A Call To Action: Save The Maddy Fund!

lifeline
AUGUST 2013
a forum for emergency physicians in california
A Call To Action:
Save The Maddy Fund!
Page 13
TABLE OF CONTENTS |
4
10
4
PRESIDENT’S MESSAGE
8
9
NEW OFFICERS
10
2013 ANNUAL ASSEMBLY
Thank You To Our Annual Assembly Sponsors
& Exhibitors!
13 ADVOCACY UPDATE
A Call To Action: Save The Maddy Fund!
15
PRACTICE MANAGEMENT UPDATE
2013 Core Measures Update
California ACEP
13
Mass Gathering & Event Medicine
20ANNOUNCEMENTS
21
UPCOMING MEETINGS & DEADLINES
22 CAREER OPPORTUNITIES
Board of Directors &
Lifeline Editors Roster
AUGUST 2013
2013-14 Board of Directors
Tom Sugarman, MD, FACEP, President
Michael Osmundson, MD, MBA, FACEP, President-Elect
Marc Futernick, MD, FACEP, Vice President
Larry Stock, MD, FACEP, Treasurer
Aimee Moulin, MD, FACEP, Secretary
Andrew Fenton, MD, FACEP, Immediate Past President
Yasmina Boyd, DO, FACEP
Vikant Gulati, MD
Jeffrey Leinen, MD, FACEP
Stephen Liu, MD, FACEP
Aakanksha Mehta, MD, CAL/EMRA
Cameron McClure, MD
Leslie Mukau, MD, FACEP
Valerie Norton, MD, FACEP
Chi Perlroth, MD, FACEP
Maria Raven, MD, MPH, FACEP, At-Large
Vivian Reyes, MD, FACEP
Eric Snyder, MD, FACEP
COMMERCE PRINTING
Page 18
EGO
Page 7
EMMA MD
Page 19
EMP
Back Cover
Fort Irwin
Page 22
GEMG
Page 22
HOAG Hospital
Page 22
Advocacy Fellowship
Aimee Moulin, MD, FACEP, Director
IEPC
Page 19
Lifeline Medical Editor
Richard Obler, MD, FACEP, Medical Editor
Michelman and Robinson, LLP
Page 19
Small LA ER
Page 22
VA Greater Los Angeles Healthcare System
(VAGLAHS)
Page 22
Lifeline Staff Editors
Elena Lopez-Gusman, Executive Director
Ryan P. Adame, MPA, Deputy Executive Director
Lucia Romo, Education Coordinator
Callie Hanft, Government Affairs Manager
Kelsey McQuaid, Program Associate
Melissa Hastie, Staff Assistant
Index of Advertisers
WELCOME new members!
Sanjay Arora, MD
Brian William Blake, MD
Sierra Bourne, MD
Caroline Brandon, MD
Myla Canales, MD
Alice Chao, MD
Mari L Cosentino, MD
Elaine H Cramer, MD, CCFP, MPH
Sharon R Cu, MD
Adam Dougherty
Robert S Farrell, MD
Gerald J Farrell, III
Amy Forrest, DO
Nicholas Steven Gastelum, MD
Yelena Gelman, DO
James A Grieme, MD
Dylan Hendy
Jennifer Hetzner, MD
Travis Inglis
Rachel Jaffe, MD
Nathaniel B Jones
Chris Katsura
Karen Keller, MD
Jeffrey Steven Kurz, MD
Elaine Lee, Resident
Eli Lessard, MD
Kirsten Liu, MD
Mari Machi, MD
Heather Mahoney, MD
Danielle N Mianzo, MD
Rachelle Nicolai, MD
Patrick Overfield, DO
Luke J Palmisano, MD, MBA
Nicholas Pokrajac, MD
Laura M Robinson, MD, FACEP
Jared L Ross
Hollie Sandlin, MD
Marisa Scofield
Michael B Shaheen, MD
Lauren V Sims
Warrik M Staines, MD
Erica Leigh Timiraos, MD
David Wang, MD
Adriel Watts, MD
Joshua A Westeren
Michael C Wu, MD
100% GROUPS
Central Coast Emergency Physicians
Emergency Medicine Specialists of
Orange County
Newport Emergency Medical Group, Inc.
at Hoag Hospital
Pacific Emergency Providers, APC
Front Line Emergency Care Specialists
Tri-City Emergency Medical Group
Loma Linda Emergency Physicians
University of California Irvine Medical
Center Emergency Physicians
Napa Valley Emergency Medical Group
AUGUST 2013 | 3
PRESIDENT’S MESSAGE |
California ACEP to Focus on
Improving Psychiatric Care
in Emergency Departments
4 | LIFELINE a forum for emergency physicians in california
By Thomas J. Sugarman, MD, FACEP
California emergency departments struggle on a daily basis to provide effective, appropriate and timely care to
psychiatric patients. Inadequate community mental health resources, unclear laws and regulations–which vary
from county to county–and poor coordination of care lead to suboptimal care for the mentally ill. The disproportionate emergency department (ED) resources devoted to patients with acute psychiatric emergencies lead to
crowding, disruptions in care, and delays impacting all patients and staff in the emergency department. The ED
stay for psychiatric patients tends to be much longer than for other patients for a myriad of reasons. In 2008, ACEP
surveyed ED directors.1
Some of the disturbing findings are:
• More than 90 percent indicated that they board psychiatric
patients every week, with more than 55 percent doing so daily
or multiple times per week.
• More than 60 percent of psychiatric patients needing
admission stay in the emergency department over 4 hours
after the decision to admit has been made, and 33 percent are
boarded over 8 hours with 6 percent over 24 hours.
Patients requiring a mental health evaluation prior to ED discharge
must often wait hours to days for a mobile psychiatric emergency
team to arrive and/or must be transferred to a designated psychiatric facility. Arranging transfers can take hours of staff time and
repeated phone calls. Beds are limited and some psychiatric hospitals refuse transfers of uninsured or Medi-Cal patients. Geriatric
and pediatric beds are even more limited, leading to even longer
boarding times in the EDs for these vulnerable populations.
• 85 percent said wait times for all patients in the emergency
department would improve if there were better psychiatric
services available.
Prior to the mental health evaluation, medical stability must be established. The requirements for medical stability (“clearance”) are
vague and often inconsistent, even for the identical facility. Standards are variable and not evidence based. An ED may not know
which facility will ultimately accept the patient or what a particular
facility will require to establish medical stability. Thus, EDs often
perform time consuming, extensive and expensive workups that
do not seem medically indicated to the emergency physician.
Inadequate community resources contribute to ED presentations
for psychiatric illness that could be better managed in a community mental health clinic or crisis unit. Some areas have no
outpatient treatment facilities; some have clinics operating only
during business hours. There tends to be poor coordination between community based mental health clinics and emergency
departments. When patients present to the ED it is often impossible to contact, much less, coordinate care with the patient’s mental
health provider.
Some of the most vexing challenges faced by emergency physicians
when caring for psychiatric patients revolve around involuntary
holds. California has two areas of law regarding holds. The older,
more well-known, Sections 5150-5157 of the Welfare and Institutions Code are part of the Lanterman-Petris-Short (LPS) Act. Section
5150 provides for the involuntary hold of a person who “as a result
of mental disorder, is a danger to others, or to himself or herself,
or gravely disabled.” That person can be detained in a facility that
is “designated by the county and approved by the State Depart-
• 62 percent indicated there were no psychiatric services
involved with patient care while patients are being boarded
in the emergency department prior to admission or transfer.
