April 2011 - California ACEP

Transcription

CAL/ACEP’s 40th Anniversary
Scientific Assembly, Newport Beach
LIFELINE
APRIL ISSUE 2011
CAL /ACEP | A FORUM FOR EMERGENCY PHYSICIANS IN CALIFORNIA
April Issue 2011 1
Circulation 3,500
INSIDE THIS ISSUE
Scientific Assembly 40th Anniversary��1-5
Legislative Leadership Conference��6
Ads/Dates to Remember/Call for Articles.............. 7
Advocacy Update...........................................................8
Welcome New Members...............................................8
WestJEM..........................................................................9
ITLS Courses................................................................ 10
President’s Message...................................................... 12
Word Search.................................................................. 14
Residents’ Region......................................................... 15
Co-Sponsored Courses................................................ 15
Career Opportunities................................................... 16
Fellowship Corner........................................................ 17
New POLST form....................................................... 18
Scientific Assembly & Ultrasound Workshop...19-23
Call for Abstracts.........................................................23
Lifeline is published monthly by the
American College of Emergency Physicians
State Chapter of California, Inc.
1020 - 11th Street, Suite 310
Sacramento, CA 95814
(916) 325-5455 Phone (916) 325-5459 Fax
Web site: www.calacep.org
©2002 American College of Emergency Physicians
Editor-in-Chief
Deanna M. Janey
djaney@calacep.org
Medical Co-Editors
Gene Hern, MD
Mathew Foley, MD
emergentt@gmail.com airfoley@gmail.com
Staff Editors
Elena Lopez-Gusman, Ryan Adame,
Lucia Romo & Callie Hanft
The views expressed in these materials
are those of the authors and do not necessarily represent those of the
American College of Emergency Physicians or the California Chapter.
BOARD OF DIRECTORS 2010-2011
President
Andrea Brault, MD
Bing Pao, MD
Andrea M. Wagner, MD
President-Elect
Peter Sokolove, MD
CAL/AAEM
Representative
Steven Gabaeff, MD
Immediate
Past President
Robert Rosenbloom, MD
Vice President
Andrew Fenton, MD
Treasurer
Thomas Sugarman, MD
Secretary
Paul Christiansen, MD
Directors
Yasmina Boyd, DO
Doug Brosnan, MD
David Feldman, MD
Mathew Foley, MD
Gary Gechlik, MD
Sam2November
Ko, MD
2009
Leslie Mukau, MD
Mark Notash, MD
Rusty Oshita, MD
2 Michael
April Issue
2011 MD
Osmundson,
CAL/EMRA
President
Sam Ko, MD
CAL/EMRA
President-Elect
Alfred Joshua, MD
Cal/ENA
Representative
Linda Broyles, RN
CAL/ACEP
Advocacy Fellowship
Advocacy
Fellowship Director
Mathew Foley, MD
Advocacy Fellows
Alexis Lieser MD
David Rankey, MD
June 23 – 25, 2011—See pages 1 through 5 and pages 19 through 24 for
CAL/ACEP’s 40th Annual Scientific Assembly Course Descriptions,
Newport Beach Marriott information, maps, area activities and directions.
June 23 – 24, 2011—Ultrasound Workshop
CAL/ACEP 40th ANNIVERSARY
Register @ www.calacep.org ■ E-mail: calacep@calacep.org ■ Call: 916-325-5455
Scientific Assembly Program – Correction
In the Scientific Assembly Program Course Descriptions for the March issue of Lifeline,
we incorrectly listed Dr. Greg Hendey’s faculty background information.
The information has been corrected in this issue and on all promotional materials associated
with the Scientific Assembly program. We apologize for any confusion
& related to our mistake.
Scientific Assembly
June 23 – 25, 2011
Ultrasound Workshop
June 23 – 24, 2011
Newport Beach Marriott
Time is Approaching Fast
by Dr. Fredrick M. Abrahamian, D.O.
Chair, 40th Annual CAL/ACEP SA
Time is quickly approaching to the 40 th Annual Cal ACEP Scientific Assembly. The
conference is scheduled to take place from June 23 rd to June 25th at the Newport Beach
Marriott. We have been busy getting speakers lined up, submitting CME applications, and
organizing the adjunct courses. Many wonderful speakers have been invited, and will present
a variety of topics relevant to the clinical practice of emergency medicine. Our faculty
represents emergency medicine programs throughout California, and we look forward to
hearing from them all.
The first day will begin with Dr. Scott Votey from UCLA discussing anaphylaxis and
the impact of the newly released guidelines in the management of this condition in the
emergency department. Next, Dr. Mallon from USC will talk about endocrine emergencies.
With his lecture titled, “Glands Gone Wild”, I am sure it will be an entertaining and
informative talk. Next, there will be a break and you can use the time to ask further questions
from the speakers, visit the exhibitors, or chat with your friends and colleagues. After the
break, Dr. Hendey from UCSF-Fresno will talk about difficult dislocations, an issue that we
all have had to deal with in the middle of the night. The lectures on this day will conclude
with Dr. Arora from USC highlighting recent EM literature effecting a change in your
everyday emergency medicine practice.
The second day is short, and we will only have two lectures that morning. Dr.
Sharieff from San Diego, a specialist in the field of pediatric emergency medicine, will lecture
first and discuss how to deal with difficult parents. Lecture topics like this are not commonly
given and I am looking forward to hearing what she has to say. Next, Dr. Ricketts from OliveUCLA will be discussing electrolyte emergencies. I have heard her lectures in the past and let
me tell you, be prepared to learn. These will be followed by the Trainor Lecture and
President’s Message, delivered by Dr. Peter Sokolove of UC Davis, and conclude with an
awards luncheon.
The third and final day of the conference will start with Dr. Nguyen from Loma
Linda, a specialist in the field of critical care and emergency medicine, discussing therapeutic
hypothermia. He will talk about the evidence and ways of incorporating this intervention in
our daily practice of emergency medicine. Next, Dr. McCollough from USC, a well-known
pediatric emergency medicine specialist, will take us through a review of the pediatric
literature. She has a wealth of knowledge and I always learn something new from her. After
the break, Dr. Vohra, a toxicologist from UCSF-Fresno will talk about the approach and
management of poisoned patients. He has tremendous knowledge and experience in this field
and I am eager to learn cool toxicology tricks from him. The day will conclude with Dr.
Langdorf from UC Irvine discussing the reversal of anticoagulation in life-threatening
bleeding.
June 23 – 25, 2011—See pages 1 through 5 and pages 19 through 24 for
th
CAL/ACEP’s
Annual
Scientific
Assembly
Descriptions,
In addition to 40
the above
lectures,
a highly
soughtCourse
after course,
the ultrasound
workshop
will
also
take
place
on information,
June 23and 24.maps,
The LLSA
course
will
take place on
areareview
activities
and
directions.
Friday, June 24.
June 23 – 24, 2011—Ultrasound Workshop
I hope the location, line-up of speakers, topics and additional workshop and courses
have given you the motivation to come and be part of this awesome conference. I am looking
forward to meeting you in June. Thank you for your continued support.
Scientific Assembly Program – Correction
In the Scientific Assembly Program Course Descriptions for the March issue of Lifeline,
we incorrectly listed Dr. Greg Hendey’s faculty background information.
The information has been corrected in this issue and on all promotional materials associated
with the Scientific Assembly program. We apologize for any confusion related to our mistake.
40th Annual
CAL/ACEP Scientific Assembly
& Ultrasound Workshop
June 23-25, 2011 - Newport Beach Marriott
Newport Beach, California
This conference is sponsored by The American College of Emergency Physicians and CAL/ACEP.
Thursday, June 23
Anaphylaxis: Should the Recent Guidelines Change Our Practice? (1 hour)
Scott Votey, MD
Understand the pathophysiology of anaphylaxis and how it influences treatment choices; Become aware of the range of presentations of
anaphylaxis so as to be able to promptly diagnose patients presenting atypically; Develop a severity-based pharmacologic therapy
regimen for anaphylaxis; Become aware of the current standards in the management of anaphylaxis including the appropriate use of
epinephrine.
William Mallon, MD
Glands Gone Wild: Endocrine Emergencies (1 hour)
Endocrine emergencies represent a group of potentially life-threatening conditions that are frequently overlooked, resulting in delays in
both diagnosis and treatment. Billy will highlight factors that contribute to their high mortality rates.
Gregory Hendey, MD
Difficult Dislocations (1 hour)
To demonstrate innovative techniques for the reduction of difficult dislocations, using multiple video clips; To assess the risk of
neurovascular compromise after a joint dislocation and plan a reasonable evaluation; To discuss sedation and anesthesia options for
facilitating reduction techniques.
Sanjay Arora, MD
Recent EM Literature that Will Change Your Practice (1 hour)
A review of the most significant studies published throughout the medical literature in past years. Each article presented will be assessed
to determine its relevance to the practice of clinical emergency medicine. This lecture will identify advances in emergency medicine by
reviewing the recent literature, describe the limitations of recent studies on the practice of emergency medicine, and discuss the
implications of recent studies regarding clinical emergency medicine.
Matthew Lewin, MD
RESEARCH FORUM (3 hours)
Find out what’s on the cutting edge of research from colleagues around the state. Ten abstracts will be presented and Awards for Best
Research, Best Presentation and Most innovative Project will be given. Upon completion of this course, participants will be able to
discuss the pros and cons of the results of a moderated oral research abstract, identify research/treatment that could be applied to clinical
practice, and explain research trends occurring in emergency medicine.
Laleh Gharahbaghian, MD and Martine Sargent, MD
David Francis, MD and Brita Zaia, MD
This ultrasound workshop introduces the technique of point-of-care Ultrasound-guided peripheral & central line IV placement and
Bladder volume assessment. For those patients who have difficult access and needs an IV for emergency management, or patients who
have urinary complaints and you need to know the volume of the bladder for assessing need for foley catheter placement, this course
allows you to learn a tool that will make it easier for your care of these patients. The lecture followed by an extensive hands-on session
discusses the tricks of trade, pitfalls, and allows for extensive practice with gel phantom models for IV placement and human models for
bladder assessment. It is safe, rapid, portable, and noninvasive; it allows rapid bedside evaluation and increases success and speed for
many procedures.
ULTRASOUND IV WORKSHOP (3 hours)
Friday, June 24
Dealing with Difficult Parent (1 hour)
Ghazala Sharieff, MD
To be familiar with the impact of antibiotic use on the development of asthma, and diarrhea; To know the clinical guidelines for obtaining
a head CT in children with head injury; To know the AAP guidelines on teenage drug testing.
Vena Ricketts, MD
Electrolyte Emergencies (1 hour)
Recognize the clinical presentations of patients presenting to the ED with Electrolyte Emergencies; Participants will have a distinctive
concise knowledge on the management of Electrolyte Emergencies; Participants will learn several clinical pearls on evaluation and
management; Learn how to avoid potential disasters.
LLSA Review (3 hours)
Peter D’Souza, MD
The 2011 Lifelong Learning and Self Assessment (LLSA) Workshop will cover all 11 articles chosen by the American Board of Emergency
Medicine as part of the Emergency Medicine Continuous Certification (EMCC Program). The workshop will be an interactive review of
the articles with participants encouraged to share pearls from their own practice relevant to the covered topics. Key "testable" concepts
from the articles will be emphasized. Participants will also receive a handout with a review of key points from the articles.
