SAEM 2003 Annual Meeting Program

2003

ANNUAL MEETING May 29 - June 1

Society for Academic Emergency Medicine 2

Attendees are urged to complete the general Annual Meeting evaluation form, as well as the individual evaluations that are available at each didactic session. Completed evaluation forms should be returned to the SAEM Registration Desk before leaving Boston. Feedback is critical to the development of future Annual Meetings.

INDEX General Information..........................................................................................................2 Schedule of Events ..........................................................................................................4 Photo Contributors..........................................................................................................10 2003 Midwest Regional Meeting ....................................................................................11 Thursday, May 29 Papers/Posters/Didactics ....................................................................12 Friday, May 30 Papers/Posters/Didactics ........................................................................17 Saturday, May 31 Papers/Posters/Didactics ....................................................................22 Sunday, June 1 Papers/Posters/Didactics........................................................................30 Innovations in Emergency Medicine Education (IEME) Exhibits ........................................32 May 31 Annual Business Meeting Agenda ......................................................................28 May 31 Medical Student Symposium ..............................................................................27 Chief Resident Forum ....................................................................................................37 Interest Group Meeting Agendas ....................................................................................38 Didactics Sessions by Topic............................................................................................40 Didactic Session Speakers..............................................................................................41 Speaker Conflict of Interest ............................................................................................42 Positions Available..........................................................................................................43 2004 Annual Meeting Calls for Didactics, Abstracts, IEME Exhibits ..................................46 Constitution and Bylaws Amendments ............................................................................47 AEM Consensus Conference ..........................................................................................48

INTRODUCTION helping you conduct and publish your research. To inspire you, and in particular to inspire our residents and medical students attending this year’s meeting, Dr. Peter Rosen will present the Spivey Lecture immediately after lunch on May 29. Sessions on nuts and bolts of research include: how-to’s such as Educational Research Methodology (May 29), “Survey Research Methodology”, “Development and Validation of Clinical Decision Rules” (both June 1); sampling issues such as “The Inconvenience of Convenience on Prospective EM Research” and a wide array of sessions on analysis, from the perennial favorite “Introduction to Statistics” (May 29) to “Interpreting Statistical Analyses: Beyond p Values” (May 30). For those of you considering (and you should be) applying for a grant, don’t miss the didactic on “Getting in the Ballpark for Federal Funding: Prerequisites for a Successful Grant Application” which will include what you should be doing before you apply for a grant. There will also be a two-part grant review workshop in which our own members will have their grants critiqued by reviewers in front of a small audience (limited seating so arrive early) followed by a session open to all to discuss the pearls and pitfalls in writing grants. And we offer a reprise of the very successful “How to Write Science” (May 29). We have also taken another and new look at the issue of disaster preparedness and bioterrorism, this year from a research point of view: the session on "Recent Advances in Terrorism and Disaster Medicine: Implications for Research" (May 30) will not only describe the new structure of the Homeland Security Department and how it affects research opportunities, but will provide some practical suggestions for the types of research best–suited to physicians in emergency medicine.

We have five truly excellent and original State-of-the-Art sessions.

We also offer several health policy and faculty development sessions designed to help all of us understand and respond to the variety of pressures facing our medical schools and emergency departments today. We strongly encourage those of you working in divisions of emergency medicine to attend the lunch session on "The Road to Achieving Departmental Status in Emergency Medicine". Feeling just a bit cramped? The didactic on “ED and Crowding: Research Agenda and Recent Solutions” will address the research on the causes and effects of overcrowding, and how some institutions have addressed it. The session on “Surviving the Collision of Health Policy and Academic Medicine” will cover the impact of HIPAA and resident hour reduction on our ability to function as clinicians, educators and researchers.

There’s much more that space, and your patience, will not permit me to describe here, and with all this we also hope you’ll find an opportunity to see a bit of Boston. While the Red Sox are not in town, the Boston Pops are, and there is plenty more to do and see. We’re looking forward to your participation in the 2003 Annual Meeting.

Welcome to Boston and the 2003 SAEM Annual Meeting! We return to a city steeped in both revolution and tradition, and similarly our program simultaneously represents both unique ideas and a return to basics. To begin with a few landmarks, our program begins Thursday morning with a Plenary Session, or rather Plenary Session One, because this year we have included an additional Plenary Session on the third day of the meeting, in order to highlight more of our excellent research. We’re offering four oral paper sessions with Open Discussion, several with guest moderators from outside emergency medicine, as well as our most effective moderator members. These sessions offer the opportunity for a bit more discussion on some of the most controversial aspects of emergency medicine research. We continue to have a poster session each day, and during each session two “moderated” poster sessions with somewhat more formal presentations and time for discussion. We are asking poster presenters to put their posters up first thing each morning (or the night before), to give all of you ample time to view the posters. We highly encourage a tour during the scheduled two-hour session to allow more interaction and feedback for those who’ve worked so hard on these projects.

I am very pleased to welcome Dr. Judah Folkman as our Keynote Speaker. Dr. Folkman’s research career, studded with both disappointment and success, led him to the discovery of tumor angiogenesis factor. He will be speaking on persistence in research at the Banquet on Thursday evening.

While we have many excellent didactic sessions, we would like to call your attention to the Bedside Teaching Track to be held on Friday, May 30, which includes sessions on educational theory, teaching procedures, teaching safety, and giving feedback. A highlight of this track is our luncheon speaker, Dr. Daniel Federman, former Dean of Education at Harvard who will speak about “What Makes a Great Teacher.” (All sessions are open to all members without preregistration except the luncheon, which requires registration and a $35 registration fee.) We have many other excellent educational offerings, including an afternoon workshop on Patient Simulation being held at the Harvard Medical School Simulator Lab (transportation included) on Sunday afternoon, as well as an Evidence-Based Medicine Workshop, also Sunday afternoon, June 1. I would also call your attention to the luncheon session on “Educating Emergency Physicians to Care for our Patients at the End of Life”, designed specifically to discuss how to educate emergency physicians in this very important and challenging area.

We have included a substantial number of didactics aimed at

Ellen Weber, MD Chair, Program Committee

2003 Annual Meeting Program Committee Chris Barton, MD David C. Cone, MD Kevin Curtis, MD Cathy Custalow, MD, PhD M. Christopher Decker, MD Brian Euerle, MD

Leonard Friedland, MD Gregory Garra, MD Diane Gorgas, MD David Guss, MD Alan Heins, MD Sean Henderson, MD

Debra Houry, MD, MPH Jack Kelly, DO Jeffrey Kline, MD David Lee, MD Diana Pancu, MD Susan Promes, MD

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Richard Shih, MD Susan Stern, MD Terry Vanden Hoek, MD Gary Vilke, MD Mary Jo Wagner, MD Ellen Weber, MD

GENERAL INFORMATION The SAEM Annual Meeting is the largest forum for the presentation of original research in emergency medicine. Approximately 1,800 emergency physicians are expected to attend (approximately 1600 have pre-registered for the conference as of May 12). The Annual Meeting will include 451 original research presentations and 24 Innovations in Emergency Medicine Education (IEME) Exhibits. The oral papers will consist of 10 minute presentations followed by 5 minutes for questions and answers. Selected oral paper sessions will include additional time for discussion. The posters are scheduled in 2-hour sessions each day. Most posters will focus on one-on-one discussion between the presenters and the attendees. However, each day two moderated poster sessions will be held during one-hour discussion sessions within the two-hour poster sessions. The moderators will focus discussion on further research in the topic. The IEME Exhibits will be held during the poster sessions with the first group scheduled on May 29 and 30 and the second session on May 31 and June 1.

All presented research must be approved by Institutional Review Boards for Human Studies or Animal Care Committees and is so certified by authors upon abstract submission. The abstracts were published in the May 2003 issue of Academic Emergency Medicine, the official SAEM journal.

All speakers at the 2003 Annual Meeting have been independently selected by the SAEM Program Committee. All speakers are required to disclose any real or apparent conflict of interest they may be related to the content of their presentation(s). The existence of commercial or financial interests of speakers related to the subject matter of their presentation should not be construed as implying bias or decreasing the value of the presentation(s). However, disclosure should provide information to participants to form their own judgments. A list of disclosed potential conflicts of interest is published in this Program.

The Annual Meeting is always a popular meeting for renewing old acquaintances and making new ones. While sessions are in progress, as a courtesy to the speakers and attendees, please limit conversations to the hallways. Also, please turn off cell phones while in meeting rooms.

Registration

Annual Business Meeting

Attendees are required to register at the SAEM Registration Desk to obtain name badges that are required for admission into all Annual Meeting sessions.

Registrants for the limited enrollment sessions (such as lunch sessions and workshops) should arrive a few minutes early to check-in. Because of the popularity of such sessions, on-site registration will not be possible if a session has sold out in advance.

The SAEM Registration Desk will be located in the Exhibit Hall and will be open from 7:00 am until approximately 7:00 pm on May 28, 29, 30, and 31. The Registration Desk will be open from 7:00 am until 12:00 noon on June 1.

It is the policy of SAEM to comply with the Americans with Disabilities Act. If special arrangements are necessary, please contact the SAEM staff at the Registration Desk.

The Annual Business Meeting will be held on Saturday, May 31 from 11:00 am until 12:00 pm in Salon E. The election results will be announced, as well as the results of the membership’s ballot regarding the Constitution and Bylaws amendments. In addition, the Young Investigator Award recipients, the recipients of the Research Training, Institutional Training, Scholarly Sabbatical, Neuroscience Research Fellowship, EMS Research Fellowship grants and the recipients of the 2002 Annual Meeting Best Presentation Awards will be presented to the membership.

Roger J. Lewis, MD, PhD, will present his Presidential Address to the membership. Incoming President, Donald M. Yealy, MD, will also be introduced.

There may be other reports and presentations to the membership. All SAEM members are urged to attend. A complete agenda is published in this Program.

Banquet and Opening Reception

Photography Exhibit and Visual Diagnosis Contest

The SAEM Banquet and Opening Reception will be held on Thursday, May 29 beginning at 6:30 pm with the Opening Reception, which will be held in Salon G of the Marriott Hotel. All Annual Meeting registrants are invited to attend the Opening Reception at no charge. Hors d’oeuvres will be served and a cash bar will be available.

The Banquet will follow at approximately 7:00 pm and will be held in Salons E and F of the Marriott Hotel. Tickets for the Banquet must be presented at the door for entry to the Banquet. SAEM is honored that Dr. Judah Folkman has accepted SAEM’s invitation to be this year’s Keynote Speaker at the Banquet.

Dr. Folkman is a world-renown researcher, surgeon and teacher who developed the idea that tumors are angiogenesis-dependent. Over many years of his career, he discovered the mechanism of angiogenesis, paving the way for clinical trials of angiogenesis inhibitors in the U.S. and Europe, with applications that extend beyond cancer therapy. Dr. Folkman has been asked to speak to Banquet attendees about persistence in research. More information on Dr. Folkman is included in this Program on page 16.

Nearly 100 cases and photos were submitted to the Program Committee for consideration of presentation at the Annual Meeting. SAEM is proud to display original photos of educational value and gratefully acknowledges the efforts of the individuals who took the time to submit photos for consideration. Please review the list of photo contributors, which is published in this Program. Selected photos and cases will be displayed in two formats in the Exhibit Hall.

Medical students and residents will be invited to participate in the “Visual Diagnosis Contest.” Score sheets may be obtained at the Registration Desk.

Winners in both medical student and resident categories will be awarded a one-year membership in SAEM, including a subscription to Academic Emergency Medicine, a free registration to attend the 2004 SAEM Annual Meeting in Orlando, a major Emergency Medicine textbook, a subscription to the SAEM Newsletter, and a SAEM coffee mug. Recipients will be announced in the July/August issue of the SAEM Newsletter.

“Clinical Pearls” photos will also be displayed for the benefit of all attendees. These photos will include a case history, as well as the diagnosis and “take home” points.

Scientific Award Candidates An asterisk (*) next to the abstract number denotes a project being considered as a finalist for an SAEM Scientific Award. Awards will be given in the categories of Faculty (Clinical Science and Basic Science), Young Investigator, Fellow, Resident, and Medical Students.

Award selection process: Authors indicated on the abstract submission form whether they wished to be considered for an award. The Program Committee selected award candidates from this group, based on reviewers’ scores and study impact. Candidates were asked to submit a full manuscript by May 25 for review by the awards subcommittee. All finalists who indicated that they will submit a manuscript by May 25 are listed with an asterisk (this program was published prior to May 25, and some manuscripts may not be submitted by May 25). Final award decisions will be based on both the submitted manuscript and the presentation in Boston. Announcements regarding the award recipients will be made immediately following the Annual Meeting.

Academic Emergency Medicine (AEM) Activities Academic Emergency Medicine, the official journal of SAEM, will convene a number of activities during the Annual Meeting: The AEM Consensus Conference on Disparities in Emergency Healthcare will be held on May 28. A full agenda is included in this Program. Registration is $50, which includes lunch.

The AEM Reviewers Workshop will be held on Thursday, May 29 at 12:001:30 pm in Salons A/B. This session is designed for current AEM reviewers and lunch will be provided. Pre-registration is required, but there is no registration fee.

The AEM Statistical Reviewers will meet on Friday, May 30 at 8:30-9:30 am in the Northeastern Room. Breakfast will be provided. All AEM statistical

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Grant Review Sessions

reviewers are invited to attend. The topic of this year’s Workshop is “Reviewers, Requests.” Specific questions that our reviewers have asked about peer review, the AEM review process and other issues of concern will be discussed.

The AEM Associate Editors will meet on Friday, May 30 at 12:00-1:30 pm in the Boston University Room. All Associate Editors are invited to attend and lunch will be provided.

The AEM Editorial Board will meet on Friday, May 30 at 1:30-3:30 pm in the Regis Suite. All Editorial Board members are urged to attend.

The SAEM Research Committee is convening two small, limited enrollment meetings that address the grant review process. These sessions are the second phase of a project which began during last year’s Annual Meeting in St. Louis and the ultimate vision is to develop a mechanism to provide rapid, helpful peer review of submitted non-funded grant applications or grants in preparation.

This year the sessions will include a review of two meritorious grant applications (one clinical and one animal model) and will be held on May 31 at 1:302:30 pm. The clinical grant application session will be held in the Provincetown Room and the grant is entitled “Identifying Key Factors in Physician DecisionMaking Regarding Disposition of Seniors Evaluated in the ED for Abdominal Pain.” The animal model grant application session will be held in the Orleans Room and the grant is entitled, “Residual Brain Damage Following Acetaminophen Overdose.”

The sessions are limited to approximately 10 individuals, on a first-come basis. A one-page synopsis of the applications will be handed out to those in attendance so that others can share their opinions about how to make their projects fundable. Those with a conflict of interest should not attend these small group sessions.

During the sessions each applicant will briefly summarize their project and state their perception of why the grant is not yet funded, or ready for submission. The experts in the field will then give their opinions on how the grant could be improved, focusing on relevant problematic areas (eg.hypothesis/specific aims, preliminary data, etc.). Specific suggestions for improvement will be offered with a focus on improving changes for funding.

In addition, a didactic session at the Annual Meeting will be held on May 31 at 3:00-4:00 pm entitled, “Pearls in Grant Writing.” Attendance at the small feedback sessions developed by the Research Committee is not required to attend the didactic session, which will provide expert advice from a series of panelists who are experienced grant reviewers.

AACEM The Association of Academic Chairs of Emergency Medicine (AACEM) will meet on Wednesday, May 28 at 8:00 am – 4:00 pm in Salons A/B. The AACEM Business Meeting and Lunch will be held on May 28 at 12:00-1:30 pm in the Regis Suite. The AACEM Banquet (members and spouses only) will be held on the evening of May 28 starting at 6:00 pm at L'Espalier.

AACEM will sponsor a “New and Future Chairs Workshop” on Thursday, May 29 at 1:00-6:00 pm in Salon J. This session is now closed, due to the large number of responses, and only pre-registered individuals may attend.

Continuing Medical Education The 2003 Annual Meeting has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of SAEM and Michigan State University, College of Human Medicine Michigan State University, College of Human Medicine is accredited by the ACCME to provide continuing medical education for physicians.

Michigan State University, College of Human Medicine designates this educational activity for a maximum of 34 hours in category 1 credit towards the AMA Physician’s Recognition Award. Each physician should claim only those hours of credit that he/she actually spent in the educational activity. Michigan State University, College of Human Medicine designates the CPC Competition for a maximum of 6 hours in category 1 credit, the Evidence-Based Medicine Workshop for a maximum of 4 hours in category 1 credit, and the Simulation Workshop for a maximum of 3 hours in category 1 credit towards the AMA Physician’s Recognition Award.

May 28 (pre-day) Schedule of Events 7:00-8:00 am 8:00 am – 4:00 pm

CORD The Council of Emergency Medicine Residency Directors (CORD) will meet on Friday, May 30 at 8:00 am until 1:00 pm in Salon G. A box lunch will be available at 12:00 noon for CORD members only. The program will include educational sessions, reports, elections, and award presentations. The agenda is published in this Program.

The New Program Directors’ Workshop will be held on May 30 at 1:00-5:00 pm in the Suffolk Room. In addition, many CORD committees and task forces will meet during the SAEM Annual Meeting and these meetings are listed in the daily schedule in this Program. All CORD members are invited to attend.

8:00 am – 4:15 pm 8:00 am – 4:00 pm 8:00 am – 4:30 pm

11:45 am – 1:00 pm 12:00-1:00 pm

CPC Competition The Semi-Final CPC Competition will be held on Wednesday, May 28 and will consist of five simultaneous sessions at 8:00 am-12:00 noon and 1:00-4:30 pm. Annual Meeting attendees are encouraged to attend. There is no registration fee to attend the CPC, which showcases emergency medicine residency programs. The CPC consist of the presentation and discussion of the best 50 cases submitted from over 80 submissions. The CPC Competition finalists will be announced during a reception held from 5:30-6:30 pm on May 28. The CPC Competition is sponsored by ACEP, CORD, EMRA, and SAEM. The CPC Final Competition, consisting of the 5 semi-finalists, will be held during the ACEP Scientific Assembly, which will also be held in Boston in the fall of 2003.

12:00-5:00 pm 12:00-1:30 pm 4:00-6:00 pm 5:00-7:00 pm 5:30-6:30 pm 6:00-8:00 pm 8:00-11:00 pm

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CPC Coordinators Breakfast, Salon H AEM Consensus Conference: Disparities in Emergency Healthcare, Salon E Chief Residents Forum, Salon F AACEM Meeting, Salons A/B CPC Semi-Final Competition (5 simultaneous tracks), Wellesley, Suffolk, Simmons, Cape Cod/Hyannis, and Provincetown/Orleans Chief Residents Forum Lunch, Salon G AEM Consensus Conference Lunch, Salons C/D EM Model Review Task Force, Boston College AACEM Business Meeting and Lunch, Regis Suite EMNet Steering Committee, Falmouth SAEM Program Committee Executive Committee, Boston University CPC Competition Reception, Salon G SAEM Orientation/Mentoring Dinner/Meeting, Regis Suite SAEM Board of Directors, Boston University

THURSDAY, MAY 29

HOTEL FLOOR PLAN ON BACK COVER

7:30-9:00 am President’s Welcome and Plenary Paper Session, Salons E/F Abstracts 1-5 (p. 12)

9:00-9:30 am Coffee Break 9:30-10:30 am Oral Paper Presentations, Salon E Preclinical Foundations of Cardiovascular Therapies Abstracts 6-9

9:30-11:00 am Oral Paper Presentations Presentations, Salon F Ultrasound Abstracts 10-15

(p. 12)

(p. 12)

10:30 –12:00 pm Oral Paper Presentations, Salon E Acute Coronary Syndromes Abstracts 16-21 (p. 12)

9:30-11:00 am EMS Research: Challenges and Solutions, Salons C/D

9:30-10:30 am Introduction to Statistics, Salon G (p. 14)

(p. 14)

11:00-12:00 pm Oral Paper Presentations, Salon F Prehospital Risk Stratification Abstracts 22-25

11:00-12:00 pm Education Research Methodology, Salon C/D

10:30-12:00 noon State-of-the-Art: Acetaminophen: Research Opportunities for Toxicology’s Biggest Headache, Salon G

(p. 15)

(p. 14)

12:00-1:30 pm LUNCH SESSION; Salons A/B AEM Reviewers Workshop, Salons A/B (by invitation, preregistration required)

12:00 - 1:30 pm LUNCH SESSION, Salon I Educating Emergency Physicians to Care for our Patients at the end of Life (pre-registration and $35 fee required)

(p. 12)

12:30-1:30 pm LUNCH SESSION; Salon G Findings of the rt-PA Acute Stroke Treatment Panel, Salon G (bring your own bag lunch) (p. 15)

(p. 15)

1:30-3:00 pm Oral Paper Presentations and Discussion, Salon E Clinical Management of Ischemic Stroke Abstracts 26-29

1:30-3:00 pm Oral Paper Presentations, Salon F Pediatrics Abstracts 30-35

(p. 12)

(p. 12)

3:00-4:00 pm Oral Paper Presentations, Salon E Infectious Disease Abstracts 36-39

3:00-4:00 pm Oral Paper Presentations, Salon F Gastrointestinal Abstracts 40-43

(p. 12)

1:30-2:30 pm Bill Spivey Memorial Lecture: Research in EM: Its Physiognomy, Salon G

1:30-2:30 pm The Inconvenience of Convenience on Prospective EM Research, Salons C/D (p. 15)

(p. 15)

2:30-4:00 pm State-of-the-Art: New Perspectives in Patient Safety Research: Innovative, Scientific Applications and International Perspectives, Salon G (p. 15)

(p. 12)

2:30-4:00 pm How to Write Science, Salons C/D (p. 16)

4:00-6:00 pm, Exhibit Hall Posters (p. 13-14) Pediatrics: Abstracts 52-63 EMS: Abstracts 64-86 CPR: Abstracts 87-93 Education: Abstracts 94-109 Gastrointestinal: Abstracts 110-115 Ethics: Abstracts 116-119 IEME Exhibits 1-12

(p. 33-34)

5:00-6:00 pm, Exhibit Hall Moderated Poster Sessions (p. 13) Mechanisms of Ischemic Brain Injury: Abstracts 44-47 ED Electroencephalography: Abstracts 48-51 6:30 pm: Opening Reception (Salons E/F) and Banquet (Salon G) (reception open to all attendees at no charge, pre-registration and tickets required for banquet) Dr. Judah Folkman is the keynote speaker at the Banquet. (p. 16)

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THURSDAY, MAY 29 SAEM and AEM Committee/Task Force/Board Meetings 7:00-7:30 am 9:00-10:00 am 10:00-11:30 am 11:00-12:00 pm 12:00-1:30 pm 1:30-3:00 pm 2:30-3:00 pm 3:00-4:00 pm 4:00-5:30 pm 5:00-6:00 pm

2003 Annual Meeting Program Committee, Harvard Ethics Committee, Northeastern Graduate Medical Education Committee, Harvard Faculty Development Committee, Northeastern AEM Reviewers' Workshop (by invitation), Salons A,B Undergraduate Committee, Northeastern Leadership Development Task Force, MIT Room Grants Committee, Harvard National Affairs Committee, Northeastern Fellowship Training Task Force, Harvard

SAEM Interest Group Meetings 12:00-1:00 pm 12:00-1:30 pm 1:00-4:00 pm 1:30-3:30 pm 3:00-4:00 pm 3:00-4:00 pm 4:00-5:30 pm 4:00-5:30 pm 4:30-5:30 pm

Patient Safety Interest Group, Regis Suite Public Health Interest Group, Suffolk Ultrasound Interest Group, Wellesley Web Educators Interest Group, Suffolk Evidence-Based Medicine Interest Group, Tufts Pediatric Interest Group, Orleans/Provincetown Injury Prevention Interest Group, Tufts Mentoring Women Interest Group, Wellesley Disaster Medicine Interest Group, Suffolk

Affiliated Meetings and Satellite Symposia 7:30 am-7:30 pm 8:00 am-4:00 pm 8:30-5:00 pm 9:00-10:00 am 11:00-12:00 pm 1:00-2:00 pm 1:00-6:00 pm 1:30-4:30 pm 2:00-3:30 pm 4:00-5:00 pm 5:30-6:00 pm 5:30-7:30 pm 6:30-8:30 pm

EMRA Board of Directors, New Hampshire Suite ABEM PTP Redesign Task Force (by invitation), Boston University New Residency Coordinators' Workshop, Simmons Suite CORD Question/Answer Bank, Boston College CORD New Program Directors’ Forum/Monograph Committee, Boston College CORD/AAEM Officers, Boston College AACEM New and Future Chairs Workshop (by invitation), Salon J EMF PEMI Site Investigator Meeting (by invitation), Regis Suite CORD Model EM Curriculum Committee, Boston College CORD CPC Committee, Harvard CORD/EMRA Officers, Boston College EMRA Committee Meetings, Maine Suite EMRA/FERNE Symposium: Traumatic Brain Injury, Wellesley

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FRIDAY, MAY 30

HOTEL FLOOR PLAN ON BACK COVER Bedside Teaching Track

8:00-9:30 am Oral Paper Presentations, Salon E Translational Research in Shock and Traumatic Injury Abstracts 120-125

8:00-9:30 am Oral Paper Presentations, Salons A/B EMS Abstracts 126-131

8:00-9:30 am State-of-the-Art: Science of Triage, Salons C/D

8:00-9:00 am Principles of Bedside Teaching, Salon F

(p. 19)

(p. 19)

(p. 17)

(p. 17)

9:30-10:30 am Oral Paper Presentations, Salon E Airway Management Abstracts 132-135 (p. 17)

9:30-11:00 am Oral Paper Presentations, Salons A/B Randomized, Controlled Clinical Trials to Reduce Pain and Nausea Abstracts 136-141

9:30-10:30 am Multivariate Analysis: When Do You Need It? How Should You Do It?, Salons C/D (p. 20)

(p. 17)

9:00-10:00 am Small Group Interactive Session, Salon F (p. 20)

10:00-11:00 am Educational Aspects of ED Procedures, Salon F (p. 20)

10:30 am-12:00 noon Oral Paper Presentations and Discussion, Salon E Pulmonary Embolism in the ED Abstracts 142-145 (p. 17)

1:30-2:30 pm Oral Paper Presentations, Salon E Measurement of Pain and Nausea Abstracts 150-153

11:00 am–12:00 noon Mission Based Budgeting: An Opportunity for Departmental Financial Solvency, Salons A/B (p. 20)

1:30-2:30 pm Oral Paper Presentations, Salons A/B Trauma Abstracts 154-157

10:30-12:00 noon Recent Advances in Terrorism and Disaster Medicine: Implications for Research, Salons C/D

11:00 am-12:00 noon Oral Paper Presentations, Salon F Education Abstracts 146-149

(p. 20)

(p. 17)

12:00-1:30 pm LUNCH SESSION, Salon K The Road to Achieving Departmental Status (pre-registration and $35 fee required) (p. 20)

12:00-1:30 pm LUNCH SESSION, Salons H/I/J What Makes a Great Teacher (pre-registration and $35 fee required) (p. 21)

1:30-2:30 pm Understanding and Applying Likelihood Ratios, Salons C/D

1:30-2:30 pm Giving Feedback in EM Education, Salon F

(p. 21)

(p. 21)

2:30-3:30 pm Incorporating Patient Safety Principles into Bedside Teaching and Your Curriculum, Salon F

(p. 17)

(p. 17)

2:30-3:30 pm Oral Paper Presentations, Salon E Traumatic Brain Injury Abstracts 158-161

2:30-3:30 pm Oral Paper Presentations, Salons A/B Geriatrics Abstracts 162-165

2:30-4:00 pm Interpreting Statistical Analyses: Beyond P Values, Salons C/D

(p. 17)

(p. 18)

(p. 21)

