SAEM PULSE July-August 2020

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SPOTLIGHT AND NOW HIS WATCH BEGINS An Interview with 2020-2021 SAEM President

James F. Holmes, Jr., MD, MPH


Leading the advancement of emergency care through education and research, advocacy, and professional development in academic emergency medicine.

SAEM STAFF Chief Executive Officer Megan N. Schagrin, MBA, CAE, CFRE Ext. 212, Director, Finance & Operations Doug Ray, MSA Ext. 208, Manager, IT Dan San Buenaventura Ext. 225, Manager, Accounting Hugo Paz Ext. 216, Director, Governance Kat Nagasawa, MBA Ext. 206, Coordinator, Governance Michelle Aguirre, MPA Ext. 205, Sr. Managing Editor, Publications and Communications Stacey Roseen Ext. 207, Manager, Digital Communications Snizhana Kurylyuk Ext. 201, Director, Foundation and Business Development Melissa McMillian, CNP Ext. 203, Manager, Business Development John Landry, MBA Ext. 204,

HIGHLIGHTS Director, Membership & Meetings Holly Byrd-Duncan, MBA Ext. 210, Sr. Manager, Membership George Greaves Ext. 211, Education Manager Andrea Ray Ext. 214, Membership & Meetings Coordinator Monica Bell, CMP Ext. 202, Meeting Assistant Maja Keska Ext. 218, AEM Editor in Chief Jeffrey Kline, MD AEM E&T Editor in Chief Susan Promes, MD AEM/AEM E&T Manager Stacey Roseen Ext. 207, AEM/AEM E&T Peer Review Coordinator Taylor Bowen Chair, SAEM Pulse Editorial Advisory Task Force Sharon Atencio, DO Associate Editor, SAEM BOD D. Mark Courtney, MD Associate Editor, RAMS Shana Zucker,

2020–2021 BOARD OF DIRECTORS James F. Holmes, Jr., MD, MPH President University of California Davis Health System

Angela M. Mills, MD Secretary Treasurer Columbia University

Amy H. Kaji, MD, PhD President Elect Harbor-UCLA Medical Center

Ian B.K. Martin, MD, MBA Immediate Past President Medical College of Wisconsin

Christopher R. Carpenter, MD, MSc Washington University in St. Louis School of Medicine Wendy C. Coates, MD Los Angeles County-Harbor -UCLA Medical Center Michelle D. Lall, MD Emory University Nehal Naik, MD George Washington University


President’s Comments A Period of Rapid Change in Emergency Medicine


Spotlight And Now His Watch Begins An Interview With 2020-2021 SAEM President Dr. James F. Holmes, Jr.

8-17 12 18-27

Richard E. Wolfe, MD Beth Israel Deaconess Medical Center/ Harvard Medical School

SAEM Award Recipients


Climate Change And Health The Emergency Physician’s Starter Guide to Climate Change Resources


Diversity and Inclusion Trauma Informed Care: Two Programs and the Pivotal Role They Play on Chicago's South Side


Ethics in Action An Ethical Justification for Teaching Physicians About Firearms


Wellness and Resilience Developing a Framework to Promote Academic Emergency Physician Well-being From a Systems Perspective

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With Covid-19, the Times, They are a-Changin’


Observation in the Era of COVID-19


COVID-19 in Prague: Taking Precautions for a Crisis That (Thankfully) Didn’t Happen


A Glimpse Into the Future


The 2020 COVID-19 Pandemic: Front Line Perspectives through Different Lenses


Administrative Fellowship Member Profile: Dr. Vanna Albert, Administrative Fellow


SGEM: Did You Know? Sex and Gender as They Relate to Schizophrenia


Academic Emergency Medicine A Year in Review: Resident Editors, AEM Editorial Board

Ava Pierce, MD UT Southwestern Medical Center, Dallas Jody A. Vogel, MD, MSc, MSW Denver Health Medical Center University of Colorado School of Medicine





AEM Education and Training AEM E&T’s First Fellow Editor-in-Training Shares Her Experience

Women In Academic EM Gender and Delegating in the Emergency Department Promoting Gender Equity in Residency Training through Consensus Building


Education The Leaders Library: A Professional Development Virtual Book Club for EM Educators and Leaders


Cocktails With Chairs: Pearls for EM Physicians-in-Training


EM Residents and Medical Students: We’re Making History!


Preparing a Morbidity and Mortality Conference


SAEM Foundation Annual Alliance Donors


Briefs and Bullet Points


Academic Announcements


Now Hiring

SAEM Pulse is published bimonthly by the Society for Academic Emergency Medicine,1111 East Touhy Ave., Ste. 540, Des Plaines, IL 60018. (847) 813-9823 The opinions expressed in this publication are those of the authors and do not necessarily reflect those of SAEM. © 2020 Society for Academic Emergency Medicine. All rights reserved. No part of this publication may be reproduced, stored, or transmitted in any form or by any means without prior permission in writing from the copyright holder.

PRESIDENT’S COMMENTS James F. Holmes, Jr., MD, MPH UC Davis School of Medicine 2020–2021 SAEM President

A Period of Rapid Change in Emergency Medicine Similar to Dr. Ian Martin during his term, I hope to discuss current, important topics related to academic emergency medicine. If you have particular topics that you wish for me to address, please contact me and provide suggestions at

“We must shape the future of academic emergency medicine that emerges from this pandemic through a thoughtful effort.”

The past four months have seen unprecedented changes in emergency medicine, health care and our lives in general. COVID-19 has upended emergency care with some hospitals overwhelmed with infected patients while most emergency departments experienced a 40-60 percent drop in patient volume. All aspects of academic emergency medicine were impacted. Education conferences went virtual. Research was stopped. Mentor-mentee meetings were upended. Many of us are in various stages of “reopening” as small in-person meetings begin and emergency care research is restarted. While some are experiencing decreasing COVID-19 numbers others are experiencing the opposite. Concerns over a second wave of COVID-19 exist, and we are all preparing for such an event. SAEM will continue to adapt to our “new” environment. Our staff and members rapidly switched gears and created a wonderful virtual meeting this past May. We have hosted multiple COVID-19 grand rounds webinars and will continue to add virtual content for our members. We will continue to grow, and we will not let the current pandemic hinder our mission. Academic emergency medicine is a community

and SAEM is our home. SAEM will proceed in its mission to advance emergency medicine education, research, advocacy, and professional development. We will seek to help medical students now impacted with the inability to do visiting rotations. We will persist in our commitment to advancing diversity and inclusion. We must further our commitment to advance emergency care research through the mentoring and active support of junior scholars. The future is uncertain. Challenges are ahead that we must face. We may continue to see outbreaks of COVID. We should, however, remain diligent and prepared. We must shape the future of academic emergency medicine that emerges from this pandemic through a thoughtful effort. You are the ones to address the challenges that will come in the next week, month and year. I am confident that you will solve these problems that we face. I look forward to the year as your President. I promise that despite the COVID-19 pandemic, we will do our utmost to make our Society stronger. ABOUT DR. HOLMES: James F. Holmes, Jr., MD, MPH, is professor and vice chair for research in the department of emergency medicine at UC Davis School of Medicine.





An Interview With Dr. James Holmes: Academic, Mentor, Birdwatcher, New SAEM President


James F. Holmes, MD, MPH is a professor and executive vice chair in the department of emergency medicine at UC Davis School of Medicine. He is originally from New Orleans, Louisiana, and received his MD from the University of Alabama, Birmingham. He completed the UC Davis Emergency Medicine Residency Program, serving as chief resident in his final year. Dr. Holmes’ research is focused on the initial evaluation and treatment of injured patients with a particular emphasis on injured children. A variety of foundations and federal agencies have funded his research including the CDC, EMSC, and the NIH. He has additionally devoted much of his career to training junior investigators. He is currently the Director of the UC Davis Clinical and Translational Science Center’s KL2 Research Training Program. Dr. Holmes has been an SAEM member since 1995 and has been very involved in a variety of SAEM endeavors through service on multiple committees, interest groups, and tasks forces. He has served as Chair of the SAEM Grants Committee, Regional Meeting Committee, and Trauma Interest Group. He has been a member of the SAEM Board of Directors since 2013. Dr. Holmes is married to Dr. Cindy Chang, also an emergency medicine physician. They have two daughters, Kaitlyn and Audrey. Dr. Holmes was interviewed for this article by Dr. Sharon Atencio, chair of the SAEM Pulse Editorial Advisory Task Force.

How has the current COVID-19 pandemic affected you, your practice, and your family?

Dr. Holmes looking for birds from the deck of a cruise ship. These trips often provide opportunities to get to difficult-to-access water and search for more unusual seabirds.

We have been fortunate, so far, in that Sacramento has not been impacted to the degree other places have, but it has certainly altered a variety of issues with our lives. School was canceled early for my children, and my wife and I worry they are not learning at the same rate as if it was in person. They want to go back!

Dr. Holmes with his kids (Kaitlyn and Audrey) after a triathlon.

Dr. Holmes and his wife, Dr. Cindy Chang.

“We will continue to adjust as necessary and advance our society and develop content and programs that are beneficial for our members in the time of COVID-19.” As for my practice, it has been somewhat of a roller coaster. At the end of February, our hospital experienced the first known U.S. case of community spread, which started us on rapid preparation for the worst. For most of March and April, I spent all my time in COVID-19–related planning. Once our clinical operations were prepared and all my travel canceled, I actually had some extra time to work on some research that had been shelved. Now, we are trying to move things back to “normal.” At work, we are having small in-person meetings (with surgical masks) and my family and I are actually taking a short family vacation into the mountains next week.

What do you hope to accomplish during your tenure as the 2020– 2021 SAEM President? That is a good question that I would have answered differently in February. I obviously want to carry out our strategic plan, which addresses goals in 1) member and leader development, 2) medical education, 3) research, and 4)

virtual relevance. With COVID-19, we will need to shift gears and change how we reach these goals. Part of our focus will now be to minimize any negative impacts of COVID-19 on SAEM. We had to cancel our in-person annual meeting in Denver, but our staff and members put on an outstanding virtual meeting. We will continue to adjust as necessary and advance our society and develop content and programs that are beneficial for our members in the time of COVID-19.

You have served in many other leadership positions with SAEM. Which were your favorites, and why? I think my favorite position in SAEM was chair of the Grants Committee. Early in my career, I received the SAEM Research Training Grant, which proved critical to beginning my career. Two years after receiving that award, I joined the SAEM Grants Committee to give back. The Grants Committee experience was great, and I was fortunate to have some great chairs (Drs. Kelly Young, Alan Jones, and Jason Haukoos) before me from whom I

learned a lot. SAEM grants have primarily targeted junior faculty, and it is great to be able to help start a career. I believe my time on the Grants Committee helped develop my interest in mentoring junior investigators.

What initially drew you to research? I have always asked questions and wanted to “figure things out.” Sometimes, it got me in trouble (I started a small fire doing an unauthorized experiment in middle school), but this desire created many opportunities for me. In medical school, I spent my first summer working on a project for a pediatric surgeon and knew at that time that research had to be part of my career. One of the primary reasons that I chose UC Davis for residency was Dr. Ed Panacek convincing me that they were committed to clinical research. Once I got to residency, I found a project to help with, spun off a side project, and I was hooked. I have also been very data driven and have a desire to continued on Page 6


continued from Page 5 make decisions that are evidence based. It started in high school when I created data sheets (that looked like Excel files) to enter my bird sightings, and it continues today, whether doing research or working on clinical operations.

What would you tell a resident who asked you why he or she should join SAEM? Residency is a unique, short, wonderful experience. Residents should try to get as much out of it as possible, including experiencing all aspects of emergency medicine. This includes exposure to academic emergency medicine. SAEM has an abundance of offerings targeted for residents and many opportunities to enhance the resident experience.

I understand you have worked closely with the March/April Pulse cover interviewee, Dr. Nate Kuppermann. How has his mentorship shaped your career? Mentorship is one of the most important variables to a successful career, and I have been incredibly fortunate to have great mentorship throughout my career. His guidance is directly responsible for me being where I am today.

Who else has influenced your path in emergency medicine? There have been many, but some that stand out include: • Dr. Ed Panacek, who was my residency director and got me involved in my first multicenter study. • Dr. Bob Derlet, who gave me my current job and first suggested leadership as a potential career path. • Dr. John Marx, who took 30 minutes of his time at the 1997 SAEM meeting in Washington, DC to talk about an academic career in emergency medicine. I was shocked that someone of his stature would take this time and talk with some random third year resident. • Dr. Michelle Biros, who gave me the wonderful opportunity to serve on the Academic Emergency Medicine Editorial Board. • Dr. Alan Jones, who convinced me to run for the SAEM Board of Directors when I had never considered it.


Dr. Holmes in current airborne precautions in the UC Davis Emergency Department.

“SAEM has an abundance of offerings targeted for residents and many opportunities to enhance the resident experience.” • All the prior SAEM presidents I served with on the BOD. Many thanks to all, as I learned so much from each of them.

• Dr. Bryn Mumma recently completed her NHBLI K08 award and is studying the clinical impact of high sensitivity troponin.

In addition to working with residents, you’ve served as principal investigator on the NIHfunded K12 Emergency Medicine Research Training Program. Do you feel the program has been successful? What have your scholars been up to since the program’s inception?

• Dr. Nam Tran was appointed to a UC Davis/California State task force to increase COVID-19 testing capabilities.

I think the program has been a great success and Jane Scott, ScD (NHLBI) has been instrumental in advancing emergency care research. A few recent highlights from our scholars include: • Dr. Austin Johnson received the SAEM Young Investigator Award at SAEM20.

You’ve also shown a deep commitment to the development of international emergency medicine. Why is this important? What should we, as American emergency physicians, be doing to help? We are certainly fortunate to live in the United States, which provides us many benefits. Emergency medicine has, over the years, developed a large cadre of individuals committed to advancing

global emergency medicine with many rising up through the Global Emergency Medicine Academy (GEMA). There are many ways to help, and I would suggest the first step is joining GEMA.

What do you think are the most urgent issues in emergency medicine in the United States? The world? Obviously, the current COVID-19 pandemic is the most pressing issue worldwide. It has had a substantial impact on emergency medicine. Emergency department volumes across the country have plummeted. Some areas (including Sacramento) are seeing volumes come back, but we are still below pre-COVID-19 numbers. Recently, we had three different patients tells us that they were scared to wait in the waiting room because of COVID-19 and left without being seen. We must prevent that. Outside of COVID-19, the biggest clinical issues are emergency department overcrowding and mental health. The path we were on prior to COVID-19 is not sustainable. In academic emergency medicine, we have pressing issues around research funding and the need for additional dollars going into emergency care research. We must continue to fight for more awareness around emergency care research.

Dr. Holmes and his family at an Auburn University football game (wife Cindy, Kaitlyn and Audrey).

What would you be doing if you hadn’t gone into emergency medicine? I would have been an ornithologist, probably studying evolutionary biology, which I find fascinating. Many people know that I am a very active birdwatcher and travel across the world to see, photograph, and voice record birds. When I was in high school, I told my parents that I wanted to study birds and get a PhD in ornithology. They were not enamored with that idea and suggested a different path (not medicine). Fortunately, I found something else that I really enjoy.

What is something about you that others would find surprising if they knew? I was once a long-distance (Ironman) triathlete. Once I got married and had children, the time needed to train was gone, and I stopped racing. In 2018, I dusted off my bike and did a much shorter triathlon, but that did not go very well. Perhaps in 2021 when races (hopefully) restart, I will race again.

What is something you wish you were good at, but aren’t?

Kaitlyn, Audrey and Cindy after delivering donated cookies to the emergency department staff.

I wish I had a better musical ear. My wife and kids are all very good with music (especially playing instruments), but I have always struggled. I do not have amusia, but it sometimes feels like I do.

If you could give your teenaged self some advice, what would it be? Besides telling myself to buy (a lot of) Apple stock, I probably would say take time to enjoy each and every day and make the most out if.

At the end of your career, what would you like to be remembered for? I hope to be remembered as someone who tried to improve the care of injured children. I would also like to be remembered as someone who gave back and served/helped others.

Dr. Holmes (before) running the 2019 Disney Princess Half Marathon.






9,000 Viewers Tune In to Historic SAEM20 Virtual Meeting! SAEM20 was to have taken place May 12–15 in Denver, Colorado…and then COVID came along and much of life, including SAEM’s annual meeting, was suddenly postponed or in our case, canceled. But in the “can-do” spirit of emergency medicine we pivoted, applied a lot of creative thinking and quick decision-making and 18 days later, we announced the SAEM20 Virtual Meeting, launched the webpages, and opened registration. For many of those who were disappointed at the lost opportunity to present their research, educational innovations, and/or didactics at SAEM20 in Denver, the virtual annual meeting was a welcome workaround. What the virtual meeting may have missed with respect to our usual in-person networking activities and experiential learning events (SimWars, Sonograms, Dodgeball, etc.), it more than made up for in high-quality, timely, and relevant educational content… And it did so while allowing us to do our part to flatten the curve and safeguard the health, safety, and well-being of all of you who are on the front lines treating the most vulnerable in our society at its greatest time of need. All in all, 9,000 of you tuned in to watch, and in some cases participate, in four full days of educational programming and thousands more have since watched recordings of the sessions on YouTube. This was an SAEM annual meeting like no other, with a previously unanticipated focus on a virus that’s turned our world upside down. Here are some of the highlights of our historic SAEM20 Virtual Annual Meeting…

A National Evaluation of Emergency Department Pediatric Readiness and Outcomes Among United States Trauma Centers Craig Newgard, MD, MPH, Oregon Health & Science University Comparative Effectiveness of Two Individualized Acute Pain Treatment Communication Tools: The Life Stories for Opioid Risk Reduction in the Emergency Department (STORRIED) Study Zachary Meisel, MD, MPH, MSHP, Center for Emergency Care Policy and Research University of Pennsylvania-Perelman School of Medicine


Disparities in Gender Representation and Salary in Emergency Medicine Leadership Roles Jennifer Wiler, MD, MBA, Denver Health Medical Center/ University of Colorado School of Medicine

One and Done? Performance of a Single, Low HighSensitivity Troponin in a Multisite United States Cohort Brandon Allen, MD, University of Florida

Dr. James F. Holmes is Installed as the Society’s 2020–2021 President

James F. Holmes, Jr., MD, MPH was installed during the SAEM20 Virtual Meeting as the Society’s 2020–2021 president. In his acceptance speech, which was broadcast virtually over SAEM social media, he acknowledged the unprecedented changes in emergency medicine, health care, and members’ personal lives as a result of the COVID-19 pandemic and the ongoing concern and preparation for a probable coming second wave. He commended SAEM staff, leadership, and members for adapting quickly to the new environment created by COVID. Using his platform to address the challenges of these uncertain times while reinforcing the Society’s support of medical students, persistence in promoting diversity and inclusion, and pledge to advance emergency care research, he said:

FEED-ER: A Novel Tool for Assessing the Quality of Feedback in the Emergency Room Sreeja Natesan, MD, Duke University Wellness in Academic Emergency Medicine: Initial Exploration of 2019 Survey of the Society for Academic Emergency Medicine Physician Membership Andra Blomkalns, MD, MBA, Stanford Department of Emergency Medicine Prevalence of Bacteremia and Meningitis in Febrile Infants Less Than or Equal to 60 Days With Positive Urinalyses Prashant Mahajan, MD, MPH, MBA, University of Michigan All abstracts submitted and accepted to SAEM20 can be viewed in the SAEM 2020 Annual Meeting Supplement.

“We will continue to grow, and we will not let the current pandemic hinder our mission. Academic emergency medicine is a community and SAEM is our home. SAEM will proceed in its mission to advance emergency medicine education, research, advocacy, and professional development.” Dr. Holmes concluded his presentation with a poignant video dedicated to our SAEM Front Line Heroes. Watch Dr. Holmes’s full presentation! Watch SAEM: A Few of Our Heroes

SAEM20 Virtual Meeting Plenary Sessions

Emergency medicine academicians in seven plenary presentations explored a variety of subjects related to the practice of emergency medicine during a special plenary session broadcast on May 14 and 15, during the SAEM20 Virtual Meeting. Representing a broad diversity of research in emergency medicine, these abstracts were selected by the SAEM Annual Meeting Program Committee as “the best” from among the 1,355 abstracts that were submitted for consideration. If you missed the Plenary Presentations or you just want to see them again, you can view them on video!

COVID-19 Keynote Address: Dr. Leana Wen

In her SAEM20 COVID-19 Keynote Address, Emergency Physicians and Public Health Providers: The New Pandemicists, Leana Wen MD, MSc, shared five lessons from the front lines: 1. Do what we can, now. 2. Evaluate, innovate, and improve. 3. Draw on our training. 4. Find interventions when we can. 5. Make the invisible, visible. continued on Page 10


WRAP-UP continued from Page 9

• Diagnostics, with David H. Persing, MD, PhD • Therapeutics, with Paul Gisbert Auwaerter, MD, MBA

Dr. Wen is a visiting professor of health policy and management at the George Washington University Milken Institute School of Public Health and the distinguished fellow of the Fitzhugh Mullan Institute for Health Workforce Equity. She previously served as the commissioner of health for the City of Baltimore and as the president and CEO of Planned Parenthood. In 2019, Dr. Wen was named one of TIME magazine’s 100 Most Influential People and as Modern Healthcare’s 50 Most Influential Clinician-Executives. Dr. Wen’s address is available to watch on video.

