A Note From the President
Happy Winter everyone. It is has been a busy, world wind of a summer and fall and time has come for another ACEP newsletter. A lot has been happening around the state and I wanted to make sure you all knew what was happening and get your help!
Anne Zink, MD, FACEP
Alaska ACEP
President
Journal Club
Dr. Nick Papacostas hosted another great journal club earlier this year. We had a lively conversation about low risk chest pain and practice patterns. It was another humbling experience getting to see such smart colleges challenge each other on what we do and why. If you missed it, we have included the articles and a summary for Nick here. These have become my favorite meetings and we are hoping to do more sessions in 2016. Our next Journal Club will be Jan. 21 from 6:30-8:30 pm at the Glacier Brew House. Please email me at annezink@icloud.com
if you think you would want to attend virtually. We have applied for a ACEP chapter grant so people can get CME's for journal club and we can have improved virtual connection for people who want to attend without being in Anchorage. We will keep you posted
Subject: PE -- Age, Pregnancy and Discharge
Articles for discussion:
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Age-Adjusted D-dimer Cutoff Levels to Rule out Pulmonary Embolism: The ADJUST-PE Study
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Outpatient versus inpatient treatment for patients with acute pulmonary embolism: an international, open-label, randomized, non-inferiority trial
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The use of D-dimer with new cutoff can be useful in diagnosis of venous thromboembolism in pregnancy
Background Articles:
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Emergency Evaluation for Pulmonary Embolism, Part 1: Clinical Factors that Increase Risk
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Emergency Evaluation for Pulmonary Embolism, Part 2: Diagnostic Approach
Narcan - SB 23
There is currently legislations to make Narcan more available, SB 23. Andy Elsberg was kind enough to write a letter for support of this legislation that ACEP is working to support. Read a quick summary here for SB 23, and you can read the letter Andy wrote here. Please take a moment to read it and help support this legislation.
Medical Provider Assaults and Harassment
Alaska ACEP and the state Emergency Nurses Association are working to add “medical provider” language to felony offenses for assaults or harassment in the first degree. Currently, the statutes as written are:
AS 12.55.155(c)(13) – Aggravating Factors for Felony Offenses
The defendant knowingly directed the conduct constituting the offense at an active officer of the court or at an active or former judicial officer, prosecuting attorney, law enforcement officer, correctional employee, fire fighter, emergency medical technician, paramedic, ambulance attendant, or other emergency responder during or because of the exercise of official duties.
AS 12.55.135(d)(1) – Sentencing for Misdemeanors
A defendant convicted of assault in the fourth degree or harassment in the first degree who knowingly directed the conduct constituting the offense at a uniformed or otherwise clearly identified peace officer, fire fighter, correctional employee, emergency medical technician, paramedic, ambulance attendant, or other emergency responder or medical professional who was engaged in the performance of official duties at the time of the assault or harassment shall be sentenced to a minimum term of imprisonment of
(A) 60 days if the defendant violated AS 11.41.230 (a)(1) or (2) or AS 11.61.118;
(B) 30 days if the defendant violated AS 11.41.230 (a)(3).
ACEP will keep you updated on the status of adding “medical provider” to the first statute.
Medicaid
As you know, Medicaid in the state is expanding with a shrinking budget. ACEP has been asked to be a key stake holder in these discussions. We have meet with the state and the consultant firm working on this topic. A group of us put together a letter or ED recommendations. I have attached it here. It has been approved by the ACEP board, but want to bring it to all the members for feedback. Please take a look at it and let us know what you think. If you want to help work on this issue, we welcome your input.
I would also like to thank Dr. Andy Elsberg and Ben Shelton for attending numerous meeting, writing summaries, and in general being incredible advocates for our profession and our patients in this time of change.
Ketamine
I continue to get questions regarding the board of nursing stance on Ketamine, as unfortunately the language is not clear.
This is a summary email from the nurse, Sam Jones as of January 2015 who took it to the state to try and clarify the issue:
"This is the policy we pushed with the board to allow us to give Ketamine http://commerce.state.ak.us/dnn/Portals/5/pub/nur1809.pdf
The outcome is essentially that we can give it as sedation for procedures and that we can give it during RSI so long as there is a LIP present provisioned with sedation, intubation, etc... and that the RN staff has been educated and show competency for the drug they are administering. Before we can begin this practice in the ED, we need to write a policy, roll out an education to the staff, and develop a competency.
Currently, RN’s still cannot give ketamine for pain control in the ED. The board only addresses this with the Post-op, opioid tolerant patient.
http://commerce.state.ak.us/dnn/Portals/5/pub/NUR_Advisory_Ketamine_Administration.pdf
This is a huge win and one we have been pushing for since the issue arose. I appreciate everyone’s understanding and patience.”
