Category Archives: Emergency Medicine

Emergency Medicine

Over 550 Emergency Medicine Positions Unfilled in This Year’s Match – Medpage Today

In this year's Match, 555 positions in emergency medicine went unfilled -- more than double the 219 unfilled positions last year and only 14 unfilled spots in the 2021 Match, according to preliminary data.

This year's data were shared across social media but not officially by the National Resident Matching Program (NRMP), and most of the spots will likely be filled in the Supplemental Offer and Acceptance Program (SOAP). Nonetheless, emergency medicine physicians are concerned about the recent trend.

"It's a radical change," said Robert McNamara, MD, chair of emergency medicine at Temple University in Philadelphia and chief medical officer of the American Academy of Emergency Medicine (AAEM). "If you go back 3 or 4 years, emergency medicine was one of the most competitive specialties."

The reasons for the jump in unfilled positions -- the exact spots and programs were also posted on social media -- are multifactorial, according to a joint statement from several emergency medicine groups published on the American College of Emergency Physicians (ACEP) website. Reasons include workforce projections, increased clinical demands, emergency department boarding, economic challenges, the COVID-19 pandemic, the corporatization of medicine, and others.

"It's still a great profession, we just don't have the narrative we did 15 to 20 years ago," said Ryan Stanton, MD, an emergency medicine physician in Lexington, Kentucky, and an ACEP board member. "It's a negative narrative. We hear about struggles with payers, and threats of continued cuts. Students listen to that."

McNamara placed special emphasis on workforce issues -- in particular, a study by ACEP that warned of future challenges with emergency physician oversupply -- and on the increasing involvement of corporate entities.

"Emergency medicine residents always have among the highest debt of any specialty," McNamara said. "They have a strong sense of social justice and often don't come from privileged backgrounds ... so they're likely to accumulate debt."

Residents carrying a lot of debt who suspect they won't be able to get a job when they graduate may be deterred from entering the specialty, he noted.

Additionally, fewer graduates are finding placement with physician-owned groups, and instead more are working for corporate entities, which can impact physician autonomy, he added.

"Doctors who work for these companies don't like it," McNamara said. "They're burning out. They get treated like a money-making machine, like a cog in the wheel. ... Emergency medicine is a 24/7/365 specialty, and with the nature of the things we see, you can't do a difficult specialty long-term if you feel someone is taking advantage of you."

Facilities have created more emergency medicine residency spots in recent years, he pointed out, noting that, in a way, the specialty is a victim of its own success. "Once you attract talented doctors, you want more," he said. "Some hospitals say, wow, they have an emergency medicine residency, I want one too. We just created too many."

He said it's not just corporations pushing to create new positions, but academic centers as well.

Stanton was particularly concerned about the creation of new residency positions. "There are no guardrails on the number of programs, whether they're produced by HCA or the expansion of academic programs," he said. "You can open up a residency program as long as you meet ACGME [Accreditation Council for Graduate Medical Education] criteria."

"A residency program is not a cost-effective staffing strategy. It is an educational opportunity," he added. "Any program expanding simply to find a cheap workforce is doing it for the wrong reasons."

Bryan Carmody, MD, of Eastern Virginia Medical School in Norfolk, who posts frequently about Match data, noted in a blog post last fall that even while emergency medicine residency positions are up -- they more than doubled in the past 15 years -- the number of applicants took a significant dip last year, and fell again in this year's Match cycle.

"Regardless of why, the what is clear," Carmody wrote. "There are unquestionably fewer emergency medicine applicants. So the next question is, if you care about emergency medicine, what -- if anything -- should you do about it?"

In the joint statement, ACEP, AAEM, and others noted that they convened a Match Task Force to identify the factors that have led to the increase in unfilled positions, and to develop a strategy to mitigate the crisis.

"Although these are challenging results, emergency medicine remains a vibrant and appealing specialty for many, with almost 2,500 new trainees already joining the emergency medicine family," the group wrote.

McNamara said there are no easy solutions. "We have to restore emergency medicine to a practice where physicians can enjoy the job," he said. "It's not going to be good for a while."

Kristina Fiore leads MedPages enterprise & investigative reporting team. Shes been a medical journalist for more than a decade and her work has been recognized by Barlett & Steele, AHCJ, SABEW, and others. Send story tips to k.fiore@medpagetoday.com. Follow

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Over 550 Emergency Medicine Positions Unfilled in This Year's Match - Medpage Today

Emergency Medicine

Libyas Emergency Medicine and Support Center serves the people affected by the Turkeys Stricken Areas – EIN News

LIBYA, TRIPOLI, March 14, 2023 /EINPresswire.com/ -- The Emergency Medicine and Support Center (EMSC) is a specialist center responsible for the provision of humanitarian assistance, medical care, and relief aid to people affected by war and natural disasters, in addition to the treatment of wounded victims and providing healthcare to all with impartiality.