3:30-5:30 pm, Exhibit Hall Posters (p. 18-19) Airway Management: Abstracts 174-187, 439 Ultrasound: Abstracts 188-193 and 440-444 Teaching Methods: Abstracts 194-199, 238 Neurology: Abstracts 200-208, 445 Geriatrics: Abstracts 209-212 Shock/Critical Care: Abstracts 213-214 Trauma: Abstracts 215-222 Wounds/Burns: Abstracts 223-228 Imaging in Abdominal Pain: Abstracts 229-233 IEME Exhibits 1-12

(p. 33-34)

4:30-5:30 pm, Exhibit Hall Moderated Poster Sessions (p. 18) Education: Abstracts 166-169 Mechanisms of Anoxic Brain Injury: Abstracts 170-173 7:00-9:00 pm First Working Session on Emergent Genomics, Regis Suite

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(p. 21)

FRIDAY, MAY 30 SAEM and AEM Committee/Task Force/Board Meetings 7:30-8:00 am 8:30-9:30 am 9:00-10:00 am 9:30-11:00 am 11:00-12:00 pm 12:00-1:30 pm 1:30-2:30 pm 1:30-3:30 pm 3:00-4:00 pm 3:30-4:30 pm 4:00-5:30 pm 6:00-9:00 pm

2003 Annual Meeting Program Committee, Harvard AEM Statistical Reviewers Breakfast, Northeastern SAEM/AACEM Officers Meeting (by invitation), Nantucket Research Committee, Harvard SAEM/EMRA Officers (by invitation), Northeastern AEM Associate Editors' Meeting and Lunch (by invitation), Boston University SAEM/CORD Officers (by invitation), Boston College AEM Editorial Board, Regis Suite Medical Student Question/Answer Bank Task Force, MIT Room SAEM/ACEP Officers (by invitation), Harvard Room Financial Development Committee, Northeastern Board of Directors, Nantucket

9:00-10:00 am 9:30-10:30 am 11:00-12:00 pm 12:00 pm 12:00-1:00 pm 12:00-1:00 pm 12:00-1:00 pm 12:30-1:30 pm 1:30-2:30 pm 4:00-5:00 pm 4:00-5:30 pm 4:00-6:00 pm 4:30-5:30 pm 5:30-6:30 pm

Health Services and Outcomes Research Interest Group, Falmouth Triage Interest Group, MIT Room CPR/Ischemia/Reperfusion Interest Group, MIT Room Clinical Directors Interest Group, (location to be determined) Trauma Interest Group, Harvard Neurologic Emergencies Interest Group, Falmouth Toxicology Interest Group, MIT Room EMS Interest Group, Cape Cod/Hyannis Domestic Violence Interest Group, Falmouth Clinical Skills Interest Group, MIT Room International Interest Group, Cape Cod/Hyannis Research Directors Interest Group, Nantucket Substance Abuse Interest Group, Falmouth Ethics Interest Group, MIT Room

7:00-8:00 am 7:30-9:00 am 8:00-9:00 am 8:00-11:00 am 8:00-1:00 pm 8:00-4:00 pm 8:30-10:00 am 10:00-11:00 am 10:00-11:30 am 10:00-11:30 am 10:30 am-1:00 pm 11:00-12:00 pm 11:30-1:30 pm 11:30-1:30 pm 12:00-1:00 pm 12:00-1:00 pm 12:00-1:30 pm 1:00-5:00 pm 1:00-5:00 pm 1:30-4:00 pm 2:00-3:30 pm 2:30-3:30 pm 3:30-4:30 pm 3:00-4:00 pm 4:30-5:30 pm 4:30-5:30 pm 5:15-6:15 pm 6:30-8:00 pm

EMF Scientific Review Committee (by invitation), Simmons Suite FERNE Board of Directors, Vineyard EMF Research Committee (by invitation), Tufts Annals of Emergency Medicine Editorial Board (by invitation), Suffolk CORD Meeting, Salon G EMARC Residency Coordinators' Workshop, Wellesley EMRA Reference Committee, Boston College AACEM/ACEP Officers (by invitation), Nantucket EMRA Representative Orientation, Boston College Delayed Admission Study, Falmouth CRUSADE Steering Committee, New Hampshire Suite AACEM/AAEM Officers (by invitation), Nantucket EMF Board (by invitation), Maine Suite EMARC Residency Coordinators' Workshop - Lunch and Business Meeting, Wellesley AACEM Executive Committee Lunch (by invitation), Nantucket Pediatric Emergency Medicine Fellowship Directors, Regis Suite ABEM Lunch for Residents (all residents invited to attend), Simmons Suite EMCREG International, Vermont Suite CORD New Program Directors' Workshop, Suffolk EMRA Representative Council, Provincetown/Orleans EMARC Residency Coordinators' Workshop Breakout Session, Vineyard/Yarmouth CORD/ABEM Officers, Boston College CORD/RRC Officers (by invitation), Boston College CORD Directed Observation Task Force, Boston University CORD/ACEP Officers (by invitation), Boston College EMRA Awards Reception, Vineyard/Yarmouth Combined EM Residency Programs, Boston University EMRA Presents: Malpractice Maladies, Wellesley 7

SAEM Interest Group Meetings

Affiliated Meetings and Satellite Symposia

SATURDAY, MAY 31 8:00-9:00 am Plenary Session, Salon E Abstracts 234-236 (p. 22) 9:00-11:00 am Oral Paper Presentations and Discussion, Salon E Controversies in Defibrillation Abstracts 237, 239-242 (p. 22)

HOTEL FLOOR PLAN ON BACK COVER

9:00-10:00 am Oral Paper Presentations, Salons H/I Computers in Medicine Abstracts 243-246

9:00-10:00 am Implementing and Optimizing Morbidity and Mortality Conference, Salons C/D (p. 24)

9:00-10:00 am Choosing and Developing Outcome Measures for Clinical Research, Salons A/B

10:00-11:00 am Getting in the Ballpark for Federal Funding: Prerequisites for a Successful Grant Application, Salons C/D

10:00-11:00 am Surviving the Collision of Health Policy and Academic Medicine, Salons A/B

9:00-4:30 pm Medical Student Symposium, Salon F

(p. 24)

(p. 22)

10:00-11:00 am Oral Paper Presentations, Salons H/I Injury Prevention Abstracts 247-250 (p. 22)

(p. 24)

(p. 24)

11:00 am-12:00 pm BUSINESS MEETING: Awards, Election Results, President's Address, and Announcements (all attendees urged to attend), Salon E 12:00-1:30 pm LUNCH SESSION, Salon K Competency in Medical Student Education (preregistration and $35 fee required)

12:00-1:30 pm LUNCH SESSION, Salon G ED and Crowding: Agenda and Recent Solutions (pre-registration and $35 fee required) (p. 25)

12:00-1:30 pm LUNCH SESSION, Suffolk Evaluating an Academic Position (pre-registration required, no fee, bring your own brown bag lunch)

12:30-2:00 LUNCH SESSION, Salon F Medical Student Symposium Lunch with Residency Directors (preregistration required)

(p. 25)

(p. 25)

1:30-2:30 pm Oral Paper Presentations, Salon E Asthma Abstracts 251-254

1:30-2:30 pm Oral Paper Presentations, Salons H/I Research Methods Abstracts 255-258 (p. 22)

1:30-2:30 pm The Lifeblood of the Department: Show Me the Money, Salons C/D (p. 25)

(p. 22)

(p. 25)

2:30-4:00 PM Oral Paper Presentations, Salon E Toxicology Abstracts 259-264

2:30-4:00 pm Oral Paper Presentations, Salons H/I Administration Abstracts 265-270

(p. 22)

(p. 22)

2:30-4:30 pm State-of-the-Art: Resuscitative Hypothermia: Recent Clinical Trials, Ongoing Research, and the Future, Salons C/D (p. 25)

4:00-6:00 pm, Exhibit Hall Posters (p. 23-24) Toxicology: Abstracts 279-293, 446 Administration: Abstracts 294-304, 306-328, 447-449, 204 Research Methods: Abstracts 329-330, 450 Disease/Injury Prevention: Abstracts 331-335, 337 Computer Technologies: Abstracts 338-344 IEME Exhibits 13-14 and 16-25

1:30-2:30 pm Power Searching: A Consumer's Guide from Point-of-Care to MetaAnalysis, Salons A/B

3:00-4:00 pm Pearls in Grant Writing, Salons A/B (p. 26)

4:45-6:15 pm Medical Student Symposium Reception/Residency Fair, Salon G (Medical Student Symposium attendees and preregistered residency programs only)

(p. 35-36)

5:00-6:00 pm, Exhibit Hall Moderated Poster Sessions (p. 22-23) Alcohol and Drug Intervention: Abstracts 271-274 Clinical ECG: Abstracts 275-278 6:00-10:00 pm - Resuscitative Hypothermia Academic Industry Roundtable, Salons A/B

8

(p. 26)

SATURDAY, MAY 31 SAEM and AEM Committee/Task Force/Board Meetings 7:30-8:00 am 9:00-11:00 am 10:00-11:00 am 2:00-3:00 pm 3:00-4:00 pm 4:00-5:00 pm 5:30-6:30 pm

2003 Annual Meeting Program Committee, Harvard 2004 Annual Meeting Program Committee, Northeastern SAEM/ABEM Officers (by invitation), Tufts Constitution and Bylaws Committee, Harvard CORD/SAEM Diversity Task Force, Northeastern Education Research Task Force, Boston College SAEM/NAEMSP Officers (by invitation), Northeastern

SAEM Interest Group Meetings 9:00-11:00 am 12:00-1:30 pm 12:00-1:30 pm 12:00-2:00 pm 2:30-3:30 pm

Medical Student Educators Interest Group, Provincetown/Orleans Geriatric Interest Group, Vineyard Diversity Interest Group, Cape Cod Simulation Interest Group, Nantucket Airway Interest Group, Vineyard

Affiliated Meetings and Satellite Symposia 7:30-9:00 am 8:00-10:00 am 8:00-11:00 am 8:30-9:30 am 8:30-2:00 pm 9:00-10:00 am 10:00 am-5:00 pm 12:00-1:00 pm 12:00-1:00 pm 12:00-2:00 pm 12:00-6:30 pm 12:30-1:30 pm 1:00-2:00 pm 1:30-2:30 pm 1:30-2:30 pm 1:30-2:30 pm 2:00-3:00 pm 2:00-3:00 pm 2:00-3:00 pm 2:30-3:30 pm 3:00-5:00 pm 4:00-5:00 pm 5:30-7:00 pm 6:00-8:00 pm

FERNE Advisory Board, Nantucket EM Hypertension Research Group, Vermont Suite RRC Task Force on Integrating the Core Competencies in the Clinical Model (by invitation), Boston University ABEM/ACEP Officers (by invitation), Tufts EMARC Residency Coordinators' Workshop, Wellesley EMRA/AAEM Officers, New Hampshire Suite EMRA Board of Directors, New Hampshire Suite CORD Board/Past Presidents Lunch (by invitation), Harvard EMARC Residency Coordinators' Workshop Lunch, Simmons Suite ACEP Executive Committee (by invitation), Tufts NAEMSP Board of Directors (by invitation), Hyannis CORD Standardized Evaluation Methods Committee, MIT Room CORD Navigating the Academic Waters Planning Committee, Boston College Grant Review - clinical application, Provincetown Grant Review - animal model, Orleans AAEM Mediterranean EM Congress Planning Committee, Northeastern CORD Information Resources Committee, MIT Room County Program Directors, Boston University ABEM/EMRA Officers (by invitation), New Hampshire Suite Expertise Group, Boston College CORD Board of Directors, Boston University CORD International EM Training Program Liaison Committee, Harvard Teaching Fellowship / EMBRS Alumni Reception (by invitation), Yarmouth EMRA/FERNE Symposium Neuro-Infectious Diseases, Wellesley 9

SUNDAY, JUNE 1

HOTEL FLOOR PLAN ON BACK COVER

8:00-9:00 am Oral Paper Presentations, Salon E Clinical Decision Rules Abstracts 345-348 (p. 30)

8:00-9:00 am Oral Paper Presentations, Salon F Radiology Abstracts 349-352

8:00-9:00 am Survey Research Methodology, Salons/AB (p. 32)

(p. 30)

9:00-10:30 am Oral Paper Presentations and Discussion, Salon E Treatment and Etiology of Headache in the ED Abstracts 353-356

9:00-10:30 am Oral Paper Presentations, Salon F Atrial Fibrillation and Congestive Heart Failure Abstracts 357-362

(p. 30)

(p. 30)

8:00-9:30 am State-of-the-Art: Exploration of the Molecular Basis of Disease in EM, Salons C/D (p. 32)

9:00-10:30 am Development and Validation of Clinical Decision Rules, Salons A/B (p. 32)

9:30-10:30 am Clinical Information Systems and Data Standards for Academic Emergency Physicians, Salons C/D (p. 32)

10:30 am-12:30 pm, Exhibit Hall Posters (p. 30-31) Psychiatry: Abstracts 371-377 Ischemia/Reperfusion: Abstracts 378-382 Clinical Decision Rules: Abstracts 383-388 Cardiovascular: Abstracts 389-408 Radiology: Abstracts 409-417 Respiratory/ENT Disorders: Abstracts 418-430, 451 Infectious Disease: Abstracts 431-438 IEME Exhibits 13-14, 16-25

(p. 35-36)

11:30 am-12:30 pm, Exhibit Hall Moderated Poster Sessions (p. 30) Psychiatry/Social Issues: Abstracts 363-366 Access to Care: Abstracts 367-370, 305 12:30-1:30 pm, Salon G BUFFET LUNCH (All Annual Meeting Registrants Invited - pre-registration required, no charge) 12:30-4:30 pm Evidence Based Medicine Workshop (pre-registration required and $40 fee, plus book)

1:30-4:30 pm Simulator Workshop (pre-registration required and $50 fee)

PHOTOGRAPHY DISPLAY CONTRIBUTORS SAEM would like to recognize and thank the following individuals who contributed to this year's Clinical Pearls and Visual Diagnosis Contest entries. It is a significant commitment of time and intellect to develop the ever-popular Photo Display.

Evan Alpert, MD Nathan R. Andrew, MD Tom Ashar, MD Alexander B. Baer, MD Robert Blankenship, MD Brian Boesiger, MD William Browder, MD Gar Chan, MD Justin C. Chang, MD Gregory Christiansen, DO Troy P. Coon, MD Chad S. Crystal, MD

Thea James, MD Abu N.G.A. Khan, MD Kevin J. Knoop, MD David C. Lee, MD Valerie R. Lint, CO Paris Lovett, MD Anuradha Luke, MD Billy J. Miller, MD D. Scott Moore, DO Jamie M. Patel, MD Laurie Pemberton, DO Lloyd Pena, MD

G. Patrick Daubert, MD Dan R. Dockham, MD Amy Drendel, DO Mary Eberhardt, MD Jason W. Edsall, MD Brian Euerle, MD Jason Gardner, MD Gus M. Garmel, MD Diane Gorgas, MD Kadeer M. Halimi, DO Alan Heins, MD David C. Hindle, MD 10

Erin Doherty-Phrampus, MD Floriano Putigna, DO David G. Reiley, MD Michael Reit, MD Jacob A. Roberts, DO Mary Ryan, MD Steven A. Seifert, MD Chu Lin Tsai, MD Brian Wexler, MD George P. Whitehead, MD

SUNDAY, JUNE 1

SAEM and AEM Committee/Task Force/Board Meetings 7:30-8:00 am 8:00-9:00 am

2003 Annual Meeting Program Committee, Harvard SAEM/AAEM Officers (by invitation), MIT Room

Affiliated Meetings and Satellite Symposia 8:00-10:00 am 8:00 am-5:30 pm 10:00-12:00 pm

ACEP Academic Affairs Committee, Falmouth NAEMSP Board of Directors (by invitation), Regis Suite ACEP Academic Affairs Committee Collaborative Meetings, Falmouth

Call for Abstracts 13th Annual Midwest Regional SAEM Meeting

Call for Advisors The inaugural year for the SAEM Virtual Advisor Program was a tremendous success. Almost 300 medical students were served. Most of them attended schools without an affiliated EM residency program. Their “virtual” advisors served as their only link to the specialty of Emergency Medicine. Some students hoped to learn more about a specific geographic region, while others were anxious to contact an advisor whose special interest matched their own.

September 19, 2003 Saginaw Cooperative Hospitals, Inc. Saginaw, MI The Program Committee is now accepting abstracts for review for oral and interactive poster presentations. The meeting will take place September 19, 2003, 8:00 am – 5:00 pm, at Curtis Hall on the campus of Saginaw Valley State University, Saginaw, Michigan.

The deadline for abstract submission is Monday, July 14, 2003, by 3:00 p.m. EDT. Only electronic submissions via the SAEM online abstract submission form at www.saem.org will be accepted. Acceptance notifications will be sent in late July.

Registration forms are available from Melinda Wardin, Department of Emergency Medicine, Saginaw Cooperative Hospitals, Inc., 1000 Houghton Avenue, Saginaw, MI 48602. Email contact is mwardin@schi.org Registration Fees: Faculty--$75; Residents/Nurses--$30; EMTs/Students—No Charge. Late fee after September 12, 2003: add $25.

Visit our website for updated information: www.schi.org

As the program increases in popularity, more advisors are needed. New students are applying daily. Please consider mentoring a future colleague by becoming a virtual advisor today. It is a brief time commitment – most communication takes place via e-mail at your convenience. Informative resources and articles that address topics of interest to your virtual advisees are available on the SAEM medical student web site. You can complete the short application on-line at http://www.saem.org/advisor/index.htm. Please encourage your colleagues to join you today as a virtual advisor.

11

Thursday, May 29

SCIENTIFIC PAPERS ORAL PAPER PRESENTATIONS

Prehospital Risk Stratification (11:00 am-12:00 noon) Moderator: Michael Sayre, MD, Beth Israel Deaconess 22. Out-of-hospital Factors Associated with Serious Abdominal or Thoracic Injury among Occupants Involved in Motor Vehicle Crashes, Craig D Newgard, MD, MPH, Oregon Health & Science University 23. Non-traumatic Prehospital Hypotension Predicts Short-term Mortality, Alan E Jones, MD, Carolinas Medical Center 24. Prospective Application of a Decision Rule by Paramedics and Emergency Physicians to Identify Pulmonary Embolism as Cause of Arrest in Outpatients with Pulseless Electrical Activity, D Mark Courtney, MD, Northwestern Memorial Hospital 25. Predictors of Survival for Out-of-hospital Respiratory Distress Patients in the OPALS Study, Ian G Stiell, MD, MSc, FRCPC, University of Ottawa

Plenary (7:30-9:00 am) Moderator: Michael Callaham, MD, University of California, San Francisco and Roger J. Lewis, MD, PhD, Harbor-UCLA *1. OPALS Study Phase III: What Is the Impact of Advanced Life Support on Out-ofhospital Cardiac Arrest?, Ian G Stiell, MD, MSc, FRCPC, University of Ottawa 2. A Randomized Controlled Trial of a Novel Anti-arrhythmic Agent RSD1235 in the Treatment of Acute Atrial Fibrillation, Brian H Rowe, MD, MSc, University of Alberta *3. Prophylaxis with Antibiotic-containing Microspheres and LiquiVent: Reduces Mortality in a Rat Model of Ventilator Associated Pneumonia, Eric W Dickson, MD, University of Massachusetts 4. Effect of Pharmaceutical Representatives on Prescribing Practices of an Emergency Medicine Residency, Kanwal Singh Gill, MD, Washington University 5. Survival of Adult Liver Stem Cells in Rat Brain after Asphyxial Cardiac Arrest, Laurence M Katz, MD, University of North Carolina

ORAL PAPER PRESENTATIONS AND DISCUSSION Clinical Management of Ischemic Stroke (1:30-3:00 pm) Moderator: Edward Jauch, MD, University of Cincinnati 26. US Emergency Department Visits for Transient Ischemic Attack, 1992-2000, Jonathan A Edlow, MD, Beth Israel Deaconess Medical Center 27. Blood Glucose Control after Acute Stroke: A Retrospective Study, Nina T Gentile, MD, Temple University *28. Short-term Prognosis after Emergency Department Diagnosis and Evaluation of Transient Ischemic Attack (TIA), Peter D Panagos, MD, University of Cincinnati 29. Long Term Mortality in Stroke Patients Treated with TPA: Emergency Physicians vs NINDS Physicians, Phillip A Scott, MD, University of Michigan

Preclinical Foundations of Cardiovascular Therapies (9:30-10:30 am) Moderator: John Watts, PhD, Carolinas Medical Center 6. Rosiglitazone Improves Endothelial Function in Rabbits with Hypercholesterolemia

by Reducing Oxidative Stress and Preserving NO/cGMP Signaling, Ling Tao, MD, Thomas Jefferson University 7. The Anti-apoptotic Effects of KW-3902, A Selective Adenosine A1 Receptor Antagonist, in Hemorrhagic Shock Rat Heart, Erhe Dao, MD, PhD, Albert Einstein Medical Center, Jefferson Health System 8. Platelet Responsiveness to Adenosine-mediated Preconditioning Is Age-dependent, Karin Przyklenk, PhD, University of Massachusetts 9. Induction of Hypothermia in Swine Using Cold Saline vs Saline Slurry, Terry L Vanden Hoek, MD, University of Chicago

ORAL PAPER PRESENTATIONS Pediatrics (1:30-3:00 pm) Moderator: Madeline Joseph, MD, University of Florida 30. Is Hospitalization Required for All Children with Post-traumatic Seizures?, James F Holmes, MD, University of California-Davis 31. Antimicrobial Susceptibility Patterns of Pediatric Uropathogens; Data from the Surveillance Network, Romolo J Gaspari, MD, MS, University of Massachusetts 32. Pain Assessment and Management of Pediatric Emergency Department Patients: Impact of a Multidisciplinary Intervention, Catherine A Marco, MD, St. Vincent Mercy Medical Center 33. The Effectiveness of Oral Dexamethasone in the Treatment of Moderate to Severe Pharyngitis in Children and Young Adults, Robert P Olympia, MD, Children's Hospital at Montefiore, Albert Einstein College of Medicine 34. Emergency Department Prevalence of Subclinical Methemoglobinemia among Dehydrated Infants, Robert J Freishtat, MD, Children's National Medical Center 35. The Effect of Limited English Proficiency on Admission Rates from a Pediatric Emergency Department: Stratification by Acuity, Alexander J Rogers, MD, Emory University

Ultrasound (9:30-11:00 am) Moderator: Michael Blaivas, MD, Medical College of Georgia 10. Accuracy of Emergency Medicine Performed Compression Ultrasound for the Evaluation of Deep Venous Thrombosis, John P Fojtik, MD, Drexel University 11. Ultrasound Changes Emergency Physician Management of Cellulitis, Nael Hasan, MD, Carolinas Medical Center 12. Doppler Ultrasound as a Non-invasive Means to Determine Stroke Volume and Cardiac Output, Robert E O'Connor, MD, MPH, Christiana Care Health System 13. Resident Performed Compression Ultrasound for the Evaluation of Proximal Lower Extremity Deep Vein Thrombosis: Fast, Accurate, and Timely, Timothy B Jang, MD, Barnes-Jewish Hospital 14. FAST vs FAST, AST, ALT and Urinalysis in Children with Blunt Abdominal Trauma, Antonio E Mu単iz, MD, Virginia Commonwealth University Health System 15. The Minimum Training Standard for "Novice" Residents Performing Focused Abdominal Sonography for Trauma (FAST), Timothy B Jang, MD, Barnes-Jewish Hospital

Infectious Disease (3:00-4:00 pm) Moderator: Edward Panacek, MD, University of California, Davis *36. The Utility of Anti-microbial Therapy for Dental Pain without Overt Infection, Michael S Runyon, MD, Carolinas Medical Center *37. Who Needs a Blood Culture? A Prospectively Derived and Validated Clinical Prediction Rule, Nathan I Shapiro, MD, MPH, Beth Israel Deaconess Medical Center 38. Efficacy of a New High Dose, Short Course of Levofloxacin vs Standard 10 Day Therapy for Treatment of Community Acquired Pneumonia (CAP) Caused by Atypical Pathogens, Lala M Dunbar, MD, PhD, Louisiana State University 39. Inability to Predict Antimicrobial Resistance of UTI Pathogens in Emergency Department Patients, Robert L Norton, MD, Oregon Health & Science University

Acute Coronary Syndromes (10:30-12:00 noon) Moderator: Marc Pollack, MD, PhD, York Hospital 16. Validation of the TIMI Risk Score in the Emergency Department Chest Pain Patient Population, Judd E Hollander, MD, University of Pennsylvania 17. Cocaine Induced Myocardial Infarction Is Associated with Reduced Microvascular Perfusion, Jim Edward Weber, DO, University of Michigan 18. The Evaluation of Hyperlipidemia in Emergency Department Patients with Possible Acute Coronary Syndrome, Andra L Blomkalns, MD, University of Cincinnati 19. Serum Markers of Coronary Pro-thrombotic State Identify High-risk Patients Missed by Traditional Myocardial Markers, Hong K Kim, MPH, Johns Hopkins University 20. The TIMI Risk Index Predicts In-hospital and Long-term Mortality in Unselected Patients with Myocardial Infarction, Leonard Ilkhanoff, MD, Massachusetts General Hospital 21. The Effect of Gender on Initial ECG Time for Patients Who Presented to an Academic Emergency Department with Chest Pain, Kevin M Takakuwa, MD, University of Pennsylvania Health System

Gastrointestinal (3:00-4:00 pm) Moderator: Stephen Hayden, MD, University of California, San Diego 40. Severe Urinary Obstruction as an Indicator of Adverse Outcome in Renal Colic Patients, Linda Papa, MD, MSc, FRCP(C), University of Florida 41. A Prospective Randomized Controlled Trial of Acupressure vs Sham for Pregnancyrelated Nausea and Vomiting in the Emergency Department, Edwin Hsu, MD, University of Pennsylvania

12

Thursday, May 29 67. Are Out-of-hospital Endotracheal Intubation Errors Associated with Patient Mortality?, Henry E Wang, MD, University of Pittsburgh 68. Intubating Conditions Produced by Etomidate Alone vs Rapid Sequence Intubation in the Prehospital Aeromedical Setting, William P Bozeman, MD, University of Florida 69. The San Diego Paramedic Rapid Sequence Intubation Trail: A Three-year Experience, Daniel P Davis, MD, University of California, San Diego 70. Inadvertent Hyperventilation following Paramedic Rapid Sequence Intubation of Severely Head-injured Patients, Daniel P Davis, MD, University of California, San Diego 71. The Effect of Paramedic Rapid Sequence Intubation on Outcome in Severe Traumatic Brain Injury, Daniel P Davis, MD, University of California, San Diego 72. The Pre-transport Index a Prospective Validation, Sarah Joanne McPherson, MD, University of Calgary 73. Comparison of Patient Needs Following Two Hurricanes, Kevin E Nufer, MD, University of New Mexico 74. Impact of an EMS Physician at Mass Casualty Incidents, Michael G Guttenberg, DO, NewYork Methodist Hospital 75. Statistical Modeling of EMS Rescue Calls, Martin L Lesser, PhD, EMT-D, North Shore University Hospital 76. Emergency Department Communication Systems (CS) Performance and Disaster Plan Response during the World Trade Center Attack (9/11/01), Rachel T Moresky, MD, Institute for International Emergency Medicine and Health, Brigham and Women's Hospital, Harvard Medical School 77. Emergency Physician Verified Prehospital Intubation, Missed Rates by Ground Paramedics, Robert Dickson, MD, Indiana University 78. Quality of Life Outcomes for Respiratory Distress Patients Treated by EMS, Josee Blackburn, MSc, University of Ottawa 79. Ultrasound in Helicopter EMS, William G Heegaard, MD, MPH, Hennepin County Medical Center 80. The Effect of Bunker Gear on Physician Performance of Advanced Life Support Procedures, C Crawford Mechem, MD, Hospital of the University of Pennsylvania 81. Adverse Events Resulting from the Discontinuation of Prehospital Droperidol Use, Kristin Sufka, MD, Hennepin County Medical Center 82. Effect of a Paramedic Pain Management Training Program on Pre-hospital Analgesic Use, David Lovesky, EMT-P, University of Massachusetts 83. Frequency of Use of Prehospital Blood Specimens for Emergency Department Diagnostic Testing, Jason Allen Borton, MD, Erie County Medical Center 84. Glasgow Coma Scale and QTc Period: Can It Help Us in the Prognosis of Patients with Organophosphate Poisoning?, Stefek Grmec, MD, PhD, Center For Emergency Medicine Maribor 85. Emergency Department Gridlock and Pre-hospital Delays for Cardiac Patients, Michael J Schull, MD, MSc, Sunnybrook and Women's College Health Sciences Center 86. Characteristics of Patients with Chest Pain Arriving by Ambulance vs Private Transport, James M Christenson, MD, Providence Health Care, University of British Columbia

