November 2012 - California ACEP

lifeline
NOVEMBER 2012
a forum for emergency physicians in california
An Attitude of Gratitude –
Giving Thanks
Page 4
TABLE OF CONTENTS |
4
4
President’s Message
7
Policy Update
Prescription Drug Monitoring Programs
9
ADVOCACY UPDATE
Governor Brown Signs California ACEP’s Key
Patient Safety Legislation, Vetoes Crowding Bill
7
15 The Fickle Finger
Romney’s Comments Reveal Widely Held
Misperceptions About ER Care
16
ANNOUNCEMENTS
17Upcoming Meetings & Deadlines
18 Career Opportunities
12 ACEP Council Recap
2012 ACEP Council in Review
California ACEP
Board of Directors &
Lifeline Editors Roster
2012-13 Board of Directors
Andrew Fenton, MD, FACEP, President
Tom Sugarman, MD, FACEP, President-Elect
Michael Osmundson, MD, MBA, FACEP, Vice President
Marc Futernick, MD, FACEP, Treasurer
Larry Stock, MD, FACEP, Secretary
Peter Sokolove, MD, FACEP, Immediate Past President
Yasmina Boyd, DO
Mathew Foley, MD, MS
Stephen Liu, MD
Cameron McClure, MD
Christina Millhouse, MD
Aimee Moulin, MD, FACEP
Leslie Mukau, MD
Valerie Norton, MD, FACEP, At-Large
Bing Pao, MD, FACEP
Chi Perlroth, MD
Vivian Reyes, MD, FACEP
Eric Snyder, MD, FACEP
Advocacy Fellowship
Mathew Foley, MD, Director
Aimee Moulin, MD, FACEP, Co-Director
Vikant Gulati, MD, Fellow
Lifeline Medical Editors
Mathew Foley, MD, MS, Medical Co-Editor
Richard Obler, MD, FACEP, Medical Co-Editor
Lifeline Staff Editors
Elena Lopez-Gusman, Executive Director
Ryan P. Adame, MPA, Deputy Executive Director
Lucia Romo, Education Coordinator
Callie Hanft, Government Affairs Manager
(Southern California)
JOB OPPORTUNITIES
•
Excellent Opportunities for
Emergency Physicians
• Very Competitive Compensation
• Pleasant Work Environment
• Hospitals include Arcadia Methodist &
Glendale Memorial (Top heart programs).
• Available practice settings in the Greater
Los Angeles area.
Contact Debbie Corn for more information.
(909) 634-3172 or fax CV to (909) 629-8755
Email: dcorn@emmamd.com
12
WELCOME new members!
Shahram Ahari
Allison M Binkowski, MD
Sarah Boulos, MD
Shabnam H Forouzandeh, MD
Anshul M Gandhi
Nicolas K Grundmann
April Gunn, DO
Adriana Gutierrez
Kurt Hansen
Aarti Jain
Russell F Jones, MD
Rajdeep S Kanwar
Julie R Kautz
Alice M Kim, DO
Ritu Kumar, MD
Nathaniel G Lane, MD
Jane McGarvey, MD
Quincy Moore
Akbar Nassiry, MD
Vicky Nguyen, MD
Taylor S Nichols
David Pomeranz, MD
Jordan A Roberts, DO
Barbara-Jean Santos, MD
Kristi Shigyo
Brittney Shook, DO
Sukhdeep Singh
James J Suel, MD
Michael Y Sunu, MD
Samuel J Tate
Mojdeh Toomarian
100% GROUPS
Central Coast Emergency Physicians
Emergency Medicine Specialists of
Orange County
Newport Emergency Medical Group, Inc. at
Hoag Hospital
Pacific Emergency Providers, APC
Front Line Emergency Care Specialists
Tri-City Emergency Medical Group
Loma Linda Emergency Physicians
University of California Irvine Medical Center
Emergency Physicians
Napa Valley Emergency Medical Group
NOVEMBER 2012 | 3
PRESIDENT’S MESSAGE |
Giving Thanks
An Attitude of Gratitude
By Andrew Fenton, MD, FACEP
“At times our own light goes out and is rekindled by a spark from another
person. Each of us has cause to think with deep gratitude of those who
have lighted the flame within us.”
— Albert Schweitzer, MD
Emmett Joseph Fenton
Sometimes I like working night shifts.
Sometimes, the pace slows and I am
allowed a chance to sit down and talk
and make a human connection with my
patient or their family. On this night at
2 am I was caring for an elderly woman with nonspecific complaints that
seemed most related to sundowning
and anxiety. She improved with listening, caring words, and attention (and a
touch of Ativan). I also met her son and
daughter-in-law. They cared for their
mother lovingly and though it was a
workday, didn’t complain or blame their
mom for her symptoms. Their love for
her was touching.
They asked about me and I told them my wife had just given birth to two healthy
baby boys a couple days before in the maternal ward next door. They seemed
genuinely happy for me. When their mother felt much better, they left and we
shook hands. They all said “Thank you,” but I felt like I got as much from the
conversation as they did. The next day I received a note in my box from the son &
his wife again thanking me for the care I gave their mother. The letter then read:
“You radiate the look of a new father. Much luck and good fortune. You will never
get enough time to hold them. Always love them. We lost a daughter last Christmas.
Nothing replaces the emptiness and loss. Hold them often. Tell them you love them.
Tomorrow is not promised.”
I am so incredibly grateful for the blessings I have in this life. During this season of
giving thanks it is the time to reflect and appreciate the gifts we have. We should
also take pride that as emergency physicians we can provide solace to those who
are suffering. In the world of politics and in the business of medicine there will
always be wins and losses. What are most important are our families, our friends,
and our calling as physicians. I wish you a happy holiday season.
The following is one of my favorite Lifeline articles (originally published in February
2006) from former California ACEP President, Myles Riner. Its message embodies
an “attitude of gratitude” and I find it useful to read annually. Enjoy.
4 | LIFELINE a forum for emergency physicians in california
Ten things I wish I had started doing the day I began
practicing emergency medicine…
by Myles Riner, MD
One diagnosis a shift: Try to pick out
a patient every shift that sticks out, for
whatever reason, and when you have a few
minutes, during or immediately after your
shift, pick up Harrison or Rosen and read a few
paragraphs on the diagnosis and treatment of
this patient’s problem. It doesn’t have to be
an unusual problem: CHF, pancreatitis, retinal
detachment, whatever. We tend to focus on
the latest journal articles and newest drugs in
our reading, and I find it really helps to review
some of the basics, especially in relation to a
particular patient.
➊
One staff member a shift: Try to pick
one of the members of your ED staff and
take a few moments to talk with them about
something other than medicine, something
of personal interest to them. Emergency
medicine is a team sport, and getting to know
your team is part of effective leadership. This is
one I really wish I did better.