Upon the instructions of His Highness, the Prime Minister of the National Unity Government, EMSC strives to provide medical care and relief aid to people affected by Turkey's stricken areas. The EMSC worked, together with the National Safety Authority, the Criminal Investigation Department, the Medical Treatment Support and Development Agency, and the Military Medicine Division, to dispatch a joint team for relief and rescue consisting of 106 medical and paramedical personnel. The team is divided into four groups and serves as humanitarian assistance.

The first group was stationed in Adana province and was assigned the task of coordinating logistics and follow-up.

The second group stationed in Jumhoriet district, Antakya, and Hatay province also contributed to rescue operations. The group recovered 69 bodies and pulled out six people alive. The location of 380 bodies was also determined, and the relevant Turkish authorities were informed.

In all duration, coordinates were provided to the authorities and were used by other foreign agencies to recover the bodies.

The third group was stationed in the Hattay Field Hospital, where first aid, advanced medical aid, resuscitation, and minor operations were provided to more than 600 cases. The group was the only one that worked hand in hand with Turkish personnel.

In addition, the fourth group conducted a field investigation of cases in camps set up for the displaced people near the epicenter of the earthquake in Jumhorit, district of Hatay Province. The group provides treatment and medication to more than 40 patients inside the aforementioned camps.

About Emergency Medicine and Support Center:

The Emergency Medicine and Support Center (EMSC) is a specialist center that provides services for the provision of humanitarian assistance, medical care, and relief aid to people affected by war and natural disasters such as flood disasters and earthquakes. Additionally, to the treatment of wounded victims and providing healthcare to all with impartiality. Consequently, the Libyan team, which consists of EMSC personnel, focuses on the treatment of Syrian cases as well as Arabic-speaking Turkish patients and other cases in general.

http://emsc.ly/

Tarek ElhamsharyEmergency Medicine and Support Centeremail us here

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Libyas Emergency Medicine and Support Center serves the people affected by the Turkeys Stricken Areas - EIN News

Emergency Medicine

In rural Mississippi, E.R. staff are being trained to care for moms and deliver babies – WBHM

Two medical teams wait patiently in the hallway outside of a hospital room at theMississippi Center for Emergency Servicesat the University of Mississippi Medical Center in mid-February. Its quiet as they slip on blue gloves and consult with their team on tasks. One will help the mother. The other will receive the baby.

Dr. Tara Lewis presents todays patient and students listen carefully as she lays out the scenario, making note of the patients age, symptoms and whats missing from her chart. Then, as the patient Victoria Tubby screams through the door, they ready themselves. Its time to deliver a baby.

But this is no ordinary hospital room, and Victoria is no ordinary patient. For starters, shes not a real person. Shes a high-tech mannequin that simulates a woman in labor. She bleeds, screams and has a removable belly and placenta.

And the delivery of her baby a slippery, 5-pound doll is all part of aSTORK training simulationunderway at MCES.

As hospitals in rural Mississippi continue to cut maternal and neonatal services, residents are strapped to find options in an emergency like going into labor. The STORK programlaunchedin May to prepare paramedics and health care providers for those rising gaps in care.

Lewis, an emergency medicine physician, said the response to STORK has been overwhelmingly positive. At its creation, the plan was to teach 10 classes in a year, but demand turned it into two per month. By the end of the programs first year, more than 400 people will have attended a STORK session, whether at the MCES or at a hospital across the state.

The training had real-world effects almost immediately.

Weve had people reach out to us that we have trained that have delivered babies the next day in their E.R., Lewis said.

Giving birth in an emergency room doesnt seem ideal for most mothers, but across the Gulf States, hospitals have had todownsize, opting to preservecritical careover maternity care and leaving pregnant people to rely heavily on emergency services. Over the past year,as many as four hospitalshave suspended labor and delivery services the most recent being Singing River hospital in Gulfport, Mississippi.

We see people having to drive two to three hours to get obstetric health care in the Delta specifically, Lewis said.

Most of the Mississippi Delta qualifies as amaternity care desert, according to the latest March of Dimes report meaning there are barely any obstetric providers for mothers in the region. Mississippis poor health care system also affects babies. With only one childrens hospital in the entire state, even patients with the least critical care needs can expect to travel hundreds of miles.

Adam Bandy, whos part of the pediatric transport team at MCES, said long ambulance trips are common and his job can take him into some deeply rural areas.

Make sure you pack your lunch because were probably going to be gone for 5 to 6 hours on this trip, Bandy said. Thats a routine trip. Thats not if theres any kind of complications or if we have to provide any kind of next level of care.

Bandy points to hub cities, such as Jackson and Hattiesburg as having adequate facilities for patients, but in places like Greenwood or Gulfport, sometimes the nearest hospital with a pediatric unit isnt in the state.