Medical Education Keynote Address: Dr. Jonathan Sherbino

In his medical education keynote address, Efficiencies in Education: How to Hack Educational Training to get from 10,000 Hours to 100 Hours, Jonathan Sherbino, MD, MEd, focused on evidence-informed techniques to improve learning efficiency and shared five key ideas:

• Rebuilding After the COVID-19 Shutdown: Choices for the Healthcare System, with Drs. Josh M. Sharfstein, MD and Lisa L. Maragakis, MD, MPH

RAMS Webinar “Maintaining Momentum: Resident and Medical Student Education and Research in the Era of COVID-19”

The RAMS-hosted the webinar “Maintaining Momentum: Resident and Medical Student Education and Research in the Era of COVID-19,” held in May during the SAEM20 Virtual Meeting, is now available to watch on video. The webinar addresses how medical students and emergency medicine residents can navigate present challenges and capitalize on potential future opportunities related to COVID- 19. Webinar speakers focus on operations, research, wellness, and education.

1. Teachers can’t “drag ‘n’ drop” information. Knowledge is constructed, not transferred. 2. Wicked learning environments require feedback. Complex learning requires specific, immediate, progressive feedback. 3. The “one-timer” is low reward. To sustain learning, you need re-inoculation. 4. Throw out your highlighters. Effortful, mixed recall of knowledge is best. 5. Learning 2.0 = Groups. We learn by observation, modelling, imitation and shared values. Dr. Sherbino is an assistant dean, health professions education research and professor of medicine at McMaster University, Ontario, Canada and the past chair of the Specialty Committee for Emergency Medicine, Royal College of Physicians & Surgeons of Canada. He is also a clinician educator, coeditor of the CanMEDS 2015 Framework, cohost of the KeyLIME (Key Literature in Medical Education) podcast, and an award-winning teacher whose accolades include the national 2018 Canadian Emergency Medicine teacher of the year.


Dr. Sherbino’s presentation is available to watch on video!


Special COVID-19 Session on Telehealth in EM, With Dr. Judd Hollander

COVID-19 has sparked a wide implementation for telehealth in the U.S. In a Special COVID-19 Session on Telehealth, featuring a keynote from Dr. Judd Hollander, leading experts shared lessons they’ve learned while using telehealth during the COVID-19 pandemic. If you missed the session, or want to see it again, you can catch it on video.

Other COVID-19 Special Sessions

In response to the outbreak of the COVID-19 pandemic earlier this year, SAEM presented three special sessions to address the pandemic from three different focal points. If you missed out on seeing the sessions in person, you can view them on video! Visit the webpage for Q&A transcripts, PowerPoint presentations, speaker bios, and videos of all three special sessions on COVID-19:

EMRA’s Cocktails With Chairs, in Collaboration With SAEM RAMS

Ever wonder what it takes to be an emergency medicine department chair? What path can you start now to poise you to lead an efficient emergency department where physicians thrive? The Emergency Medicine Residents’ Association (EMRA), in collaboration with SAEM RAMS (Residents and Medical Students) EMRA’s Cocktails with Chairs event, held on May 13, provided an opportunity for informal discussion with chairs to find answers to these and other questions, and gain insight regarding career goals. The virtual, interactive session was well attended by more than 250 registrants and dozens more on SAEM Facebook and YouTube. If you missed it, you can watch it now! For an overview of the event, see the "Cocktails With Chairs" article in this issue of SAEM Pulse. Cocktails With Chairs Panelists • Andra Blomkalns, MD, MBA, Stanford University School of Medicine • Michael Brown, MD, MSc, Michigan State University College of Human Medicine • Bo Burns, DO, Oklahoma University School of Community Medicine • Gabe Kelen, MD, The Johns Hopkins School of Medicine • Angela Mills, MD, Columbia University • Ian B.K. Martin, MD, MBA, Medical College of Wisconsin

Looking Ahead... Chief Resident Forum, Session 4

Join Cynthia Price, MD on July 20 from 2-3 p.m. CT for the fourth and final session of the SAEM Chief Resident Forum (CRF) — the premiere annual training event for up and coming chief residents. Dr. Price is the associate residency program director and an assistant professor at the University of Connecticut. The CRF introduces incoming chief residents to key leadership lessons that will help them in the upcoming year and beyond. This year’s CRF is divided over four sessions to provide residents with the “just-in-time” training needed for the upcoming year. Full details and a registration link may be found at the CRF webpage. Register Now

Registration for the Virtual Residency & Fellowship Fair is Now Open!

Residents and medical students… Sign up for the SAEM20 Virtual Residency & Fellowship Fair, July 27–30, and meet online with representatives from coveted residency and fellowship programs from around the country at NO COST to you. More than 100 residency and fellowship slots have been filled; all are waiting to video conference with you in real time about their programs and give you advice to help you prepare for applying. This event is free, so register for as many virtual meetings as you want! Registering is easy! Visit the webpage and click the time slot links for each program you wish to attend. Once registered you’ll receive an e-mail confirmation (one for each registration) with your individual Zoom link and meeting time. Want to check out a specific program before making your selections? Interested in learning more about a selected program prior to your video conference? Just click the institution name for a direct link to the program website! SAEM/RAMS is excited to provide residents and medical students with this convenient and cost-effective careerbuilding opportunity!

Accepting Virtual Presentations of SAEM20Accepted Educational Content!

Presenters of SAEM20-accepted didactics, abstracts, innovations, and IGNITE! are invited to record their presentations and upload them to SAEM’s YouTube channel where they will be shared with more than 24,000 followers via SAEM social media channels. This work-around lets SAEM members and others view SAEM20 presentations from the socially-distanced safety of their homes or offices and gives presenters the opportunity to share their work broadly. For details, view the SAEM20 Virtual Presenter Instructions. Deadline: August 1. Check out the SAEM20 presentations submitted so far! View dozens of presentations, with more coming in daily, at the SAEM20 Virtual Presentation webpage!

The SAEM21 Program Committee is already hard at work to make our in-person annual meeting comeback a stellar success! Make note of these dates and plan to join us next spring at SAEM21, May 11-14, at the beautiful Atlanta Marriott Marquis!

SAEM20 Submission Deadlines


Remember These Dates!

Advanced EM Workshops August 1– September 15, 2020 Didactics August 15–October 1, 2020 Abstracts November 1, 2020– January 4, 2021 Innovations/IGNITE! November 1, 2020–January 11, 2021

SAEM Consensus Conference 2021 From Bedside to Policy: Advancing Social Emergency Medicine and Population Health through Research, Collaboration, and Education May 11, 2021, Atlanta Marriott Marquis, Atlanta, GA

Postponed until SAEM21 • Program Officer Event • Meet, Greet, and Tweet • Experiential Learning Events (Dodgeball, SonoGames, SimWars, MedWAR, Jeopardy, etc.) • Social Events (RAMS Party, luncheons, dinners, etc.) • Medical Student Symposium • SAEM Leadership and Junior Faculty Development Forums • Affiliate Meetings 11

Congratulations to This Year’s SAEM Award Recipients! SAEM has announced the recipients of its annual awards given in recognition of exceptional contributions to emergency medicine and patient care through leadership, research, education, and compassion. Congratulations to all of our 2020 award winners on a job well done!

John Marx Leadership Robert W. Neumar, MD, PhD

r. Neumar is professor and chair of the department of emergency medicine at the University of D Michigan. In this role, he has been a strong advocate for expanding critical care capabilities within the specialty of emergency medicine, which is exemplified by the creation of the Emergency Critical Care Center (EC3) in the University Hospital Adult Emergency Department and the Michigan Center for Integrative Research in Critical Care. Dr. Neumar is recognized as an international leader in the field of cardiac arrest resuscitation. He has been a national and international leader for advancing the specialty of emergency medicine. Through Dr. Neumar's leadership and advocacy, the NIH has finally had formal recognition of emergency medicine, and Dr. Neumar's work helped lead to the development of the Office of Emergency Care Research at NIH.

Excellence in Research Kevin R. Ward, MD

Dr. Ward is professor of emergency medicine and biomedical engineering at the University of Michigan. Dr. Ward's major research focus is in developing platform technologies to improve the care of the critically ill and injured with an emphasis on combat casualty care. Dr. Ward's work has been funded by the NIH, Department of Defense, NSF, and industry. Dr. Ward was awarded a Certificate for Patriotic Civilian Service by the Department of the Army and the Joint Special Operations Training Center. Dr. Ward is a Lieutenant Colonel in the U.S. Army Reserves Medical Corps.

Hal Jayne Excellence in Education Susan B. Promes, MD, MBA

Dr. Promes is professor and chair of the department of emergency medicine at Penn State Health – Milton S. Hershey Medical Center. Dr. Promes is a nationally and internationally known scholar in academic emergency medicine. Her interests include team training, bedside teaching, medical errors, and clinical guidelines; her research focuses on medical education and faculty development with a current emphasis on evaluation of learners. She is the Editor-in-Chief of Academic Emergency Medicine Education and Training.

Marcus L. Martin Leadership in Diversity and Inclusion VIRTUAL ANNUAL MEETING WRAP-UP

Alden Matthew Landry, MD, MPH


r. Landry is an assistant professor and emergency medicine physician at Beth Israel Deaconess D Medical Center and assistant dean for the Office for Diversity Inclusion and Community Partnership. Dr. Landry is a national leader in the study of health disparities and regularly lectures on these topics across the country. He has been awarded multiple grants for his initiatives and has published on the topic. Dr. Landry founded the non-profit group Motivating Pathways. Through its flagship program, the Tour for Diversity in Medicine, groups of health professionals travel the country to promote careers in the health professions to underrepresented minorities.

FOAMed Excellence in Education Anand Swaminathan, MD, MPH

Dr. Swaminathan is an assistant clinical professor of emergency medicine and the medical education fellowship director at St. Joseph's Hospital in Paterson, NJ. His main interests are in resident education, faculty development, resuscitation and knowledge translation. He is a deputy editor and conference chair for EM: RAP. He is a big believer in and contributor to the Free Open Access Medical Education (FOAM) movement. Dr. Swaminathan is an associate editor for REBEL EM and REBELCast and a regular contributor to the EM Cases Quick Hits podcast.

Mid-Career Investigator Raina M. Merchant, MD, MSHP

Dr. Merchant is an associate vice president at Penn Medicine and an associate professor of emergency medicine at the University of Pennsylvania. Her research is at the intersection of digital media and health. She has specifically conducted projects evaluating health behaviors and communication using digital platforms like Facebook, Twitter, Yelp, Instagram, Reddit, and Google. Much of her work also bridges new technologies in the fields of cardiovascular health, mental health, cancer care, disaster medicine, public health, and resuscitation science.

William Meurer, MD, MS


SAEM Award Recipients

Dr. Meurer is an associate professor of emergency medicine and neurology at the University of Michigan Health System. He works to improve the care of patients with acute neurological disease both through his work on the acute stroke team and as a researcher. His work in the field focuses on the design of clinical trials with adaptive and flexible components.

Alex F. Manini, MD, MS

Dr. Manini is a professor of emergency medicine at the Icahn School of Medicine at Mount Sinai in New York City. He is associate program director of the nation's first clinician scientist training program (T32) in emergency care research at Mount Sinai (funded by NIH/NHLBI). He is an independent investigator and clinician-scientist with a research focus on the emergency medical and cardiovascular consequences of drug overdose.

Young Investigator Kristin L. Rising, MD, MS

Dr. Rising is associate professor and director of acute care transitions in the department of emergency medicine at Thomas Jefferson University. Her career goal is to develop a more patient-responsive care delivery system able to address whole-person needs . Her approach to accomplishing this goal is to establish the rigorous evidence base needed to change policy. Her work to date has focused primarily on addressing patient uncertainty as a driver of care utilization and developing the evidence needed to incorporate interventions focused on addressing social determinants of health into routine care delivery.

Kori Sauser Zachrison, MD, MSc

Dr. Zachrison is assistant professor of emergency medicine at Massachusetts General Hospital (MGH). Dr. Zachrison's academic focus has been on improving systems of care for time-sensitive emergency care delivery. She studies telemedicine and stroke systems of care, bringing an innovative approach, including applications of network science and mathematical decision modeling.

M. Austin Johnson, MD, PhD

Dr. Johnson is an assistant professor in the division of emergency medicine, department of surgery at the University of Utah School of Medicine. Dr. Johnson's research is primarily translational, "bench-tobedside," research focused on the development of novel interventions for early resuscitation of critically ill patients. This research has focused on the development of automated endovascular devices for precision blood pressure control, which has applications in trauma, cardiac arrest and stroke care.

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SAEM AWARD RECIPIENTS continued from Page 13

Public Health Leadership Garen Wintemute, MD, MPH

Dr. Wintemute is the founding director of the Violence Prevention Research Program (VPRP) and holds the Baker–Teret Chair in Violence Prevention at the University of California, Davis. He was among the first to study firearm violence as a public health problem, and firearm violence remains the primary focus of his research and policy work. His current research focuses on violence risk factors and interventions to prevent violence.

Advancement of Women in Academic Emergency Medicine Jeannette Wolfe, MD

Dr. Wolfe is an associate professor of emergency medicine at the University of Massachusetts– Baystate. Her academic area of interest and personal passion is studying the influence of biological sex and gender on physiology, pathophysiology, and behavior. Her primary educational focus is on engaging medical colleagues about the importance of considering the variables of sex and gender in health-related outcomes so that they may more intentionally include them in their own clinical practice, teaching, and research.

Organizational Advancement Luan Lawson, MD

Dr. Lawson is the associate dean of curricular innovation in medical education at the Brody School of Medicine at East Carolina University. She is recognized for her work in strengthening the education arm of SAEM. Her extensive work over the past year has led to advancements in innovative products and services for educators such as the new ARMED MedEd course. She has also led the Clerkship Directors in Emergency Medicine academy in realigning the academy mission and goals with SAEM, and elevating the academy to be the voice for educators within the Society.

Martin Reznek, MD, MBA

Dr. Reznek is professor and vice chair for clinical operations and education in the department of emergency medicine at the University of Massachusetts Medical School. He is recognized for his work leading the Finance and Membership Committees of SAEM. Because of his contributions, SAEM has become more sophisticated at reporting on statistics and developing analytics, which has led to increased net assets, total revenue, investments, and membership. Dr. Reznek is one of the key leaders that has shaped the Society into what it is today.


Arnold P. Gold Foundation Humanism in Medicine


Randall S. Jotte, MD

Dr. Jotte is an associate professor of emergency medicine at Washington University in St. Louis, providing clinical care at Barnes-Jewish Hospital. During his career, he has focused on identifying opportunities to improve health and outcomes for individuals and populations while enhancing efficiency. Recent programs he has helped develop include Familiar Faces, Complex Care, and Hospital-toHousing. These programs focus on the needs of unique patient populations by addressing significant medical, social, and behavioral needs.

Benjamin A. White, MD

Dr. White is an attending physician at the Massachusetts General Hospital Department of Emergency Medicine, and an associate professor of emergency medicine at Harvard Medical School. His academic and administrative career has focused on improving patient care and experience across the spectrum of the ED visit. His work had included multiple ED operations and systems improvement projects, with an emphasis on clinical innovations that reduce unnecessary waits and waste, increase communication quality and frequency, optimize patient comfort, and improve the overall environment of care.

Joshua Davis, MD

Dr. Davis is a third year emergency medicine resident at Penn State Milton S. Hershey Medical Center. He received the 2018 Resident Research Award from the Academy of Emergency Ultrasound. Dr. Davis has more than 30 peer reviewed publications. His research focuses on using point of care ultrasound to help diagnose dehydration in children.

Resident Educator Carolyn V. Commissaris, MD

Dr. Commissaris is a fourth year and chief resident at the University of Michigan Emergency Medicine residency. Dr. Commissaris has been active in resident and medical student education, regularly lecturing and eventually building an educational niche in lecture design and delivery.


Resident Researcher

RAMS Award Recipients RAMS Innovative Educator Cleavon Gilman, MD

Dr. Cleavon Gilman is a fourth year Chief Resident in Emergency Medicine at NewYork-Presbyterian Hospital in New York City. Dr. Gilman stutters, but learned as a child that his stutter disappeared when he rhymed over music. He is deeply passionate about resident education, but couldn't teach in the traditional sense due to his speech impediment. As a second year resident, he began rhyming about physician wellness, health policy, and evidence-based medicine, which earned him first place at SAEM's Got Talent in 2019.

RAMS Excellence in Research Patrick D. Tyler, MD

Dr. Tyler is a chief resident and a third-year emergency resident at Beth Israel Deaconess Medical Center (BIDMC) in Boston, MA. He has published on the interhospital transfer of and laboratory value interpretation in critically ill patients, the effect of fluids on the glycocalyx in patients with sepsis, and the effects of shift hour on provider behavior. Dr. Tyler's objective is to become an emergency researcher with expertise in pragmatic translational clinical trials, with the overall goals of decreasing morbidity and improving outcomes for acutely ill patients and their families.

RAMS Leadership in Emergency Medicine Omar Z. Maniya, MD, MBA

Dr. Maniya is currently a senior resident at The Mount Sinai Hospital in NYC. He speaks nationally and writes regularly, with more than 100 presentations and publications, and has been featured on CNN & Fox News. He is a MedTech 40 under 40 Healthcare Innovator, a McKinsey Emerging Scholar, and an AMA Foundation Leadership Award recipient.

Abraham Akbar

Mr. Akbar is a fourth-year medical student at Baylor College of Medicine in Houston. He has presented his research at several national conferences, including ACEP and SAEM. He has also served as the president of Baylor's Emergency Medicine Interest Group, and previously was the second-in-command of his collegiate EMS organization at Rice University. In 2020, Abraham was also chosen as the Texas ACEP Outstanding Medical Student of the Year.

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SAEM AWARD RECIPIENTS continued from Page 15

SAEM19 Presentation Award Winners SAEM19 Best Young Investigator Presentation

Marc Probst, Mt. Sinai School of Medicine, Risk-stratification of Older Adults who Present to the Emergency Department with Syncope: The FAINT Score

SAEM19 Best Medical Student Presentation

Nella Hendley, Wake Forest University, Sex and Race Differences in Safety and Effectiveness of a Chest Pain Accelerated Diagnostic Protocol

SAEM19 Best Resident Presentation

Louis Yu, UC San Francisco, Aortic/Great Vessel Injury in the Pan-scan Era

SAEM19 Best Fellow Presentation

Jonathan D. Casey, Vanderbilt University, Bag-Mask Ventilation During Tracheal Intubation of Critically Ill Adults

SAEM19 Best Faculty Presentation

Jeffrey Perry, University of Ottawa, A Prospective Cohort Study to Validate the Canadian TIA Score to Characterize Risk for Subsequent Stroke in Transient Ischemic Attack Patients

SAEM19 Best Basic Science Presentation

David H. Jang, MD, MSc FACMT University of Pennsylvania, In Vitro Comparison of Hydroxocobalamin and Mitochondrial-Directed Therapy in a Cell Model of Cyanide Poisoning


The SAEM20 Virtual Meeting is on YouTube!