➋
Sit for the history AND for the
discharge: You have all heard that sitting
down to take the patient’s history gives the
impression that you are really interested
in the patient and that you are an active
listener. Likewise, you should try to sit when
giving your discharge instructions or talking
about admission to the hospital and further
treatment. This is the opportunity to make a
final impression about your care, and sitting
down to do this once again indicates that you
care, and not just happy to be finished with
your patient. Every treatment space in your ED
needs a gurney and two chairs (one for you,
one for a family member).
➌
Thank the staff at the end of your shift:
This one takes but a couple of minutes
but really leaves good feelings in your wake as
you leave. No one in the ED ever gets enough
appreciation for their efforts, and if you can be
specific around particularly good work, you
will reinforce the best in your staff. Remember,
these folks help you earn your living.
➍
Attend every staff meeting you can: It
may not be obvious, but every ED has a
mission, and in most cases, several missions;
and it is difficult to be in sync with these
missions if you aren’t in the room when your
medical director or hospital administrator
lays them out for your department. Why is it
important to get on the bus with the rest of
the staff in your ED? Because it only takes one
uninformed, disinterested, couldn’t care less
team member to steer the bus off the road
and into the ditch. Staff meetings are your
opportunity to help chart the course for your
practice, learn from your peers, and turn a job
into a profession.
➎
Always read the Discharge summary
of every patient you admit: Emergency
medicine suffers from one particularly vexing
problem that makes it difficult to excel as a
healer – the lack of feedback and follow up
on the care we provide. How do you get really
good at managing septic shock if you rarely
get to see the patient the day after admission?
How many surgeons remember to tell you
the outcome of the surgery for possible
appendicitis? Ideally, your hospital should
arrange to get you access to the discharge
summary of every patient you admit, either
on paper or electronically. If not, find a way to
make this happen; it is well worth the trouble.
➒
Always thank the paramedic: A simple
idea that I need to really try harder to
do. Their jobs are at times very difficult, and
let’s remember that it’s not hard to triage the
paying customers somewhere else. These
folks are part of the team as well, and deserve
to be acknowledged for their contributions.
➓
➏
Don’t bitch about it, fix it: So you have
two options – you can gripe about the
file cabinet that never has the special forms
you need when you look for them, or you can
find a way to get all those forms scanned or
copied electronically so you can print one out
from an indexed computer file whenever you
need one. The most vexing issues in the ED
are usually systems or operational issues that
typically would be easy to fix if someone in
your department took the time to straighten
them out. If you are counting on your medical
director or the nurse manager to take care of
these issues, they may never get around to it
because the list is probably longer than your
arm. Do yourself and everyone else a favor
and grease the wheels of your ED on your own
initiative. Be part of the solution.
➐
Call your patients back: This is the one
that has added the most to my practice.
I try to make a follow-up call to about 10 or
12 patients a shift, usually within two or
three days, sometimes sooner. I use this as
an opportunity for:(1) service recovery if the
patient does not seem happy when they
leave; (2) follow up to enhance my skills and
learn what works best; (3) enhancing patient
satisfaction and the scores that go with this;
and (4) giving my patients an opportunity
to ask the questions they forgot to ask at
discharge or to seek further advice. Mostly I do
these call-backs because I get a lot of positive
reinforcement for the service. I even call on
patients who were admitted, and sometimes
I will make a change in treatment if it seems
prudent (and dictate an addendum to the
medical record if I do). There is an art to doing
these follow-up calls, and in the near future I
might elaborate on the tricks of this trade; but,
for now, let me say that there are few things
in the practice of emergency medicine that
bring me as much personal satisfaction as
making these calls. n
Bring two cookies for every one you
eat: No one likes a mooch, everyone
loves a chocolatier.
➑
Samual Lawrence Fenton
NOVEMBER 2012 | 5
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To care for patients.
A mission perfected
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Here‘s to those dedicated
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to excellence.
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| POLICY UPDATE
Prescription Drug Monitoring Programs
By Bing Pao, MD, FACEP
Pain is a common complaint for patients seeking care in the emergency department.
The management of acute and chronic pain frequently
requires the use of narcotic pain medications. Overall,
the medical use of opioid analgesics and related
emergency department visits continues to grow.1,2,3
Unfortunately, a subset of patients can develop
opioid dependence and is prone to substance abuse.
Prescription drug abuse has been identified as the
country’s fastest drug problem and represents a
significant problem in the management of emergency
department patients.4 According to the Centers for
Disease Control and Prevention (CDC), the number
of emergency department visits for nonmedical
use of opioids increased by 112% from 2004 to
2008.5 The increase represents a total increase from
144,600 to 305,900 emergency department visits.5
The nonmedical use of a prescription was defined
as taking a higher than recommended dose, taking a
drug prescribed for another person, drug facilitated
assault or documented misuse.5 The opioid most
frequently cited for nonmedical use was oxycodone,
hydrocodone and methadone.5 Drug diversion by
“drug seeking” patients has been estimated to cost the
healthcare industry $100 billion dollars a year.6 Illicit
drug abuse has been correlated with increased prehospital encounters and emergency room utilization.7
Patients that are identified as “drug seeking” have high
community-wide emergency department utilization
rates.8 The emergency provider must be able to
distinguish between patients who should legitimately
receive pain medications and patients who seek to
abuse narcotics. Making the distinction between who is
“drug seeking” and patients who should be treated with
opioid analgesics can be difficult.
Screening patients with
prescription monitoring
programs will allow providers
to identify patients at risk for
substance abuse.
NOVEMBER 2012 | 7
POLICY UPDATE |
Prescription drug abuse has been
identified as the country’s fastest drug
problem and represents a significant
problem in the management of
emergency department patients.
Prescription drug monitoring programs are state administered data
collection systems that track prescriptions for opioids. Prescription
drug monitoring programs have been established in several
states to help identify patients that abuse opioids.9 The Controlled
Substance Substances Utilization Review and Evaluation System
(CURES) is the California prescription drug monitoring program that
was permanently established in 2003. Prescription drug monitoring
program can alert prescribers about drug diversion, drug abuse or
illegal attempts to acquire controlled substances. Prescription drug
monitoring programs allow physicians to make more informed
decisions on when to prescribe opioids.
