Free Book Chapter on Infectious Diseases Available to ACEP Members

As relieved as we are that the Ebola outbreak appears to be limited and less of a daily concern in our emergency departments, we do still remain on alert for the outbreak of other infectious diseases. It’s been very gratifying to see several ACEP members who are subject matter experts in infectious disease step up and help us create the resources we’ve posted on ACEP.org for the entire emergency medicine community. Among those experts are Kristi Koenig and Carl Schultz from the University of California at Irvine. They’re working on a new edition of their book on disaster medicine and realized that the chapter on emerging infectious diseases would be very useful to us all right now. As they said,

“The emergency health care system must be prepared for an evolving public health event of international significance such as this. Emergency physicians are on the front lines and should be knowledgeable, up-to-date, and ready to effectively manage infectious disease threats. It doesn’t matter whether such threats arise from Ebola virus disease, Enterovirus D-68, MERS-CoV, SARS, the 2009 H1N1 pandemic, or the next big event, as yet unnamed. We should be leaders in our hospitals, EMS systems, and communities, advocating for protection of the public health, our patients, and colleagues.”

Kristi and Carl have donated a preliminary electronic draft of that chapter to the College – to all of you, really – as a resource to help you and your team prepare to screen for and treat the wide range of infectious diseases any of us could see any day of the week.

Just follow this link to download the chapter now.

Best wishes to you all, and be well. We hope to see you next week in Chicago for ACEP14.

Sincerely,

Alex M. Rosenau, DO, CEP, FACEP
ACEP President

Micahael J. Gerardi, MD, FAAP, FACEP
ACEP President-Elect

ACEP President: College Offering Several Ebola Information Initiatives to Health Care Professionals

Dr. Alex M. Rosenau

Dr. Alex M. Rosenau

With so much information and speculation being circulated about Ebola presentations in the United States, I want you – our members – to know what your College is doing on this issue.

The landscape about treatment and containment of this infectious disease is changing minute by minute. ACEP has been working in many ways to filter the information and provide you with a trusted source of updates. We also have many initiatives planned for next week, next month and beyond as we continue to help you in these challenging times and be a supportive advocate for our specialty and our patients. Advocating for your safety and making sure you have everything you need are our most important goals.

Here are some of the things we are doing:

Expert Panel

  • Immediately convene a panel of 8 emergency care infectious disease experts.
  • Review materials pertinent to emergency care for dissemination to members.
  • Respond to questions posted by members via an easily accessible form on the www.acep.org/ebola resource page.
  • Develop repository of best practices for managing the patient with suspected and confirmed Ebola and work with CDC, WHO, and other federal, state and local agencies to develop protocols that can be implemented in hospitals with limited resources. Update the content regularly.

Resources on ACEP Website

  • Consolidation of pertinent resources, including those from the Expert Panel, on www.acep.org/ebola with frequent updates.
  • Continue to promote availability of resources through social media, e-newsletters and other communication vehicles.

Advocacy Agenda

Identify short and long-term legislative initiatives designed to assist our members and other health care providers to enhance their disaster preparedness:

  • Advocate for regionalization protocols
  • Enactment of trauma systems/emergency regionalization legislation
  • Funding of a national grid of bio-containment hospital annexes,
  • Increase funding for disaster preparedness
  • Increase supplies of PPEs
  • Additional resources for training and retention of first responders
  • Good Samaritan liability protection for first responders in a national emergency

Communications with Members

  • EM Today curates the media daily for a round-up of the most pertinent articles and editorials.
  • Immediate dissemination of important information through social media, e-newsletters and stand-alone messages.
  • Section listservs include the latest updates and guidelines from CDC to some of the most impacted sections – Air Medical Transport, Disaster Medicine, EMS-Prehospital Care, and Tactical Emergency Medicine.
  • EMS Committee review of CDC guidelines to consider operational ‘suggestions’ on meeting the requirements or model practices.

Communication with the Public and the News Media

  • Linking reporters with ACEP experts in infectious disease and disaster preparedness. ACEP is managing 10 to 20 calls a day from reporters on this issue. (a round-up of ACEP spokesperson in the news can be found at http://www.acep.org/Content.aspx?id=80956)
  • Coordinated editorial about Ebola response for ACEP President Dr. Alex Rosenau published in USA Today.
  • Developed talking points for use by ACEP spokespersons to conduct press interviews.
  • Using responses from ACEP infectious disease and preparedness experts to craft public messages.