42. Predictors of a Clinically Significant Diagnostic Nasogastric Aspirate, Jeff Schneider, MD, Boston University *43. Clinically Significant Improvement in Nausea as Measured on a Visual Analog Scale, Neil F Donner, USC-Keck

MODERATED POSTER SESSIONS (5:00-6:00 pm) Mechanics of Ischemic Brain Injury Moderator: Brian O'Neil, MD, William Beaumont Hospital 44. Neuroprotective Effect of Gamma-hydroxybutyrate and Its Chemical Precursors, Gamma-butyrolactone and 1,4-Butanediol, in the Rodent Model of Focal Cerebral Ischemia by Permanent Middle Cerebral Artery Occlusion, Timothy J Maher, PhD, Children's Hospital Boston *45. The Role of Decoy Molecules in Neuronal Ischemic Preconditioning, Daniel P Davis, MD, University of California, San Diego 46. Withdrawn 47. Temperature Dependence of tPA Thrombolysis in an In-vitro Clot Model, George J Shaw, MD, PhD, University of Cincinnati

ED Electroencephalography Moderator: Robert Vissers, MD, University of North Carolina at Chapel Hill 48. Mathematical Modeling of the Electroencephalogram, David M Schreck, MD, MS, FACP, Capital Health System 49. Bispectral Analysis of Head Injured Patients as a Predictor of Trauamtic Brain Injury, Eric Haug, MD, Hennepin County Medical Center 50. Bispectral EEG Analysis of Acute Overdose Patients, Ryan Fringer, MD, Hennepin County Medical Center 51. The Utililty of the Bispectral Index in Procedural Sedation in the Emergency Department, Karen Kirven, MD, Hennepin County Medical Center

POSTERS (4:00-6:00 pm) Pediatrics 52. Clinical Predictors of Respiratory Syncytial Virus (RSV) in Children, Magdy W Attia, MD, Alfred I duPont Hospital for Children 53. Clinical Predictors of Influenza in Children, Marla J Friedman, DO, Alfred I duPont Hospital for Children 54. The Frequency, Location and Age Distribution of Acute Invasive Procedures Performed on Severe Pediatric Trauma Patients in Ontario, Angelo Mikrogianakis, MD, FRCPC, Children's Hospital Of Eastern Ontario 55. Pain Assessment: A Comparison of Patient, Physician and Parent Ratings and of Rating Scales, Debra L Weiner, MD, PhD, Children's Hospital Boston/Harvard Medical School 56. Measures of Emergency Department Use in Suburban vs Urban Infants Enrolled in Medicaid, Evaline A Alessandrini, MD, MSCE, The Children's Hospital of Philadelphia 57. Wrestling with Reality: Are Pediatric Injuries Related to Media Violence?, Thuy T Bui, MD, Emory University 58. Medicaid-enrolled Infants Seeking Care for Viral Upper Respiratory Infections: The Primary Care Office or Emergency Department, Amy L Puchalski, MD, The Children's Hospital of Philadelphia 59. Does Parental Report of Insurance Status Agree with Hospital Administrative Data for Children Presenting to the Emergency Department?, Mark I Neuman, MD, Children’s Hospital 60. How Are Pediatric Patients Managed by EMS and What Are Their Outcomes?, Martin Osmond, MD, FRCPC, University of Ottawa 61. Vomiting after Liquid Steroid in Children with Asthma, Michael K Kim, MD, Medical College of Wisconsin 62. Clinical Significance of Extreme Leukocytosis in the Emergency Department Evaluation of Young Febrile Children, Samir S Shah, MD, The Children's Hospital of Philadelphia 63. Etomidate vs Pentobarbital for Sedation of Children for Head and Neck CT Imaging, Andrew J Kienstra, MD, Baylor College of Medicine

CPR 87. Comparison of Endobronchial and Endotracheal Epinephrine Delivery Methods, Mark E Brauner, Ohio University 88. The Effect of Race/ethnicity on Survival to Hospital Discharge after Out-of-hospital Cardiac Arrest: A Survival Disadvantage for Caucasians, Jason S Haukoos, MD, Harbor-UCLA 89. Age Is Associated with Elevated Troponin T in Out-of-hospital Cardiac Arrest, Christopher S Lai, MD, University of Pittsburgh 90. Protocol Adherence of Community Sites in the Public Access Defibrillation Trial, Robert E O'Connor, MD, MPH, Christiana Care Health System 91. Retention of Advanced Cardiac Life Support(ACLS) Skills Taught in a One-day Course Is Better Than That Found after a Two-day Course, D Matthew Sullivan, MD, Carolinas Medical Center 92. Ischemically Induced Ventricular Fibrillation (VF): A Comparison of Fixed and Escalating Energy Defibrillation, James T Niemann, MD, Harbor-UCLA Medical Center 93. The Fallacy of Energy as an Accurate Descriptor of Relative Shock Intensity among Different Clinically Used External Defibrillators, Robert G Walker, Medtronic PhysioControl

EMS 64. The Practice of Pain Medication Administration Following EMS Protocol Change, Joe Chang, MD, University of Michigan 65. Out-of-hospital Cardiac Arrest Survival Rates in an EMS System Utilizing the System Status Management Dispatch Model, Rollin J Fairbanks, MD, MS, NREMTP, University of Rochester 66. Improvement in Misplaced Endotracheal Tube Recognition within a Regional Emergency Medical Services System, Eric Carter, MD, Orlando Regional Medical Center

Education 94. The Impact of Emergency Medicine Student Clerkships on Ambulatory Medical Education: An Encounter-based Analysis, John F Mahoney, MD, University of Pittsburgh

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Thursday, May 29 108. Female Chairs and Female Faculty, David Cheng, MD, University of Arkansas 109. The Effect of Working Nights on Missed Diagnosis among Patients with Acute Cardiac Ischemia in the Emergency Department, Denise C Rollinson, MS, MD, Tufts-New England

95. The 2002 Emergency Medicine Program Directors' Survey, Michael S Beeson, MD, MBA, Summa Health System 96. Impact of Medical Trainees on Clinician Efficiency and Diagnostic Utilization, Grant D Innes, MD, Providence Health Care, St. Paul's Hospital 97. The National Prevalence of Illegal and Inappropriate Residency Interview Questions, H Gene Hern, Jr., MD, MS, Alameda County Medical Center - Highland Hospital 98. What Aspects of a Residency Program’s Website Are Important to Medical Student Applicants?, Theodore J Gaeta, DO, MPH, New York Methodist Hospital 99. Determining Redundancy among Items Used to Evaluate Practice-based Learning and Improvement, Earl J Reisdorff, MD, Ingham Regional Medical Center 100. Do Emergency Medicine Residents' Obsevations of Their Residency Program Correlate with Emergency Medicine Applicants' Perceptions?, Armando Hevia, MD, University of North Carolina 101. Determining Distinct Measures for the ACGME General Competencies for Emergency Medicine Training, Earl J Reisdorff, MD, Michigan State University 102. Resident Error in Emergency Medicine: The REEM Study, Armando Hevia, MD, University of North Carolina 103. “Healthy People 2010” Emergency Medicine Module: A Survey of Emergency Medicine Residency Programs and Validation Study, Dominic A Borgialli, DO, MPH, Michigan State University 104. Does Attitude Affect Behavior?: Emergency Physicians Attitudes and Beliefs Toward Patients with Alcohol-related Problems, Maria C O'Rourke, MD, Madigan Army Medical Center, University of Washington 105. What Characteristics of Emergency Medicine Applicants Will Predict Future Performance as an Emergency Medicine Resident?, Stephen R Hayden, MD, University of California-San Diego 106. Does Fellowship Pay?, Steven L Kristal, MD, William Beaumont Hospital 107. Evaluation of the Utility of an Off-service Orthopedic Rotation for Emergency Medicine Residents, Barry Jay Hahn, MD, State University of New York-Downstate and Kings County Hospital Center

Gastrointestinal 110. Is Fecal Leukocyte Esterase Testing Useful for the Evaluation of Infectious Diarrhea?, Peter E Sokolove, MD, University of California-Davis 111. Influence of Age and Seasonality on Patterns of Gastroenteritis in an Emergency Department Biosurveillance System, Vashun A Rodriguez, UMDNJ-Robert Wood Johnson Medical School 112. Is There a Relationship between the Size of a Kidney Stone and the Degree of Hydronephrosis?, Jagruti Patel, MD, North Shore University Hospital 113. Pharmacotherapeutic Approach to Nausea & Vomiting in the Emergency Department, Manish M Patel, MD, Emory University 114. Nausea and Vomiting Management in US Emergency Departments, Jonathon M LaValley, BS, University of New Mexico 115. The Clinical Presentation of Acute Biliary Pancreatitis, Kathleen A Delaney, MD, University of Texas-Southwestern

Ethics 116. Do Not Resuscitate Orders: Do They Extend beyond the Arrest Situation?, David E Manthey, MD, Wake Forest University Baptist 117. Families and Friends Are Inadequate Sources for Advanced Directive Decisions, Patrick Pettengill, MD, William Beaumont Hospital 118. Informed Consent for Emergency Department Procedures, Catherine A Marco, MD, St. Vincent Mercy Medical Center 119. Interactions between Emergency Medicine Programs and the Pharmaceutical Industry, Samuel M Keim, MD, University of Arizona

DIDACTIC SESSIONS Introduction to Statistics (9:30-10:30 am)

State-of-the-Art: Acetaminophen: Research Opportunities for Toxicology's Biggest Headache (10:30 am - 12:00 noon)

Roger J. Lewis, MD, PhD, Harbor-UCLA Medical Center This session will cover introductory statistical topics such as data types, common statistical tests and their application, the meaning of p values and confidence intervals, and simple sample size and power calculations. An investigator with a firm understanding of these concepts is better equipped to plan a sound research study, develop testable hypotheses, choose appropriate analytic methods, and determine the feasibility of performing a study in a given population and setting. Issues surrounding multiple testing, subgroup analysis, and the intention-to-treat principle will also be discussed. At the completion of the session, participants will understand basic statistical concepts and methods that are needed for collaboration with more experienced researchers and biostatisticians on the design and analysis of a study.

Barry Rumack, MD, Rocky Mountain Poison and Drug Center Kennon Heard, MD, University of Colorado Mark Kirk, MD, Blue Ridge Poison Center Acetaminophen (APAP) poisoning is the most common cause of poisoning death in the US. This ninety-minute session will discuss three aspects of acetaminophen poisoning where current understanding is limited or has recently changed. The goal of this session is to highlight research opportunities and potential pitfalls. Each discussant will address a preset list of questions to help focus the discussion. Dr. Rumack will discuss risk factors that may predispose patients to liver injury from APAP poisoning and the critical biochemical pathways. Recent developments have changed our understanding of how genetics, nutritional, and medical factors (drugs and disease) alter APAP metabolism.

Currently accepted criteria must be re-evaluated and new studies must incorporate these findings to accurately identify the "high risk patient". This speaker will focus on the gaps in knowledge where more research is needed. Dr. Heard will discuss evaluation of the non-acute APAP ingestion. While these patients represent a substantial proportion of the morbidity and mortality associated with acetaminophen poisoning, they cannot be evaluated with standard techniques. This discussion will highlight the magnitude of this disease, the limitations of current approaches and describe a research approach to address this problem. Dr. Kirk will discuss the science behind the current duration of therapy, why shorter treatment is feasible, discuss limitations of recent clinical data and propose future trials to investigate the optimal duration of therapy. He will address the benefits of such a study and the problems that may be associated with this research, including the need for a multi-center trial (with limited funding) and difficulty in obtaining meaningful follow-up on patients. At the completion of the session, participants will be able to: Identify the flaws in the classic description of a patient at high risk for acetaminophen toxicity, and understand what future work needs to be performed to accurately identify these patients. Describe what new studies must be done to risk stratify patients following chronic acetaminophen poisoning. Discuss the appropriateness and design of a multi-center trial of shorter duration therapy for acetaminophen poisoning.

EMS Research: Challenges and Solutions (9:30-11:00 am) David C. Cone, MD, Yale University Ronald G. Pirrallo, MD, MHSA, Medical College of Wisconsin It is well recognized that out-of-hospital research is in many ways very different from inhospital and in-laboratory research. Much work has been done elucidating the many barriers and challenges that the field environment presents. What has been less well discussed are distinct tools, mechanisms, and models for overcoming the difficulties associated with out-of-hospital clinical and systems research. The purpose of this session is to move from "problems" to "solutions," including both generic tools and principles that out-of-hospital researchers can use, presenting and analyzing specific solutions that have successfully been applied to specific problems in recent out-of-hospital studies.

Certain study designs and methodologies will be examined in terms of their applicability to the field environment, and the differences between systems research and clinical research will be discussed. At completion of this session, participants will 1) have a toolbox of techniques, models, and concepts for anticipating and overcoming frequently encountered problems in out-of-hospital research; 2) be aware of successful studies that have used these approaches; 3) understand why certain research designs are more amenable to field research than others, and how to choose and apply the right design successfully for a given project; 4) understand the applicability of systems research methodologies to the complex, poorly controlled out-of-hospital environment; and 5) be able to raise questions regarding research implementation and be given best practice solutions.

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Thursday, May 29 Educational Research Methodology (11:00 am - 12:00 noon)

Bill Spivey Memorial Lecture: Research in Emergency Medicine: Its Physiognomy (1:30-2:30 pm)

Gloria Kuhn, MD, Wayne State University Janet Hafler, EdD, Harvard Medical School This session will provide the participant with the tools needed to design and implement a research project in the area of emergency medicine education. The first lecture will describe the process of designing an educational research project. It will cover the generation of a well-defined and answerable research question, the selection of an appropriate study design, and the differentiation between quantitative and qualitative outcome measures. The second lecture will discuss qualitative research, which may often be more appropriate in the study of educational outcomes and the process of human learning.

This research methodology is used specifically to gather data about particular settings, persons, or events that cannot be gathered through other sources. Basic concepts in qualitative research and its potential in medical education research will be explored. At the completion of the session, participants will be able to: (1) compare and contrast quantitative versus qualitative research, (2) describe the components of a well-designed educational research project, (3) describe various outcome measures.

Peter Rosen, MD, University of California, San Diego This course will focus on some of the key questions facing academic Emergency Medicine: Why do we need a research base in Emergency Medicine? What kinds of research projects will be successful? What obstacles are there for doing clinical research in Emergency Medicine? What constitutes proof? What does it take for people to change their practice? In addition, Dr. Rosen will discuss flaws that are commonly seen in Emergency Medicine research currently, elaborating on current research methodologies.

He will discuss the difference between statistical and clinical significance, and relate this to practice standards. At the completion of the session, participants will 1) understand the history of Emergency Medicine research. 2) understand obstacles inherent in clinical research and the common flaws of current emergency medicine research studies. 3) understand the difference between statistical and clinical significance of data. 4) understand the threshold of proof that has historically been necessary for physicians to change the practice standards. This session is especially designed for residents and junior faculty.

Lunch Session: Educating Emergency Physicians to Care for Our Patients at the End of Life (12:00-1:30 pm)

The Inconvenience of Convenience on Prospective Emergency Medicine Research (1:30-2:30 pm)

Terri Schmidt, MD, Oregon Health and Sciences University Tammie E. Quest, MD, Emory University J. Andrew Billings, MD, Massachusetts General Hospital It has been estimated that the average person lives for 3 years in a chronically ill state before their death. Training programs in emergency medicine focus on technology, aggressive interventions and resuscitation. At the same time, patients are living longer with chronic diseases. Palliative or "comfort" care, while part of medicine through out the lifespan, may predominate as a goal of care for patients with such diagnoses as CHF, COPD, Alzheimer's, cancers (in and out of remission), and AIDS with an expected survival of 6 months or less. Many of these patients will present to ED for acute events during their dying process. An important part of the skill set for EPs is the professionalism and communication skills newly part of the core curriculum which encourage patient conversations, assessment and decisionmaking to facilitate the patient's wishes during crises with chronic disease and at the end of life. We propose to provide a didactic session that will address the following issues: 1. What exactly is excellent EOL/Palliative Care? (Dr. Billings) 2. What are the characteristics of a patient that presents for End-ofLife/Palliative care in the ED and what skill set is required of the Emergency Physician? ? (Dr. Schmidt) 3. How do we begin to effectively and comprehensively teach EOL and Palliative Care in the Emergency Setting given the ACGME Core Curriculum Requirements? (Dr. Quest) Proposed format: Presentation by each panelist with Dr. Quest also serving as moderator when needed. Panel: National trends, teaching resources, experiences at the panelists' institutions Panel: Questions from audience. At the completion of the session, participants will be able to identify: 1. What are the characteristics of a patient that presents for End-of-Life/Palliative care in the ED? 2. What exactly is excellent EOL/Palliative Care and what skill set is required of the Emergency Physician? 3.

How do we begin to effectively and comprehensively teach EOL and Palliative Care in the Emergency Setting given the ACGME Core Curriculum Requirements? (Pre-registration and $35 fee required).

Edward A. Panacek, MD, University of California, Davis Judd Hollander, MD, University of Pennsylvania J. Lee Garvey, MD, Carolinas Medical Center Prospective clinical trials traditionally produce the most impact on patient care and the career of a clinical researcher. In the hectic setting of the busy emergency department, many prospective studies obligatorily become convenience studies. This session will focus on the concept of "inconvenience" as the archenemy of the young investigator who seeks to conduct a prospective clinical trial. This session will first focus on the definition and cause of "inconvenience" and how it damages study design, induces bias, changes the predicted sample size, and destabilizes enrollment. The second part will then offer potential solutions from the viewpoint of successful investigators. These will include specific points of study design and execution that can help obtain a random sample in treatment and diagnostic studies. The speakers will also address methods they have found helpful in educating and training colleagues to assist with enrollment in a prospective study. At the completion of the session, participants will 1) Describe the classical study designs for treatment and diagnostic studies 2) Describe the difference in methods used to estimate a sample size for a treatment study compared with a diagnostic study 3) Isolate the main causes of "inconvenience" in emergency department research 4) Recognize the adverse effect of "inconvenience" on the study design, effect size and sample size in emergency department research 5) Describe the most common pitfalls in overestimating rate of subject enrollment with respect to training and recognition of colleagues 6) Describe a method to help measure bias induced by "inconvenience" in prospective research

State-of-the-Art: New Perspectives in Emergency Medicine Patient Safety Research: Innovative Scientific Applications and International Perspectives (2:30-4:00 pm) Moderator: Christopher Beach, MD, Northwestern University Shawna J. Perry, MD, University of Florida, Jacksonville Ravi Behara, PhD, Florida Atlantic University John Vinen, MD, FACEM, FIFEM, Royal North Shore Hospital, Australia Safety science is a relatively new area of study in medicine. Research in patient safety has enjoyed input from both clinical and non-clinical sciences. One of the distinguishing aspects of study in patient safety is the development of a skill set which requires extensive understanding and interest in sciences outside of classic medical teaching. For instance, communication, teamwork and leadership have large impacts on patient care and efficiency; ED ergonomic structures, both architecturally and human factors may play large roles in coordinating safe, dependable clinical care; and, lastly cognitive forcing functions may help the most unreliable aspect of care, 'the human', become the most reliable component of great emergency medical care. Patient safety efforts in medicine have recently received tremendous support from funding agencies, predominantly through AHRQ. Multiple Fortune 500 companies created a watchdog group, the Leapfrog Group to ensure the safe delivery of medical care to their employees. Emergency medicine is developing a Center of Excellence focused on patient safety entitled, the Center for Safety in Emergency Care (CSEC). Patient safety has risen on the agenda of political, business and administrative groups just as it has seen support and new thought in medicine. This session will provide students and faculty with new concepts and alternative pathways to study patient safety in medicine. It will also describe current research endeavors both within the United States and abroad. The moderator (Dr. Beach) will introduce each speaker, provide a brief overview of the session and direct the question and

Lunch Session: Findings of the rt-PA Acute Stroke Treatment Review Panel (12:30-1:30 pm) Moderator: Lewis Goldfrank, MD, Bellevue Hospital Center/New York University Medical Center Vicki Hertzberg, PhD, Emory University Timothy Ingall, MB, BS, PhD, Mayo Medical School Thomas Louis, PhD, Johns Hopkins Bloomberg School of Public Health The critical analysis undertaken by the review pane will be discussed. These analyses will include: 1) Investigation of the lack of balance between the two treatment groups with respect to baseline NIHSS, and the impact of adjustment for this imbalance on the clinical outcome variables; 2) Assessment of the implications of using different scales of measurements of the outcome variables, resulting in estimates of odds ratios, relative risks, and absolute risks that are adjusted for imbalance; and 3) Evaluation of the risk of ICH among all the stroke patients in the study, with particular emphasis on those treated with rt-PA. Analysis of high blood pressure and its management for both a history of hypertension prior to the stroke, and hypertension during the acute event will also be discussed. At the completion of the session, participants will learn the process utilized by the National Institute of Neurological Disorders and Stroke to create an independent review panel; learn the review committee's processes in addressing whether there is concern that eligible stroke patients may not benefit from rt-PA given according to the protocol used in the trials and whether the subgroup imbalance invalidates the entire trial.

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Thursday, May 29 How To Write Science (2:30-4:00 pm)

answer portion. Speaker #1 (Dr. Perry) will describe recent literature and on-going efforts in patient safety research within the United States. Dr. Perry will also introduce new perspectives and applications from traditionally non-clinical sciences including organizational theory, communications, and human factors and ergonomics. Speaker #2 (Dr. Vinen) will describe successes and failures in patient safety research from Australia. He will present data from the Australia Critical Incident Monitoring System. Lastly, he will offer international perspectives and review current studies from abroad on safety in health care. Speaker #3 (Dr. Behara) will describe how operations science and knowledge management can be applied to patient safety research in emergency medicine. He will provide insight on current directions of non-clinical safety research, including NASA, and may reveal personal experiences with medical error from the patient’s perspective.

Presentations will be made by each member of the panel; leaving ample time for a lengthy question and answer session. At the completion of the session the audience will 1) understand the unique skill set necessary for study in the safety sciences; 2) recognize the important non-clinical sciences that are being applied to safety research in medicine; 3) learn how these collaborative efforts began and how they may be applied to clinical care; and 4) identify safety researchers and their particular subject matter expertise, both within and without the United States.

Michelle H. Biros, MS, MD, Hennepin County Medical Center David C. Cone, MD, Yale University School of Medicine Scientific writing is both an art form and a technical skill. This session will cover both, focusing on both the style considerations and the mechanical "nuts and bolts" of putting together a sound research paper and shepherding it through the review and publishing process. Elements of a research manuscript's style, including both content (the actual elements of the project performed, and thus of the resulting manuscript) and the context (elements of the overall project that are not controllable features of the research protocol, but can significantly determine the value of and disposition of the paper), will be described in detail. The value of planning and even drafting the manuscript before beginning data collection will be emphasized, and specific techniques for prospectively converting the research project into a readable, accurate manuscript will be discussed.

Ethical issues, logistical and process issues, and publication politics will be covered as well. The session will also teach prospective authors how the process by which a submitted manuscript evolves into a published paper can be best used to maximize the quality and value of the work. A question and answer session will be offered at the conclusion of the presentation. At the completion of the session, participants will 1. Recognize the importance of writing and publishing to the overall goals of research, to the success of a given research project, and to the advancement of EM as a specialty. 2. Understand both technical and cognitive reasons why manuscripts fail. 3. Recognize and be able to avoid common manuscript errors. 4. Understand ethical issues regarding authorship, conflicts of interest, permissions, and dual submission. 5. Understand the peer review process and how to use it (not fight it) to improve a research manuscript and get it published.

BANQUET KEYNOTE SPEAKER the basis for development of Norplant, the contraceptive used internationally, and initiated the field of controlled release technology. At this time, Folkman also began growing tumors in isolated perfused organs, which led to the idea that tumors are angiogenesis-dependent.

Folkman’s discoveries of the mechanism of angiogenesis opened a field of investigation that has led to clinical trials of angiogenesis inhibitors in the United States and Europe. Largely because of Folkman’s research, the possibility of anti-angiogenic therapy is now on a firm scientific foundation, not only in the treatment of cancer, but of many non-neoplastic diseases as well.

Folkman holds honorary degrees from eleven universities and is the recipient of numerous national and international awards. He was elected to the National Academy of Sciences, the American Academy of Arts and Sciences, the American Philosophical Society and the Institute of Medicine of the National Academy of Sciences.

In addition to his distinguished accomplishments in research, Folkman has served as a surgeon and teacher. He began his career as an instructor in surgery for Harvard’s Surgical Service at Boston City Hospital, Boston, was promoted to professor of surgery at Harvard Medical School, and became the Julia Dyckman Andrus Professor of Pediatric Surgery in 1968. From 1967 he served as surgeon-in-chief at the Children’s Hospital Medical Center for 14 years. Folkman also is professor of cell biology at the Harvard Medical School.

Born in Cleveland in 1933, Folkman graduated cum laude from The Ohio State University, Columbus, Ohio, in 1953. He continued his education at Harvard Medical School, where he graduated magna cum laude in 1957.

Folkman began his surgical residency at the Massachusetts General Hospital and served as chief resident in surgery from 1964-1965.

As a student, Folkman coauthored papers describing a Judah Folkman, M.D. new method of hepatectomy for liver cancer and developed the first atrio-ventricular implantable pacemaker for which he received the Boylston Medical Prize, Soma Weiss Award and Borden Undergraduate Award in Medicine.