Studies examining data from prescription monitoring programs have
demonstrated that opioid prescriptions from multiple providers
were more frequent than any other controlled substances.10 Previous
studies have also indicated that prescription drug monitoring
programs can decrease the amount of a controlled substance a
physician prescribes. Moreover, prescription monitoring program
have been shown to specifically influence prescribing patterns for
opioid medications by emergency providers.11 In an Ohio survey,
most providers are aware of the state-wide prescription monitoring
program.12 Despite the availability of drug monitoring programs,
providers often do not routinely access the programs. Less than
59% of the survey participants who were aware of the prescription
monitoring program actually accessed the program.12 Emergency
providers were the most likely specialty to be aware of and use
prescription monitoring programs.12 The most common reason
cited for accessing prescription drug monitoring programs was
because of concerns about prescription drug abuse.12
Screening patients with prescription monitoring programs will
allow providers to identify patients at risk for substance abuse.
Prescription information allows providers to make a more informed
decision about whether or not to prescribe opioids. Identifying a
patient at risk for substance abuse could to lead to more appropriate
referral of patients to chronic pain management therapy or drug
addiction treatment programs. However, funding to maintain
the CURES database is a struggle. California ACEP continues to
advocate for adequate funding for the CURES database to preserve
our mission of providing quality emergency care. n
8 | LIFELINE a forum for emergency physicians in california
LITERATURE CITED
1. Wisniewski AM, Purdy CH, Blondell RD. The epidemiological
association between opioid prescribing, non-medical use and
emergency department visits. J Addict Dis. 2008; 27 (1): 1-11.
2. Braden JB, Russo J, Fan MY, Edlund MJ, Martin BC, DeVries A, Sullivan
MD. Emergency department visits among recipients of chronic opioid
therapy. Arch Intern Med. 2010 Sept 13; 170(16): 1425-32.
3. Joranson DE, Ryan KM, Gilson AM, Dahl JL. Trends in medical use and
abuse of opioid analgesics. Jama. 2000 Apr 5; 283(13): 1710-4.
4. United States Office of National Drug Control Policy. Epidemic:
Responding to America’s prescription drug abuse crisis. Executive
office of the President of the United States. Retrieved January 22,
2012, from http://www.whitehouse.gov/sites/default/files/ondcp/
policy-and-research/rx_abuse_plan.pdf.
5. Center for Disease Control and Prevention. Emergency department
visits involving nonmedical use of selected prescription drugs –
United States, 2004-2008. MMWR. 2010 Jun 18; 59(23): 705-9.
6. Clark S. Formulating an effective response to emergency room drug
diversion by drug seeking patients. J Healthc Prot Manage. 2009;
25(1): 1-8.
7. Alexander JL, Burton JH, Bradshaw JR, Colin F. Suspected opioidrelated emergency medical services encounters in a rural state, 19972002. Preshosp Emerg Care. 2004 Oct-Dec; 8(4): 427-30.
8. Aechnich AD, Hedges JR. Community –wide emergency department
visits by patients suspected of drug-seeking behavior. Acad Emerg
Med. 1996 Apr; 3(4): 312-7.
9. Katz N, Houle B, Fernandez KC, Kreiner P, Thomas CP, Kim M, Carrow
GM, Audet A, Brushwood D. Update of prescription monitoring in
clinical practice: a survey study of prescription monitoring program
administrators. Pain Med. 2008 Jul-Aug; 9(5): 587-94.
10. Wilsey BL, Fishman SM, Gilson AM, Casamalhuapa C, Baxi H,
Zhang H, Li CS. Profiling multiple provider prescribing of opioids,
benzodiazepines, stimulants, and anorectics. Drug Alcohol Depend.
2010 Nov 1; 112(1-2): 99-106.
11. Baehren DF, Marco CA, Droz DE, Sinha S, Callan EM, Akpunonu P.
A statewide prescription monitoring program affects emergency
department prescribing behaviors. Ann Emerg Med. 2010 Jul; 56(1):
19-23.
12. Feldman L, Williams KS, Coates J, Knox M. Awareness and utilization
of prescription monitoring program among physicians. J Pain Palliat
Care Pharmacother. 2011; 25(4): 313-7.
| ADVOCACY UPDATE
Governor Brown Signs
California ACEP’s Key Patient
Safety Legislation, Vetoes
Crowding Bill
By Elena Lopez-Gusman & Callie Hanft
I
n a major victory for California ACEP and emergency care
patients, Governor Jerry Brown signed California ACEP’s
sponsored legislation AB 1803 (Mitchell) on September 22,
2012. Unfortunately, less than a week later he also vetoed
the Chapter’s other sponsored bill, SB 336 (Lieu).
SB 336
Despite the calls and letters of support sent to the Governor from
our members, and an aggressive advocacy strategy from California
ACEP, Governor Brown vetoed SB 336 on September 28, 2012. In his
veto message, Governor Brown stated that he “appreciate(ed) the
author’s and the proponents’ desires to alleviate emergency room
overcrowding and the harms that come with it. This bill, however, is
AB 1803
Through AB 1803, California ACEP was successful in extending the
too prescriptive in its approach”, and that solving the overcrowding
crisis was “…best left to the hospital governing boards”.
prudent layperson protection to our state’s Medicaid (Medi-Cal)
Needless to say, California ACEP strongly disagrees with the
fee-for-service program. While the federal Balanced Budget Act of
Governor’s assessment that this crisis is best solved by the same
1997 would seem to require that all Medicaid managed care plans
means that have allowed this threat to patient health to grow so
abide by the prudent layperson standard, there is no similar federal
precipitously. The Chapter Board will be discussing options for
language requiring Medicaid fee-for-service programs to follow
addressing crowding in the coming weeks.
prudent layperson. The Chapter sponsored legislation (AB 1803) to
address that gap at the state level and prevent state officials from
For questions or comments on the Governor’s recent
pursuing a program similar to what was proposed in Washington
action on sponsored legislation, please contact us at
State, in which Medicaid would not pay for an ED visit that was
advocacy@californiaacep.org. n
determined to be a “non-emergency” based on final diagnosis. The
Chapter is thrilled for what this means for California and we also
expect other states to use it as a model for pro-active advocacy.