If you missed out on the SAEM20 Virtual Meeting and your FOMO kicked into overdrive, we have a cure for you: The SAEM20 Virtual Meeting playlist where you’ll find videos of every one of the sessions that were livestreamed during the annual meeting. View them all again so you can pause and take notes or enjoy them for the first time! • Telehealth in EM During the COVID Crisis • Remarks from the SAEM Presidents • Keynote Sessions • Other special sessions on COVID-19 • Plenary Session Presentations • RAMS: Maintaining Momentum: Resident and Medical Student Education and Research in the Era of COVID-19 • EMRA’s Cocktails with Chairs, in collaboration with SAEM RAMS

The Society for Academic Emergency Medicine congratulates this year’s recipients of the SAEM Medical Student Excellence in Emergency Medicine Award. The award is offered to each medical school in the United States and internationally to honor an outstanding medical student. Matthew Chasnoff Johnson Albany Medical College

Briana Bennett Medical College of Georgia

Erik Loescher Arizona College of Osteopathic Medicine

Kelly Tillotson Medical College of Wisconsin

Elizabeth Adams Baylor College of Medicine

Dean Gebler Medical University of South Carolina

Alexandra Heyes-Darwin University of Miami Miller School of Medicine Regional Medical Campus

Kristopher Hendershot Cooper Medical School of Rowan University

Tianci Liu New York Medical School

Danica Cutshall University of Minnesota Medical School

Michael MacMillan Dalhousie University

Adam Pissaris Northwestern University Feinberg School of Medicine

Logan Wilson University of Mississippi Medical Center

Hayden Jacob Schenker Drexel University College of Medicine Matthew Coco East Carolina University - Brody School of Medicine Laura Jayne Stamper East Tennessee State University Quillen College of Medicine Sean M. Whitty Eastern Virginia Medical School Nikita Olehovych Shokur ETSU Quillen College of Medicine Daniel Puebla Florida International University Grant Michael Wallenfelsz Florida State University of Medicine Rebecca Breed Georgetown University School of Medicine Quinton T. Nannet Indiana University School of Medicine Aaron Sing Bola Jacobs School of Medicine & Biomedical Sciences, University at Buffalo Ryan Ebisu John A Burns School of Medicine Jose Reyes Johns Hopkins University School of Medicine Austin Zearley Lincoln Memorial University-DeBusk College of Osteopathic Medicine Charles Emerson Brown Loma Linda University School of Medicine Malia Lynn Tarpley Louisiana State University School of Medicine-Shreveport Taylor Petrusevski Loyola University of Chicago Stritch School of Medicine

Arjun Agrawal Penn State College of Medicine

Joshua Goldstein University of Miami Miller School of Medicine Miami Campus

Mallori Wilson University of North Carolina- Chapel Hill

Benino Navarro Rush Medical College

Bethanne Bartscherer University of Rochester School of Medicine and Dentistry

Doreen S Agboh Rutgers New Jersey Medical School

Nicolas S. Osborne University of South Carolina School of Medicine

Jordan R. Feltes Saint Louis University School of Medicine

Sean Grumbach University of South Carolina School of Medicine Columbia/Prisma Health Richland

Sarah Galler SUNY Downstate Medical School Anthony Fabiano The Ohio State University College of Medicine Geoffrey Hogan The Warren Alpert Medicine School of Brown University

Kelly McWilliams University of South Florida Heather Renfro University of Texas Southwestern Caleb Knight University of Vermont Laner College of Medicine

Thomas Yan Tulane University

Shannon Wright University of Virginia

Ahmed Farhat UC Irvine School of Medicine

Mike McDonough University of Washington

Luke Edgar UGME, University of Ottawa

John Harringa University of Wisconsin School of Medicine and Public Health

CPT Gerrit W. Davis Uniformed Services University of the Health Sciences

Eriny Hanna Vanderbilt University School of Medicine

Kristen Douglass University of California, Davis School of Medicine

Kyle Nielsen Via College of Osteopathic Medicine

Laura Checkley University of California, San Francisco School of Medicine

Christopher Brown Virginia Commonwealth University

Marika Kachman University of Chicago Pritzker School of Medicine


2020 Medical Student Excellence in Emergency Medicine Award Recipients

Elizabeth Rempfer West Virginia University School of Medicine

Samuel Southgate University of Connecticut School of Medicine

Conner Holthaus, MD Western Michigan University Homer Stryker M.D. School of Medicine - EM

Alexander Parker University of Louisville School of Medicine

Dennis Wang Yale School of Medicine


COVID-19 With Covid-19, the Times, They are a-Changin’ By Vicken Y. Totten, MD It happened in the days of the Virus. Of course, like many changes, it started slowly. Most people didn’t even notice. Just like the dinosaurs didn’t notice the ever-brightening star in the heavens. The first doctor to sound the alarm asked his friends if they were seeing what he was seeing. In response, local authorities told him to retract his posts because they were alarmist. By the time he died of it, even the local officials knew that calamity had hit. Back in the USSR, there was no news reaching us boys. None from North Korea, but South Korea was scared. As soon as they got a few cases, they socially distanced and tested everyone. They quickly contained their contagion. But the tsunami was racing around the world. Effusive Italy was inundated. The Germans, with their love of order and rules, bunkered up, tested, and contained. The mighty USA mostly ignored the threat. After all, it is more important to reassure the economy than protect the people. A few voices were crying out in the wilderness: “Repent of hoarding your N-95 masks! Your toilet paper! Repent and we may all be saved!” but the hot wind from the Politi-Critters blew the warnings away.


Standing on the shores, watching the pre-Tsunami waters recede and the White Boards eerily empty, were


the emergency doctors, BAFERDs and JAFERDs alike. They reached for their armor, for their weapons, ready to gird their loins for the onslaught. They reached behind them and found, to their dismay, their swords had turned to cardboard, their shields were only bandanas, and their bosses told them that their helmets scared patients, so they were not to wear them. The waters, ominously, were rising. Both on the Left Coast and then the Right Coast. Proverbial Birds were coming home to roost in great numbers. Each screaming each its own song. “You need to wear Hazmat suits!” “A surgical mask is enough when you intubate!” “Make your own PPE!” “Walk off the job if your employer won’t protect you!” “Self-quarantine!” “Stay home and protect us, because we go to work to protect you!” “You signed up for this, go to work!” Memes sprouted everywhere. Sweeping in from the coasts, the waves met in the heartland of America, just as the grain started leaping into the spring sunshine. In the heartland, meat packers who started the union

movements in the 1800s to protest working conditions were hit again: ordered to stay on the lines. Beefeaters could keep eating meat. Infected in droves, they showed both the strengths and economic harms of shutdown. Not until 80 percent of everyone left alive has been soaked to the bone will the Times slow down their changin’.

ABOUT THE AUTHORS Dr. Vicken Totten, an academic emergency physician, recently retired after 40 years of practice. After a family medicine residency and two years in the National Health Service Corps (NHSC), she started her emergency medicine career riding circuit in lowvolume, remote emergency rooms in California. After a decade or so, she achieved academia, eventually becoming firstly Emergency Medicine Research Director and lastly Institutional Research Director. Six months into retirement COVID hit, and she deployed herself to an Indian Health Service (IHS) location a few times, to help out.

“And you better start swimmin' Or you'll sink like a stone For the times they are a-changin'.”


Observation in the Era of COVID-19 By Sanjey Gupta, MD, Gregory Garra, DO, and William Apterbach, MD on behalf of the SAEM Operations Interest Group The SARS-CoV-2 virus bulldozed through the New York City region in the late winter and early spring of 2020, forcing EDs and hospitals to rapidly alter operations in order to manage the influx of COVID-19 patients while simultaneously attempting to maintain some semblance of normalcy for the management of non-COVID-19 related complaints. Observation services in the ED are not immune to the needs of operational mutability in the era of COVID-19. As we are all proverbially “building the plane while flying it,” the following recommendations are based on experiences during the COVID-19 upswing, sustained peak, and initial recovery phase in our department.

Acute Needs Redesign of current protocols to minimize disease exposure

One professional workplace action is to adopt clinical practices that mitigate the potential spread of infection between patients and healthcare workers. First, consider removing procedures that require prolonged human-tohuman exposure. This may include substituting CT coronary angiography for cardiac stress testing, restricting echocardiography from your chest pain or syncope protocols, or substituting

CT or MR angiography for carotid dopplers in TIA protocols. Further, consider utilizing telehealth services for specialty consultation. Under the CARES ACT, CMS expanded the use of Medicare telehealth services to include all of those who are eligible to bill Medicare for professional services. This includes consultant services and Initial and Subsequent Observation and Observation Discharge Day Management (CPT codes 9921799220; CPT codes 99224- 99226; CPT codes 99234- 99236). (Details can be found here.)

Workforce agility based on patient volume

In parallel to the nationwide reduction in overall ED patient volume, expect a similar decline in observation cases. In considering observation staffing, the ACEP policy statement on “Emergency Department Observation Service” proffers that an ED physician and an ED nurse should direct ED observation areas. If your ED volume rises significantly with critical COVID-19 patients, or if you encounter other ED staffing needs, e.g. illness coverage, alternate care site development, you may have to redeploy full-time ED observation staff to other key areas in the ED. Consider cross-training

and utilizing staff deployed from other departments to the ED as elective procedures and surgical cases are cancelled in your hospital.

Prepare for increasing psychosocial issues and substance use complaints

Despite an overall reduction in observation cases, you can expect an increase in several distinct observation diagnoses. First, prepare for an increase volume of patients with social support needs (e.g. homelessness, food insecurity, need for home care, SAR or SNF placements, etc.) as many outpatient services and agencies are closed or unable to handle COVID-19+ patients. Second, expect an increase in the number of patients presenting with intoxication and substance use concerns as access to outpatient and inpatient addiction services are reduced and maladaptive coping mechanisms are pushed to their limits. Further, COVID-19 + patients may also be sent from their current SNFs for new placement in a COVID-19 capable facility. Establishing close and frequent communication with case management and social work teams is paramount. continued on Page 20


OBSERVATION continued from Page 19

Preparing a COVID-19 specific protocol

Invariably, conditions will arise in which patients will require observation services for COVID-19 specific complaints (e.g. hypoxia that can be mitigated with a home oxygen concentrator, fatigue due to continued fever or diarrhea, acute dehydration, etc.). As described by the ACEP State of the Art: Observation Unit in the Emergency Department PREP, observation patients may be in the unit for an average of fifteen hours. With the variable presentation of COVID-19, protocols will have to be wide and encompassing, yet still afford proper safe patient selection, goal-setting, and predictable outcomes. Observation protocols should clearly delineate supplemental oxygen requirements, frequency and need for repeat inflammatory serology testing, and potential DVT prophylaxis using established hospital protocols or a validated prediction tool. A final observation protocol to consider is using a scatter bed approach in order to cohort COVID+ observation patients with COVID+ patients in the ED, thereby minimizing potential exposure to COVID- patients.


Long term considerations


Many of the long-term considerations for observation services in the era of COVID are borne out the lessons learned from the acute upswing, peak, and return to baseline operations during the COVID pandemic.

Infection Control

As many EDs have developed “COVID vs. Non-COVID” areas, the same consideration must be given to observation patients due to their longer length of stay and increased potential contact with different caregivers and diagnostic/therapeutic areas. Surveillance literature suggests that 25-50% with SARS-CoV-2 infection are asymptomatic. Consider COVID-19 testing on all patients admitted to ED observation services. This action may also expedite inpatient bed assignment for patients upgraded to admission. This “COVID” area may be a separate dedicated observation area or scattered bed model where patients continue care in COVID + designated spaces of the ED.

Maturation of COVID protocols based on local clinical and regulatory requirements Local and State Health Departments’ COVID regulations are moving targets. As such, it is important that your COVID observation protocols are flexible to meet health department demands. For example, New York State recently pivoted in its stance and is disallowing patients who are COVID + to be discharged back to SARs and SNFs. This change in state DOH policy prevents EDs from dispositioning a patient until the return of COVID PCR testing, which may take 12 hours or more. Our COVID protocol had to be modified in real time to meet the new needs of this requirement.

Modifications of protocols based on a patient’s prior history of COVID+ status

As the clinical features of this disease continue to be elucidated,

hypercoagulability and inflammation seem to be clinical hallmarks. Consider modification of current protocols (e.g. TIA, dyspnea, COPD/asthma, DVT/ PE, etc.) to reflect the higher risk nature of these patients presenting to the ED. This also includes partnering with social work and case management in order to help plan a safe discharge with appropriate medication and follow up. The evolution of observation services in the era of COVID-19 reflects the growing role of infection control, case management/social work, and the clinical impact of the infection on multiple body systems. Successful management of observation services will depend on constant vigilance of and ability to flex in response to the continuously transforming clinical and regulatory landscape surrounding COVID-19.

ABOUT THE AUTHORS Dr. Sanjey Gupta is an associate professor of emergency medicine at the Donald and Barbara Zucker School of Medicine at Hofstra/ Northwell, and is the chair of emergency medicine at Southside Hospital in Bay Shore, NY. r. Gregory Garra is an associate professor of D emergency medicine at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, and associate chair of emergency medicine at Southside Hospital in Bay Shore, NY. r. William Apterbach is an assistant professor of D emergency medicine at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, and vice-chair of emergency medicine at Southside Hospital in Bay Shore, NY.


COVID-19 in Prague: Taking Precautions for a Crisis That (Thankfully) Didn’t Happen By Miloslav Loucka MD, Ondrej Sedivka MSC, Marek Dvorak MD, Ondrej Franek MD, and Adan Atriham MD A perspective of the course of the coronavirus pandemic from the Prague Emergency Medical System (EMS), intensive care physicians, and Motol University Hospital. Prague, the capital of Czech Republic, has a population of approximately 1.3 million. It is a cosmopolitan city of rich history and culture, blended with an advanced and developed infrastructure. The health care system is modern and consists of a highly functional combination of prehospital and hospital networks. Economically, the income per capita of the citizens of Prague is well above the national average and comparable to the rest of the European Union. The capital is also a busy tourist destination, welcoming more than 10 million visitors every year. Vaclav Havel International Airport is well connected with traffic of 49,000 passengers a day, and strategically located within several hours drive to other important European cities like Berlin, Vienna, Milan and Paris. The EMS in Prague uses the rendezvous model where an emergency medicine physician is dispatched to severe cases. Our system provides around the clock care from its 23 bases and responds to an average of 120,000 open calls per year. There are seven specialized hospitals in the city, capable of providing high level care to patients of all ages with multiorgan failure requiring mechanical ventilation and circulatory support. By the end of 2019, there were reports of a new virus emerging in China. During that time, not many people considered this a real threat, and the Czech Republic even sent shipments of PPE to China in order to help with the severe shortages there. In March, there was an increasing concern with the raising number of cases around the world, especially in Italy. On March 1, the Czech Republic confirmed its first COVID case, around the same time when Czech citizens were returning home from sky holidays

Motol University Hospital COVID-19 ICU

Handover of patient with COVID-19

in the Alps. In order to prevent further spread of the virus, relatively strict measures were deployed. On March 17, all elective procedures were postponed, ambulatory care was limited to acute cases and several wards were reorganized to accommodate COVID patients. As of May 17, 2020 there had been 8,445 confirmed cases in the Czech Republic, with 296 deaths. These numbers represent 27.7 deaths per million habitants. The Prague EMS began taking the necessary precautions for a possible pandemic as early as January, when the department of crisis management

purchased additional PPE. The first contact with a COVID positive patient occurred on March 14, 2020 and as the number of cases continued to increase, it became obvious that responding to all emergencies with full PPE would have been impossible. As a feasible solution, dispatchers began classifying emergencies by routinely asking questions about symptoms to assess the risk of infection. Each caller was asked about cough, fever, shortness of breath, and possible contact with a suspected or confirmed COVID-19 continued on Page 22


PRAGUE continued from Page 21 case. Based on the answers, calls were classified as C?, C- and C+ for the level of PPE required. C+ calls were attended in full protective gear, including Tyvek suit, FFP3 respirator, goggles and gloves. For C- calls, providers used FFP2 mask, goggles, gloves and a plastic mac. C calls were classified by the team upon arrival at the scene. For aerosol generating procedures, such as orotracheal intubation, providers wore improvised diving masks with a filter (see picture). Taking all of these precautions was necessary to protect our workforce, but they also proved to be challenging, resulting in slight delays in response times. All of our protocols were adjusted as more information about transmissibility of COVID became available, but all things considered, our system worked well resulting in a small number of providers becoming infected.


Motol University hospital is a tertiary center with an annual volume of more than one million visits. The emergency department provides around the clock care to patients with all sorts of illnesses and injuries. When caring for patients without history of respiratory illness (dyspnea, cough, fever) providers wore FFP2 mask and gloves only. If there was any suspicion for respiratory infection, the patient was placed in specially designated room and staff donned full PPE including FFP3, full body suit, goggles and gloves. Similarly, soon after the onset of the pandemic, our protocol for endotracheal intubation was standardized across all of our sites. Rapid sequence intubation with videolaryngoscopy became the method of choice, although direct laryngoscopy was utilized in some circumstances. Viral filters were mandatory for each intubation and transparent plastic covers provided an extra layer of protection. All of these changes were extremely important and very effective in the reducing the risk of infection amongst our workforce.


On March 23 a special ICU dedicated to COVID-19 patients was set up. There were 20 beds equipped with mechanical ventilation, dialysis and extracorporeal membrane oxygenation capabilities. Over the course of 42 days, we treated a total of eight patients; two of them died and six were transferred to different units after testing negative for COVID.

“All of our protocols were adjusted as more information about transmissibility of COVID became available, but all things considered, our system worked well resulting in a small number of providers becoming infected.”

EMS Prague personnel in protective suits

When looking at these numbers, we can obviously say that we never reached capacity, and despite some organization challenges, the ability to provide care for these patients was excellent. The COVID ICU operation ended in May 13. In early April frightening reports were coming from Italy — stories of medics collapsing in the hallways after spending entire shifts wearing PPE without rest, tales of extremely difficult decisions of resource allocation having to choose who would get the ventilator and who would die, and the thousands of patients without hope for recovery. Despite the fear of the unknown and the enormous challenges, all of our colleagues displayed high levels of determination and professionalism. Furthermore, the public contributed with material and emotional support showing their solidarity. This pandemic has been a unique crisis that has taught us to pay more attention to global health problems and wake up to the reality of emergent infectious diseases. At this time, life is slowly returning back to normal in the Czech Republic, and the number of cases remains relatively low compared with other countries. The exact reason for this is uncertain, but likely to be related to the public discipline, strict social distancing, and the professional work of the medical community of this country. Whatever the reasons might be, we are thankful for all of them.

ABOUT THE AUTHOR Dr. Miloslav Loucka is currently working as a physician in postgraduate training for the Department of Anesthesiology and ICM at Motol University Hospital and EMS Prague. Dr. Ondrej Franek is an emergency physician and head physician at Prague EMS.

Dr. Adan Atriham is an emergency physician from Houston, Texas, USA. His special interests are team logistics, point-of-care ultrasound, and trauma care. Ondrej Sedivka, MSc, is a crisis manager at Prague EMS.

Dr. Marek Dvorak is an emergency medicine specialist with a backround in EMS and HEMS in the Hradec Kralove (Eastern Bohemia) region. His clinical base is at the University Hospital Motol, Prague.


A Glimpse Into the Future By Stephen Colucciello, MD The novel coronavirus will forever change the world in ways we have yet to realize. What will our lives look like when the crisis abates? Will we still shake hands? Will my Italian relatives still kiss me on both cheeks (or just give air kisses)? When this is over there may be fewer elderly, more guns, less movie theaters, and greater paranoia in America … but perhaps more generosity and kindness as well. Most of what will change after the pandemic is beyond my ability to guess. However, I see more clearly the changes that will come to emergency medicine once the Hot Zone has cooled. Let’s pull back the curtain of time and glimpse into the future for our specialty after the Time of COVID …

Emergency Medicine, Summer 2023…

When I proudly left my residency almost four decades ago, I was disheartened to find out that I was a JAFERD (Just

Another F*cking Emergency Room Doc) to many in my new hospital. In the past 40 years, we slowly climbed the hierarchy of medicine through hard work, patient advocacy, and dedication. Then suddenly, in the spring of 2020, we transformed into BAFERDs (Bad A** F*cking Emergency Room Docs), respected for our stamina, resoluteness, and courage. In those days, when I walked down the hall, physicians who I barely knew stopped to ask, “Is there anything I can do for the ER?” I got e-mails from administrators I hadn’t seen for months telling me how proud they were of the job our department was doing. One night, when one of my colleagues left her shift, people had written “thank you’s ” in chalk all around her car. Our nurses and advanced practice providers (APPs) all received accolades for conspicuous service and bravery. When the dust settled after

COVID-19, emergency department (ED) workers were respected in ways we couldn’t imagine before the contagion. Today, in the summer of 2023, instead of aspiring to be astronauts or presidents, children dress up as emergency providers in full PPE with N95 masks.

Psychiatric Patients

For decades, we placed psychiatric patients in the most antitherapeutic place in the hospital, our ED, surrounded by screaming, sobbing, and moans. Police and ambulances bypassed psychiatric facilities only to leave psych patients at our door. For decades we fought to have the EDs medically clear psychiatric patients and then move them out to a psychiatric facility or to a hospital bed where they could undergo telepsychiatry. Despite years of effort, nothing changed. continued on Page 24


FUTURE continued from Page 23 Suddenly, in March 2020 everyone agreed that psychiatric patients had no place in the Hot Zone and they left our hallways forever.



Before 2020, some hospitals experienced “turf battles” over the use of point-of-care ED ultrasound and some radiology departments resisted expansion of this technology. But during the pandemic, ultrasound techs rebelled, justifiably afraid of catching SARS-CoV-2 from prolonged direct contact with patients. While CT and MRI techs were safely ensconced in their anterooms, the ultrasound techs remained at high risk of viral transmission. In April of 2020, many radiology departments required preapproval for US exams on COVIDpositive patients or persons under investigation (PUI) and even encouraged credentialed ED providers to perform more point-of-care ultrasounds (POCUS).


During the era of COVID, ED providers transformed the role of POCUS. We became expert at lung ultrasounds having learned from hundreds of patients with SARSCoV-2. Biliary and DVT studies were wrested from radiology by the summer of 2020, followed shortly by evaluation of appendicitis and intussusception in

children. ED residencies initially led the way, but private groups soon became credentialed at a pace never imagined. In 2023, ED docs and APPs are acknowledged masters of ultrasound.

Boarding of Patients in the Emergency Department

After decades of fruitless meeting and ineffective benchmarking, hospitals finally became dramatically more efficient within weeks. Many of us attended Avogadro’s number of meetings on hospital flow during the 20teens only to see ED boarding of admitted patients skyrocket. Suddenly in early March of 2020, the average length of stay for ED admissions plummeted to <30 minutes, where it has remained to this day. Most inpatients are discharged before noon, surgery schedules are smoothed to 7 days a week, and hallway boarding on the inpatient floor is routine. Our younger colleagues laugh at how we used to put up with hallway boarding in the ED. I always hang my head in shame when we talk about this—since they are right; we should never have let it happen.

Emergency Department Critical Care

While emergency physicians were always experts in the management of the critically ill, we hit our stride in April of 2020. We became mavens at ventilator management, intubating while wearing a protective hood,

proning patients, and managing acute respiratory distress syndrome (ARDS). We lost our slavish devotion to the “one-size-fits-all” approach to fluid resuscitation and in November 2021 CMS sent out a national notice regarding the sepsis bundle stating simply, “Sorry, we were wrong.” We quickly became skilled at the management of cytokine storm and alternative airway management such as helmet CPAP (and lateral position highflow nasal cannula). Now, in the spring of 2023, we still get calls from our hospital intensivists asking for advice.