While serving as a lieutenant in the U.S. Navy from 1960-1962, Folkman and a colleague at the National Naval Medical Center, Bethesda, MD, first reported the use of silicone rubber implantable polymers for the sustained release of drugs. Their findings became 16

Friday, May 30

SCIENTIFIC PAPERS *141. A Comparison of the Use of Iontophoresis and Oral Non-steroidal Anti-inflammatory Medication in the Pain Management of Acute Soft Tissue Injuries in the Emergency Department Setting, Dean C Bailey, Medical College of Ohio

ORAL PAPER PRESENTATIONS Translational Research in Shock and Traumatic Injury (8:00-9:30 am) Moderator: John Younger, MD, University of Michigan 120. Activation of Myocardial Caspase in Experimental Septic Shock in Rats, John A Watts, PhD, Carolinas Medical Center 121. Comparison of the Effects of DADLE and Norepinephrine Treatments on Hemodynamics and Survival in Hemorrhagic Shock, Richard L Summers, MD, University of Mississippi *122. Hypertonic Saline Invokes Divergent Inflammatory Effects on Human Vascular Smooth Muscle, Maria E Moreira, MD, Denver Health Medical Center 123. Preliminary Study of Nicotinamide (Vitamin B3) as a Neuroprotective Agent Following Experimental Spinal Cord Injury, Kori L Brewer, PhD, East Carolina University 124. Regional Blood Flow and Organ Perfusion in a Swine Model of Hemorrhagic Shock, Lance Wilson, MD, MetroHealth Medical Center 125. CNI-1493 Enhances Reepithelialization of Second Degree Burns in Swine, Adam J Singer, MD, State University of New York

ORAL PAPER PRESENTATIONS AND DISCUSSION Pulmonary Embolism in the ED (10:30-12:00 noon) Moderator: Samuel Goldhaber, MD, Brigham & Women's Hospital 142. Identifying Patients at Risk for Hospital-acquired Venous Thromboembolism in the Emergency Department, Susan B Sheehy, MSN, MS, RN, CEN, FAAN, Beth Israel Deaconess Medical Center 143. An Independent Validation of the Latest D-dimer Assay for Pulmonary Embolism, Tae Kim, MD, Loma Linda University 144. The Frequency of Pulmonary Embolism Depends on the Suspected Diagnosis, Christopher Kabrhel, MD, Brigham and Women's Hospital 145. Use of Spiral CT Angiogram to Replace Ventilation-perfusion Scan or Pulmonary Angiogram in Strategies for the Diagnosis of Pulmonary Embolism. A Cost-effectiveness Analysis, Rodney W Smith, MD, St. Joseph Mercy Hospital

EMS (8:00-9:30 am)

ORAL PAPER PRESENTATIONS

Moderator: Theodore Delbridge, MD, MPH, University of Pittsburgh 126. Prospective Countywide Trial to Decrease Ambulance Diversion Hours, Gary M Vilke, MD, Univerisity of California, San Diego Medical Center 127. Aspiration of Gastric Contents: Association with Prehospital Intubation, Jacob W Ufberg, MD, Temple University Hospital 128. Intranasal Naloxone Is a Safe First-line Treatment for Patients with Respiratory Compromise Due to Suspected Opiate Overdose, Anne-Maree Kelly, MD, Jospeh Epstein Centre for Emergency Medicine Research 129. Determination of Accurate Out-of-hospital Cardiac Arrest Location in 20 Communities, Christian Vaillancourt, MD, FRCPC, University of Ottawa 130. Comparing the Ability of Colorimetric and Digital Waveform End Tidal Capnography to Verify Endotracheal Tube Placement in the Prehospital Setting, Amar Singh, MD, Christiana Care Health System 131. Out-of-hospital Cardiac Arrest Locations in a Predominantly Rural Community: Where Should We Place AED?, Marc E Portner, MS, Penn State University

Education (11:00-12:00 noon) Moderator: Katherine Heilpern, MD, Emory University 146. A Comparison of Faculty Contact Time with Emergency Medicine Residents in Different Teaching Venues, Laura F Whenmouth, Indiana University 147. Assessing Global Performance in Emergency Medicine Using a High-fidelity Patient Simulator: A Pilot Study, James A Gordon, MD, MPA, Massachusetts General Hospital-Harvard Medical School 148. Comparison of Learning Rates and Skill Retention for Two Procedure Training Methods, Richard L Lammers, MD, Kalamazoo Center for Medical Studies 149. Does the Demand for Clinical Productivity Compromise Teaching in Academic Emergency Departments?, Todd J Berger, MD, Emory University

Measurement of Pain and Nausea (1:30-2:30 pm) Moderator: Adam Singer, MD, Stony Brook University Hospital 150. Inter-rater Variation in the Emergency Department Abdominal Exam in Patients Presenting with Abdominal Pain, Jesse M Pines, MD, MBA, University of Virginia 151. Randomized Trial of Three Methods of Improved Pain Assessment: Graphing Pain as a Vital Sign Results in Improved Awareness of Analgesic Needs, Stephen H Thomas, MD, MPH, Harvard Medical School 152. The Anesthetic Effectiveness of Lidocaine-adrenaline-tetracaine Gel on Finger Lacerations, Nicholas White, MD, Medical College of Wisconsin 153. Feasibility of Pain Measurement in the Prehospital Setting, Samuel A McLean, MD, University of Michigan

Airway Management (9:30-10:30 am) Moderator: Ron Walls, MD, Brigham & Women's Hospital 132. Use of the Intubating Laryngeal Mask Airway in Prehospital Patients with Failed Rapid Sequence Intubation, Michael Gibbs, MD, Maine Medical Center 133. Traching an Airway Learning Curve: Multicenter Analysis of Over 6000 Initial and Rescue Intubation Attempts by EM Residents, Yi-Mei Chng, MD, Brigham & Women's Hospital 134. General Anesthesia During Emergency Department Procedural Sedation With Propofol, William E Hauter, MD, Indiana University 135. Assessing Mallampati Scores, Thyromental Distance, and Neck Mobility in Emergency Department Intubated Patients, Richard M Levitan, MD, University of Pennsylvania

Trauma (1:30-2:30 pm) Moderator: Craig Newgard, MD, Oregon Health and Sciences University 154. Role of Single Worst Injury vs Multiple Injuries in Predicting Pediatric Trauma Mortality, Stephen M DiRusso, MD,PhD, New York Medical College/Westchester Medical Center 155. Ethanol and Drug Ingestion Do Not Affect the Diagnostic Performance of Base Deficit in Trauma Patients, Shahriar Zehtabchi, MD, SUNY Downstate Medical Center/Kings County Hospital 156. Validation of Decision Instrument to Limit Pelvic Radiography in Blunt Trauma, Brandie Anne Niedens, MD, Maricopa Medical Center 157. Rapid Bedside Ultrasonic Evaluation of Depressed Skull Fractures, Kishani Heendeniya, MD, The Brooklyn Hospital Center

Randomized, Controlled Clinical Trials to Reduce Pain and Nausea (9:30-11:00 am) Moderator: Michelle Blanda, MD, Summa Health Systems 136. Comparison of Topical Anesthetics and Lubricants Prior to Urethral Catheterization in Male Patients. A Randomized Controlled Trial, John Siderias, DO, State University of New York *137. Analgesia for Musculoskeletal Injuries in Children: A Randomized, Blinded, Controlled Trial Comparing Acetaminophen, Ibuprofen and Codeine, Eric A Clark, MD, FRCPC, Children's Hospital of Eastern Ontario 138. A Randomized Controlled Trial Comparing Femoral Nerve Block to Intravenous Morphine in Isolated Femur Fractures, James Levine, MD, Albany Medical Center 139. A Prospective, Randomized, Double-blind Comparison of Buffered vs Plain Tetracaine in Reducing the Pain of Topical Ophthalmic Anesthesia, Christopher S Weaver, MD, Indiana University *140. Low Dose Naloxone Does Not Improve Nausea and Pruritis Associated with Bolus IV Morphine Administration, Jennifer Provataris, MD, Albert Einstein College of Medicine

Traumatic Brain Injury (2:30-3:30 pm) Moderator: David Wright, MD, Emory University 158. Multicenter Comparison of GCS and RTS Scores at Scene vs at Trauma Hospital, Majid Al-Salamah, MD, University of Ottawa 159. Multicenter Comparison of the Predictive Value of the Revised Trauma Score and the Glasgow Coma Scale, Majid Al-Salamah, MD, University of Ottawa 160. Multicenter Prospective Validation of the New Orleans Criteria for CT in Minor Head Injury, Ian G Stiell, MD, MSc, FRCPC, University of Ottawa

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Friday, May 30 186. Comparison of the Percentage of Glottic Opening (POGO) Scale to Laryngoscopy Grading Scale (LGS) and Global Difficulty of Intubation, Willaim P Bozeman, MD, University of Florida 187. The Insecure Airway: A Comparison of Knots and Commercial Devices for Securing Endotracheal Tubes, Paris B Lovett, MD, Beth Israel Medical Center 439. Triage Application of Topical Anesthetic for IV Placement in the Pediatric Emergency Department (PED): Comparing a Prediction Model to Nurse Judgment, Joel A Fein, MD, The Children's Hospital of Philadelphia

161. Multiple Episodes of Mild Traumatic Brain Injury Impair Cognitive Performance in Mice, Catherine E Creeley, MA, Washington University

Geriatrics (2:30-3:30 pm) Moderator: Stephen Meldon, MD, MetroHealth Medical Center 162. How Does Octogenarian Status Affect Morbidity, Mortality, and Functional Outcomes of Elderly Drivers in Motor Vehicle Crashes in Pennsylvania, 1988 to 2001?, Philip N Salen, MD, St. Lukes Hospital *163. Utility of Performing Lumbar Puncture in the Afebrile Elderly Patient with Altered Mental Status, Kaushal H Shah, MD, Beth Israel Deconess Medical Center 164. Intracranial Pathology in the Elderly with Minor Head Injury, Niels Rathlev, MD, Boston Medical Center, Boston University 165. Alcohol and Nicotine Dependence in Elderly Emergency Department Patients: Rates, Health and Medical Care Utilization, Daren D Girard, MD, Rhode Island Hospital

Ultrasound 188. Sonographic Assessment of the Epiglottis, Robert A Jones, DO, RDMS, MetroHealth Medical Center 189. Deep Vein Thrombosis in the Emergency Department (DVT-ED), Tenny Thomas, MD, George Washington University 190. The Influence of Operator Confidence on the Accuracy of Emergency Department Ultrasound, Daniel P Davis, MD, University of California, San Diego 191. Short and Long Term Effects of Emergency Medicine Ultrasound on Formal U/S Utilization: A Decade of Experience, Jeanne L Jacoby, MD, St. Luke's Hospital 192. Success Rate of Peripheral IV Catheter Insertion by Emergency Physicians Using Ultrasound Guidance, Thomas G Costantino, MD, Drexel University 193. Emergency Ultrasound Optic Nerve Sheath Measurement to Detect Increased Intracranial Pressure in Head Injury Patients: Preliminary Study of Interobserver Variability in Normal Human Subjects, Vivek S Tayal, MD, Carolinas Medical Center 440. Frequency Of Incomplete Abdominal Aorta Visualization By Ultrasound When Ruling Out Aneurysm, Michael Blaivas, MD, RDMS, Medical College of Georgia 441. Short Axis Versus Long Axis Approaches For Teaching Ultrasound Guided Vascular Access, Michael Blaivas, MD, RDMS, Medical College of Georgia 442. Ultrasound Image Quality In The Emergency Department; Sonosite 180 Plus Versus GE 400, Michael Blaivas, MD, RDMS, Medical College of Georgia 443. ED Ultrasound Evaluation of the Index Flexor Tendon: A Comparison of Water-Bath Evaluation Technique (WET) versus Direct Contact Ultrasound, Paul R Sierzenski, MD, RDMS, Christiana Care Health System 444. Water-bath vs Direct Contact Ultrasound: A Randomized, Controlled, Blinded Image Review, Paul Sierzenski, MD, RDMS, Christiana CareHealth Sstem

MODERATED POSTER SESSIONS (4:30-5:30 pm) Education Moderator: Wendy Coates, MD, Harbor-UCLA Medical Center 166. Procedural Competence of New PGY1 Emergency Medicine Residents, Richard L Lammers, MD, Michigan State University 167. Predictors of Residency Program Scholarly Productivity, Sonia M Chacko, MD, Washington University 168. Exposure and Comfort of Emergency Medicine Residents with Thrombolytic Therapy for Acute Myocardial Infarction, Charles L Maddow, MD, University of Rochester 169. Inaccuracies on Applications for Emergency Medicine Residency Training, Martha Susan Roellig, MD, Washington University in St. Louis

Mechanisms of Anoxic Brain Injury Moderator: Robert Neumar, MD, PhD, University of Pennsylvania *170. Cardiac Arrest and Hypothermia Increase GDNF in Brain, Katherine M Schmidt, University of Pittsburgh *171. Adenoviral Transfer of the Heme Oxygenase-1 Gene Protects Astrocytes from Heme-mediated Oxidative Injury, Zhi Ping Teng, MD, PhD, Thomas Jefferson University 172. A Novel Approach to Oligonucleotide Microarray Analysis to Identify Candidate Genes for Neuronal Ischemic Preconditioning, Daniel P Davis, MD, University of California, San Diego *173. Inhibiting ERK Activation during Hypothermia after Cardiac Arrest, Brian J D'Cruz, BS, University of Pittsburgh

POSTERS

Teaching Methods 194. High-fidelity Medical Simulation and Its Role in Evaluating Advanced Cardiac Life Support (ACLS) Skills, Marc J Shapiro, MD, Brown University 195. The Validation of Simulation to Evaluate Flight Crew Members’ Airway Management Skills, Steven A Godwin, MD, University of Florida 196. Retention of Emergency (EM) Residents’ Cricothyrotomy Skills at 14 Months after a Procedure Lab Using a Deer Neck Model to Practice this Procedure, Robert Schwaner, MD, North Shore University Hospital 197. Full-scale High Fidelity Human Patient Simulation vs Problem Based Learning: Comparing Two Interactive Educational Modalities, Wendy C Coates, MD, Harbor UCLA Medical Center 198. Focused Computer Tutorials in the Pediatric Emergency Department: A Randomized Controlled Trial, Martin V Pusic, MD MA, University of British Columbia 199. Learning Style Analysis in Emergency Medicine ResidencyTraining, Sanjey Gupta, MD, North Shore University Hospital 238. Investigation of the Use of Core Practical Objectives for Standardizing the Experiences of Fourth Year Medical Students during an Emergency Medicine Clerkship, Jay H Woodland, University of Illinois College of Medicine at Peoria

(3:30-5:30 pm)

Airway Management 174. Unrecognized Misplaced Endotracheal Tubes in a Mixed Urban to Rural EMS Setting, Michael E Jemmett, MD, Maine Medical Center 175. The Minimum Acceptable Reduction in Pain on a Visual Analog Scale, Barbara G Lock, MD, NewYork-Presbyterian Hospital, Columbia University 176. NPO Status and Adverse Events in Children Undergoing Procedural Sedation and Analgesia in the Emergency Department, Dewesh Agrawal, MD, Children's Hospital Boston 177. Ketamine with and without Atropine: What's the Risk of Excessive Salivation?, Lance Brown, MD MPH, Loma Linda University Medical Center and Children's Hospital 178. Comparison of Needle Cricothyrotomy with Manual Jet Ventilation vs Surgical Cricothyrotomy in a Can Not Intubate/Can Not Ventilate Sheep Model, Seth Manoach, MD, SUNY-Downstate Medical Center and Kings County Medical Center 179. Patient Refusal of Pain Medication in the Emergency Department, David E Fosnocht, MD, University of Utah 180. Effect of Patient Volume and Acuity on Pain Management in the Emergency Department, Matthew B Hollifield, MS, University of Utah 181. Measuring Pain Intensity in the Emergency Department: Correlation of a Numeric Rating Scale with a Visual Analog Scale, David E Fosnocht, MD, University of Utah 182. Withdrawn 183. Tracheal Tube Stylet Shape and Its Effect on Target Visualization and Tip Maneuverability, Richard M Levitan, MD, Hospital of the University of Pennsylvania 184. Alternating Day Emergency Medicine and Anesthesia Resident Responsibility for Management of the Trauma Airway: A Study of Laryngoscopy Performance and Intubation Success, Evan M Meiner, MD, North Shore University Hospital 185. Evaluation of a Blind, Rotational Technique for Selective Mainstem Intubation, Melissa J Doherty, MD, University of California-Davis

Neurology 200. Risks Factors for a Traumatic Lumbar Puncture, Kaushal H Shah, MD, Beth Israel Deaconess Medical Center 201. Intravenous Atropine vs Intravenous Lorazepam for the Treatment of Peripheral Vertigo, Timothy Scott Talbot, MD, Madigan Army Medical Center-University of Washington Emergency Medicine Residency 202. Assessing Urban Community Knowledge of Acute Stroke: Results with a Culturally Sensitive Instrument, Davida E Manor, MD, Mount Sinai School of Medicine 203. Gender and Traumatic Brain Injury: Do the Sexes Fare Differently?, Jonathan J Ratcliff, MPH, Emory University 204. Common Misconceptions in the Evaluation of Emergency Department Dizzy Patients Parallel Those Found in Emergency Medicine Texts, David Edward Newman-Toker, MD, The Johns Hopkins Hospital 205. Perception of Stroke Acuity in US Emergency Departments, David W Wright, MD, Emory University 206. Oral vs Intravenous Phenytoin Loading, David E Manthey, MD, Wake Forest University Baptist

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Friday, May 30 207. Interrater Reliability of Emergency Department Glasgow Coma Scale Scores, David G Reiley, MD, Loma Linda University 208. A Randomized, Prospective, Cross-over Study to Determine if there Is a Difference in Opening Pressure in Cerebrospinal Fluid in Patients Placed in a Flexed Lateral Recumbent vs Upright Sitting Position during Lumbar Puncture, M Andrew Levitt, DO, Alameda County Medical Center 445. Higher Diagnostic Imaging Use in TPA-treated Stroke Patients In University Hospital Compared to Matched Community Teaching Hospital, Phillip A Scott, MD, University of Michigan

219. Are Mortality Rates for Teens with Severe Penetrating Trauma Lower at Adult Trauma Centers?, Wayne A Satz, MD, Temple University Hospital 220. The Incidence of False Negative Initial Cervical Spine Radiographs for Patients Admitted to a Level-I Trauma Center, Robert E O'Connor, MD, MPH, Christiana Care Health System 221. Performance of the Pediatric Glasgow Coma Scale in Pediatric Head Trauma, James F Holmes, MD, University of California-Davis 222. Serum Glutathione in Trauma Patients, Imo P Aisiku, MD, Virgina Commonwealth University

Geriatrics

Wounds/Burns 223. Clinical Scaphoid Fracture - Overtreatment of a Common Injury?, Robert J Stenstrom, MD, PhD, St Paul's Hospital 224. Wound Bursting Strength and Surface Characteristics of New Tissue Adhesives, Adam J Singer, MD, State University of New York 225. Burn Outcomes: Patient Priorities and Agreement with Practitioner Assessments, Adam J Singer, MD, State University of New York 226. Evaluation of a New High Viscosity Octylcyanoacrylate Tissue Adhesive for Laceration Repair: A Randomized Controlled Trial, Adam J Singer, MD, State University of New York 227. Development of an Excisional Wound Model, Adam J Singer, MD, State University of New York 228. Do Serum Salicylate Levels Detect Unsuspected Ingestion?, Lisa D Mills, MD, Louisiana State University

209. Inappropriate Medication Use in Older Emergency Department Patients: Results of a National Probability Sample, Scott T Wilber, MD, Summa Health Systems / NEOUCOM 210. Emergency Department Physician Initiated Elder Screen (PIES) for Health and Social Services: A Pilot Study, Michelle Blanda, MD, Summa Health System 211. Administration of Inappropriate Medications to Elderly Emergency Department Patients: Results of a National Survey, Jeffrey M Caterino, MD, Allegheny General Hospital 212. The Effect of a Short Depression Screen on the Care of Older Emergency Department Patients, Fredric M Hustey, MD, The Cleveland Clinic Foundation

Shock/Critical Care 213. The Pharmacokinetics of a Hemoglobin-based Oxygen Carrier, HBOC 201, Does Not Change during Second Trimester Pregnancy, L Bruce Pearce, PhD, Biopure Corporation 214. The Shock Index in Early Acute Hypovolemia, Robert H Birkhahn, MD, New York Methodist Hospital

Imaging in Abdominal Pain 229. The Clinical Factors and Outcomes in Patients with Acute Mesenteric Ischemia in Emergency Department, Hsien-Hao Huang, MD, Taipei-Veterans General Hospital, Taipei 230. Noncontrast Abdominal CT Scans in Patients Being Evaluated for Right Lower Quadrant Pain, Jeannette M Wolfe, MD, Baystae Medical Center 231. Pilot Study to Develop a Decision Rule for the Selective Use of CT Scan in Undifferentiated Abdominal Pain, Matthew J Scholer, MD, PhD, University of North Carolina 232. Influence of Increasing CT Scan Usage on the Management of Appendicitis in Adults, Steven P Frei, MD, Lehigh Valley Hospital in affiliation with Pennsylvania State University 233. Impact of Abdominal/pelvic Computed Tomography with and without Oral Contrast on Emergency Department Patients Undergoing Appendectomy, Leigh V Evans, MD, Yale University

Trauma 215. Needle Thoracostomy in Trauma Patients: What Catheter Length Is Adequate?, Jonathan L Marinaro, MD, University of New Mexico 216. Mortality and Functional Outcome in Pediatric Trauma Patients with and without Head Injuries, Christine Pavlovitch, MS, New York Medical College/Westchester Medical Center 217. Early Damage to the Articular Cartilage Matrix Occurs Following Traumatic Knee Injuries without Fracture, Gregory D Jay, MD, PhD, Brown University 218. Emergency Department Opioid Analgesia in Trauma Patients Is Less Common in the More Severely Injured, Martha L Neighbor, MD, University of California, San Francisco

DIDACTIC SESSIONS State-of-the-Art: The Science of Triage (8:00-9:30 am)

Principles of Bedside Teaching (8:00-9:00 am)

Drew Richardson, MB, BS, FACEM, The Canberra Hospital, Garran, Australia Michael Bullard, MD, FRCPC, University of Alberta David Eitel, MD, MBA, York Hospital Paula Tanabe, PhD, RN, Institute for Health Services Research and Policy Studies, Northwestern University Most EDs in the US currently triage patients as emergent, urgent, and non-urgent, but many studies have shown these three levels to have poor reliability and validity. The CDC NHAMCS retroactively adds another category of semi-urgent (can wait 1-2 hours) and concludes that emergent visits have declined 17%. Standardized 5-level triage systems are mandatory in Australia and Canada, and being implemented in Britain, the US, and elsewhere, and are proving to be a powerful tool for research and management as well as patient care. Dr Richardson will describe the evidence for a 5-level triage scale, its development in Australasia, and its use as a research tool. Dr Bullard will describe the Canadian system and his new eTriage program. Dr Eitel will describe the development of the Emergency Severity Index algorithm, its validation in seven sites funded by the AHRQ, and a new application in ED modeling. Dr Tanabe will review current and future research on 5-level triage. At the completion of this session, participants will be able to: 1. Review past research with the different 5 level triage systems. 2. Identify key differences between the following 5 category triage systems: Australasian, Canadian, and the ESI Triage System. 3. Identify the administrative and patient care advantages of 5 level triage. 4. Identify future research needed to improve the reliability and validity of the Australasian, Canadian, and ESI Triage systems.

Gloria Kuhn, DO, PhD, Wayne State University This lecture will introduce a number of theories related to bedside teaching. The difference between experiential learning and didactic learning will be discussed including contextual, tacit and procedural knowledge. There will be a discussion of deliberate practice in bedside teaching, a structured method of practice used by many disciplines to improve competency in their learners. Reflection in action and reflection on action are methods of teaching and learning that can be used when seeing patients to improve competence and these will be discussed in this session. Finally, cognitive apprenticeship is a type of training that can be used to ensure the competencies we wish to promote in medical students and residents. There will be a short lecture followed by a period of audience discussion which giving the audience a chance to discuss the information. The object is to give cognitive practice much as we give motor practice in a procedural workshop. After this lecture learners will be able to 1) State a number of theories which underlie and improve bedside teaching, 2) utilize this information to improve their instruction of residents and students at the bedside, 3) allow attendees to gain more information about the topics if they wish to do so and, 3) use some tips from the literature on ambulatory teaching when it can be modified for emergency medicine.

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Friday, May 30 Bedside Teaching: Small Group Interactive Session (9:00-10:00 am)

The threat posed by terrorist acts will continue for the foreseeable future. Academic emergency physicians can play an important role in improving the nation’s preparation and response to these acts through research. To be effective in this endeavor, we need to stay current with the latest developments impacting the research environment. This didactic session will review the creation of the Department of Homeland Security, discuss the implications of this reorganization on emergency medicine research, and explore new opportunities for research and funding. The material is divided into three presentations, each lasting about 20 minutes. At the end, time is allotted for audience interaction with the panel. The first speaker will describe how the new Department of Homeland Security is organized, which functions are completely new, and which agencies have been transferred in from other departments. The second speaker will examine this reorganization from the perspective of its impact on emergency medicine research. Potential opportunities and concerns will be emphasized. The last speaker will identify issues that can be evaluated by emergency medicine researchers, including syndromic surveillance, smallpox vaccinations, and appropriate personal protective equipment for emergency department staff. In addition, the presenter will discuss potential funding sources. At the completion of the session, participants will be able to 1) Describe the organizational plan for the Office of Homeland Security and list the various departments that have been relocated to this new entity; 2) Discuss how the creation of the Office of Homeland Security may impact emergency medicine research; and 3) Identify three issues related to terrorism preparation and response that lend themselves to research projects appropriate for emergency medicine and how they might be funded.

Gloria Kuhn, DO, PhD, Wayne State University Diane Birnbaumer, MD, Harbor-UCLA Stephen Playe, MD, Baystate Medical Center Robert Wahl, MD, Wayne State University This session will involve small group round table discussion of cases in bedside teaching. Four experts in emergency medicine bedside teaching will each supply two cases that have provided challenges in bedside teaching. The audience will be divided into small groups. Each expert will be the facilitator for a group. The expert will state a case providing the challenges which are present and the group will discuss why the challenges might have occurred and provide some possible solutions. This will be repeated for the second case. This portion will occupy 30 minutes of the session. The second thirty minutes will be used by the experts to review the cases, the challenges and the solutions for the general audience. After this small group discussion learners will be able to 1) State some of the challenges encountered in bedside teaching in the emergency department, 2) state some solutions to these problems, and 3) develop new solutions when they encounter "new" problems within their own clinical setting.

Multivariate Analysis: When Do You Need It? How Should You Do It? (9:30-10:30 am) Robert L. Wears, MD, MS, University of Florida Many research settings in emergency medicine are complicated by the problem that several variables may simultaneously affect the outcome of interest. In this situation, simple bivariate analyses relating the outcome variable to one or more dependent variables taken separately may be misleading. Multivariate analysis is a collection of methods for addressing this problem. There are at least three different approaches to multivariate analysis: stratification, regression modeling, and CART modeling. Many researchers are unfamiliar with these methods, and if they do know of them, they tend to know only one and thus use it exclusively without considering other alternatives. This problem is compounded by the fact that the methods have different intellectual and historical roots so there has been little cross-fertilization among them. This lecture will demonstrate the need for multivariate approaches and in particular, why a series of bivariate analyses may be misleading. It will then illustrate the general approach, assumptions, strengths, and limitations of each of the three approaches using a series of examples. It will conclude with a general strategy that can be used as a guide for developing an analytic plan.

The goal of the session is to help researchers know when a multivariate approach is required, and how to choose and use a specific method intelligently. At the completion of the session, participants will be able to: 1. Describe how simple bivariate analyses may be potentially misleading. 2. List three major approaches to multivariate analysis. 3.

Describe the strengths and limitations of the three approaches. 4. Choose a multivariate method appropriate to the type of problem and intended audience. 5. Articulate a reasonable analytic strategy.

Mission Based Budgeting: An Opportunity for Departmental Financial Solvency (11:00 am-12:00 noon) M. Chris Decker MD, Medical College of Wisconsin Ann Chinnis MD, West Virginia University Nicholas Benson MD, MBA, Brody School of Medicine Financial solvency is critical to the success of an academic department. Some missions within a department create revenue, while others need financial support--yet all are critical to the overall mission of the department. This session will describe Mission Based Budgeting, a method which allows a department to clarify the costs and revenues of each mission and determine what cross subsidies are needed for each mission to remain solvent. Mission Based Budgeting is a technique promoted by the American Association of Medical Colleges in partnership with the CSC healthcare group and has been successfully used in 22 medical schools. In this session, the moderator will describe the method of Mission Based Budgeting. Physicians from three different emergency departments will present their use of these budgeting principles and how this method has resulted in success. Two physicians will be from a department in which the medical school has adopted Mission Based Management enterprise wide. The third physician will be from a department that practices mission based budgeting amidst a traditional medical school environment. Lastly, pitfalls of Mission Based Budgeting that have led some medical schools to abandon these efforts will be discussed. At the completion of the session, participants will: 1) Be familiar with Mission Based Budgeting Principles 2) Be familiar with and understand the importance of cross subsidies 3) Be familiar with the application of these principles in departments from traditional medical schools and in schools that have adopted these principles enterprise-wide.