NOVEMBER 2012 | 9
36th
ANNUAL
EMERGENCY
MEDICINEIN
YOSEMouITnEd
& Ultras
Workshop
JAN 16-19
2013
PROGRAM FOUNDER & CHAIR:
RONALD CROWELL, MD, FACEP
PRESENTED BY:
HOTEL INFORMATION
e 1395NE)
rniaacep.org (Room block cod
Reserve online at www.califo
ekend Rate: $459.00
ekday Rate: $349.00 \ We
AHWAHNEE HOTEL \ We
nd Rate: $161.00
eke
We
\
ay Rate: $104.00
YOSEMITE LODGE \ Weekd
room block rate.
ask for the California ACEP
Or call 1-801-559-4884 and
REGISTER ONLINE AT
WWW.CALIFORNIAACEP.ORG
THIS ACTIVITY HAS BEEN
APPROVED FOR AMA PRA
TM
CATEGORY 1 CREDIT(S)
WEDNESDAY |\ JANUARY 16TH
SATURDAY \\ JAN 19TH
9:30am \ BRUNCH: “My Personal Journey Through Emergency Medicine Into
Health Policy Analysis and Formulation.” \ Arthur L. Kellermann, MD, MPH, FACEP
7:00 - 7:45am \ BREAKFAST AND COFFEE
1:00pm \ GROUP HIKE: Mirror Lake
7:45 - 8:45am \ A PRACTICAL REVIEW OF OPHTHALMOLOGIC
EMERGENCIES \ Wirachin Ying Hoonpongsimanont, MD*
1:00 - 5:00pm \ ULTRASOUND WORKSHOP*
J. Christian Fox, MD, FACEP \ M. Rusty Oshita, MD
8:45 - 9:45am \ DEBATE: EMR in the Emergency Department: Pro and Con
David Schriger, MD, FACEP \ Frank Day, MD*
5:30 - 9:00pm \ OPENING RECEPTION:
Dinner with Art and Musical Performances
9:45 - 10:15am COFFEE BREAK
6:30 - 6:45pm \ WELCOME AND OPENING REMARKS \ Dr. Ronald Crowell
6:45 - 7:00pm \ KAREN BIEBER, ARTIST
7:00pm \ DINNER AND MUSICAL ENTERTAINMENT
10:15 - 11:15am \ EMR AND MALPRACTICE:
The Risk of Electronic Health Record \ Graham Billingham, MD, FACEP*
11:15am - 12:15pm \\ JOURNAL CLUB: The Important Studies of the Past Year
David Schriger, MD, FACEP*
* = Approved for AMA PRA Category 1 Credit(s)TM
THURSDAY |\ JANUARY 17TH
7:00 - 7:45am \ REGISTRATION: Breakfast, Coffee and Visiting Exhibitors
7:45 - 8:45am \ RAPID RULE OUTS AND OBSERVATION UNITS*
Matthew Strehlow, MD, FACEP
8:45 - 9:15am \ WHEN BNP RESULTS ACTUALLY CHANGE CARE*
William Mallon, MD, FACEP
9:15 - 9:45am \ POSITIVE ULTRA-SENSITIVE TROPONINS*
IN NON-ACS CONDITIONS \ William Mallon, MD, FACEP
9:45 - 10:45am \ FEVER IN THE RETURNING TRAVELER*
S.V. Mahadevan, MD, FACEP
10:00am \ SPOUSAL PROGRAM: Water Color Demonstration \ Karen Bieber
10:45 - 11:15am COFFEE BREAK & VISITING EXHIBITORS
11:15 - 11:45am \ NEONATAL FEVER WORKUP \ Christopher Doty, MD*
11:45 - 12:15pm \ MAMMALIAN BITES: What’s New? \ Christopher Doty, MD*
FINANCIAL
In accordance with the ACCME Standards for Commercial Support and policy of
the American College of Emergency Physicians, all individuals with control over
CME content (including but not limited to staff, planners, reviewers, and faculty)
must disclose whether or not they have any relevant financial relationship(s) to
learners prior to the start of the activity. All individuals with control over CME
content have no significant financial interests or relationships to disclose.
ACCREDITATION
This activity has been planned and implemented in accordance with the
Essential Areas and Policies of the Accreditation Council for Continuing Medical
Education through the joint sponsorship of the American College of Emergency
Physicians and California ACEP. The American College of Emergency Physicians
is accredited by the Accreditation Council for Continuing Medical Education to
provide continuing medical education for physicians.
5:00pm \ WINE AND CHEESE RECEPTION
The American College of Emergency Physicians designates this live activity for
a maximum of 17.25 AMA PRA Category 1 Credit(s)TM. Physicians should claim
only the credit commensurate with the extent of their participation in the activity.
5:00pm \ EMERGENCY PHYSICIAN UP CLOSE AND PERSONAL:
Photographs by Gary Sindell, MD
Approved by the American College of Emergency Physicians for a maximum
of 17.25 hour(s) of ACEP Category I credit.
5:30 - 6:15pm \ MEDICINE ON THE VOLCANO:
Setting up Clinics in Ecuador \ Graham Billingham, MD, FACEP
NURSES
1:00pm \ GROUP HIKE: Vernal Falls
FRIDAY |\ JANUARY 18TH
7:00 - 7:45am \ REGISTRATION: Breakfast, Coffee and Visiting Exhibitors
7:45 - 8:45am \ DIAGNOSTIC ERRORS IN MEDICINE: Predictable Errors
in EM and How We Avoid Making Them \ Christopher Doty, MD*
8:45 - 11:15am \ CPR SYMPOSIUM: What Have We Learned in the
Past 50 Years? What is Current State of the Art? What is the Future?
Joseph Bellezzo, MD \ Zach Shinar, MD, FACEP \ James Manning, MD*
10:00 - 10:15am COFFEE BREAK & VISITING EXHIBITORS
11:15 - 11:45am \ COMPLICATIONS IN THE BARIATRIC SURGERY PATIENT
Brian Lin, MD*
11:45 - 12:15pm \ BURN MANAGEMENT: What’s New? \ Brian Lin, MD*
1:00pm \ GROUP HIKE: Yosemite Falls
5:00 - 9:00pm \ WINE AND CHEESE RECEPTION AND EVENING PROGRAM
5:00pm \ KAREN BIEBER: Watercolors
6:00 - 7:00pm \ KEYNOTE ADDRESS: The Explosive Growth of Healthcare
Costs: What Can We Do? \ Arthur L. Kellermann, MD, MPH, FACEP*
California ACEP is approved by the California Board of Registered
Nursing for 17.25 contact hours, Provider Number 15059.
EMTS/PARAMEDICS
EMREF is approved by the Sacramento County EMS Agency for
17.25 Continuing Education Units, Provider Number 34-4600.
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.
DOS
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 2013-15 CME Cycle of 10 Credits ACCME
Category 1 Credits and 20 AOA Category 1-A Credits.
ACEP COUNCIL RECAP |
2012 ACEP Council in Review
ACEP’s annual Council meeting brings together representatives from all of ACEP’s sections, 53 chapters, as well as other
interested groups who have been granted Council seats by the College. The Council serves the College as the legislative
body, which sets policy and priorities for ACEP as well as electing the Board of Directors, Council officers and President-elect.
Chapters and sections are allocated 1 Councillor per 100 members based upon the membership as of December 31st of the
previous year.
This year California ACEP sent 27 Councillors plus a number of Alternate Councillors to Denver, Colorado for the meeting –
representing nearly 10% of the total Council – which was held immediately prior to the Scientific Assembly. With the College
having just surpassed 30,000 members nationwide this year, both the Chapter delegation and the Council meeting itself were
the biggest they’ve ever been.
