, D.O.

Tania Castro, D.O. Alexis L. Cates, D.O. Maurice J. Chao, D.O. Stephen E. Chester, D.O. A.Dale Chisum, D.O. Jerfi D. Cicin, D.O. Gary R. Clark, D.O. Stephen R. Cluff, D.O. Eric K. Clymer, D.O. Ryan Coates, D.O. Douglas B. Coffman, D.O. Jason G. Coisman, D.O. Damian L. Cole, D.O. Elizabeth Colella, D.O. James Combs, D.O. Patrick Johnmichael Connolly, D.O. Eric Cook, D.O. Elizabeth A. Cook, D.O. Guy Paul Cooper Stephen Corriz, D.O. Brian P. Crowley, D.O. Joseph Cruz, D.O. Maryvic C. Cuison, D.O. Czar Medical Services Alan A. Daar, D.O. Stephanie D'Agostino, D.O. Michael T. Dalley, D.O. Anne M. Darlington, D.O. Frederick Davis, D.O. John Deagle, D.O. DeGara, PLLC Scott E. Dellinger, D.O. Janice DeMaray, D.O. Paul C. DePonte, D.O. Douglas P. Dero, D.O. John F. Dery, D.O. John A. DeSalvo, D.O. Francesca DeTrana, D.O. Eric K. Dichter, D.O. Paul DiModica John B. Ditchman, D.O. Anamika Doma, D.O. Joseph A. Dombroski, D.O. Jennifer Donze, D.O. Arthur J. Dortort, D.O. Trace Dotson, D.O. G. Phillip Douglass, D.O. William R. Downs, D.O. Melissa Martens Drake, D.O. Aleksandr Dubrovskiy, D.O. Carla'nne Dukes, D.O. Kevin T. Dwyer, D.O. Sara Eadie-Pelliccia, D.O. Pamela Eaton, D.O. Donna M. Eget, D.O. Tiffany Elliott, D.O. Emergent Care Management Randy A. Engelman, D.O. Jack D. England, D.O. Warren Entwistle , D.O. Michael Epter, D.O. Julie Evans, D.O. Kathleen L. Faccio, D.O. James P. Farinosi, D.O.

the PULSE | January 2014

FOEM | BEACON Larry G. Farmer, D.O. Sofia Farooqi Syrita S. Farrow, D.O. Osama Fashho, D.O. Susan Tartelone Fedewa, D.O. Kurt R. Feighner, D.O. Harold E. Feiler, D.O. Claudio M. Fernandez, D.O. Eric Fete, D.O. DeKalb Physicians Clinic Michael Fill, D.O. David R. Fisher, D.O. Jerry L. Fitzgerald, D.O. Andrew Flanagan, D.O. Marc E. Flores, D.O. Kim D. Floyd, D.O. Edward R. Fog, D.O. Farrah Fong Albert E. Ford, D.O. Jeffrey Foster, D.O. James J. Foutty, D.O. William E. Franklin, D.O. Michael G. Fraters, D.O. Michael J. Fucci Gregory Fuller, D.O. Jesamyn L. Fuscardo, D.O. Karen Gaber-Patel, D.O. Frank Gabrin, D.O. Allan Galarneau, D.O. Michael J. Garcia, D.O. Gavin Gardner, D.O. Aaron M. Garrett, D.O. Patrick Garrity, D.O. Brent J. Gear, D.O. David M. Gearhart, D.O. Mark Geary, D.O. Scott R. Geiger, D.O. Robert J. George, D.O. Cynthia F. Gessler, D.O. Mary Gessner-Peterson, D.O. George Gibson, D.O. Elizabeth Gignac, D.O. Chelsey Coburn Gilbertson, D.O. Joseph J. Ginejko, D.O. Evan M. Gleimer, D.O. Natali P. Gleimer, D.O. David Glorius, D.O. David Goldman, D.O. Sodi H. Goldstein, D.O. Nancy Goodwin, D.O. Natalie Goran, D.O. Christine Goss, D.O. Karina Gotilboym, D.O. Jason Green, D.O. Kirsten Green, D.O. Karen Greenberg, D.O. Brian Greenberg, D.O. Dwynn N. Greenfield, D.O. Mark J. Greenwood, D.O. Kevin Grieb, D.O. Pamela Grigg, D.O. Randy N. Grinspan , D.O. David Scott Grounds, D.O. Shilpa Gupta, D.O.