Educational Aspects of Emergency Department Procedures (10:00-11:00 am) Cathy Custalow, MD, PhD, University of Virginia Christopher King, MD, University of Pittsburgh Daniel Price, MD, Highland General Hospital This lecture will provide an overview of procedural education for emergency medicine residents, including the basic principles involved in teaching procedural skills, a review of the major learning styles, methods for improving bedside teaching of procedures and alternative models for procedural practice. The lecture will include a description of the currently available educational models for practicing procedures, including volunteers, mannequins, simulators, cadaver laboratories, animal laboratories, and the newly dead.

The advantages and disadvantages of each will be discussed. The session’s concepts will be further illustrated with videotape. Finally, the panel will discuss a number of clinical scenarios to illustrate the various approaches to the bedside teaching of procedures. At the completion of the session, participants will understand the basic principles involved in teaching procedural skills, the various learning styles, methods for improving bedside teaching of procedures and alternative models for practing procedures.

Lunch Session: The Road to Achieving Departmental Status in Emergency Medicine (12:00-1:30 pm) William Barsan, MD, University of Michigan Wyatt Decker, MD, Mayo Clinic and Mayo Medical School Benjamin Honigman, MD, University of Colorado Emergency medicine (EM) departmental designation offers many advantages including enhanced recruitment and development opportunities for faculty committed to excellence in education, scholarship and leadership. Approximately one-half of U.S. Medical Schools have academic departments of emergency medicine and attaining departmental status has been difficult at some institutions. The discussants include chairs and chiefs of emergency medicine, some who have been successful in getting approval and others who are struggling with difficulties in achieving this goal. There will be a discussion of some of the key aspects of the process including the need to gain support of key individuals, understand the culture of the institution, align the prospective department within the medical school’s values and emphasize the mutual advantages of departmental status to other departments. Finally, the panel will discuss a number of cases to illustrate these issues. At the completion of the session, participants will understand many of the important qualifications and characteristics of emergency medicine programs that have achieved departmental status. (Pre-registration and $35 fee required).

Recent Advances in Terrorism and Disaster Medicine: Implications for Emergency Medicine Research (10:30 am-12:00 noon) Moderator: Carl H. Schultz, MD Kristi L. Koenig, MD, Office of the Under Secretary for Health, Veterans Health Administration, Department of Veterans Affairs Eric K. Noji, MD, MPH, Principal Deputy to the U.S. Surgeon General for Homeland Security and Disaster Medicine Jonathan Burstein, MD, Harvard Medical School

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Friday, May 30 Lunch Session: What Makes a Great Teacher (12:00-1:30 pm)

Incorporating Patient Safety Principles into Bedside Teaching and Your Curriculum (2:30-3:30 pm)

Daniel Federman, MD, Harvard Medical School What are the qualities that make someone a great teacher? Dr. Daniel Federman, a nationally-recognized educator and former Dean of Education at Harvard Medical School will address this question for teaching in general, and with particular regard to the education of medical students and residents in the clinical setting. At the completion of this session attendees will 1) understand what qualities make someone a great teacher; 2) how those qualities can be taught or learned 3) what preparation is necessary for being an effective teacher. (Pre-registration and $35 fee required).

Moderator: Marc Shapiro, MD, Brown University Karen Cosby, MD, Cook County Hospital/Rush Medical School Stephen Schenkel, MD, University of Michigan While great effort has been invested in developing curricula and cases with the goals of teaching about medical error and patient safety, there has been little practical discussion either of the implementation of curricula or the daily challenges in teaching these topics at the bedside. This session seeks to rectify this by offering the experience of three seasoned teachers. The approach will be case based; we intend that this will be an interactive session and anticipate that everyone will leave with a new appreciation for the ways in which patient safety can be incorporated into clinical education. We intend 1) to illustrate opportunities for incorporating patient safety topics into existing educational activities including board-side rounds, bed-side teaching, and chief resident or "teaching resident" activities; 2) to provide a forum for discussion on how patient safety education should be tailored and implemented for different levels of trainees from medical students through faculty; and 3) to address ways to overcome specific impediments to teaching about safety, such as professional defensiveness and the difficulty of maintaining trust and openness while still effectively supervising. At completion of this session, participants will take home several new techniques for incorporating patient safety and medical error education into their daily teaching activities. Participants will better understand the possibilities and pitfalls of patient safety education.

Understanding and Applying Likelihood Ratios (1:30-2:30 pm) Edward A. Panacek, MD, MPH, University of California, Davis Likelihood ratios (LR) are perhaps the most important direct clinical application of diagnostic test performance. They have powerful and stable properties combine both sensitivity and specificity, but are not affected by prevalence of disease. As a result, they are increasingly being used to report the results of studies of diagnostic tests or testing strategies. They also have very direct bedside application, particularly when teaching the priciples of evidence-based medicine while delivering patient care. This session will cover the origins of likelihood ratios, their definitions and how to calculate them. The differences between LRs and other measures of association, such as Odds ratios and Relative risk ratios will be explained. The important differences between LR positive and LR negative will be emphasized. Examples from actual emergency medicine studies and clinical scenarios will be used to optimize understanding by the audience. At the completion of the session, participants will: 1. Be able to define Likelohhod Ratios(LR). 2. Be able to explain the difference between LR+ and LR-. 3. Be able to calculate LRs from data sets and for various diagnostic test strategies.

Interpreting Statistical Analyses: Beyond P Values (2:30-4:00 pm) Robert O. Wright MD MPH, Harvard Medical School and Harvard School of Public Health Stephen C. Porter MD MPH, Harvard Medical School Observational research studies have become increasingly complex. The results of observational research studies can be driven by properties other than chance or causation.

While these factors may drive the p values of the results, they also change the appropriate interpretation. Workshop Methods: In the first half of this workshop, we will formally define confounding, effect modification, restriction vs heterogeneity of exposure, intermediate variables, selection bias, and differential vs. nondifferential information bias. In the second half, we will use a case-based approach to illustrate examples of studies in which the results are driven by these factors and compare differences in the appropriate interpretation in the presence and absence of these factors. Minimal math skills will be needed, however, familiarity with basic concepts of study design and data analysis (case control vs cohort study, interpretation of OR's etc) is recommended. We will specifically illustrate examples of effect modification vs confounding, intermediate variables vs confounding, selection bias, underpowered studies, and the role of measurement error in determining effect estimates. At the completion of the session, participants will understand the concepts of effect modification, bias and intermediate variables and how they may influence p values and effect estimates. Participants will have a deeper understanding of what study results mean, which is more robust then simply interpreting a p value alone.

Giving Feedback in Emergency Medicine Education (1:30-2:30 pm) Jack Ende, MD, University of Pennsylvania Feedback in medical education is one of the most important ways in which individuals learn how to become better physicians. Unfortunately, many educators have difficulty giving feedback, and either shy away from it or give feedback in ways that are not as helpful to the learner as they might be. Dr. Ende, former residency program and clerkship director, is a recognized author on the subject of feedback in medical education and his 1983 article in JAMA on the subject remains an important contribution to the literature on medical education. This session will focus on feedback as part of the everyday clinical learning process. The barriers to providing feedback effectively will be explored, and guidelines useful for clinical teaching and supervision will be developed. Then, the focus will turn to providing feedback in the context of the performance appraisal meeting that should take place soon after students and residents complete their rotations. The difficulties surrounding this type of meeting will be explored, and suggestions for emergency medicine teachers and program directors will be offered. At the completion of the session, participants will 1) understand the primary principles of how to give effective feedback 2) have learned methods to provide feedback in the context of a brief emergency medicine clinical encounter, 3) understand how to make the most of a performance appraisal session.

First Working Session on Emergent Genomics 7:00-9:00 pm, Regis Suite •

There is a revolution underway in the field of medical genomics; genetic variants associated with illness are being identified at a rapid and still accelerating pace. Underlying genetic variation no doubt affects the nature and severity of disease among patients cared for in Emergency Departments. It remains unclear, however, what role if any increased understanding of these unalterable patient characteristics might play in the actual delivery of emergent medical care.

Fundamental hurdles abound, such as upon which diseases and genes focus should be placed and whether genetic information can ever realistically become available in clinically meaningful ‘real time.’

This session will provide a forum for investigators to briefly present ideas, strategies, and preliminary data and to troubleshoot every aspect of this very challenging new endeavor. This will not be a didactic session! Rather, it will be an informal opportunity* for investigators and potential investigators to discuss their work, no matter how preliminary, in this area.

We therefore extend an open invitation to anyone currently working in the area with experience in any of the following: • • • • •

Addressing consent and regulatory hurdles related to emergent collection of genetic material, including HIPPA.

The time available for individual presentations will be inversely proportional to the number of interested participants. This session has been approved to be held in conjunction with the SAEM Annual Meeting.

Scheduled Participants “Use of rapid screening methods to detect thrombophilic gene mutations as an adjunct to pretest probability assessment and risk stratification in venous thromboembolic disease in the ED setting,” Jeff Kline, MD, Carolinas Medical Center “Mannose binding lectin polymorphisms: a potential target for infectious and inflammatory disease characterization in the ED?,” John Younger, MS, MD, University of Michigan “Acute molecular triage for infectious disease in the ED,” Richard Rothman, MD, PhD, and Samuel Yang, MD, Johns Hopkins University “Microarray technology as a screening tool for gene expression changes in neuroinjury,” David W. Wright, MD, Emory University “Identifying genetic risk factors in the conversion of traumatic synovitis to osteoarthritis,” Gregory Jay, MD, PhD, Brown University

Identifying which diseases warrant study Selecting candidate genes Choosing a detection technique (PCR, real-time PCR with fluorescent probes, gene sequencing, etc.)

Reliably collecting blood leukocyte, buccal scrape, or other tissue in the ED for DNA isolation Using point-of-care DNA extraction systems and thermocyclers (including hand-held PCR devices)

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Saturday, May 31

SCIENTIFIC PAPERS ORAL PAPER PRESENTATIONS

Albert Einstein College of Medicine 253. The Relationship of Gender to Asthma Prevalence, Healthcare Utilization, and Medications in a Large Managed Care Organization, Carlos A Camargo, Jr., MD, DrPH, Massachusetts General Hospital 254. Asthma Coaching in the Emergency Department, Sharon R Smith, MD, Washington University

Plenary (8:00-9:00 am) Moderator: Arthur Kellermann, MD, MPH, Emory University 234. Multicenter Controlled Clinical Trial to Evaluate the Impact of Advanced Life Support on Out-of-hospital Chest Pain Patients, Ian G Stiell, MD, MSc, FRCPC, University of Ottawa 235. The Bedside Investigation of Pulmonary Embolism Diagnosis (BIOPED) Study, Dimitri Makropoulos, MD, University of Ottawa 236. Impact of a Clinical Decision Rule and a D-dimer Plus Alveolar Deadspace Measurement to Rule-out Pulmonary Embolism in an Urban Emergency Department, Jeffrey A Kline, MD, Carolinas Medical Center

Research Methods (1:30-2:30 pm) Moderator: Roger Lewis, MD, PhD, Harbor-UCLA Medical Center 255. Determination of Sample Size Parameters for Community Intervention Cluster Trials in Cardiac Arrest, Christian Vaillancourt, MD, FRCPC, University of Ottawa 256. Mortality Benefit of Transfer to Level 1 vs Level 2 Trauma Centers for Head Injured Patients: Analysis Using Instrumental Variables, K John McConnell, PhD, Oregon Health & Science University 257. Use of Computer-assisted Attribute Matching to Estimate Pretest Probability, Jeffrey A Kline, MD, Carolinas Medical Center 258. A Comparison of Research Data Gathered Prospectively and Retrospectively, John T Nagurney, MD, MPH, Partners Health Care

ORAL PAPER PRESENTATIONS AND DISCUSSION Controversies in Defibrillation (9:00-11:00 am) Moderator: William Mallon, MD, LAC & USC Medical Center *237. Public Access Defibrillation Programs without Training Are Ineffective, Richard Neville Bradley, MD, University of Texas 239. Esmolol Improves Survival Following Prolonged Ventricular Fibrillation, Gregory P Walcott, MD, University of Alabama at Birmingham *240. Mathematical Model Predicting the Potential Impact of Various Community Bystander CPR Rates on Overall Survival from Cardiac Arrest, Christian Vaillancourt, MD, FRCPC, University of Ottawa *241. Angular Velocity of Phase-space Trajectory Quantifies Change in Ventricular Fibrillation over Time, Lawrence D Sherman, MD, University of Pittsburgh School of Medicine 242. A Location-specific Utility Measure to Guide the Distribution of Public Access Defibrillation (PAD) Programs within the Community, Valerie J De Maio, MD, MSc, University of North Carolina

Toxicology (2:30-4:00 pm) Moderator: Binh Ly, MD, University of California, San Diego 259. Ecstasy’s (MDMA) Effect on Oxidative Phosphorylation in Isolated Rat Liver Mitochondria, Daniel E Rusyniak, MD, Indiana University 260. Pharmacokinetic Effects of Co-ingested Diphenhydramine or Oxycodone on Simulated Acetaminophen Overdose, Anil Goklaney, MD, Washington University 261. QT Prolongation and Cardiac Arrhythmias Associated with Droperidol Use in Critical Emergency Department Patients, Marc Martel, MD, Hennepin County Medical Center *262. Analysis of Moonshine for Contaminants, Jeffrey D Ferguson, MD, University of Virginia *263. Glibenclamide as a Treatment for Severe Verapamil Toxicity, Jason Chu, MD, St. Luke's-Roosevelt Hospital Center 264. Jimsonweed (Datura stramonium) Seed Extract as a Protective Agent in Severe Organophosphate Poisoning, Dallas Bailes, MD, Metropolitan Hospital/New York Medical College

ORAL PAPER PRESENTATIONS Computers in Medicine (9:00-10:00 am) Moderator: Jonathan Handler, MD, Northwestern University *243. Effect of Implementation of a Computerized Order Entry System on Emergency Department Patients’ Length of Stay, Andrew T McAfee, MD, MSc, Brigham and Women's Hospital 244. The Feasibility and Patient Acceptance of Computer-assisted Asthma Education in the Emergency Department, James Feldman, MD, Boston University Medical Center 245. A Standardized Communication System (SCS) Linking the Emergency Department with Primary Care Physicians: Impact on Continuity of Care, Eddy S Lang, MD, Sir Mortimer B Davis Jewish General Hospital, McGill University 246. Calculation of the Arterial Partial Pressure of Oxygen Using Venous Blood Gases and the Oxyhemoglobin Dissociation Curve Is Inaccurate, Anne-Maree Kelly, MD, Joseph Epstein Centre for Emergency Medicine Research

Administration (2:30-4:00 pm) Moderator: Brent Asplin, MD, Regions Hospital 265. The Predictive Validity of the Canadian Triage and Acuity Scale (CTAS), Rob Stenstrom, MD PhD, Providence Health Care 266. Characteristics of Primary Care Practices Affect Patients' Emergency Department Use, Robert A Lowe, MD, MPH, Oregon Health and Science University 267. The Prevalence and Effect of Information Gaps in the Emergency Department, Alan Forster, MD, MSc, University of Ottawa 268. Reasons Why Patients Leave without Being Seen from the Emergency Department, Brian H Rowe, MD, MSc, University of Alberta 269. A Comparison of Two Methods for Biosurveillance of Respiratory Disease in the Emergency Department: Chief Complaint vs ICD9 Diagnosis Code, Melissa Mocny, New York State Department of Health 270. Emergency Medicine Patients' Access to Healthcare (EMPATH) Study: Reasons for Seeking Care in the Emergency Department, Lynne D Richardson, MD, Mount Sinai School of Medicine

Injury Prevention (10:00-11:00 am) Moderator: Gregory Larkin, MD, MS, MSPH, The University of Texas Southwestern 247. Driver Mortality in Paired Angle Collisions Due to Incompatible Vehicle Types, Cameron S Crandall, MD, University of New Mexico 248. Identification of Injury Clusters Using Emergency Medical Services Dispatch Data and a Geographic Information System, E Brooke Lerner, PhD, University of Rochester 249. Survey of Fall History and Fall Risk Factors in Ambulatory Geriatric Emergency Department Patients, Christopher R Carpenter, MD, Allegheny General Hospital 250. Smoking Cessation Interventions in the Emergency Department for Smokers with Chest Pain, Bruce Mark Becker, MD, MPH, Brown University

MODERATED POSTER SESSIONS (5:00-6:00 pm) Alcohol and Drug Intervention Moderator: Bruce Becker, MD, MPH, Rhode Island Hospital *271. Stages of Change Is Predictive of Response to a Brief Intervention for Alcohol Problems in Young Adult Emergency Department Patients, Luba Leontieva, MD, West Virginia University Center for Rural Emergency Medicine 272. Randomized Controlled Trial of an Emergency Department-based Interactive Computer Program to Prevent Alcohol Misuse among Injured Adolescents, Jean T Shope, MSPH, PhD, University of Michigan Transportation Research Institute 273. Linking Emergency Department Patients with Alcohol and Other Drug Problems to Treatment, Gail D'Onofrio, MD, MS, Yale University

Asthma (1:30-2:30 pm) Moderator: Charles Pollack, MD, Pennsylvania Hospital 251. A Prospective, Randomized Trial to Evaluate Heliox as a Delivery Vehicle to Nebulize Albuterol in Acute Asthma Exacerbations in the Emergency Department, Richard Lanoix, MD, St. Lukes-Roosevelt Hospital Center 252. Intra-muscular vs Oral Methylprednisolone in the Treatment of Asthma Exacerbations Discharged from an Emergency Department, Michael Lahn, MD,

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Saturday, May 31 300. Accuracy of Laceration Length Estimation, Michael J Lemanski, MD, Baystate Medical Center 301. Emergency Medicine Patients' Access to Healthcare (EMPATH) Study: Racial/ethnic, Gender and Age Related Differences in Emergency Department Use, Lynne D Richardson, MD, Mount Sinai School of Medicine *302. Effect of Treatment Guidelines for Odontalgia on Number of Emergency Department Visits, Marek Ma, MD, University of Cincinnati 303. Comparison of Physician’s Choice of Charting Template to ICD9 Codes for Biosurveillance Using an Emergency Department Electronic Medical Records Database, Dennis George Cochrane, MD, Morristown Memorial Hospital 304. The Effect of Bedside Registration on Patient Encounter Times in an Urban Academic Emergency Department, Kevin M Takakuwa, MD, University of Pennsylvania 306. Development and Implementation of a Relative Value Scale for Teaching in Emergency Medicine: The Teaching Value Unit (TVU), Naghma S Khan, MD, Emory University 307. Total Daily Patient Care Time as a Measure of Emergency Department Overcrowding, Drew B Richardson, MB, BS(Hons), The Canberra Hospital 308. Prospective Confirmation That Total Daily Patient Care Time Can Measure Emergency Department Overcrowding, Drew B Richardson, MB, BS(Hons), The Canberra Hospital 309. Relationship between Total Daily Patient Care Time and Performance as a Measure of Emergency Department Efficiency, Drew B Richardson, MB, BS, The Canberra Hospital 310. The Inter-rater Reliability of Triage in an Acute Care Emergency Department Setting, Eric J Grafstein, MD, Providence Health Care 311. Impact of Ambulance Transportation on the Use of Resources in the Emergency Department, Adrian Marinovich, Sir Mortimer B Davis Jewish General Hospital *312. Emergency Department Volume and Patient Acuity as Factors in Patients Leaving without Treatment, Jason T McMullan, Medical University of South Carolina 313. Headache Patients, Who Does Not Come to the Emergency Department?, Peter L Lane, MD, FRCPC, Albert Einstein Medical Center 314. Variability of Admission Practice Patterns among Emergency Physicians, Robert H Baevsky, MD, Baystate Medical Center 315. The Overcrowded Emergency Department: Perception vs Reality, Timothy J Reeder, MD, MPH, East Carolina U niversity 316. Who Should Be Estimating Your Patient’s Weight in the Emergency Department?, Jill Corbo, MD, Albert Einstein College of Medicine 317. Emergency Code Systems and Disaster Preparedness in Level-1 Trauma Centers in the US, Robert E Antosia, MD, MPH, Beth Israel Deaconess Medical Center 318. Patterns and Factors Associated with “Increased” and “Intensive” Emergency Department Utilization: Implications for Allocating Resources, Lawrence Lewis, MD, Washington University 319. Improving Accuracy of Triage of “Borderline” Patients, Lawrence Lewis, MD, Washington University 320. Establishing a Predictive Model for Emergency Physician Clinical Workload, Robert Stenstrom, MD, PhD, St. Paul's Hospital 321. The Terrorist Attack. Will We Respond?, James I Syrett, MD, University of Rochester 322. Emergency Waiting Room Care: Are Some of Our Emergency Patients Being Poorly Cared For?, Eric J Grafstein, MD, Providence Health Care 323. Does Physician Order Entry Reduce Emergency Department Length of Stay (LOS) in an Overcrowded Emergency Department, Grant D Innes, MD, Providence Health Care, St. Paul’s Hospital 324. Financial Effects of Emergency Department Admissions Compared to Electives within Surgical Diagnosis Related Groups (DRGs) at 11 Hospitals in Suffolk County, NY, Stephen P Havasy, MD, MBA, State University of New York 325. Early Return as a Predictor of Recidivism in Patients with Cholelithiasis, Lisa D Mills, MD, Louisiana State University 326. A National Estimate of Characteristics of Uninsured Patients Who Seek Emergency Department Care, Peter Louis Lane, MD, FRCPC, Albert Einstein Medical Center 327. Diabetes Education and Emergency Department Recidivism, Paul Vanderbeek, MD, Albert Einstein Medical Center 328. Methodologic Issues in the Classification of Race/Ethnicity in Clinical Research, Gabrielle C Hunter, Massachusetts General Hospital 447. Identifying Medical Errors: Developing Consensus on Classifications and Consequences, Jennifer L Eaton, University of North Carolina 448. National Study of ED Patients Who “Left Before Being Seen” by a Physician, 19922000, Emily E Spilseth, MD, Massachusetts General Hospital 449. Language Barriers Among Patients in Boston EDs: Use of Medical Interpreters After Passage of Interpreter Legislation, Gabrielle C Hunter, Massachusetts General Hospital

274. Can Trained Health Educators Provide Screening, Brief Intervention and Referral Services in an Academic Teaching Hospital Emergency Department?, Theodore C Chan, MD, University of California-SanDiego

Clinical ECG Moderator: Robert Zalenski, MD, Wayne State University 275. Syncope and Electrocardiograms: What Abnormalities are Most Significant and How Sensitive Is It for Acute Myocardial Infarction (AMI)?, Daniel A McDermott, MD, University of California, San Francisco 276. Upwardly Concave ST Segment Morphology Is Common in Acute Left Anterior Descending Coronary Artery Occlusion, Stephen W Smith, MD, Hennepin County Medical Center 277. Relationship between Time to ECG Acquisition and Adverse Cardiac Events in Patients with Unstable Angina or Non ST Elevation Myocardial Infarction, Deborah B Diercks, MD, University of Californi-Davis 278. Ratio of T Amplitude to QRS Amplitude Best Distinguishes Acute Anterior MI from Anterior Left Ventricular Aneurysm, Stephen W Smith, MD, Hennepin County Medical Center

POSTERS (4:00-6:00 pm) Toxicology 279. A Model for Drug Effects on Intracranial Pressure at Altitude, Alan B Storrow, MD, University of Cincinnati 280. Vasopressin vs Glucagon to Treat Beta-antagonist Toxicity in a Porcine Model, Christopher L Obetz, MD, Regions Hospital 281. Ethnic Differences in the Home Management of Poisonings, Gregory Luke Larkin, MD, MS, MSPH, The University of Texas Southwestern 282. Effects of Physostigmine Following Cessation of Chronic GHB Administration in Mice, Theodore C Bania, MD,MS, St. Luke's-Roosevelt/Columbia University 283. Mechanism of Protective Effects of Datura Stramonium in Organophosphate Poisoning, James Smith, MD, St. Luke's-Roosevelt/Columbia University 284. Severe Gamma-hyroxybutyric Acid Withdrawal in an Animal Model, Theodore C Bania, MD, MS, St. Luke's-Roosevelt Hospital Center 285. In Vitro Binding of Lithium Carbonate to Prussian Blue and Activated Charcoal, InHei Hahn, MD, St. Luke's-Roosevelt Hospital Center 286. Characterization of the Pharmacokinetic and Pharmacodynamic Interaction between Gamma-hydroxybutyrate and Ethanol in the Rat, Diederik K Van Sassenbroeck, MD, Heymans Institute of Pharmacology, University of Ghent, Belgium 287. Hemodyamic Effects of Cyanide Toxicity, Pham Cuong Julius, MD, Henry Ford Hospital 288. A Standardized Intoxication Scale vs Breath Ethanol Level as a Predictor of Observation Time in the Emergency Department, Chris McCoy, MD, Hennepin County Medical Center 289. Diagnosing Pupillary Dilation by Measurement: More Specific than Gestalt Judgment, Michael D Witting, MD, University of Maryland *290. Diazepam Attenuates Acute Central Respiratory Depression from Acute Organophosphate Poisoning, Steven B Bird, MD, University of Massachusetts 291. A Prospective Evaluation of Abbreviated Oral N-acetylcysteine (NAC) Therapy for Acetaminophen Poisoning, Steven B Bird, MD, University of Massachusetts 292. Cytoprotective Effects of Intraperitoneal Amifostine on alpha-amanitin Toxicity in Mice, Brandon Wills, DO, MS, Akron General Medical Center 293. Effect of Oral Calcium Disodium EDTA on Iron Absorption in a Human Model of Mild Iron Overdose, Michael Habibe, MD, Naval Medical Center-San Diego 446. Noninvasive Fireground Assessment Of Carboxyhemoglobin Levels In Firefighters, David C Cone, MD, Yale University

Administration 294. The Emergency Severity Index Triage Instrument Predicts Resource Consumption, Paula Tanabe, PhD, RN, Northwestern University 295. Waiting Time Correlates with Patient Walk-out Rates But Not with Patient Satisfaction Scores, Gretchen K Lipke, MD, Mayo Clinic 296. The Children's Health Insurance Program (CHIP): A Multicenter Trial of Outreach through the Emergency Department, James A Gordon, MD, MPA, Massachusetts General Hospital 297. Prospective Confirmation of Casemix-independent Increased Inpatient Length of Stay in Patients with Long Total Emergency Department Time, Drew B Richardson, MB, BS(Hons), The Canberra Hospital 298. Characterizing Payments for Emergency Department Visits: Do the Uninsured Pay Their Way?, Alexander C Tsai, MA, Case Western Reserve University 299. Factors Associated with Patients Who Leave without Being Seen, Steven K Polevoi, MD, University of California-San Francisco

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Saturday, May 31 336. Withdrawn 337. Emergency Medical Services Responses to Shootings and Stabbings as Predictors of Homicide, Jamie K Hensen, Medical College of Wisconsin

Research Methods 329. A Comparison of Three Methods for Defining Acute Myocardical Infarction, John T Nagurney, MD, MPH, Partners Health Care 330. Impact of Informed Consent Requirements on Cardiac Arrest Research in the United States: Exception from Consent or from Research?, Ella Huszti, MSc, University of Ottawa 450. Federal Funding of Emergency Medicine Investigators, Carlos A Camargo, Jr., MD, DrPH, Massachusetts General Hospital

Computer Technologies 338. Instant Disposition: Validation of an Admission Prediction Model, Jonathan A Handler, MD, Northwestern University 339. The Use of Electronic Clinical Practice Guideline Resources in Two Canadian Emergency Departments, Brian H Rowe, MD, MSc, University of Alberta 340. Documentation of Emergency Medicine Resident Procedures Using a Personal Digital Assistant, David R Lane, MD, University of Massachusetts 341. Can an Artificial Neural Network Predict the Need for Hospital Admission Using Routine Triage Data?, Wayne A Satz, MD, Temple University 342. Evaluation of Triage Nurse Satisfaction with Training and Use of an Electronic Triage Tool, Michael J Bullard, MD, University of Alberta 343. Development of a Computerized System to Reduce Medical Errors: A Pilot Study, Adam J Singer, MD, State University of New York 344. Supporting Clinical Practice at the Bedside Using Wireless Technology, Michael J Bullard, MD, University of Alberta

Disease/Injury Prevention 331. Risk Factors for Hyponatremia among Runners in the Boston Marathon, Christopher S Almond, MD, Children's Hospital 332. New Jersey Heating Oil Company Responses to Questions Regarding Carbon Monoxide Poisoning and Hyperbaric Oxygen Therapy, Marc A Bornstein, DO, Morristown Memorial Hospital 333. Child Passenger Fatalities Involving Drinking Drivers, Patricia C Ramos, MD, MCP, University of New Mexico 334. From Poppy Fields to Potter's Field: Increased Mortality after Nonfatal Heroin Overdose, Cameron S Crandall, MD, University of New Mexico 335. Identification of Cardiac Arrest Clusters Using Historical Data and a Geographic Information System, E Brooke Lerner, PhD, University of Rochester

DIDACTIC SESSIONS Implementing and Optimizing Morbidity and Mortality Conferences

sion aims to tap into the skills and experience of those who have reached this success in order to help remove some of the barriers to this achievement for those EM academicians who aspire to an independent research career. The speakers for this panel are all successful (funded) investigators who have been members of NIH, AHRQ, CDC or other funding agency review panels and who together have expertise in basic science, clinical and health systems research. Each will describe, based on their own experiences, the major pre-requisites required for serious consideration of all research grant applications.

