President Letter

As summer comes to a close I would like to share some of our 2018-19 plans so you can participate.

Annual Board Meeting Nov. 1
Mark your calendar: Our annual board meeting will be Nov. 1 in the Glacier Brewhouse conference room at 7pm. We will work efficiently through an update of our chapter’s activities and will vote in new leaders and board members. We will discuss some of the issues facing Emergency Medicine and where we want to focus as an organization. Please reach out to me if you are interested in running for office or for the board. We especially would like to recruit some new energy into the group so please consider reaching out to me or joining the meeting to get involved. We are increasingly being invited into state healthcare discussions and we want your voice heard on legislation and regulations that could impact your practice.

80% rule and other state politics
AK-ACEP engaged with legislators over the last year as healthcare politics have become hot issues. Last year we supported Rep. Grenn’s bill to eliminate balance billing when the 80th percentile rule was maintained. This bill did not make it through the process and we expect it as well as competing bills to be introduced the next legislative session.

We have again been invited to the Alaska State Hospital & Nursing Home Association (ASHNHA) Juneau legislative fly-in session, Feb. 26-27, 2019. This is a great opportunity for us to meet in Juneau, spend time with our legislators and connect with colleagues. You don’t want to miss this!

If you have not already, please make time this summer to connect with your state legislators – meet them for coffee or invite them to tour your ED. Take time to build a personal relationship with your lawmakers before we need their help on healthcare issues. Visit the Alaska State Legislature website for more information.

Federal Healthcare Politics
Consider joining us May 5-8, 2019 for national ACEP’s Leadership and Advocacy Conference. Each year we meet with our Alaskan legislators in Washington, DC. Many of the local issues we are working on are being looked at nationally and having our leadership in Washington learn about healthcare from us is a tremendous opportunity.

AK State Medicaid Redesign
The next combined Steering Committee and Clinical Consensus Group meeting is Oct. 30. The Emergency Department Information Exchange project (EDIE) is being implemented across the state. The PDMP (prescription drug monitoring database) is now able to be linked to the EDIE system and this linkage is rolling out across the system.

Opioids
Last October, we welcomed Dr. Don Teater who spoke to us about opioid addiction and pain management in the Emergency Department at an event in Anchorage. The State is interested in assisting us to develop another education conference with Dr. Teater. If you are interested in attending or organizing an event, please reach out to me so I can gauge participation and potential locations.

Journal Clubs
Our next Journal Club will Sept. 26 at 6:30pm. Nick Papacostas will be organizing the event and the articles will be shared ahead of time. If you’d like to help organize Journal Club events in 2019 please let me know.

Legislative Committee and AK-ACEP Board Members Needed!
We expect healthcare to continue to be a high priority political issue both in the state and nationally. And we will continue our efforts to work with the state to advocate for our patients and our practice. If you would like to participate more, please reach out to me at benjamin.shelton@mac.com.

Many of our existing AK-ACEP Board Members have carried the torch for Emergency Medicine in Alaska for several years. Please let me know if you would like to serve on the board. Your energy is needed.

I hope everyone has a great end to your 2018 Alaska Summer. I look forward to catching up more at this fall’s events.

Ben

Benjamin Shelton, MD, MPH, FACEP
Anchorage, AK

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AK-ACEP Awarded Grant

The chapter was recently awarded a $12,500 grant from national ACEP to continue our state legislative work. The grant will be used to create a public relations campaign to aid with our 80th Percentile advocacy work.

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Social Media Guru Needed

Love Facebook? Can’t Tweet enough? Consider becoming the official AK-ACEP social media point person. Contact the AK-ACEP office at plp@wsma.org to learn more.

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MAT Waiver Training at ACEP18

ACEP will be hosting an 8-hour in person Medication Assisted Treatment (MAT) Waiver training, at ACEP18 in San Diego as a preconference on Sunday, Sept 30, 2018, 8 am- – 5:30 pm. Learn more.

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Don’t Miss these Important Events in 2018-19

• Sept. 26, 2018 – AK-ACEP Journal Club, Glacier Brewhouse, at 6:30 pm.
• Oct. 1-4, 2018 – ACEP18 in San Diego, CA
• Nov. 1, 2018 – AK-ACEP Board Meeting, Glacier Brewhouse 7-9pm
• Feb. 26-28, 2019 – AK-ACEP Juneau meeting in conjunction with ASHNA Legislative Fly In, Feb. 26-27
• · May 5-8, 2019 – ACEP Legislative and Advocacy Conference in Washington, DC

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Going to ACEP18 in San Diego? Meet up with the AK Chapter

The Alaska Chapter will have a meet up Wednesday, Oct. 3 from 5-7 pm at the Old City Hall in San Diego. RSVP plp@wsma.org if you will be at ACEP18 and want to attend.