Manoj K. Gupta, D.O. Ashley Guthrie, D.O. Bradley Gutierrez, D.O. William G. Hadcock, D.O. Sophia T. Haleem, D.O. Tara A. Hallahan, D.O. Robert Jared Halterman, D.O. Janet Eng Hamel, D.O. Hamot Medical Center William Hampton, D.O. Robert T. Harper, D.O. Kristopher K. Hart, D.O. Todd D. Hartgerink, D.O. Laura Harvey, D.O. Jennifer Hauler, D.O. Daniel P. Hearld, D.O. Jeanine Heitmann, D.O. Tiffany Heu, D.O. Paul K. Hick, D.O. James O. Hill, D.O. Tyler L. Hill, D.O. Susan Hinchliffe , D.O. Amy Hoffman, D.O. Eric T. Hogan, D.O. Michael J. Hoh, D.O. Michael S. Hohlastos, D.O. Joshua M. Hoien, D.O. Dorene Hojnicki, D.O. Adam Holbrook, D.O. Robert J. Horn, D.O. Bruce D. Horton, D.O. Richard C. Houck, D.O. Jamey Paul Hourigan, D.O. GFK Custom Research Hrothgar Medical, Inc Ben Huang, D.O. Shao Huang, D.O. Debby Hudson, D.O. Matthew R. Huff, D.O. Heather A. Hughes, D.O. Mary J. Hughes, D.O. Patrick Hughes, D.O. Joseph T. Imbesi, D.O. Kenneth L. Jacobs, D.O. Ali Jamehdor, D.O. Daniel Jarrell, D.O. Tabatha Jeffers, D.O. Edward J. Jelonek, D.O. Jeanne Johnston, D.O. Bruce G. Jones, D.O. Paula Lynn Jones, D.O. Michael J. Jule, D.O. Jennifer Julian, D.O. Ebrahim H. Karkevandian, D.O. Mark Katsaros, D.O. Randy Scott Katz, D.O. Steven Bradley Keehn, D.O. J. David Keitz, D.O. Amy E. Kelleman, D.O. Catherine Kelly, D.O. Shon Kendall, D.O. Adam Kessler, D.O. LaToya Khalil, D.O. Khamis Gerious Khamis , D.O.

the PULSE | January 2014

Joseph Kidd, D.O. Jessica Jewart Kirby, D.O. Kevin Klauer, D.O. Michael Alan Kleiman, D.O. Scott Kleiman, D.O. Harry E. Kleiner, D.O. Patrick Klocek, D.O. Joseph W. Knight, D.O. Timothy C. Koch, D.O. Megan McGrew Koenig, D.O. Scott Kohl, D.O. Joby Kolsun, D.O. Joseph George Kovacic, D.O. Robin Koval Lahr, D.O. Michael B. Kovalick, D.O. Daniel J. Kranitz, D.O. Ellen M. Kroon, D.O. Alexander A. Kucewicz, D.O. Michael Kupon, D.O. Ellen J. Kurkowski, D.O. Elizabeth Ann Lacy, D.O. Natalie Lambie, D.O. Michael J. Lamers, D.O. Amos Mart Lane, D.O. David A. Larkin, D.O. Marisa Laurosa , D.O. Daryl Lawrence-Friedl, D.O. Evan W. Lee, D.O. Jeremy F. Lee, D.O. Joseph C. Lee, D.O. Teddy Lee, D.O. Valerie Lee Yvette LeFebvre, D.O. Mark Lekas, D.O. Tracie J. Leonhardt, D.O. Fred Lepore, D.O. Scott Leuchten, D.O. Lori Levine, D.O. Adam Levy Marc Lewbart, D.O. Thomas C. Licata, D.O. Jeremy E. Lindley, D.O. Jennifer C. Liu, D.O. Thomas Liu, D.O. Locums Doc Hollis London, D.O. Catherine Loniewski-Girdler, D.O. Nathan Lowien, D.O. Iscovich Foundation William Lubinsky, D.O. Gerald A. Maddalozzo, D.O. Tavi Madden Madden-LeDuc, D.O. G. Edward Mallory, D.O. Molly E. Malone-Prioleau, D.O. Andrea Marconi, D.O. Gennaro J. Marino, D.O. Louis J. Marquet, D.O. Kenneth A. Martin, D.O. Sheffey Massey, D.O. Julie Massoud, D.O. Susan M. Mastellone, D.O. Mary L. Mazza, D.O. Heather McArthur, D.O. John McCarthy, D.O.