Using specific examples taken from successful and unsuccessful applications, speakers will briefly outline the review process and describe the basic components that reviewers look for in their initial screening of applications. The session will focus on why many applications from inexperienced grant writers are essentially "marked for death" during this first screening and never receive serious consideration by the study section.

Speakers will then give detailed advice as to the necessary steps to be taken by junior faculty in the months and years prior to "putting pen to paper" that will eventually fulfill these "grant pre-requisites" and lead to grant writing success. Examples of the specific topics to be discussed include the importance of developing a "track record" in a field of investigation, the creation of a strong collaborative team, the need for collection of adequate pilot data and how to gain adequate knowledge of the funding agencies’ priorities.

At the completion of the session, participants will: 1) learn the grant review process within the funding agency study section (2) Understand the pre-requisites a grant application must have for serious consideration (3) Learn the key steps to be taken by a researcher early in their career that will prepare them for later funding success (4) Obtain a more global view for the pathway to successful funding.

(9:00-10:00 am) D. Matthew Sullivan, MD, Carolinas Medical Center Alan E. Jones, MD, Carolinas Medical Center Morbidity and mortality conferences are ubiquitous in medicine. The common objective these conferences share is to promote academic learning, growth, responsibility and maturity through the tracking and discussion of medical errors. The manner in which the conferences are implemented varies immensely. Preparing an M&M properly leads to development of individual learning, leadership and accountability. However, if improperly prepared these conferences are often a source of shame, ridicule and resentment. This course will present an in depth discussion about: (1) the basics of how to present a conference, (2) choosing, researching and preparing cases for conference use and, (3) methods for faculty and residents to encourage peer constructive criticism and continuous quality improvement. At the completion of this course, participants will: 1. Understand the basics of case presentations, 2. Understand how to choose and prepare a case for use in morbidity and mortality conference, 3. Be familiar with methods for offering constructive criticism of cases and encouraging physician accountability.

Choosing and Developing Outcome Measures for Clinical Research (9:00-10:00 am) Carlos Camargo, MD, DrPH, Massachusetts General Hospital This session will provide an overview of how to select appropriate outcome measures for clinical research. The speaker will use examples from his own work in respiratory illnesses as well as others to discuss: validity and reliability, generalizability, surrogate outcome measures, gold standards, single vs composite measures, constructing scoring systems, multivariate techniques, and continuous vs categorical measures. Selection of inappropriate outcome measures can lead to spurious results. It is important that researchers understand the basic principles underlying how to select and develop outcome measures. It is also important for clinicians to understand these principles so that they may appropriately apply study results to clinical care. At the completion of the session, participants will be able to recognize the characteristics of and develop appropriate outcome measures for clinical research.

Surviving the Collision of Health Policy and Academic Medicine (10:00-11:00 am) Brent R. Asplin MD, MPH, Regions Hospital and HealthPartners Research Foundation The worlds of academic medicine and health policy are colliding on a daily basis, forcing academic emergency physicians to face new policies that will affect their research, educational, and clinical missions. Recent regulations to protect medical privacy threaten our ability to conduct population-based research. Limitations on resident work hours will affect the availability of on-call services and change the climate of off-service rotations for emergency medicine residents. The return of federal budget deficits will once again threaten funding for priorities such as graduate medical education and disproportionate share payments. These funding streams will be critical for academic medical centers in the years ahead, because the current economic downturn has predictably led to a higher number of uninsured Americans. This course will discuss the intersection of health policy and academic medicine, highlighting the most important recent events for academic emergency medicine and identifying avenues to influence the policymaking process. At the completion of the session, participants will be able to: 1) Describe how medical privacy regulations threaten the reliability of population-based research in emergency medicine 2) Identify specific financial threats to academic medical centers resulting from recent federal budget deficits 3) Discuss the specific burden that increasing numbers of uninsured Americans places on academic medical centers.

Getting in the Ballpark for Federal Funding (NIH, CDC, and AHRQ): Prerequisites for a Successful Grant Application (10:00-11:00 am) Moderator: Gary Green, MD, Johns Hopkins University Gary Krause, MD, Wayne State University Robin Weinick, PhD, Agency for Healthcare Research and Quality Steve Hargarten, Medical College of Wisconsin Making the transition to an independent researcher by obtaining grant funding is the hallmark of a successful research career and therefore one of the ultimate goals of nearly all researchers in academic emergency medicine. However this goal remains elusive, with only a handful of emergency physicians having gained funding success. This ses-

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Saturday, May 31 Lunch Session: Competency in Medical Student Education

The Lifeblood of a Department: Show Me the Money (1:30-2:30 pm)

(12:00-1:30 pm) Douglas Ander, MD, Emory University Barbara Richardson, MD, Mount Sinai Hospital, New York Cherri Hobgood, MD, University of North Carolina Susan Farrell, MD, Brigham and Women's Hospital With the growth of emergency medicine departments nationally and the LCME requirement that emergency medicine be part of an overall medical school curriculum, undergraduate medical educators are experiencing increased pressure to define their curricular goals and objectives. Medical educators will have to define what is meant by "a successful learner outcome." Medical educators will be expected to articulate the differences between superior and satisfactory mastery of a competency, or criteria for failure.

Furthermore, faculty evaluators must have consistent assessment tools to ascertain learner performance in identified competencies and objectives. One particular aspect of overall competency in emergency medicine for the senior student is their clinical performance. Composite evaluations of observed student performance are the most common means of assessing clinical skills. This session will describe competencies to be assessed in a senior level emergency medicine rotation, provide the educators with the necessary tools to create an evaluation instrument for clinical performance, and define criteria for various levels of success (e.g. Honors, High Pass, Pass and Failure). At the completion of the session, participants will 1) be able to describe the clinical skills that should be assessed in a senior level emergency medicine rotation; 2) be provided with the tools to create evaluation tools for medical students' performance on clinical rotations; be able to list the positive and negative attributes of the global rating scales typically used on emergency medicine rotations to evaluate clinical performance; be able to describe methods to implement a global rating scale evaluation system in an emergency medicine rotation; and 5) be able to define a successful outcome (competency).

Participants will be able to define what qualifies as superior, satisfactory, or a failing performance. (pre-registration and $35 fee required)

Moderator: William Barsan, MD, University of Michigan David Guss, MD, University of California, San Diego Robert A. Schwab, MD, Truman Medical Center Resources to finance academic emergency departments are becoming scarcer. It is becoming imperative that emergency physicians, especially those who desire to assume greater administrative responsibilities, understand the economic constraints and challenges that face academic medical centers and how they may affect the Department of Emergency Medicine. This didactic session will address issues that concern the business aspects of academic emergency medicine. Each of the speakers on the panel has had extensive experience in managing resource allocation and creating departmental budgets. The panel will discuss the flow of money within an academic medical center and the Department of Emergency Medicine. Organizations such as the medical school, the medical center, physicians practice group, and city and county governments all play key roles in resource generation and allocation. Traditional and innovative funding streams will be addressed in this session. The panel will also discuss factors that are weighed when creating an annual budget for a Department of Emergency Medicine. At the completion of this session, participants will be able to discuss: 1. Economic constraints and challenges at an academic medical center. 2. The flow of money and sources of funds within an academic medical center and Department of Emergency Medicine. 3. Factors that are weighed when creating an annual budget for a Department of Emergency Medicine. 4.

Challenges of implementing incentivized physician compensation plans.

Power Searching: A Consumer’s Guide From Point-of-Care to Metaanalysis (1:30-2:30 pm) Marlena M. Wald, Emory University While emergency physicians are well-acquainted with Medline as a source for a literature search, many others exist. This session will introduce the emergency physician to other major medical and life science literature databases that are relevant to our practice and research, and in which many emergency medicine publications are listed.

Marlena Wald, (add from biosketch), will describe the history and background of these databases and compare the variety of online vendors and formats. This will be followed by an overview of query formation and search techniques that can be used across these databases which are appropriate for a range of search situations spanning point-of-care to meta-analysis. Good searching practice, using a real-time on-line connection, will be demonstrated with audience participation. Attendees will be able to see a variety of resources such as Biosis (Biological Abstracts), IPA (International Pharmaceutical Abstracts), EmBase (Excerpta Medica), Medline (Index Medicus), PsychLit (Psychological Abstracts), and World of Science (Science Citation Index). At the completion of the session, participants will: 1)Be familiar with the history of online scientific databases 2) Be familiar with the types of vendors and products 3) Learn or improve search strategy for appropriate retrieval.

Lunch Session: The Emergency Department and Crowding: Research Agenda and Recent Solutions (12:00-1:30 pm) Brent Asplin, MD, MPH, Regions Hospital and HealthPartners Research Foundation Stephan Epstein, MD, MPP, Harvard Medical School, Beth Israel Deaconess Medical Center Charlotte Yeh, MD, American Hospital Association Regional Medicare Medical Director Richard Wolfe, MD, Beth Israel Deaconess Medical Center This session will review the data that exists on crowding with regard to its causes and its effect on practice, education and research in the academic emergency department as well as current research efforts to explain the causes of overcrowding. Dr. Epstein will discuss research that has been and is ongoing, and further research needs in this area.

Dr. Wolfe will discuss how a department approaches its research and faculty needs during overcrowding based on his research and work in this area. Dr. Yeh, a member of the Board of Directors of the American Hospital Association, will discuss key issues identified by the AH and suggestions for solutions. The speakers will also discuss the research avenues that need to be pursued to affect efforts at the level of the hospital administrators, insurers, governing and legislative bodies. At the completion of the session, participants will understand the main causes of overcrowding. Participants will also understand the direction of present and future research to address this issue. (pre-registration and $35 fee required)

State-of-the-Art: Resuscitative Hypothermia: Recent Clinical Trials, Ongoing Research, And The Future (2:30-4:30 pm) Moderator: Robert Silbergleit, MD, University of Michigan Fritz Sterz, MD, University of Vienna, Austria Guy L. Clifton, MD, University of Texas Medical School at Houston Simon Dixon, MD, William Beaumont Hospital, Royal Oak Derk Krieger, MD, Cleveland Clinic A confluence of recent studies and technological developments have brought induced hypothermia back to the forefront of experimental resuscitative therapies. Two large randomized controlled trials of induced hypothermia in survivors of cardiac arrest have demonstrated markedly improved neurologic outcomes in treated patients. At the same time, new endovascular internal cooling technologies promise to allow much more practical application of hypothermia to a wider range of patients. Important differences in the physiologic response to external versus internal cooling will be reviewed. The effectiveness of hypothermia seems to depend in part on early and rapid cooling. Successful study and application of this therapy will require initiation in the Emergency Department.

The speakers will describe what has been learned about resuscitative hypothermia, what is currently being studied, and what lies ahead in the use of this therapy in cerebral ischemia, traumatic brain injury, and myocardial ischemia. At the completion of the session, participants will: Be more knowledgeable about recent and ongoing clinical trials of hypothermia, Better understand the physiologic responses to external and internal cooling, Be more prepared to define the future role of induced hypothermia in the ED.

Lunch Session: Evaluating an Academic Position (12:00-1:30 pm) David Guss, MD, University of California, San Diego John Marx, MD, Carolinas Medical Center Sandy Schneider, MD, University of Rochester This session will provide individuals searching for junior faculty positions a better understanding of the academic job market, the unique characteristics of academic positions, and the talents they will need to succeed. Senior faculty involved in hiring new faculty at their institutions will be the speakers. The session is intended to give job applicants a better understanding of these unique features and help them prepare for the job interview/selection process. At the completion of the session, participants will be able to undersatnd the answers to the following questions: 1) What is the range of expectation that various academic institutions have for faculty research and teaching activities leading to career advancement and promotion? 2) What are reasonable expectations of junior faculty regarding protected time, mentoring, and provision of financial and administrative support? 3) What talents and abilities of new faculty are currently in greatest demand? 4) What is the current status of the academic job market? (pre-registration required, no fee, bring your own brown bag lunch)

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Saturday, May 31 first come-first served basis. The small group audiences in these sessions will be have the oppportunity to hear the review process in real-time and participate with questions or comments as time allows. A copy of the entire grant will be made available to the audience during these session for purposes of discussion. The reviewers will prepare a brief summary description of the grant and a short critique which the applicants can use for further development of their grant.

Pearls in Grant Writing (3:00-4:00 pm) Gary Krause, MD, Wayne State University James Olson, PhD, Wright State University Gabor D. Kelen, MD, The Johns Hopkins University Melissa McCarthy, PhD, The Johns Hopkins University Mark G. Angelos, MD, Ohio State University Gary Green, MD, MPH, The Johns Hopkins University Judd Hollander, MD, The University of Pennsylvania This workshop is intended for faculty or fellows who are at various stages of the grant application process from early drafts to submitted but unfunded applications. The session will build on experiences gained from last year's didactic session 'Surviving Grant Rejection' by: (1) Broadening the number of applications to be reviewed; (2) Providing an increased diversity of expert reviewer comments; (3) Providing more detailed one-on-one feedback to those who submit applications; (4) Offering summary 'take home' points to a general academic emergency medicine audience who are either currently in the grant writing process or are contemplating doing so in the future; (5) Providing a general audience with the opportunity for questions and answers related to content issues in grant applications as they apply to the EM community.

Session 2. Pearls in Grant Writing (3:00-4:00 pm) The second session is a didactic with open enrollment that will discuss the grant submission and review process, and will include a question and answer session from the audience. The individual reviews from the preceding session will be used as the take-off points for discussion and to provide a series of ‘take-home points’ that are useful to a wider audience. One expert from each review team will briefly summarize the content of the grant proposals previously reviewed for purposes of opening the discussion. Each expert will focus on a particular section of the grant (Background; Preliminary Data; Methods etc), with particular attention to problem areas frequently encountered (e.g. organization of material, power calculations, etc). The theme of this session will be pearls and pitfalls in grant writing from the reviewers’ perspective. Following each brief presentation an open panel session will follow which will provide the audience with an opportunity for questions and answers. At the completion of the session, participants will: 1.

Gain insight into the common errors in grant writing 2. Understand the thought process of a grant reviewer 3. Know the similarities and differences between grant writing for basic science and clinical research.

Session 1. Grant Mentoring Workshop (1:30-2:30 pm) In the first session, expert reviewers will be paired with individual grant applicants to give detailed feedback on the applications. This will take place in two small group sessions with a limited audience enrollment of up to 10 for each small group and selected on a

Resuscitative Hypothermia Academic Industry Roundtable 6:00-10:00 pm, Salons A/B Recent trials and evolving new technologies have generated renewed enthusiasm for research into the role of induced hypothermia in the resuscitation of patients with several different pathologies. These data also suggest the critical importance of very early initiation of hypothermia in the Emergency Department. Hypothermia research in the past has been primarily organized by specialists from several different disciplines that often had limited contact with each other. Academic emergency medicine is uniquely positioned to facilitate interdisciplinary research efforts and communication in hypothermia research.

RHAIR will bring researchers in emergency medicine with an interest in hypothermia together with hypothermia researchers from neurology, cardiology, neurosurgery, and anesthesiology, as well as with representatives of the relevant industries and governmental funding and regulatory agencies. The participants will discuss specific topics related to the general theme; "How to Build Interdisciplinary Research in Hypothermic Resuscitation". A proceeding of the meeting will be produced for peer-reviewed publication.

Agenda 6:00-6:30 pm Keynote Address: How to Build Interdisciplinary Research in Hypothermic Resuscitation, Fritz Sterz, MD, Vienna General Hospital.

6:30-7:30 pm Identification of the Barriers to and Opportunities for Initiating Multidisciplinary Emergent Hypothermic Resuscitation Research Efforts, Guf Clifton, MD, University of Texas Houston, Celia Witten, MD, PhD, Food and Drug Administration, George Sopko, National Health Lung and Blood Institute, Simon Dixon, MD, William Beaumont Hospital, and Michael Sayre, University of Cincinnati.

7:30-8:30 pm What are the Critical Questions of Science to be Answered in the Next Five years for Hypothermia? Myron Ginsberg, MD, University of Miami, Sam Tisherman, MD, University of Pittsburgh, Midori Yenari, MD, Stanford University, and Clifton Callaway, MD, PhD, University of Pittsburgh.

8:30-9:30 pm What are the Best Models of Collaborative Research Efforts in Hypothermia? Is it Valuable and Feasible to Develop Consensus Methodologies for Effectiveness and Safety Endpoints, Patient Management Strategies, Data Fields and Timepoints? Do we Need a Consortium, a Registry, a Consensus Conference or Something Else? Derk Krieger, MD, Cleveland Clinic, Michael Todd, MD, University of Iowa, Mary Ellen Michel, PhD, NINDS, and Dave Wright, MD, Emory University.

9:30-10:00 pm Summar and Final Open Discussion All Annual Meeting registrants are invited to participate in this session. There is no registration fee.

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Saturday, May 31

MEDICAL STUDENT SYMPOSIUM May 31, 2003, Salon F The Medical Student Symposium is intended to help medical students understand the residency and career options that exist in emergency medicine, evaluate residency programs, explore research opportunities, and select the right residency. At the completion of the session, participants will: 1) know the characteristics of good emergency physicians and the “right” reasons to seek a career in this specialty, 2) have a better understanding of the application process with regard to letters of recommendation, personal statement, planning the 4th year, etc., 3) consider factors important in determining the appropriate residency, including geographic locations, patient demographics, length of training, etc., 4) understand the composition of an emergency medicine rotation and what to expect while they are rotating in the ED, 5) discuss the skills needed to get the most out of your educational experience in the ED rotation,. 6) Identify the standard sources of information in the field of emergency medicine, 7) have an appreciation of various career paths available in Emergency Medicine, including academics, private practice, and fellowship training, and 8) discover current areas of research in Emergency Medicine.

9:00 - 9:15 am 9:15 - 10:00 am

10:00 - 10:30 am

10:30 - 10:45 am 10:45 - 11:45 am

11:45 - 12:15 pm

12:30 - 2:00 pm 2:00 - 2:30 pm

2:30 - 3:30 pm

3:30 - 4:30 pm

4:45 - 6:15 pm

Welcome & Introduction, Susan Promes, MD, Duke University Health System How to Select the Right Residency for You, Wendy Coates, MD, Harbor-UCLA An overview of EM residency programs will be discussed. Important factors to consider in the selection process including length of training, geographical location, patient demographics, and academic vs. clinical setting will be reviewed.

Getting Good Advice, Donald Kosiak, MD, Mayo Clinic One of the keys to any successful career is getting and following good advice. How do you choose the right advisor? What do you do when your medical school doesn’t have an EM Residency Program?

Break Navigating the Residency Application Process, Peter DeBlieux, MD, Louisiana State University This presentation will provide students with tips on how to prepare their ERAS application, how and when to successfully interview and how to follow-up with top programs.

EM Research in Medical School – Should I be doing It? James Adams, MD, Northwestern University Students interested in emergency medicine are constantly struggling with the question of whether or not they need to do research in order to be a competitive applicant to the specialty. Come and hear this speaker’s advice on this hot topic.

Lunch with Program Directors, Salon F Getting the Most out of Your EM Clerkship, Gus Garmel, MD, Kaiser Santa Clara, Stanford University An emergency medicine clerkship is a valuable part of a medical student's education. It provides a unique learning environment and educational opportunities that are not easily reproduced in any other medical school rotation. There is no better rotation to learn the basics of how to approach an undifferentiated patient. In addition, students are taught the principles of assessment and stabilization of the patient with an acute illness or injury, are provided opportunities to learn basic procedural skills, as well as to learn the basics of how to approach common emergency complaints. Despite the vast opportunities for clinical education and the advantages of the emergency department, it can be a very difficult place to learn because of the often seemingly chaotic environment. This session will provide the student with valuable tips for getting the most from your emergency department clerkship.

Specific topics to be discussed will include: 1) appropriate educational goals for an emergency medicine rotation 2) how to best prepare for your rotation in order to make the most of your ED experience 3) recommended textbooks and references 4) important considerations when deciding when and where to do your emergency medicine rotation Career Paths and Prospects in Emergency Medicine, Pam Dyne, MD, Olive-View UCLA This session will expose students to a variety of career paths including private practice, academics, and dual training (EM-IM or EM-PEDS) as well as fellowship training.

Breakout Groups, Salons F/J/K: So You’re Going to be an Intern The students will learn the basic principles of EM before arriving for their first day of residency. Highlights will include tips for success, clinical pearls, and which books you should carry.

Getting Involved in EM in Pre-Clinical Years In this session, the students will discuss the opportunities available for participation in emergency medicine prior to their clerkships such as involvement in EM interest groups, shadowing emergency physicians, and research opportunities.

Optimizing Your Fourth Year This session will provide students with recommendations for making the most of their senior year including information about EM and other electives, research experience, and when to take their Boards exams.

Residency Reception/Fair, Salon G An informal opportunity to speak with individuals from residencies across the country about their programs and EM. 27

Saturday, May 31

SAEM ANNUAL BUSINESS MEETING 11:00-12:00 noon Salon E All members invited and encouraged to attend.

1. SAEM Award and Grant Presentations, Roger J. Lewis, MD, PhD, SAEM President 2002 Hal Jayne Academic Excellence Award: Blaine White, MD, Wayne State University 2003 Hal Jayne Academic Excellence Award: Judd Hollander, MD, University of Pennsylvania 2003 Leadership Award: E. John Gallagher, MD, Albert Einstein College of Medicine Young Investigator Awards Daniel Davis, MD, University of California, San Diego Edward Jauch, MD, MS, University of Cincinnati Paul Klawitter, MD, PhD, Ohio State University Resident Research Year Grant James Holmes, MD, University of California, Davis Institutional Research Training Grant Mark Angelos, MD, Ohio State University Scholarly Sabbatical Grant Daniel Morris, MD, Henry Ford Hospital EMS Research Fellowship Carin Van Gelder, MD, Yale-New Haven Hospital Neuroscience Research Fellowship Selim Suner, MD, Brown University 2002 Annual Meeting Awards, Ellen Weber, MD, Chair, SAEM Program Committee Faculty Clinical Science Presentation Debra Weiner, MD, PhD, Children's Hospital: Effectiveness and Safety of Inhaled Nitric Oxide for the Treatment of Vasoocclusive Crisis in Sickle Cell Disease Faculty Basic Science Presentation Richard Summers, MD, University of Mississippi: Effect of Delta Receptor Agonist on Duration of Survival During Hemorrhagic Shock Young Investigator Presentation Daniel Rusyniak, MD, Indiana University: Hyperbaric Oxygen Treatment in Acute Ischemic Cerebral Vascular Accidents: A Prospective, Double-Blind, Placebo-Controlled Pilot Study Basic Science Fellow Presentation Mark Su, MD, New York University/Bellevue Hospital Center: Amiodarone (Ami) Attenuates Fluoride-induced Hyperkalemia in Human Erthrocytes (RBCs) Clinical Science Fellow Presentation Linda Papa, MD, CM, CCFP, University of Ottawa: Predicting Need for Intervention in Renal Colic Patients after ED Discharge IEME Exhibit Presentation Eric Savitsky, MD, University of California, Los Angeles: A Multimedia Web-based Trauma Tutorial and an Interactive Multimedia Procedure Tutorial Clinical Science Resident Presentation Joe Suyama, MD, University of Cincinnati: Surveillance of Infectious Disease Occurrences in the Community: An Analysis of Symptom Presentation in the ED Basic Science Resident Presentation Steven Bird, MD, University of Massachusetts: Diphenhydramine as a Protective Agent in Severe Organophosphate Poisoning Medical Student Presentation James Frederick, BA, University of Pennsylvania: Delayed Inhibition of Calpain Activity after Global Brain Ischemia 2. Election Results, Roger J. Lewis, MD, PhD, SAEM President The following slate of nominees was presented to the membership for vote by mail ballot: President-elect: Carey Chisholm, MD, Indiana University Board of Directors: Leon Haley, MD, Emory University Steve Hargarten, Medical College of Wisconsin James Hoekstra, MD, Wake Forest University Catherine Marco, MD, St. Vincent Mercy Medical Center Susan Stern, MD, University of Michigan

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Saturday, May 31

Young Investigator Awards

Daniel Davis, MD

Edward Jauch, MD, MS

Paul F. Klawitter, MD, PhD

Grant Recipients

Mark G. Angelos, MD

James Holmes, MD

Daniel Morris, MD

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Selim Suner, MD

Carin Van Gelder, MD

ing point with five possible answers, convey the correct answer to the question within a case explanation, and submit the text and associated images to the database through an online form. The trainee has now identified a case of educational value, researched its subject matter, and presented it through an educational innovation for others to learn from.

clinician knows exactly what is available or where to begin searching. Through an NIH grant, a joint project between the Galter Health Sciences Library at Northwestern University and the Division of Emergency Medicine created a “Smart Library.” The result is a “metasearch” tool that puts all digital full-text journals and textbooks at a clinician’s fingertips over the Internet. All resources can be reached through a single search bar.

These tools make all digital textbooks and journals available. The system is configurable to multiple specialties besides emergency medicine and makes “intelligent” guesses as to what resources would best serve that clinician. Other features include filing cabinets to store articles and a “current awareness” alerting service for new developments in a topic of interest. This system is built on the “open-source” model and is available free to any library. We will demonstrate a live version of this system.

17 Medical Student Director Apprenticeship for Emergency Medicine (EM) Residents Thomas A. Rebbecchi, Andrew L. Nyce, J. Hope Kilgannon, Brigitte M. Baumann; Cooper Hospital / University Medical Center EM faculty responsible for medical student (MS) education often never receive formal training prior to acquiring these responsibilities. These individuals are frequently expected to learn “on the job,” at times to the detriment of the education they are supposed to foster. We developed a 2.5 year MS Education Director apprenticeship for residents who plan on pursuing teaching careers. Resident objectives: Preparing and presenting medical student lectures; providing student mentorship; assisting in preparation of Letters of Recommendation (LOR’s), and fulfilling the residency scholarly activity requirement. The apprenticeship begins in January of the PGY1 year. The PGY1 shadows the course director in scheduled program activities. During the PGY2 and 3 years, the resident presents a core lecture/month and provides mentorship to one student/month. Mentorship includes: review of case presentations, review of case logbooks, assistance with oral presentation, participation in course evaluations, and preparation of LOR’s. The PGY3 is additionally required to prepare a teaching case for the EM MS web case-based teaching site. The Education Director provides formal feedback on the resident’s core lectures, guides mentorship responsibilities, and provides suggestions for maximizing the effectiveness of case-based teaching. Each resident meets with the course director on a bimonthly basis to review student/resident performance. Resident evaluation consists of student evaluations, course director assessment and resident self-assessment.