Well go to Louisiana, Alabama [and] Tennessee on occasion, and we will transfer either from here to there, or we will bring them from there for resources since Jackson has the only childrens hospital in the state of Mississippi, he said.

Those resources can be hard to come by, so STORK provides each participant with a duffle bag packed with supplies to deliver a baby or stabilize a laboring mom. If the paramedic uses anything in the bag, STORK will replace it.

Bandy was present at the February STORK training, but it isnt his first time completing the course. He said its vital to keep those skills sharp. Lewis said STORK gives health care providers the opportunity to practice skills they may not use daily. The class is made up of paramedics, flight medics, and nurses, many of whom have never had to deliver a baby.

Before the simulation, students attend a lecture to learn how to stabilize a patient, stop a hemorrhage and intubate an infant emergency procedures that could mean life or death.

In the hospital room, they pay special attention to Victoria and check her and her babys vitals on a large screen. Victoria is responsive and offers feedback to her providers while they work. She can be affirming and grateful that theyve gotten the baby out, or can be difficult, yelling out dont touch me! She sometimes goes into shock, and its a scramble to then bring her back, but participants can practice as many times as they want.

She can simulate things like seizures, postpartum hemorrhage, pre-eclampsia, abnormal presentation of the baby, Lewis said. She does it all.

Students practice multiple best- and worst-case scenarios, offer fluids and medicine and support Victoria through labor. Everyone keeps a watchful eye to help her safely deliver her baby.

You can actually get your hands on it and catch a baby and do it multiple times because that repetition kind of helps educate people, helps you get that just muscle memory of what to do, Lewis said.

This story was produced by theGulf States Newsroom, a collaboration betweenMississippi Public Broadcasting, WBHMin Alabama,WWNO andWRKFin Louisiana andNPR. Support for reproductive health coverage comes fromThe Commonwealth Fund.

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In rural Mississippi, E.R. staff are being trained to care for moms and deliver babies - WBHM

Emergency Medicine

Grit and Goals: DFCM Resident Dr. Hayley Wickenheiser on the … – University of Toronto

After a storied hockey career that culminated in being inducted to the Hockey Hall of Fame, Hayley Wickenheiser pursued another childhood dream: becoming a doctor. She traces her interest in the medical field to her youth, when one of her friends was badly injured after being hit by a truck. There were 30 kids in our neighbourhood, and wed go as a pack to check on her. I remember the doctors and nurses being very kind. We were little and they made it less scary for us. It was at that point that I got a real interest in medicine, says Wickenheiser, who is in her second year of residency at the Department of Family and Community Medicine at the University of Toronto.

Wickenheiser was named to the Canadian womens national ice hockey team at the age of 15 years, but despite being laser focused on the sport during her young adulthood, she felt a pull toward medicine. I always knew I needed a life after hockey and thought that would be a good one, says Wickenheiser, who is training to become an emergency medicine physician.

She will begin her enhanced skill year in emergency medicine at DFCM in July 2023. Wickenheiser says she chose to do her residency at DFCM because of the wide breadth of topics learned and for generalist training that would allow for maximum flexibility in her career. Against a backdrop of fewer graduating medical students ranking family medicine as their first choice when applying to residency, Wickenheiser says she is very happy with her decision. Family medicine is touted as less'sexy' than specialist training, but I think it's the best kept secret in medicine and one of the most underrated routes to choose. I have zero regrets about choosing DFCMit's been amazing. From awesome professional development to preceptor teaching, it's really a choose-your-own-adventure at times. I like that.

After announcing her retirement from the sport in January of 2017, she began medical school that same year at the University of Calgary. The transition was eased by years of preparation. For close to a decade before her retirement, Wickenheiser shadowed an emergency department doctor, which helped her realize her affinity for the specialty. I dont do well sitting all day long, she says. She is quick to rattle off the things that drew her to emergency medicine: Every patient encounter is different. You have to think quickly, work in a team and be very good under pressure. It feels very much like a team sport.

At that point, Wickenheiser, who is widely regarded as the greatest female hockey player of all time, thought she would be done with the sport. Then the Toronto Maple Leafs called a few months into medical school, she says, with a laugh. As an assistant general manager for the Leafs, Wickenheiser oversees 11 staff members and is responsible for the development of not only the franchise players, but of prospects and players from the Toronto Marlies and affiliate Newfoundland Growlers. My job is to make sure its a high-functioning department where were helping the players both on and off the ice to maximize their potential and get them prepared to be successful NHL players. If they already are a successful NHL player, then help them find that one per cent here and there that can elevate their game, she says.

Her workday varies depending on her clinical responsibilities, but in general, she wakes up early and heads to the rink for a workout or because of her duties with the Leafs. If she is doing a family medicine rotation, then she will work an afternoon or evening clinic. If she is doing a hospital-based shift that runs from 8 a.m. until late afternoon, then she will adapt her schedule accordingly.