April Issue 2011 3
Saturday, June 25
Therapeutic Hypothermia Post-Cardiac Arrest: Evidence to Practice (1 hour)
H. Bryant Nguyen, MD
To review guidelines for post-cardiac arrest care; To review the evidence for therapeutic hypothermia/ targeted temperature management
post-cardiac arrest; To discuss cooling methods; To discuss best practices and implementation issues for a post-cardiac arrest care
bundle.
Maureen McCollough, MD
Pediatric Literature Review (1 hour)
Bedside ultrasound has dramatically changed the practice of emergency medicine for adult patients and is just beginning to change the
face of pediatric emergency medicine. This course will be a great review of the most recent articles covering a wide variety of pediatric
emergency medicine topics from fever and respiratory illness to abdominal pain and trauma, this lecture will definitely change your
practice.
Rais B. Vohra, MD
Cool Tox Tricks: Simple Solutions for Poisoned Patients (1 hour)
This lecture will cover 6 clinical cases in poison management with 6 simple solutions for busy ER doctors that are easy to learn,
efficiency-boosting, and evidence-based.
Mark I. Langdorf, MD
Reversal of Anticoagulation in Life Threatening Bleeding (1 hour)
Learn the indications and contraindications to reversal of anticoagulation in patients with intracranial hemorrhage; Appreciate the
controversies in management; Understand the limited research in this area; Learn reversal strategies for Coumadin, Heparin, aspirin
and Plavix.
Faculty
Fred Abrahamian, DO
Scientific Assembly Program Chair
Assistant Professor of Medicine/Emergency Medicine
UCLA School of Medicine
Director of Education, Department of Emergency
Medicine, Olive View-UCLA Medical Center
Matthew Strehlow, MD
CAL/ACEP Education Committee Chair
Clinical Assistant Professor of Surgery/Emergency
Medicine, Associate Medical Director
Director, Clinical Decision Area
Stanford University Emergency Department,
Division of Emergency Medicine, Stanford, California
Sanjay Arora, MD
Associate Professor of Clinical Emergency Medicine,
University of Southern California, Keck School of
Medicine, Los Angeles County Hospital
Peter D’Souza, MD
Clinical Instructor of Surgery, Division of Emergency
Medicine, Stanford University School of Medicine
Dave Francis, MD
Fellow Emergency Ultrasound, Clinical Instructor of
Surgery, Division of Emergency Medicine, Stanford
University Hospital & Clinics Emergency Medicine
Laleh Gharahbaghian, MD
Associate Director, Emergency Ultrasound; Co-Director,
Emergency Ultrasound Fellowship, Stanford University
Medical Center, Division of Emergency Medicine
Department of Surgery, Stanford, California
Gregory Hendey, MD
Professor, Clinical Emergency Medicine,
UCSF School of Medicine, San Francisco,
California; Vice Chair and Research
Director, UCSF-Fresno Emergency
Medicine Residency Program, Fresno,
California
Mark I. Langdorf, MD
Associate Residency Director Department Chair, Medical
Director of Emergency Medicine
Professor of Clinical Emergency Medicine, Department of
Emergency Medicine, University of California, Irvine
Matthew Lewin, MD
Director, Center for Exploration and Travel health, California
Academy of Sciences, San Francisco, California
William Mallon, MD
Associate Professor of Clinical Emergency Medicine, Keck
School of Medicine, University of Southern California;
Director, Division of International Emergency Medicine; LACUSC Medical Center, Los Angeles, California
Maureen McCollough, MD
Associate Professor of Emergency Medicine and Pediatrics,
Keck USC School of Medicine; Medical Director, Department
of Emergency Medicine, Los Angeles County USC Medical
Center, Los Angeles, California
H. Bryant Nguyen, MD
Associate Professor, Department of Emergency Medicine and
Department of Internal Medicine, Critical Care, Loma Linda
University, Loma Linda, California
Vena Ricketts, MD
Professor of Medicine, UCLA School of Medicine
Assistant Chief, Department of Emergency Medicine,
Olive-View UCLA Medical Center, Los Angeles,
California
Martine Sargent, MD
Ultrasound Director, Assistant Professor, UCSF
Department of Emergency Medicine San Francisco
General Hospital & Trauma Center
Ghazala Sharieff, MD
Division Director, Emergency Department, Rady
Children’s hospital and health Center/ Clinical Professor,
University of California, San Diego; Director, Pediatric
Emergency Medicine, Palomar-Pomerado Hospital/
California Emergency Physicians, San Diego, California
Rais B. Vohra, MD
Director of Toxicology, Department of Emergency
Medicine, Olive View-UCLA Medical Center
Scott Votey, MD
Professor of Clinical Medicine/Emergency Medicine,
UCLA School of Medicine
Program Director, UCLA/Olive View-UCLA Emergency
Medicine Residency Program
Brita Zaia, MD
Attending Physician and Clinical Instructor, Department
of Emergency Medicine, Kaiser Permanente Medical
Center, San Francisco, California
FACULTY: Those involved in the planning and teaching of this activity are
required to disclose to the audience any relevant financial interest or other
relationship. All faculty, planners, and staff in a position to control the
content of this CME activity have indicated that he/she has no relationship,
which could be perceived as a potential conflict of interest.
Accreditation
Physicians: This activity has been planned and implemented in accordance with the Essential Areas and Policies for the Accreditation Council of
Continuing Medical Education through joint sponsorship of ACEP and CAL ACEP. The American College of Emergency Physicians is accredited by the
Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The American College of Emergency
Physicians designates this live activity for a maximum of 17.00 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate
with the extent of their participation in the activity.
ACEP: Approved by the American College of Emergency Physicians for a maximum of 17.00 hour(s) of ACEP Category I credit.
Physician Assistants: The American Academy of Physician Assistants (AAPA), The National Certification Council for Physician Assistants (NCCPA)
and The California Department of Consumer Affairs Physician Assistant Committee (PAC) accepts AMA PRA Category 1 Credit(s)™ as equivalent to
AAPA Category 1 credit for continuing medical education.
Nurses: CAL/ACEP is approved by the California Board of Registered Nursing for 17 contact hours, Provider Number 15059.
EMTs/Paramedics: EMREF is approved by the Sacramento County EMS Agency for 17 Continuing Education Units, Provider Number 34-4600.
DO’s: American Osteopathic Association (AOA) recognizes ACCME Category 1 Credit as AOA Category 2-A Credit. All members of AOA are required
to participate in CME programs to meet the 2010-12 CME Cycle of 15 Credits ACCME Category 1 Credits and 15 AOA Category 1-A Credits.
4 April Issue 2011
REGISTRATION FORM
40th Annual
SCIENTIFIC ASSEMBLY
California Chapter, American College of Emergency Physicians
CONTACT
Toll-Free: (800) 735-2237 | Office: (916) 325-5455
Website: www.calacep.org | E-Mail: calacep@calacep.org
REGISTER
Online at: www.calacep.org
Mail to: 1020 11th Street, Suite 310 ▪ Sacramento, CA 95814
E-Mail to: calacep@calacep.org
Fax to: (916) 325-5459
JUNE 23 – 25, 2011
ULTRASOUND WORKSHOP
JUNE 23 – 24, 2011
Newport Beach Marriott Hotel & Spa
Newport Beach, California – (800) 266-9432 $155/night + tax
REGISTRANT INFORMATION
First Name:
Last Name:
Degree/Title (Check all that apply):
MD
DO
RN
ACEP ID #:
NP
PA
EMT
PhD
JD
FACEP
Other (Specify):
Mailing Address:
City:
State:
Zip Code:
Hospital/Business:
Position/Title:
Preferred Telephone:
Fax:
Preferred E-Mail:
REGISTRANT BADGE (As you would like it to appear)
GUEST BADGE (As you would like it to appear)
Name:
Name:
Position/Title:
Position/Title:
City:
City:
REGISTRATION FEES (Early Bird rates apply until 4/15; Regular rates apply 4/16 – 5/31; Onsite rates apply on & after 6/1)
Ultrasound Workshop
6/23-24
Scientific Assembly
6/23-25
Scientific Assembly
Ultrasound
Workshop
REGISTRATION
FEES
SUBTOTAL
Optional Workshops
Main Program
Category
(Early Bird thru
5/15; Regular
thereafter)
ACEP Member
$750/825
$275/325/375
Free
Free
$50
Free
$140
AAEM Member
$899/975
$375/425/475
Free
Free
$50
Free
$160
Physician
$899/975
$475/525/575
Free
Free
$50
Free
$160
Allied Health Professional
$899/975
$200/250/300
Free
Free
$50
Free
$119
Resident
$725/795
Free
Free
Free
$50
Free
$140
Medical Student
$725/795
Free
Free
Free
$50
Free
$140
EVENT FEES (RSVPs Required; Please Include Guests)
Awards Luncheon (6/24, afternoon)
#
@ Free =
President’s Dinner (6/24, evening)
#
@ $100 =
Research
Forum
(6/23)
Financial
Plan. Sem.
(6/23)
LLSA
(6/24)
Residents’
Conference
(6/24)
Peripheral
IV U/S
(6/25)
GUEST FEES (Includes 3 Breakfasts, 1 Lunch + Reception)
$0
Guest Fees
#
of Adult Guests
@ $75 per Guest =
#
of Child Guests
@ $50 per Guest =
EVENT FEES SUBTOTAL
GUEST FEES SUBTOTAL
PAYMENT
Registration Fees Subtotal
Check Enclosed:
Event Fees Subtotal
Credit Card #:
Guest Fees Subtotal
Cardholder Name:
TOTAL DUE
All attendees must read and agree to abide by the policies listed below.
Check #:
Visa:
CVV#:
MC:
AMEX:
Exp. Date:
I have read and agree to abide by the Registration Rates and Refund & Cancellation policies (check box – required):
REGISTRATION RATES POLICY
Registration fee rates are determined by the date the registration is received. Except where noted, “Early Bird” rates apply through April 15, 2011; “Regular” rates apply
from April 16 – May 31, 2011; “Onsite” rates will apply to all registrations received on or after June 1, 2011. Registration fees paid by attendees include the CME
program and any optional workshops requested and paid for, as well as three breakfasts, Awards Lunch (RSVP required), Opening Reception and access to exhibits.
Guest fees include three breakfasts, Awards Lunch (RSVP required), Opening Reception and access to exhibits.
REFUND & CANCELLATION POLICY
CAL/ACEP contracts in advance with hotels and conference sites in order to secure the lowest possible room rates for attendees and to control the costs of our
conferences in order to manage valuable member resources as prudently as possible; room blocks and certain portions of food & beverage costs are guaranteed in
advance in order to accomplish these goals. Therefore, CAL/ACEP can only grant full refunds for registration fees, less a $50 administrative fee, if said reservations are
canceled by Tuesday, May 31, 2011. Any refund requests made from June 1 - 15 will be refunded 50% of the registration fees, less a $50 administrative fee.
No refunds will be granted after June 15. All refunds must be submitted in writing to calacep@calacep.org, faxed to (916) 325-5459 or mailed to CAL/ACEP at
1020 11th Street, Suite 310, Sacramento, CA 95814 and be received by the dates listed above. CAL/ACEP is not responsible for any hotel charges that may be incurred
by cancellations.