RESOLUTIONS
The Chapter sponsored or co-sponsored
five resolutions in total, on a variety of
issues:
Resolution: 12
Subject: Criteria for Inclusion of
Organizations in the ACEP Council
Chapter: Co-Sponsor
Action: Adopted, as amended
RESOLVED, That the ACEP Council,
through the Council Steering Committee,
develop explicit criteria for the
inclusion of additional organizations as
component bodies of the ACEP Council;
and be it further
RESOLVED, That the Council Steering
Committee report these criteria for
review and discussion to the 2013 ACEP
Council no later than six weeks prior to
the deadline for submission of regular
resolutions.
Resolution: 17
Subject: Ensuring ED Patient Access
to Adequate and Appropriate Pain
Treatment
Chapter: Original Author & Co-Sponsor
Action: Adopted, as amended
RESOLVED, That ACEP support each
state chapter having the autonomy to
establish guidelines or protocols for pain
management of emergency department
patients; and be it further
RESOLVED, That ACEP support the
development of evidence-based,
coordinated pain treatment guidelines,
promoting adequate pain control, health
care access, and flexibility for physician
clinical judgment; and be it further
RESOLVED, That ACEP oppose nonevidence based public or private limits
on prescribing opiates, mandatory opioid
related documentation, and mandatory
opioid related CME; and be it further
RESOLVED, That ACEP work with
government and regulatory bodies on
the creation of evidence-supported
guidelines for responsible emergency
physician prescribing that takes into
consideration lack of access while
respecting the uniqueness of every
individual doctor-patient encounter.
Resolution: 18
Subject: Opposition to Routine Abscess
Culturing
Chapter: Original Author & Co-Sponsor
Action: Adopted, as amended
12 | LIFELINE a forum for emergency physicians in california
RESOLVED, That ACEP recognizes the
treating emergency physician as the
clinician most appropriate to determine
the necessity of antibiotic therapy and/or
cultures in the management of abscesses
in emergency department patients; and
be it further
RESOLVED, That ACEP oppose the
recommendation and/or requirement
that all abscesses with cellulitis treated
with antibiotics be cultured; and be it
further
RESOLVED, That ACEP oppose federal or
state legislation and/or regulation that
require an attending physician to be
the person who contacts and notifies
patients of positive cultures.
Resolution: 26
Subject: Patient Satisfaction Scores and
Pain Management
Chapter: Original Author & Co-Sponsor
Action: Not Adopted
RESOLVED, That ACEP work with
appropriate agencies and organizations,
including hospitals, to exclude
emergency department patients with
chronic non-cancerous pain complaints
from patient satisfaction surveys; and be
it further
ELECTIONS
RESOLVED, That ACEP oppose any new
Core Measure that relates to chronic
pain management in the emergency
department; and be it further
The Chapter also sponsored a memorial resolution for Dr. Richard A. Midthun. As
with any legislative process, very little policy is adopted without much deliberation
and amendment. The resolutions as amended do not necessarily represent their
intent, rather, the compromise required to pass through the Council.
RESOLVED, That ACEP continue to
promote timely, effective treatment of
acute pain while supporting the rights of
treating physicians to determine the best
individualized care plan for patients who
report pain; and be it further
In addition, the Chapter’s endorsed candidates for Board of Directors, Drs. Jay Kaplan
of California (Incumbent), William Jaquis of Maryland, and Vidor Friedman of Florida
were all elected to the Board along with Dr. Rebecca Parker of Illinois (Incumbent).
The Council elected Dr. Alexander Rosenau of Pennsylvania as the President-elect;
Dr. Rosenau will assume the Presidency at the Scientific Assembly in Seattle in 2013
upon the conclusion of Dr. Andrew Sama’s term, which began in Denver. Chapter
members who attended the Chapter Scientific Assembly in Monterey in June will
remember Drs. Friedman, Kaplan, and Rosenau who attended the conference.
RESOLVED, That ACEP bring the subject
of patient satisfaction scores and pain
management to the American Medical
Association for national action.
Serving as a Councillor and/or Alternate Councillor is a great way to help shape policy
at the Chapter and College level. The Chapter’s delegation is typically comprised of
members of the Board of Directors, past Councillors and leaders, but is also open to
Chapter members for appointment by the Board.
Below are the dates of future ACEP Councils and Scientific Assemblies:
Resolution: 31
Subject: Firearm Injury Prevention
Chapter: Original Author & Co-Sponsor
Action: Adopted, as amended
RESOLVED, That ACEP condemn the
recent massacre in Aurora, CO, and
Wisconsin, and daily firearm violence
throughout our nation; and be it further
RESOLVED, That ACEP state its
commitment against gun violence
including advocating for public and
private funding to study firearm violence
prevention.
Year
Council Meeting
Scientific
Assembly
Location
2013
October 12-13
October 14-17
Seattle, WA
2014
October 25-26
October 27-30
Chicago, IL
2015
October 24-25
October 26-29
Boston, MA
2016
October 13-14
October 15-18
Las Vegas, NV
October 28-29
Oct. 30-Nov. 2
Washington, D.C.
2017
2018
You can help select the 2018 site by voting at: www.acepnews.com/
The Chapter begins the Councillor selection process in the Spring, typically in early
May. If you would like to be considered to serve as a Councillor, or to submit ideas
for Chapter-sponsored resolutions – which must be submitted by approximately the
end of June preceding the Council meeting – or to be appointed an ACEP or Chapter
committee, please contact the Chapter at info@californiaacep.org. n
NOVEMBER 2012 | 13
VOLUNTEER OPPORTUNITIES
Help shape Chapter policy and priorities in your
area of expertise. Consider volunteering for a
committee, task force, the Council or run for the
Board – it’s a great way to network with EM leaders
in California, and build your CV. For resident
members, the Chapter provides reimbursement to
attend all Chapter Board meetings so that residents
can help shape the future of EM in our state.
Contact the Chapter at info@californiaacep.org for
information on:
☛☛Committees Appointments – Open Year-Round
•
•
•
•
Education
Emergency Medical Services
Finance
Government Affairs
•
•
•
•
Membership
Practice Management
Public Relations
Reimbursement
☛☛Board of Directors – Nominations Due March 1, 2013
☛☛Chapter Awards Nominations – Due Spring 2013
☛☛Councillor & Alternate Councillor Appointments – Spring 2013
14 | LIFELINE a forum for emergency physicians in california
☛☛ACEP Recommendations – Year-Round
•
•
•
•
Member recommendations/attestations for FACEP recognition
Member recommendations for committee appointments
Member recommendations for awards
Member recommendations/endorsements for Board of Directors
☛☛Residents – Year-Round
• Reimbursement to attend Chapter Board meetings
• Discounted resident activities at Chapter conferences
☛☛Advocacy Fellowship – Year-Round
Romney’s Comments Reveal Widely Held
Misperceptions About ER Care
W
hen candidate for President Mitt Romney, channeling
George W. Bush, implied that access to ER care under
EMTALA mandates was equivalent to having ‘health
insurance’ for those who could not afford or purchase it; he was
roundly criticized by the media and even members of his own
party’s leadership. This is but one of many misperceptions about
ER care that are commonly held, but it was odd to see this one
politically naive blunder from a presidential candidate stimulate
so many comments from so many others who likewise seem to
have very little clue what emergency department services, and
the EMTALA obligation to provide emergency care to everyone,
regardless of insurance status or ability to pay, are all about.