Involvement in this apprenticeship provides residents with basic mentoring, teaching, and administrative skills prior to graduation. These skills are particularly important for residents who wish to pursue careers in academic EM.

13 Emergency Medicine Clinics; An Innovation in Emergency Medicine Resident Education David S. Brancati, Curtis Sandy, Catherine Marco, Randy King, Paul DeSaintVictor; St. Vincent’s Mercy Medical Center Introduction: The concept of weekly continuity clinics, now standard in many primary care and specialty training programs, has yet to be implemented in emergency medicine residencies in the United States. Owing to many factors, including the obvious lack of anticipated continuity of care and unlikelihood of an outpatient ambulatory practice setting, protected clinic time for emergency medicine residents has been overlooked. Over a one-year period beginning July of 2002 at St. Vincent’s Mercy Medical Center we introduced and implemented the first Emergency Medicine clinics. A modification of the outpatient ambulatory clinics utilized in other specialty training programs, the Emergency Medicine Clinics provide continuity in emergency medicine training and a revolutionary new concept in emergency medicine graduate medical education. Methods: One halfday per week on a pre-assigned, yearly basis PGYI emergency medicine residents participate in an “Emergency Department Clinic.” EM residents rotating off - service proceed to the emergency department, where they are met by an ED faculty member or senior resident. They then receive formalized training in emergency medicine including didactic, oral board simulation, procedural competency and actual patient encounters.

Results: The clinics have been well received by the PGYI class. Conclusion: Emergency department clinics is a preliminarily, well received concept whose clinical and academic effectiveness should be studied scientifically

18 Web-based Emergency Medicine Interactive Case Studies for Medical Students Andrew L. Nyce, J. Hope Kilgannon, Thomas A. Rebbecchi, Brigitte M. Baumann, Paul R. Mehne; Cooper Hospital / University Medical Center Due to the brevity of the clinical rotation, medical students participating in an Emergency Medicine (EM) rotation may not have adequate exposure to classic EM cases. In order to provide a more standardized clinical and educational experience, we developed multiple web-based EM interactive case studies. Fundamental EM cases such as acute myocardial infarction, diabetic ketoacidosis, and pulmonary embolism were formatted into the software application Quandary (www.halfbakedsoftware.com). Quandary promotes the generation of a web-based action maze that is readily applied to medical scenarios. Each EM case begins with a clinical scenario followed by a question, along with multiple options. The correct answer is rewarded with a detailed explanation referenced by core EM textbooks and other pertinent literature. An incorrect answer yields a similar explanation and returns the student to the previous question until the correct answer is provided. The student proceeds in a step-wise fashion through the case until complete. The objectives of this teaching modality include the: 1) provision of a more standardized clinical experience to students; 2) promotion of independent learning; 3) further development of students’ clinical problem-solving skills. The content of the cases are focused towards improving students’: 1) history and physical skills; 2) differential diagnostic skills; 3) diagnostic reasoning; and 4) patient management skills. Students may access the cases at any time during the rotation but are required to complete all cases prior to the rotation’s conclusion. Student feedback has been extremely positive and supportive. A demonstration will be provided.

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Pediatric Mock Resuscitation: Evaluation of a Clinical Curriculum David S. Brancati, Joseph V. Dobson, Rollin Nagel; St. Vincent’s Mercy Medical Center Objective: To assess the impact of a 6-hour Pediatric Mock Resuscitation Curriculum on the comfort levels of resident physicians’ evaluation and treatment of critically ill pediatric patients. Methods: Learners included Pediatric (51.6%), Internal Medicine/Pediatric (12.9%) and Emergency Medicine (35.5%) residents. A survey instrument evaluated resident comfort levels, measured on a seven digit Likert scale ranging from significantly uncomfortable to significantly comfortable, in 13 areas of pediatric resuscitation. To complete the course, residents had to demonstrate proficiency in knowledge and procedural skills during mock resuscitation scenarios and on both written and oral examinations. Results: 31 residents participated in the study: 54.8% were PGYI, 29% PGYII and 16.1% PGYIII. Participants in the course had little previous experience with pediatric resuscitation (83% had been involved in <= 5 pediatric resuscitations). In all 13 areas of pediatric resuscitation tested, residents reported improvement in comfort levels following the course (p<0.001; Wilcoxon Signed Rank Test). The most significant changes were observed for the 3 following items: Cardioversion and Defibrillation, Rapid Sequence Intubation, and Resuscitation of Pulseless Arrest. Less than 48% of learners rated themselves as comfortable in these areas prior to training, but after course completion, >80% rated themselves in the comfortable range. Overall, the residents improved from an average level of neutral (neither comfortable or uncomfortable) to moderately comfortable with pediatric resuscitation. Conclusion: Implementation of a Pediatric Mock Resuscitation Curriculum improves comfort levels of pediatric and emergency medicine residents. This curriculum can be used in residency training to document the acquisition of core competencies, knowledge and procedural skills needed for the evaluation and treatment of the critically ill child.

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Emergency Department Orientation Utilizing Web-based Streaming Video Michael A. Gisondi, Swaminatha V. Mahadevan, Shannon S. Sovndal, Gregory H. Gilbert; Stanford University Medical Center Orientation videos have been shown to improve employee training in such areas as occupational safety and systems-based error reduction. Our residency program has been using VCR tapes to facilitate training in these areas, as well as emergency department orientation for new employees, housestaff, and students. Over the past year we have produced a new series of orientation materials to be presented as a sequence of streaming videos viewed through an on-line internet player. As our program sees off-service residents and students beginning their EM rotations with various start dates throughout the month, this system of web-based video improves access and compliance with our department orientation process. The material has been broken into a series of short videos that can be reorganized to create separate nursing, resident and student orientations. The shorter videos are also more cost-effective, as updates can be made to particular sequences without re-filming the entire orientation video. Our exhibit will include a laptop with video feed from each of the main content areas: ‘welcome’, ‘patient flow’, ‘chart flow’, ‘sign-out’, ‘ED personnel review’, ‘seeing patients’, ‘chart completion/billing’, ‘ED decision-making’, ‘disposition’, ‘special services’ and ‘helpful hints/closing’. We will

16 Case Studies in Emergency Medicine Marc Bellazzini; University of Chicago A residency in emergency medicine or student rotation through the emergency department is a great opportunity for case-based learning. Unfortunately, interesting or educational cases are seldom shared with other trainees who would benefit from their educational value. Case Studies in Emergency Medicine (CSEM) has been developed to correct this deficiency. CSEM is an on-line educational module that gives students and residents the opportunity of posting interesting cases and clinical images to a website. The cases are available though the web for other residents and students to learn from. Let us use the example of a student evaluating an interesting patient in the emergency department. The student will gather clinical information, obtain a digital photograph, if appropriate, and research the topic at hand. He or she will write a case narrative describing the patient’s presentation, formulate a question based on an important teach-

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tive for biochemical terrorism response training. We envision a full curriculum consisting of one high fidelity simulation for each major class of agent, supplemented by the flat screen simulator and lectures. Our demonstration of this project will consist of a poster, one laptop computer illustrating the learning objectives, and one laptop computer with video footage from the simulation.

describe the process by which we generated these videos, focusing on cost, human resources, product selection and implementation.

19 The UCSD Research Associate Program: A Recipe for Successfully Integrating Undergraduates with Emergency Medicine Research Jennifer C. Poste, Daniel P. Davis, Siobhan Guthrie, Donna Kelly; University of California, San Diego Previous reports have documented the successful integration of undergraduates into the ED to assist in data collection for various research projects, with resultant improvements in departmental academic productivity. These reports have not detailed the exact procedures required to institute such a program. Over 50 undergraduates from two institutions currently participate in the UCSD Research Associate Program. This exhibit will document our experience with the inception of such a program and define the various components required to successfully conduct an ED undergraduate research associate program. The roles of key personnel will be defined, including a program director, administrative assistant, nurse coordinator, and student liaison. The administrative component will be detailed, addressing liability issues, orientation to hospital policy and patient interactions, coordination of participant information, uniforms, and parking.

Recommendations for designing and implementing research projects will be provided, including discussion of project appropriateness, data sheet design, research associate training, instruction sheets, patient enrollment procedures, and consent issues.

Participant recruitment strategies will be outlined, making use of campus organizations, prehealth advisory offices, formal subject departments, publications, internship opportunities, and online resources. Techniques for maintaining participant interest and education will be discussed, including course credit, internships, medical school application enhancement, and formalized didactic sessions. Lastly, monitoring strategies to ensure maximal patient enrollment and accurate data collection will be addressed. Sample documents will be supplied, including data collection sheets, student announcements, instruction sheets, and didactic session materials. This exhibit should help define the steps required to successfully initiate an ED undergraduate research associate program.

23 Using Human Patient Simulation to Instruct Emergency Medicine Residents in Cognitive Forcing Strategies William Bond, Lynn M. Deitrick, Marianne Kostenbader, Darryl C. Arnold, Charles C. Worrilow, Gavin C. Barr; Lehigh Valley Hospital / Penn State College of Medicine Introduction: Emergency physicians are likely to encounter certain cognitive errors in every day practice. We present a new approach to teaching metacognition and error avoidance in a high-fidelity simulation setting. Methods: 15 emergency medicine residents (PGY3 n = 8, PGY2 n = 7) experienced a difficult simulator lab scenario designed to lead the residents into an error trap of giving succinylcholine to a hyperkalemic patient. Residents were debriefed for 5 minutes post lab on their individual performance.

Part two of the debriefing consisted of a PowerPoint® with audio format CD-ROM with information on the use of succinylcholine (15 min) and cognitive forcing strategies (30 min). After debriefing, residents were interviewed by an ethnographer and given a written survey. Results: One PGY2 and one PGY3 resident did not fall into the error trap.

Relative to other learning experiences, the residents ranked their simulation experience second, with only direct supervised patient care ranking higher. Residents reported little or no prior exposure to cognitive forcing strategies (mean response 1.27), with 1 = no exposure and 5 = extensive exposure. Interview data reveals differences between PGY3s and PGY2s, especially in their ability to explain the concept of cognitive forcing strategies or metacognition (5 PGY3s and 1 PGY2 were able). When asked what they learned, 6 PGY3s and 1 PGY2 commented on cognitive strategies or heuristic techniques.

PGY2s focused on the knowledge gained about succinylcholine (5 of 7). Most residents agreed that experiencing an error was helpful (14 of 15) and most (14 of 15) described the overall experience as positive. Conclusion: Preliminary data suggests that metacognitive strategies can be taught through simulation and debriefing, although it may best be taught at the senior resident level.

20 Teaching Our Own: The ED-based Focused Orthopedics Rotation for Emergency Medicine Residents Edward Kim, Charles L. Maddow; University of Rochester EM residencies commonly schedule off-service clinical rotations to ensure exposure to particular specialties. On such rotations EM residents are neither observed nor evaluated by EM faculty. Educational emphases may involve practices and priorities beyond or at variance with EM scope and standards of care. We replaced our standard first-year inpatient and consult orthopaedics rotation with a pilot ED based curriculum, which we describe here. The EM Orthopaedics resident (EMO) is stationed within the ED 50 hours per week, in scheduled shifts. EMO’s work closely with Triage and Charge RN’s to identify all patients presenting with orthopaedic injuries or complaints. These cases, including those who would otherwise be seen in a “fast track” staffed by mid-level providers, are treated by the EMO under the direct supervision of an EM attending physician. All orthopaedic injuries incidental to other presentations (e.g., hip fracture from syncope) are stabilized and managed by the EMO, who initiates all appropriate consultations for definitive treatment or follow-up. This pilot ED-based, specialty-focused rotation increases residents’ exposure to acute orthopaedic presentations, emphasizes the initial management of orthopaedic injuries under EM faculty supervision, and eliminates unproductive floor and OR service work. We will assess this curriculum’s success in providing our interns adequate case selection and procedural experience.

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Emergency Medicine Pelvic Ultrasound CD-ROM Tutorial Brian Chinnock; Texas Tech University Health Sciences Center Pelvic ultrasound of the symptomatic first-trimester pregnancy patient is an important application of bedside EM ultrasound. Learning anatomy, particularly in regards to the transvaginal scan, can be particularly difficult for the novice EM sonographer. This CDROM tutorial, through different teaching modules, teaches the student the normal and pathologic sonographic findings of a first-trimester pregnancy. The tutorial makes particular emphasis of video, rather than still images, of ultrasound findings, as bedside ultrasound is a dynamic application. Each of the videos has both unlabeled versions so the student can first try to interpret the scan without help, then a detailed labeled version so the student can fully understand the sonographic findings. There are numerous interactions during the tutorial in which the student answers questions regarding material they have just learned in order to reinforce learning objectives. The module also has a quiz at the end which can be used by the individual to identify areas of deficiency, or by a residency ultrasound director to track results of residents and put it into a database.

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Staged Trauma Resuscitation Used to Integrate a New Medical School Curriculum Alan Gelb; San Francisco General Hospital, University of California The centerpiece of a new integrated first year medical school curriculum is a surprise, staged Emergency Department resuscitation of a moulaged motorcycle crash victim. The case follows a “patient” through the Emergency Department resuscitation, the Intensive Care Unit, and discharge planning in four separate sessions. These elaborate reenactments on the stage of a lecture hall include orotracheal intubation, chest tube and subclavian line insertions, FAST ultrasound, and other procedures. Each staged scenario is immediately followed by interviews with members of the team of physicians, nurses and social workers who care for the patient and the opportunity for students to ask these participants questions. Interview topics are carefully chosen to integrate the basic, clinical and social science concepts covered in the “Prologue” six-week introductory block of the new curriculum. Some of the 16 post-reenactment interview topics and the tie-in to curriculum content include: “The ABCs of Trauma Resuscitation and Shock” (cardiopulmonary physiology and anatomy), “Universal Precautions” (introduction to clinical medicine), “Routes of Medication Administration” (pharmacology) and “Compartment Syndrome” (anatomy and cellular physiology). The reenactment and interview approach enhance the relevance and retention of the information covered. Supplementary material is time-released to students on the university web site, including an on-line forum for the posting of questions by students and answers from members of the cast, PowerPoint® slides used in the interviews, and digitized video and scripts of the reenactments. The exhibit will include video of the staged resuscitation and interviews, as well as the supplementary web site.

22 Use of High Fidelity Patient Simulation Combined with Flat Screen Simulation for Biochemical Weapons Response Training Italo A. Subbarao, William F. Bond, Marianne Kostenbader, Howard A. Schwid; Lehigh Valley Hospital, University of Washington After 9/11 the need for biochemical weapons response training has become clear. We combined modalities and converted a sarin gas scenario from flat screen CD-ROM (Bioterrorism Simulator, Anesoft Corp, Issaquah, WA) to a high fidelity mannequin-based scenario (using the METI Human Patient Simulator, METI Corp, Sarasota, FL). Debriefing was accomplished using the Learning Objectives portion of the CD simulator. A survey was conducted as to effectiveness of the combined modality as a teaching tool and realism of the scenario. Objectives were to: 1) Recognize Contamination, 2) Decontaminate with Airway Management, 3) Notify Public Health, 4) Recognize Toxidrome, 5) Use Antidotes. Three actors including a paramedic, nurse, and technical partner were present during simulation. A PGY-3 team leader and PGY-2 were paired together randomly without any advance notice of simulation. A laptop computer with Internet access and palm pilot with PEPID (Portable Emergency Physician Database, PEPID, Chicago IL) were present in the room for access. The scenario lasted until objectives were met (approximately 15-20 minutes). Fifteen Emergency Medicine residents completed the simulation (8 PGY-2, 7 PGY-3), debriefing and survey. The survey was a 5 point Likert scale with 1 completely disagree to 5 completely agree. Mean results: realism of scenario 4.2, effectiveness for learning antidotes 4.7, CD effectiveness as debriefing tool 4.4. High fidelity simulation with flat screen simulator debriefing was perceived to be realistic and effec36

CHIEF RESIDENT FORUM May 28, 2003, Salon F 7:30 - 8:00 am

Registration and Continental Breakfast

8:00 - 8:15 am

Welcome & Opening Remarks – Richard D. Shih, MD, Morristown Memorial Hospital

8:15 - 8:45 am

Characteristics of Good Leaders – Scott Syverud, MD, University of Virginia This session will discuss the qualities of a good leader (e.g., organizational skills, honesty, communication skills, consistency), the methods to incorporate leadership skills into one’s daily life, and methods to motivate others.

8:45 - 9:30 am

Practical Tips for a Successful Year – Douglas Lee, MD, St. Luke's-Roosevelt Hospital; Thomas MacFarlane, MD, University of California, Davis This session will include a discussion of practical advice on being a chief resident. It will be led by two senior residents who are currently finishing their year as a chief resident in emergency medicine, and will involve actual problems they have faced along with solutions. Specific situations to be discussed will include the chief resident as an interviewer, as well as how to best evaluate junior residents and medical students.

9:30 - 10:30 am

Small Group Discussion Session - Developing Your Chief Resident Skill Set Each of the small groups will be led by a faculty member and/or chief resident. Topics to be discussed will include various situations that may arise during the year and possible solutions. Emphasis will be placed on the skills that are necessary to have a successful year as chief resident.

10:30 - 10:45 am Break 10:45 - 11:15 am Scheduling Tips – Kevin Rodgers, MD, Methodist Hospital, Indianapolis This session will discuss RRC mandates as they apply to resident scheduling, different methods for scheduling shifts (e.g., varying shifts lengths, advancing shifts), and factors that can affect a schedule and how to deal with sudden changes (e.g., illness or injury).

11:15 - 11:45 am Professional Growth and Success as a Chief Resident – Rita Cydulka, MD, MetroHealth Medical Center This section will help chief residents understand and describe the advantages and pitfalls of being a chief resident; the importance of developing short and long term goals, with specific examples; the importance of selecting a role model and developing a mentoring relationship; and the challenges of transitioning to the role of Chief Resident and mechanisms to facilitate this change.

11:45 - 1:00 pm

Lunch/Question & Answer Session, Salon G This session is an opportunity for chief residents to meet the various speakers and ask questions in a relaxed atmosphere. Each speaker will sit at a table with a group of residents.

1:00 - 1:30 pm

The Resident in Crisis – Robert McNamara, MD, Temple University During this session chief residents will learn how to define an impaired resident, become familiar with ways to identify an impaired resident, and review roles and responsibilities of the chief resident as they pertain to the impaired resident (e.g., reporting responsibilities, confidentiality).

1:30 - 1:45 pm

Break

1:45 - 2:15 pm

Ethics and Professionalism – Jim Adams, MD, Northwestern University This session will discuss ethical and confidential issues that involve other residents, how to set professional examples for others, and how to represent your department in the hospital setting.

2:15 - 3:30 pm

Question & Answer Session – Flavia Nobay, MD, University of California, San Francisco; Richard D. Shih, MD, Morristown Memorial Hospital; and Mary Jo Wagner, MD, Saginaw Cooperative Hospitals Inc. This session will involve discussion of questions that are solicited from participants prior to the date of the conference. Topics are anticipated to involve various EM residency issues.

3:30 - 4:15 pm

The Chief Resident as a Teacher – Steve Hayden, MD, University of California, San Diego This session will include advantages and disadvantages of the lecture format and alternatives to this method, effective speaking and presentation techniques (e.g., preparing slides and computer driven presentations, make eye contact, do not speak to your slides, speak up), and effective clinical bedside teaching techniques. Interesting approaches to journal club will also be discussed.

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INTEREST GROUP MEETING AGENDAS DIVERSITY INTEREST GROUP Saturday, May 31 · 12:00-1:30 pm · Cape Cod I. Old Business A. Medical Spanish EMR curriculum B. Diversity Scoring departments II. New Business A. URM Task Force 1. Focus Groups – Glenn Hamilton 2. Evolution to URM curriculum TF – Marcus Martin B. Proposals for URM faculty development 1. Recruiting new URMs to academics CORD – Ferguson 2. Consultation service for department recruiting – Ferguson C. New business from members III. Adjourn

IV.

DOMESTIC VIOLENCE INTEREST GROUP

V. VI.

Friday, May 30 · 1:30-2:30 pm · Falmouth I. Discussion of old business from last meeting.

II. Guest speakers (TBA) will discuss funding opportunities (CDC, NIH, AHRQ, private foundations) for domestic violence including active projects.

EVIDENCE-BASED MEDICINE INTEREST GROUP Thursday, May 29 · 3:00-4:00 pm · Tufts I. Business A. Announcement of chair for 2003-2004 (Wyer) B. Membership report (Wyer) C. Listserv for IG (Yeh) II. Activities and Projects (Old Business) A. EBM Workshop SAEM 2003 (Eskin) B. CORD Best Practices Conference (Brown) C. Consultancy for EM Programs (Hayden) D. Rational Clinical Exam Project • Bibliography web update (Wyer, Kuhn) III. Forward Plans, Meetings and Perspectives (New Business) A. Didactic Proposal SAEM 2004 • Standard EBM Workshop • Meta-analysis Workshop • Ideas?

B. Undergraduate EBM (Ismach) C. Online EBM Course (Irvin) D. EM CAT Bank E. Other new projects IV. Adjourn

VII.

HEALTH SERVICES AND OUTCOMES INTEREST GROUP Friday, May 30 · 9:00-10:00 am · Falmouth Donald B. Chalfin, MD, MS, Director, Division of Research, Maimonides Medical Center, Brooklyn, New York, Albert Einstein/Beth Israel Medical Center, Chair, SAEM Health Services and Outcomes Interest Group As in years past, the Health Services and Outcomes Research (HSOR) Interest Group meeting will address issues related to new advances and emerging trends in health services and outcomes research in emergency Medicine and related disciplines. In addition, this year’s meeting will explore ways to promote and enhance collaboration between group members and the institutions and departments that they represent. Another topic for discussion will be HSOR sponsored proposals and proposed didactic sessions at the 2004 Annual Meeting of the SAEM. All interested individuals are invited to attend. For further information, please contact Dr. Chalfin via telephone at 718-2836052 or via email at dchalfin@maimonidesmed.org or dchalfin@applied-decision.com.

GERIATRIC INTEREST GROUP Saturday, May 31 · 12:00-1:30 pm · Vineyard I. Welcome and Introductions (5 min) II. Chair’s report (10 min) III. Discussion and Progress on 2002-2003 Objectives (5 min) A. Design and conduct a multi-center study focusing on management of abdominal pain in elder patients.

B. Develop a didactic session proposal for the 2003 annual meeting presenting the state of the art in geriatric trauma prevention and management.

C. Plan to have a distinguished speaker present at the 2003 interest group meeting.

Speaker (45 min) Assessing Seniors Quickly in Emergency Departments Hilary Siebens, MD, Medical Director, Center for Seniors and Younger Persons with Disability, University of California, Irvine, Medical Center Dr Siebens will describe the Domain Management Model that she developed. The model categorizes patient issues into four easily remembered domains: I. Medical/Surgical Issues, II. Mental Status/Emotions/Coping, III. Physical Function, and IV. Living Environment (physical, social, financial). This model is especially helpful for patients presenting with functional decline and falls along with acute illness. It facilitates efficient case discussion within and across ED programs. This new "mental model", in use already by some geriatricians and physiatrists, can be used for teaching and for streamlining communication among ambulance personnel, ER staff, PCPs and other healthcare settings.

Introduction of Steven Meldon, MD, Chair 2003-2005 (5 min) Objectives and plans for 2003/2004 Dr. Meldon (20 min) Suggested: Use of Hartford/AGS funds Fund fellow/resident research projects in geriatric emergency care.

Prepare a didactic session to be presented at the 2004 annual meeting.

Update the abdominal pain, cardiac, and trauma teaching modules.

Develop a proposal for a multicenter study.

Plan to have a distinguished speaker present at the 2004 interest group meeting.

Closing (5min)

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MEDICAL STUDENT EDUCATORS INTEREST GROUP

PEDIATRIC INTEREST GROUP Thursday, May 29 · 3:00-4:00 pm · Orleans/Provincetown I. Welcome and introductions II. Report from SAEM Board Liaison and from the SAEM Program Committee III. Update on PECARN activities IV. Organizational planning A. Development of short- and long-term goals for the interest group B. Terms of office V. Adjournment

Saturday, May 31 · 9:00-11:00 am · Orleans/Provincetown 9:00 – 9:05

9:05 – 9:20 9:20 – 9:35 9:35 – 9:55

9:55 – 10:00

Douglas Ander, MD Welcome Objectives of session Introduction of speakers Todd Berger, MD Providing Feedback: Why and how Lori Weichenthal, MD Strategies for dealing with the difficult student Standardized Students Demonstration of providing feedback and dealing with the difficult student using case scenarios and standardized students Wrap-up and questions

SIMULATION INTEREST GROUP I.

NEW INTEREST GROUP: MENTORING WOMEN Thursday, May 29 · 4:00-5:30 pm · Wellesley A new SAEM Interest Group has recently been formed entitled Mentoring Women. The objectives of this Interest Group are two-fold: 1) to increase opportunities for women in emergency medicine through formal and informal mentorship and 2) to look for opportunities to improve women in academic emergency medicine. The group will hold its first organizational meeting at the upcoming SAEM Annual Meeting in Boston. This formative meeting is open to all SAEM members – men and women alike. We will be discussing our objectives and brainstorming ways to accomplish them in the coming year, as well as electing a chairperson for the group. If you will not be able to attend the meeting but would like to be part of this new interest group, please contact Dr. Susan Promes at prome001@mc.duke.edu.

II. III. IV. V. VI.

VII.

NEUROLOGIC EMERGENCIES INTEREST GROUP I. II. III.

IV. V. VI. VII.

Saturday, May 31 · 12:00-2:00 pm · Nantucket Review of the last year, W. Bond, 10 min A. Growth B. Research C. Education D. Interaction with other societies Web Site Introduction, J. Vozenilek, 15 min EMCRM Research Update, P. Harter & R. Smith-Coggins, 15 min Simdot, W. Bond, 10 min A. What is it?

B. How can we become involved?

Introduction of new members, 10 min Future Directions (roundtable), 45 min A. Have bandwidth need content B. Future interaction with other societies C. Future educational offerings D. Continuing direction and use of website E. Officer term durations F. Open discussion Officer elections, 15 min

TOXICOLOGY INTEREST GROUP

Friday, May 30 · 12:00-1:00 pm · Falmouth Room Welcome and introduction, Ed Jauch Neurologic education survey results, Brian Stettler FERNE update, Ed Sloan A. Advisory Board B. Web site C. Ongoing research Research opportunities, David Wright / others Co-chairperson structure of the NEIG, Ed Jauch Elections Other business

Friday, May 30 · 12:00-1:00 pm · MIT Room Meeting topics to be covered will include a review of our interest group objectives and elections. Please contact kennon.heard@ushsc.edu to add a topic to the agenda.

Visit the AEM Booth in the Exhibit Hall Academic Emergency Medicine will once again sponsor an AEM booth during the Annual meeting. SAEM members are invited to come to the booth and subscribe for their free subscription to the on-line version of the journal at www.aemj.org <http://www.aemj.org/> (be sure to get your member number from the SAEM Registration Desk). In addition, information on becoming a peer reviewer for AEM, instructions for authors, and tips on how to get published in AEM will be available. The Editors of AEM will staff the booth and will be pleased to answer questions about the journal, becoming a peer reviewer, the review process, or any other aspect of our journal. We invite our readers to visit us and we welcome comments and suggestions.