James McClay, D.O. Matthew D. McCormick, D.O. John W. McCracken, D.O. Anthony P. McKeen, D.O. John R. McKinney, D.O. John McMahon, D.O. Amber M. McPherson, D.O. Donald Meade, D.O. Ragini R. Mehta Parekh, D.O. Bryan J. Menges, D.O. MidState Medical Leo Midure, D.O. Ronel B. Millana, D.O. Lewis J. Miller, D.O. Julie M. Mills, D.O. Evelyn Moore Mills, D.O. Kenneth M. Minett, D.O. Jeffrey M. Moldovan, D.O. Elizabeth Stoddart Monnot, D.O. Mary Kathryn Montgomery, D.O. Enash Moodley MaryEllen Moore, D.O. Terrall Moore, D.O. Russell E. Mordecai, D.O. Moises A. Moreno, D.O. Jason Morris, D.O. Joshua P. Morrison, D.O. Victoria L. Mossbrook McElroy, D.O. Lauren M. Muchorski, D.O. Terrence Mulligan, D.O. Stephan F. Mussehl, D.O. Joan Naidorf, D.O. Nanakwand Emergency Dept Joshua R. Nast, D.O. Tessa N. Ndille, D.O. Matthew Nerland, D.O. Themy T. Ngo, D.O. Tung Nguyen, D.O. Minh Van Nguyen, D.O. Dzung-Young M. Nguyen, D.O. Oanh Clark Nguyen, D.O. Alexander Norinsky, D.O. Jeri A. Norman, D.O. Sara Nowicki, D.O. Gerald F. O'Malley, D.O. Rory O'Neill, D.O. Frank S. Orth, D.O. Chantel O'Shea, D.O. Nicole Ottens, D.O. Jeannine Owens, D.O. James M. Owens, D.O. Jeffrey Ozan, D.O. Andrew Peter Pacitti, D.O. Joseph J. Pagano, D.O. Michael Painter, D.O. Natalie M. Painter, D.O. Hema B. Pandit, D.O. Brandon Parker, D.O. Cindy Parker, D.O. Sandeep Patel, D.O. Kishan B. Patel, D.O. Punam R. Patel, D.O. Frank A. Paul, D.O. James Pavlich, D.O.

FOEM | BEACON David Pawsat, D.O. Amanda Wyatt Pearce, D.O. Thelma Peery, D.O. Hale T. Peffall Ralph S. Peiris, D.O. Nadia Pellett, D.O. Salvatore Pepe, D.O. Kimberly Perry, D.O. Joseph R. Peters, D.O. Bradford D. Pflaum, D.O. Physicians Practice Enhancement Jessica Pierog, D.O. Jehangir Pirzada, D.O. Mary Lynn Pitlanish, D.O. David S. Porter, D.O. David Edward Porterfield, D.O. Robert A. Prahl, D.O. Rachel Gooch Pughsley Shaila Quazi, D.O. Alfredo L. Rabines, D.O. Brian Rader, D.O. Ambreen Rahman, D.O. Vishnuvardhan Rao, D.O. David Kade Rasmussen, D.O. Denis J. Reavis, D.O. Michael Reddington, D.O. Jody Rein, D.O. Allison M. Remo, D.O. Christopher Cody Reynolds, D.O. Dow J. Richards, D.O. William Richardson, D.O. Omer Richman, D.O. Sasha Rihter Gregory Rimmer, D.O. Holly Ringhauser, D.O. Vincent J. Rizzo, D.O. Ann C. Robenstien, D.O. Shannon L. Robinson, D.O. Ellen B. Rodman, D.O. Gregory J. Rokosz, D.O. Jaclyn M. Ronovsky Joel Rosenbloom, D.O. Thomas A. Rosier, D.O. Chadwick Ross, D.O.

