Fall 2016

President Letter: We Showed Up for the Climb

A few months after I got married my husband suggested we climb the east face of Mt. Whitney.  It was more alpine rock than I had done before, but it was thought to be one of the best climbs in North America, so why not? I had two days off from medical school, and it wasn’t too far away.  How hard could it be?

As we made our way up the valley, however, my stomach sank.  The massive grant wall that makes up the east face began to come into full view.  The wall loomed high over head. It was like a gate to another world not meant to be crossed.  That evening, cuddled in my bivy sack, under a boulder, in the pouring rain, thinking of that wall ahead, my anxiety grew until I suggested we head back down the next morning.  Getting this far is good, right?  Besides, the weather was awful, our time was short, and, honestly, I was scared to death.

It's easy from the comfort of your bag to find a reason to head back down. It was then that my husband said to me, “You always have to show up for the climb.” 

The next morning in the dark I followed his lead to the base, trying to keep my fears in check.  With each step, the clouds broke some, and the sun started to appear.  By the time we were at the base, it was clear, it was time to climb, and there were no excuses left.  Step by step, pitch by pitch, we picked our way up the mountain.  Working together, giving each other “slack” when a big move was needed, but always secure on the other end of the rope, we made our way up the massive wall.  I finally relaxed and started to enjoy the both the beauty of the place and of the riddle of the mountain.  When we pulled over the last ledge, I smiled, and told myself, “I will always show up for the climb.”

These past two years as Alaska ACEP president, I have had the same sense of accomplishment as I did on that climb for what can happen when you show up.

  • Together, we passed legislation as part of SB 74 referred to as EDCP (Emergency Department Coordination Project) to get an information exchange through all our EDs that includes the PDMP, supports case managment, and care coordination for frequent flyers or “familiar faces” of the emergency departments. 
  • We have physicians serving on all major sections of the Medicaid redesign task forces as well as State EMS and the State Trauma Committees. 
  • We have been asked to discuss licensure regarding state wide opioids guidelines and have nearly finalized ED opioid guidelines for the state. 
  • We established strong working relations to the State, ASHNHA (Alaska State Hospital and Nursing Home Association), ENA (Emergency Nurses Association).
  • We created a robust regular journal club that will be streamed to include people from around the state (Nick you rock!). 
  • We held a conference with the medical directors from around the state.
  • We created a listserve for better communication.
  • We spoke about these issues on NPR, as well as have been quoted in the ADN. 
  • We wrote to and testified on behalf of our patients and our departments.
  • Our state and national representatives, as well as National ACEP, have better idea of who we are, the challenges we face, and of our advocacy for our patients.
  • We have had each other’s backs, we supported each other, and we showed up for the climb.

I want to thank each and every one of you for your time, effort and dedication to your specialty.  As a speaker said at ACEP, “You are on the caring edge of health care”.  As physicians we have two commitments: One is to our patients and the other is to our profession.  I also want to thank Pauline, our new executive director and the entire Washington State ACEP leadership for being the rope that has kept us together, from falling off the ledge and continually providing guidance, support and reassurance.

Most importantly, I would like to thank the Alaska Board of Directors and invite any member interested in getting more involved with the chapter to contact me. We’ll have Board elections in January.

Thank you for all you do! Thank you for showing up!

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Update from the Medical Directors Conference

Thank you to those who came to the medical direction conference with Dr. Jay Kaplan in September.   It was truly a highlight of the year. We had representatives from Tok, Juneau, Fairbanks, Anchroage, Homer, Mat-Su, Talkeentana and beyond who all graciously took the time out of their busy schedules to come together to discuss how to make Emergency Medicine in the state stronger.  In the morning we had a fantastic update on trauma issues by Dr. Sacco and a great panel discussion regarding transport issues from around the state.  The afternoon was then all about behavioral health with a fantastic panel discussion with Attorney Steven Bookman, Office of the Attorney General, Attorney Robert J. Dickson, Atkinson, Conway & Gagnon , Dr. Michael Alexander, Director of Alaska Psychiatric Services and Randall Burns, Director of the Division of Behavioral Health.

The State CMO, Dr. Jay Buttler updated us all on Narcan distribution and prescriptions. 