End-of-Life Decisions

As used to death as we were, nothing prepared us for the events of Spring 2020. We soon learned that prolonged CPR in the era of COVID was a “no-win” proposition. If medics did not obtain return of spontaneous circulation in the field, efforts were stopped and patients went to the morgue instead of the ED. We learned by early April of 2020 that if a COVID patient arrested on a vent, less than one percent walked out of the hospital; CPR was never started under such circumstances. Consults for palliative care and hospice increased a thousand-fold and by May of that year, patients and their families already had end-of-life plans made before we even asked. Today every patient over 60 and those with serious disease have their end-of-life directives in a separate section of the


electronic medical record. Years after the pandemic, we can only shake our heads at how end-of-life decisions were routinely left to emergency providers to address.

Tele-emergency Medicine

Before the spring of 2020 our exposure to telemedicine was limited to telepsychiatry and an occasional teleneurology consult. By that summer, more than 85 percent of ED physician groups were employing video assessments in (and outside of) their ED. We began with drive-through COVID screening tents and expanded to intake/triage areas. To assist in surge capacity, on-call physicians logged into the video platform from home. These video assessments conserved diminishing supplies of PPE and allowed COVID-exposed providers and those who were mildly ill to work from home while ensuring full reimbursement. ED nurses rose to meet the challenge and became our handson site. Their skills at auscultation and palpation peaked during the epidemic as we asked them to perform remote physical examinations after we took our telemedicine history. Video platforms were later used to limit interhospital patient transfers and assist in handoffs of complex admissions within the same hospital. Now in 2023, up to 25 percent of ED shifts in large departments are videoenabled.

Hospitals at Home

For most of our entire careers, emergency providers were limited to one of two patient dispositions: admit or discharge. Alternatively, we could discharge or admit (and sometimes we would “waffle”). But there was no middle ground. By late spring of 2020, a new model arose, that of the virtual hospital. Overnight, hospital bed boards expanded by thousands. Emergency providers admitted only the sickest of patients while the less ill could be discharged to home in a virtual hospital. In some of these virtual hospitals vital signs were monitored remotely, while in others, patients were given an automated blood pressure cuff and a pulse oximeter so they could text or call in their vital signs several times per day. Those who were designated as “walking well” received several phone calls per day from providers while the more severely ill had visits by community paramedics

Photo credit: Dr. Jacki Davis

or home-health nurses. If the medics or nurses had concerns, they would call for a video assessment by a hospitalist team. By the time the COVID-19 vaccine ended the pandemic in late March 2021, 30 percent of all “hospitalized” patients were cared for at home and this number continues to grow.

foe. Years from now, our grandchildren will ask about the grim days in the spring of ’20 and what life was like “during the plague.” They will ask about tales of brave emergency workers who led the fight against the coronavirus and put themselves in harm’s way, and we will all have stories to tell.

Looking Back

This article is reprinted from the June 2020 issue of Academic Emergency Medicine journal. A version of this article was originally published in an EPIX Patient Safety Brief.

The COVID pandemic of 2020 profoundly changed life as we knew it. Despite the success of new antivirals and the Zefram-Cochrane vaccine, the world remains apprehensive about a new viral contagion. Society, government, and health care are forever altered. It is true that the “Time of COVID” was full of opportunists, deceivers, and blunderers, but we had our heroes too. Our nurses, techs, paramedics, APPs, and physicians fought (and died) on the front lines of a battle against an invisible

ABOUT THE AUTHOR Dr. Stephen Colucciello is professor of emergency medicine, University of North Carolina School of MedicineCharlotte Campus, Charlotte, NC.


The 2020 COVID-19 Pandemic: Front Line Perspectives Through Different Lenses By Wendy Coates, MD This editorial appears in the online, early view version of Academic Emergency Medicine Education and Training (AEM E&T) journal and will be included in the July issue of AEM E&T.


“COVID-19…has pushed emergency medicine to do what we do best, rapidly assessing and responding to crisis.” — Angela Mills, MD


News and information about the 2020 SARS-CoV-2, COVID-19 pandemic is plentiful. We are bombarded with data and often conflicting statistics, trends, and emerging clinical studies to evaluate and treat the virus through scientific journals, the news media, and social media. Human interest stories, frequently centered on patients, abound. Physicians permeate the

national media scene to educate the community and governmental officials about the facts and alert them to critical needs for increased research funding, access to personal protective equipment (PPE), and about the importance of social distancing to curb the spread of COVID-19. Ordinary people now use terms such as “flatten the curve” and “R-naught.”

line who are battling the challenges of the pandemic. Each contributor is at a different career stage, and although their individual challenges may appear to be very different, there is a consistency in the underlying message, one that underscores the unrelenting commitment of emergency physicians to serve their communities, innovate, and support one another.

What is missing from the news stories? Physicians are experiencing inconceivable challenges that affect their daily routines, academic career advancement, mental health, and sometimes, even their survival. In the July issue of Academic Emergency Medicine Education and Training, we explore a continuum of first-person perspectives of physicians on the front

Medical students in their clinical phase of study were advised to curtail clinical activities. Benefits of this decision include decreased exposure to the virus for novice trainees, preservation of scarce PPE, and reduced time demands on academic faculty who have expanded clinical workloads. Given the tight schedule in usual times, this decision may create

Of all the physicians in the emergency department, residents generally work the most hours. Not surprisingly, they are likely facing physical and emotional exhaustion at an intense level while they continue their post-graduate education. PPE shortages affect them daily, and once familiar routines are adapted to ensure their safety. Bennett and his coresidents are dealing with prematurely disquieting tasks, like executing their own advanced directives and health care proxies, prompted by witnessing infected patients of their age succumb to COVID-19. He sums it up by saying, “Hoping for the best, prepared for the worst.” Academic faculty are charged with shaping the careers of trainees and participating in scholarly activities while also remaining clinically adept. Relying on evidence-based medicine as a guideline for teaching and practicing is standard. However, as Dubosh points out, “COVID-19 had officially transformed our world and the realities began crashing down on our old paradigm of training.” Feeling responsible for the safety of her residents, she was conflicted about involving them in high-risk airway management, which they pointed out was a necessity in their training. She had to modify her academic activities, including teaching, mentoring, and conducting research on electronic platforms. Undaunted and true to her mission, she states, “Though answers are in short supply, what is clear is our need to continue to persevere as academicians and train the next generation of physicians.” The challenges of the emergency medicine (EM) department chair’s role are intensified in times of crisis. These challenges are accentuated when the chair is afflicted by the very disease that is at the root of the pandemic. Nevertheless, Mills, a chair of a major academic department in hard hit New York City, called upon familiar leadership skills and applied them directly to combatting the challenges her department faced. She points to

AEM Education and Training COVID-19 Perspectives Series


additional challenges for residency match and graduation. Shamapant describes the ambiguity of his current role and details of the future yet notes that “Medical students share a sense of purpose and common struggle that is only more unifying in the face of this upheaval.”

“Factual news and information surrounding the 2020 SARS-CoV-2, COVID-19 pandemic is plentiful, but the perspectives of doctors on the front lines illuminate the impact of the disease. Confronting the same threat, this “Perspectives” series reveals the motivations, inner fears, and insights across the spectrum of academic emergency medicine physicians including a medical student, resident, faculty educator, chair, and emeritus faculty. While the individual challenges may appear to be very different, there is a consistency in the underlying message, one that underscores the unrelenting commitment of emergency physicians to serve their communities, innovate, and support one another.” —Wendy Coates, MD, Interim Editor-in-Chief, AEM Education and Training COVID-19: A NYC Department Chair’s Perspective COVID-19: A Medical Student’s Perspective COVID-19: A Faculty Educator’s Perspective COVID-19: An Emeritus Faculty’s Perspective COVID-19: A Resident's Perspective The above articles appear in the online, early view version of Academic Emergency Medicine Education and Training (AEM E&T) journal and will be included in the July issue of AEM E&T. the value of interpersonal relationships across the entire spectrum of the pandemic, and hopes “…that we continue these acts of kindness and collaboration not only during this prolonged crisis, but also after.” The perspective of an emeritus faculty member who has traversed all of the career stages included in this series, advises us that academic EM is a series of transitions. Hockberger shares that “…the most important lesson I’ve learned is that we are ultimately defined more by how we manage those transitions, and how we treat the people we meet along the way, than we are by the professional accomplishments that bring us recognition and awards.” Although each of the authors whose perspectives are featured in this series

are at vastly different stages of their academic EM journey, all emphasize that it is through interpersonal connections that they are surviving and growing during this pandemic. Creativity and collaboration at each stage inspire systemic success. The specialty of EM has what it takes: Anyone, Anything, Anytime.

ABOUT THE AUTHOR Dr. Wendy Coates is the Interim Editor-in-Chief of Academic Emergency Medicine Education and Training (AEM E&T). She also serves as a member of the Society for Academic Emergency Medicine Board of Directors.


ADMINISTRATIVE FELLOWSHIP Member Profile: Dr. Vanna Albert, Administrative Fellow What advice would you give to someone who is on the fence about doing an administrative fellowship?

When deciding whether or not to do an administrative fellowship, I took the time to reflect upon what my priorities were. One of the things that pushed more towards an administrative fellowship was the opportunity to pursue an MBA and incorporate the tools from an MBA into emergency medicine administration. I was also drawn by the idea of having a mentor as I embark upon a career in administration. Additionally, the fellowship was also a way for me to get an idea of what a career would look for administration in academics versus the community.

What was the most career-enhancing, or eyeopening thing, you gained from the fellowship?


The fellowship allowed me to merge the ideas behind an MBA with real work application in the emergency department. I learned that the key to being a good administrator is being a good clinician and listening to your patients as well as your staff and colleagues.


Vanna Albert, MD, Administrative Fellowship University of Massachusetts Medical School-Baystate Medical Center

Search for SAEM-approved fellowships in the Fellowship Directory to find programs that meet the highest standards of training in your subspecialty. View the criteria for SAEM-approval of fellowship programs at

Who is an educational fellowship best suited for?

An educational fellowship is best suited for someone who wants to explore opportunities in a specific niche in emergency medicine. A fellowship is also a useful way of obtaining mentorship and cementing your interests in academic or community emergency medicine.

own mental and emotional health with regards to secondary traumatic stress we may incur on a daily basis.



Sex and Gender as They Relate to Schizophrenia r. Dany Accilien is a PGY2 D and rising chief resident for the 2020-21 academic year at the University of Chicago.

By Megan Heeney, Mayo Clinic Alix School of Medicine, MD candidate 2020, on behalf of the SAEM Sex and Gender in Dr. Arthur Pope is a PGY2 and Emergency Medicine Interest Group rising chief resident for the

Schizophrenia is a academic heterogeneous disease 2020-21 year at and there isthean increasing body of research University of Chicago. He evaluating the biological plansimpact to pursueof a fellowship in sex and psychosocial gender on this disease medical education. process. Patients living with schizophrenia are often suffering from comorbid conditions. Enhancing our knowledge about sex and gender as it relates to schizophrenia may allow emergency medicine (EM) practitioners to provide better, personalized care for these patients presenting to the emergency department (ED).

What do we know?

• US data demonstrates that there are approximately 382,000 ED visits annually related to schizophrenia in adults (18-64 years-old). ED visit rates for men with schizophrenia were nearly double the rates for women. • Females are more likely to have affective symptoms; males are more likely to have negative symptoms, co-morbid substance abuse, and social functioning issues. • Age of disease onset differs between men and women, with men on average being diagnosed in their early 20s and women in their early 30s. • Potential life lost for individuals with schizophrenia by all causes of death is 28.5 years. Standardized mortality ratios were higher for women than men. Women with schizophrenia spectrum disease were at increased risk for natural and unnatural death including risk of cardiovascular disease, COPD, cancers and homicide. • Pharmacologic research demonstrates that women are more likely to have burdening side effects from antipsychotics; further studies are needed to determine cause. Ongoing research is studying the linkage of estrogen to improved symptoms. Post-menopausal women in particular may benefit from antipsychotic medication adjustments. • Females with schizophrenia who are treated with anti-psychotics are more likely to have prolonged QTc intervals in comparison to males on anti-psychotics.

What can you do?

We can work to improve health equity by assuring that we provide specialized, thoughtful care to our patients who are dealing with schizophrenia spectrum illnesses. Compassionate care includes expanding our knowledge of the unique aspects that gender and sex contribute to the presentation of Schizophrenia especially in crisis situations. This includes adding biological sex and gender identity in research designs.

SGEM "Did You Know?" is a recurring SAEM Pulse submission designed to represent concise facts that demonstrate how patient sex and gender effect emergency care. We welcome submissions. Please send contributions to the co-editors Lauren Walter and Alyson J. McGregor at


ACADEMIC EMERGENCY MEDICINE A Year in Review: Resident Editors, AEM Editorial Board The resident-in-training (“resident”) appointment to the Editorial Board of Academic Emergency Medicine (AEM) is intended to introduce residents to the process of peer review, editing, and publishing of medical research manuscripts. The appointment provides the selected resident(s) with an experience that will enhance his/her career in emergency medicine and in scientific publication. Below, the 2019-2020 AEM Resident Editors reflect on their experiences serving on the AEM Editorial Board.

Diane Kuhn, MD

Joshua Lupton, MD, MPH

University of Maryland School of Medicine 2019–2020 AEM Resident Editor

Oregon Health & Science University 2019–2020 AEM Resident Editor

When I initially saw the posting for the Academic Emergency Medicine resident editor position, it struck me that I knew almost nothing about the peer review process itself. For me, the position offered both the potential to work with leaders in the emergency medicine field and also the opportunity to trial an academic position. Although I learned valuable lessons about the art of peer review and editing this year, perhaps the most unexpected lesson was one that working parents before me already knew: raising a toddler has a negative effect on academic productivity. Thyroid storm medications to the tune of Baby Shark? Done. Daycare closed for a pandemic? I guess my 28-hour call can segue into a day of farm animal noises. Just don't blame me if the pig stops oinking and starts snoring.


While the challenges of work-life balance are not new, COVID-19 has thrust them into the spotlight. All parents face these issues, but historically, women have borne more of the burden. In the era of COVID-19, the increased domestic workload of homeschooling and absence of help from services such as house cleaning has disproportionately affected women. Among the consequences, journal submissions by women academics have decreased significantly relative to those by men. (Nature, Inside Higher Ed)


Being a physician and a mother has made me realize the urgency of achieving gender equity both professionally and domestically. Being a resident editor confirmed that academic emergency medicine is both the right pathway for me and a profession that, like many others, suffers from gender inequities. The world we live in has changed dramatically over the past few months. Once a sense of normalcy is restored, we have an obligation to address the inequities and social shortcomings that the pandemic has highlighted. After all, while the burdens have been unevenly shared, the responsibility for addressing them belongs to us all.

“Your PDF has been built and requires approval,” the email read, and I was nearly finished with submitting my research article and culminating months of coordination and work. I knew next would come, hopefully, responses from reviewers, more revisions, and ultimately an acceptance for publication. This past year I was able to see what went on behind the curtains as I had the pleasure of serving as one of the resident editors for Academic Emergency Medicine (AEM) journal. This experience allowed me to see the many hats we all must wear in academic medicine as authors, reviewers, and editors. As a reviewer, I was both a gatekeeper and, at times, cheerleader for the many articles I read. Although not all manuscripts submitted to AEM warrant publication, because they are not the right fit for AEM’s readership, each deserve specific feedback to improve the work and encouragement for the authors to move forward. As a resident editor, I was able to see the balance between sending too many papers for review versus feeling like you are rejecting too many manuscripts outright. I found that balance also occurred when correlating feedback from the different reviewers to give to the author — a much more active process for an editor than I had previously appreciated. Finally, as an author submitting to Academic Emergency Medicine, I was able to be on the other end of the process from start to finish. I was particularly impressed with how hard AEM tries to promote an author's work within its journal through visual abstracts, podcasts, and editorials, to name a few strategies. Overall this year has been a fantastic experience and one any young emergency medicine resident interested in an academic career should pursue. I thank all of the authors of the great papers I reviewed and for which I served as an editor. Thanks also to the hard working AEM editorial board for this experience.

For more information about the AEM Resident Editor Program, contact Mark B. Mycyk, MD, director of the Resident Member of the Editorial Board Program, at or

AEM EDUCATION AND TRAINING AEM E&T’s First Fellow Editor-inTraining Shares Her Experience The Academic Emergency Medicine Education and Training (AEM E&T) Fellow Editor-in-Training Program is intended to mentor a medical education fellow in the process of peer review, editing, and publishing of education research manuscripts. The appointment provides the selected fellow with an experience that will enhance his/her career in emergency medicine and in peer review publication. Below, the 2019–2020 AEM E&T fellow editor reflects on her experience serving on the AEM E&T Editorial Board.

Jessica Fujimoto, MD Chief Resident, Department of Emergency Medicine Temple University Hospital 2019–2020 Fellows Editor We are incredibly fortunate to belong to a medical specialty that is at the forefront of medical education. Indeed, few specialties have their own medical education journal, and few journals have programs to instruct trainees in the peer review process. Thus, I feel honored to have served as the first Academic Emergency Medicine Education and Training (AEM E&T) fellow editor-in-training. In this role, I had the privilege of serving on the editorial board of our specialty’s only education-focused journal. In this unique position, I helped contribute to the growing body of medical education literature by writing and reviewing manuscripts with mentorship from decision editors. This experience helped me to refine my writing style and structure my process for appraising literature. I also had the opportunity to explore the intersection of novel and traditional methods of dissemination by interviewing publication authors for the AEM E&T podcast series. I have appreciated the opportunity to work with and learn from leaders in the field. The ability to work alongside the editorial board, discussing current topics in emergency medicine education, was valuable and instructive. I am especially grateful for the mentorship of Dr. Esther Chen, who has taught me so much over the past year. This was an incredible experience that allowed me to gain a deeper understanding of medical education scholarship during my medical education fellowship and affirmed my desire to stay in academic medicine. I highly recommend this program to any medical education fellow.

“We are incredibly fortunate to belong to a medical specialty that is at the forefront of medical education. Indeed, few specialties have their own medical education journal, and few journals have programs to instruct trainees in the peer review process.”

For information about the AEM E&T Fellow-in-Training program, contact the program’s director, Esther Chen at



The Emergency Physician’s Starter Guide to Climate Change Resources


By Caitlin Rublee, MD, MPH and Katelyn Moretti, MD on behalf of SAEM’s Climate Change and Health Interest Group


Climate change is harming our patients. Emergency departments and acute care services are, and will continue to be, at the front lines of treating illnesses related to acute and chronic climate stressors. According to the Centers for Disease Control and Prevention, health effects from rising temperatures, extreme weather events, rising sea levels, and increased atmospheric carbon dioxide will continue to accumulate. From direct trauma, mental health effects, and changing infectious disease burdens, it is clear that the consequences are geographically diverse and widespread — a public health problem requiring us to enact change. For the emergency medicine physician, an effective response lies in preparedness and in supporting community resilience.

I this article the authors share insights with health professionals new to this concept and link the intersection of climate change and emergency medicine with key resources and opportunities for professional engagement.

Key Resources Climate Science and Health Intersect

The Intergovernmental Panel on Climate Change (IPCC), scientific societies, government agencies, and organizations have robust evidence that greenhouse gas emissions are rising due to human activity, contributing to increased climate variability impacting health. The IPCC shares past, present, and future climate scenarios based on leading evidence.

The Synthesis Report (SYR) of the IPCC Fifth Assessment Report (AR5) The Impacts of Climate Change on Human Health in the United States: A Scientific Assessment

Extreme Weather Events are Intensifying and Increasing in Frequency

Extreme heat, wildfires, floods, droughts, and hurricanes directly and indirectly threaten health and amplify conditions where health care facilities suffer care disruptions and in severe cases, evacuations. Pharmacy closures impact outpatient medication availability, blocked transportation routes halt ambulances, facility damage ceases supply chain production, and power outages ruin temperature-sensitive

“Extreme heat, wildfires, floods, droughts, and hurricanes directly and indirectly threaten health and amplify conditions where health care facilities suffer care disruptions and in severe cases, evacuations.� medication or vaccination stores. The events ultimately influence health care utilization and access for patients. Safe Haven in the Storm: Protecting Lives and Margins with Climate-Smart Health Care

More Acute on Chronic Disease Exacerbations

Climate change contributes to acute exacerbations of chronic diseases. Ground ozone and particulate matter are linked to asthma exacerbations and premature deaths. Heavy rain, rising pollen counts, and longer seasons worsen allergies. Wildfire smoke exposure influences cardiovascular and pulmonary

morbidity and mortality. Extreme heat increases heat-related illnesses as well as risk of cardiovascular, renal, and respiratory diseases. Droughts are linked to dust storms, worsening underlying pulmonary diseases. Fourth National Climate Assessment

Changing Infectious Disease Burdens

Climate change lengthens the seasonal viability of disease vectors (ticks and mosquitoes) and thus, the length of time they may transmit disease throughout the year. Warming temperatures and changing ecosystems affect the geographic distribution of disease spread.