Wickenheiser says the parallels between sport and medicine are striking. Everything I learned in hockey, I use every day, says the four-time Olympic gold medallist. Medicine is a team game. Youve got to think on your feet. Youve got to handle stress. Youve got to be physically at your best. She also says that using constructive criticism to enhance performance is another common theme. In medicine, youre being told what you need to improve on all the time. Being able to handle that in a productive way is very important to your development as a physician.

One big difference between these two worlds, however, has to do with self-care and wellness. As an athlete, youre celebrated for taking care of your body. In medicine, sometimes it feels like that should be the last thing you should be doing as a physician taking care of everyone else. I think its counter intuitive. Its something I think medicine has to get a lot better at, she says.

When asked what motivates her to stay on this difficult path, Wickenheiser, who grew up on a farm in rural Saskatchewan, says hard work is part of her identity. I dont think of myself as overly smart or special in any way, but one thing I hang my hat on as an athlete and what I do in medicine, is that Im confident I can outwork just about anyone. Its the one thing I know I can control in my life even when there are other things happening that I cant. You can always control your effort.

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Grit and Goals: DFCM Resident Dr. Hayley Wickenheiser on the ... - University of Toronto

Emergency Medicine

Quick take: Head-up CPR, drones and hypothermic emergencies – EMS1.com

BOSTON The 30th annual National Collegiate EMS Conference was held February 24-26, 2023, in Boston. The conference included 13 workshop sessions, three plenary sessions, an academic poster session, hands-on skills labs, student lecture competition, BLS and ALS competition, and several social and networking functions for over 1,200 registrants from 112 colleges and universities across the United States and Canada.

Annual awards were presented to recognize outstanding achievement by collegiate EMS organizations and individuals, including:

Following are takeaways from several conference sessions.

Presented by N. Alex Cutsumbis, BS, NRP, a graduate of the SHRS Emergency Medicine Program, and an instructor for the University of Pittsburgh and Center for Emergency Medicine paramedic education programs

The idea behind heads-up CPR came about after analyses of the impact of CPR when tilting the body. It was found that contrary to expectations, head-down CPR outcomes were poor. It was theorized that tilting the head down would increase blood flow to the heart and brain from the force of gravity. What was found in animal experiments was that tilting the head down increased intracranial pressure and decreased cerebral perfusion pressure. By tilting the head up for CPR, the ICP fell and cerebral perfusion pressure increased by statistically significant levels. Long-term outcomes were improved.

Elevated CPR is performed with an impedance threshold device and using mechanical cardiopulmonary resuscitation with a device to elevate the head and thorax. A few EMS systems have been engaged in studies and Baptist Health became the first U.S. hospital system to adopt heads-up CPR.

Studies have been conducted on animals and in EMS systems, and there are some conflicting results. Results include an increase in cerebral blood flow, lower ICP pressures, and increased cerebral perfusion pressure. Generally, the studies have been finding a higher probability of ROSC and favorable neurological outcomes. More research is needed.

Presented by J. Dominic Singh, BA, NRP, I/C, staff advisor to UMass Amherst EMS, chief of operations for Spencer EMS, and a career firefighter/paramedic for Amherst Fire

Non-transporting EMS is common among organizations such as fire departments, quick response services and events EMS. Collegiate EMS often provides services to support sports, concerts and other campus activities not requiring transport services. Some of the considerations for non-transporting EMS include the gear needed, scene planning and planning for egress.

Gear considerations consist of managing immediate life threats and stabilization of the patient, (e.g., stop the bleed and airway supplies). Consider lightweight equipment, including handheld suction rather than electric suction pumps. A pulse oximeter with plethysmograph is handy to have. Gear should be portable as a fully stocked ambulance is not necessary for patient stabilization. Scene planning is important and based on the venue. Preplan egress to move a patient with consideration given for narrow stairs, tight hallways and other unique features found in the venue.

Presented by Tom Leith, AB, a fourth-year medical student at the University of Michigan

Drones and unmanned aerial vehicles (UAVs) are becoming more common with both hobbyists and in public safety. In addition to being used for video and surveillance, drones are being used to deliver equipment and supplies to the scene of an incident. As more advanced drones are developed, they may be used to transport patients in the future. Some of the items being delivered by drone include AEDs and medications. Delivery can be made to lay rescuers on the scene of an incident, to rural areas, for disaster medicine, and to remote areas in wilderness EMS and search and rescue. Use of drone delivery is low cost with potentially high reward. Studies suggest that improved delivery times can lead to improved quality of life years. Drone delivery of AEDs can be more flexible than fixed-point public access AEDs.

Responders in remote locations may not be able to carry an exhaustive supply of different medications. With the increase in opioid overdoses, one medication that can be delivered by drone is naloxone. Other medications that can be delivered as needed include benzodiazepines for acute seizures and blood. Rwanda is using drones to deliver blood. In search and rescue, drones can deliver food, water, clothing, shelter and rope rescue gear. Drones are also used for surveillance, including finding people in wildfires, in avalanches, and for maritime rescue using imaging and following radio transceiver signals.