Educational Opportunities

  • New course on Ebola infection and emergency department response added to ACEP14 — “Ebola: Hemorrhagic Fever and the U.S. Experience” will be presented Tuesday, October 28, during ACEP14, the world’s largest meeting of emergency physicians.
  • ACEP14 Ebola Courses – Three presentations from ACEP14, October 27-30, will be captured live and presented as free courses in ACEP eCME, the College’s online and mobile education platform to members and other EM colleagues. Each of the three courses will have a pretest, an audio and slide presentation of the lecture as it was delivered live in Chicago, and a post-test. Each of the courses also is approved for AMA PRA Category 1 Credit.™The courses are:
    • Inside the Hot Zone: Highly Infectious Pathogens in the ED / David C. Pigott, MD, RDMS, FACEP, will identify those pathogens—including Ebola and anthrax—that are most likely to be encountered in the ED as well as those that present the greatest risk for health care providers and other personnel. This case-based review will include a discussion of appropriate barrier precautions, including personal protective equipment, as well as departmental and hospital-based infectious disease transmission precautions.
    • Ebola: Hemorrhagic Fever and the U.S. Experience / David C. Pigott, MD, RDMS, FACEP; and Alexander P. Isakov, MD, FACEP will discuss the risk factors for exposure to the Ebola virus, the clinical features associated with, and considerations for, evaluation and management of patients with suspected or confirmed Ebola virus disease (EVD). They will highlight the most recent recommendations for infection control and prevention applicable for healthcare workers in both the out-of-hospital (EMS) and emergency department setting. Participants will be provided a framework that permits the delivery of optimal care to this special patient population while minimizing risk to members of the healthcare team.
    • Infections From Abroad: Unwanted Souvenirs / Ever heard about “airport malaria?” Should you be worried about that “funny rash” on the Ugandan businessman? What medical advice do you give your sister who is planning a trip to Vietnam? Swaminatha Mahadevan, MD, FACEP, will identify infectious hotspots around the world and highlight “must-know facts” about travelers and visitors from these areas. In addition, find out what precautions travelers should consider as they plan their next great adventure abroad.
  • “Emerging Infectious Diseases: Concepts in Preparing for and Responding to the Next Microbial Threat” – Two of the nation’s experts in disaster medicine, Kristi Koenig, MD, FACEP, and Carl Schultz, MD, FACEP, along with Cambridge University Press, have donated the “rough cut” of this chapter from the second edition of their book, Koenig and Schultz’s Disaster Medicine: Comprehensive Principles and Practice to help emergency physicians care for patients with a wide variety of emerging and re-emerging infectious diseases. It will be posted on the ACEP Ebola Resources page (www.acep.org/ebola) by Oct. 24, 2014. The chapter covers many diseases and a variety of issues such as resource allocation, preparedness training exercises, personnel, communications, and much more.
  • “Innovations in Patient Safety Presented by ACEP, Urgent Matters, and the Emergency Medicine Patient Safety Foundation” is a 5-hour conference scheduled for Sunday, Oct. 26, in Chicago. It will be captured live, and the portions addressing error prevention in the care of infectious diseases such as Ebola will be made available as another free educational resource.
  • “ACEP Advanced EMS Practitioners’ Forum and Workshop” is another education event scheduled for Oct. 26, in conjunction with ACEP14. It, too, will be recorded so that information related to prehospital response and precautions in infectious disease can be disseminated to a larger audience. There will be three presentations on Ebola and the Dallas experience.
  • “Fighting Ebola by Design” is a 10-minute EDTalk in the innovatED space presented by HKS/MI2. These companies were involved in Project ER One, which was federally funded to develop design features for ED’s to address terrorism, disaster and epidemics of emerging diseases. Innovative design features developed for ER One will be presented, as well as how one can mitigate the risk of infection transfer. Key features of design and new technology will be discussed. This talk will be videotaped and made available to the public as soon as possible after the conference.

Survey Members

  • Ebola response survey being developed for dissemination through our Emergency Medicine Patient Safety Network (EMPRN) to gather data on preparedness for Ebola, EV-D68 and other infectious diseases. Members will be asked about their need for  education/resources/assistance from ACEP and/or government sources to effectively respond to an Ebola case in their hospital.
  • Surveyed the Disaster Medicine Section, EMS Committee and Section and ACEP infectious disease experts about response needs and preparedness

Work with Other Organizations

  • Meet with high-level officials at the CDC.
  • Convene a meeting(s) with the American Hospital Association, Emergency Nurses Association, National Association of EMS Physicians, Emergency Medicine Residents’ Association, and other key stakeholders for information/resource sharing.
  • Work with additional federal agencies, such as National Institutes of Health, Assistant Secretary for Preparedness and Response, Emergency Care Coordination Center, Department of Homeland Security, and National Highway Traffic Safety Administration, to develop resources for infectious disease response.
  • Share information with top officers of the American Medical Association and other groups.

Regionalization will be a key discussion point in all conversations.

Sincerely,

Alex M. Rosenau, DO, CPE, FACEP

 

October audio/podcast available!

Click here to get the shiny new October issue of the audio/podcast for Annals of EM.