April Issue 2011 5
6 April Issue 2011
2010-2011
Board of Directors
Meeting Schedule
April 27, 2011 (Wednesday)
9:00 AM – 4:00 PM in Sacramento, CA
June 22, 2011 (Wednesday)
11:00 AM – 5:30 PM in Newport Beach, CA
Dates to Remember
Non Contract Lifeline Advertising Rates
Display Ads: Full Page (7-½” x 10”)
½ Page (7-½“ x 4-7/8”)
¼ Page (3-5/8” x 4-7/8”)
1/8 Page (3-5/8” x 2-7/16”)
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Career Opportunities:
(40 word minimum)
$
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Full Page
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April 26, 2011
(Tuesday)
Emergency Medicine
Legislative Leadership
Conference
Sacramento, CA
June 23 & 24, 2011
(Wednesday & Thursday)
Ultrasound Workshop
(Thursday – Saturday)
Scientific Assembly
Newport Beach, CA
$
Career Opportunities:
(40 word minimum)
119.00
6 month
$1,385.00
$ 701.00
$ 363.00
$ 195.00
11 month
$1,302.00
$ 657.00
$ 342.00
$ 184.00
$ 110.00
$ 101.00
$700.00 (full color)  $590.00 (two colors)  $480.00 (one color) rates available
Please contact: Deanna M. Janey  Director of Events & Marketing
E-mail: djaney@calacep.org
Phone: 1-800-735-2237  Fax: 1-916-325-5459
Advertising must be submitted on the 1st of the month preceding publication!
Payment must be received in advance or a credit card submitted at the time of placement.
Newport Beach, CA
June 23 – 25, 2011
132.00 ($1.00 for each addt’l word)
Method of payment
(We do not accept American Express)
_______ Check enclosed Credit Card #____________________________________
_______ Master card
Expiration Date: ________________________________
_______ Visa
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A Call for Lifeline Articles!
Get involved!  Share ideas!  Submit an article to:
H. Gene Hern, Jr., MD
Asst. Clinical Professor of Medicine, UCSF
Assoc. Residency Director
Department of Emergency Medicine
ACMC-Highland General Hospital
1411 E. 31st Street  Oakland, CA 94602
(510) 437-4896 office  (510)382-2429 Pager
emergentt@gmail.com
Deanna M. Janey
Mathew Foley, MD
Director of Events & Marketing
Advocacy Fellowship Director
CAL/ACEP
1020 11th Street, Suite 310  Sacramento, CA 95814
(800) 735-2237 Toll-free  (916) 325-5459 Fax
djaney@calacep.org
CAL/ACEP
1020 11th Street, Suite 310  Sacramento, CA 95814
(800) 735-2237 Toll-free  (916) 325-5459 Fax
airfoley@gmail.com
Author’s Name: _______________ Hospital: ________________ Company: ________________
Address: ________________________________ City, State, Zip: __________________________
Phone: _________________ Fax: ___________________ E-mail: _________________________
Please check your interest and submit an article!
Clinical Corner ___ Case of the Month ___ Legal Corner ___ Residents’ Region ___ Special Interests ___ Advocacy ___ Other ___
Articles must be submitted on the 1st of the month preceding publication!
April Issue 2011 7
ADVOCACY UPDATE
Maddy EMS Fund
Takes Major Hit
by Elena Lopez-Gusman & Callie Hanft
On Thursday, March 3rd, the Budget
Conference Committee in the California
Legislature took an action that stripped $55
million from the Maddy Emergency Medical
Services (EMS) Fund. The item had never
been raised in any budget subcommittee or
conference committee meeting, or previously
discussed with stakeholders. The conference
committee action instead redirected the
money to Medi-Cal under the theory that
it could be matched with federal funds and
help providers treat the same population
under the Section 1155 Waiver. While there
is clearly a benefit to matching every dollar
possible, there are several fallacies with this
decision: 1) The money was not earmarked
for providers 2) The 1115 waiver is a county
option. There is no guarantee that every
county will take the action to make this
population eligible for Medi-Cal; 3) Even if
every county did, and every eligible person
(adults up to 133% Federal Poverty Level)
were enrolled, the 1115 waiver only applies
to 500,000 people- hardly a dent in the 7.5
million uninsured in California.
Maddy EMS Funds are fines collected
by the counties that reimburse physicians
and hospitals for treating the uninsured. This
is the only source of funding to compensate
physicians for treating the uninsured. ERs
have already been hit with many other budget
cuts. The year’s budget proposes even deeper
cuts to Medi-Cal; a 10% cut off provider
reimbursement, and a cap on the number of
visits Medi-Cal patients can have each year.
The Maddy EMS fund was cut by $25 million
in 2009 by Governor Schwarzenegger, and all
other Medi-Cal, clinic, mental health cuts at
the state and local levels have further strained
struggling ERs.
CAL/ACEP, immediately upon hearing
of the redirection of funds, engaged with
lawmakers and stakeholders to reach for a
solution which would protect emergency
services statewide. $55 million is critical
to supporting the emergency care safety
net in California, yet not a large amount in
the scheme of state budgets. We urged our
members to contact their representative
in the California
Legislature and ask
that a compromise
be made to allow
for portions of
the Maddy EMS
Fund to remain in
order to continue
to
reimburse
physicians for the cost of treating the
uninsured. The response from our physician
community was astounding, and a true
testament to the importance in grassroots
efforts from our physicians. We earned
multiple pieces of press, including an article
in the Los Angeles Times (read here).
The cut was not in the initial package of
spending cuts approved by Governor Brown,
but another round of cuts, including those to
the Maddy Fund are planned sometime in the
budget process, so the fight is not over.
Some $12 billion remains to be cut out of
the budget. Talks between Governor Brown
and legislative leadership have broken down;
a planned special election to have voters
determine whether or not to extend existing
increases to cover the $12 billion gap appears
to be dead. These events all mean one thing:
more budget cuts are on the way. While there
has been a lull in budget talks between the
Governor and Legislature, rest assured that
CAL/ACEP’s leadership and advocates will
continue to defend you and the Maddy Fund
as relentlessly as you have.
The Maddy Fund will be our top priority
for our upcoming lobby day- the Legislative
Leadership Conference (LLC) on April 26th.
Come to Sacramento and keep the pressure on
the legislature! Tell them in-person how vital
Maddy Fund dollars are. As always, LLC
is free and registration takes less than five
minutes (register here!).
For more information, or to contact the
advocacy team, call us at (916) 325-5455, or
by email at advocacy@calacep.org.
CAL/ACEP
Welcomes New Members
February 2011
Jennifer K. Avila, MD
Kathleen S. Edmunds, MD
Peter M. Galich, MD
Daniel C. Garza, MD
Elizabeth Mitchell, MD
March 2011
Joseph Becker, MD
Michael R. Blum, MD
Christopher Cha, MD
Clint Christensen
Pamela S. Laesch, MD
Samuel Ong, MD
Daniel Orjuela, MD
Jason Ruben, MD
Sammy Y. Shon, MD
Sania Zubair, MD
8 April Issue 2011
Western Journal of Emergency Medicine
www.westjem.org.
Supervising Section Editor: Matthew Strehlow, MD
Submission history: Submitted February 20, 2009; Revision Received July 29, 2009; Accepted November 16, 2009
Reprints available through open access at http://escholarship.org/uc/uciem_westjem
Sgarbossa Criteria:
Highly Specific for
Identifying Acute
Myocardial Infarction
by
Kevin R. Maloy, MD
Rahul Bhat, MD
Richard Morrissey, MD
Jonathan Davis, MD
Kevin Reed, MD
Georgetown University,
Department of Emergency
Medicine,Washington, DC
Objective: In 1996 Sgarbossa reviewed 17
ventricular-paced electrocardiograms (ECGs)
in acute myocardial infarction (AMI) for
signs of ischemia. Several characteristics of
the paced ECG were predictive of AMI. We
sought to evaluate the criteria in ventricularpaced ECGs in an emergency department
(ED) cohort.
Methods: Ventricular-paced ECGs in patients
with elevated cardiac markers within 12
hours of the ED ECG and a diagnosis of AMI
were identified retrospectively (n=57) and
compared with a control group of patients
with ventricular-paced ECGs and negative
cardiac markers (n=99). A blinded board
certified cardiologist reviewed all ECGs for
Sgarbossa criteria. This study was approved
by the institutional review board.
Results: Application of Sgarbossa’s criteria
to the paced ECGs revealed the following:
1) The sensitivity of “ST-segment elevation
of 1 mm concordant with the QRS complex”
was unable to be calculated as no ECG fit this
criterion;
2) For “ST-segment depression of 1 mm in
lead V1, V2, or V3,” the sensitivity was 19%
(95% CI 11-31%), specificity 81% (95%
CI 72-87%), with a likelihood ratio of 1.06
(0.63-1.64);
3)For “ST-segment elevation >5mm discordant
with the QRS complex,” the sensitivity was
10% (95% CI 5-21%), specificity 99% (95%
CI 93-99%), with a likelihood ratio of 5.2
(1.3 - 21).
Conclusion: In our review of ventricular-
paced ECGs, the most clinically useful
Sgarbossa criterion in identifying AMI was
ST-segment elevation >5mm discordant with
the QRS complex. This characteristic may
prove helpful in identifying patients who may
ultimately benefit from early aggressive AMI
treatment strategies. [West J Emerg Med.
2010; 11(4): xxxxx]
INTRODUCTION
Establishing the diagnosis of acute
myocardial infarction (AMI) in the setting of
a ventricular paced rhythm (VPR) is a difficult
task and often results in delay of definitive
treatment. In a 2001 retrospective cohort
study, patients with a VPR were significantly
less likely to receive emergent reperfusion
and aspirin.1 These paced patients were noted
to have an increased long-term mortality rate
when compared with non-paced controls,
even after accounting for disease severity.
In the emergency department (ED), the
diagnosis of AMI still relies primarily on
history and the 12-lead electrocardiogram
(ECG). Publications examining the utility of
the ventricular paced ECG in the evaluation
of acute chest pain have been limited to case
reports, case series and review articles.2-5
Occasionally, the intermittent presence of a
native rhythm or progressive ECG changes
may aid in the diagnosis of AMI.6,7 The
diagnostic accuracy of the ECG in the
absence of these findings, however, has not
been thoroughly evaluated.
In 1996 Sgarbossa published a retrospective
review of 17 ventricular paced ECGs with AMI
confirmed by cardiac biomarkers, compared
with 17 ventricular-paced controls.8 In this
study, several characteristics of the paced
ECG were examined for findings that might
be predictive of AMI.
Three findings appear to have low
sensitivities, but potentially clinically useful
specificities: 1) ST elevation >1mm in
leads with a predominantly positive QRS
(sensitivity 18%, specificity 94%); 2) ST
segment elevation of >5mm in leads with
predominantly negative QRS (sensitivity 55%,
specificity 88%); 3) ST depression >1mm in
v1, v2, v3 (sensitivity 29%, specificity 82%).
As this initial study had relatively small
numbers (34 total patients), we sought
to revisit the sensitivity and specificity
calculations by reviewing a larger cohort
of patients.
METHODS
This study is a chart review to identify a
gold standard with de novo cardiology review
of ECGs. The chart review identified existing
patient records with paced ECGs who had
an AMI. For this study, AMI is defined as
a rise/and or fall of cardiac biomarker with
at least one value above the most stringent
manufacturer recommended cutoff or the
suggestion of the hospital laboratory and a
discharge International Disease Classification
9 (ICD-9) code of AMI (410.XX). This
study was approved by the institutional
review board.