Presented by Benjamin Abo, DO, P, EMTT, FAWM, an emergency physician and toxicologist, and assistant professor for Florida State University School of Medicine

The traditional infographics and posters for heat and cold injuries do not give complete information and can be misleading. For example, heat stroke should not be defined as when a persons body stops sweating and is red and dry. Heat stroke occurs when there is an altered mental status and high body temperature. Cooling on the scene before transporting the patient is critical to survival. One way this can be performed is through cold water immersion rather than simply placing ice packs in the armpits and on the groin. Use the body bag from the ambulance with bags of ice from a convenience store. Fill the body bag with ice and water from a fire hose. Stop the hyperthermic process and then transport the patient. Hypothermia, likewise, should be treated aggressively. Patients will lose core body heat through convection and to the ground through conduction. They need to be warmed up!

The annual NCEMSF conference is held the last weekend of February and rotates among several cities. Check http://www.ncemsf.org/conference for announcements for next years conference location, information on presenting and registration. Vendors, exhibitors, graduate medical and health school programs, and alumni are always welcome.

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Quick take: Head-up CPR, drones and hypothermic emergencies - EMS1.com

Emergency Medicine

Opinion | Emergency Doctors Are Ill Prepared to Handle Psychiatric … – Medpage Today

More than four decades ago, an article appeared in the American Journal of Psychiatry defining the subspecialty of emergency psychiatry (EP). Since those early days, despite some research and consolidation into a new association complementing emergency medicine (EM), the impact on meaningful access to, integration with, and quality of care for psychiatric emergencies has been inconsequential.

In point of fact, one of the factors impeding progress in EP has been, in my opinion, the lack of momentum from the very entity professing support of the critically mentally ill.

Although the American Board of Psychiatry and Neurology offers 15 psychiatric subspecialty certifications, EP is not among those accredited core areas approved by the Accreditation Council on Graduate Medical Education (ACGME). Furthermore, the current ACGME EM residency program requirements do not specify that programs ensure residents have ample experiences treating psychiatric patients. Yet, the majority of EM residents believe, as do their psychiatric counterparts, that their program should offer more education on managing psychiatric emergencies.

Based on these unsettling facts, it appears that EM, as well as psychiatric residents, are expected, in the face of adverse clinical and supervisory experiences, to develop competent skills in treating psycho-behavioral conditions through onthejob training in the ED. Good luck.

Over the last 4 years, I have written about behavioral health emergencies including the simultaneous impacts of unusual presentations, inadequate assessments, stale methodologies, violence against staff, pandemic lockdowns, anaphylactic suicide, and an equation for suicidal lethality. I have introduced an American College of Emergency Medicine (ACEP)-specific and Centers for Medicare & Medicaid Services (CMS) supported algorithm for consistent improvements in risk medical decision-making with revenue cycle management benefits. I have emphasized that the number of behavioral emergency chief complaints, now estimated to be one in every seven patients of approximately 140 million annual U.S. ED admissions, demands competent triage, admirably fast stabilization, and staff safety. These collective educational and protective factors against increasing patient and ED violence, boarding, and burnout cannot be understated.

Clearly, the pathway to positive change in EP is a noble goal from afar, but oh what a mess we've made. The need to address the current U.S. mental health crisis and to climb to even higher levels of workforce supply and proficiency is considerable. But is it too little too late? In other words, is the opportunity for significant change in youth and adult mental healthcare going, going, almost gone?

It is now sadly possible to paraphrase the inimitable Yogi Berra's baseball imagery from "It is getting late early" to "It is now very late early."

The Demand Crisis

Dwindling Supply Coupled With Inadequate Proficiency

Suggestions

It is essential to establish psychiatric emergencies as the legal and medical equivalent of medical emergencies, advocate for ACGME accreditation of current and new EP fellowships, and promote improvements in resident recruitment and training. Clearly, readily available EP expertise represents both a need for the community and advancing the field, but it remains haphazard. Beyond these steps, how do we advance prompt practical ED solutions to meet some of the crisis demands outlined above?

Past recommendations have been plentiful but far less than promised. The following are two innovative paths with direct, measurable, judicious impacts on demand and proficiency.

First, community EDs, with EP input, must immediately integrate risk triage training with local schools, including universities. Combined workshops could address the current ED psychiatry crisis and the overwhelmed mental health system thus improving the balance of patient and hospital consequences to benefits. Increasing awareness of skills required and challenges experienced in respective settings could encourage crosstalk preventative strategies, innovative diagnostic adeptness, and personalized care with timely follow-up and safety benefits.