Changes to the ACEP Board
Ky Burden has served on the ACEP board for years and worked as the treasure this past year. He has been a great source of knowledge, fun stories and has provided the board a great rural perspective. He has decided to step down to pursue other interests and fulfill other demands. He will be greatly missed and we appreciate all of his time and service to Alaska ACEP.
The Board appointed Nate Peimann as the treasurer position. He has served on the board, as the Alaska Alternative councilor and showed interest in the treasurer position. We are excited to have his experience and leadership.
This leaves one spot open on the board. We would love someone to be a part of this growing and changing board and help move Alaska ACEP forward. Let me know if that is you or someone you know are you are interested.
Biggest State News Yet!
We are honored to welcome Pauline Proulx as Alaska ACEPs new executive director. She has been the Washington ACEP executive director for years now and has taken their chapter to a new level. We have continued to build a coalition with Washington and having her as our new executive is an exciting new step in this partnership. To add to that, she is simply a fantastic human who is great to work with. If you need toe articles again, your are not getting our emails, you want something up on the website, she is your gal. You can contact her at
plp@wsma.org. Her team is also taking over our website where we are hoping to have more updates, have the links to the journal club articles and most importantly have the meeting and locations and call in numbers listed FAR in in advance for your planning needs. Please do not hesitate to contact her or I with any ideas on how to make Alaska ACEP better.
State Spot Light: Fairbanks
Fairbanks’ new surgery wing is 70 percent complete with plans to open next summer. They have been working hard on their trauma system and are the state model on how to do PI. They have finally succeeded in getting a blood fridge in the ED so they have quick access to uncross matched blood. This is serving them as well as they have seen a significant increase in gsw and stabbings in Fairbanks over the past six months.
But most importantly Dr Bill McIntyre and Dr. Stan Robinson had a great hunt.
Inaugural EM Wellness Week Focuses on the Well-being of the Care-Giver
Created and spearheaded by the American College of Emergency Physicians, the 2016 Emergency Medicine Wellness Week™ is an opportunity all emergency physicians and their colleagues to take the time to self-renew while staying dedicated to the highest quality patient care.
The inaugural event is slated for January 24-30, 2016. To participate, visit the website, www.acep.org/EMWellnessWeek, and sign up for daily wellness tips, print a personal pledge card, find resources and videos about better wellness, and share your stories of personal improvement.
“As emergency physicians, we care a lot about our patients. That’s why we chose this specialty. But all too often we are so busy caring for others, we forget to care about ourselves,” said ACEP President Jay A. Kaplan, MD, FACEP. “We want this week to be about action rather than just ideas. Everyone makes resolutions around the New Year; we hope that this week will help us and our colleagues make commitments to become more healthy, less burned out, and more resilient.”
First, fill out an anonymous pledge card from the website, selecting areas that you will focus on for the week. Print it out and stick it on your refrigerator, your mirror, anywhere you’ll see it every day. There will be suggested improvements in three major areas, such as:
Physical
Eat healthy
Drink water, not soda
Exercise
Get at least 7 hours of sleep per night in blocks of at least 4 hours
Connections
Spend time with family, friends
Spend time connecting to your spiritual self
Do one community project
Career Enhancement
Learn to recognize burnout and decrease it
Develop a new networking contact
Plan your next career move
Next, sign up to receive daily messages about wellness for that week to help you keep on track, and introduce resources that will help improve your wellness that week and beyond. At the end of the week, ACEP will ask you how you did and what worked for you.
“More importantly, at the end of the week, we want you to feel better – about yourself, about your family and friends, about your patients and your work,” Dr. Kaplan said. “We’d like you to remember, once again, why you chose medicine, and emergency medicine, for your life’s work. And to be proud and happy with that decision.”
www.acep.org/EMWellnessWeek
Mark Your Calendar with these Important 2016 Dates
Journal Club
Jan. 21
6:30-8:30 pm
Glacier Brew House
Anchorage
Comprehensive US Course
February 11-12
Bartlett Regional Hospital
Juneau
3-9pm
Learn more
2016 WA-ACEP Summit to Sound
April 27-29
Bell Harbor Conference Center
Seattle, WA
Learn more
ACEP Leadership and Advocacy Conference
May 15-18
Washington, DC
Learn more
Advanced US Course
March 25-27
April 30-May 2
Bartlett Regional Hospital
Juneau
3-9pm each day
Learn more
Loren Marshall 10th Annual Resuscitation and Critical Interventions Conference
May 19-21
Hotel Captain Hook
Anchorage
Learn more
Spring ACEP Meeting
May 18
Anchorage
Journal Club
Sept. 8
6:30-8:30 pm
Location TBD
ACEP16
Las Vegas, NV
Learn more
Fall ACEP Meeting
Nov. 3 (tentative)
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