1.http://www.acep.org/uploadedFiles/ACEP/Advocacy/federal_issues/PsychiatricBoardingSummary.pdf
AUGUST 2013 | 5
PRESIDENT’S MESSAGE |
Some of the most vexing
challenges faced by
emergency physicians
when caring for psychiatric
patients revolve around
involuntary holds.
ment of Mental Health as facility for 72-hour hold and detention.”
Peace officers and others designated by the county mental health
director may place 5150 holds. Unless specifically designated by the
county, emergency physicians cannot place 5150 holds; many counties do not allow emergency physicians to place 5150 holds in any
situation; some only allow emergency physicians practicing in designated psychiatric facilities to place 5150 holds.
Section 5150 allows designated individuals, to “cause, take, or
cause to be taken, the person into custody and place him or her in
a designated facility." Although there is language in the 5150 law
that requires designated facilities to accept all patients brought by
a peace officer, there is no language requiring them to accept patients brought by any other means. Additionally, 5150 provides no
guidance regarding patients who meet 5150 criteria but are not at a
designated facility. Because the vast majority of emergency depart-
6 | LIFELINE a forum for emergency physicians in california
ments are not part of a 5150-designated facility, the 5150 law does
address detention of a patient in those emergency departments.
Section 1799.111 of the Health and Safety Code provides a mechanism to detain patients brought to EDs in a non-designated facility
when no psychiatric bed is available or who require medical care that
cannot be provided in a designated facility.
1799.111 allows a patient to be held in a non designated ED if several conditions are met, including: “The person cannot be safely
released from the hospital because, in the opinion of the treating
physician and surgeon, or a clinical psychologist…the person, as a
result of a mental disorder, presents a danger to himself or herself, or
others, or is gravely disabled.” The hold is allowed for 8 hours while
“appropriate mental health treatment” is being sought or for up to
24 hours “because of the need for continuous and ongoing care,
observation, or treatment that the hospital is providing.” 1799.111
allows an emergency physician (without requiring any designation
by the county) to detain a patient if the conditions are met.
The ability to detain or hold a patient in both 5150 or 1799.111 is
based upon immunity from liability for detaining the person if the
conditions specified by 1799.111 exist. Each law has a mechanism
to continue the immunity from liability if specified conditions exist when the person is released. However, neither section of law
requires that a person be detained. In fact, 1799.111 only allows
ongoing detention after the initial 8 hours, if the person “as a result
of a mental disorder, is still a danger to himself or herself, or others,
or is gravely disabled.” Unfortunately, some counties require that
patients be held or detained until a county designated person lifts
the hold. It is unclear what law(s) this requirement is based upon.
Another problem is that neither section of law makes any provision
for the psychiatric patient that requires hospitalization for medical
reasons but remains suicidal, homicidal or gravely disabled. Neither
section of law applies to a patient admitted to a general hospital.
Unfortunately, in many community hospitals, there are no or very
limited mental health services available to mental health patients. In
some localities a mobile crisis team is available, but often with a long
wait. In other places, no mental health professionals are available and
the only option is to transfer the patient to a designated psychiatric
facility. Given the complex and confusing requirements concerning
detention and holds, emergency physicians may have difficulty in
arranging for psychiatric evaluations as many crisis teams and psychiatric hospitals require that the patient be on a hold. There may
be disagreements between the emergency physician’s assessment
that a psychiatric emergency exists and the determination by the
county’s designated professional or a peace officer. It seems ridiculous that the judgment of a peace officer or social worker is deemed
more reliable than that of a board certified emergency physician. Yet
I am aware of situations where emergency physicians felt emergency
psychiatric evaluation was necessary but it could not be obtained because no one designated to place a hold would do so. On the other
hand, due to poor understanding and/or the varying interpretations
of the laws, emergency physicians may be reluctant to release patients no longer meeting the requirements for detention.
In the ideal world there would be enough funding to care for all
of our patients, including the mentally ill. But that is not the case
and funding is often more limited for the mentally ill then others
as they are among the most vulnerable in society. A comprehensive redesign of the emergency mental health system would be
best but is not feasible. Nevertheless, emergency physicians should
continue to work collaboratively to gain some improvements in the
system. Over the past decade or so, California ACEP has lobbied to
establish and then improve the 1799.111 law. This year, there are
likely to be changes to the 5150 law. We are lobbying to ensure that
the proposed changes do not worsen the situation in emergency
departments. Going forward, California ACEP aims to work on
simplifying, standardizing and clarifying the laws and regulations
around involuntary holds.
There are also non-legislative actions that emergency physicians
can make. California ACEP is convening a work group, led by our
Vice President, Marc Futernick, to examine the best strategies to
improve the care we provide to mental health patients in California’s EDs. Ideas under consideration include working with mental
health directors, psychiatric hospitals, psychiatrists and others to
standardize the required testing and exam for medical stabilization.
Developing education for emergency physicians on the nuances
of the laws regarding caring for psychiatric patients will be helpful. This may lead to developing model policies for EDs that can be
modified depending on the county’s implementation of 5150. Improving emergency physicians’ knowledge and ability to provide
better psychiatric assessments and deliver better psychiatric care
will likely lead to decreased need for transfers and thus decreased
boarding. If we can open lines of communication and create a common understanding, we should be able to improve coordination of
care with community mental health resources. Overall our goal is to
provide the right care, in the right location at the right time to all of
our patients, including the mentally ill. n
AUGUST 2013 | 7
New Officers
At the Annual Assembly Board of Directors meeting on June 13, 2013,
the Chapter Board elected its new officers for the 2013-14 year. Please
welcome your new 2013-14 Board of Directors:
OFFICERS
BOARD OF DIRECTORS
PRESIDENT
Thomas J. Sugarman, MD, FACEP
Yasmina Boyd, DO, FACEP
PRESIDENT-ELECT
Michael Osmundson, MD, MBA, FACEP
Jeffrey Leinen, MD, FACEP
VICE PRESIDENT
Marc Futernick, MD, FACEP
Aakanksha Mehta, MD, CAL/EMRA
TREASURER
Lawrence Stock, MD, FACEP
Leslie Mukau, MD, FACEP
SECRETARY
Aimee Moulin, MD, FACEP
IMMEDIATE PAST PRESIDENT
Andrew Fenton, MD, FACEP
Vikant Gulati, MD
Stephen Liu, MD, FACEP
Cameron McClure, MD
Valerie Norton, MD, FACEP
Chi Perlroth, MD, FACEP
Maria Raven, MD, MPH, FACEP
Vivian Reyes, MD, FACEP
Eric Snyder, MD, FACEP
LIKE US ON
FACEBOOK
FACEBOOK.COM/CALIFORNIAACEP
FOLLOW US
ON TWITTER
@ CALIFORNIAACEP
8 | LIFELINE a forum for emergency physicians in california
C A L IF O R N IA A
C E P .O R G
| PRACTICE MANAGEMENT UPDATE
2013 Core
Measures Update
By California ACEP Practice Management Committee
T
his is a follow up to the 2012 Core Measures (June 2012 issue
of Lifeline) outpatient review and includes the new 2013 requirements as well as a brief review of the four measures that
went unchanged in 2012: Acute Ml, Chest Pain, Pain Management
for Long Bone Fractures, and Stroke. The major changes for 2013
involve the outpatient measures started in 2012 and modified for
this year, including three ED throughput areas; Median Time from
ED Arrival to Departure for Discharged ED patients (Outpatient
measure 18), Door to Diagnostic Evaluation by Qualified Medical
Personnel (Outpatient 20) ,and Left Without Being Seen (Outpatient 22). The 2012 Core Measure for Outpatient Troponin Results
was dropped last year and is not being reinstated for 2013.