Second, CMS has, at long last, incentivized behavioral healthcare that focuses on high-risk populations. Implementation of research supported and EP practiced AI ICD-10/CPT coding provides improved provider and hospital revenue benefit. Specifically, ACEP triage guidelines will be available where and when needed. Medical decision-making using social determinants of health on risk underscores non-stigmatizing benefits including staff satisfaction, ED flow efficiencies, and patient safety.

In summary, over 30% of persons who die by suicide are treated in an ED, outpatient specialty, or primary care 7 days prior to death. Undoubtedly, it is only access to competent EP care -- not ED or community care alone -- that holds the potential for transformative, realistic reduction in suicide rates beyond annual Zero Suicide and CDC aspirational projections. These patients deserve definitive care. EP physicians, fellows, and non-EP clinicians deserve excellent support.

Russell Copelan, MD (Ret.), lives in Pensacola, Florida. He graduated from Stanford University and UCLA Medical School. He trained in neurosurgery and completed residency and fellowship in emergency department psychiatry at UC, Irvine and University of Colorado, Denver. He is a reviewer for Academic Psychiatry and founder of eMed Logic, a non-profit originator and distributor of violence assessments. Copelan is also a presenter for the National Association of School Psychologists (NASP) Speaker's Bureau, and a consultant to the American Association of Suicidology.

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Opinion | Emergency Doctors Are Ill Prepared to Handle Psychiatric ... - Medpage Today

Emergency Medicine

ACR, ACEP announce landmark recommendations for addressing actionable incidental findings – Newswise

Newswise Washington, DC (March 13, 2023) The American College of Radiology (ACR) and the American College of Emergency Physicians (ACEP) released new landmark recommendations to help health systems, physicians and other clinicians improve patient outcomes by addressing actionable incidental findings (AIFs) in emergency department imaging.

There were more than 150 million emergency department visits in the United States in 2019. Radiologic imaging was performed in more than half of these encounters.[1] AIFs, defined as masses or lesions, detected by an imaging examination performed for an unrelated reason, are often encountered. However, the reporting and communication of these findings can be challenging.

Unlike other specialties, emergency physicians focus on addressing a patients possible life-threatening conditions and are less directly involved in follow-up care, said Susan E Sedory, MA, CAE, Executive Director and CEO of ACEP. Partnerships at the national and local level can enhance information sharing to help ensure all patients receive the ongoing, quality care they need.

The white paper, Best Practices in the Communication and Management of Actionable Incidental Findings in Emergency Department Imaging, published in the Journal of the American College of Radiology, concentrates on four areas of consensus between the specialties: 1) report elements and structure; 2) communication of findings with patients; 3) communication of findings with clinicians; and 4) follow-up and tracking systems.

Strong communication and collaboration between clinicians when addressing actionable incidental findings is key to providing optimal patient care and preventing adverse outcomes, said William T. Thorwarth Jr., MD, FACR, CEO of ACR. The recommendations created by ACR and ACEP highlight a multispecialty effort between radiology and emergency medicine that aim to improve the reporting and communication of AIFs, which will ultimately benefit the patient.

Radiologists are committed to working with our emergency department and primary care colleagues to improve follow up for incidental findings, said Gregory Nicola, MD, FACR, chair of the ACR Commission on Economics. This is a team effort to ensure that we implement and maintain these recommendations to help us provide the best possible care for patients before, during and after they visit the emergency department.

Imaging is an integral part of emergency care, and incidental findings with recommended follow up are common, said Christopher L. Moore, MD, professor of emergency medicine, Yale School of Medicine. Collaboration between emergency medicine and radiology and a systems approach are essential to ensure that actionable incidental findings dont fall through the cracks. We are proud to have brought together a diverse group, including radiologists, emergency physicians and patient advocates to develop and define best practices to address AIFs.

The recommendations listed in the white paper are meant to be best practices and are not standards.

# # #

About the American College of Radiology

The American College of Radiology (ACR), founded in 1924, is a professional medical society dedicated to serving patients and society by empowering radiology professionals to advance the practice, science and professions of radiological care.

About the American College of Emergency Physicians The American College of Emergency Physicians (ACEP) is the national medical society representing emergency medicine. Through continuing education, research, public education, and advocacy, ACEP advances emergency care on behalf of its 40,000 emergency physician members, and the more than 150 million people they treat on an annual basis. For more information, visitwww.acep.organdwww.emergencyphysicians.org.

[1] Rui, P. & Kang K. National Hospital Ambulatory Medical Care Survey: 2017 emergency department summary tables. 37 (2017).

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ACR, ACEP announce landmark recommendations for addressing actionable incidental findings - Newswise

Emergency Medicine

Men Over 65 at Greater Risk than Women of Skull Fractures from Falls – Florida Atlantic University

Each year, more than 3 million people ages 65 and older are treated in emergency departments for fall injuries.

