Spring 2014 Issue

Alabama Chapter ACEP

Spring 2014

Alabama Chapter ACEP

Bobby Lewis, MD, FACEP
President

Leonardo Nasca, MD
Editor

Denise Louthain,
Executive Director

Contact us:
al.chapter@acep.org

Phone: 877-2-ALACEP
Fax: 334-671-1685

From the Editor
Leonardo Nasca, MD, FACEP

Report Card 2014

Well, by now you should have heard that Alabama received a D. That is worse than what we had in our Report Card 2009 of D+. We also moved from being number 38 to number 44 in the United States of America. The stats and calculations for the grade came from government figures put out by federal agencies like the CDC, Centers for Medicare and Medicaid Services, The US Department of Health and Human Services, EMS agencies, National Highway Traffic Safety Administration, and many more. ACEP did not make these up.

Many of you sent letters to editors of several newspapers. But, to my surprise, none that I gave information to revealed the figures in their newspapers. This should have been big "news". There were some letters by some of AL ACEP members that did get recognized in print. But, we cannot just mention this once and let them shove it under the rug. The more we alert citizens, government officials and our legislatures of the need to improve support for our citizens needs for emergency care, the more we may have a chance to get some improvement. So, I am going to try again to alert editors of newspapers about the Report Card. In addition, I am going to send my city government officials and state legislatures a letter as well. Maybe they have not heard about it yet. Maybe they did not get "the news".

Click here to find out how Alabama did and how we compare with the national average and other states. You can then see the different aspects that were analyzed to prepare these report cards.

UAB Emergency Medicine Resident's Corner

Dan Neuberger, PGY-II

This will be a recurring section in the ALACEP newsletter aimed at keeping emergency physicians practicing in Alabama up to date on residency news/events. As many of you know, UAB is the only Emergency Medicine Residency program in the state and enrolled its first class in 2001. It is a PGY 1-3 format with a resident cohort of 10 per year. Residents in the program have clinical duties at UAB hospital and Children's of Alabama in Birmingham as well as Baptist South in Montgomery. Graduates of the program are currently practicing throughout the state of Alabama and beyond.

Now is an exciting time for the program as we are nearing the end of recruiting season for the incoming intern class. Applications from hundreds of qualified medical students from across the country were received and nearly one hundred fourth year students were interviewed. This included a strong contingent of UAB School of Medicine and University of South Alabama College of Medicine students who will pursue Emergency Medicine as a career. Match day is March 21st and medical students, residents and faculty are eagerly awaiting the results.

Graduation is also rapidly approaching for the current PGY-IIIs. Nine of the current senior residents will be entering community practice and one will be staying at UAB for fellowship in International Medicine. A total of 3 senior residents will continue to practice Emergency Medicine in Alabama, 3 in Georgia and 1 each in Mississippi, Louisiana, Kentucky and North Carolina.

Pediatric Corner

Child Maltreatment - There Is No Excuse

The month of April is National Child Abuse Prevention month. Since this is such an important topic, we, as clinicians, need to recognize and take appropriate steps to save our children from the dangerous environment they are being held in. You may be their only chance for survival and/or escape to a more loving home. STAND UP FOR CHILDREN. There is no excuse for child abuse. That is the motto for you to follow.

Definition

Child abuse can be defined as words or actions that cause harm, potential harm or the threat of harm to a child under the age of 18. It encompasses verbal, physical and sexual abuse.

Epidemiology

  • In 2010, 9586 children in Alabama were victims of child abuse or neglect.
  • In 2010, 13 children in Alabama died as a result of child abuse or neglect.
  • In the US, homicide is the leading cause of death in the first year of life.
  • 50% of maltreated children who die have a history of prior episodes of abuse that were unreported or not taken seriously.

Historical Factors Concerning For Abuse

  • Mechanism of injury that is not plausible given developmental stage of the child
    e.g. A newborn that has rolled off of a couch
  • Delay in seeking care
  • Past medical history of multiple traumatic injuries
  • Different histories between caregivers
  • Discrepancy between mechanism of injury and severity of injury
    e.g. Multiple fractures after a 5 month old infant rolls off of a couch

Physical Findings Concerning For Abuse

  • Multiple bruises in locations not typically injured in routine child play (as opposed to typical bruising over shins, knees, forehead, bony prominences, etc.)
    e.g. Buttocks, cheeks, ears, abdomen
  • Perioral, genital or perianal injuries
  • Bizarre injuries
    Human bites, cigarette burns, well demarcated burns, rope marks, etc.
  • Multiple old fractures on x-ray
  • Skull or rib fractures in children < 2 years old
  • Long bone fractures in children < 3 years old

What should be done if child maltreatment is suspected?

In the state of Alabama anyone who comes in regular contact with children has a legal duty to report incidents of suspected or obvious child maltreatment. This includes but is not limited to doctors, nurses, school teachers, law enforcement agents and social workers. If there is a concern a call should be placed to either the department of human resources or a law enforcement agency.

Reference:

Nicole Jones, MD, Asst. Professor of Pediatrics at Children's Hospital in Birmingham, AL

Child Welfare Information Gateway is a nice web site for information about child abuse and what services may be available to you in your area as well. This is presented by the US Department of Health and Human Services.

CRNP Corner

NPsights is a nice website for you to learn about different topics for CRNP of different professions. It is free. It is for CRNPs only. After joining this site, you can receive a newsletter full of facts and articles from your peers. There is even a blog for sharing information and ideas. In addition, there are free CEUs to be had.