There were two goals for the meeting.  The first was to address two major topics affecting many of us: transport issues and psychiatric issues.  The second was to increase state and national awareness on the issues affecting emergency care in the state.  We are very fortunate in this state to have such dynamic leaders and be able to work so closely with the Hospital Association, Alaska State Leaders and National ACEP.  Thank you all for helping make these goals a reality.

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Updated Alaska Opioid Prescribing Guidelines

Please take a look at the Opioid Prescribing Guidelines which were recently updated in September.  We are working closely with the hospital and nursing home association to get hospital buy in and to get these out in the departments soon!

Take a look at the information on our website and email plp@wsma.org with suggestions.

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Migraines: There Is a Better Way

Dr. Russ Johanson made the following algorithm with evidence based practices and related reference for your use.  Check out this handy algorithm

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CEDR Update

The ACEP Board of Directors allocated additional funds to staff the Clinical Emergency Data Registry (CEDR) project as we try to get everyone onboarded who expressed a desire to sign up.

The hope is that participants who have completed their contractual portion of the sign up will have the IT process complete and can begin submitting data by the end of the year. Others in the process should be onboard from ACEP's side early first quarter.  This will represent about 140 groups nationally. 

The hope is to have 3,000 providers submitting data early in 2017, maybe 8-10K by 2018.

The metrics have been accepted by CMS to begin, and the task force is examining new proposals.
The plus or minus 9% Medicare swing remains.

ACEP has also created a new position in the administrative hierarchy, carving out a leadership position in charge of Quality (metrics, CEDR, tracking the value of EM).

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Calendar of Events

Journal Club

November 3, 630pm
at Sushi & Sushi
3337 Fairbanks St.
Anchorage, AK 99502
Note: This is in the strip mall behind Moose’s Tooth.  This is across street from the new rock gym.
Topic: Hospital Cardiac Arrest

Amiodarone, Lidocaine, or Placebo in Out-of-Hospital Cardiac Arrest

Manual Cardiopulmonary Resuscitation Versus CPR Including a
Mechanical Chest Compression Device in Out-of-Hospital Cardiac Arrest: A Comprehensive Meta-analysis From Randomized and Observational Studies

Effect of Dispatcher-Assisted Cardiopulmonary Resuscitation Program and Location of Out-of-Hospital Cardiac Arrest on Survival and Neurologic Outcome

Trial of Continuous or Interrupted Chest Compressions during CPR

Visit the new Alaska ACEP Journal Club Forum to facilitate information sharing between physicians practicing emergency medicine in Alaska. Posting of comments is limited to members who register with the site. Log-in or register above to participate in a topic discussion.

41st Annual Alaska EMS Symposium
Nov. 2-5
Egan Convention Center
Anchorage, AK,
FMI and to register, visit here

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News from ACEP National

New Epinephrine Labeling
There has been a change to the labeling of epinephrine. Epi 1:1000 used for anaphylaxis and asthma is now labeled 1.0mg/ml. Epi 1:10,000 used for cardiac arrests is now labeled 0.1 mg/ml. There has been concern that the current labeling caused confusion and inappropriate dosing.

The epic code is 1:1000, drip and push epic is 1:10,000

New Crowding Solutions Resource
A new information paper on the causes, impacts and solutions to the crowding and boarding problem has been approved by the Board of Directors.  Members are encouraged to distribute this reader-friendly paper to their hospital administrators or local policymakers who may benefit from a better understanding of why they must, and how they can, address this vexing and dangerous problem. A link to the new paper entitled “Emergency Department Crowding: High Impact Solutions” is available here.

New Sections at ACEP
A sufficient number of members have come together to officially form three new Sections in the College. The Pain Management Section was formed earlier this year and is now being followed by the creation of the Medical Directors Section and the Event Medicine Section. The new Sections will meet at ACEP16 for the first time. Members interested in any of these topics are invited to attend the Section meetings and/or join the new Sections.

The other great thing about the section is it allows you to be a part of a list serve with leading experts in the world on a given topic and exchange ideas.

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Alaska ACEP

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Seattle, WA 98121

(206) 956-3648