Many commentators chose to take Mr. Romney’s comments out
of context, and ignore the fact that he followed the now infamous
blooper with some references to state-supported charity care
clinics that may or may not be available to the poor and uninsured
to provide the care that ERs are not designed to provide. However,
even if you acknowledge these references, it does not mitigate Mitt’s
presumption that ER care is ‘free’ to the uninsured, or that hospitals
and physicians who provide this care will not at least attempt to
pursue payment, some even all the way through bankruptcy court.
The fact that emergency physicians provide an average of $145,000
dollars worth of charity care every year does not mean that every
uninsured ER patient gets a pass, or irresponsibly ignores the
bills they receive for this care. Clearly, Mr. Romney has never had
to personally deal with such mundane issues. ER care is neither a
substitute for health insurance nor an open-ended guarantee of
free care for the uninsured.
Furthermore, as many emergency physicians have already said in
response, ERs can only do so much: they don’t provide screening
colonoscopies, or prenatal care, or cancer chemotherapy, or genetic
screening, or rehab therapy after the heart attack or the car accident.
For that matter, the state-run charity care clinics Romney alluded
to often are unable to provide this kind of care either. Mr. Romney
could have pointed to the health reform program he instituted in
Massachusetts in response to the question about providing health
insurance to the 50 million uninsured in the US, but predictably
he chose to stumble over his party’s newly minted not so
compassionate conservatism and try to break his fall by
leaning on the open door of the ER.
What happened next is what really got my
attention. All sorts of talking heads in the
media immediately pointed to Romney’s
comments from two years ago citing
his criticism of ‘ER socialism’: “”It
doesn’t make a lot of sense for us
to have millions and millions of
people who have no health
insurance and yet who
can go to the emergency
room and get entirely
free care for which they
have no responsibility”.
Curiously, this concept
was accepted as a truism
| The Fickle Finger
By R. Myles Riner, MD, FACEP
by nearly everyone who used it to suggest that the candidate had
flip-flopped on the issue. Believe me when I say that you can’t get
entirely free care in an ER for which you have no responsibility. In
some cases, you can duck this responsibility, in other cases you will
absolutely be held responsible, and it may have nothing to do with
whether or not you can afford to pay.
Then came all the allusions to the ‘inefficiency’ of the ER. I even saw
one comment to the effect that ERs are ‘the worst possible place to
get health care’! If ERs are so ineffective and inefficient, why do so
many ER patients come to the ER at the recommendation of their
primary care physicians when the patients need urgent diagnostic
evaluation and timely management? And how about this one from
Bob Confer of the Tonawanda News (and about a dozen other
bloggers and commentators): “Never mind the fact that ER care is
the most expensive form of medical treatment there is.” Really? I
guess they never spent any time in an operating room, or an ICU,
or a cardiac cath lab. He (and they) also had comments like: “ER
treatment is not health care. It’s death prevention.” Reducing even
the most painful shoulder dislocation really can’t be considered a
life-saving procedure, can it?
Then we got the economic arguments deriding ER care, like the
following from Robert Bowen in Examiner.com: “Government data
shows that the average emergency department visit cost $922 in
2008. The average office visit, meanwhile, came in at $199. Here’s
another way to put it: Emergency room visits accounted for 4.4
percent of doctor visits but 14.4 percent of doctor visit costs.” Yes,
when you are talking about comparing treatment for a simple urinary
tract infection, care in the ER is much more expensive than care in
the doctor’s office; but when we are making comparisons like this,
can we at least agree to compare apples with apples, and do some
acuity adjusting while we are at it? How many UTIs in the doctor’s
office are bordering on sepsis? How many visits to the doctors’ office
include the cost of the x-ray done in the radiology suite, or the blood
tests done at the lab? How many such comparisons consider that
it sometimes takes three visits over five days to arrive at the same
result that one visit to the ER accomplishes? Some would call that
‘efficiency’, but I guess one’s perspective depends on who is paying
the bill, and who is receiving the care.
The list of inane comments about the ER in response to Romney’s
gaff go on and on, and it makes me think that emergency physicians
have not been as effective in getting the real story about ER care
out as we hoped, though not for lack of trying. These blogs are my
contribution to the effort, and there are lots of other EM bloggers
out there who do a much better job of conveying the truth about
emergency medicine. And of course, ACEP’s leadership puts many
thousands of hours in to try to get the message out. You would
think 130 million visits a year and one of the best rated shows ever
on television would give us plenty of opportunity to demonstrate
the value proposition for ER care. Perhaps being the poster child for
what is most right and what is most wrong with health care in this
country portrays such a mixed message that conveying an accurate
picture of the role of the ER and emergency physicians is nearly
impossible, especially in an election year. n
This article is a selection from "The Fickle Finger," a blog written
by Chapter Past President R. Myles Riner, MD, FACEP. It has been
reproduced with his permission but does not necessarily reflect the
views or positions of California ACEP.
NOVEMBER 2012 | 15
CEMAF
Donors
The California Emergency Medicine Advocacy Fund
(CEMAF) has transformed California ACEP’s advocacy efforts from primarily legislative to robust efforts
in the legislative, regulatory, legal, and through the
Emergency Medical Political Action Committee, political arenas. Few, if any, organization of our size can boast of
an advocacy program like California ACEP’s; a program that
has helped block Medi-Cal provider rate cuts, stop the $100
million raid on the Maddy EMS Fund, and fight for ED overcrowding solutions – and that’s just the last year! The efforts
could not be sustained without the generous support from
the groups listed below, some of whom have donated as much
as $0.25 per patient visit to ensure that California ACEP can
fight for emergency medicine. Thank you to our 2011-12
contributors (in alphabetical order):
• Acute Care Medical Group of Orange County
• Alvarado Emergency Medical Associates
ANNOUNCEMENTS |
California ACEP Sponsored Courses
LIVE CONFERENCES
California ACEP’s 36th Annual Emergency Medicine in
Yosemite Conference
• Antelope Valley Emergency Medical Associates
January 16-19, 2013
Yosemite Lodge
Yosemite, California
• Beach Emergency Medical Associates
Info: (916) 325-5455
www.californiaacep.org
• CEP America
California ACEP Sponsored Courses
• Centinela Freeman Emergency Medical Associates
• Central Coast Emergency Physicians
Jointly sponsored by California ACEP and the American College of
Emergency Physicians
• Chino Emergency Medical Associates
ENDURING MATERIALS - ONLINE CME
• Culver City Emergency Medical Group
• Downey Acute Care Medical Group
• EMP
• EMS Management
• Front Line Emergency Care Specialists
• Mills Peninsula Emergency Medical Group
• Montclair Emergency Medical Associates
• Napa Valley Emergency Medical Group
• Orange County Medical Associates
• Pacifica Emergency Medical Associates
• Riverside Emergency Physicians
• San Dimas Emergency Medical Associates
• San Francisco Emergency Medical Associates, Inc.