Let's briefly review the unchanged measures for AMI, Chest Pain,
Stroke, and Pain Management in Long Bone Fractures, relevant to
the ED. AMl is still monitoring 5 areas: Median time to fibronolysis,
fibronolytic therapy received within 30 minutes, median time to
transfer to another facility for acute coronary intervention, aspirin
at arrival and median time to ECG. The criteria and tracking of these
issues is essentially unchanged from 2012 and can be reviewed in
last year’s article.
As mentioned, the new areas of emphasis for 2013 are all related to
ED throughput, which is the government's major agenda for EDs.
The first target is time [in minutes] from ED arrival to ED departure
for patients discharged from the ED, excluding any patients that
expire in the ED. The data elements are: arrival time, discharge
code, E/M code, ED departure date and time, ICD-9-CD principal
diagnosis code, observation services and outpatient encounter
date. The stated goal is to decrease the median value; however no
benchmarks or standards were given for comparison. The second
stated goal, “Transition Record with Specified Elements Received
by Discharged Patients" is much more complicated and was
discontinued recently due to difficulty in reaching a clear consensus
on the topic. This measure will not be used this year.
Outpatient measure 20, “Door to Diagnostic Evaluation by a
Qualified Medical Provider,” tracks all ED patients except those
that expire. It measures arrival time, discharge and E/M codes,
encounter date and provider contact time. No metrics or specific
goals are yet set.
Outpatient measure 22, “Number of Left Without Being Seen
Patients from the ED,” includes anyone not seen/evaluated by an
MD or mid-level provider. This is unchanged from 2012, and has not
had specific primers assigned to it yet.
Outpatient measure 21, “Pain Management in Long Bone Fractures,”
is unchanged from 2012. It includes all patients over two years old
and is measured by time to oral or parenteral pain medications. The
goal is to decrease the median value of time, however no specific
number has been given.
The final measure, Outpatient 23, is about Stroke and is unchanged
from last year. The objective is, again, to have either a Head CT or
MRI done and interpreted within 45 minutes of arrival. The measure
includes all patients over 18 with a diagnosis of either ischemic or
hemorrhagic stroke. The goal remains unchanged; an increase in
the rate meeting this criterion.
In summary, the 2013 Core Measures are essentially the same
as 2012 except Troponin time within an hour of ED arrival
was eliminated last year and the new Outpatient measure 19,
transitional medical record, was dropped. Once again there is a
lack of specific data from the 2012 results and no metrics for 2013.
However, it is clear that there are plans to attach metrics and dollars
to these measures in the future, so be ready and keep good data
tracking your improvements. n
AUGUST 2013 | 9
Thank You to Our Annual
Assembly Sponsors & Exhibitors!
10 | LIFELINE a forum for emergency physicians in california
| 2013 ANNUAL ASSEMBLY
SPONSORS
• UCLA-Olive View, Sponsored By
Emergent Medical Associates
Platinum Sponsor ($5,000+)
• Antelope Valley Emergency Medical
Associates
“A” Sponsors ($2,500+)
• CEP America - Bag Sponsor
• Emergency Medicine Scribe Systems USB Drive Sponsor
• Independent Emergency Physicians
Consortium - Pen Sponsor
• UCSD, Sponsored By Drs. Bing Pao &
Ghazala Sharieff
• USC, Sponsored By Drs. Mel Herbert
& Rick Bukata
EXHIBITORS ALPHABETICAL
LISTING
• CEP America
• Dale Medical Products
• Emergency Groups Office
• Michelman & Robinson, LLP Lanyard Sponsor
• Emergency Medicine Patient Safety
Foundation
“B” Sponsors ($1,500+)
• Emergency Groups Office - Closing
Reception Bar Sponsor
• Emergency Medicine Physicians
• Emergency Medicine Scribe Systems
• Emergent Medical Associates
• Kaiser Permanente - Luncheon
Sponsor
• Independent Emergency Physicians
Consortium
• Mckesson - Break Sponsor
Golf Tournament/Hole Sponsors ($300)
• Intermedix
• Baja Sharkeez
• Karl Storz
• Eureka
• Mckesson
• Lazy Dog Restaurant & Bar
• Medaphor, Inc.
• Tin Roof Bistro
• Meddata, Inc.
• Medhost
Resident Sponsors
• Michelman & Robinson, LLP
The chapter would like to specially
acknowledge the individual members
and groups that have provided
sponsorship and/or off-set registration
fees for residents from:
• Mirador Biomedical
• Newsura, Inc.
• Nuvomed, Inc.
• Physicians Choice
• Arrowhead Regional Medical Center,
Sponsored By Dr. Rodney Borger
• Porter Instrument
• Loma Linda, Sponsored By
Dr. Kathleen Clem
• Teamhealth
• Specialists On Call
• Naval Medical Center, San Diego,
Sponsored By Dr. Valerie Norton
• T-System Inc.
• UC Davis, Sponsored By Dr. David
Barnes
• Valley Emergency Physicians
• UCLA-Harbor, Sponsored By Torrance
Memorial & Dr. Franklin Pratt
• U.S. Army Healthcare Recruiting
• Vidacare
• Wakefield & Associates
Thank You
AUGUST 2013 | 11
2013 ANNUAL ASSEMBLY |
Congratulations
to the 2013 Annual Assembly Awards Recipients
CAL/EMRA Award
Christina Millhouse, MD
Chapter Service Award (Physician)
Bing Pao, MD, FACEP
Education Award
Edward Panacek, MD, MPH, FACEP
EMS Achievement Award
Eric Rudnick, MD, FACEP
House of Medicine Award
Rodney Borger, MD, FACEP
Injury Prevention Award
Larry Foreman, MD, FACEP
Key Contact Award
Michael S. Agron, MD, FACEP
Media Award
Peter Nicks
Walter T. Edwards Meritorious Service Award
Andrea Brault, MD, MMM, FACEP
12 | LIFELINE a forum for emergency physicians in california
| ADVOCACY UPDATE
A Call To Action:
SAVE THE MADDY FUND!
California ACEP’s sponsored legislation, SB 191 (Padilla), which would renew some $50 million in emergency care
safety net funding (Maddy EMS Fund), will be sent to Governor Jerry Brown this month. The bill has seen overwhelming
support in the Legislature, but the fight is coming when the bill reaches the Governor’s desk.
Governor Brown has made clear his dislike for penalty fee
assessments to pay for programs that he feels should be paid for
by taxpayers generally, not just those who pay traffic fines, though
he has also expressed support for the goals of the programs
themselves – including emergency care funding. In 2011, Governor
Brown took the unusual step of allowing AB 412, which was
sponsored by California ACEP and which renewed the Santa Barbara
County Maddy Fund, to become law without his signature. The
Governor even went so far as to send a message to the Legislature
to accompany his “action”, which is normally reserved to vetoes and
in which he stated his support for the program, if not the funding
mechanism. In light of this, California ACEP is embarking on a grassroots push to urge the Governor to sign SB 191, and we will need
help from all of our members and allies or we won’t succeed!