39

DIDACTIC SESSIONS

BY

TOPIC

Improving the Quality of Research

Faculty Development

Thursday, May 29, 2003 EMS Research: Challenges and Solutions Introduction to Statistics Spivey Lecture: Research in Emergency Medicine: Its Physiognomy How to Write Science The Inconvenience of Convenience on Prospective EM Research Findings of the rt-PA Acute Stroke Treatment Review Panel

Friday, May 30, 2003 Mission Based Budgeting: An Opportunity for Departmental Financial Solvency The Road to Achieving Department Status in Emergency Medicine Saturday, May 31, 2003 Evaluating an Academic Position The Lifeblood of a Department: Show Me the Money

Friday, May 30, 2003 Multivariate Analysis: When Do You Need It? How Should You Do It? Understanding and Applying Likelihood Ratios Interpreting Statistical Analyses: Beyond P Values

Medical Student/Resident Wednesday, May 28, 2003 Chief Residents' Forum

Saturday, May 31, 2003 Choosing and Developing Outcome Measures for Clinical Research Getting in the Ballpark for Federal Funding: Prerequisites for a Successful Grant Application Power Searching: A Consumer's Guide from Point-of-Care to Meta-Analysis Grant Mentoring Workshop Pearls in Grant Writing

Thursday, May 29, 2003 Spivey Lecture: Research in Emergency Medicine: Its Physiognomy

Sunday, June 1, 2003 Survey Research Methodology Development and Validation of Clinical Decision Rules Clinical Information Systems and Data Standards for Academic Emergency Physicians

Friday, May 30, 2003 Recent Advances in Terrorism and Disaster Medicine: Implications for Emergency Medicine Research

Saturday, May 31, 2003 Medical Student Symposium Evaluating an Academic Position

Health Care Policy

Saturday, May 31, 2003 Surviving the Collision of Health Policy and Academic Medicine ED and Crowding: Research Agenda and Recent Solutions

Enhancing Teaching Skills/Improving Quality of Education

State-of-the-Art

Thursday, May 29, 2003 Educational Research Methodology Educating Emergency Physicians to Care for our Patients at the End of Life

Thursday, May 29, 2003 Acetaminophen: Research Opportunities for Toxicology's Biggest Headache New Perspectives in Patient Safety Research: Innovative, Scientific Applications, and International Perspectives

Friday, May 30, 2003 Principles of Bedside Teaching Bedside Teaching: Small Group Interactive Sessions Educational Aspects of ED Procedures What Makes a Great Teacher Giving Feedback in EM Education Incorporating Patient Safety Principles into Bedside Teaching and Your Curriculum

Friday, May 30, 2003 The Science of Triage Saturday, May 31, 2003 Resuscitative Hypothermia: Recent Clinical Trials, Ongoing Research and the Future Sunday, June 1, 2003 Exploration of the Molecular Basis of Disease in Emergency Medicine

Saturday, May 31, 2003 Implementing and Optimizing Morbidity and Mortality Conference Competency in Medical Student Education Sunday, June 1, 2003 Basics of Evidence-Based Medicine Workshop The Use of Simulation for Training Health Care Professionals 40

DIDACTIC SESSION SPEAKERS Jim Adams, MD (pg. 27, 37) Northwestern University

Rita Cydulka, MD (pg. 37) MetroHealth Medical

Sean O. Henderson, MD (pg. 32) University of Southern California

Robert McNamara, MD (pg. 37) Temple University

John Allegra, MD, PhD (pg. 32) Morristown Memorial Hospital

Daniel Davis, MD (pg. 32) University of California, San Diego

Vicki Hertzberg, PhD (pg. 15) Emory University

Flavia Nobay, MD (pg. 37) University of California, San Francisco

Douglas Ander, MD (pg. 25) Emory University

M. Chris Decker, MD (pg. 20) Medical College of Wisconsin

Cherri Hobgood, MD (pg. 25) University of North Carolina

Mark G. Angelos, MD (pg. 26) Ohio State University

Wyatt Decker, MD (pg. 20) Mayo Clinic and Mayo Medical School

Judd Hollander, MD (pg. 15, 26) University of Pennsylvania

Eric K. Noji, MD, MPH (pg. 20) Principal Deputy to the U.S. Surgeon General for Homeland Security and Disaster Medicine

Brent R. Asplin MD, MPH (pg. 24, 25) Regions Hospital and HealthPartners Research Foundation

Peter DeBlieux, MD (pg. 27) Louisiana State University

Benjamin Honigman, MD (pg. 20) University of Colorado

Simon Dixon, MD (pg. 25) William Beaumont Hospital, Royal Oak

Timothy Ingall, MB, BS, PhD (pg. 15) Mayo Medical School

Pam Dyne, MD (pg. 27) Olive-View UCLA

Alan E. Jones, MD (pg. 24) Carolinas Medical Center

David Eitel, MD, MBA (pg. 19) York Hospital

Gabor D. Kelen, MD (pg. 26) The Johns Hopkins University

Jack Ende, MD (pg. 21) University of Pennsylvania

Christopher King, MD (pg. 20) University of Pittsburgh

Stephan Epstein, MD, MPP (pg. 25) Harvard Medical School, Beth Israel Deaconess Medical Center

Mark Kirk, MD (pg. 14) Blue Ridge Poison Center

William Barsan, MD (pg. 20, 25) University of Michigan Christopher Beach, MD (pg. 15) Northwestern University Ravi Behara, PhD (pg. 15) Florida Atlantic University Nicholas Benson, MD, MBA (pg. 20) Brody School of Medicine J. Andrew Billings, MD (pg. 15) Massachusetts General Hospital Diane Birnbaumer, MD (pg. 20) Harbor-UCLA Michelle H. Biros, MS, MD (pg. 16) Hennepin County Medical Center William Bond, MD (pg. 32) Lehigh Valley Hospital Michael Brown, MD (pg. 32) Grand Rapids MERC/Michigan State University Michael Bullard, MD, FRCPC (pg. 19) University of Alberta Jonathan Burstein, MD (pg. 20) Harvard Medical School Carlos Camargo, MD, DrPH (pg. 24, 32) Massachusetts General Hospital Ann Chinnis, MD (pg. 20) West Virginia University Guy L. Clifton, MD (pg. 25) University of Texas, Houston Wendy Coates, MD (pg. 27) Harbor-UCLA David C. Cone, MD (pg. 14, 16) Yale University Karen Cosby, MD (pg. 21) Cook County Hospital/Rush Medical School Cathy Custalow, MD, PhD (pg. 20) University of Virginia

Donald Kosiak, MD (pg. 27) Mayo Clinic

Barnet Eskin, MD, PhD (pg. 32) Morristown Memorial Hospital

Derk Krieger, MD (pg. 25) Cleveland Clinic

Susan Farrell, MD (pg. 25) Brigham and Women’s Hospital

Gloria Kuhn, MD (pg. 15, 19, 20) Wayne State University

Daniel Federman, MD (pg. 21) Harvard Medical School

Kristi L. Koenig, MD (pg. 20) Office of the Under Secretary for Health, Veterans Health Administration, Department of Veterans Affairs

Gus Garmel, MD (pg. 27) Stanford University J. Lee Garvey, MD (pg. 15) Carolinas Medical Center Lewis Goldrank, MD (pg. 15) New York University Medical Center Gary Green, MD (pg. 24, 26) Johns Hopkins University James Gordon, MD, MPA (pg. 32) Harvard University David Guss, MD (pg. 25) University of California, San Diego Janet Hafler, EdD (pg. 15) Harvard Medical School

41

Ronald G. Pirrallo, MD, MHSA (pg. 14) Medical College of Wisconsin Stephen C. Porter, MD, MPH (pg. 21) Harvard Medical School Daniel Price, MD (pg. 20) Highland General Hospital Susan Promes, MD (pg. 27) Duke University Health System Tammie E. Quest, MD (pg. 15) Emory University Barbara Richardson, MD (pg. 25) Mount Sinai Hospital Drew Richardson, MB, BS, FACEM (pg. 19, 25) The Canberra Hospital, Garran, Australia

Peter Rosen, MD (pg. 15) University of California, San Diego

Douglas Lee, MD (pg. 37) St. Luke’s Roosevelt Hospital

Elaine Rousseau, PhD (pg. 32) Center on Aging, University of Arizona

Roger J. Lewis, MD, PhD (pg. 14) Harbor-UCLA Medical Center

Brian Rowe, MD (pg. 32) University of Alberta

Thomas Louis, PhD (pg. 15) John Hopkins Bloomberg School of Public Health

Barry Rumack, MD (pg. 14) Rocky Mountain Poison and Drug Center

Steven McLaughlin, MD (pg. 32) University of New Mexico

Kennon Heard, MD (pg. 14) University of Colorado

Stephen Playe, MD (pg. 20) Baystate Medical Center

Eddy Lang, MD (pg. 32) McGill University

Melissa McCarthy, PhD (pg. 26) The Johns Hopkins University

Steve Hayden, MD (pg. 37) University of California, San Diego

Shawna J. Perry, MD (pg. 15) University of Florida, Jacksonville

Kevin Rodgers, MD (pg. 37) Methodist Hospital, Indianapolis

John Marx, MD (pg. 25) Carolinas Medical Center

Steve Hargarten, MD, MPH (pg. 24) Medical College of Wisconsin

Edward A. Panacek, MD (pg. 15, 21) University of California, Davis

Gary Krause, MD (pg. 24, 26) Wayne State University

Thomas MacFarlane, MD (pg. 37) University of California, Davis

John D. Halamka, MD, MS (pg. 32) CareGroup Health System

James Olson, PhD (pg. 26) Wright State University

Arthur B. Sanders, MD (pg. 32) University of Arizona Stephen Schenkel, MD (pg. 21) University of Michigan Terri Schmidt, MD (pg. 15) Oregon Health and Sciences University Sandy Schneider, MD (pg. 25) University of Rochester

DIDACTIC SESSION SPEAKERS CONTINUED Carl H. Schultz, MD (pg. 20) University of California, Irvine

Ian G. Stiell, MD, MSc, FRCPC (pg. 32) University of Ottawa

Mary Jo Wagner, MD (pg. 37) Saginaw Cooperative Hospitals, Inc.

Richard Wolfe, MD (pg. 25) Beth Israel Deaconess Medical Center

Robert A. Schwab, MD (pg. 25) Truman Medical Center

Fritz Sterz, MD (pg. 25) University of Vienna

Robert Wahl, MD (pg. 20) Wayne State University

Robert O. Wright, MD, MPH (pg. 21) Harvard Medical School and Harvard School of Public Health

Marc Shapiro, MD (pg. 21, 32) Brown University

D. Matthew Sullivan, MD (pg. 24) Carolinas Medical Center

Marlena M. Wald, MPH (pg. 25) Emory University

Richard D. Shih, MD (pg. 37) Morristown Memorial Hospital

Scott Syverud, MD (pg. 37) University of Virginia

Robert L. Wears, MD, MS (pg. 20) University of Florida

Robert Silbergleit, MD (pg. 25) University of Michigan

Paula Tanabe, PhD, RN (pg. 19) Institute for Health Services Research & Policy Studies, Northwestern University

Robin Weinick, PhD (pg. 24) Agency for Healthcare Research and Quality

John Vinen, MD, FACEM, FIFEM (pg. 15) Royal North Shore Hospital, Australia

George A. Wells, PhD (pg. 32) University of Ottawa

Linda Spillane, MD (pg. 32) University of Rochester

POTENTIAL CONFLICT

OF INTEREST

Peter Wyer, MD (pg. 32) Presbyterian Hospital Charlotte Yeh, MD (pg. 25) American Hospital Association Regional Medicare Medical Director

DISCLOSURE

As an accredited provider of continuing medical education Michigan State University, College of Medicine is required to ask speakers to disclose any real or apparent conflict of interest they may have as related to the content of their presentation(s). The existence of the commercial or financial interests speakers related to the subject matter of their presentation should not be construed as implying bias or decreasing the value of their presentation(s). However, disclosure should provide information to participants to form their own judgements.

All speakers were independently selected by the SAEM Program Committee. Those speakers (of both didactics and abstract presentations) who disclosed affiliations or any potential conflicts are listed below.

Andra Blomkalns, MD Michael Bullard, MD Lala Dunbar, MD, PhD Joel Fein, MD William Heegaard, MD, MPH Ella Huszti, MSc Hong Kim, MPH Jeffrey Kline, MD Robert Lowe, MD, MPH Xin Ma, MD James Niemann, MD Charles Pollack, MA, MD Ronald Pirrallo, MD, MHSA Brian Rowe, MD Brian Rowe, MD Susan Sheehy, MSN, MS, RN Adam Singer, MD Adam Singer, MD Adam Singer, MD Howard Smithline, MD Ian Stiell, MD, MSc Ian Stiell, MD, MSc Shkelzen Hoxhaj, MD

Merck & Co. Inc. Alberta Medical Association and Alberta Wellnet Ortho McNeil Pharmaceutical Astra Inc. LifeLink III CIHR Biosite, Inc. Breath Quant Medical System Glaxo Smith Kline Glaxo Smith Kline Medtronic Physio-Control Corp.

Ischemia Technologies SBIR Cardiome Pharmaceutical Abbott Pharmaceutical Aventis Pharmaceutical Closure Medical CytoKine Pharmaceutical Services Ethicom, Inc. Hewlett Packard Medtronic Physio-Control Corp.

CIHR Micromedex

42

2004 Annual Meeting May 16-19, 2004, Orlando, Florida CALL FOR DIDACTIC PROPOSALS The Program Committee is inviting proposals for didactic sessions for the 2004 Annual Meeting. This year the Program Committee would like to emphasize proposals on educational research methodology and leadership development (including advancement within academic departments, medical schools and national organizations). Didactic proposals may be aimed at medical students, residents, junior faculty and/or senior faculty. The format may be a lecture, panel discussion, or workshop. The Program Committee will also consider proposals for pre- or post-day workshops or multiple sessions during the Annual Meeting aimed at in-depth instruction in a specific discipline.

Didactic proposals must support the mission of SAEM (to improve patient care by advancing research and education in emergency medicine) and should fall into one of the following categories: • Education (educational research methodology, education methodology, improving the quality of education, enhancing teaching skills) • Research (research methodology, improving the quality of research) • Career Development • State-of-the-Art (presentation of cutting-edge basic science or clinical research that has important implications for further investigation or the future practice of emergency medicine, not a review of the literature or a summary of clinical practice) • Health Care Policy and National Affairs The deadline for submission is Wednesday, September 10, 2003 at 5:00 pm Eastern Daylight Time. Only online submissions will be accepted. To submit a proposal, complete the online Didactic Submission Form at www.saem.org. For additional questions or information, contact SAEM at saem@saem.org or call 517-485-5484 or send a fax to 517-485-0801.

CALL FOR ABSTRACTS The Program Committee is accepting abstracts for review for oral and poster presentation at the 2004 SAEM Annual Meeting. Authors are invited to submit original research in all aspects of Emergency Medicine including, but not limited to: abdominal/gastrointestinal/genitourinary pathology, administrative/health care policy, airway/anesthesia/analgesia, CPR, cardiovascular (non-CPR), clinical decision guidelines, computer technologies, diagnostic technologies/radiology, disease/injury prevention, education/professional development, EMS/out-of-hospital, ethics, geriatrics, infectious disease, IEME exhibit, ischemia/reperfusion, neurology, obstetrics/gynecology, pediatrics, psychiatry/social issues, research design/methodology/statistics, respiratory/ENT disorders, shock/critical care, toxicology/environmental injury, trauma, and wounds/burns/orthopedics.

The deadline for submission of abstracts is Tuesday, January 6, 2004 at 3:00 pm Eastern Time and will be strictly enforced. Only electronic submissions via the SAEM online abstract submission form will be accepted. The abstract submission form and instructions will be available on the SAEM web site at www.saem.org in November. For further information or questions, contact SAEM at saem@saem.org or 517-485-5484 or via fax at 517-485-0801.

Only reports of original research may be submitted. The data must not have been published in manuscript or abstract form or presented at a national medical scientific meeting prior to the 2004 SAEM Annual Meeting. Original abstracts presented at national meetings in April or May 2004 will be considered.

Abstracts accepted for presentation will be published in the May issue of Academic Emergency Medicine, the official journal of the Society for Academic Emergency Medicine. SAEM strongly encourages authors to submit their manuscripts to AEM. AEM will notify authors of a decision regarding publication within 60 days of receipt of a manuscript.

CALL FOR SUBMISSIONS The Program Committee is accepting Innovations in Emergency Medicine Education (IEME) Exhibits for consideration of presentation at the 2004 SAEM Annual Meeting, May in Orlando. Submitters are invited to complete an application describing an innovative new educational methodology that they have designed, or an innovative educational application of an existing product. The exhibit should not be used to display a commercial product that is already available and being used in its intended application. Exhibits will be selected based on utility, originality, and applicability to the teaching setting. Commercial support of innovations is permitted but must be disclosed. IEME exhibits will not be published in Academic Emergency Medicine with other abstracts, but will be published in the on-site program. However, if submitters have conducted a research project on or using the innovation, the project may be written up as a scientific abstract and submitted for scientific review in the appropriate subject category by the January 6 deadline.

The deadline for submission of IEME Exhibit applications is Wednesday, February 11, 2004 at 5:00 pm Eastern Time. Only online submissions using the form on the SAEM web site at www.saem.org will be accepted. For further information or questions, contact SAEM at saem@saem.org or 517-485-5484 or via fax at 517-485-0801.

46

CONSTITUTION The Constitution and Bylaws Committee and the Board of Directors have developed a number of proposed amendments to the Constitution and Bylaws for consideration by the membership. A ballot has been mailed to all active members of SAEM. The results of the ballot will be presented during the Annual Business Meeting, which will be held on May 31 in Boston. The proposed amendments are published below, and the entire document may be viewed on the SAEM web site at www.saem.org.

In the amendments below, strike-outs note the old language, while new proposed language is provided in bold-face.

1. Deleting the Membership Committee: The Board of Directors and Constitution and Bylaws Committee agree that references to the Membership Committee should be deleted, since the Board does not review individual membership applications. It was agreed that language regarding the Membership Committee was not useful.

The proposed amendments are: Constitution: Article III – Membership, Section 2: (5) Candidates for emeritus membership shall be (a) active members who seek such status and who have given 15 continuous years of active service to the Society and have attained the age of 65 years or (b) other active members who under special circumstances are invited for such emeritus status by the Membership Committee Board of Directors.

Constitution: Article V- Committees: The standing committees shall be the: (1) Nominating Committee, (2) Membership Committee, and (3) Constitution and Bylaws Committee.

Bylaws: Article II – Board of Directors: The Secretary-Treasurer shall chair the Membership Committee.

Bylaws: Article VI – Committees and Liaisons: Section 4: Membership Committee. The Board of Directors shall constitute the Membership Committee. The Secretary-Treasurer shall serve as chair of the Membership Committee.

The Membership Committee has the responsibility for establishing the qualifications for each membership classification. Applicants reviewed by the Executive Director and SecretaryTreasurer not meeting the qualifications for

AND

BYLAWS AMENDMENTS

election to a requested classification of membership shall require presentation to and approval by the majority of the Membership Committee, before membership in that classification can be granted.

2. Defining Board Membership on Committees and Task Forces: The Board of Directors agreed that given the current hierarchy within SAEM, Board members should not serve on committees and task forces. The proposed amendment is: Bylaws: Article II – Board of Directors, Section 2, Responsibilities: Members of the Board may not serve on as chairs or members of committees, or task forces, or interest groups of the Society. No Board member may serve as chair of the Constitution and Bylaws Committee. with the following exceptions: The Presidentelect serves as chair of the Nominating Committee and the Board elects one member of the Board to serve a one-year term on the Nominating Committee. Members of the Board may serve as members of interest groups. Members of the Board may serve on subcommittees or working groups of the Board. The Board has oversight responsibility for all publications of the Society. the Secretary-Treasurer serves as chair of the Membership Committee. The entire Board serves as the Membership Committee.

Members of the Board may be appointed to serve as chairs of ad hoc committees and task forces.

3. Clarifying Committee and Task Force Appointments: The Board of Directors and Constitution and Bylaws Committee agreed to clarify the role and tenure of committees and task forces. The proposed amendment is: Constitution: Article V – Committees: Additional committees and task forces may be created by the Board of Directors and President to aid in the Society’s efforts to achieve and further its goals. All appointments to committees and task forces are for one year. The Board of Directors and president-elect will evaluate each committee and task force annually to ascertain whether the committee or task force will be continued, restructured, or dissolved. Task Forces may be reappointed for one additional year, for a maximum of two 47

years.

4. Clarifying the Assessment of Dues: It was noted that the Board of Directors has authority to assess all SAEM dues and that specifying the various membership categories was not necessary. In addition, it was noted that in the future it may be necessary to assess dues for emeritus members as that classification of membership increases. The proposed amendment is: Bylaws: Article I – Membership, Section 2: Dues: Annual dues for active, associate, resident/fellow, and medical student members will be established by the Board of Directors.

Honorary and emeritus members are exempt from dues. Membership in the Society may be terminated for nonpayment of dues.

5. Clarifying Financial Reports to the Board: The Constitution and Bylaws Committee recommended an amendment that clarified the financial reports that are presented to the Board. The proposed amendment is: Bylaws: Article II – Board of Directors, Section 11: The A financial record report will be presented to the membership biannually. Detailed financial reports are provided to the Board of Directors, and at such times as requested by the President of the Society. The financial records of the Society shall be reviewed annually by the Board of Directors. upon request of the Secretary-Treasurer for consideration during Board meetings. The Board of Directors may retain a certified accountant or financial consultant to review the financial records of the Society.

6. Clarifying Board Meetings: The Constitution and Bylaws Committee recommended an amendment that clarified the meetings of the Board. The proposed amendment is: Bylaws: Article II – Board of Directors, Section 8: Regularly scheduled Mmeetings of the Board of Directors are open to all members of the Society and to the public. However, Cclosed meetings of the Board and Executive Committee and Executive Director may be convened by order of the President.

AEM CONSENSUS CONFERENCE Disparities in Emergency Health Care May 28, 2003 Salon E 8:00 am 8:30 am 9:30 am

11:00 am

12:00 pm 1:00-3:00 pm

3:00-4:00 pm

Introduction: Goals and Objectives Lewis Goldfrank, MD, Bellevue Hospital Center Keynote Address: General Overview of Health Care Disparities Jordan Cohen, MD, President, Association of American Medical Colleges Health Care Disparities in Emergency Medicine Moderator: Robert A. Lowe, MD, MPH, Oregon Health and Sciences University Panelists: Joseph Betancourt, MD, MPH, Director for Multicultural Education, Multicultural Affairs Office, Massachusetts General Hospital; Knox Todd, MD, MPH, Emory University; Lynne Richardson, MD, Mt. Sinai Medical Center ● Summary of clinical studies to date (related to Emergency Medicine) ● Summary of socio-economic/behavioral studies to date (Emergency Medicine) ● Where are we research rich/research lacking? ● Investigating root causes of emergency health care disparities ● Racism, Sexism, Money ● What is known; what needs to be done Researching Disparities in Health Care Moderator: Robin Weinick, PhD, Agency for Healthcare Research and Quality ● Summary of the unique aspects of researching disparities ● Current markers/measures/methods ● What works and what does not ● Special confounder issues Lunch Plenary Session: Healthy People 2010: Setting Research Priorities for Emergency Medicine, Salons C/D Nicole Lurie, MD, Rand Corporation Consensus Groups 1) Researching Emergency Medicine Health Care Disparities Facilitator: Robert A. Lowe, MD, MPH, Oregon Health and Sciences University AEM Coordinator: Gary Green, MD, MPH, Johns Hopkins University ● Where are we research rich/research poor? ● Where are our methodologic strengths and weaknesses? ● How can we study disparities? ● What are our best measures, our outcome parameters?

2) Emergency Medicine Education and Health Care Disparities Facilitator: Glenn Hamilton, MD, Wright State University AEM Coordinator: Catherine Marco, MD, St. Vincent Mercy Medical Center ● Do we teach our residents to deliver disparate care? ● Does our educational milieu set up biases? ● How have curriculum in Emergency Medicine incorporated HCD issues? ● What are the best educational practices on this, and assessment?

3) Clinical aspects and implications of Emergency Medicine Health Care Disparities Moderator: Lynne Richardson, MD AEM Coordinator: Charlene Irvin, MD, St. John Hospital and Medical Center ● What inequalities exist in Emergency health care? ● Under what circumstances do these inequalities arise? ● What are the clinical obstacles to fulfilling our moral imperatives? ● What are the public health advantages of eliminating disparities?

4) Systems and Administration Moderator: Leon Haley, MD, Emory University AEM Coordinator: Robert O’Connor, MD, MPH, Christiana Healthcare System ● Are all disparities bad? ● Are only the vulnerable served inadequately by our current health care system? ● Are what appear to be inequities really systems incompetence? ● We assume there should be no inequality in health care: does society also assume this? ● What would be the systems cost of equality in health care?

Summary Presentation and Consensus Groups Findings Moderator: Lewis Goldfrank, MD, Bellevue Hospital Center

48

SAEM 2004 Research Grants Emergency Medicine Medical Student Interest Group Grants These grants provide funding of $500 each to help support the educational or research activities of emergency medicine medical student organizations at U.S. medical schools. Established or developing interest groups, clubs, or other medical student organizations are eligible to apply. It is not necessary for the medical school to have an emergency medicine training program for the student group to apply. Deadline: September 4, 2003.

Research Training Grant This grant provides financial support of $75,000 per year for two years of formal, full-time research training for emergency medicine fellows, resident physicians, or junior faculty. The trainee must have a concentrated, mentored program in specific research methods and concepts, and complete a research project. Deadline: November 3, 2003.

Institutional Research Training Grant This grant provides financial support of $75,000 per year for two years for an academic emergency medicine program to train a research fellow. The sponsoring program must demonstrate an excellent research training environment with a qualified mentor and specific area of research emphasis. The training for the fellow may include a formal research education program or advanced degree. It is expected that the fellow who is selected by the applying program will dedicate full time effort to research, and will complete a research project. The goal of this grant is to help establish a departmental culture in emergency medicine programs that will continue to support advanced research training for emergency medicine residency graduates. Deadline: November 3, 2003.

Scholarly Sabbatical Grant This grant provides funding of $10,000 per month for a maximum of six months to help emergency medicine faculty at the level of assistant professor or higher obtain release time to develop skills that will advance their academic careers. The goal of the grant is to increase the number of independent career researchers who may further advance research and education in emergency medicine. The grant may be used to learn unique research or educational methods or procedures which require day-to-day, in-depth training under the direct supervision of a knowledgeable mentor, or to develop a knowledge base that can be shared with the faculty memberâ&#x20AC;&#x2122;s department to further research and education. Deadline: November 3, 2003.

Emergency Medical Services Research Fellowship This grant is sponsored by Medtronic Physio-Control. It provides $60,000 for a one year EMS fellowship for emergency medicine residency graduates at an SAEM approved fellowship training site. The fellow must have an indepth training experience in EMS with an emphasis on research concepts and methods. The grant process involves a review and approval of emergency medicine training sites as well as individual applications from potential fellows.

Deadline: November 3, 2003.

Neuroscience Research Fellowship This grant is sponsored by AstraZeneca. It provides one year of funding at $50,000 for an emergency medicine resident, graduate, or junior faculty member to obtain a mentored research training experience in cerebrovascular emergencies. The research training may be in basic science research, clinical research, or a combination of both, and the mentor need not be an emergency medicine faculty member. Completion of a research project is required, but the emphasis of the fellowship is on the acquisition of research skills. Deadline: November 3, 2003.

EMF/SAEM Medical Student Research Grants This grant is co-sponsored by the Emergency Medicine Foundation and SAEM. It provides up to $2,400 over 3 months for a medical student to encourage research in emergency medicine. More than one grant is awarded each year. The trainee must have a qualified research mentor and a specific research project proposal. Deadline: To be announced.

Geriatric Emergency Medicine Resident/Fellow Grant This grant is made possible by the John A. Hartford Foundation and the American Geriatric Society. It provides up to $5,000 to support resident/fellow research related to the emergency care of the older person. Investigations may focus on basic science research, clinical research, preventive medicine, epidemiology, or educational topics.

Deadline: To be announced.

Further information and application materials can be obtained via the SAEM website at www.saem.org.

MARRIOTT HOTEL FLOOR PLAN THIRD FLOOR

SAEM Registration

FOURTH FLOOR

The Vermont Suite, Maine Suite, and New Hampshire Suite meeting rooms are located on the fifth floor.