• Santa Cruz Emergency Physicians
Patient Safety Risk Solutions* Enduring Materials - Webinar
Info: www.psrisk.com
• Teamwork and Communications in Emergency Medicine
• The Dilemma of the Psychiatric Patient in the Emergency
Department
• Treating Stroke in the ED; and the Standard of Care Is…
The Center for Medical Education, Inc.* Enduring Materials Internet Subscriptions
Info: www.ccme.org
• August 2012, Risk Management Monthly/Emergency
Medicine
SonoSim* Enduring Materials - Computer Software (Modules)
Info: (310) 315-2828
www.sonosim.com
• SonoSim Ultrasound Training Solution
• Sherman Oaks Emergency Medical Associates
• South Coast Emergency Medical Group, Inc.
• Tarzana Emergency Medical Associates
• Team Health
• Tri-City Emergency Medical Group
• Valley Emergency Medical Associates
• Valley Presbyterian Medical Associates
• West Hills Emergency Medical Associates
16 | LIFELINE a forum for emergency physicians in california
*Approved for AMA PRA Category I CreditsTM
| CALIFORNIA ACEP UPCOMING MEETINGS & DEADLINES
For more information on upcoming meetings, please e-mail us at
info@californiaacep.org; unless otherwise noted, all meetings are held
via conference call.
November 2012
NOVEMBER 2012
sun
mon
tues
Wed
thurs
fri
sat
1
2
3
6th at 9:00 am
Reimbursement Committee
Conference Call
12th
Veterans' Day
4
5
6
7
8
9
10
15th at 10:00 am
Board of Directors Meeting
The California Endowment, Sacramento, CA
11
12
13
14
15
16
17
15th
Last Day for Early Bird Registration for the 36th Annual
Emergency Medicine in Yosemite and Ultrasound Course
18
19
20
21
22
23
24
25
26
27
28
29
30
DECEMBER 2012
December 2012
11th at 1:30 am
EMREF Meeting
Conference Call
13th at 10:00 am
Government Affairs Committee
Conference Call
12th
Last Day to Reserve a Room under the Room Block for the 36th
Annual Emergency Medicine in Yosemite and Ultrasound Course
2
3
4
5
6
7
8
9
10
11
12
13
14
15
14th at 10:00 am
Practice Management Committee
Conference Call
16
17
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19
20
21
22
24th
Christmas Eve
23
24
25
26
27
28
29
25th
Christmas Day
30
31
31st
New Year's Eve
sun
mon
tues
Wed
thurs
fri
sat
1
JANUARY 2013
January 2013
sun
1st
New Year's Day
2nd at 9:00 am
Executive Committee
Conference Call
8th at 9:00 am
Reimbursement Committee
Conference Call
10th at 9:00 am
EMREF Meeting
Conference Call
14th at 10:00 am
Practice Management Committee
Conference Call
16th at 11:00 am
Board of Directors Meeting
Yosemite Lodge at the Falls, Yosemite National Park
16th - 19th
36th Annual Emergency Medicine in Yosemite and
Ultra Sound Course
Yosemite National Park
mon
tues
Wed
thurs
fri
sat
1
2
3
4
5
6
7
8
9
10
11
12
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NOVEMBER 2012 | 17
CAREER OPPORTUNITIES |
RESEARCH DIRECTOR
Department of
Emergency Medicine
University of California, Irvine
School of Medicine
The Division of Emergency
Medicine in the Department of
Surgery at Stanford University
School of Medicine
Is conducting a search for a Clinical
Assistant Professor or a Clinical
Associate Professor in the Clinician/
Educator Line in the Division of
Emergency Medicine, Department of
Surgery, to serve as Clinical Medical
Director of the Marc and Laura
Andreessen Emergency Department
at Stanford Hospital. Candidates
must be board certified in Emergency
Medicine, and have at least five years of
clinical experience, including trauma
center experience. Applicants must
be competent in the management
of pediatric and adult patients.
Candidates must have demonstrated
a high level of experience in
operational leadership of clinical
programs. In addition, candidates
must have demonstrated excellence
in clinical care and teaching. The
Stanford ED is a level 1 trauma
center with an accredited residency
program, a 23-hour observation unit,
and a fast track program. Attending
physician responsibilities include
direct patient care, supervision of
residents and medical students, and
teaching. Stanford University is an
equal opportunity, affirmative action
employer.
For consideration, a letter outlining
your interest and experience, with a
Curriculum Vitae and the names and
addresses of three references should be
sent to: Robert L. Norris, M.D., FACEP,
Chief, Emergency Medicine, Stanford
University School of Medicine, 300
Pasteur Drive, Alway Building, M121,
Stanford, CA 94305-2200.
SOUTHERN CALIFORNIA
Regional Medical Director (RMD)
Your Neighborhood Urgent Care
(YNUC) is recruiting two RMD’s for
it’s 10 urgent care clinic network
in Orange County and San Diego
County. BC in Emergency Medicine or
in Family Practice, Internal Medicine
with Urgent Care experience required.
Management/Administrative
experience in previous health care
positions very desirable. Independent
Contractor for 2 years, then equity
available. Position is based at the
MSO and is 20 hours per week clinical
and 20 hours per week Quality
Improvement. Very attractive hourly.
Contact ramster@ynuc.us now!
Make a Difference in Your Life
and in the Lives of Our Troops!
Humana Military Healthcare Services
is seeking Full Time or Part Time
Board Certified/Board Eligible EM,
IM, FP, or PD emergency medicine
trained physicians to provide services
at Weed Army Community Hospital;
Fort Irwin (outside of Barstow, CA)
Attractive remuneration & malpractice
insurance provided. The service hours
of these excellent positions are 12
hour shifts between the hours of 8:00
a.m. and 8:00 p.m., rotating days/
nights, holidays, weekends. Qualified
candidates shall have completed any
primary care residency and possess a
minimum of 1 year part time recent ED
experience within a similar or higher
lever ED (level 3, low acuity). Current
licensure in any one of the U.S. States
and possession of BLS, ACLS, ATLS,
and PALS certifications is required.