ALACEP and AirMed Partner to Provide Air Ambulance Services to Members

AirMed International (airmed.com), the premiere global air ambulance and medical solutions company is pleased to officially announce its partnership with The Alabama Chapter of Emergency Physicians (ALACEP) to offer its award winning air ambulance membership program to members of ALACEP. A low-cost AirMed membership surpasses travel insurance by bringing you to the hospital of your choice. Purchasing an AirMed membership through ALACEP is the simple solution to unexpected travel emergencies. ALACEP members, their families and their patients will receive an exclusive discount on annual AirMed membership plans through this exceptional offer. We are honored that the ALACEP chose to recommend AirMed over our competitors. It's a testament to their commitment to providing the best benefits available for the membership," said Jeff Tolbert, AirMed International CEO. "ALACEP members can now join more than 1 million AirMed members who enjoy peace of mind while away from home, knowing we will be there for them if they need us."

Click here for additional information about the AirMed/ALACEP partnership and discounted pricing.

Leadership and Advocacy Conference

Learn how to maximize your impact as an emergency medicine advocate during ACEP's Leadership and Advocacy Conference, May 18-21, in Washington, DC at the Omni Shoreham Hotel. You can register for the conference and the hotel on ACEP's website.

During this dynamic conference, you will gain skills in media relations and networking for influence, meet with members of Congress and other key policy makers, and identify your role in advancing key issues facing emergency medicine.

See the video of members enjoying last year's conference.

Clinical News

Stroke Risk Jumps After Head, Neck Trauma
Eleven of every 100,000 patients younger than 50 years who were seen for traumatic injury developed an ischemic stroke within 4 weeks, a study of data on 1.3 million people found.
Read the full article

Imaging No-NosTop List of Avoidable Tests in Emergency Medicine
Imaging studies take four of the five slots in a newly unveiled list of unnecessary tests and procedures commonly performed in the emergency department, with CT scans in low-risk trauma cases earning particular censure.
Read the full article

Biphasic Reaction Risk Rises with Severity of Initial Anaphylactic Attack
The more severe an anaphylactic reaction, the more likely that a child will have a second reaction within several hours, according to data from a review of more than 400 children. The findings were presented at the annual meeting of the American Academy of Allergy, Asthma, and Immunology.
Read the full article

ACEP Now

If you haven't seen ACEP's new publication, ACEP Now, you've missed an Affordable Care Act Roundtable discussion with emergency medicine leaders, an article about pain posters in the ED, a pro-con piece on protecting your assets from litigation and much, much more.

ACEP has partnered with a new publisher and added new medical editor in chief, Kevin Klauer, DO, EJD, FACEP, to give the monthly member benefit a content boost and revamped artistic presentation. Don't worry. All the clinical topics and news emergency physicians expect from ACEP's official publication are still there. You'll get tips on using Ultrasound, legal advice and opinions on the latest emergency medicine issues. Don't miss the new ACEP Now.

International Trauma Life Support (ITLS) Program Aims to Improve Trauma Care, Training Worldwide

ITLS is a global training program dedicated to preventing death and injury from traumatic injuries through education and trauma care. While many of you might be familiar with ITLS, you may not be aware of its history or connection with ACEP.

Founded in 1985 as Basic Trauma Life Support, it was funded from an ACEP Chapter Grant to the Alabama Chapter. The course was originally developed by John Campbell, MD, FACEP who was given the first ACEP Outstanding Contribution in EMS Award in 1989. The course has been endorsed by ACEP since 1986.

ITLS is now an independent not-for-profit organization. Since 1994 it has been managed by the Illinois College of Emergency Physicians. Many ACEP Chapters sponsor and manage ITLS Chapters for their state as well, including Ohio, Florida, New York, Virginia, West Virginia, California, Illinois, Alabama, Colorado, Texas, Arizona, Louisiana, and Missouri.

ITLS has grown to be an international standard with 95 chapters and training centers in 36 countries. Chapters and training centers are located on all continents except Antarctica. To date, ITLS has trained more than 600,000 trauma care professionals in 70 countries worldwide.

ITLS courses combine classroom instruction with hands-on skill training and scenario assessment stations to challenge the students to expand their knowledge and skills in trauma care. ITLS has become accepted internationally as the standard for training pre-hospital professionals in trauma care. It is taught both as a continuing education course but also as part of many initial EMT and paramedic training programs. ITLS also offers eTrauma which is an online educational program that provides the didactic portion of the ITLS Provider course. It can be taken for CEU credit only or followed by an ITLS Completer course for skills and testing for ITLS certification.

ITLS can be taught at two levels: Basic and Advanced. ITLS Basic provides the core knowledge and skills for all levels beginning at the EMT-Basic and first responder levels. ITLS Advanced builds on this knowledge and skills to address advanced procedures for paramedics, trauma nurses, and physicians. Other related ITLS courses include ITLS Access, ITLS Pediatric and ITLS Military. ITLS Access trains EMS crews with the skills they need to access, stabilize, and extricate trapped patients. ITLS Pediatric continues the training of the Basic and Advanced courses with an emphasis on trauma in children. And ITLS Military is a custom edition of a stand-alone military edition designed for military personnel.

To learn more information about ITLS, to arrange for a class, or set up a training center, visit our website.

Careers Section Longevity and Tenure Award Applications Due July 18

Cathey Wise, Director, EMF

The ACEP Section of Careers in Emergency Medicine is soliciting nominations for an award for emergency physicians in the following two categories:

  • A Longevity Award for the physician with the longest active career in emergency medicine.
  • A Tenure Award for the physician with the longest active career in the same emergency department.

Recognition is also given to those physicians who are still actively practicing emergency medicine after 20, 25, 30, and 35 years.

The deadline is July 18.

Eligibility Criteria

To be eligible, physicians must have worked an average of 1,000 or more hours per year in emergency medicine practice or teaching; hours for residency training and administration are not included. They must be a current ACEP member.

Previous applicants may apply every year; however, they may not win the same award within a 5-year period.

Information is attached and can also be found on our website.