Vector-borne diseases such as West Nile Virus, Lyme, dengue, chikungunya, and Zika are thriving in increasingly northern latitudes, potentiated by climateenergized heavy downpour events, which promote vector breeding through flooding and areas of standing water. Ease of human mobility, sociopolitical disruptions, and animal/human interactions increase concerns for transmission further. The 2018 Report of the Lancet Countdown on Health and Climate Change: Shaping the Health of Nations for Centuries to Come

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CLIMATE continued from Page 33


Disproportionate Effects on Vulnerable Populations


While climate change affects us all, social and environmental determinants of health influence specific populations differently: low-income households, older adults, minorities or those with disabilities. As examples, it is often easier for healthy individuals to recover from smoke inhalation than older individuals with comorbidities and for high-income earners to rebuild following a flood compared with low-income families. In Hurricane Katrina, those who died in New Orleans were up to four times more likely to be black, and 50 percent were 75 years or older. At baseline, vulnerable populations tend to live in areas with greater urban heat islands (large areas of asphalt and concrete which result in higher surface temperatures), lower resources to manage extreme heat, and reduced access to health services. They have higher rates of baseline chronic diseases making the added stress of climate change more difficult from which to recover. Hurricane Katrina Deaths, Louisiana, 2005 Future Heat Events and Social Vulnerability

“Recognizing our role in contributing to climate change is the first step to be able to enact change and abide by the Hippocratic Oath, “first, do no harm”.” Health Sector Waste Contributes to Greenhouse Gas Emissions

Opportunities for Climate Action

We too are part of the problem. The health care industry contributes approximately 10 percent of all greenhouse gas emissions in the United States. U.S. health care is one of the worst emitters in the world, with the health sector footprint equivalent to 141 coal-fired power plants operating for a year. Recognizing our role in contributing to climate change is the first step to be able to enact change and abide by the Hippocratic Oath, “first, do no harm.”

Organizational Involvement

Health Care Climate Footprint Report

Curriculum Integration

Environmental Impacts of the U.S. Health Care System and Effects on Public Health

Health Care Without Harm and Practice Greenhealth, Physicians for Social Responsibility, and the Medical Society Consortium on Climate and Health are organizations offering opportunities for health professionals to engage in education and advocacy. The Society of Academic Emergency Medicine (SAEM) also has a Climate Change and Health Interest Group. The Medical Society Consortium on Climate and Health The American Medical Association adopted a policy in 2019 supporting physician education on climate change science, risks, and health impacts. The

Global Consortium on Climate and Health Education was launched to prepare health professionals in informing and acting on climate change. Students are increasingly calling for formal and informal curriculum and action.

opportunities to mitigate, adapt, and build resilience across the U.S.

Global Consortium on Climate and Health Education

Emergency physicians cannot avoid the perturbations of a changing climate. They will be called upon to lead during acute disasters just as they lead in a resuscitation bay. Whether it be through involvement in emergency medical systems, critical care, operations, global health, policy or education, emergency medicine physicians will continually be impacted. We will be challenged to communicate and collaborate across disciplines, to implement solutions that benefit the health of patients and each other.

National Institute of Environmental Health Sciences Literature Portal

Creating Climate-smart Emergency Departments

A recent article provides guidance on how to clean up our own specialty’s climate footprint. Strategies are outlined for addressing waste that include analyzing current waste streams, evaluating the environmental impact of purchasing decisions, and encouraging sustainable food purchasing. It also discusses changes hospitals can make to promote energy efficiency and reduce transportation. The Climate-Smart Emergency Department: A Primer


There is overall a paucity of health professional engagement with political leaders on climate and health. Emergency care professionals have the communication skills and clinical narratives that can amplify the voices of patients and advocate for health equity. An annual policy brief addresses these

2019 Lancet Countdown on Health and Climate Change: Policy Brief for the U.S.


As one final resource, we share a piece in the New England Journal of Medicine from Dr. Renee Salas highlighting The Climate Crisis and Clinical Practice: The Climate Crisis and Clinical Practice Climate change can feel overwhelming, and we are tempted to look the other way—to think that this is a problem for tomorrow, not today. We hope these resources serve as a guide to act. As emergency medicine physicians, we are in a unique position to educate, advocate, and implement changes that advance climate justice and protect our communities. If not us, then who?

ABOUT THE AUTHORS Dr. Caitlin Rublee is the 20192020 Living Closer Foundation Climate and Health Science Policy Fellow, a clinical instructor of emergency medicine at the University of Colorado, and soon-to-be assistant professor of emergency medicine at the Medical College of Wisconsin in Milwaukee. Dr. Rublee has collaborated with professional societies, government agencies, and non-governmental organizations to address climate change impacts on health. She is vice chair of the SAEM Climate Change and Health Interest Group. Dr. Katelyn Moretti is an assistant professor of emergency medicine at The Miriam Hospital in Rhode Island and a global emergency medicine fellow through the Department of Emergency Medicine at Brown University. She is currently pursuing a Masters in Clinical and Translation Research at Brown. Dr. Moretti founded, and currently co-chairs the Rhode Island American College of Emergency Physicians Climate Change and Health Committee and is chair of the advocacy and education group within the SAEM Climate Change and Health Interest Group.





Trauma Informed Care: Two Programs and the Pivotal Role They Play on Chicago's South Side By Dany Accilien MD and Arthur Pope MD, PhD on behalf of the SAEM Academy of Diversity and Inclusion in Emergency Medicine “A seventeen-year-old male is coming in for multiple lower extremity GSWs, ETA three minutes.” The trauma team prepares the resuscitation bay per protocol in anticipation of possible interventions. The room is silent. They’re here. We quickly get the report from emergency medical services and continue running advanced trauma life support. We instruct the patient to follow certain commands, trying to uncover “what’s wrong” and what we can acutely fix. He’s angry, scared, combative, and asking for family. We talk to him and administer pain medications to help him calm down so that we may safely continue our assessment. Imaging is negative for any acute injuries. We provide crutches and he gets a script

for pain medications and is discharged home. Though this ends the care in the hospital, the long-term effects for this patient last well beyond this traumatic experience. This scenario is common at trauma centers across the country. In the Chicago South Side region, more than 90 percent of individuals have experienced trauma in some manner, with 60 percent experiencing trauma by age six. Over the last decade there has been a shift towards trauma informed care (TIC) when treating these individuals who are among our most vulnerable patients. The idea of TIC is to shift our thinking from how we can “fix” a medical issue to understanding the systemic injustice that leads to this point. TIC focuses on the

physical, psychological, and emotional aspects of care for both the providers and survivors of trauma, in order to provide a sense of empowerment amid traumatic experiences. Creating a culture that abides by this TIC way of thinking requires a paradigm shift and dedication to treating trauma as a disease. In 1988, the University of Chicago closed its adult trauma center, leaving the community without immediate access to trauma care. The death of an eighteen-year-old South Side activist Damian Turner ignited the movement that eventually led to the reopening of the trauma center — this time with

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DIVERSITY continued from Page 37


a commitment to TIC. The focus was placed on creating a structure that emphasized having a greater connection not only to the patient but also the surrounding community, as trauma not only impacts the individual but the community as a whole.


Within that framework two vital programs, among several, were created to provide guidance in and out of our institution: Chaplain Service and Violence Recovery Program (VRP). We reached out to these services to hear about the pivotal roles they play in providing TIC and how we can best utilize their services for our patients and to assist us in coping with our own trauma.

Julian Bond

Emergency Room Trauma Chaplain How would you define traumainformed care?

“A holistic approach that is unique in each case. It involves all employees that work in the ED.”

What recommendations do you have for residents on how to deal with difficulties that may come with experiencing trauma within the workspace?

“It is important to talk and have a psychologist and spiritual care provider that can probe your brain. Having a chaplain be present when delivering news to family can assist and improve bedside manners as you learn to improve talking paths that are diverse and respective of persons, culture, and/ or creed.”

What systemic implementations would support trauma-informed care within the hospital? “Better training for staff and security in their response to grieving persons. Anxiety vignettes could be helpful in huddles.”

The Violence Recovery Program at the University of Chicago was designed in partnership with the local community prior to reopening of the trauma center. As a hospital-based recovery program,

it focuses on a comprehensive recovery from trauma, including an emotional and mental perspective. A key part of the program is that it consists of individuals from the community it serves who have a better pulse on what is going on in the community.

Dwayne Johnson

Lead Recovery Specialist How would you define traumainformed care? “Trauma informed care is the way in which we care for and understand individuals and families that have been affected by trauma. The key components to trauma informed care are having knowledge of the different symptoms and behaviors that present when an individual has been traumatized. It involves knowing how it affects individuals physiologically and working from a place of empathy and compassion.”

What benefits towards traumainformed care does your role provide? We approach trauma holistically and with consideration of how to best

“The idea of TIC is to shift our thinking from how we can ‘fix’ a medical issue to understanding the systemic injustice that leads to this point.” interact with individuals that have experienced trauma using evidencebased, best practices. In doing so, we realize someone has been traumatized and the impact that it may have on an individual. We respond appropriately with compassion and empathy that are implemented into our policies and practices in our institutions, and we actively seek to resist re-traumatization. I believe the most important benefits would be the positive responses from the patients and families we serve. We have the ability to not take their behaviors and symptoms personally or as a form of disrespect, understanding it as stress responses to trauma. This in turn enables me to operate from a place of empathy and compassion in a way that I was not able to before I became trauma informed. This approach allows me to have a more productive interaction with the individuals we serve. It also helps me to manage my emotions and the vicarious trauma that I experience, thus allowing me to better serve and provide self-care for myself.”

What systemic implementations would support trauma-informed care within the hospital and/or community?

I would love to see each and every employee within the institution trained in trauma informed care. In addition to this, it would be great if the cultural competency course was mandatory institution-wide, just as the annual training for HIPPA, infection control, and other protocols are. Lastly, we need to be very intentional about educating the community on trauma informed care through educational outreach initiatives as well as being intentional about ensuring community partners are not only trauma informed but also culturally competent to

develop a trauma informed eco-system within the community.”

What recommendations do you have for residents on how to deal with difficulties that may come with experiencing trauma within the workspace?

“I recommend implementing an educational component for trauma informed care and a cultural competence course to address assumptions and bias that may rise to the surface while working with the most vulnerable populations. Particularly, when we think about institutional, systemic and structural racism/oppression. This is a very uncomfortable yet necessary topic for all.” Trauma informed care involves making a commitment to a journey. As emergency physicians, we have a unique perspective into the lives of our most underserved population when they are most vulnerable. While implementing or enhancing TIC within your institution will likely be a long

and arduous process, remember that it involves not only better care for the patients we serve, but also creates an environment to better our own mental and emotional health with regards to secondary traumatic stress we may incur on a daily basis.

ABOUT THE AUTHORS r. Dany Accilien is a PGY2 D and rising chief resident for the 2020-21 academic year at the University of Chicago.

Dr. Arthur Pope is a PGY2 and rising chief resident for the 2020-21 academic year at the University of Chicago. He plans to pursue a fellowship in medical education.

About ADIEM The Academy for Diversity & Inclusion in Emergency Medicine (ADIEM) works towards the realization of our common goals of diversifying the physician workforce at all levels, eliminating disparities in healthcare and outcomes, and insuring that all emergency physicians are delivering culturally competent care. Joining ADIEM is free! Just log into your member profile. Click “My Account” in the upper right navigation bar. Click the “Update (+/-) Academies and Interest Groups” button on the left side. Select the box next to the academy you wish to join. Click “save.”



An Ethical Justification for Teaching Physicians About Firearms


By Andrew Ketterer, MD, MA on behalf of the SAEM Ethics Committee


It’s a tragically familiar refrain: every day in the United States, about 72 people will die from injuries related to gun violence. These deaths take many forms, ranging from gang violence to suicide to a toddler’s finding and accidentally firing his parents’ handgun. Most of our attention gets drawn to the horrific paroxysms of violence we know as mass shootings, but it is worth remembering that the overwhelming majority of firearm deaths are on a smaller but no less tragic scale. Nor are we in the health care environment immune to gun violence. Emergency physicians (EPs) everywhere know the toll taken by firearms, as we regularly take care of the aftermath of gun violence. Gun violence even occasionally makes its way into the hospital itself: in 2015, my own town of Boston saw the death of a cardiac surgeon at the hands of a patient’s

family member who then took his own life. When I was in residency in Chicago, a patient at a hospital in the suburbs stole a gun from a prison guard and terrorized hospital staff until he was eventually killed in a shootout with the police. Despite this, evidence suggests that we in the medical community lack familiarity with firearms. In a recent national survey of community and academic EPs, my colleagues and I found that although firearm ownership among EPs roughly tracks with community ownership rates, these providers are far outnumbered by their colleagues who do not own guns. Only a small minority of EPs reported ever having formal training in safely handling firearms, despite the fact that more than 50 percent nationwide reported encountering guns in the emergency department at least once a year.

Statistics like this suggest that EPs, and likely physicians as a whole, might benefit from being trained to safely handle firearms. EPs in particular bear the risk of encountering guns while at work in the emergency department, where over one-third of hospital-based shootings have occurred. An obvious occupational hazard may be handling a firearm found on a patient’s person during the course of duty: how sure are you that you can remove it safely without accidentally firing it? Although many hospitals have protocols dictating that security be called to remove the firearm, it may not be practical to wait for them if, for example, you are trying to run a trauma resuscitation when you come across the weapon. Additionally, my colleagues and I found that only a small minority of emergency providers were aware of a specific hospital protocol regarding firearms in the clinical

“Emergency physicians in particular bear the risk of encountering guns while at work in the emergency department, where over one-third of hospital-based shootings have occurred.� environment. In other words, we are unlikely to know what to do with a firearm if we find it, or even if our institutions have a recommended approach to the problem. At the same time, given the aforementioned societal havoc wrought by gun violence, some physicians may have strong moral feelings against handling firearms at all. These concerns may extend to physician education: firearms education for providers might be interpreted as a tacit approval of attitudes espoused by advocacy organizations like the National Rifle Association (NRA), and some of these attitudes may not be compatible with the medical code of ethics to which we subscribe. Additionally, it might be argued that while patient values and cultural mores must be respected as a general rule, so must those of physicians who find it ethically problematic to personally engage with firearms. Such an attitude might run into legal difficulties on a policy level, as similar arguments could be made in support of physician refusal to provide other forms of care such as birth control; however, these concerns highlight the inappropriateness of the other extreme, namely mandating

hands-on firearm safety training for all providers. EPs also need to learn about firearms so that they can provide necessary care to their patients. EPs are the frontline providers for victims of firearm injury, to say nothing of our role in caring for at-risk patients such as those exhibiting suicidality. As such we have the opportunity intervene at a crucial point in our patients’ lives and may thereby prevent future morbidity and mortality. Unfortunately, we know that patients are reticent to turn to physicians as sources of information regarding firearms safety. Multiple studies have shown that patients do not think of physicians as reliable in this regard. Physicians, too, are often reticent to initiate conversations about firearms. Although not much has been published that is specific to EPs, pediatricians and psychiatrists cite a lack of personal knowledge as being a major barrier to counseling patients on firearm injury prevention. There is no reason to think EPs are different. Taking all of this together, EPs would likely benefit from a clear understanding of firearm safety. This may include the

basics of safely handling a gun, available gun safety equipment such as trigger locks, and the legalities of removing firearms from at-risk patients such as those endorsing homicidal or suicidal ideation. The means by which such information is taught will likely differ among institutions based on local rules and regulations. Ultimately, however, EPs are responsible for anyone who walks through the door, whether it is a teenager with depression whose parents are gun owners or a victim of firearm injury who happens to have a gun on his person. Learning more about ways to decrease the risk for future firearm injury and death is right thing to do for our patients and ourselves.

ABOUT THE AUTHOR Dr. Andrew Ketterer is an instructor of emergency medicine at Harvard Medical School and assistant program director for the Beth Israel Deaconess Medical Center (BIDMC) Harvard-Affiliated Emergency Medicine Residency. He serves on the ethics committees for BIDMC and SAEM.



Developing a Framework to Promote Academic Emergency Physician Wellbeing From a Systems Perspective


By Leon D. Sanchez MD, MPH and Al’ai Alvarez MD on behalf of the SAEM Wellness Committee


The COVID-19 pandemic has significantly increased the amount of administrative and clinical work for academic emergency physicians. At the same time, the personal risk of clinical work has changed the way we practice and how we live our lives outside of work. While our experiences vary based on our location (with places like New York City experiencing volumes and acuity that were unimaginable six months ago), the new normal for all of us is very different than prior to the pandemic. There are daily concerns about exposure, extra steps and cognitive work required to maintain appropriate PPE, added difficulty and discomfort of having to constantly wear

PPE, concerns about limited resources — all of which have had an impact on patient care and personal safety and have made the clinical practice of emergency medicine (EM) much more challenging and stressful. EM physicians in New York City are experiencing a new reality that many of us living and working in other areas of the country cannot begin to imagine. Yet even beyond the boundaries of the hardest hit areas, the pandemic has had a profound effect on our lives at work and at home. In addition to seeing COVID patients, many of us have colleagues who have been hospitalized or died because of the COVID-19 virus.

Some of our resident trainees have been furloughed from new jobs or have even had job offers rescinded. And due to significantly decreased ED volumes and the cancellation of elective surgery cases, many hospitals are considering salary reductions. As EM physicians, we always strive to do our best. As demands have increased due to COVID, we’ve put our heads down and got the job done — but at what cost? With no expectation that the pandemic will be over any time soon, focusing on physician wellbeing and workplace safety are more important now than ever before.

“How we address quality and peer review and creating psychological safety and Safety-II debriefing are key not only to improving patient care, but to promoting physician well-being. In addition, we must learn to compensate for academic performance just as we incentivize clinical performance.� The SAEM Wellness Committee is developing a knowledge hub that will serve as a repository of resources that address several of the challenges that affect academic EM physicians all the time, but especially during the COVID pandemic. The hub will include best practices and research that addresses clinical and academic performance metrics, shift scheduling and total work hours, the work environment, the teaching and learning environment, and individual needs such as nutrition and sleep. How we address quality and peer review and creating psychological safety and Safety-II debriefing are key not only to improving patient care, but to promoting physician well-being. In addition, we must learn to compensate for academic performance just as we incentivize clinical performance. Another key aspect of a developing a system-driven framework is creating a culture that optimizes scheduling and values time dedicated to other aspects of academic EM. The idea of a 40-hour work week does not actually exist since, in addition to clinical workload, there are several administrative and academic

duties that encroach on our home lives. Optimizing the clinical work environment also has significant downstream effects on stress levels and the amount of work time spent at home. These challenges include inefficient charting, complex admissions processes, and patient boarding. Beyond clinical shifts, we must also optimize the path for scholarly productivity in teaching and in research. How we handle stress is also important, including learning resilience strategies and developing healthy habits of sleep and balanced nutrition. Our goal is for the knowledge hub to contain information and references on current research and best practices around a variety of topics, including the above, which are relevant to academic EM physician well-being and professional fulfillment. Now more than ever, we must advocate for structural changes that promote wellness at both the local institutional level and at the national level. The SAEM Wellness Committee is taking the lead in providing access to available resources and research. This will also have a significant impact on highlighting areas where we need further research

and/or innovation. The knowledge hub is one step on the road to achieving this goal. We welcome your ideas and feedback as we work towards developing this valuable resource for SAEM members. View the Systems Framework to Promote Academic Emergency Physician Well-being here.

ABOUT THE AUTHORS Dr. Leon D. Sanchez is associate professor of emergency medicine, Harvard Medical School Department of Emergency Medicine/Beth Israel Deaconess Medical Center, Boston, MA Al’ai Alvarez, MD is assistant residency program director and clinical assistant professor, Department of Emergency Medicine, Stanford University School of Medicine, Stanford, CA @alvarezzzy



Gender and Delegating in the Emergency Department


By Anita Chary MD, PhD


When I was a junior resident, a male attending told me during post-shift feedback that he noticed I did a lot of my own work. He saw me getting repeat vital signs on patients, fetching them water and blankets, gathering supplies to perform simple procedures like laceration repairs, and delivering transferred patients’ imaging discs to radiology. He told me that delegating these tasks to technicians, coordinators, and nurses would be crucial in transitioning to a senior resident and attending. I appreciated the advice: with increasing patient volume, it wouldn’t be efficient or feasible to perform every task, clinical or non-clinical, for every patient. However, in my experience up to that point, requesting help from staff in the department usually led to

responses directing me to do the tasks myself. As an emergency physician in training, I rotate across four hospitals, each of which has variable availability of support personnel and distinct expectations of what is within the purview of each staff member in the emergency department. Even across these practice settings, my experience as a junior resident was the same. Despite my strategic and polite requests for help from staff who seemed otherwise unoccupied, they often deflected. Quickly, I stopped asking for help and found it faster and easier on my relationships to accomplish tasks on my own. Although I observed that male attendings’ requests were often honored, I initially assumed the differential responses were due to my position as a junior trainee: I was a new

face and a fledgling doctor—what could I expect? When I turned to female co-residents, both within my residency program and at others, however, our collective experiences suggested gender influenced our abilities to delegate. Some shared their experiences of witnessing emergency department (ED) staff supporting male co-residents and consultants with tasks, without being asked; for example, bringing gauze and saline to the bedside for a bleeding patient, or prepping and positioning a patient for a procedure with lidocaine at the ready. We all noted that as female physicians, we had learned to minimize our requests for help, and when we did dare ask for assistance with tasks, we couched our questions in apologetic language: “I’m so sorry to bother you.”

Or we qualified our requests: “…if you’re not too busy with something else.” My female co-residents had received the same feedback about delegating from male attendings, and similarly felt the advice was impractical, so I turned to female physician mentors for advice. Here is how they responded.