SB 191 has over 60 supporters and California ACEP will be reaching
out to each and every one of them for their help in securing the
Governor’s signature. This broad coalition of supporters ranging
from counties to specialty care groups to community organizations
will work tirelessly contacting the Governor through all means
possible. California ACEP is hopeful that the large coalition of
supporters will make all the difference in our fight to save the
Maddy Fund.
California ACEP’s advocacy plan includes phone calls to the
Governor, postcards, outreach to supporters, and a social media
campaign.
But the key to getting SB 191 signed into law is you. In the coming
weeks, we will be contacting our members via email and here
in Lifeline for a call-to-action. We’ve included some important
information and talking points below, but please also detach the
post-card in this issue and mail it in ASAP!
Please use the phone script and sample email language for
contacting the Governor’s office. Members may also Tweet at
the Governor and visit the Save The Maddy Fund Facebook page
(www.facebook.com/SaveTheMaddyFund). Don’t forget to sign
and mail the SB 191 postcard to the Governor (included in this issue
of Lifeline).
AUGUST 2013 | 13
ADVOCACY UPDATE |
Contact the Governor by PHONE
Governor’s Office Phone: (916) 445-2841
When calling the Governor please use this phone script.
Hello, my name is ____________.
I am calling today to urge Governor Brown to sign SB 191
(Padilla). SB 191 continues crucial funding for the Maddy EMS
fund. Allowing this program to sunset would result in the loss of
approximately $50 million from the emergency care safety net
and the only source of pediatric trauma funding in the state.
Despite the implementation of the Affordable Care Act, three to
four million Californians will still remain uninsured. Without these
crucial funds, hospitals and physicians will not have the adequate
resources to treat Californians, both insured and uninsured.
Please save the Maddy Fund and sign SB 191.
TWEET the Governor
If you have a Twitter account, don’t forget to tweet at the
Governor. Please use #SaveTheMaddyFund, #SignSB191, and
#SB191 in your tweets.
Sample Tweets:
@JerryBrownGov please #SignSB191 and #SaveTheMaddyFund
@JerryBrownGov The safety net will lose $50 mil if you don’t
#SignSB191. Please #SaveTheMaddyFund
@JerryBrownGov Without #SB191 there will be no pediatric
trauma funding in CA. #SaveTheMaddyFund
FACEBOOK the Governor and like the “Save The Maddy
Fund” Page
Thank you.
Contact the Governor by E-MAIL
To Email the Governor visit:
http://govnews.ca.gov/gov39mail/mail.php
The following is a sample email to use when contacting the
Governor’s office.
Dear Governor Brown,
Please sign SB 191 (Padilla) to extend crucial funding for the
Maddy EMS fund. Allowing this program to sunset would result
in the loss of approximately $50 million from the emergency
care safety net and the only source of pediatric trauma funding
in the state. Despite the implementation of the Affordable Care
Act, three to four million Californians will still remain uninsured.
Without these crucial funds, hospitals and physicians will not
have the adequate resources to treat Californians, both insured
and uninsured.
Please save the Maddy Fund and sign SB 191.
Sincerely,
Your Name Here
14 | LIFELINE a forum for emergency physicians in california
California ACEP members can also receive updates on SB 191
(Padilla) by visiting the Chapter Facebook page (www.facebook.
com/CaliforniaACEP) or by “liking” the SaveTheMaddyFund
Facebook page (www.facebook.com/SaveTheMaddyFund).
Contact the Chapter office for more information about
SB 191 (Padilla) and what you can do to help get the bill signed into
law. Please share this information with your friends and colleagues.
Together we can save the Maddy Fund! n
Mass Gathering & Event Medicine
By Vivian Reyes, MD, FACEP
& Rolando Valenzuela, MD
Emergency Medicine with its links to EMS and Disaster
Medicine is uniquely positioned to fill what is identified as a
new subspecialty niche: Mass Gathering & Event Medicine.
W
hat is Mass Gathering &
Event Medicine? This is an
emerging field related to the
preparation for and provision
of medical care for sizeable gatherings of
people, often associated with prominent
international or national events with large
expected crowds (often in the millions).
Whether it is the Olympics, World Cup,
America's Cup, a marathon, large concert
or political convention, Mass Gathering &
Event Medicine seeks to provide on-site
medical services and expedited care while
mitigating surge at local medical facilities.
Logistics planning is often extensive and
involves consideration of venue design,
security, EMS access/egress routes, water
supply, sanitation and waste concerns,
staffing, supply, and support for on-scene
temporary medical facilities. Each mass
gathering event will have specific planning
needs based on the event characteristics.
How many spectators are expected? For
how long will the event run? What activities
are planned? How many competitors are
involved, and in what activities? What
activities are planned for spectators? In
what season will the event take place? Are
there environmental concerns that may
exacerbate preexisting conditions? Are
there infectious disease concerns related
to the event (e.g., the surge in meningitis
cases often observed after the Hajj)? Is there
a secure clean water supply with adequate
distribution? Is alcohol or illicit drug use /
abuse expected at the venue or event?
What is the expected age of participants?
Finally, one more unfortunate question
must be considered: is the event a likely
terrorist target?
This last question was tragically underscored
at this year's Boston Marathon when two
improvised explosive devices detonated
near the finish line. Event Medicine planners
must always be prepared to switch over
into a Disaster Medicine response should a
Mass Casualty Incident (MCI) occur during
a mass gathering. All planners hope their
event will not require disaster medicine
expertise, but none can (or should) ignore
the possibilities. This is why emergency
medicine is moving quickly into the Mass
Gathering & Event Medicine subspecialty.
Our focus is on the larger picture, as
opposed to Sports Medicine, which has,
by necessity, a narrow focus solely on
competitors. In addition, many gatherings
are not competitive. Burning Man, for
example, is a multi-day event held in the
Nevada desert, far from the niceties of
urban or suburban life. Some planners even
describe certain mass gatherings, such
as large marathons or massive religious
events such as the Hajj, as “slow moving
MCIs” whose medical needs can be reliably
predicted. Clearly, there is much overlap
between Mass Gathering & Event Medicine
and Emergency Management.
Two Recent Examples:
LOS ANGELES MARATHON
Tackling a Mass Gathering & Event
Medicine project requires dedication,
substantial resources, and collaboration
with communities, EMS, Police, Fire, and
political and governmental entities. This
represents a major service that Emergency
Medicine provides.
LA County + USC Medical Center
(LAC+USC) volunteered to provide medical
care to the LA Marathon in 2012 and 2013.
AUGUST 2013 | 15
The LAC+USC residency program has 68
residents, over 45 full-time faculty, and
several fellowships. The Department of
Emergency Medicine at LAC+USC has
direct ties to the EMS community via
Marc Eckstein MD, FACEP, Medical Director
for LA City Fire Department. With such
enormous resources, the chairman (Sean
Henderson MD, FACEP) decided that USC
was uniquely positioned to commit to
provision of health care at this event. The
LA Marathon involves over 24,000 runners,
from 61 different countries, running a
26.2 mile course from Dodger Stadium on
the east side of Los Angeles, to the sea,
naturally crossing through many different
jurisdictions and operational areas. During
the 2013 event, runners were fortunate to
have a relatively cool day, thus mitigating
athlete injury related to temperature. The
successful management of this event was a
feather in the cap of LAC+USC, and a real
success for the EM residency at LAC+USC
that comprised much of the physician work
force (fig. 1).