Arthur Albert Ruediger, D.O. Herbert E. Russell, D.O. Scott M. Russo, D.O. Kelly Salinas, D.O. Vanessa M. Santos, D.O. Yazan M. Sarsour, D.O. Herbert Nutt Schiffer, D.O. Arnold Schiller, D.O. Grant Schmidt, D.O. Robert L. Schoenen, D.O. Ryan Scholz, D.O. Kathleen Schomer, D.O. Michael L. Schreiber, D.O. John Wilhelm Schroeder, D.O. Eric Schwiger, D.O. Edmund M. Sciullo, D.O. Jennifer E. Scott, D.O. Tamara Scott, D.O. Seacost Emergency Phys Thomas Seglio, D.O. David A. Sestak, D.O. Sunil K. Sethi, D.O. Troy B. Shaffer, D.O. Tara E. Shapiro, D.O. Rameen Sharefei, D.O. Joshua W. Sheatsley, D.O. Daniel P. Sheesley, D.O. Steven P. Shepherd, D.O. Jeffrey L. Shipman, D.O. Stacia Shipman, D.O. John A. Shivdat, D.O. Chad Shuff, D.O. Stephen Shy, D.O. Lori Lee A, Siemon, D.O. Doni Marie Sigerivas, D.O. Kelly E. Signorelli, D.O. Christopher Sikes, D.O. David E. Sikorski, D.O. Dean Silverberg, D.O. Donna M. Simmers-Dabinett, D.O. Kerrilene E. Sinapi, D.O. Pragyya Singh, D.O. Juan I. Sinisterra, D.O. Annie Sinnott, D.O.

Rita Sivils, D.O. Gerald Michael Smith, D.O. Lawrence E. Smith, D.O. Rebecca J. Smith, D.O. Thomas M. Smolin, D.O. Niels E. Snyder, D.O. William E. Sotack, D.O. Peter J. Spence, D.O. Jon Spyridakis, D.O. Christopher I. Stark, D.O. Daria M. Starosta, D.O. Michael K. Steele, D.O. Louis C. Steininger , D.O. Matthew C. Stensland, D.O. Cynthia Stephenson, D.O. Edward Stolyar, D.O. Derek Stout, D.O. Douglas Stranges, D.O. Jason L. Stringer, D.O. Daniel J. Suders, D.O. Carolyn Swallow, D.O. Shannon Lee Swanson, D.O. Michael Systma, D.O. Javier Talamo, D.O. Steven Talbot, D.O. Robert Tam, D.O. David Tan, D.O. Laurie L. Taylor, D.O. Timothy Taylor, D.O. Texas Family Medicine Linda V. Thomas, D.O. Brian Thommen Christine Tichansky, D.O. Kevin Tishkowski, D.O. Haley Todsen, D.O. Garrett M. Tomasino, D.O. Paul U. Toote, D.O. Paul A. Traficanti, D.O. Avi Trope, D.O. Costandinos Tsagaratos, D.O. Jeremy D. Tucker, D.O. Barry C. Turek, D.O. Dawn Marie Turner, D.O. Danielle K. Turrin, D.O.