Why does it seem harder for female physicians to delegate tasks in emergency medicine? Dr. Regan Marsh, Brigham and Women’s Hospital: “I highly recommend the FemInEM talk by Nick Gorton, a transgender man who Regan Marsh practiced emergency medicine as both a woman and now as a man. He described it as switching a video game from the ‘hard’ to the ‘easy’ setting. For me, the most provocative and important part is around 6:00 minute mark in the video where he talks about societal traits traditionally associated with men and women (achievement

vs. communal oriented), and how concordance/discordance with these expectations often results in women physicians being perceived as ‘bitches’ and kind men end up as saints.” Dr. Onyekachi Otugo, Brigham and Women’s Hospital: “Delegation is something that is expected from our male colleagues and Onyekachi Otugo is often questioned when coming from women. However, it is often difficult for women to often delegate because we are worried about how we may be perceived by others— whether we will be seen as unfriendly, overly aggressive, or whether our orders will be questioned. Regardless of how uncomfortable these situations might make us feel or how we will be perceived, delegation allows for efficiency and ensures that our patients are receiving the best care possible. “In addition to delegation, it is often essential to know when to step in. For

example, in a situation where there is a critical patient that needs bloodwork and has had multiple failed IV attempts, instead of waiting to be asked to assist in obtaining access, a critical step is taking the initiative to grab an ultrasound and place the IV. This requires situational awareness—stepping in without being asked. Situational awareness is just as essential as being able to delegate.”

How do you navigate the dynamics of asking for help with simple but time-consuming tasks? Dr. Onyinyechi Eke, Massachusetts General Hospital: “I trained at a county program where you had to do things yourself — wheeling Onyinyechi Eke patients to x-ray, getting patients supplies, blankets, and sandwiches, and many times even

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GENDER continued from Page 45


discharging the patient — removing the IVs and so on. I had to learn names and be respectful. At Cook County, most of the nurses and technicians looked like me and were minorities. A number of them even spoke my ethnic language. With limited resources and high patient ratios, I knew they were busy and overwhelmed. As I progressed through residency, those nurses and techs became my lifeline during acute/trauma cases and gave me a break during simple cases. “Now in a new environment, as a new attending, most of the nurses look very different from me and have different life experiences. I have also found it important to learn names, be respectful and additionally, be firm. Do I notice that sometimes male colleagues get things done for them faster? I do. Are there multiple factors at play? Of course. Even

so, I trained well and relationships take time to grow/change.” Dr. Susan Wilcox, Massachusetts General Hospital: “I frequently do many of these things myself as well! I cannot remember ever Susan Wilcox asking a technician or nurse to gather supplies for me. Ever. In fact, I can recall numerous times when I have asked for help with issues that fall strongly within their purview, not mine, and still being told to do it myself. I too find it to be a pleasant surprise when someone volunteers to help — and I’m a PGY 17. The way I’ve navigated these dynamics is that... I don’t. I’ve decided that being liked by nurses and technicians gains me more long term than getting help in the short term. I think this highlights the chasm between our experiences, even

working in a couple of fairly enlightened departments.”

What are your strategies for successfully delegating? Dr. Kelli O’Laughlin, University of Washington: • “Learn names of medical assistants and nurses Kelli O’Laughlin

• Ask the right person to do the right thing. If you need a sandwich for a patient, try to ask the technician and not the nurse. • Sometimes, if I am sensing resistance, I give enough explanation to justify the mission, i.e.: ‘I need your help. I have a few competing demands right now, but our patient really needs us to address his nose bleed promptly. I need you to find the ENT cart and bring it to Room 10. Can you do that?’

“Despite my strategic and polite requests for help from staff who seemed otherwise unoccupied, they often deflected.” • If they cannot, ask them who they recommend you request help from — especially if one medical assistant is busy, which one is assigned to that pod? They often know better. • If the nurse cannot do an urgent task, I ask the charge nurse who is available to do it. This is more often needed for critically ill patients or if there is a delay to admit someone.” As I start my last year of residency, my own approach has become an amalgamation of the above. With more

clinical experience and longer-standing relationships, it has indeed become easier to delegate; yet my approach to delegation remains cautious. If I don’t feel strapped for time, I try to do everything myself. I limit my requests to moments of great need — typically with a critically ill patient. I continue to do my best to learn all my colleagues’ names. And I still personally get plenty of water and warm blankets for my patients. Delegation is a crucial skill in emergency medicine, even if we take different paths to get there based on our social identities. I am

always deeply appreciative of receiving help and will never take it for granted.

ABOUT THE AUTHOR Dr. Anita Chary, chief resident at the Harvard Affiliated Emergency Medicine Residency.




Promoting Gender Equity in Residency Training through Consensus Building


By Anita Chary MD, PhD, Laura Dean MD, Chris Nash MD, Adaira Landry MD, MEd, Eric Shappell, MD, MHPE


“Hi, I’m Dr. [Lastname]. I’ll be the doctor taking care of you today,” a female resident introduces herself to her patient. He responds: “Oh, hi, nurse, nice to meet you. Yeah, I just met Joe, the doctor,” referring to the attending physician, who introduced himself by his first name. “We’re going to need to do a transvenous pacer for the patient in room 15,” the attending announces. A female senior resident is eager to perform the procedure, but before she can express interest, a junior male resident has jumped up from his workstation and said, “I’d love to do it. I’ll grab the supplies now.” The attending responds: “Great!” The above incidents are common types of gendered interpersonal

interactions that affect female physician confidence and educational opportunities in residency. They reflect broader problems of gender discrimination that female residents face in emergency medicine training. Within our residency, we identified professional introductions and access to procedural opportunities as two areas of concern for female residents. A small working group (bylined above) led residency-wide discussions to develop consensus strategies to respond to these issues, with the goal of promoting a more equitable training environment. We took a multimodal approach to initiate conversations and distribute actionable interventions to residents and faculty. First, the residency hosted a journal club that addressed

gender disparities in EM residency evaluations.1,2 Subsequently, at our annual residency retreat, we led small groups in focusing on resident experiences with collaborative care team introductions and improving access to procedural opportunities. Discussions included framing the problems, sharing personal anecdotes, and identifying solutions. Through these events, our residency developed the following practices: • We modeled consistent use of “Dr. Last Name.” We have promoted this practice among those who feel comfortable sharing their last names with patients. (Importantly, some residents voiced a desire to go by a first name or a nickname due to ethnic/racial discrimination from patients when sharing their last name.)


THEME Improved Awareness of Gender Equity

Practice Change

REPRESENTATIVE QUOTES “I did not think much before [about introductions]. After, I realized that it is something that matters a lot to my female colleagues.” “I did not realize that female residents were offered less procedures.” “Hadn’t even considered it before retreat, but now have started introducing myself only as Dr. Last Name.” “I have changed my practice since, and I feel it makes a difference when my attending does the same.” “We need continued discussions about this.”

Need for Continued Discussion

Suggested Involvement of Non-Trainee Stakeholders

“I've been so grateful that these conversations are happening, both within HAEMR and at our teaching hospitals. There's a ton of work to be done…” “Educate the faculty. It's got to be a sea change across generations.” “Give training to the nurses and auxiliary staff and people in other departments outside of EM too who we have to interact with.”

This article was reprinted from the June 2020 issue of AWAEM Awareness, published by SAEM’s Academy of Women in Academic Emergency Medicine. REFERENCES 1. D ayal A, O’Connor DM, Qadri U, Arora VM. Comparison of Male vs Female Resident Milestone Evaluations by Faculty During Emergency Medicine Residency Training. JAMA Intern Med. 2017;177(5):651-657. doi:10.1001/jamainternmed.2016.9616 2. Mueller AS, Jenkins TM, Osborne M, Dayal A, O’Connor DM, Arora VM. Gender Differences in Attending Physicians’ Feedback to Residents: A Qualitative Analysis. J Grad Med Educ. 2017;9(5):577-585. doi:10.4300/JGME-D-17-00126.1

ABOUT THE AUTHOR Dr. Anita Chary, chief resident at the Harvard Affiliated Emergency Medicine Residency.


Introduced self as “Dr. Last name” prior to intervention


Introduced self as “Dr. Last name” after intervention


Reported session improved awareness of gender discrimination


• We encouraged residents to develop the practice of a personal “minitimeout” before volunteering to do a procedure. This involves taking stock of one’s own experience with a procedure, other residents in the department and assessing their interests, offering to walk another resident through a procedure with which one is already familiar, and prioritizing senior residents in performing rare procedures. Written summaries were shared with residents and faculty and reviewed at faculty meetings for both of our affiliated teaching institutions. Residents were then surveyed regarding the impact of these interventions (results in Tables 1 & 2).


The journal club had the highestever attendance, and the actionable practices for improved gender equity have been well-received. Sixty percent of surveyed residents reported introducing themselves as “First Name” prior to these conversations. On a follow-up survey

six weeks after the discussions, more than 80 percent reported introducing themselves as “Dr. Last Name.” The journal club and retreat working group were cited as key motivating factors for this change. Perceived differences in procedural opportunities have led us to study procedural distribution and access to procedural training by gender. Strong leadership support and protected time for small group conversation outside of the clinical environment added to this initiative’s value.

Next steps

Culture and practice change will depend on longitudinal engagement regarding these issues and regular reminders of consensus best practices. We hope to continue to emphasize gender equity in our didactic curriculum going forward. We have also received feedback from residents that they hope for increased faculty participation in sessions addressing gender equity.

Dr. Laura Dean, Harvard Affiliated Emergency Medicine Residency.

Dr. Chris Nash, Harvard Affiliated Emergency Medicine Residency.

Dr. Adaira Landry, assistant residency director, Harvard Affiliated Emergency Medicine Residency and Department of Emergency Medicine, Brigham and Women’s Hospital / Harvard Medical School r. Eric Shappell, assistant D director Harvard Affiliated Emergency Medicine Residency and assistant professor Department of Emergency Medicine, Massachusetts General Hospital / Harvard Medical School

About AWAEM The Academy for Women in Academic Emergency Medicine works to promote the recruitment, retention, advancement and leadership of women in academic emergency medicine. Joining AWAEM is free! Just log in to your member profile. Click “My Account” in the upper right navigation bar. Click the “Update (+/-) Academies and Interest Groups” button on the left side. Select the box next to the academy you wish to join. Click “save.”


The Leaders Library: A Professional Development Virtual Book Club for EM Educators and Leaders By Steven Polevoi MD, on behalf of the SAEM Education Committee The Leaders Library is a “closed, asynchronous, pop-up, virtual community discussion of mainstream books which have direct relevance to healthcare clinicians, educators, and leaders.� The series features a rotating group of internationally renowned facilitators discussing books with participants on the real-time messaging platform Slack. Launched in 2019 by ALiEM (Academic Life in Emergency Medicine), the series features a rotating group of internationally renowned facilitators and is led by Dr. Dina Wallin, assistant clinical professor of emergency


medicine and pediatrics at the University of California San Francisco. In addition to her role as the series editor, Dr. Wallin is also a co-member of the SAEM Education Committee, and a colleague of mine. Having served as both medical director and quality director in our department for many years I was intrigued by the series. Wanting to gain experience with Slack and curious about how the asynchronous process would work, I signed up for and was accepted to participate in the third installment of the series.

The book chosen for discussion was The Coffee Bean: A Simple Lesson to Create Positive Change, by Jon Gordon and Damon West. A Google review of the book indicated that it was a brief read and seemed to have a message that would lend itself to focused conversation with others. A primary theme of the book is stepping back and considering how we interact with the environment in which we live. In short, do we allow the environment to influence us in a negative way or do we harness our strengths and influence the environment for the good? Those of us who think

“What was most remarkable to me was the degree of comfort participants had in sharing intensely personal experiences as leaders in their respective systems.� about medical education realize how important this concept of critical reflection is to learning and growth. I read the book and then began a discussion with my family in the midst of the COVID-19 quarantine. While on long walks around our city we engaged in spirited talks about the inspiring message of The Coffee Bean, so when the time arrived for the official meeting, I was primed for discussion. Two days were devoted to the asynchronous portion of the event, with one hour designated on the second day for a live meet up on Zoom. I found Slack relatively easy to use and appreciated the simple prompts that the facilitators posed to get the conversation going.

The meeting included participants from all over the country and even a few from out of the country, which added to the richness of the discussion. What was most remarkable to me was the degree of comfort participants had in sharing intensely personal experiences as leaders in their respective systems. Powerful connections were made in only an hour on Zoom. Participants posed a number of possible explanations for this connectivity and closeness, including like-mindedness, medical education focus, and humility in all having experienced the ups and downs of our various leadership roles. In retrospect, I am pleased to have experienced this process and highly

recommend other members of SAEM with leadership interests to join in future events. The asynchrony works well for us in emergency medicine and the intimate, yet geographically diverse group of participants lends itself to in-depth conversations that are truly relevant to our work and personal lives.



Dr. Steven Polevoi is a clinical professor of emergency medicine in the Department of Emergency Medicine at the University of California, San Francisco. He is a member of the SAEM Education Committee.


COCKTAILS WITH CHAIRS: PEARLS FOR EM PHYSICIANS-IN TRAINING By Nicholas Cozzi MD, MBA, Adrian Cotarelo MD, MHS and Wendy Sun MD While the COVID-19 pandemic continued to affect every corner of the world, emergency medicine (EM) physicians were leading on the front line while also meeting together to imagine the future of our specialty. EMRA (Emergency Medicine Residents Association) and SAEM RAMS (Residents and Medical Students) collaborated alongside EM department chairs across the nation as part of the SAEM20 Virtual Meeting in May. The “Cocktails with Chairs” event sought to reduce the power distance between residents and EM department chairs and afforded an intimate session, over cocktails, with residents, attending physicians, and medical students. Chairs who attended the event included: • Dr. Andra Blomkalns, founding chair of the Department of Emergency Medicine at Stanford School of Medicine. • Dr. Michael Brown, founding chair of the Department of Emergency Medicine at the Michigan State University College of Human Medicine and Immediate past president of the Association of Academic Chairs of Emergency Medicine. • Dr. Bo Burns, the George Kaiser Family Foundation Chair of the Department of Emergency Medicine at the University of Oklahoma School of Community Medicine and current CORD board member. • Dr. Gabe Kelen, founding chair of the Department of Emergency Medicine at Johns Hopkins University and current ACEP board member. • Dr. Ian Martin, chair of the Department of Emergency Medicine at the Medical College of Wisconsin and immediate past president of SAEM. • Dr. Angela Mills, founding chair of the Department of Emergency Medicine at Columbia University Vagelos College of Physicians and Surgeons, chief of emergency services at NewYork-Presbyterian/Columbia, and secretarytreasurer of the SAEM Board of Directors. The chairs provided insight into their experiences, day-today roles, and career trajectories from resident physician to department chair and leader in emergency medicine. Below are ten pearls gleaned from the event that you can use on your journey to become an emergency physician.

1. Secret Sauce: Failure is necessary

Remember that not every idea, project, or initiative will be successful. Some things are better in theory than they are in practice. Part of leadership is learning from these experiences, taking setbacks in stride, and moving forward.


Watch the full Cocktails with Chairs webinar!

2. Overcome Imposter Syndrome

Many students and residents face imposter syndrome and feelings of inadequacy; EM department chairs are no exception. Let overcoming imposter syndrome be a driving factor in working hard to develop your clinical knowledge base.

3. Plant Trees Under Whose Shade You May Never Sit

Being a chair means growing the next generation of leaders in emergency medicine. Their success is your lasting legacy. Being a chair is also like being a maestro. You need to be an inspirational leader and visionary teacher while coordinating and developing groups of diverse, highly skilled professionals to achieve high quality performance. One of the key tenets of being a chair also includes advocating for your department, junior learners, and the field of emergency medicine.

4. Establish a High Reliability Culture

It is important to establish a highly reliable culture of continuous improvement, trust, and consistency. This triad helps accelerate the process of building trust that can help you starting from day one of residency.

5. The Power of Radical Candor

Honest, professional, and direct conversations build relationships that hold people accountable. Be candid, but compassionate, as you lead your department and in your residency.

6. Develop a Portfolio of Skills

Cultivate skills that will make you an effective leader, including listening, understanding and being approachable.

Dr. Angela Mills Receives EMRA’s Inaugural Chair of the Year Award

A tweet from 2020 EMRA’s Virtual Cocktail with Chairs in collaboration with SAEM RAMS, displayed with permission from Megan Davis, MD, MBA candidate, Boston University School of Medicine

Be intellectually flexible. Be a learner and take advantage of various developmental and national opportunities within EMRA and SAEM.

7. Be the First to Step Up and Help

In times of need, raise your hand to help. Leadership roles often occur serendipitously when a person steps up to do what they feel is right. Follow your ambition, pursue the changes that you feel are necessary, and your career will follow.

8. Yes, Introverts Can Lead!

Leaders come in all shapes, sizes, and personality types. Introverts can and do succeed in leadership at every level in emergency medicine.

9. Practice Makes Permanent

Consistent, intentional, and deliberate effort leads to progress. No one develops competency overnight. Improvement comes with having a growth mindset.

10. Send the Elevator Back Down

A EM department chair is inherently a mentor. As a resident physician, you have the ability to mentor countless medical students, undergraduates, and even high school. Take the first step today. Repeat often. Doctor’s orders! ABOUT THE AUTHORS: Dr. Wendy Sun (@WSunED) is a PGY-2 at Yale-New Haven Health and an SAEM RAMS Board Member who is passionate about equity and inclusion, wellness, and health innovation. Dr. Cotarelo (@AdrianCotarelo) is a PGY-1 at St. John's Riverside Hospital in Yonkers, NY and a RAMS board member-at-large. Dr. Nicholas Cozzi is chief emergency medicine resident at Spectrum Health / Michigan State University College of Human Medicine and chair-elect of the Spectrum Health House Staff Council. Dr. Cozzi serves on the EMRA Administration and Operations Committee and is the EMRA representative to the ACEP EM Practice Committee.

Angela Mills, MD, received EMRA’s first-ever Chair of the Year Award during the Cocktails With Chairs virtual event, May 13. The award recognizes an emergency medicine department chair who innovates the emergency department and supports innovation in residency training. This individual goes above and beyond to mentor emergency medicine residents to support their interests and to foster active participation in organized medicine, research and community service. Dr. Mills is the J. E. Beaumont Professor and inaugural chair of the Department of Emergency Medicine at Columbia University Vagelos College of Physicians and Surgeons and chief of emergency services for NewYork-Presbyterian–Columbia. She maintains an active research career focused on emergency diagnostic imaging, undifferentiated abdominal pain, and clinical operations. She has authored over 100 scientific publications and has received research funding from both federal agencies and industry. Dedicated to combining scholarship with mentoring, Dr. Mills has influenced the careers of numerous faculty and trainees. She is strongly committed to education with a teaching style that allows for growth and pursuit of individual research interest. Dr. Mills is an elected member of the Board of Directors of the Society for Academic Emergency Medicine (SAEM) and currently serves as secretarytreasurer. She has been honored with two prestigious SAEM awards: the Arnold P. Gold Foundation Humanism in Medicine Award and the Mid-Career Award from SAEM’s Academy for Women in Academic Emergency Medicine (AWAEM). Dr. Mills is a Fellow of the American College of Emergency Physicians.


EM RESIDENTS AND MEDICAL STUDENTS: WE’RE MAKING HISTORY! By Gregory Jasani, MD My favorite class in school was always history. I believed then, as I do now, that understanding the past is the key to making sense of the present. Yet even while I enjoyed reading about the pivotal moments in our nation’s history, I could never fully grasp the emotional impact of actually living through those moments. Well, residents and medical students, this is our moment to make history! As emergency medicine physicians, we are on the frontline of a pandemic unlike anything this world has seen in more than a century. Our nation, and arguably the world, is experiencing a defining moment in its history and we have the privilege of playing an active part in it. I always knew as an emergency physician I would have the opportunity to make a difference in my community, but I never imagined that I would be called upon to serve my country in such a dramatic way. Every time I go to work, I get to try and stem the onslaught of this deadly virus. My role is admittedly a small one compared to that of others, but I take pride in knowing that I am helping my fellow citizens through this trying time. Of course, I would be lying if I said I am not scared…I am scared! Coronavirus has killed thousands of people, including many fellow health care workers. I worry for the safety of my loved ones and myself. Yet, during these trying times, I think about the men and women who have helped to write our nation’s history. Undoubtedly, they experienced fears and trepidation along the way; however, they overcame their doubts to forge an enduring legacy. I take comfort and


"OUR NATION, AND ARGUABLY THE WORLD, IS EXPERIENCING A DEFINING MOMENT IN ITS HISTORY AND WE HAVE THE PRIVILEGE OF PLAYING AN ACTIVE PART IN IT." inspiration from the words of President Franklin Delano Roosevelt: “Courage is not the absence of fear, but rather the assessment that something else is more important than fear.” One day, hopefully soon, the coronavirus pandemic will be history. It will be written about and studied for generations to come. But for those of us on the front lines, this event will never just be words on a page…It will be history that we actually lived! Our actions in emergency departments today are shaping what will appear on the pages of history books in the future…. And that is something to be proud of! ABOUT THE AUTHOR: Dr. Jasani is a resident at the University of Maryland Medical Center

PREPARING A MORBIDITY AND MORTALITY CONFERENCE By Michael Anana MD, Linda L. Herman MD, and David K. Barnes MD on behalf of the SAEM Education Committee Most emergency medicine residencies use morbidity and mortality (M&M) conferences for educational purposes. Since the publication of “To Err is Human: Building a Safer Health System” in 1999, the science of improvement has been introduced to all providers in health care. Patient safety and quality are important in all aspects of healthcare. M&M conferences can be used for teaching and improving patient safety and quality. M&M conferences can provide information about cognitive errors, allowing the residency to prepare residents to avoid committing such an error. This article provides information about organizing, preparing, and presenting an interactive and informative M&M conference. A form is included to assist in preparation.