FIG. 1 Chief Resident Jaime Eng MD and
Chairman Scott Henderson MD, FACEP
take care of the injured at the 2013 LA
marathon; Chief Resident Nick Greco,
MD oversees patient care for an injured
runner at the 2013 LA Marathon.
THE AMERICA’S CUP
This year’s America’s Cup is a uniquely
challenging Mass Gathering & Event
Medicine experience, extending over 81
days from July 4th- September 22, 2013. This
is one of the oldest events in sports history,
with the first trophy awarded in 1851 after
a race around the Isle of Wight in England.
For 2013, up to 35,000 people are expected
to attend at 3 official viewing sites along
the San Francisco waterfront for the 42
race days, with thousands more expected
to participate in non-race day concerts and
events held on the surrounding grounds.
With this event, there will be people in the
air (media/spectator rotary wing aircraft)
on the sea (racing catamarans, racing
support vessels, spectator boats, media
16 | LIFELINE a forum for emergency physicians in california
boats, police/coastguard/fire boats) and
on land (spectators at venue events and
surrounding waterfront) along miles of the
historic San Francisco waterfront (fig. 2).
Such a large event, lasting for so many
days, requires massive mobilization of
resources. Kaiser Permanente, led by
Hernando Garzon, MD and Vivian Reyes,
MD, FACEP, volunteered to support this
challenging endeavor. Two state-of-the-art
medical stations and one first aid station
have been set up with staffing 12 hours/
day on race days, and Kaiser Permanente’s
team also created a new iPad-based mobile
computing application for patient care,
triage, and tracking.
The logistics and staffing for an event of this
magnitude and complexity are fascinating.
The competitors will be on the water,
filmed by various helicopters. Thousands of
spectators will be on the water on private
watercraft, with even more watching from
land. The racecourse stretches across the
bay, from the Golden Gate Bridge to the
America’s Cup Village at Pier 27 and 29 (Fig 2)
and will involve the Coast Guard and the San
Francisco Police Department patrolling the
water. Race teams will also have their own
support staff trailing the racing catamarans.
In addition to the KP staffing, Paul Abboud,
MD, FACEP, created a senior EM resident
elective rotation in Mass Gathering
Medicine at Kaiser Permanente’s Medical
Support for the America’s Cup. Eleven
emergency medicine residents enrolled
from around the country, representing
residency programs as far away as New
York City, Chicago, and Denver. Many of
these young physicians have an interest or
experience in disaster medicine, or sports
medicine, but this will be their first exposure
to Mass Gathering Medicine.
The Kaiser Permanente medical team will be
prepared to treat basic medical conditions
while also being ready to provide a
higher level of care, such as point of care
(POC) blood and urine testing, bedside
ultrasound, ECG, vital sign monitoring,
video conferencing, as well as portable
X-ray (fig. 3). Transport arrangements
and coordination plans with city services,
community organizations, and medical
facilities in the areas surrounding the event
have been developed as well.
With the growing threat of terrorism, and
the greater size and complexity of large
mass gathering events, the planning and
resource demands for an appropriate
health care response are increasing. This is
both a challenge and an opportunity for the
development and growth of Mass Gathering
& Event Medicine. Kaiser Permanente has
done extensive planning and coordination
to develop and implement its Mass
Gathering & Event Medical response. The
safeguarding of health for spectators and
racers during this event represents a major
contribution to the entire Bay Area.
The LA marathon and the America’s Cup
showcase how emergency medicine has
captured a new subspecialty niche in Mass
Gathering & Event Medicine. No other
specialty is able to bring our skill set or
connections to Emergency Medical Services
or the Disaster Medicine Community. The
future will bring an exciting time with new
methods of data collection using mobile
computing as well as improved wireless
networks and satellite technology. As our
specialty evolves to fill this demand and
our experience in this new field grows, we
must continue sharing our experiences
and research to nurture the growth of this
nascent subspecialty. n
FIG. 2 & 3
Vivian Reyes, MD, FACEP,
is a Kaiser Permanente
Physician, a California ACEP
Board Member, and the
Assistant Medical Director
for the Kaiser Permanente's
medical services facilities at
the America’s Cup.
Rolando Valenzuela, MD,
is the Merkin Fellow of
International Emergency
Medicine at LAC+USC
Medical Center.
AUGUST 2013 | 17
live green print green
BUY LOCAL!
Sacramento’s economy depends on small business.
What can we do to bring jobs into this city? BUY LOCAL!
Through the purchase of goods and services from small
businesses, we can boost the economy by producing more income,
more local jobs, and more tax receipts for our communities,
thereby preserving the economic diversity of Sacramento and the
unique character of its surrounding neighborhoods.
916.442.8100 • www.commerceprinting.com
Independent Emergency Physician Group + Multiple
Group Collaboration = IEPC
At IEPC (Independent Emergency Physicians Consortium),
we provide an umbrella of strength for shared best clinical
and business practices, purchasing power, recruitment,
innovation, data repository, benchmarking, and a free
exchange of ideas.
An independent emergency
group may feel isolated in the
sea of large emergency group
practices. Join IEPC and benefit
from collaboration with many
similar emergency medicine
groups while maintaining your
independent group culture. A
single branch is easily
breakable, but tied together, a
group of branches gains much
strength.
For employment opportunities
at various IEPC affiliated
hospitals, visit our web site.
Independent Emergency Physicians Consortium
145 E Prospect Avenue, Suite 218B, Danville, CA 94526
925.855.8505 | www.iepc.org
Southern California
JOB OPPORTUNITIES
•
Excellent Opportunities for
Emergency Physicians
• Very Competitive Compensation
• Pleasant Work Environment
• Hospitals include Arcadia Methodist &
Glendale Memorial (Top heart programs).
• Available practice settings in the Greater
Los Angeles area.
Contact Debbie Corn for more information
(909) 634-3172 or email CV to dcorn@emmamd.com
Michelman & Robinson, LLP
Representing emergency physicians throughout California in
reimbursement disputes, employment matters, contracting,
fraud and abuse, as well as litigation, transactions, mergers
and acquisitions, and risk management.
M&R attorney Andrew Selesnick can be reached by phone at (818) 783-5530
or by email at aselesnick@mrllp.com.
Los Angeles | Orange County | Sacramento | San Francisco | New York | www.mrllp.com
M&R is a dynamic, national law firm with locations throughout California and New York. The Firm specializes in Health Care, Advertising, Marketing & Media, Commercial & Business
Litigation, Construction, Corporate & Securities, Environmental, Financial Services & Bankruptcy, Insurance Coverage & Bad Faith, Intellectual Property, Labor & Employment, Real Estate,
Regulatory & Administrative, Tax, and Writs & Appeals. For more information, please visit www.mrllp.com.