The study reviewed records from two
sites. Site A is a large tertiary care center
with an ED volume of approximately 70,000
visits per year. Cardiologists’ reads of ECGs
are stored electronically and are searchable.
ECGs of interest were identified by searching
the text of the readings for "electronic
pacemaker." These patients were then
searched for a Troponin I greater than 0.8
Ng/ml (normal reference 0.000-0.080 Ng/ml
before 2/1/08 and 0.000-0.120 after 2/1/08)
within 12 hours of the ECG being performed.
The cutoff of 0.8 Ng/ml was chosen as it is the
most stringent manufacturer recommended
criteria according to the American College
of Emergency Physician clinical policies.9
First, minimum and maximum Troponin I
levels and times of the test were recorded.
When available, cardiac catheterization
information (at the minimum date and time of
catheterization) was recorded as well. Controls
for Site A were identified in a similar way to
those with AMI, except that each control had
at least one Troponin I performed, and all
Troponin I's performed during that hospital
stay were less than 0.080 Ng/ml.
Site B is a large community hospital
with an ED volume of 100,000 visits per
year. Unlike Site A, Site B does not store
their ECG reads electronically. The search
strategy for Site B consisted of identifying
ED patients with a history of a permanent
pacemaker by ICD-9 code (V45.01) recorded
at that hospital. These were then searched for
a Troponin I greater than 2 Ng/ml (reference
range 0.0-0.3 Ng/ml before 5/1/04 and 0.00.1 Ng/ml after 5/1/04) within 12 hours of
admission from the ED. A Troponin I of
>2Ng/ml was defined as abnormal by the
(Continued on page 11)
April Issue 2011 9
Looking for an ITLS course?
EMREF offers the following California providers list:
Allan Hancock College
Mike DeLeo, EMT – Course Coordinator
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Nancy Black, RN, Course Coordinator
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Phone: (866) 577-9197
Fax: (650) 701-1968
Email: nancy@caems-academy.com
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California EMS Education and Training
Eric Spoonhunter, EMTP, Program Director
214 W. Line Street
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Phone: (888) 519-8890
Fax: (888) 519-8479
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Jason Manning, EMS Course Coordinator
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Camino, CA 95709
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CSUS Prehosptial Education Program
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Mobile: (916) 316-7388
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Mike Thomas, Course Coordinator
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Santa Cruz, CA 95065
Phone: (831) 476-8813
Toll-Free: (800) 700-8444
Fax: (831) 477-4914
Email: mthomas@emergencytraining.com
Web: www.emergencytraining.com
Loma Linda University
Medical Center
Lyne Jones, Administrative Assistant
department of Emergency Medicine
11234 Anderson St., A108
Loma Linda, CA 92354
Phone: (909) 558-4344 x 0
Fax: (909) 558-0102
Email: LJones@ahs.llumc.edu
Web: www.llu.edu
Medic Ambulance
Perry Hookey, EMTP, Education Coordinator
506 Couch Street
Vallejo, CA 94590-2408
Phone: (707) 644-1761
Fax: (707) 644-1784
Email: perry@medicambulance.net
Web: www.medicambulance.net
Mendocino Lake Community College
Patrick Magee, MA, EMT-P
1000 Hensley Creek Road
Ukiah, CA 95482
Phone: (707) 467-1047
Fax: (707) 467-1011
Email: pmagee@mendocino.edu
Web: www.mendocino.edu
Northern California Medical Education
Scott Rebello, Course Coordinator
6617 Madison Avenue, #12
Carmichael, CA 95608
Phone: (916) 724-0830
Email: 2coolrns@starband.net
Web: NorCalMedEd@comcast.net
NCTI
National College of Technical Instruction
Lawson E. Stuart, RN, CEN, EMT-P
Lena Rohrabaugh, Course Manager
333 Sunrise Ave Suite 500
Roseville, CA 95661
Phone: (916) 960-6284 x 105
Fax: (916) 960-6296
Email: jlcasa@caltel.com
Web: www.ncti-online.com
Oakland Fire Department
Sheehan Gillis, EMT-P, EMS Coordinator
47 Clay Street
Oakland, CA 74607
Phone: (510) 238-6957
Fax: (510) 238-6959
Email: sean@baycj.com
PHI Air Medical, California
Graham Pierce, Course Coordinator
801 D Airport Way
Modesto, CA 95354
Phone: (209) 550-0884
Fax: (209) 550-0885
Email: gpierce@philhelico.com
Web: www.phiwestcoast.com
Riggs Ambulance Service
Greg Petersen, EMT-P
Clinical Care Coordinator
100 Riggs Ave.
Merced, CA 95340
Phone: (209) 725-7010
Fax: (209) 725-7044
Email: Gregp@riggsambulance.com
Web: www.riggsambulance.com
Santa Rosa Junior College
Public Safety Training Center
Bryan Smith, EMT-P, Course Coordinator
5743 Skylane Blvd.
Windsor, CA 95492
Phone: (707) 836-2907
Fax: (707) 836-2948
Email: medic9001@comcast.net
Web: www.santarosa.edu
VeriHealth - REACH Training Institute, Inc.
Ken Bradford, Director
200 Montgomery Drive
Santa Rosa, CA 95404
Phone: (707) 766-2403
Mobile: (707) 953-5795
Email: ken@verihealth.com
Web: www.verihealth.com
WestMed College
Brian Green, EMT-P
5300 Stevens Creek Blvd., Suite 200
San Jose, CA 95129-1000
Phone: (408) 977-0723
Email: jonesds777@hotmail.com
Web: www.westmedcollege.com
Work Safe Environment
Steve Bristow, EMTP
176 Plaza Circle
Danville, CA 94526
Phone: (925) 708-5377
Email: worksafeenvironment@yahoo.com
Web: www.worksafeenvironment.com
EMREF is a proud sponsor of
California ITLS courses
Please call 916.325.5455 or E-mail Lucia Romo: lromo@calacep.org for more information.
10 April Issue 2011
West JEM...
(Continued from page 9)
hospital laboratory from 8/16/98 onward. ED
ECGs are routinely scanned into the medical
information system with the ED chart
with a unique, searchable code identifying
them as ECGs. One abstracter searched
all scanned ECGs to identify those whose
machine interpretation was a paced rhythm.
The abstracter then recorded the first value,
minimum and maximum Troponin I values
and times of the test.
Controls from Site B were identified
in a similar way to those with AMI except
that each control had at least one Troponin
I performed and all Troponin I's performed
during that hospital stay were less than 0.1
Ng/ml.
ECGs were de-identified and given a
random number in a sequence. A blinded
cardiologist reviewed these ECGs for signs
of ischemia according to Sgarbossa criteria.
When reproduction of the ECG changed
the mV scale, the cardiologist adjusted
appropriately (e.g., when the 10mm standard
was measured at 8mm secondary to xeroxing
adjustment, the 5mm discordance criteria
was adjusted to 4mm).
Results were calculated using R (Vienna,
Austria) version 2.7.2 with package
DiagnosisMed version 0.0.2.10,11 Microsoft
Excel (Redmond, Washington) Version 11.5
was used for summary statistics.
RESULTS
For
the
ventricular-paced
acute
myocardial infarction (VPAMI) group, 72
paced ECGs with positive Troponin I were
identified from Site A from December 1,
2002 to April 1, 2008. 39 were not coded as
acute MI at hospital discharge. This left 33
ECGs from Site A. At Site B, 35 paced ECGs
with positive Troponin I were identified from
Site A from December 1, 2002 to April 1,
2008. Ten of these were not coded as AMI at
hospital discharge. This left 25 ECGs from
Site B, for a total of 58 ECGs in the VPAMI
group.
For the control group, 101 ECGs with
negative Troponin I were randomly selected.
100 was chosen as it was estimated there
might be approximately 100 VPAMI ECGs.
When the cardiologist reviewed the
ECGs, three were excluded (one control ECG
and two ECGs from the VPAMI group) due
to the presence of atrial pacers in two ECGs
and missing information from lead V4 in an
additional ECG. This left 57 ECGs from the
VPAMI group and 99 control ECGs. The
cardiologist also noted that seven ECGs (four
potentially ischemic and three control) were
recorded at one-half standard voltage,;these
were kept in the cohort, but 1/2 voltage
Sgarbossa criteria were used. Only one ECG
met more than one criteria (Score 3 and 2).
This ECG was a control ECG and it was
entered twice for data analysis.
The average age and sex distribution
in the VPAMI group was 76.0 years with
63% male patients, while the control group
averaged 73.8 years with 63% male patients.
Application of the Sgarbossa criteria to
the ECGs found the following:
1) The sensitivity of ST-segment elevation 1
mm and concordant with QRS complex was
unable to be calculated as none of the VPAMI
ECGs fit this criteria.
2) For ST-segment depression 1 mm in lead
V1, V2 or V3, the sensitivity was 19% (95%
CI 11-31%), specificity 81% (95% CI 7287%) and likelihood ratio 1.06 (0.63-1.64).
3) For ST-segment elevation >5mm and
discordant with QRS complex, the sensitivity
was 10% (95% CI 5-21%), specificity 99%
(95% CI 93-99%) and a likelihood ratio of
5.2 (1.3 - 21).
DISCUSSION
We evaluated 57 ventricular-paced ECGs
admitted and discharged with an elevated
serum troponin and an ultimate diagnosis
of AMI. This number represents to our
knowledge the largest study population
to date examining the diagnosis of AMI
in the setting of a ventricular-paced ECG.
We sought to evaluate the sensitivity and
specificity analysis of Sgarbossa using 99
paced ECGs with normal serum troponins as
the control group.
Using the criterion of ST segment
elevation of 1mm with concordant QRS
complex resulted in a sensitivity and
specificity that could not be calculated as
none of the VPAMI or control ECGs fit
this criterion. It was noted to be the most
specific finding in Sgarbossa’s study (94%
specificity) and was thus assigned the highest
point value. In our study, the criteria of ST
segment elevation >5mm and discordant with
the QRS complex had the highest specificity
(99%), but a low sensitivity (10%) when
compared with Sgarbossa’s study (specificity
88% with a sensitivity of 53%). The criteria
of ST-segment depression in V1, V2 or V3
had similar test characteristics to Sgarbossa’s
study (sensitivity of 19%, specificity of 81%
compared with a sensitivity of 29% and
specificity of 82% in Sgarbossa’s study).
This criterion’s test characteristics make it
of limited value given its unacceptably high
false positive and false negative rate.
The results of our study indicate that
the ventricular-paced ECG is of little
diagnostic value in ruling out the diagnosis
of AMI using Sgarbossa criteria, but may
be helpful in ruling in the diagnosis. Our
key finding of applying Sgarbossa’s criteria
to paced ECGs, specifically the presence of
ST segment elevation >5mm in leads with
a discordant QRS, shows high specificity
(99%) for the diagnosis of acute MI. The
low sensitivity of ECG criteria for AMI in
this study is consistent with a recent study by
Kontos el al. They found that of 1641 patients
with AMI, only 22% had diagnostic ST
elevation on initial ECG..12 As prior studies
have suggested, possible benefit of early
reperfusion with percutaneous intervention
in patients with paced ECGs13,14, the third
Sgrabosssa criteria may be most useful in the
ED setting to help rapidly identify patients to
be considered for this intervention.