Medical error is the failure of a planned action to be completed as intended, or the use of the wrong plan to achieve the aim. Errors are either acts of commission (doing something wrong) or acts of omission (failing to do the right thing). Emergency department patients are exposed to potential medical errors in multiple areas. Cosby described ten factors contributing to medical error: • Patient factors • Outside systems and ED access

• Teamwork Failure • Local ED environment: the microsystem • Hospital environment: the macrosystem • Hospital administration and third-party factors • Community/society/health care policy Morbidity and mortality conferences, known as M&M, are a mainstay in academic medicine, including emergency medicine residency programs. The objective of an M&M conference is to track and discuss medical errors in an environment that facilitates learning, encourages accountability, and promotes leadership and academic development. This article will guide residents who are preparing an M&M conference. It will focus on choosing the case, determining the type of error which occurred, formatting the presentation, solutions for preventing repetition of the errors, and teaching how to avoid cognitive errors.


Beginning in 1983, the Accreditation Council for Graduate Medical Education (ACGME) required all training programs to institute regular M&M conferences. Currently, 98.4 percent of emergency medicine (EM) training programs routinely conduct M&M conferences as part of their academic curricula. The

• Triage • Human Error continued on Page 56


CONFERENCE from Page 55 formerly-known Institute of Medicine released its landmark 1999 report, To Err is Human, which found that preventable medical errors caused between 48,000 and 98,000 deaths each year, and defined best practices to build a safer health system. Then in 2014, the ACGME published Clinical Learning Environment Review (CLER) Pathways to Excellence “…to encourage clinical sites to improve engagement of resident and fellow physicians in learning to provide safe, high quality patient care.” Morbidity & mortality conference is an opportunity to achieve these objectives.

Who Presents?

Aside from being a vehicle to identify, review, and articulate medical errors, an M&M conference serves as an opportunity for presenters to develop leadership and teaching skills. Senior residents are often selected to present M&M conferences, supporting the notion that they have more refined speaking and leadership skills. These advanced trainees are also more fluent in their institution’s policies and procedures and can provide valuable context and experience when leading complex discussions about cognitive errors and systems failures.

How Cases Are Chosen

The process for M&M case selection varies widely by institution. Many programs now use M&M as part of a broader quality improvement curriculum. Cases can be referred to the residency program by faculty members, a peer review committee, hospital quality and safety, risk management, or emergency medicine residents themselves. A majority of EM residency programs report they receive


M&M cases from multiple sources. Some programs, departments, or hospitals require peer review before a case is presented at an M&M conference. In the past, unusual cases or uncommon presentations of a common problem have been used as M&M cases. These cases may be more suited for clinical pathological cases (CPC) than M&M. The primary focus of the M&M conference should be medical error and its prevention as part of a larger patient quality and safety initiative.


Presentations are typically assigned at the beginning of the academic year; therefore, residents are encouraged to be proactive and to prepare early, at least 3-4 weeks in advance. The presenter should discuss with the referring individual, the peer review committee, or the quality improvement/ patient safety champion for the department. Regardless of how the case was assigned, the resident should investigate and determine any medical error identified during the peer review process. The resident should keep this in mind but also consider that they may disagree with the committee or determine that other errors were made. The resident should obtain and read the medical record thoroughly to determine what occurred including: pre-hospital documentation; the emergency department record including triage, physician notes, diagnostic test results, and resuscitation records; and inpatient records, including progress notes, procedure notes, nursing notes, discharge summary, etc. Only after a thorough review can the presenter determine if an error occurred. The presenter should critique the original decision about the error and attempt to classify the type of error in order to frame the discussion about root cause and future prevention. The attached form lists common types of medical errors

Presenters should notify all physicians and staff involved in the case before presenting the M&M conference to provide them the opportunity to attend. Not only is this an expected professional courtesy, but it is also an opportunity to discuss the case with those who were primarily involved.


Presenters commonly use a slide presentation, but this is not necessary if the presenter knows the case well. If a slide presentation is used, it is vital to illustrate a timeline of important events (i.e. time of ED arrival, chief complaint, critical events, diagnostic tests, etc.). Interaction and engagement with the audience improves interest. The presenter should encourage the audience to ask questions regarding the evaluation, treatment, and disposition, and ask the audience to commit to a course of action at key junctures. Hiding important information is discouraged, as is revealing key information too early. Physician anonymity is institution dependent. Some programs recommend resident physicians use their own patient encounters for M&M presentations. If human error is a factor, the lack of anonymity has the potential to negatively impact the well being of a physician-in-training. However, presenting others’ cases absolves a resident of accountability. In either case, we urge residency programs to promote a safe and objective learning environment that focuses on the system that allowed the error to occur, not to judge or vilify the person who made it. Rather than interpreting laboratory studies, radiologic tests, and other diagnostic studies, instead ask the audience to interpret the results. This process maximizes the learning opportunities for junior learners and facilitates an honest, objective, empathic view of the circumstances as experienced by those involved in the case. This avoids the Monday morning quarterback phenomenon of premature judgment. Allow the case presentation to evolve by revealing what occurred and the final diagnosis. If anonymity is requested or required, several real-time polling platforms are available through which the audience can respond electronically (e.g. Slido, Poll Everywhere, PCI Pro, etc.). Be prepared to discuss in depth, any errors that occurred. If it was a missed diagnosis, the correct diagnosis can be revealed and the process by which the correct diagnosis was discovered. A few well-researched and sourced teaching points about the diagnosis will engage the audience and provide the necessary pedagogical closure to the case. Because cognitive error is inherent to many M&M cases, presenters should be prepared to discuss strategies to prevent these types of errors from occurring. The first step to avoiding cognitive error is to acknowledge its existence. Physicians can minimize the chances of future errors by reflecting on those that already occurred and by analyzing their own decision making as critical self-analysis and reflective thinking can reframe one’s own cognitive process and mitigate error potential. A detailed discussion of cognitive error is beyond the scope of this article. Those interested are directed to many excellent resources for further reading. If a system error has occurred, suggestions can be gathered from the audience as to how to improve the system to ensure

"THE PRIMARY FOCUS OF THE M&M CONFERENCE SHOULD BE MEDICAL ERROR AND ITS PREVENTION AS PART OF A LARGER PATIENT QUALITY AND SAFETY INITIATIVE." that type of error does not occur in the future. A system should be in place in which the information that is gathered during the M&M can be shared with those in position to improve the healthcare system. On the enclosed form, the group attending the M&M conference can decide to whom the information should be forwarded (i.e. department medical director, ED operations committee, nursing director, etc.). Finally, a summary of the discussion, while optional, is appreciated by most and can be distributed in paper form or electronically. While any summary should include a few key recommendations or teaching points and a bibliography, it should never include any case specifics, names (patients or physicians), inflammatory language, or protected health information.


M&M conference in emergency medicine has matured from an educational presentation to an instrument of quality improvement. Within this framework, M&M conferences facilitate medical knowledge acquisition, encourage reflective thinking, and teach others how to avoid cognitive errors to improve patient care. ABOUT THE AUTHORS: Dr. Michael Anana is an assistant professor and assistant program director in the Department of Emergency Medicine at Rutgers New Jersey Medical School. Dr. Linda L. Herman is an associate professor and program director, University of California, Irvine, Kaweah Delta Health Care District Emergency Medicine Program.

Dr. David K. Barnes is a health sciences clinical professor and program director in the Department of Emergency Medicine at the University of California, Davis.


SAEM FOUNDATION Thank You to Our Annual Alliance Donors! January 1– July 6, 2020 Sustaining Donors Thomas Arnold, MD William Barsan, MD Steven Bernstein, MD - In honor of E. John Gallagher, MD Steven B. Bird, MD and AnneMarie Bird - In honor of Dr. Peter Rosen Michelle Blanda, MD James Brown, Jr., MD Charles B. Cairns, MD Gail D’Onofrio, MD, MS and Robert Galvin, MD Robert Hockberger, MD and Patricia Pickles Amy Kaji, MD, PhD Gabor D. Kelen, MD Nathan Kuppermann, MD, MPH Louis Ling, MD Ian B.K. Martin, MD, MBA Roland Clayton Merchant, MD, MPH, ScD Andrew S. Nugent, MD Ali S. Raja, MD, MBA, MPH Michael Runyon, MD, MPH and Stacy Reynolds, MD - In memory of John A. Marx, MD Kirsten Rounds, RN, MS David Sklar, MD - In memory of Lou Binder, MD and John Marx, MD Brian J. Zink, MD

Advocate Donors Benjamin Abella, MD, MPhil - In honor of Dr. William Baxt Srikar Adhikari, MD, MS Harrison Alter, MS, MD Andra Blomkalns, MD, MBA Chris Carpenter, MD, MSc and Panechanh Carpenter Anna Marie Chang, MD Wendy Coates, MD Jim Comes, MD D. Mark Courtney, MD David F.M. Brown, MD Deborah B. Diercks, MD, MSc Nina Gentile, MD Thomas R. Hellmich, MD Brian C. Hiestand, MD Cherri D. Hobgood, MD James W. Hoekstra, MD Judd E. Hollander, MD James F. Holmes, MD, MPH Andy S. Jagoda, MD Michelle Lall, MD, MHS


Phil Levy, MD Robert McCormack, MD Angela Mills, MD Joe Miller, MD Nicholas Mohr, MD, MS Paul Musey, MD, MS Robert W. Neumar, MD, PhD Brian O'Neil, MD - In honor of Gloria Kuhn Megan Ranney, MD, MPH Niels Rathlev, MD Martin Reznek, MD, MBA Megan Schagrin, MBA, CAE, CFRE Elizabeth Schoenfeld, MD, MS Manish Shah, MD Scott Silvers, MD, MPH Peter Sokolove, MD Joseph Adrian Tyndall, MD J. Scott VanEpps, MD, PhD Gregory A. Volturo, MD Scott Weiner, MD, MPH David E. Wilcox, MD, FACEP Richard Wolfe, MD Richard Zane, MD

Mentor Donors Anonymous (1) Michael R. Baumann, MD Michelle Biros, MD, MS Michael Brown, MD, MSc Bo Burns, DO Jeffrey Caterino, MD Brendan Carr, MD Theodore Chan, MD Carl Chudnofksy, MD Francis Counselman, MD Gregory Fermann, MD Steven Galson, MD, MPH and Jessie Galson, PhD - In honor of Dr. Peter Rosen Charles Gerardo, MD, MHS Richard Hamilton, MD Babak Khazaeni, MD Terry Kowalenko, MD Eric Legome, MD James McCarthy, MD Lawrence Melniker, MD, MS, MBA Lewis Nelson, MD Brian O'Neil, MD Jonathan Olshaker, MD David Overton, MD Edward Panacek, MD, MPH Arthur Pancioli, MD Peter Pang, MD Ava Pierce, MD

Susan Promes, MD, MBA Doug Ray, MSA Ralph Riviello, MD, MS David Seaberg, MD Rahul Sharma, MD, MBA Benjamin Sun, MD, MPP Jeremy Thomas, MD David W. Wright, MD James M. Ziadeh, MD

Young Professional Donors Anonymous (3) Rik Austin, MD Aaron Barksdale, MD John Burkhardt, MD Douglas Char, MD Sam Clarke, MD, MAS Jeffrey Druck, MD Daniel Egan, MD Robert Ehrman, MD Raymond Fowler, MD, MS Colin Greineder, MD Marquita Hicks, MD, MBA Ula Hwang, MD, MPH - In honor of all our wonderful mentors Danielle McCarthy, MD Bryn Mumma, MD, MAS Robert Parson - In memory of Dr. Peter Rosen Michael Puskarich, MD Scott Rodi, MD, MPH Kirsten Rounds, RN, MS Amber Sabbatini, MD Jody Vogel, MD, MSc, MSW Sandra Werner, MD

Resident Donors Austin McDonald, MD, PhD Nehal Naik, MD Andrew Starnes, MD, MPH Wendy Sun, MD

Medical Student Donors Anonymous Rachel A. Dahl

Commit yearly to the SAEM Foundation by joining a community of like-minded individual’s intent on producing quality research and education that will change the future of the specialty. View the benefits of becoming an Annual Alliance donor. Donate online or download the pledge form to join.

Sustaining Donors

Thomas Arnold, MD

William Barsan, MD

Steven Bernstein, MD

Steven B. Bird, MD

Michelle Blanda, MD

James Brown, Jr., MD

Charles B. Cairns, MD

Gail D'Onofrio, MD

Robert Hockberger, MD

Amy Kaji, MD, PhD

Gabor D. Kelen, MD

Nathan Kuppermann, MD, MPH

Louis Ling, MD

Andrew S. Nugent, MD

Ali S. Raja, MD, MBA, MPH

David Sklar, MD

Brian J. Zink, MD

Ian B.K. Martin, MD, MBA Roland C. Merchant, MD, MPH, ScD

Michael Runyon, MD, MPH

Kirsten Rounds, RN, MS




Several New Papers Added to Online COVID-19 Collections for SAEM Journals!

To facilitate the rapid dissemination of COVID-19 findings, Academic Emergency Medicine and AEM Education and Training journals are fast-tracking submissions related to COVID-19 and making the latest research available in online collections of accepted, citable COVID-19 articles. The final edited versions of record of these articles will appear online and in future digital issues of the journals. These collections are being updated constantly, so be sure to check frequently for the latest COVID-19 research from SAEM journals! AEM Online COVID-19 Collection AEM E&T Online COVID-19 Collection

COVID-19 National Grand Rounds Webinars Now Available on YouTube

During the month of April SAEM was pleased to present two National Grand Rounds webinars on COVID-19. Both webinars are now available in video format on SAEM YouTube: Lessons Learned from an Academic Health System in New York City From Katrina to COVID-19: Emergency Care for the Underserved During Times of Crisis

Apply for SAEM Foundation Grants by August 1 The SAEM Foundation is now accepting applications for several grant categories including the:

SAEM’s Research Learning Series (RLS) features valuable education on popular emergency medicine research topics delivered by experts in the field of emergency research. Sign up for these high-yield, interactive educational events for free, or view previous podcasts and lectures, housed online at the RLS webpage.

Research Training Grant (RTG) – $300,000 Research Large Project Grant (LPG) – $150,000 Education Research Grant (ERG) – $50,000 MTF-SAEMF Toxicology Research Grant – $10,000 SAEMF/Clerkship Directors in Emergency Medicine (CDEM) Innovations in Undergraduate Emergency Medicine Education Grant – $5,000 And many more! All applications are due at 5 p.m. CT on August 1, 2020. To view a full listing of grant offerings through the SAEM Foundation, visit the SAEM Foundation website under What We Fund.

SAEM Statements RE: COVID-19 • ACEP and SAEM’s Joint Statement on Research During the COVID-19 Pandemic. • SAEM’s position Statement Regarding PPE for Those Working in the Emergency Department. • SAEM’s position statement on COVID-19. • SAEM signs onto AAEM’s Position Statement on Protections for Emergency Medicine Physicians during COVID-19 • Consensus Statement on the 2020-2021 Residency Application Process for US Medical Students Planning Careers in Emergency Medicine in the Main Residency Match* • SAEM Signs Joint Statement in Support of the Mental Health of EM Physicians


Novice and Mid-Career EM Researchers: SAEM’s Research Learning Series Offers Valuable, Online Research Content!

Megan L. Ranney

Watch now: “Social Media in Emergency Medicine,” presented by Dr. Megan L. Ranney, associate professor, Dept. of Emergency Medicine/ Dept. of Health Services.

Your Donations to SAEMF Help Sustain Research and Educational Research Training During the COVID-19 Crisis

Current SAEM Foundation grantees are facing many challenges with their research during this time of COVID-19 crisis: • Enrollment for emergency care research that requires patient contact has halted in the ED to save Personal Protective Equipment (PPE) for clinicians and to practice social distancing • Some institutions are converting part of their emergency departments or research facilities into respiratory distress units for increased patient care • Academicians are being called to work more clinical shifts to take care of patients • Research staff have been reassigned to “other duties as directed” • Focus has largely shifted to COVID-19 research With this uncertainty and these widespread changes, the full impact on emergency medicine as a whole is still unknown. Please donate today and help the SAEMF sustain research and educational research training during and long after the COVID-19 pandemic.

SAEM Foundation Issues Automatic Six-month Extensions for Grantees The SAEM Foundation recognizes that the COVID-19 pandemic is having a significant effect on emergency care and emergency care research. For this reason, the SAEM Foundation is offering an automatic six- month extension to all SAEM Foundation grantees. To confirm that you would like a six-month extension for your SAEM Foundation grant, email grants@saem. org. If you cannot accept a six-month extension due to an overlap with another funded grant, please also contact

SAEM Foundation Awards $50,000 in COVID-19 Research Grants

This week, the SAEM Foundation awarded $50,000 to two emergency care investigators for their studies on COVID-19. Bernard Chang, MD, Bernard Chang PhD, professor of emergency medicine at Columbia University Medical Center will receive $25,000 for his study on The Psychological Effects of COVID-19 Amongst Evan Bradley Emergency Providers. Dr. Evan Bradley at the University of Massachusetts will also receive $25,000 for his research on the Nasopharyngeal Microbiome and Clinical Outcomes in Patients with COVID19. The new COVID-19 Research Grant program was developed by SAEM Foundation in April 2020 as a response to the coronavirus pandemic that has swept the globe and has had a tremendous impact on emergency care.

SAEM NEWS Planning to Attend ARMED? Apply for One of Three Available Scholarships!

Three ARMED scholarships are available to SAEM residents or fellows who are interested in pursuing a research-oriented career. The awards are to offset costs associated with attending SAEM21 (including the Chief Resident Forum) in Atlanta and the ARMED live workshop at SAEM headquarters. Scholarship recipients will have their tuition to these

events waived and be reimbursed up to $1,000 for the costs of registration, travel, and housing. For eligibility requirements, selection criteria, and instruction on how to apply, please visit the scholarship webpage. Scholarship applications are due July 31.

Introducing Virtual Rotations and Educational Resources From CDEM

The Inaugural ARMED MedEd is Accepting Applications Through August 31

Apply now for the inaugural ARMED MedEd (Advanced Research Methodology Evaluation and Design Medical Education) course. The course builds upon the fundamental knowledge and skills of health professions education researchers and equips them to design a high-quality medical education research project and grant proposal. Taught by leading experts, the course is recommended for individuals who have already completed an introductory course in health professions education research or are presently enrolled in a fellowship or graduate degree program. Application deadline is August 31, 2020. Visit the ARMED MedEd webpage for all the details, including course fees and schedule.

SAEM’s Clerkship Directors in Emergency Medicine (CDEM) academy has launched a directory of virtual rotations and educational resources to expose students to emergency medicine topics and give them access to programs that provide virtual rotations. The most current opportunities and most recent educational resources are listed at the top under each heading. Submit educational resources or information about virtual rotation programs to


July 31 is the Application Deadline for the Advanced Research Methodology Evaluation and Design Course

Applications are being accepted for the 2020-2021 Advanced Research Methodology Evaluation and Design (ARMED) course. Taught by leading experts in academic emergency medicine, the purpose of the course is to equip junior faculty (within five years of graduation), fellows, and senior residents who are interested in pursuing a career in research, with the fundamental knowledge and skills to design a highquality research project and grant proposal. Application deadline is July 31, 2020. Visit the ARMED webpage for all the details, including course fees and schedule.

SAEM Publishes Special COVID-19 Issue of SAEM Pulse

The 100+ page special COVID-19 issue of SAEM Pulse, published in May, contains more than 25 articles covering timely COVID-19 topics ranging from teaching during a pandemic, to ethics, wellness, and health equity issues; from having difficult conversations with critical COVID-19 patients and their families, to perspectives and personal reflections. The issue includes a Spotlight continued on Page 62


BRIEFS continued from Page 61 interview with COVID-19 survivor Dr. Dara Kass, who talks about the critical role of academic emergency medicine physicians in directing COVID-19 messaging. If you haven’t taken the time to flip through this historic, SAEMmember generated special issue, you’ll want to be sure to do so!

Academic Emergency Medicine: • Rubber Meeting the Road: Access to Comprehensive Stroke Care in the Face of Traffic • Teacher Teacher-Tell Me How To Do It (Diagnose a PE) All journal podcasts are also available on iTunes.

Call for Papers: Racism as a Public Health Crisis

SAEM Pulse is looking for writers to author non-research articles that address any and all matters related to diversity, health equity, and racism as a public health crisis: • Discrimination and health • Institutional, cultural, and/or intersectional racism and health • Racism across the life course • Residential segregation and other neighborhood factors and health • Approaches and strategies to addressing racism and achieving health equity • Educational strategies to teach about racism and its health impact • Challenges with recruitment, retention, pipeline, faculty development/ advancement Papers should focus on emergency medicine, academic emergency medicine and/or issues relevant to either/both. Paper formats can be essays, narratives, profiles, interviews, op-ed pieces, human interest stories, “think” pieces, or informational/how-to articles. Length: 400-700. Deadline August 1, 2020 Direct inquiries to Stacey Roseen, senior editor, publications and communications at

Listen Up! Here are the Newest Journal Podcasts

Here are the latest podcasts from SAEM journals: AEM Education and Training: • The Implementation of a National Multifaceted Emergency Medicine Resident Wellness Curriculum Is Not Associated With Changes in Burnout


Mortality and Complication Rates in Adult Trauma Patients Receiving Tranexamic Acid: A Single-center Experience in the Post–CRASH-2 Era Pablo Joaquin Erramouspe by Dr. Pablo Joaquin Erramouspe et al. Read EIC Kline’s commentary, Tilting the Balance.