Lyncean Ung , D.O. Franklin B. Veer, D.O. Al Villarin, M.D. Karen S. Vincent, D.O. Jessica Lynn Vinyard-Davis, D.O. Dana Sean Vitale, D.O. Sarah M. Vitello, D.O. Michael Volpe, D.O. Florence Wachtler, D.O. Nicole Wadsworth, D.O. Brianne Waggoner, D.O. Pierre E. Wakim, D.O. James Walker, D.O. Anne M. Wall, D.O. Arthur G. Wallace, D.O. Sandy Wang, D.O. Travis P. Washut, D.O. Kenneth R. Watson, D.O. Kristin Wattonville, D.O. Shannon Weinstein, D.O. Sherry Wells, D.O. Serge Wenzel, D.O. Douglas Wheeler, D.O. Maureen L. Whiteley, D.O. Kenneth Scott Whitlow, D.O. Kirk R. Whyte, D.O. Ernest Randal Williams, D.O. Timothy Scott Wilson, D.O. John Winter, D.O. Warren Wisnoff, D.O. Jared G. Wolfert, D.O. William P. Wylie, D.O. Julianne M. Wysocki, D.O. Travis W. Yates, D.O. Timothy G. Ying, D.O. Jasper Yung, D.O. Peter Zackle Shabnam Zarrabi, D.O. Stephanie Zaugg, D.O. Jennifer L. Zernec, D.O. Kristy Ziontz, D.O. Faizah Zuberia, D.O.

View back issues and read current articles from your laptop, desktop, tablet or mobile device. www.acoep.org/pulse the PULSE | January 2014

2014

LOS CABOS

RAFFLE

Enter to win one week* in a beautiful two bedroom villa at the Grand Regina Resort in Los Cabos (www.grandregina.com). OR One week* in a two bedroom unit at any comparable member resort in The Registry Collection (www.registrycollection.com). Tickets sales will end Friday, March 28, 2014. Winner will be announced Tuesday, April 1, 2014. For official rules and regulations, please contact Stephanie Whitmer at swhitmer@foem.org *Week selected is subject to availability and must be used before December 31, 2014.

You may purchase tickets at www.FOEM.org OR mail a check to: Foundation for Osteopathic Emergency Medicine Attn: Stephanie Whitmer 142 E Ontario St, Ste 1500 Chicago, IL 60611 (F) 312-587-9951 the PULSE | January 2014

Resident Wrap Up

M. Steve Brandon, DO ACOEP Resident Chapter President ACOEP Board of Directors

Things are settling down after another amazing conference in San Diego, and the Resident Chapter is looking forward to the upcoming year with anticipation and excitement. For starters, for the first time that I am aware of, the resident chapter actually had more people registered for the conference than the student chapter. This is not due to a decline in the student chapter (which always puts on an outstanding conference), but speaks to an ever-increasing effort and quality of events produced by the Resident Chapter. In my three years being involved with the Resident Chapter, I can say without a doubt that every conference has been better than the one prior to it. We have received much feedback from our membership and frequently adjust our plans in response to it. We consistently push ourselves to evolve into something better, and this year will be no different. Adding to that, the Resident Chapter Board has never looked so strong. I found myself repeatedly telling people in San Diego that a Resident Chapter President “never had it so good.” I am truly humbled by the talent and capability of the current Resident Board. While our board did lose some quality people from last year, we are fortunate enough to retain the experience and leadership of our former President (Megan Koenig) as the Past President on our board. Of the 13 people on our board, we return seven from last year’s board, have three who were on last year’s student board, and added on three more who bring so much to the table that we haven’t skipped a beat. We even have three former Student Chapter Presidents on our Resident Board! For those who appreciate a sports analogy. This is like returning four of the five starters from your previous year’s championship basketball team, in addition to adding on the number one draft pick as that fifth starter. Both the student and resident chapters are clearly developing strong leaders that will continue to contribute to the ACOEP for years to come. If you can’t tell, I’m pretty excited about the upcoming year. Sincerly,