LIMITATIONS
Limitations of our study include the
retrospective design and data collection.
In addition, this study did not address inhospital or long-term data regarding patient
morbidity and mortality. ICD-9 codes and
Troponin I values have inherent limitations in
the diagnosis of AMI. Therefore, we chose to
combine the two to ensure that the diagnosis
was accurate. This likely excluded some
ventricular- paced patients who had AMIs
during the study time period.
Due to problems with reproduction, our
sample included four ECGs that did not
reproduce at the correct size. These were
scaled by the reviewing cardiologist adjusting
the criterion measured 10mm standard boxes.
These measurements were not tested for
inter-observer variability.
CONCLUSION
In our review of ventricular-paced ECGs,
the most clinically useful Sgarbossa criterion
in identifying AMI was ST-segment elevation
>5mm discordant with the QRS complex.
This criterion demonstrated a high specificity
and low sensitivity suggesting that it may
be helpful in identifying patients who could
ultimately benefit from early, aggressive
AMI treatment strategies. The clinical utility
of the aggregate Sgarbossa criterion is
questionable.
Address for Correspondence: Kevin
Maloy, MD, Department of Emergency
Medicine, Georgetown University Hospital,
3700 Reservior Road NW, First Floor CCC
Building, Washington, DC 20057. Email
(Continued on page 13)
April Issue 2011 11
PRESIDENT'S MESSAGE
Fraud, Compliance and
the OIG 2011 Work plan
Part 1
by Andrea Brault, MD
I attended the
February
ACEP
Coding
and
Reimbursement
S t r a t e g i e s
Conference. It is
an annual event
that feels like a
homecoming for
many of us who
attend
regularly.
Usually I sit in back and think, I could give
these talks, but this year I took many notes
as I realized that our industry is under more
scrutiny than ever.
PPACA (Section 6401) requires
providers of Medicare/Medicaid
services, as a condition of enrollment,
“establish a compliance program that
contains certain core elements.” (Fed.
Reg. @ 58227)
Even though the “certain core elements”
will be defined later this year, if your group
does not have a robust compliance program
or you believe that it’s someone else’s job to
protect you, you are not in a good place. The
government has made it clear that the provider
of service “is always held accountable for the
billing in his or her name regardless of who
submits or processes the claim.”
The first document to review is the ACEP
Guide on Fraud, Compliance and Emergency
Medicine published in 2004. The OIG also
published a compliance program guide
for individual and small group physician
practices in 2000 but I think your time would
be better spent on ACEP’s guide. This article
will begin the discussion of what your group
should be focusing on now.
Understand that implementing a generic
or off-the-shelf compliance program that is
not specific to your group’s risk areas may be
worse than no program at all. It is expected
that you will implement completely all that
you are committing to. The good news
is that for most one or two-site groups, it
would be appropriate to have a smaller, more
focused plan administered by one member of
the group.
12 April Issue 2011
There are specific elements to a
“lack of” medical necessity. Certainly,
compliance plan but the purpose is to create
California, as well as other states, has
a quality assurance plan to which your group
renegade payers whose denial codes or
adheres. The OIG has outlined seven key
“medical review” has nothing to do with
elements for a provider’s compliance plan.
the medical care provided. However,
1) Compliance Standards and Procedures
your compliance program should ensure
a) For this section, you would begin by
that your group does not have providers
assessing your compliance risk areas and
who order unnecessary tests or provide
then develop standards and procedures for
99285 level work-ups when a lower level
each. Edward Gaines, JD, CCP lectured
of service was more appropriate. You
on this topic. He broke the analysis for
should also monitor your providers for
emergency medicine groups into pre and
critical care (99291) billing for the same
post billing risk areas. I thought this
purpose. Your compliance program should
was a useful suggestion for emergency
concentrate on monitoring providers that
medicine groups.
have an average patient charge or billing
for particular CPTs (evaluation and
i) For an emergency department
management distribution) that are 5% or
group, the biggest pre-billing risk area
8% higher than the group average. You
is documentation and coding. The
will then need to do a focused audit that
standard documentation guidelines
is statistically significant (your billing
for teaching physicians, Medicare
company can help define this for you) and
requirements, medical students, and
respond to the results.
physician extenders, etc. are likely
(a) Further, I must comment that the
not new to you. There were four
MDM has been the deciding factor in the
areas of current focus with sort of a
last several audits that EGO was involved
new twist: ROS finishing statement,
in. The charts were well documented in
medical necessity and completion and
terms of HPI, ROS, and physical exam.
authentication of orders with qualifying
It came down to proving that a 99285
signatures, and the electronic medical
level of service was indicated for that
record (EMR).
patient on that day. A well-documented
(1) Medicare recommends specific
HPI and relevant differential diagnosis
language that allows you to document
is key. This area is well worth spending
your pertinent positives and negatives and
then state “all other ROS
are negative” to indicate
you have met the 10-system
review requirement. While
the California Medicare
carrier has not made this a
specific focus of their audits;
__________________________________
other state’s Medicare
carriers
have
denied
Central Coast Emergency Physicians
claims or down-coded
claims because providers
used different language to
Emergency Medicine Specialists
finish their ROS. Use the
of Orange County
recommended language,
“all other systems are
Napa Valley Emergency Medical Group
reviewed and negative”
and you should be
safe. Otherwise, simply
Newport Emergency Medical Group, Inc.
document the 10 systems
or more you have asked
Pacific Emergency Providers
about.
(2) Another risk area is
St Jude Emergency Medicine Group, Inc.
documentation of medical
necessity, a topic that was
discussed repeatedly this
Tri-City Emergency Medical Group
year. This should be a
major focus now as so
University of CA at Irvine
many payers question
or reduce payment for
CAL/ACEP SALUTES
OUR 100%
MEMBERSHIP GROUPS
President's Message...
a false claim.
ii) Electronic Medical Records have put
some time on. It’s important from emergency medicine into two new compliance
a medical-legal, reimbursement and risk categories for two reasons. The prompts
compliance perspective.
have caused the E&M levels to climb at a
(3) “Medicare requires that services noticeable rate (several audit examples were
provided/ordered be authenticated by the given) and the defaults and macros produce
author” – Change Request (CR) 6698/ “clone-like” charts that are part of the 2011
Transmittal 327. Medicare Conditions of OIG work plan.
Participation (CoP) requires that for all
Medicare Part B Carrier (and now MAC
medical records “the author of each entry contractor) Trailblazer stated: “Medicare
must be identified and must authenticate is also concerned that the provider’s
his or her entry” … “must be authenticated computerized
documentation
program
and dated promptly by the person who is defaults to a more extensive history and
responsible for the ordering, providing, physical examination than is medically
or evaluating the service provided.” necessary to perform on a given day, and does
At first, I did not really understand the not differentiate new findings and changes in
compliance issue and neither did the a patient’s condition.” ** **The Report on
audience as evidenced by the repetitive Medicare Compliance, 5/28/07.
questions. WOW, then it was clear. The
From Part B News: documentation
bedside ultrasound that you did cannot be shortcuts that raise audit risk and how to fix
billed for UNLESS you actually ordered them. October 25, 2010, “Your doctors might
it. What about the chest pain patient that think documentation shortcuts save time and
gets an EKG on arrival. The EKG is not a boost efficiency, but they could also raise
billable event unless you order it. Further, your practice's audit risk when government
there is very specific language regarding inspectors come knocking”, experts tell Part B
what constitutes “authentication”. If News. Remember: EHRs may make it faster
your signature is illegible or your billing for physicians to document, but at significant
company sends the claim in before you risk of up coding. By prompting physicians
electronically sign your charts, it may be on every possible condition, contraindication
or symptom patients
may have, your EHR
th
may suggest high40 Annual
level E/M services not
CAL/ACEP Scientific Assembly
actually justified by
clinical facts.
The
medical
record generated by
the EMR needs to be
@ 11:15 AM
specific to the patient
for the particular datePRESIDENT'S MESSAGE
of-service and our
Peter Sokolove, MD
industry appears to have
significant risk here.
An address by the new Chapter President on the year
If your group works
to come and their priorities for the Chapter
from an EMR, you
need to do a focused
@ 12:00 PM
review. For example,
AWARDS LUNCHEON (RSVP Required)
pull 5-10 charts by
The annual Chapter Awards Luncheon will honor
provider for a specific
Chapter members who have made outstanding
type of chief complaint.
contributions to emergency medicine and to the Chapter
If
each
provider’s
documentation
sounds
@ 6:00 PM - $100
the same, or worse,
PRESIDENT’S RECEPTION & DINNER
all of the charts sound
the same, you have a
compliance risk area.
Register under the Optional Events section
This is part of the 2011
of CAL/ACEP’s Scientific Assembly
OIG work plan.
registration form at www.calacep.org.
Next month, the rest
of your risk assessment.
Friday Events
West JEM...
maloykr@georgetown.edu
Conflicts of Interest: By the WestJEM
article submission agreement, all authors are
required to disclose all affiliations, funding
sources, and financial or management
relationships that could be perceived as
potential sources of bias. The authors
disclosed none.
REFERENCES
1. Rathore SS, Weinfurt KP, Gersh BJ. Treatment of
patients with myocardial infarction who present with
a paced rhythm. Ann Intern Med. 2001; 134:644- 51.
2. Madias JE. The nonspecificity of ST-segment
elevation >or=5.0 mm in V1-V3 in the diagnosis
of acute myocardial infarction in the presence of
ventricular-paced rhythm. J Electrocardiol. 2004;
37:135-9.
3. Ufberg J, Harrigan RA, Wittenberg AJ. Acute
myocardial infarction complicated by a ventricularpaced rhythm. J Emerg Med. 2004; 27:81-3.
4. Harper RJ, Brady WJ, Perron AD, et al. The
paced electrocardiogram: issues for the emergency
physician. Am J Emerg Med. 2001; 19:551-60.
5. Kozlowski FH , Brady WJ. The electrocardiographic
diagnosis of acute myocardial infarction in patients
with ventricular-paced rhythms. Acad Emerg Med.
1998; 5:52-7.
6. Brady WJ. Cases in electrocardiography. Am J
Emerg Med. 1998; 16:85-6.
7. Rosner MH, Brady WJ. The electrocardiographic
diagnosis of acute myocardial infarction in patients
with ventricular-paced rhythms. Am J Emerg Med.
1999; 17:182-5.
8. Sgarbossa EB, Pinski SL, Gates KB, et al. Early
electrocardiographic diagnosis of acute myocardial
infarction in the presence of ventricular-paced
rhythm. GUSTO-I investigators. Am J Cardiol.
1996; 77:423-4.
9. Jagoda AS, Decker WW, Edlow JA, et al.
Clinical Policy: Critical Issues in the Evaluation
and Management of Adult Patients with Non–STSegment Elevation Acute Coronary Syndromes. Ann
Emerg Med. 2006; 48:270-301.
10. R Development Core Team. R: A language
and environment for statistical computing. Vienna,
Austria; 2008. Version 2.7.2.
11. Brasil P. DiagnosisMed: Diagnostic test
accuracy evaluation for medical professionals.
Vienna, Austria; 2008. Version 0.0.2.