Each year, more than 3 million people ages 65 and older are treated in emergency departments for fall injuries. Head trauma is the leading cause of serious injury with skull fractures being reported as a serious outcome. According to the 2016 National Trauma Database annual report, females account for 58 percent of these falls.

Because geriatric females have an increased rate of falls and facial fractures, determining if they also are at an increased risk of skull fractures is crucial. Currently, research is sparse on the prevalence of skull fracture due to head injury in this population. Moreover, there is an overall lack of research concerning head injury management guidelines among the geriatric population.

Researchers from Florida Atlantic Universitys Schmidt College of Medicine conducted a study to assess and compare the risk of skull fracture secondary to head trauma in female and male patients ages 65 and older. They prospectively evaluated all patients with head trauma at two level-one trauma centers in southeast Florida serving a population of more than 360,000 geriatric patients.

For the study, researchers examined skull fracture due to acute trauma and compared them by sex as well as patient race/ethnicity and mechanism of injury. Among the 5,402 patients enrolled, 56 percent were female, 44 percent were male. Eighty-five percent of the head injuries sustained were due to falls, and this trend also was seen across race/ethnicity and mechanism of injury. Both females and males had a similar mean age, 82.8 and 81.1 years, respectively.

Results of the study, published in the American Journal of Emergency Medicine , showed that when comparing geriatric males and females, males had a significantly increased incidence of skull fracture secondary to head trauma, due mostly to falls. This outcome was unexpected, as previous research has indicated females are more susceptible to facial fractures. This trend also was seen across race/ethnicity, though results were only statistically significant for whites.

The high incidence of head injury and subsequent skull fractures due to falls is a cause for concern as our aging population continues living active lifestyles, said Scott M. Alter, M.D., first author, associate professor of emergence medicine, and assistant dean for clinical research, FAU Schmidt College of Medicine. As falls caused the greatest number of head injuries and subsequent skull fractures, fall prevention may be an important intervention to consider in reducing morbidity. Although fall prevention education can be addressed in the primary care setting or at assisted living facilities, the emergency department could also represent an opportunity to educate patients and to prevent future death and disability from falls in this population.

Study co-authors are Michelly R. Gonzalez; FAU medical student; Joshua J. Solano, M.D.; associate professor of emergency medicine and clerkship director; Lisa M. Clayton, D.O., chair and associate professor of emergency medicine and program director, emergency medicine residency; Patrick G. Hughes, D.O., associate professor of emergency medicine and associate program director, emergency medicine residency; and Richard D. Shih, M.D., professor of emergency medicine, all within the Department of Emergency Medicine, FAU Schmidt College of Medicine and Delray Medical Center.

This research was funded by a grant from the Florida Medical Malpractice Joint Underwriting Association awarded to Shih as the principal investigator.

-FAU-

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Emergency Medicine

Ousted WHO Official Takeshi Kasai Has Background in Emergency … – The Japan News

AP file photoTakeshi Kasai addresses the media in Manila on Oct. 7, 2019.

&The Yomiuri Shimbun

16:28 JST,March 9, 2023

Ousted World Health Organization official Takeshi Kasai is a doctor with a background in emergency medicine and an expert in infectious diseases and health crisis management.

Kasai has been dismissed from his post as director of the WHOs Western Pacific Regional Office over allegedly racist behavior, He joined the WHO after working at the then Health and Welfare Ministry.

He released a statement after allegations about racist and abusive misconduct emerged, saying that he never targeted employees of a particular nationality, although he acknowledged being hard on staff. Kasai also denied the accusation that he leaked confidential information.

Excerpt from:

Ousted WHO Official Takeshi Kasai Has Background in Emergency ... - The Japan News

Emergency Medicine

5 things we could do right now to ease ER overcrowding (Guest Opinion by Dr. John B. McCabe) – syracuse.com

John B. McCabe, M.D., FACEP, is professor/chair emeritus at Upstate Medical University. In 1987, McCabe was the only physician in Syracuse trained in emergency medicine. He was the first chair of the Department of Emergency Medicine at Upstate, and he practiced and taught emergency medicine in CNY for over 30 years. He has served as CEO at University Hospital and as president of the American College of Emergency Physicians. In retirement, he is the medical director for CAVAC, the Cazenovia Area Volunteer Ambulance Corps, and he volunteers as an ambulance driver, frequently bringing patients to all area hospitals.

Reporter Jim Mulders recent article (Syracuse emergency rooms are jammed, dirty and frustrating; waits are among worst in U.S., Feb. 27, 2023) and the editorial board opinion (ERs are in crisis in Syracuse and across US. When will Washington act? March 5, 2023) described the horrific state of affairs of the emergency departments in Syracuse hospitals.

Unfortunately, Mulder presented an accurate view of ERs that are overcrowded, dirty and chaotic. There are too few staff who, frustrated in their inability to deliver the care they know would be best for patients, may seem uncaring. At the same time, frustrated and angry patients are either waiting to be seen by a doctor or waiting for the hospital bed they have been promised. Patients feel lost in the system.