Steve Brandon, DO

ACOEP Resident Chapter President ACOEP Board of Directors Emergency Medicine Resident, St. Mary Mercy Hospital, Livonia, MI

the PULSE | January 2014

Residency Spotlight ACOEP is pleased to continue to shine a spotlight on four more outstanding Residency Programs! Program: Aria Health Address: 10800 Knights Road City/State/Zip: Philadelphia, PA 19114 Hospital Information: Type (Community, rural, urban): Community Trauma Level: 2 Number of Hospital Beds: 3 Hospitals total Number of ED Beds: 3 EDs total 100 EM Program Information: Phone: 215-612-5161 Website: http://www.ariahealth.org/Careers-Education/ Graduate-Medical-Education/Residency-Programs Total Number of EM Residents: 16 EM, 20 EM/IM, 24 FP/ EM Residents to Attending Ratio Working Clinically: 1:1 Accepts Medical Student Rotations? Yes EM Program Curriculum: PGY 1: EM, PEM, Trauma, Surgery, US, Anesthesia, Critical Care, OBGYN, IM PGY 2: EM, PEM, Trauma, Critical Care, Ortho, US PGY 3: EM, PICU, Burn Unit, Level 1 Trauma, Research, Elective PGY 4: EM, PEM, Admin, Tox, Critical Care, EMS, Elective EM Program Application Information: Dates applications are accepted: Prefers COMLEX Scores of: >500 Interview Dates: October-January Number of Letters of Recommendations and who can write the letters: 3; at least 1 from EM and preferably SLOE __________________________________________________ Program: Southern Ohio Medical Center Address: 1805 27th Street City/State/Zip: Portsmouth OH 45662 Office of Medical Education 1735 27th Street Waller Building, Suite B-06 Portsmouth, OH 45662 Hospital Information: Type (Community, rural, urban): Community, Rural Trauma Level: no designation Number of Hospital Beds: 223 Number of ED Beds: 43

the PULSE | January 2014

EM Program Information: Phone: 740-356-8051 Website: http://www.somc.org/employee/mededucation/emr/ index.php Total Number of EM Residents: 16 Residents to Attending Ratio Working Clinically: 1,1.5-2 Accepts Medical Student Rotations? Yes, application on website EM Program Curriculum: PGY 1: • Anesthesiology1 block • Cardiology1 block • Emergency Medicine4 blocks • Internal Medicine/Hospitalists2 blocks • OB/GYN1 block • Pediatric Emergency Medicine (Children's Hospital, Columbus)1 block • Pulmonology/ICU1 block • Surgery2 blocks PGY 2: • Cardiology/CCU1 block • Selective (may choose two half-blocks)1 block • Emergency Medicine7 blocks • Orthopaedics1 block • Pediatric Emergency Medicine1 block • Pulmonology/ICU2 blocks PGY 3: • Cardiology/CCU1 block • Selective (may choose two half-blocks)1 block • Emergency Medicine7 blocks • Orthopaedics1 block • Pediatric Emergency Medicine1 block • Pulmonology/ICU2 blocks PGY 4: • Emergency Medicine9 blocks • Elective1 block • Emergency Medicine Administrative1 block • Emergency Medicine (Grant Medical Center, Columbus)1 block • Trauma (Grant Medical Center, Columbus)1 block EM Program Application Information: Dates applications are accepted: August Prefers COMLEX Scores of: Higher the Better!! Interview Dates: Thursdays September-November Number of Letters of Recommendations and who can write the letters: Recommended EM, Surgery, Intensive Care, 3 letters, EM SLOE preferred.

Residency Spotlight (continued) Program: Kent Hospital Emergency Medicine Residency Program Address: 455 Toll Gate Rd. City/State/Zip: Warwick, RI 02886 Hospital Information: Type (Community, rural, urban): Community Trauma Level: II Number of Hospital Beds: 359 Number of ED Beds: 43 plus CPR/Trauma/Behavioral Health Units EM Program Information: Phone: 401.737.7010 x35640 Website: www.kenthospital.org Total Number of EM Residents: 26 Residents to Attending Ratio Working Clinically: 1:1 Accepts Medical Student Rotations? yes EM Program Curriculum: CURRICULUM/ROTATIONS SCHEDULE: 13 four week units PGY 1 (“Internship”) • Emergency Medicine: 6 units • Internal Medicine: 1 unit • Surgery: 1 unit • Cardiology: 1 unit • Critical Care: 1 unit • OB/GYN: 1 unit • Anesthesiology/Ultrasound: 1 unit • Trauma: 1 unit - University of Maryland Shock Trauma Center