12. Kontos MC, Roberts BD, Tatum JL, et. al.
Mortality based on the presenting electrocardiogram
in patients with myocardial infarction in the troponin
era. AJEM 2009; 27:146–152.
13. Nunn CM, O’Neill WW, Rothbaum D. Long term
outcome after primary angioplasty: report from
the Primary Angioplasty in Myocardial Infarction
(PAMI-I) trial. J Am Coll Cardiol. 1999; 33:640-6.
14. Rathore SS, Gersh BJ, Weinfurt KP. The role
of reperfusion therapy in paced patients with
acute myocardial infarction. Am Heart J. 2001;
142:516- 9.
April Issue 2011 13
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RESIDENTS� REGION
unfortunately ----------------only after withdrawing
----------------REGION
Critical
Care RESIDENTS’but
its application for added qualifications to
Certification
CCM (2).
for
Emergency
Critical
Care Certification
Current Updates
There has been a boon of editorials stating
Physicians,
for Emergency Physicians,
that emergency physicians can “soon” sit for
Myth or
Myth
orFact?
Fact?
the internal medicine critical care board exam
(3) since the release of the ABEM-ABIM
joint statement in November 2010 (4). It
states, “ABIM and ABEM have approved
the development of a proposal for the cosponsorship of the ABIM subspecialty of
Critical Care Medicine.” Though this is a
significant step for ABEM, the proposal has
not been submitted yet and afterward there
is no promise that the American Board of
Medical Specialties (ABMS) will approve
by
Dinh,MD
MD
by Viam Dinh,
the proposal. This can be very misleading
Emergency Medicine
Emergency
MedicineResident
Resident
for EM graduates pursuing a critical care
Loma Linda
Center
career. I believe it is still too premature to
Loma
Linda University
UniversityMedical
Medical
Center
say emergency physicians can “soon” sit for
As all emergency physicians have the CCM boards in the US, especially given
experienced,
critical care
and emergency
the previous
history
of verbal medicine
and written
As all emergency
physicians
have experienced,
critical care
and emergency
are
medicine
are
deeply
linked.
Wecan
know
that care,
deeply linked. We know that we
do critical
and we know
that wenot
canfallen
do it well.
But
agreements
that have
through.
we
can
care,
andcertified
we know
we Even
why
aredowecritical
not able
to get
in that
the United
States?
Rationally
it makes
so much
sense. In
though
it seems
so close,
the reunion
of
can
it well.
why arethewe
not able
to EM
this do
article
I wantBut
to discuss
history
of critical
care medicine
relation
emergency
and CCM(CCM)
is stillinup
in theto air
with no
medicine
(EM),
current
updates,
andRationally
current options
for critical
training.
get
certified
in the
United
States?
definite
time care
frame.
it makes so much sense. In this article I want
History
to
discuss the history of critical care medicine Current Options
Currently there is no United States board
(CCM) in relation to emergency medicine
In order to understand the obstacles of getting
certified for
in critical
care, itphysicians
is important
to
certification
emergency
(EP)
(EM), current updates, and current options
know the history. Here is the story of how EM metexcept
CCM and
how aeach
went
their separate
ways.
through
dual
IM
(internal
medicine)/
for
critical
care training.
Both
specialties
began to form in unison during the 1960’s and the Society for Critical Care
EM residency. However, there are still
Medicine
initially
agreed to accept EM trained physicians as a prerequisite for admission to a
History
programs that acccept EM trained graduates
critical
care fellowship
(1). In 1979,
the American Board of Emergency Medicine (ABEM) was
In order
to understand
the obstacles
1 ora conjoint
2 year fellowships
under
surgery/
approved as a conjoint (modified) board. However,forbeing
board disabled
ABEM
from
of
getting certified in critical care, it is
These
issuing sub-specialty designations. Meanwhile, theanesthesia
same year, and
CCMinternal
became amedicine.
sub-specialty
for
important
to know the history. Here is the programs
canpediatrics,
be found and
on surgery
the ACEP
four existing primary boards: anesthesia, internal
medicine,
withand
a
story
of promise”
how EMthat
metemergency
CCM andmedicine
how each
(5,6).
After
going
“verbal
wouldSAEM
be able websites
to sit for the
CCM
boards
(2). through
ABEM
went
theirtoseparate
Bothboard
specialties
struggled
becomeways.
a primary
due to opposition
by thecritical
American
of Internal
one of these
careBoard
fellowships,
US
began
to
form
in
unison
during
the
Medicine (ABIM) against having CCM1960’s
as an added
qualification.
ABEM get
eventually
a
graduates
can currently
certifiedbecame
through
and
the Society
Critical
Medicineonly the
primary
board infor1989,
but Care
unfortunately
afterEuropean
withdrawing
its application
for added
Society
of Intensive
Care
qualifications
to CCM
initially
agreed
to (2).
accept EM trained Medicine. Many hospitals will accept EPs,
physicians as a prerequisite for admission with critical care training and European
Current
Updates
to
a critical
care fellowship (1). In 1979, the boards, to work in their ICU.
American Board of Emergency Medicine Conclusion
(ABEM) was approved as a conjoint
Critical care certification for EPs in the US
(modified) board. However, being a conjoint is still a myth at this point. The time frame
board disabled ABEM from issuing sub- for when the proposal will be submitted by
specialty designations. Meanwhile, the same ABEM and then approved by ABMS is still
year, CCM became a sub-specialty for four undetermined. For now I believe the safest
existing primary boards: anesthesia, internal way to go would be to apply to a two-year
medicine, pediatrics, and surgery with a critical care program under internal medicine.
“verbal promise” that emergency medicine Then when ABMS passes the proposal, you
would be able to sit for the CCM boards (2). can sit for the CCM boards. Be aware that if
ABEM struggled to become a primary board you complete a surgical/anesthesia critical
due to opposition by the American Board of care fellowship you will not be able to sit for
Internal Medicine (ABIM) against having the ABIM critical care boards and currently
CCM as an added qualification. ABEM it seems unlikely that surgery or anesthesia
eventually became a primary board in 1989, will allow EPs to take their boards in the near
future. At present, the best we can do is to
get certified in Europe after a critical care
fellowship.
Questions or comments?
viamdinh@gmail.com
Bibliography
1) Safar P. The Critical Care Physician. Report on
the Conference on Education of the Physician in
Emergency Medical Care. Chicago, IL: American
Medical Association, 1973.
2) Somand D, Zink B. The Influence of Critical Care
Medicine on the Development of the Specialty of
Emergency Medicine: A Historical Perspective. Acad
Emerg Med. 2005;12:879-883.
3) Kenen, J. Forget Paris, Emergency Physicians Can
Soon Sit for US Critical Care Boards. Annals of Emer
Med. 2011;15A-17A.
4 ) h t t p : / / w w w. a b e m . o rg / P U B L I C / _ R a i n b o w /
Documents/Joint%20Statement%20for%20Web%20
11-24-10%20EDITED-ABIM.pdf
5) http://www.acep.org
6) http://www.saem.org
CAL/ACEP Sponsored Conferences
CAL/ACEP 22nd Annual
Emergency Medicine
Legislative Leadership Conference
April 26, 2011 – Sacramento, CA
Information: 800-735-2237 or www.calacep.org
CAL/ACEP 40th Annual
Scientific Assembly & Ultrasound Workshop
June 23-25, 2011 – Newport Beach Marriott
CAL/ACEP 35th Annual
Emergency Medicine in Yosemite
January 11-14, 2012 – Yosemite, CA
Jointly-Sponsored Courses
Jointly sponsored by CAL/ACEP
and the American College of Emergency Physicians
EMPSF: First Annual Patient Safety Summit
Type: Live Conference
Las Vegas, NV - May 5-6, 2011
Information: 916-357-6723
www.empsf.org
Point of Care US Guided Nerve Blocks
San Francisco, CA - June 10, 2011
www.ulscourse.com
Wilderness Medicine
Santa Fe, N.M – June 1-5, 2011
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Big Sky, Montana - July 25-29 , 2012
www.wilderness-medicine.com
The Center for Medical Education, Inc.
Type: Enduring Materials: Internet Subscriptions
Emergency Medical Abstracts
Risk Management Monthly/ Emergency Medicine
Information: www.ccme.org
Patient Safety Risk Solutions
Type: Enduring Materials: Webinar
Teamwork and Communication in
Emergency Medicine
The Dilemma of the Psychiatric Patient in the
Emergency Department
Information: www.psrisk.com
April Issue 2011 15
CAREER OPPORTUNITIES
CAL/ACEP cannot guarantee the validity or accuracy of advertisements.
ACEP MEMBERSHIP
ACEPPREFERRED:
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16 April Issue 2011
-------------- FELLOWSHIP CORNER -------------Advocacy Fellow
FELLOWSHIP CORNER
Advocacy Fellow
VisittotoD.C.
D.C.
- 2/28/11
Visit
- 2/28/11
Mike Rapp, MD, Director of the Quality
Measurement & Health Assessment Group in
the Centers for Medicare & Medicaid Services’
Office of Clinical Standards & Quality
William Rogers, MD Medical Officer,
Centers for Medicare and Medicaid Services
Director, Physicians Regulatory Issues Team
Typically we met with legislators either at
their office or at a fundraiser. If in their office,
we would often meet with the Congressman’s
staffer responsible for health policy issues or
the Congressman himself. The content of our
visits ranged from simple introductions to
by David Rankey MD
discussions of strategies for advancing ACEPby
David
Rankey
MD
Overcrowding/Boarding
CAL/ACEP Advocacy Fellow
sponsored legislation. The office visits were
CAL/ACEP Advocacy Fellow
• Expand number of available
straightforward but sometimes difficult to
The CAL/ACEP Advocacy Fellowship
psychiatric beds
obtain, and at times we met with resistance
offers its fellows an elective month at the
due to the member’s political ideology. The
ACEP Public Affairs Office in Washington, Medicare
fundraisers
we ACEP
attendedPublic
generally
took place
• Repeal current
physician
Cal/ACEP
offersMedicare
its fellows
an elective month
at the
Affairs
D.C., and The
this past
February IAdvocacy
was fortunateFellowship
at
a
restaurant
over
lunch
or
dinner.
payment
formula
(SGR)
toOffice
participate.
The
experience
was
full
of
in Washington, D.C., and this past February I was fortunate to participate. The experience was fullThe
challenges of the fundraisers were different
activity
with
recent
reform
of activity the
with
the health
recentcare
health
careHealth
reform
legislation
Care
Reform and the new Republican House majority, and it was
from the office visits in that we were
legislation and the new Republican House
• Protect
emergency
medicine
provisions
very insightful
political
process.
This
is an essay
to share
my experience
and
lessons
learnedforwhile
competing
with
other interests
attention
majority,
and it was into
very our
insightful
into our
included in PPACA
working
in ourThis
nation’s
Capitol.
and time to address our issues.
political
process.
is an essay
to share
• Repeal Independent Payment Advisory
Educating members can be a particularly
my experience and lessons learned while
Board (IPAB)
difficult
becausealong
there with
are sothe
many
working inDuring
our nation’s
Capitol.
my time in D.C. my duties were to learn ACEP’s policy goals andtaskagenda,
interests vying for their attention. These
During my time in D.C. my duties were Workforce
background information for all relevant subject material, and to convey
our message to members of
members have a barrage of groups and
to learn ACEP’s policy goals and agenda, • Expand number of emergency medicine
Congress
Federal
Regulators.
greatestslots
surprise during my visit was
how our
lobbying
lobbyists
meeting
with efforts
them inwere
various
along
with theand
background
information
for all Theresidency
drowned
out
by
hundreds
of
other
lobbyists,
all
of
them
with
data
and
convincing
stories.
