2014 Summer Issue

Alabama Chapter ACEP

Summer 2014

Alabama Chapter ACEP

Melissa Costello, MD, FACEP

Leonardo Nasca, MD

Denise Louthain,
Executive Director

Contact us:

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

From the President
Melissa Costello, MD, FACEP

Dear Alabama Chapter,

It is an honor and a privilege to take over as President of the Alabama Chapter of the American College of Emergency Physicians. The passing of the torch from our now Immediate-Past President, Dr. Bobby Lewis took place at the Annual Southeastern Chapters ACEP meeting. Hosted again this year by the boards of the Alabama and Tennessee ACEP chapters and put together by our academic conference planning superstar, Dr. Annalise Sorrentino, the conference was our largest ever. Physicians, Advanced Practice Clinicians (PA’s and NP’s), Nurses and EMS Providers from around our region heard 4 days of lectures from some amazing faculty representing all of the states in the SEC Chapters. It was an educational and entertaining time, with plenty of relaxing at the beach and hanging out with friends, new and old! If you have never been to this conference, I definitely encourage everyone to try and attend next year at Sandestin Golf and Beach Resort, June 8-11, 2015.

With only a year as the President of the Chapter, there is not much time to get the work done. I have set three primary goals for this year. First, I would like to increase involvement of both the EM Boarded Emergency Physicians and the alternate-Boarded Emergency Department Physicians (EDPs). Increased involvement will improve our ability to speak for all physicians practicing in the ED’s around the state. Despite the differences in our residency backgrounds and Board Certifications, the issues that arise in day-to-day ED practice unite us across the ABMS lines.  In these challenging times in medicine, we need to speak with one voice in order to advocate for our specialty with hospital administrations, insurers, legislators, other specialists and patients.

Second, I would like to also improve our relationships with the organizations that speak for the Advanced Practice Clinicians/Mid-levels that support our practice in Alabama. The Emergency Nurse Practitioners within the Alabama Emergency Nurses Association (ENA) already has active participation in ALACEP and support through their primary organization, but the Physician Assistants practicing in Alabama’s EDs have not come together as cohesively. ALACEP will benefit from these voices at our table. National ACEP already provide the support as a partner for the Society for Emergency Medicine Physician Assistants (SEMPA), and I am open to the development and support of a chapter here in Alabama. If you are working with motivated, engaged APC’s, please send them my way.
Finally, and on a lighter note…we need a new logo!! Our logo was pulled together many years ago and while there are aspects of it that I love, we need to make sure that our logo and our website header uniformly and easily identify us as both EP’s and as Alabamians. We need to be able to carry a single logo from web, to social media, to letterhead, etc. I need some creative brains and skilled graphics folks to wrap their brain around what it is that represents us as Alabama’s Emergency Physicians. Submissions are welcome and even if your art skills are at the first-grade-fat-crayon-level, like mine, we will take ideas of any kind, in any format. Please email submissions or ideas to me at the address below.

I am looking forward to the year ahead. Please contact me by e-mail with any questions, advice, guidance, concerns, or feedback.

AL ACEP Board of Directors Election Results

President: Melissa Costello, MD, FACEP (Mobile, AL)
President- Elect: John E. Campbell, MD, FACEP (Montgomery, AL)
Secretary/Treasurer: David J. Garvey, Ph.D., MD, FACEP (Hampton Cove, AL)
Immediate Past President: Bobby R. Lewis, DMD, MD, FACEP (Clanton, AL)

Others elected to the board include Bryan Balentine, MD, FACEP. John M. Newcomb, MD, FACEP resigned. There was discussion that the board's quarterly meetings, which has usually been held in Montgomery, may be on a rotation throughout the state to meet fellow ED physicians, CRNP and PACs to get a better feel of the regional needs. Look forward to the Board meeting coming near you.

You can always contact Denise Louthain, the Executive Director for the State AL ACEP office, if you have any questions or ideas for the board to consider.

Past President Note
Bobby R. Lewis, DMD, MD, FACEP, UHM

June Newsletter

The much anticipated annual SEC Education conference is beginning in San Destin with participation of all of the usual SEC states. Annalise Sorrentino, our new program chairperson, has done a great job with coordinating the program with help from representatives from each of the participating states, and with speakers from each of the participating states. This meeting always has a good turnout and gets rave reviews for the program content and speakers, and is a great location for a family vacation. We are expecting an increase in the number of registrants over the past year.

Newly elected officers were installed at the annual meeting. Dr. Melissa Costello is the new president and Dr. John Campbell was elected President elect. Dr. Dave Garvey was re-elected to his post of secretary/treasurer.

I very much appreciate the help and support from the membership and officers in the organization over the past year and look forward to continued participation in Alabama ACEP as the past-president.



To one of our fellow Alabama physicians, Annalise Sorrentino, MD, for her article in the February 2014 ACEP News, "Could I Do It All Again?" This is a great article for anyone interested at looking into being a physician. It is easy reading for high school and college students. Dr. Sorrentino was the education Chairperson for our successful Southeastern Chapters of ACEP Conference 2014.

There were many individuals on the AL ACEP staff working behind the scenes to make the conference such a success as well. It is great seeing all of the other chapters getting involved. I always like the Jeopardy.

UAB Emergency Medicine Resident’s Corner
Sean Vanlandingham

Spring has been a busy and exciting season for the UAB Emergency Residency Program. Our graduating PGY-III’s are looking forward to beginning their careers in EM as they finish strong during this final stretch of training. We are very proud of this dynamic and talented group, who all plan to practice medicine in the Southeast, with 3 of 10 staying in the state of Alabama. We are especially thankful to ALACEP for their sponsorship of the Class of 2014’s graduation ceremony, which will be held on June 26th. This will be a special time for residents and their families to celebrate and share memories from the past three years at UAB.