PGY 2 • Emergency Medicine: 8 units - Kent • Toxicology: 1 unit - Children’s Hospital, Boston/ Regional Poison Center • Orthopedics: 1 unit • OBER: 1 unit - Women’s & Infant’s Hospital ED • Emergency Medical Services: 1 unit • Ophtho/ENT/Plastics: 1 unit PGY 3 (Junior EM Year) • Emergency Medicine: 8 units - Kent • Pediatric Emergency Medicine: 2 units – St. Anne's/ Memorial/Tufts • Critical Care: 1 unit • Trauma: 1 unit – University of Maryland Shock Trauma Center • Elective: 1 unit PGY 4 (Senior EM Year) • Emergency Medicine: 9 units – Kent • Pediatric Emergency Medicine: 2 units – St. Anne's/ Memorial/Tufts • Elective: 1 unit • Admin: 1 unit EM Program Application Information: Dates applications are accepted: up to October 1st Prefers COMLEX Scores of: > 500 Interview Dates: October-January Number of Letters of Recommendations and who can write the letters: 3; 1 EM LOR required, prefer SLOE

the PULSE | January 2014

Committed Physicians Interested in Serving on College Committees ACOEP's most valuable resource is our incredible membership base. Your experience, expertise, and insight are an indispensable tool in shaping the future or emergency medicine! Share your vies by becoming involved in one of our dynamic committees! Visit www.acoep.org/committees to learn what opportunities are available! 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

Are You Making the Most of your Membership? Visit www.acoep.org/benefits to see the exclusive offers ACOEP members receive from these great partners!

the PULSE | January 2014

Check out the Student's and Resident's recently redesigned online publication

ce! for Spring Conferen ? Start looking at AZ Tired of the cold yet

The Fast Track e9 Winter 2014 - Issu

DICINE PUBLICATION AN EMERGENCY ME

RRRRRRR! BUUURR emergencies that for the cold weather Be prepared near you! are coming to and ED

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.

eye out! You’ll shoot yoaur BB gun! Ralphie! Shot in the face with

? S in the ED CarotidarenU/ probe on a ’t scared to throw a You bet! We ical decision making! neck to help our med

view Rosh Re k at it again. review experts are bac The board

Here are some articles featured in the Winter 2014 issue: • Cold Weather Emergencies Coming to a ED Near You • Shot in the Face with a BB Gun • Carotid Ultrasound in the ED • Rosh Review Board Questions • Pediatric Corner: Seizures

2 March 2011 - Issue

Pediatric Corner estiatus nonsendam Comnia doluptio et voluptatem non venditius eatem ex

m be scary parents, dont let the Seizures are scary for

for you!

You can view The Fast Track online by going to the Student Members page at:

www.acoepsc.org the PULSE | January 2014

Presorted Standard U.S. Postage

PAID

Chicago, IL Permit No. 2177

142 E. Ontario Street Suite 1500 Chicago, Illinios 60611

Magic in the ED

starts here.

EMP party at ACEP SA Seattle, WA.

On the dance floor. At a cookout. Skiing the slopes. At EMP, we’ve been told we’re different than other groups. Residents touring our EDs often comment on the camaraderie they see. They feel the energy, see physicians supporting each other, hear the laughter, and wonder – what makes this group different? It’s simple. At EMP, we’re all in. We’re physicians first, partners second, and best of all a family.

Visit emp.com/jobs

or call Ann Benson at 800-828-0898. abenson@emp.com

Opportunities from New York to Hawaii. AZ, CA, CT, HI, IL, MI, NH, NV, NY, NC, OH, OK, PA, RI, WV