SAEM RAMS The Latest Issues of AEM are Ready for Your Review! Full issue PDFs of the May and June issues of Academic Emergency Medicine (AEM) are now available for download... or read the issues online!

• Download full PDF of May AEM or read online • Download full PDF of June AEM or read online

AEM E&T is Seeking SAEM20 Virtual Meeting Papers Relevant to Education and Training

SAEM Academies, Committees, and Interest Groups…AEM Education and Training (AEM E&T) is seeking SAEM20 submissions relevant to education and training for publication in a late 2020/ early 2021 issue of the journal. In addition to the standard manuscript types, conceptually-based white papers that share cutting edge ideas and concepts unique to their areas of expertise—with an emphasis on education and training in emergency medicine—will be considered. For details and submission instructions, visit the webpage. Deadline is July 15.

AEM Editor-in-Chief Picks

Here are the latest picks and corresponding commentaries from Jeffrey A. Kline, MD, editor-in-chief (EIC) of Academic Emergency Medicine:

• An Event-based Approach to Measurement: Facilitating Observational Measurement in Highly Variable Clinical Settings • Rethinking Residency Conferences in the Era of COVID-19

et al. Read EIC Kline’s commentary, Decision Rules May Be Great, But People are Crazy.

Lauren Westafer

Provider Perspectives on the Use of Evidence-Based Risk Stratification Tools in the Evaluation of Pulmonary Embolism: A Qualitative Study by Dr. Lauren Westafer,

Dr. Bernard Chang is First Interview in a New Podcast Series from RAMS An interview with Dr. Bernard Chang, MD, PhD, professor of emergency medicine at Columbia University Medical Center is the first podcast in a new Bernard Chang “biosketch” series from SAEM Residents and Medical Students (RAMS). The series interviews established researchers in emergency medicine and covering topics of interest to residents. RAMS podcasts are also available on iTunes.

A New Webinar From RAMS: Advising Applicants for the 20202021 ERAS Application Cycle

Miss out on the June 8, RAMS-hosted webinar Advising Applicants for the 2020-2021 ERAS Application Cycle? No worries, because you can now view it on video! The webinar video provides up-to-date guidance regarding the unprecedented 2020-2021 ERAS application season during the COVID-19 pandemic. A panel of clerkship directors and assistant residency program directors discuss many of the current ongoing topics of concern, including canceled away rotations, SL OEs, non-SLOE letters of recommendation, how to strengthen your application, and more.

Happy 10th SAEM Anniversary to Melissa McMillian! Introducing “Fast 15”: A New Resource From RAMS and SAEM’s Industry Advisory Council

Hosted by the SAEM Industry Advisory Council in collaboration with SAEM RAMS, “Fast 15” is designed to give you critical content in 15 minutes flat. In the first “Fast 15” installment, leading financial entrepreneurs in the medical community provide their expertise for navigating finances in the era of COVID-19.

SAEM congratulates Melissa McMillian, CNP, SAEM director, foundation and business development, for reaching 10 years with the organization. Melissa began her career at SAEM in 2010 as grants coordinator, worked her way up to grants and foundation manager in 2013, and in 2017 she was promoted to SAEM Director, Foundation and Business Development. In 2018 Melissa was named an Association Melissa McMillian Forum “Forty Under 40” honoree, an honor which recognizes accomplished association professionals under the age of 40 who demonstrate high potential for continued success in leadership roles, and exhibit a strong passion for, and commitment to, the association management industry. Indeed, the overwhelming success of SAEM's foundation and business development efforts these past 10 years is largely due to Melissa’s dedication, exceptional ability, and hard work. Anyone who has ever worked alongside Melissa knows that her work ethic is second only to her kindness toward and compassion for the people. SAEM is so fortunate to have Melissa on our team and we look forward to many more years of her influence and contributions to the Society.

SUBMIT YOUR ANNOUNCEMENT! The SAEM Pulse Academic Announcements section publishes academic appointments, promotions, retirements, grant awards, research announcements, published papers, etc. Send your content (50-75 words max) to The next content deadline is August 1, 2020 for the September/October 2020 issue. 63

SAEM E-Resources SAEM Membership Guide, part of our new member onboarding initiative, highlights all the programs, services, and opportunities the Society offers its members, takes new members through the ins and outs of the organization and shows them the ropes, and gives all members the tools and information to make the most of their SAEM membership‌ all in one fun, easy-to-use, interactive format. Academic Promotion Toolkit provides a brief, pragmatic approach to the promotion process. Endorsed by seven SAEM Academies, this “Quick Guide to Promotion for the Uninitiated,â€? is intended to provide a useful framework to help assistant professors reach the associate professor milestone. AWAEM Toolkit is a helpful digital guide that offers advice and resources for the challenges and opportunities which arise for women in academic emergency medicine. Chapters cover topics including professional development, mentoring, promotion, recruitment/support, grant writing, developing scholarship, wellness, and gender-specific needs. SAEM Academic Career Guide is a comprehensive professional guidebook for students, residents, fellows, and early career emergency physicians interested in pursuing a career in academic emergency medicine (EM). It includes highlights, strategies, and tips to work toward positions such as department chair, residency program director, clerkship director, designated institutional official, and dean. Useful for anyone who is still growing in their career in academic EM. RAMS Roadmaps: The Definitive Guide to Academic Careers in Emergency Medicine for Residents and Students provides guidance to the second-year medical student looking to get into an emergency medicine residency, to individuals looking for timelines and insider advice on advanced training, and even to seasoned attendings transitioning to academia.


ACADEMIC ANNOUNCEMENTS Dr. Jill M. Baren Named Provost at University of the Sciences Jill M. Baren, MD, has been named provost and vice president of academic affairs at University of the Sciences. Dr. Baren comes to USciences from the University of Pennsylvania where she is currently professor of emergency medicine, pediatrics, and medical ethics at the Perelman School of Medicine. Recently, Jill M. Baren she has served in the Provost’s Office as the Faculty Leadership Development Fellow. She is currently serving a term as the President of the American Board of Emergency Medicine; whose mission is to ensure the highest standards in the specialty.

Dr. Sheryl Heron Appointed to Associate Dean for Community Engagement, Equity and Inclusion at Emory Sheryl Heron, MD, MPH has been appointed to the role of Associate Dean for Community Engagement, Equity and

Sheryl Heron

Inclusion, effective July 1. Dr. Heron is a Professor of Emergency Medicine in the School of Medicine. Dr. Heron joined the Emory University School of Medicine faculty in 1996. Dr. Heron is an editor of two textbooks addressing diversity and inclusion in quality patient care and is the recipient of numerous awards.

Dr. Marcia Perry Named Associate Chair of Diversity, Equity, and Inclusion at the University of Michigan Marcia Perry, MD, has been named the associate chair of Diversity, Equity and Inclusion (DEI) at the University of Michigan. Dr. Perry is an assistant professor in the department of emergency medicine and an assistant director of the emergency medicine residency program at the University Marcia Perry of Michigan. Dr. Perry is also the director of House Officer Programs and the director of the Health Equity Visiting Clerkship in the Office for Health Equity and Inclusion.

SAEM/ADIEM Statement on the Death of George Floyd In the wake of the latest police killing of an African American man in Minneapolis, the Society for Academic Emergency Medicine (SAEM) joins those calling for reforms on the use of deadly force by law enforcement, the review of discriminatory practices, and justice for those whose lives have been taken as a result of racism targeting people of color. This past Monday George Floyd died while handcuffed, with a police officer's knee upon his neck, gasping for breath. His final words: "I can't breathe." As emergency physicians, when a human being says, "I can't breathe," our immediate response is a call to action to save a life. We have committed our lives to reducing disparities in the emergency department and to providing compassionate, unconditional care for all who need it, regardless of race, ethnicity, creed, gender, sexual orientation, physical ability, or any other human factor. Unfortunately, as emergency physicians, we also know all too well that racism is a public health crisis and a national plague. We, all too often, see its devastating effects, most recently in the disproportionate COVID-19 deaths of people of color due in part to the long-standing health inequities that continue to exist. George Floyd's death follows other recent killings of African Americans, including emergency medical technician Breonna Taylor in her home by Louisville police, and Ahmaud Arbery, murdered while jogging. In the loudest and strongest possible terms, we condemn these needless killings. Systemic racism and oppression targeting people of color must be addressed. The time is now; it is long overdue. SAEM pledges, with a renewed sense of purpose, to champion equitable care for everyone in America, to train up just and compassionate emergency care providers, and to fight for a society that condemns racism and cherishes our rich diversity.


NOW HIRING POST YOUR OPEN JOBS IN FRONT OF OUR QUALIFIED CANDIDATES! Accepting ads for our “Now Hiring” section! Deadline for the next issue of SAEM Pulse is August 1. For specs and pricing, visit the SAEM Pulse advertising webpage.

Vice Chair for Clinical Operations Department of Emergency Medicine The Department of Emergency Medicine at the Medical College of Wisconsin (MCW) seeks a visionary and highly-motivated board-certified Clinician Leader to join the Department as an Associate or Full Professor for the position of Vice Chair for Clinical Operations. The Vice Chair will report directly to the System Chair of the Department of Emergency Medicine and be responsible for the development and implementation of strategic plans for the patient care mission of the Department in conjunction with Department Chair. The successful Vice Chair for Clinical Operations shall provide oversight, direction, and leadership for the clinical operations of all practices staffed by the Medical College of Wisconsin Department of Emergency Medicine.

Our Department maintains a thriving clinical practice including: Froedtert and MCW (F&MCW) Froedtert Hospital Emergency Department (level 1 adult trauma center); Children’s Wisconsin (level 1 pediatric trauma center); Clement J. Zablocki Veterans Affairs Medical Center Emergency Department; F&MCW Froedtert Moorland Reserve Health Center (free-standing) Emergency Department; F&MCW Froedtert Menomonee Falls Emergency Department; and a series of soon-toopen, community-based, neighborhood hospital Emergency Departments. Across this myriad of clinical practices, our faculty, fellows, residents, and advanced practice providers (APPs) care for more than 200,000 patient visits each year. Our Department is home to a competitive training program of 36 residents, which attracts top-notch housestaff from medical schools across the nation. Many of our faculty members, fellows, residents, APPs, and staff are engaged in a host of extramurally-funded, cutting-edge, investigative research. Inquiry in the areas of cardiac arrest and resuscitation, injury, EMS, and others have garnered MCW a reputation as an Emergency Medicine research powerhouse. Successful candidates should be residency-trained and board-certified in Emergency Medicine by the ABEM. Desired qualities and skills include prior management and leadership experience at Service Chief or Medical Director level in an academic medical center. The candidate should have successful demonstration of operational improvements and innovations in clinical operations. The candidate should have documented academic accomplishments to be appointed at the Associate Professor or Professor level, with or without tenure, at the Medical College of Wisconsin.

 Please submit a CV, letter of interest, and a list of references to: Ian B.K. Martin, M.D., M.B.A., FACEP, FAAEM Professor with Tenure and System Chairman, Department of Emergency Medicine, Professor, Department of Medicine The Medical College of Wisconsin Medical School at The Medical College of Wisconsin is an equal employment opportunity and affirmative action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other characteristic protected by law.


Innovation - does joining a team that is re-imagining acute care delivery inspire and excite you? Impact - do you want to shape the future of healthcare? The Department of Emergency Medicine at The Sidney Kimmel Medical College at Thomas Jefferson University in Philadelphia, PA continues to expand its faculty complement. Our team is revolutionizing the way emergency care is taught to our students, residents and faculty and how care is provided to patients. We have pioneered emergency telemedicine and design thinking in EM. We have nimbly integrated our diverse faculty and forward-looking enterprise to impact population health, emergency medical services, access to care, patient flow and clinical research. We are interested in emergency physicians that wish to be a part of a department that will contribute to the ongoing transformation of acute unscheduled care. We have an extensive and robust clinical footprint, with the opportunity to practice across the acute care spectrum. We provide faculty and resident coverage at two emergency departments – TJUH (center city campus), a 700-bed academic quaternary-care, Level 1 trauma center that treats 73,000 patients annually, and the Methodist Hospital Division of TJUH, a 140-bed community hospital that treats 34,000 patients annually. Faculty also provide coverage at seven urgent care centers run by the department as well as the clinical decision unit (CDU) at Thomas Jefferson University Hospital and have the opportunity to provide on-demand direct-to-consumer through our Telehealth Program. Faculty will be responsible for patient care and bedside teaching of students and residents and will have the opportunity to develop their academic focus. Additional information on the department can be found at: We seek the following: Director of Emergency Medical Services The Director of EMS will be the forward-facing leader for prehospital care. This person will have a multifaceted mission with core responsibilities in EMS education, EMS outreach and EMS research. Additionally, they will work collaboratively with JeffSTAT (the ground and air-based program that moves patients across our 14-hospital enterprise). In doing so, there is opportunity for medical command and education at the JeffSTAT training center. This person will also represent Jefferson EMS locally, regionally and nationally while concurrently building relationships and bolstering Jefferson’s presence in these domains. With Jefferson’s focus on innovation and care transformation in mind, specific touch points are working in partnerships with JeffSTAT and the city of Philadelphia to re-imagine prehospital care and safe inter-facility patient movement. Clinical Faculty Clinical faculty provide patient care and bedside teaching of students and residents in the ED, clinical decision unit and urgent care. Additionally, clinical faculty have opportunities to become involved in administration, clinical operations, undergraduate and graduate medical education. The Sidney Kimmel Medical College at Thomas Jefferson University values a diverse and inclusive community as it allows us to achieve our missions in patient care, education, and research and best allows us to serve the healthcare needs of the public. Thomas Jefferson University and Hospitals is an Equal Opportunity Employer. Jefferson values a diverse and inclusive community diversity and encourages applications from women, those underrepresented in medicine, Lesbian, Gay, Bisexual and Transgender (LGBT) individuals, disabled individuals, and veterans. Interested candidates are invited to send their curriculum vitae to: Bernard L. Lopez, MD, MS, CPE, FACEP, FAAEM Executive Vice Chair, Department of Emergency Medicine


Exciting opportunities at our growing organization • Emergency Medicine Faculty Positions • PEM Faculty Positions • EM Medical Director • Vice Chair, Research

Penn State Health, Hershey PA, is expanding our health system. We offer multiple new positions for exceptional physicians eager to join our dynamic team of EM and PEM faculty treating patients at the only Level I Adult and Level I Pediatrics Trauma Center in Central Pennsylvania. What We’re Offering: • Salaries commensurate with qualifications • Sign-on Bonus • Relocation Assistance • Retirement options, Penn State University Tuition Discount, and so much more! What We’re Seeking: • Emergency Medicine trained physicians with additional training in any of the following: Toxicology, Ultrasound, Geriatric Medicine, Pediatric Emergency Medicine, Research • Completion of an accredited Emergency Medicine Residency Program and Fellowship for PEM positions • BE/BC by ABEM or ABOEM • Observation Medicine experience is a plus

What the Area Offers: We welcome you to a community that emulates the values Milton Hershey instilled in a town that holds his name. Located in a safe familyfriendly setting, Hershey, PA, our local neighborhoods boast a reasonable cost of living whether you prefer a more suburban setting or thriving city rich in theater, arts, and culture. Known as the home of the Hershey chocolate bar, Hershey’s community is rich in history and offers an abundant range of outdoor activities, arts, and diverse experiences. We’re conveniently located within a short distance to major cities such as Philadelphia, Pittsburgh, NYC, Baltimore, and Washington DC.


Heather Peffley, PHR FASPR at: Penn State Health is committed to affirmative action, equal opportunity and the diversity of its workforce. Equal Opportunity Employer – Minorities/Women/Protected Veterans/Disabled.


THANK YOU for being your best when things are seemingly at their worst Clinicians are our most valuable resource. Thank you for your tireless efforts and dedication to safe, high-quality patient care.

Find COVID-19 clinician resources at or call



Medical Toxicologist Opportunity

University of Southern California, Los Angeles, CA

The Department of Emergency Medicine at the Keck School of Medicine of the University of Southern California in Los Angeles, California, is seeking a talented board certified/board eligible Medical Toxicologist and Emergency Physician to join our faculty at Los Angeles County + USC Medical Center.

LAC+USC Medical Center is a 600 bed public teaching hospital and Level 1 Trauma Center, one of the largest and busiest public hospitals in the the United States. The 120 bed Emergency Department serves over 180,000 patients per year, providing care for a culturally diverse and largely underserved patient population.

Our Toxicology Division runs an active inpatient consult service and provides all toxicology education for the 4 year EM residency program, including a required PGY3 resident rotation. We are also the primary toxicology teaching site in Los Angeles, educating Emergency Medicine residents and Pediatric Emergency Medicine fellows from other regional programs. A unique feature of the USC Toxicology Division is that we also cover call for USC’s hyperbaric chamber, located just off the southern California coast on picturesque Catalina Island. Prior hyperbaric experience is not required; a training course in hyperbaric medicine would be provided.

We offer a competitive salary with protected time, a generous benefits package, academic appointment at Keck School of Medicine of USC, and a supportive infrastructure to promote research, clinical interests, and academic advancement.

The ideal candidate has a strong commitment to advancing toxicology education, a passion for clinical care, a dedication to working with vulnerable populations, and an interest in research.

For more information, please contact:

Fiona Garlich, MD

Assistant Professor of Clinical Emergency Medicine

Director, Division of Medical Toxicology

Department of Emergency Medicine

University of Southern California

cell: 612-325-8222


Clinical and Translation Science Fellowship Transforming clinical emergency medicine! Contact: Jean Baril at 508-421-1750 Email:

• Launch your career in research that directly impacts health systems, clinicians, and patients • Develop research skills essential to studying the translation of evidence based practices into routine care in emergency settings • Earn your Masters of Science in Clinical Investigation • Work with internationally recognized EM translation and implementation science mentors

Department of Emergency Medicine University of North Carolina at Chapel Hill, Department of Emergency Medicine is currently recruiting for full-time faculty openings for 2020-2021. Full-time faculty are currently being recruited with expertise in Administration, Research and Ultrasound. Successful applicants will be Board Certified/Board Prepared in Emergency Medicine. UNC Hospitals is a 950-bed Level I Trauma Center. The Emergency Department sees upward of 70,000 high acuity patients per year. Applicants should send a letter of interest and curriculum vitae to: Gail Holzmacher, Business Officer (, Department of Emergency Medicine, Phone: (919)843-1400. The University is an equal opportunity, affirmative action employer and welcomes all to apply without regard to age, color, gender, gender expression, gender identity, genetic information, national origin, race, religion, sex, or sexual orientation. We also encourage protected veterans and individuals with disabilities to apply.


WASHINGTON DC – The Department of Emergency Medicine at the George Washington University is offering Fellowship positions beginning July 2021: Clinical Research

Operations Research

Disaster & Operational Medicine

Simulation in Medical Education

Emergency Ultrasound

Sports Medicine

Health Policy

Telemedicine/Digital Health

International Emergency Medicine

Ultrasound for Family Medicine

Medical Leadership & Operations

Wilderness Medicine

Medical Toxicology

Wilderness & Telemedicine Combined Fellowship

Fellows receive an academic appointment at The George Washington University School of Medicine & Health Sciences and work clinically at a site staffed by the Department. The Department offers Fellows an integrated, interdisciplinary curriculum, focusing on research methodologies and grant writing. Tuition support for an MPH or equivalent degree may be provided, as per the fellowship’s curriculum. Complete descriptions of all programs, application instructions, and Fellowship Director contacts can be found at:

SUBMIT YOUR ANNOUNCEMENT! The SAEM Pulse Academic Announcements section publishes academic appointments, promotions, retirements, grant awards, research announcements, published papers, etc. Send your content (50-75 words max) to The next content deadline is August 1, 2020 for the September/October 2020 issue.

EM Jobs Now on SAEM Facebook Does your institution have an open position it’s looking to fill? Contact John Landry at 847-257-7224 or to add your name to the career widget on our SAEM Facebook page. Job seekers: Click on “Careers” on the left-hand menu of SAEM’s Facebook page to view recently posted jobs in academic emergency medicine.

Free CV Critique Did you know that EM Job Link offers a free CV critique service to job seekers? As a job seeker, you have the option to request a CV evaluation from a writing expert. You can participate in this feature through the CV Management section of your account. Within 48 hours of opt-in, you will receive an evaluation outlining your strengths, weaknesses and suggestions to ensure you have the best chance of landing an interview.

Job Alert! Are you looking for a job in academic emergency medicine? Create a personal job alert on EM Job Link so that new jobs matching your search criteria will be emailed directly to you. Make sure the perfect opportunity doesn’t pass you by. Sign up for job alerts today on EM Job Link by clicking on Job Seekers and then selecting Job Alerts. You will be notified as soon as the job you’re looking for is posted.


THANK YOU To our brave and dedicated emergency physicians, nurses, and other medical staff who are on the front lines answering the call to care for the most vulnerable in our society during this time of great need.