How
can
we
betheir
capacities
to
convince
them
to
help
meet
relevant subject material, and to convey our
Pharmaceuticals
group’s
goals.
For
ACEP,
the
motivation
message
to
members
of
Congress
and
Federal
effective in delivering our message •with
so much background noise? Also surprising were the varying is
Ensure appropriate supply of necessary
to supportmessage
legislators was
who ininterpreted
turn will support
Regulators.
The
greatest
surprise
during
knowledge bases of these political players
and the
wayforinusewhich
ACEP’s
pharmaceuticals
available
by
emergency physicians. A relationship with
my visit was how our lobbying efforts were
differently when being presented to a freshman
bureaucrat.
emergencylegislator
physicians versus a 30 year CMS
a legislator often begins at the state level,
drowned out by hundreds of other lobbyists,
all of them with data and convincing stories.
Below is a listthof legislators and federal and as the politician’s career advances
Congress:
Below
a list
ACEPinLegislative
How
caniswe
be of
effective
delivering Agenda
regulatorsfor
I 112
met with
to discuss ACEP’s the relationship continues at the federal
level. With ACEP-supported legislators in
our message with so much background political objectives:
positions of influence on certain committees,
noise?
Also
surprising
were
the
varying
Reimbursement
knowledge bases of these political players • Joe Heck - United States Congressman 3rd the likelihood of achieving our political
District of Nevada
objectives is greatly improved.
and the way in which ACEP’s message was
•
Lamar
Smith -provided
United States
•
Appropriate
payment
for
patient
care
services
by Congressman
emergency physicians
The most important lesson from my
interpreted differently when being presented
21st District of Texas
experience
is that politicians
listen to their
to•a freshman
versus
a 30
year CMS
Extendlegislator
Primary
Care
bonus
payments
for
Medicaid
services
at
Medicare
rates
to emergency
physician
• Charlie Dent - United States Congressman constituents. As emergency physicians we
bureaucrat.
Evaluation and Management (E&M)15th
codes
District of Pennsylvania
can have a great impact on legislators who
Below is a list of ACEP's Legislative
•
Steve
Stivers - United States
•
Tax
deductions
for
uncompensated
EMTALA-related
careCongressman represent our home districts both on a state
Agenda for 112th Congress:
15th District of Ohio
• Assignment of Benefits
and federal level. While in D.C. I met with
Reimbursement
• Michael C. Burgess - United States
the Congressman
my home district and
Reauthorize
federal
reimbursement
for care provided
to undocumented
aliens
(MMA, from
§1011)
• •Appropriate
payment
for patient
care
Congressman
26th District
of Texas
arranged to meet him in his home office to
services provided by emergency
• Shelly Moore Capitol - United States
discuss further the challenges for health care
physicians Reform
Congresswoman 2nd District of West
Liability
in the emergency department and ways to
• Extend Primary Care bonus payments
Virginia
make improvements. My hope is to build
for Medicaid services at Medicare rates
• Dennis Ross - United States Congressman
an ongoing
relationship
with him so that he
•to emergency
Comprehensive
on non-economic
damages, expert witness requirements,
pre-trial
screening
physician (caps
Evaluation
and
12th District of Florida
can
be
my
voice
in
the
Capitol
to help make
panels, etc.)
Management
(E&M) codes
• Amy Klobuchars - United States Senator
things better.
• •Tax Liability
deductions protections
for uncompensated
from post-stabilization
Minnesota
for EMTALA and
services
Please become a political advocate and
EMTALA-related care
• Chuck Schumer's staff - United States
look into joining ACEP 911 legislative
• Assignment of Benefits
Senator from New York
network at the web address below: http://
• Reauthorize federal reimbursement for
www.acep.org/advocacy/becomeanadvocate/
care provided to undocumented aliens
Others:
(MMA, §1011)
Liability Reform
• Comprehensive (caps on non-economic
damages, expert witness requirements,
pre-trial screening panels, etc.)
• Liability protections for EMTALA and
post-stabilization services
• Raise burden of proof for emergency
physicians by demonstrating "clear and
convincing evidence" that malpractice
occurred
• Raise standard to sue emergency
physicians to "gross negligence"
April Issue 2011 17
New POLST Form
Available April 1, 2011
by Andrew Fenton, MD
CAL/ACEP Board Member
Beginning April 1, 2011 a new POLST
(Physician Orders for Life-Sustaining
Treatment) form will be released for
widespread use throughout the state. Since
its inception in January 1, 2009 the use of the
POLST form has spread throughout numerous
California counties. The goal of the POLST
form remains the same. It allows patients
to state what kind of medical treatments,
specifically resuscitative interventions, they
want toward the end of their lives. In the last
two years, additional studies have proven that
POLST helps give patients more control over
their end-of-life care and have shown that
their wishes are met more accurately.
CAL/ACEP was an original sponsor
in 2009 of the legislation that established
the POLST form into law (AB 3000 by
then-Assembly Member Wolk). Since that
time CAL/ACEP has remained active on
statewide committees designed to assist in
18 April Issue 2011
.
its widespread implementation. CAL/ACEP
also was part of the committee who reviewed
and accepted changes to the form. As part
of this group we were able to incorporate
improvements suggested by CAL/ACEP
members into the new 2011 edition (see 2011
edition below).
CAL/ACEP changes accepted include
adding contact information and phone
numbers for the legally recognized
decisionmaker on the front of the form. We
also have included an additional contact
person and number on the back of the form.
These improvements will more easily allow
treating physicians to contact family members
and loved ones during the critical time when
the POLST form becomes useful.
Our organization also removed the
language for patients who desired only
comfort measures that stated, “Antibiotics
only to promote comfort.” This vague and
confusing term led many “comfort care only”
patients to get powerful IV antibiotics though
not clearly desired. Instead we included
language in the directions that states,
“IV antibiotics generally are not comfort
measures.”
Finally, CAL/ACEP also provided
language at the top of the form accepted by
all parties that clarifies the physician role in
the hospital: “California law requires that
the orders in a POLST form be followed by
health care providers, and provides immunity
to those who comply in good faith with a
patient’s POLST wishes. In the hospital
setting, a patient will be assessed by a
physician who will issue appropriate orders.”
The 2011 form now includes the important
immunity clause that CAL/ACEP and CMA
fought for in the original 2009 bill.
The 2011 POLST form now also includes
reference to the Advance Directive, defines
a legally recognized decision maker, and
provides more direction for health care
professionals filling out the form. In addition,
wording and formatting was changed or added
in certain sections to provide greater clarity.
In making these changes it was our goal
to maintain the form as a one-page, twosided document, and to keep all the critical
information on the front of the form for ease
of reference. The form will still be printed on
bright pink paper though copies remain valid.
Previous versions of signed POLST forms
also will remain valid.
More information about these changes
and additional copies of the form can be
obtained at http://www.capolst.org/
Things to See and Do
The Newport Beach Marriott Concierge
Recommends
Welcome to Newport Beach! Whether you are interested in fine dining, history, art, botanical gardens or just having fun in the sun.
We are proud to be able to offer a variety of activities to appeal to almost every interest. The suggestions listed are just a few of the memorable “Things to See and Do”
in the Newport Beach area. For more specific interests, the concierge desk will be happy to assist you.
Enjoy the quaint atmosphere of Balboa Island by strolling its main street and shopping in its small stores
and boutiques. Treat yourself to a ―Balboa Bar‖ or a frozen banana.
Take the historic three car ferry to balboa Peninsula where you can walk along the beach, take a sightseeing harbor cruise
or enjoy the rides at the balboa Fun Zone—one of the oldest boardwalks in the United States!
Walk, jog, bike or rollerblade around Balboa Island, Balboa Peninsula or the Back Bay Ecological Reserve.
Enjoy a hamburger and cherry coke at ―Ruby’s Diner‖, located at the end of Balboa Pier.
Experience Fashion Island, one of Newport Beach’s finest shopping centers. Towering palms and ocean views, koi ponds, fountains, carousels,
exclusive shops and award winning restaurants are all just across the street. It’s dog-friendly and great for people watching.
Rent a sailboat, paddle boat or kayak at ―Newport Dunes‖. Enjoy calm water beaches, slides, swings and restaurants—fun for the whole family.
Go on a Dolphin Safari off Dana Point Harbor with Captain Dave. You can talk to the dolphins and even listen to them talk back!
Whale watching too! (January –March)
Allow yourself to be pampered with a manicure and facial without ever leaving the hotel!
―Pure Blu‖ offers a wide variety of ways to relax the body and revive the spirit.
Celebrate an anniversary, or other significant date, with a romantic evening cruising through Newport Harbor in an authentic Venetian gondola.
Enjoy a major theatrical production on the stage of the exquisite ―Orange County Performing Arts Center‖ or ―South Coast Repertory‖.
Attend the Orange County Market Place (Swap Meet) located at the Orange County Fairgrounds Saturdays and Sundays from 7am- 4pm.
Explore the tide pools of Little Corona beach during low tide.
Enjoy a wildlife nature tour of the Back Bay Ecological Reserve. (October- March)
View the current exhibitions at the Orange County Museum of Art or the Newport Sports Museum, both located within walking distance
of the hotel, or the Newport Nautical Museum located at the Balboa Fun Zone.
Use that competitive edge and tee-off for a round of golf at one of the spectacular courses in our area.
The concierge desk will be happy to provide you with a list of nearby courses.
If you have a ―green Thumb‖, or just wish you did, tour the free botanical gardens and world renowned selections at Roger’s Garden
or the lovely botanical gardens and tea room at Sherman’s Library and Garden for a nominal fee.
Experience deep sea fishing off the Newport Coast with Davey’s Locker or Newport Sports Fishing.
Allow your taste buds to savor the fine dining cuisines of the many restaurants in Newport Beach.
Whatever your favorite, we have more than 300 restaurants to serve you.
Learn about California’s early history with a tour of mission San Juan Capistrano. If you are lucky enough to be visiting in March, watch
for the amazing return of the Swallows to the Mission every March 19th.
Visit the ―Happiest Place on Earth‖. Disneyland, Downtown Disney, or Disney’s California Adventure are truly magical experiences
for the whole family—only 35 minutes away!
Take a trip back to the Old West at Knott’s Berry Farm. Enjoy the rides, Pan for Gold
and enjoy some of Mrs. Knott’s famous chicken and boysenberry jam.
Rise early and watch the Dory Fleet arrive at the foot of Newport Pier with its daily fresh catch.
You can also watch them prepare their catch for public sale.
Take the Catalina Flyer to Santa Catalina Island—―26 miles across the sea‖. Once there, you can participate in a variety of Island tours,
go scuba diving or snorkeling, hike the Island trails, go horseback riding or even play a round of golf.
The Concierge will be happy to assist you with maps, directions, reservations or tickets.
Please stop by our desk or call extension 3506 for assistance.