Highlights:
-Patient satisfaction: is it a marker of quality care? NOPE
-Pediatric appendicitis: can EPs accurately use bedside sono?
-Navigating online EM resources: 5 tips
-Steroids for bronchiolitis: yes or no

Enjoy the ACEP 2014 SA in Chicago, find us and say ‘hello’. Also, email annalsaudio@acep.org any time.

D&A

ps We forgot to post it on Central Line, but Sept is up as well — download and listen, it’s a good one.

From the President – Ebola Screening Resources Available

RosenauBy Dr. Alex M. Rosenau
ACEP President

As emergency physicians, we are skilled in responding to disasters and treating every kind of medical condition as part of our daily routines. We also are critical to America health care response to infectious diseases. This is because patients often show up first in emergency departments, as we saw during the anthrax attacks after 9/11 and in Dallas, Texas, yesterday when the first case of Ebola was confirmed in the United States. Clearly this disease deserves our attention and emphasis from health care providers across the country.

Ebola is a serious communicable disease. Heightened vigilance for case presentations and strict adherence by health care personnel to CDC advice, public education and a pre-planned medical response is necessary. Hospital physicians and entire health care teams have planned for these types of medical threats. Like SARS, MERS, and Hantavirus, newly identified serious population health threats continue to occur.

Even if this Ebola case is isolated, it is incumbent upon emergency physicians and other health care providers to properly screen and manage potential Ebola presentations. The CDC, the Emergency Care Coordination Center and the Assistant Secretary for Preparedness and Response, have provided materials that are excellent resources for emergency physicians and other staff in the ED to have readily available for dissemination.

These resources are available on ACEP’s website at www.acep.org/ebola.

They include screening criteria and case definition.

The CDC recommends two initial steps in screening for Ebola Virus Disease:

  1. The symptoms are likely to be fever, headache, joint and muscle aches, weakness, fatigue, diarrhea, vomiting, stomach pain and lack of appetite, and in some cases bleeding.
  2. Travel to West Africa or other countries where EVD transmission has been reported by the World Health Organization within 21 days of symptom onset.

If both of these criteria are met, the patient should be moved to a private room, and standard-contact and droplet isolation precautions followed during further assessment.

We see dozens of patients each week, and particularly at this time of year, many will have a common cold or influenza. All health care professionals in the emergency department should know the protocols and what to ask so we can do everything possible to ensure that this Ebola case in Dallas remains isolated.

ACEP Meets with U.S. News and Doximity About Residency Program Survey

Hans R. House, MD, FACEP, Mark Mitchell, DO, FACOEP,  Jordan Celeste, MD, and Jeffrey N. Love, MD, MSC, represented ACEP at a meeting this week with U.S. News & World Report and Doximity about  their recent residency program survey.

Hans R. House, MD, FACEP, Mark Mitchell, DO, FACOEP, Jordan Celeste, MD, and Jeffrey N. Love, MD, MSC, represented ACEP at a meeting this week with U.S. News & World Report and Doximity about their recent residency program survey.

Emergency physicians from top organizations representing emergency medicine traveled to Washington, DC, this week to meet with Ben Harder, managing editor and director of health care analysis at US News & World Report and Dr. Nate Gross, co-founder of Doximity, an online social networking service for U.S. physicians that conducts surveys for US News.

The purpose of these meetings was to convey the concerns of nine emergency medicine organizations about the results of a Doximity survey, which was promoted by US News & World Report, identifying the nation’s top emergency medicine residency programs.

Prior to the meeting, emergency physicians from the nine organizations held a conference call and developed a joint letter to US News and Doximity challenging the sampling method and the implications of providing misleading information to medical students and the public.

Four physicians represented the group at these meetings:

  • Hans R. House, MD, FACEP, ACEP  board member
  • Jeffrey N. Love, MD, MSC, president, Council of Emergency Medicine Residency Directors
  • Jordan Celeste, MD, president, Emergency Medicine Residents’ Association
  • Mark Mitchell, DO, FACOEP, president, American College of Osteopathic Emergency Physicians

During the meetings, the physicians conveyed that the results:

  • Are misleading to medical students because they are not based on objective criteria.
  • Are not useful to medical students because residency choices are made for many reasons, including geography, which are not factors in the Doximity survey.
  • Are not an accurate portrayal of residency programs because they are based solely upon opinions expressed by physicians who have no first-hand knowledge of any residency training programs other than the ones they attended.
  • Do not reflect the unique nature of emergency medicine.
  • Send a dangerous public health message to patients having medical emergencies.

The physicians conveyed there is potential value in a secure data service for communicating HIPAA-compliant messages among emergency physicians.  Also, a resource that provides detailed information on residency programs and their alumni could help medical students in making decisions about their applications to specialty training.  However, the collective organizations that represent all of emergency medicine could not support the data as long as the rankings were included.  Both US News and Doximity agreed there were significant limitations of the data and discussed the challenges of developing objective measures for emergency medicine, because it is a unique medical specialty.  Both also agreed that these data would not be promoted to the general public.