AUGUST 2013 | 19
CEMAF
Donors
The California Emergency Medicine Advocacy
Fund (CEMAF) has transformed California ACEP’s
advocacy efforts from primarily legislative to robust efforts in the legislative, regulatory, legal,
and through the Emergency Medical Political Action Committee, political arenas. Few, if any, organization of our size can boast of an advocacy program
like California ACEP’s; a program that has helped block
Medi-Cal provider rate cuts, stop the $100 million raid
on the Maddy EMS Fund, and fight for ED overcrowding
solutions – and that’s just the last year! The efforts could
not be sustained without the generous support from
the groups listed below, some of whom have donated as
much as $0.25 per patient visit to ensure that California
ACEP can fight for emergency medicine. Thank you to
our contributors (in alphabetical order):
• Acute Care Medical Group of Orange County
• Alvarado Emergency Medical Associates
• Antelope Valley Emergency Medical Associates
• Beach Emergency Medical Associates
• Berkeley Emergency Medical Group
• CEP America
• Centinela Freeman Emergency Medical Associates
• Central Coast Emergency Physicians
• Chino Emergency Medical Associates
• Culver City Emergency Medical Group
• Downey Acute Care Medical Group
•EMP
• EMS Management
• Front Line Emergency Care Specialists
• Mills Peninsula Emergency Medical Group
• Montclair Emergency Medical Associates
• Napa Valley Emergency Medical Group
• Orange County Medical Associates
• Pacific Emergency Providers
• Pacifica Emergency Medical Associates
• Riverside Emergency Physicians
• San Dimas Emergency Medical Associates
• San Francisco Emergency Medical Associates, Inc.
• Santa Cruz Emergency Physicians
• Sherman Oaks Emergency Medical Associates
• South Coast Emergency Medical Group, Inc.
• Tarzana Emergency Medical Associates
• Team Health
• Tri-City Emergency Medical Group
• Valley Emergency Medical Associates
• Valley Emergency Physicians
• Valley Presbyterian Medical Associates
• West Hills Emergency Medical Associates
20 | LIFELINE a forum for emergency physicians in california
ANNOUNCEMENTS |
CALIFORNIA ACEP SPONSORED COURSES
Please check back for more information on our upcoming
2014 courses.
CALIFORNIA ACEP JOINTLY-SPONSORED COURSES
Jointly sponsored by California ACEP and the American College
of Emergency Physicians
ENDURING MATERIALS - ONLINE CME
Patient Safety Risk Solutions* Enduring Materials - Webinar
Info: www.psrisk.com
• Teamwork and Communications in Emergency Medicine
• The Dilemma of the Psychiatric Patient in the Emergency
Department
• Treating Stroke in the ED; and the Standard of Care Is…
SonoSim* Enduring Materials - Computer Software (Modules)
Info: (310) 315-2828
www.sonosim.com
• SonoSim® Ultrasound Training Solution: Aorta/IVC Module
• SonoSim® Ultrasound Training Solution: Bladder Scanning
Module
• SonoSim® Ultrasound Training Solution: FAST Protocol
Module
• SonoSim® Ultrasound Training Solution: Fundamentals of
Ultrasound Module
• SonoSim® Ultrasound Training Solution: Intestinal/Biliary
Module
• SonoSim® Ultrasound Training Solution: Musculoskeletal
Module
• SonoSim® Ultrasound Training Solution: Ocular Module
• SonoSim® Ultrasound Training Solution: Rapid Ultrasound
Module
• SonoSim® Ultrasound Training Solution: Soft Tissue Module
• SonoSim® Ultrasound Training Solution: Vascular Access
Module
*Approved for AMA PRA Category I CreditsTM
| CALIFORNIA ACEP UPCOMING MEETINGS & DEADLINES
For more information on upcoming meetings, please e-mail us at info@californiaacep.org; unless otherwise noted, all
meetings are held via conference call.
AUGUST 2013
AUGUST 2013
5th – 6th
Chapter Board of Directors Retreat
Hyatt Regency Sacramento
Sacramento, CA
7th at 9:00 am
Chapter Board of Directors Meeting
Hyatt Regency Sacramento
Sacramento, CA
13th at 1:30 pm
Emergency Medicine Research & Education Foundation
Board of Trustees Meeting
Conference Call
22nd
Covered California Board Meeting (Exchange Board)
East End Complex
Sacramento, CA
SEPTEMBER 2013
SUN
MON
TUES
WED
THURS
FRI
SAT
1
2
3
4
5
6
7
8
9
10
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16
17
18
19
20
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22
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SEPTEMBER 2013
SUN
MON
TUES
WED
THURS
FRI
SAT
1
2
3
4
5
6
7
8
9
10
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12
13
14
Chapter Council Delegation – Subcommittee B Meeting
Conference Call
15
16
17
18
19
20
21
19th at 2 pm
Chapter Council Delegation – Subcommittee C Meeting
Conference Call
22
23
24
25
26
27
28
19th
Covered California Board Meeting (Exchange Board)
East End Complex
Sacramento, CA
29
30
2nd
Labor Day
Chapter Office Closed
19th at 9 am
Chapter Council Delegation – Subcommittee A Meeting
Conference Call
19th at 11 am
27th at 10 am
Government Affairs Committee
Conference Call
TBA
Practice Management Committee
Conference Call
OCTOBER 2013
SUN
MON
TUES
WED
THURS
FRI
SAT
1
2
3
4
5
6
7
8
9
10
11
12
Emergency Medicine Research & Education Foundation
Board of Trustees Meeting
Conference Call
13
14
15
16
17
18
19
20
21
22
23
24
25
26
11th – 13th
CMA House of Delegates
Disneyland Hotel
Anaheim, CA
27
28
29
30
31
12th- 13th
ACEP Council Meeting
Sheraton Seattle Hotel & Towers
Seattle, WA
14th – 17th
ACEP Scientific Assembly
Washington State Convention Center
Seattle, WA
24th
Covered California Board Meeting (Exchange Board)
TBA
OCTOBER 2013
8th at 1:30 pm
AUGUST 2013 | 21
CAREER OPPORTUNITIES |
Are You Looking for the Perfect Balance Between
Work and Play? Join Us in Caring for Our Military
Servicemen and Women at Fort Irwin.
Humana Government Business is seeking Full Time and
Part Time Board Certified/Board Eligible EM, IM, FP, or PD
physicians to provide services at Weed Army Community
Hospital; Fort Irwin (outside of Barstow, CA). This low
acuity ED has an annual patient volume of 16,000. 12 hour
shifts. Lodging provided for block scheduling. Attractive
remuneration & malpractice insurance provided. Qualified
candidates shall have completed a primary care residency
and possess a minimum of 2 of the last 3 years Emergency
Medicine experience within a similar or higher level facility.
Current licensure in any one of the U.S. States and BLS, ACLS,
ATLS, and PALS certifications is required. Candidates must
be U.S. citizens.
Contact Michelle Sechen at 1-877-202-9069, forward CV via
email to msechen@humana.com, or by fax at 502-322-8759
ORANGE COUNTY
Newport Emergency has an opening at Hoag Hospital Irvine
for a BE/BC Emergency Physician. Newport Emergency staffs
the Emergency Departments at Hoag Hospitals in Newport
Beach and Irvine. New additions to the EDMD staff at the
Irvine campus earn 80% of the senior hourly rate of $206/
hour the first year and progress to senior status over three
years. Newport Emergency began services at Hoag Hospital
in Newport Beach in 1981 and is an extremely stable EDMD
managed private group of 25 EDMDs. The Irvine facility has
a daily census of 85 patients per day. There are three 9-10
hour overlapping EDMD shifts supported by a 9-10 hour
PA shift during the late afternoon and evening hours. Hoag
Irvine is an Orange County Cardiac Receiving Center.