April Issue 2011 19
Transportation Fact Sheet - Newport Beach Marriott Hotel & Spa
900 Newport Center Drive - Newport Beach, CA 92660
BY AIR:
From John Wayne Airport – OC
The airport is serviced by Alaska Airlines, Alpha Air, America West,
American Airlines, Continental Airlines, Delta Airlines, Northwest
Airlines, Sky West, Southwest Airlines, TWA, United Airlines, US Air,
and Jet Blue. The airport is located 10 minutes from the hotel.
From Los Angeles International Airport:
The airport is serviced by all major air carriers.
Ground
transportation includes regularly scheduled airport bus service,
private limousine, taxi, rental cars, and shuttle vans. Driving time to
Newport Beach is approximately 55 minutes on Interstate 405 (San
Diego Freeway)
From Long Beach Airport:
The airport is serviced by Alaska Airlines, America West, American
Airlines, American Eagle, Delta Airlines, Northwest Airlines, Reno
Air, Sky West, Southwest Airlines, United Airlines, US Air Express
and Jet Blue. Ground transportation includes private limousine, taxi,
rental cars, and shuttle vans. Driving time to Newport Beach is
approximately 70 minutes.
BY AUTOMOBILE:
From John Wayne Airport – OC:
Take MacArthur south to Jamboree Road. Turn right on Jamboree
Road. Continue down Jamboree to Santa Barbara Drive. Turn left on
Santa Barbara Drive. Hotel will be on the right at the top of the hill.
From Los Angeles International Airport:
Take San Diego Freeway (405) South to San Joaquin Hills Toll Road
(73). Exit on Jamboree, turning right towards Corona Del Mar.
Continue down Jamboree Road to Santa Barbara Drive. Turn left on
Santa Barbara Drive. Hotel will be on the right at the top of the hill.
From Long Beach Airport:
Take San Diego Freeway (405) South to San Joaquin Hills Toll Road
(73), Exit on Jamboree, and turn right towards Corona Del Mar.
Continue down Jamboree Road to Santa Barbara Drive. Turn left on
Santa Barbara Drive. Hotel will be on right at the top of the hill.
20 April Issue 2011
From Ontario International Airport:
Take San Bernardino Freeway (10) west to Orange Freeway (57).
Take Orange Freeway south to Santa Anna Freeway (5). Take Santa
Ana Freeway south to Newport Freeway (55). Take Newport Freeway
South to San Joaquin Hills Toll Road (73). Exit on Jamboree, turning
right towards Corona Del Mar. Continue down Jamboree Road to
Santa Barbara Drive. Turn left on Santa Barbara Drive. Hotel will be
on the right at the top of the hill.
From Downtown Los Angeles:
Take Santa Ana Freeway (5) South to Newport Freeway (55). Take
Newport Freeway South to San Joaquin Hills Toll Road (73). Exit on
Jamboree, turning right towards Corona Del mar. Continue down
Jamboree Road to Santa Barbara Drive. Turn left on Santa Barbara
Drive. Hotel will be on the right at the top of the hill.
From San Bernardino/Riverside Inland Empire:
Take Riverside Freeway (91 – accessible via 15 or 60 Freeways) west
to Newport Freeway (55). Take Newport Freeway south to San
Joaquin Hills Toll Road (73). Exit on Jamboree, turning right
towards Corona del Mar. Continue down Jamboree Road to Santa
Barbara Drive. Turn left on Santa Barbara Drive. Hotel will be on the
right at the top of the hill.
From Sacramento/Northern California:
Take the 5 freeway South all the way down past Los Angeles, into
Orange County. From the 5 take the Newport Freeway (55) South to
San Joaquin Hills Toll Road (73). Exit on Jamboree Road and turn
right. Continue to Santa Barbara Drive, turn left. Hotel will be on the
right hand side at the top of the hill.
From San Diego:
Take the Santa Ana Freeway (5) North to San Joaquin Hills Toll Road
(73). Exit at Bonita Canyon and turn left continue on Bonita Canyon
which turns into Ford Road. Then turn left onto Jamboree Road,
continue to Santa Barbara Drive. Turn left on Santa Barbara Drive.
Hotel will be on the right at the top of the hill.
From Pasadena:
Take the 210 Freeway to the 605 Freeway South. From the 605
Continue to the San Diego Freeway (405) South. Exit on to the San
Joaquin Hills Toll Road (73). Exit on Jamboree Road. Continue to
Santa Barbara Drive. Turn left on Santa Barbara Drive, the hotel will
be on the right at the top of the hill.
Newport Beach Area Golf Courses
Tustin Ranch Golf Club – Tustin, CA ($75-$150) - (20 minutes, 12.5 Miles)
Contact: Michael Larsen ● Phone: (714) 734-2102 Fax: (714) 730-6236 Email: mlarsen@tustinranchgolf.com
http://www.tustinranchgolf.com/contact-us.html
Experience the grand tradition of golf at Tustin Ranch Golf Club. Inside you’ll find 6,800 yards of classic Ted Robinson design—all
grass, boundary to boundary, very walkable and all meticulously maintained. This 18-hole course offers private caddie service, a
unique and popular amenity at this golf course in Orange County. Experience breathtaking scenery, sparkling lakes and cascading falls
at Tustin Ranch, consistently voted one of the "Best Orange County Golf Courses" by the readers of the Orange County Register. In
addition, Tustin Ranch is a 4-Star recipient of Golf Digest Magazine's "Places to Play ".
Monarch Beach Golf Links – Dana Point, CA ($100-$200) - (30 minutes, 15 miles)
Contact: Clint Cook ● Phone: (949) 487-3845 Fax: (949) 240-9210 Email: ccook@troongolf.com
http://www.monarchbeachgolf.com/index.html
Located near the cliffs of Dana Point with commanding sweeping views to the sea, this par-70 championship course offers an
unending variety of play. The dramatic vistas and abundance of vegetation add to the charm of the Robert Trent Jones Jr. Designed
Layout. Its undulating greens and gathering bunkers enhance the natural landscape and provides an enjoyable test of golf for players
at all skill levels. Cooled by ocean breezes in summer and blesses with a mild climate, “The Links” is an ideal year-round golf
destination, with a full range of amenities for the convenience of guests.
Strawberry Farms Golf Club – Irvine, CA ($80-150) - (14 minutes, 8.1 miles)
Contact: Tom McCray ● Email: tmccray@sf-golf.com Phone: (949) 551-2560 http://www.strawberryfarmsgolf.com/
Strawberry Farms Golf Course combines the rural beauty and tranquility of the surrounding area with the challenge of true
championship golf. As the premier golf course in Southern California, Strawberry Farms is the preferred course among corporate
groups and golf enthusiasts alike. The par-71, 6,700 yard course is set amid canyons and wetlands; the 18-hole course offers
picturesque vistas across the 35-acre reservoir, large rolling greens surrounded by wildlife and natural vegetation and scenic hills
studded with granite boulders and natural waterfalls. Course Designer Jim Lipe, member of the Nicklaus design team.
April Issue 2011 21
Highlights: Fashion Island - Laguna Beach - Balboa Island – Disneyland - Knott's Berry Farm - Universal Studios - Catalina Island
Beverly Hills/Hollywood - Newport Harbor/Fishing Cruises - Verizon Wireless Ampitheatre
Local Tour Services: Catalina Ferry - Newport Beach to Avalon - Catalina Island - Catalina Tours - 1-888-317-3576
Sea Lions, Celebrity Homes, Newport Harbor - The Fun Zone Boat Company - 1-949-673-0240
Newport Harbor Gondola Tour - Newport Harbor Gondola Company of Newport Beach - 1-949-675-1212
22 April Issue 2011
40th Annual CAL/ACEP Scientific Assembly
CALL FOR ABSTRACTS
by Matthew R. Lewin, MD, Research Forum Chairman
Thursday, June 23rd @ Newport Beach Marriott
Newport Beach, CA
Abstracts are being accepted for the Research Forum at the 2011
CAL/ACEP Scientific Assembly. Oral presentations will be conducted on
the afternoon of June 23rd at Newport Beach Marriott, Newport Beach,
CA. Authors are encouraged to submit original research in all aspects of
emergency medicine. Resident, Fellow and junior faculty participation is
strongly encouraged. Abstracts must not have previously appeared in a
peer-reviewed journal prior to the meeting date. Abstracts to be presented
at other scientific meetings (including SAEM & ACEP) are eligible for
presentation. Only 10 abstracts will be selected for presentation.
All presentations are oral presentations.
AWARDS
Awards will be presented for
BEST RESEARCH PROJECT, BEST PRESENTATION PROJECT
and MOST INNOVATIVE PROJECT. Abstracts should include
the following sections and should generally follow the SAEM guidelines:
Objectives, Methods, Results, and Conclusions. All abstracts must be
submitted by e-mail, no later than May 21st 2011. The abstract may be
typed or pasted into the text of an e-mail message or as an attached file.
Be sure to include the following information:
 Names of all authors
 Institution
 Person who will present the abstract and
 Contact phone numbers
CONTACT
Matthew R. Lewin, MD
Director, Center for Exploration and Travel Health
California Academy of Sciences, San Francisco, CA, USA
Email: mlewin@calacademy.org
40th Annual CAL/ACEP
Scientific Assembly
LLSA Review
Dr. Peter D’Souza
Friday, June 24th @ 2PM - 5PM
The 2011 Lifelong Learning and Self Assessment
(LLSA) Workshop will cover all 11 articles chosen
by the American Board of Emergency Medicine as part
of the Emergency Medicine Continuous Certification
(EMCC Program). The workshop will be an interactive
review of the articles with participants encouraged to
share pearls from their own practice relevant to the
covered topics. Key "testable" concepts from the articles
will be emphasized. Participants will also receive a
handout with a review of key points from the articles.
$50
REGISTER TODAY
Register by selecting “LLSA” under the Optional Workshop
section of CAL/ACEP’s Scientific Assembly registration form.
www.calacep.org
ULTRASOUND
WORKSHOP
June 23 -24
SAVE THE DATE
$750 - $825
REGISTRATION IS LIMITED TO 50
CHAIRS: Drs. J. Christian Fox & Rusty Oshita
www.calacep.org
ULTRASOUND IV
BLADDER ASSESSMENT
WORKSHOP
www.calacep.org
Faculty: Laleh Gharahbaghian MD
Martine Sargent, MD, David Francis, MD, Brita Zaia, MD
Saturday, June 25th @ 9 AM (3 hours)
This ultrasound workshop introduces the technique of
point-of-care Ultrasound-guided peripheral & central line IV
placement and Bladder volume assessment. For those patients
who have difficult access and needs an IV for emergency
management, or patients who have urinary complaints and you
need to know the volume of the bladder for assessing need for
foley catheter placement, this course allows you to learn a tool
that will make it easier for your care of these patients. The lecture
followed by an extensive hands-on session discusses the tricks of
trade, pitfalls, and allows for extensive practice with gel phantom
models for IV placement and human models for bladder
assessment. It is safe, rapid, portable, and noninvasive; it allows
rapid bedside evaluation and increases success and speed for
many procedures.
REGISTER TODAY, SPACE IS LIMITED!
$119 Nurses
$140 Member / $160 Non-Member
April Issue 2011 23
LIFELINE
CALIFORNIA CHAPTER,
AMERICAN COLLEGE OF EMERGENCY PHYSICIANS
1020 11TH STREET, SUITE 310
SACRAMENTO, CA 95814
PRSRT STD
U.S. Postage
PAID
AUTOMATE

April 2011 - California ACEP

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