The editor at US News described the new organiza

tion’s publications that rank hospitals and medical specialties as “consumer decision support,” which are intended to help members of the general public make decisions about where to seek care for complex medical problems.  Emergency medicine has never been included in these rankings in the past, and there are no plans to begin doing so.  The editor conveyed that US News recognizes that, in a medical emergency, the best place to get care is the nearest emergency department.

The physicians asked to provide a companion piece to the US News article about the results.  The editor agreed to review and publish, if acceptable.  The co-founder of Doximity offered to discuss these issues with leaders in his organization and suggested further discussion at ACEP 14 in Chicago.

The following organizations are participating in this effort:

  • American College of Emergency Physicians
  • American Academy of Emergency Medicine
  • American Academy of Emergency Medicine Resident and Student Association
  • American Board of Emergency Medicine
  • American College of Osteopathic Emergency Physicians
  • Association of Academic Chairs of Emergency Medicine
  • Council of Emergency Medicine Residency Directors
  • Emergency Medicine Residents’ Association
  • Society for Academic Emergency Medicine

ACEP Disagrees With EM Residency Survey Method Used by US News & World Report

ACEP and the leaders of other medical specialties representing emergency medicine, have taken issue with a recent survey of emergency medicine residency programs, by US News & World Report and Doximity. Below is a letter from Dr. Rosenau to US News & World Report.

September 12, 2014

Mr. Ben Harder
Managing Editor and Director
Health Care Analysis
US News & World Report
105 Thomas Jefferson Street, NW
Washington, DC 20007

Dear Mr. Harder:

As leaders of the top organizations representing emergency medicine, we have been contacted by scores of emergency physicians from around the country about a survey being conducted by U.S. News & World Report and Doximity. We appreciate your recognition of emergency medicine as an academic medical specialty with a unique core of knowledge and robust research agenda.

However, we are concerned about the sampling method chosen for this survey, because we believe it will fail to achieve your objective for this survey — to identify America’s top emergency medicine training programs. Asking only physicians enrolled in a social media website to nominate their five most preferred residencies will result in egregious sample bias and is not capable of resulting in a scientifically valid result. The results will be based solely upon opinions expressed by physicians who have no first-hand knowledge of any residency training programs other than the ones they attended themselves.

While not a formal ranking of residency programs, the results would convey that some programs provide better training than others. However, given the limitations, this would not be an accurate portrayal — to medical students or to the public. It also would not be useful to many medical students, because research shows that more than 75 percent of emergency physician residents report the number one reason for selecting a residency program is geography.

More concerning, the results could send a dangerous public health message to people with medical emergencies. It implies they should consider bypassing hospital emergency departments with residency programs that fared poorly in the survey. In a medical emergency, people should seek emergency care at the nearest emergency department, not one that scored better on a highly subjective opinion survey.

Patients need confidence in their physicians in times of crisis, especially since comparison shopping among doctors is not an option when someone is having a medical emergency. Emergency medicine residency programs train physicians in the emergent and acute conditions of just about every medical specialty in health care. As a result, emergency physicians are uniquely qualified to handle a full range of adult and pediatric emergencies. In addition, they see every kind of human drama imaginable, often treating multiple patients at a time.

The overall quality of medical care delivered in emergency departments in the United States is excellent, thanks to the uniformly high standards that govern the accreditation of residency programs in emergency medicine. Emergency medicine residencies collaborate openly with shared curricular tools built around a core model of clinical practice, an approach that is fairly unique in medical education. Ranking training programs above others is contrary to the principles of our specialty, although we recognize that certain programs are best suited for certain trainees.

Many factors contribute to a successful residency program, not all of which can be measured or compared. If your target audience is medical students contemplating a career in our field, we would be happy to work with you to identify objective, measurable factors to help students find the best program for their individual needs.

Unfortunately, our organizations, which represent more than 40,000 emergency physicians, could not recommend or encourage participation in the current survey by emergency physicians. We would, however, be happy to meet with you and help to identify the parameters that might better accomplish that purpose. If you are interested, please contact Marjorie Geist at 800-798-1822, ext. 3290.

Sincerely,

Alex M. Rosenau, DO, CPE, FACEP
President, American College of
Emergency Physicians

Meaghan Mercer, MD
President, American Academy of Emergency
Medicine Resident and Student Association

Mark Mitchell, DO, FACOEP
President, American College of Osteopathic
Emergency Physicians

Jeffrey N. Love, MD, MSc
President, Council of Emergency Medicine
Residency Directors

Jordan Celeste, MD
President, Emergency Medicine Residents’
Assocation

cc: Avery Comarow, Health Rankings Editor