Old City Hall
672 Fifth Ave
Gaslamp Quarter
San Diego, CA
619.595.0123

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New ACEP Policy Statements and Information Paper

During their June meeting, the ACEP Board of Directors approved the following new or revised policy statements: 

• Access to 9-1-1 Public Safety Centers, Emergency Medical Dispatch, and Public Emergency Aid Training – New
• Appropriate Use Criteria for Handheld/Pocket Ultrasound Devices – New
• Coverage for Patient Home Medication While Under Observation Status – New
• Delivery of Care to Undocumented Persons – Revised
• Disaster Medical Services – Revised
• Financing of Graduate Medical Education in Emergency Medicine – Revised
• Guideline for Ultrasound Transducer Cleaning and Disinfection – New
• Impact of Climate Change on Public Health and Implications for Emergency Medicine– New
• Interpretation of Diagnostic Imaging Tests – Revised
• Interpretation of EMTALA in Medical Malpractice Litigation – New
• Non-Discrimination and Harassment – Revised
• Patient Autonomy and Destination Factors in Emergency Medicine Services (EMS) and EMS-Affiliated Mobile Integrated Healthcare Community Paramedicine Programs– New
• Prescription Drug Pricing – New
• Relationship between Clinical Capabilities and Medical Equipment in the Practice of Emergency Medical Services Medicine – New
• Resident Training for Practice in Non-Urban/Underserved Areas – Revised

The Board also reviewed the information paper Emergency Department Physician Group Staffing Contract Transition (PDF)

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Articles of Interest in Annals of Emergency Medicine

Sam Shahid, MBBS, MPH
Practice Management Manager, ACEP

ACEP would like to provide you with very brief synopses of the latest articles in Annals of Emergency Medicine. Some of these have not appeared in print. These synopses are not meant to be thorough analyses of the articles, simply brief introductions. Before incorporating into your practice, you should read the entire articles and interpret them for your specific patient population

Duber HC, Barata IA, Cioe-Pena E, Liang SY, Ketcham E, Macias-Konstantopoulos W, Ryan SA, Stavros M, Whiteside LK. Identification, Management and Transition of Care for Patients with Opioid Use Disorder in the Emergency Department

In this clinical review article, they examine the current body of evidence underpinning the identification of patients at risk for OUD, ED-based symptomatic treatment of acute opioid withdrawal, medication-assisted treatment (MAT) of OUD upon discharge from the ED, and transition to outpatient services. In this article they also present options for targeted opioid withdrawal and management, as well as a variety of other medications to consider for symptomatic opioid withdrawal treatment for patients that do not require opioids for acute pain. Full text available here.

Klein LR, Driver BE, Miner JR, Martel ML, Hessel M, Collins JD, Horton GB, Fagerstrom E, Satpathy R, Cole JB. Intramuscular Midazolam, Olanzapine, Ziprasidone, or Haloperidol for Treating Acute Agitation in the Emergency Department

In this prospective observational study of 737 patients, medications were administered based on an a priori protocol where the initial medication given was predetermined in the following 3-week blocks: haloperidol 5mg, ziprasidone 20mg, olanzapine 10mg, midazolam 5mg, haloperidol 10mg. The primary outcome was the proportion of patients adequately sedated at 15 minutes, assessed using the Altered Mental Status Scale (AMSS). Results showed that Intramuscular midazolam achieved more effective sedation in agitated ED patients at 15 minutes than haloperidol, ziprasidone, and perhaps olanzapine. Olanzapine provided more effective sedation than haloperidol. No differences in adverse events were identified. Full text available here.

Brenner JM, Baker EF, Iserson KV, Kluesner NH, Marhsall KD, Vearrier L. Use of Interpreter Services in the Emergency Department

This paper highlights the importance of effective communication in the provider-patient therapeutic relationship and how language barriers have the potential to compromise all aspects of medical care. The authors identify that in the US, as of 2013, more than 25 million persons had limited English proficiency, making quality medical interpreter services an important public health issue that affects a large proportion of our diverse population. They recommend that a professional interpreter should be offered if practical and available when a patient has either limited English proficiency or hearing impairment and that a modality of interpretation should be chosen between in-person, video, or telephone based on what best suits the clinical situation. Full text available here.

Nowak RM, Gandolfo CM, Jacobsen G, Christenson RH, Moyer M, Hudson M, McCord J. Ultra-Rapid Rule-Out for Acute Myocardial Infarction Using the Generation 5 Cardiac Troponin T Assay: Results from the REACTIONUS Study

The objective of this study was to determine how well a new FDA approved single cardiac troponin T Generation 5 (cTnT Gen 5) below the level of quantification (6 ng/L) baseline measurement and a novel study derived baseline/30 minute cTnT Gen 5 algorithm might adequately exclude acute myocardial infarction (AMI) in patients with suspected acute coronary syndrome (ACS) in a United States (US) Emergency Department (ED). They enrolled patients presenting with any symptoms suspicious of ACS. Baseline and 30 minute blood samples were obtained, the cTnT Gen 5 levels later batch analyzed in an independent core laband the AMI diagnosis was adjudicated by a cardiologist and an emergency physician. They found that a single baseline cTnT Gen 5 measurement <6 mg/L and values at baseline <8 ng/L and a delta 30 discharge to were randomized to receive 2 L of Lactated Ringer’s (LR) or NS. The primary outcome was symptom scores measured by the validated Quality of Recovery-40 (QoR-40) instrument (scores 40-200) 24 hours after enrollment. Results showed that there was no difference in post-enrollment QoR scores between NS and LR groups. Although pre-enrollment scores were higher in the LR group, adjusting for pre-survey imbalances did not change the primary outcome. The authors concluded that NS and LR were associated with similar 24-h recovery scores and 7-day health care utilization in stable ED patients.

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Preorder the Title that Celebrates the Depth and Diversity of EM

Explore the side of emergency medicine few see – the emotional, the heartbreaking, the thrilling, the heroic – the human side of EM. ACEP’s 50th Anniversary Book, Bring ’Em All, reveals how far the specialty has come in its short, vibrant life. Famed photographer Eugene Richards captures the breathtaking moments that make the lives & careers of American emergency physicians. Reserve your copy today.

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