As we honor the outgoing PGY-III’s, we are equally looking forward to the arrival of our new intern class. The Class of 2017 shows tremendous potential, bringing us some of the very brightest medical school graduates from Georgia, Florida, Mississippi and Alabama. On June 28th we will kick off the new academic year with our annual intern lake party, generously hosted by Dr. Bobby Lewis. As our interns take the plunge at Lake Mitchell, they’ll gear up for a busy but exciting year ahead.

We are proud to be sending three of our residents to the ALACEP Annual Educational Conference in Sandestin, Florida, June 9 – 12. Here they will share poster presentations on their work in Global Health and Medical Education. We are also optimistic that they will make a good showing during the annual Jeopardy trivia competition and take the 2014 trophy back to Birmingham.

EMS Corner

EMS Committee Report on the State EMS Medical Control Committee

SEMCC meeting was held in Clanton at the Alabama Power Conference Center on 3 June 2014 at 1 PM.

Administrative Update:
SE EMS region will go on-line for trauma on 1 July 2014. This means all EMS regions will now be participating in the state trauma system.

SE region is doing a pilot on stroke patients via tele-medicine in delivering TPA when indicated. Only 16.8 -18.6% of patients with acute CVA in the BREMSS and SE regions qualified for TPA, mostly due to delay in presentation. From 2003 to 2013 the number of hemorrhagic CVA’s increased from 10.1% to 22.4% (BREMSS data).

NAEMSP and ACS/COT position statement on use of back boards:
SEMCC is going to fine tune the current Long Spine Board (LSB) use protocol in order to decrease use of this device. Hard data exists showing LSB’s create problems primarily due to pressure breakdown on people left on LSB’s for more than 20 minutes. Current protocols allow for EMS to not immobilize patients; but only rarely does this occur. Wording will be chosen to allow for ambulatory patients and patients with isolated extremity injuries to not be boarded.

Medication and IV fluid shortage:
In addition to the known intermittent shortages of Valium, Ativan, and Morphine; now Normal Saline (NS) is in short supply nationally. EMS services were advised to use NS only when absolutely indicated. In addition, they were advised to hold on to expired meds and NS for at least 3 months, storing them in a separate location. They are to advise the state office of EMS and Trauma of inability to locate the approved substitute medications. Additionally other IV fluids including: D5NS, D5 1/2NS, and 1/2NS were approved as substitute fluids.

Emergency Medical Services for Children (EMSC)
A video on respiratory emergencies is now on the EMSC web site.

Respectfully submitted,
John McMahon, MD FACEP
ALACEP representative to the SEMCC

ClinCon 2014 is on July 17-20, 2014 in the Caribe Royale Orlando in Orlando Florida. Pre-conference highlight is on the treatment of pediatric ill or injured patients. The course is presented by the American Academy of Pediatrics. There will be a friendly competition (sure it will be) between International and National EMT and Paramedic teams. This is an Emergency Medicine Learning and Resource Center sponsored event. This is a great event to get 24.5 credits for physicians, EMTs, paramedics, nurses and EMS physicians. For information, click here to view the web site.

Nurse Practitioner Corner

Contact www.NPsights.com for up-to-date info on articles, CME events and blogs with fellow nurse practitioners. Join and receive a free newsletter.

Physician Assistant Corner

Society of Emergency Medicine Physician Assistants link: www.sempa.org. A great way to get involved with other EM PAs. SEMPA puts on an annual conference with up to date education. American College of Emergency Physicians (ACEP) and SEMPA are working together on education, legislation and administrative areas. It is time to start getting involved.

National ACEP Visits Annual Conference

The SEC ACEP Conference in Sandestin was the sight for several National ACEP figures. This was a great opportunity to ask questions of our candidates running for the board; Rebecca B. Parker, MD FACEP and Jay A. Kaplan, MD, FACEP are running for President and John J. Rogers, MD, FACEP is running for the board. Jon Mark Hirshon, MD, MPH, PhD, FACEP was also present to answer questions. Dr Hirshon was a leading physician for the EM Report Card analysis which was released earlier this year. President-elect, and frequent SEC lecturer, Michael Gerardi, MD, FACEP presented several lecture related to ACEP updates. These physicians, and others, will have leading roles for the Affordable Care Act and other government policies being set up in the near future ranging from the payment issues of our Medicaid system to Value-based procedures.

Other AL News

As of July 1st, 2014, Alabama will have statewide Stroke and Trauma systems. The next system to enact will be the STEMI System for rapid PCI as presently being performed in the Gulf Region EMS. Stay tuned for more info on this.

It is election time again. Remember to send your AL PAC some donations. It is recommended to send them a tax deductible $200 contribution.

Tim Nelson, MD, an anesthesiologist, is running for Senator.

Clinical News

Hypertonic Saline Indications for Bronchiolitis Lack Evidence for Clear Guidance
The therapeutic value of hypertonic saline in treating bronchiolitis in young children remains unclear, based on the findings of two randomized controlled trials with conflicting results.
Read the entire article

Statins Don't Help, May Harm in COPD, Sepsis-Associated ARDS
Two separate prospective, multicenter trials of statins stopped early when interim results showed they did not help – and potentially harmed – patients with moderate to severe chronic obstructive pulmonary disease or sepsis-associated acute respiratory distress syndrome.
Read the entire article

Telemedicine Gives Small Hospitals the Biggest Boost in rTPA Use for Stroke
A telemedicine program for patients with acute ischemic stroke increased the use of recombinant tissue plasminogen activator by as much as 13% in the year after implementation.
Read the entire article