Send indication of interest and CV to Ray Ricci, MD at
rayriccimd@me.com.
LOS ANGELES
ER Physician Needed in Small ER (35-40 pts / 24hr); Southeast
part of LA. May be Primary Care with ER experience (Family
Med; Surgery; etc.); 12 hour shifts. ACLS/PALS. Immediate
opening; 2 Day shifts and 2 Night shifts per week.
Thomas A. Gionis, MD JD MPH MBA MHA LLM FICS –
TGionis@gmail.com
SAN DIEGO, CALIFORNIA
Grossmont Emergency Medical Group has an immediate
opportunity for a Board Certified or Board Prepared
emergency physician. Both part time and full time
positions are available in busy, high acuity department
with annual visits >90K. Emergency Department is in new
"state of the art" Critical Care Center with computerized
tracking system and physician order entry. Shifts are
8 hours with 112 physician hours /24 midlevel provider hours
of coverage daily. Come live and work in America's Finest City.
E-mail CV and references to erwin.handley@gemg.net
VA Greater Los Angeles Healthcare System
VA Greater Los Angeles Healthcare System (VAGLAHS)
is recruiting for a Chief of Emergency Medicine. This
individual should be eligible for an academic appointment
to the UCLA School of Medicine faculty, will direct the
Emergency Medicine program for VAGLAHS and will
participate in VA-related patient care, education, research,
and administrative activities. The emergency medicine
program consists of approximately 8 physician providers
and a pool of 35 per diem staff at the West Los Angeles
Medical Center. The Chief of Emergency Medicine will work
closely and collaboratively in VAGLAHS with executive
leadership, nursing service, and all clinical services, to
provide high quality, efficient, and effective emergency
medicine care at VAGLAHS.
To advertise with Lifeline and to take advantage of our circulation of over 3,000 readers, including Emergency Physicians, Groups, and Administrators
throughout California who are eager to learn about what your business has to offer them, please contact us at info@californiaacep.org or give
us a call at (916) 325-5455.
22 | LIFELINE a forum for emergency physicians in california
Looking for an ITLS course?
EMREF offers the following California providers list:
Allan Hancock College
Mike DeLeo, EMT – Course Coordinator
800 S. College
Santa Maria, CA 93454
Phone: (805) 878-6259
REF offers
Fax: (805) 922-5446 EM
Email: Mikedeleo52@msn.com
Allan Hancock
College
Web: www.hancock.cc.ca.us
Lookinthe
Mike DeLeo, EMT – Course Coordinator
American Medical Response (AMR)
800 S. College,
Santa Maria, CA 93454
Ken Bradford, Operations
Phone: (805)
841878-6259
Latour Court, Ste D
Napa, CA 94558-6259
Fax: (805) 922-5446
Phone: (707) 953-5795
Email: Mikedeleo52@msn.com
Email: ken.bradford2@gmail.com
Web: www.hancock.cc.ca.us
e?
ours
c
S
L
T
I
n
g for a
ETS – Emergency Training Services
Mike Thomas, Course Coordinator
3050 Paul Sweet
iders list:
rovRoad
ia pCA
lifornCruz,
aSanta
C
95065
g
in
w
o
ll
fo
Phone: (831) 476-8813
Toll-Free: (800) 700-8444
Fax: (831) 477-4914
Email: mthomas@emergencytraining.com
Fast Response
School of Health Care Education
Web: www.emergencytraining.com
John Greene,
CE Programs Coordinator
A Work Safe Environment
American Steve
Medical
Response
Bristow,
EMTP (AMR)
Ken Bradford,
Operations
3140
Aldridge Way
Dorado
CA 95762
841 Latour El
Court,
SteHills,
D, Napa,
CA 94558-6259
Phone: (925) 708-5377
Phone: (707)
953-5795
Email: worksafeenvironment@yahoo.com
Email: ken.bradford2@gmail.com
Web: www.worksafeenvironment.com
California
EMS Academy
A Work Safe
Environment
Nancy Black, RN, Course Coordinator
Steve Bristow,
EMTP
1098 Foster City Blvd., Suite 106 PMB 608
3140 Aldridge
Way,
El CA
Dorado
Foster
City,
94404Hills, CA 95762
Phone: (925)
708-5377
Phone:
(866) 577-9197
Fax: (650) 701-1968
Email: worksafeenvironment@yahoo.com
Email: nancy@caems-academy.com
Web: www.worksafeenvironment.com
Web: www.caems-academy.com
California California
EMS Academy
EMS Education and Training
EMTP, Program Director
Nancy Black,Eric
RN,Spoonhunter,
Course Coordinator
Box 1146
1098 FosterPOCity
Blvd, Suite 106 PMB 608, Foster City, CA
Bishop, CA 93515-1146
94404
Phone: (888) 519-8890
Phone: (650)
504-9046
Fax:
(888) 519-8479
Email: espoonhunter@mac.com
Fax: (650) 701-1968
Web: www.cemset.org
Email: nancy@caems-academy.com
Web: www.caems-academy.com
Compliance Training
Jason Manning, EMS Course Coordinator
Robles Drive
California 3188
EMSVerde
Education
and Training
Camino, CA 95709
Eric Spoonhunter,
EMTP, Program Director
Phone: (916) 429-5895
PO Box 1146,
CA 93515-1146
Fax:Bishop,
(916) 256-4301
Phone: (888)
519-8890
Email:
Kurgan911@comcast.net
2075 Allston
Way, Berkeley,
94704Care Education
Fast Response
School CA
of Health
Phone:Erick
(510)
809-3648
Weldon,
Director of Academics
2075 628-5876
Allston Way
Fax; (866)
CA 94704
Email: Berkeley,
jgreene@fastresponse.org
Phone: (510) 809-3648
Web: www.fastresponse.org
Fax; (866) 628-5876
Email: eweldon@fastresponse.org
www.fastresponse.org
LomaWeb:
Linda
University Medical Center
Lyne Jones, Administrative Assistant
Loma Linda University
Department
of Center
Emergency Medicine
Medical
11234Lyne
Anderson
A108, Loma
Linda, CA 92354
Jones, St.,
Administrative
Assistant
of Emergency
Phone:department
(909) 558-4344
x 0 Medicine
11234 Anderson St., A108
Fax: (909)
558-0102
Loma Linda, CA 92354
Email: Phone:
LJones@ahs.llumc.edu
(909) 558-4344 x 0
Web: www.llu.edu
Fax: (909) 558-0102
Email: LJones@ahs.llumc.edu
www.llu.edu
MedicWeb:
Ambulance
Perry Hookey,
EMTP, Education Coordinator
Medic Ambulance
506 Couch
Street, Vallejo,
94590-2408
Perry Hookey,
EMTP, CA
Education
Coordinator
Couch
Street
Phone:506
(707)
644-1761
Vallejo, CA 94590-2408
Fax: (707)
644-1784
Phone: (707) 644-1761
Email: Fax:
perry@medicambulance.net
(707) 644-1784
Email: perry@medicambulance.net
Web: www.medicambulance.net
Web: www.medicambulance.net