The inability to care for patients in a timely manner and to move them to an appropriate hospital bed, resulting in severe overcrowding, is not an ER problem. It is a problem of hospital operations and system-wide dysfunction.

There is no simple solution, nor a solution that will change things overnight. The editorial board makes the case for federal, congressional and presidential action. While reasonable, none of these levels of government will yield near-term results. Similarly, the states push for workforce development, although necessary, is the beginning of a training pathway that will take years.

Let me suggest several actions that could make a difference:

1. We could change existing state regulations to allow nursing staff to initiate appropriate diagnostic studies and basic ER treatments before evaluation by a physician. Such decision-making would be based on complaint-driven protocols, a common practice in many states. This change would allow earlier initiation of care, helping to speed patient throughput and improve waiting room conditions. Such a change should be a high priority for state lawmakers and regulators.

2. Hospitals could improve the speed and access to care by ensuring that all medical, surgical, ancillary and support services are available 24/7. With ER overcrowding, it is hard to accept that a patient in a hospital bed, ready to be discharged to home or to a long-term care facility, waits for days to receive a diagnostic study, a piece of durable medical equipment, a specialty service consultation, a home care referral or a needed pharmaceutical treatment.

The same can be said for facilities that receive patients discharged from hospitals. No patient who is ready to go to a nursing home on Friday afternoon should wait in a hospital bed until the following week for transfer.

3. Severe overcrowding does not happen suddenly. It can be anticipated. Previously, Central New York hospitals used an objective scoring system (National Emergency Department Overcrowding Score, or NEDOCS) to regularly assess the state of overcrowding in the ER. Such an objective score should be linked to a written plan that determines how hospital operations will adjust as the ER gets more and more crowded.

For instance, the number and function of social workers, discharge planners, bed supervisors, transport staff and physician staff need to change as crowding worsens. Means to alert the entire system to worsening overcrowding must result in an all-hands-on-deck approach that more quickly moves patients through the system to discharge or transfer. All hospitals should have a mechanism to communicate the status of their ERs to the public, so that patients and their physicians can make informed decisions, in real time, about going there for care.

As another example, hospitals should implement systems to efficiently move ER hallway patients to other hospital locations. While awaiting inpatient beds, such patients could be moved to defined hallway spaces on each inpatient unit. What seems better for the patients: 20 patients waiting for beds in ER hallways, or one or two patients in hallway beds, awaiting a room, on each inpatient floor?

Administrators must be prepared, at times, to make the hard decision to cancel profitable elective admissions or surgeries to free beds and ease ER overcrowding. They should be prepared to utilize preoperative, postoperative and other non-ER spaces to accommodate the overflow of ER patients.

Hospitals can change the mindset in implementing disaster plans. If 20 patients were to show up suddenly from a bus crash or a mass shooting, the disaster plan would kick in, with extra staff and resources being made immediately available to the ER. Why should the presence of 20 sick patients waiting for inpatient beds, in a congested and overrun ER, result in any less of an aggressive approach to care for them?

4. In addition, the physician community as a whole must bear some responsibility for ER overcrowding and must be a part of any viable solution. Many physicians have focused on outpatient care, not on the care of hospitalized patients. Some physicians choose not to cover the ER, as they used to, and not to provide specialty consults on hospitalized patients, as they used to.

With the emphasis on office care, physicians in the community should rethink the all-too-common response of go to the ER when their patients call with health complaints. While perhaps the easiest answer, going to the ER may not be the best approach for an individual patient, for the hospital, or for the ER staff.

Community specialists and subspecialists should recommit to being active partners in systems that deliver comprehensive and timely response for the evaluation, management and disposition of ER patients. It is unreasonable for commonly needed physician specialties, who are plentiful in the community, to be unavailable to patients in our ERs or inpatient units (as noted for GI/ endoscopy services in Mulders article).

5. The typical response of we have no money and no staff doesnt fix anything. Solutions must be found with policy change, creative staffing, innovative thinking, hard decisions, and prioritization of ER care.

This is where healthcare insurers and federal and state governments must step up. These community and civic leaders must realize that the funding decisions they make have real consequences in ER hallways and exam rooms and on the floors of hospitals and nursing homes.

As CEO, I often commented that people in CNY didnt always realize the breadth, depth and quality of medical services available locally. The current circumstances in the ERs are preventing patients from receiving this quality care in a timely manner, if at all.

Finally, as troublesome and difficult as ER overcrowding is for patients, this situation is also grossly unfair to the dedicated ER staff who struggle every day with inadequate resources and poorly functioning systems to provide care to our most needy and vulnerable populations.

It is time for a concerted effort to fix this problem for our patients and for our healthcare professionals.

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5 things we could do right now to ease ER overcrowding (Guest Opinion by Dr. John B. McCabe) - syracuse.com