Mendocino Lake Community College
Mendocino Lake Community College
PatrickPatrick
Magee,Magee,
MA, EMT-P
MA, EMT-P
1000 Hensley
CreekCreek
Road,
Ukiah, CA 95482
1000 Hensley
Road
95482
Phone:Ukiah,
(707)CA
467-1047
Phone: (707) 467-1047
Fax: (707)
467-1011
Fax: (707) 467-1011
Email: Email:
pmagee@mendocino.edu
pmagee@mendocino.edu
Web: www.mendocino.edu
Web: www.mendocino.edu
Fax: (888) 519-8479
CSUS Prehosptial Education Program
Email: espoonhunter@mac.com
Derek Parker, Program Director
Web: www.cemset.org
3000 State University Drive East
Valley
College
Napa Napa
Valley
College
Cori Carlson, EMS Director
Gregory2277
Rose,
EMS
Co-Director
Napa Highway
2277 Napa
Highway,
Napa CA
94558 Napa CA 94558
256-4596
Phone:Phone:
(707) (707)
256-4596
Email: CCarlson@napavalley.edu
Email: Web:
GRose@napavalley.edu
www.winecountrycpr.com
Web: www.winecountrycpr.com
Fax: (916) 256-4301
Email: Kurgan911@comcast.net
ScottCalifornia
Rebello, Course
Coordinator
Northern
Medical
Education
6617 Madison Avenue, #12
Scott Rebello,
Course
Coordinator
Carmichael, CA 95608
6617 Madison
Avenue,
#12, Carmichael, CA 95608
Phone: (916)
724-0830
Phone:Email:
(916)2coolrns@starband.net
724-0830
NorCalMedEd@comcast.net
Email: Web:
2coolrns@starband.net
Web: NorCalMedEd@comcast.net
Napa Hall
Sacramento,
Compliance
TrainingCA 95819-6103
Office: (916) 278-4846
Jason Manning,
EMS Course Coordinator
Mobile: (916) 316-7388
3188 Verdedparker@csus.edu
Robles Drive, Camino, CA 95709
Phone: (916)
429-5895
http://www.cce.csus.edu
CSUS Prehospital Education Program
Thomas Oakes, AHA Training Center Coordinator
3000 State University Drive East, Napa Hall, Sacramento, CA
95819-6103
Office: (916) 278-4846
Mobile: (916) 316-7388
Email: oakest@csus.edu
Web: www.cce.csus.edu
Northern California Medical Education
NCTI
National College of Technical Instruction
Lawson E. Stuart, RN, CEN, EMT-P
Lena Rohrabaugh, Course Manager
NCTI
– National
College
333 Sunrise
Ave Suite
500 of Technical Instruction
Lawson
E. Stuart,
RN, CEN, EMT-P
Roseville,
CA 95661
Phone:
(916) 960-6284
x 105
Lena
Rohrabaugh,
Course
Manager
Fax:Sunrise
(916) 960-6296
333
Ave Suite 500, Roseville, CA 95661
Email: jlcasa@caltel.com
Phone:
(916) 960-6284 x 105
Web: www.ncti-online.com
Fax: (916) 960-6296
Oakland
Fire Department
Email:
jlcasa@caltel.com
Sheehan Gillis, EMT-P, EMS Coordinator
Web:
www.ncti-online.com
47 Clay Street
Oakland, CA 74607
Oakland
Fire Department
Phone: (510) 238-6957
Sheehan
Gillis,
EMT-P, EMS Coordinator
Fax: (510)
238-6959
47Email:
Clay sean@baycj.com
Street, Oakland, CA 74607
Web: http://www.oaklandnet.com/fire/
Phone:
(510) 238-6957
Fax:
(510)
238-6959
PHI Air Medical,
California
Email:
SGillis@oaklandnet.com
Graham
Pierce, Course Coordinator
801 D
Airport Way
Web:
http://www.oaklandnet.com/fire/
Modesto, CA 95354
Phone:
(209) 550-0884
PHI
Air Medical,
California
Fax: (209) 550-0885
Graham
Pierce, Course Coordinator
Email: gpierce@philhelico.com
801
D http://www.phiairmedical.com/
Airport Way, Modesto, CA 95354
Web:
Phone: (209) 550-0884
Riggs
Ambulance
Service
Fax:
(209)
550-0885
Greg Petersen, EMT-P
Email:
gpierce@philhelico.com
Clinical Care Coordinator
Web:
http://www.phiairmedical.com/
100 Riggs
Ave.
Merced, CA 95340
Riggs
Phone:Ambulance
(209) 725-7010Service
Fax:Petersen,
(209) 725-7044
Greg
EMT-P, Clinical Care Coordinator
Email:
Gregp@riggsambulance.com
100
Riggs
Ave, Merced, CA 95340
Web: www.riggsambulance.com
Phone: (209) 725-7010
Fax:
(209)
725-7044
Santa
Rosa
Junior College
Public
Safety Training Center
Gregp@riggsambulance.com
Email:
Bryan Smith, EMT-P, Course Coordinator
Web:
www.riggsambulance.com
5743 Skylane Blvd.
Windsor, CA 95492
Santa
Rosa Junior College Public Safety Training Center
Phone: (707) 836-2907
Bryan
Smith,836-2948
EMT-P, Course Coordinator
Fax: (707)
Email:Skylane
medic9001@comcast.net
5743
Blvd, Windsor, CA 95492
Web: www.santarosa.edu
Phone:
(707) 836-2907
Fax:
(707) 836-2948
WestMed
College
Email:
Brianmedic9001@comcast.net
Green, EMT-P
5300www.santarosa.edu
Stevens Creek Blvd., Suite 200
Web:
San Jose, CA 95129-1000
Phone:
(408) 977-0723
UEI
Colleges,
Santa Cruz Campus
Email: jonesds777@hotmail.com
Mike
Thomas,
Course
Coordinator
Web: www.westmedcollege.com
3050 Paul Sweet Road, Santa Cruz, CA 95065
Phone: (831) 476-8813
Toll-Free: (800) 700-8444
Fax: (831) 477-4914
Email: mthomas@fremont.gov
Web: www.iecolleges.com
WestMed College
Brian Green, EMT-P
Creek Blvd., Suite
200, San
Jose, CA 95129-1000
EMREF is a proud sponsor 5300
of Stevens
California
ITLS
courses
Phone: (408) 977-0723
Please call 916.325.5455 or E-mail Lucia Romo: Email:
lromo@californiaacep.org
for more information.
amrmedic2003@yahoo.com
Web: www.westmedcollege.com
Search for upcoming courses:
Search for http://cms.itrauma.org/CourseSearch.aspx
upcoming courses: http://cms.itrauma.org/CourseSearch.aspx
EMREF is a proud sponsor of California ITLS courses.
Please call 916.325.5455 or
E-mail Lucia Romo: lromo@californiaacep.org for more information.
lifeline
PRSRT STD
US POSTAGE
California Chapter, American
College of Emergency Physicians
PAID
CPS
1121 L Street, Suite 407
Sacramento, CA 95814
Be a traveling physician
and live a life of adventure.
Join a special breed
we call “Firefighters” –
our heroes who travel to
where help is needed most.
EMP firefighters outing in Park City, Utah.
As part of this elite team,
you’ll enjoy a flexible schedule
and top-grade benefits,
plus all costs paid. With
our new, industry-leading
compensation package,
it’s a great time to join
EMP. We love owning
and managing our business.
It gives us the power to
put patient care first,
live life on our terms
and own the future.
Visit us at
booth 915
Go to EMP.com/firefighter to learn more about our new Firefighters comp package
or call Ann Benson at 800-828-0898. abenson@emp.com
Opportunities from New York to Hawaii.
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