Candidates must be U.S. citizens.
Contact Michelle Sechen at
1-877-202-9069, forward CV via
email to msechen@humana.com, or
by fax at 502-322-8759.
18 | LIFELINE a forum for emergency physicians in california
The University of California, Irvine
is recruiting for a full-time faculty
member with MD or PhD to serve
as Research Director, in the Clinical
Scholar (Clinical X) Series at the
Associate or full Professor level.
Candidates for the Clinical Scholar
Series will have demonstrated an
independent research program
and a nationally recognized track
record in scholarly activity including
extramural funding. Successful
candidate will be tasked with faculty
development to foster grant pursuit
and funding, and mentorship of
junior faculty and residents. PhD
methodologist/statistician already
on department faculty. With MD
degree, board certification in EM is
required. A subspecialty fellowship
or Masters degree, or both is strongly
desired. Appropriate rank and series
commensurate with qualifications.
UC Irvine Medical Center is a 472-bed
tertiary care hospital with all residencies.
The ED is a progressive 37-bed
Level I Trauma Center with 42,000
patients, in urban Orange County.
Collegial relationships with all services.
Excellent salary and benefits with
incentive plan. To apply please log onto
UC Irvine’s RECRUIT located at
https://recruit.ap.uci.edu. Applicants
should complete an on-line application
profile and upload the following
application material electronically to be
considered for the position.
1. Cover Letter
2. Curriculum Vitae
3. Names of five referees
UCI is an equal opportunity employer
committed to excellence through diversity.
Looking for an ITLS course?
EMREF offers the following California providers list:
Allan Hancock College
Mike DeLeo, EMT – Course Coordinator
800 S. College
Santa Maria, CA 93454
Phone: (805) 878-6259
REF offers
Fax: (805) 922-5446 EM
Email: Mikedeleo52@msn.com
Allan Hancock
College
Web: www.hancock.cc.ca.us
Lookinthe
Mike DeLeo, EMT – Course Coordinator
American Medical Response (AMR)
800 S. College,
Santa Maria, CA 93454
Ken Bradford, Operations
Phone: (805)
841878-6259
Latour Court, Ste D
Napa, CA 94558-6259
Fax: (805) 922-5446
Phone: (707) 953-5795
Email: Mikedeleo52@msn.com
Email: ken.bradford2@gmail.com
Web: www.hancock.cc.ca.us
e?
ours
c
S
L
T
I
n
g for a
ETS – Emergency Training Services
Mike Thomas, Course Coordinator
3050 Paul Sweet
iders list:
rovRoad
ia pCA
lifornCruz,
aSanta
C
95065
g
in
w
o
ll
fo
Phone: (831) 476-8813
Toll-Free: (800) 700-8444
Fax: (831) 477-4914
ETS –Email:
Emergency
Training Services
mthomas@emergencytraining.com
Web: www.emergencytraining.com
Mike Thomas,
Course Coordinator
A Work Safe Environment
American Steve
Medical
Response
Bristow,
EMTP (AMR)
Ken Bradford,
Operations
3140
Aldridge Way
Dorado
CA 95762
841 Latour El
Court,
SteHills,
D, Napa,
CA 94558-6259
Phone: (925) 708-5377
Phone: (707)
953-5795
Email: worksafeenvironment@yahoo.com
Email: ken.bradford2@gmail.com
Web: www.worksafeenvironment.com
California
EMS Academy
A Work Safe
Environment
Nancy Black, RN, Course Coordinator
Steve Bristow,
EMTP
1098 Foster City Blvd., Suite 106 PMB 608
3140 Aldridge
Way,
El CA
Dorado
Foster
City,
94404Hills, CA 95762
Phone: (925)
708-5377
Phone:
(866) 577-9197
Fax: (650) 701-1968
Email: worksafeenvironment@yahoo.com
Email: nancy@caems-academy.com
Web: www.worksafeenvironment.com
Web: www.caems-academy.com
California California
EMS Academy
EMS Education and Training
EMTP, Program Director
Nancy Black,Eric
RN,Spoonhunter,
Course Coordinator
Box 1146
1098 FosterPOCity
Blvd, Suite 106 PMB 608, Foster City, CA
Bishop, CA 93515-1146
94404
Phone: (888) 519-8890
Phone: (866)
577-9197
Fax:
(888) 519-8479
Email: espoonhunter@mac.com
Fax: (650) 701-1968
Web: www.cemset.org
Email: nancy@caems-academy.com
Web: www.caems-academy.com
Compliance Training
Jason Manning, EMS Course Coordinator
Robles Drive
California 3188
EMSVerde
Education
and Training
Camino, CA 95709
Eric Spoonhunter,
EMTP, Program Director
Phone: (916) 429-5895
PO Box 1146,
CA 93515-1146
Fax:Bishop,
(916) 256-4301
Phone: (888)
519-8890
Email:
Kurgan911@comcast.net
3050 Paul
Sweet Road, Santa Cruz, CA 95065
Fast Response School of Health Care Education
Phone:Erick
(831)
476-8813
Weldon,
Director of Academics
2075(800)
Allston
Way
Toll-Free:
700-8444
Berkeley,
CA 94704
Fax: (831)
477-4914
Phone: (510) 809-3648
Email: Fax;
mthomas@emergencytraining.com
(866) 628-5876
Web: www.emergencytraining.com
Email: eweldon@fastresponse.org
Web: www.fastresponse.org
Fast Response School of Health Care Education
Loma Linda University
Erick Weldon,
Director of Academics
Medical Center
2075 Allston
Way,Administrative
Berkeley, CAAssistant
94704
Lyne Jones,
of Emergency Medicine
Phone:department
(510) 809-3648
11234628-5876
Anderson St., A108
Fax; (866)
Loma Linda, CA 92354
Email: Phone:
eweldon@fastresponse.org
(909) 558-4344 x 0
Web: www.fastresponse.org
Fax: (909) 558-0102
Email: LJones@ahs.llumc.edu
www.llu.edu
LomaWeb:
Linda
University Medical Center
Lyne Jones,
Administrative
Assistant
Medic Ambulance
Department
of Emergency
Medicine Coordinator
Perry Hookey,
EMTP, Education
Couch Street
11234506
Anderson
St., A108, Loma Linda, CA 92354
94590-2408
Phone:Vallejo,
(909) CA
558-4344
x0
Phone: (707) 644-1761
Fax: (909)
558-0102
Fax: (707) 644-1784
Email: Email:
LJones@ahs.llumc.edu
perry@medicambulance.net
Web: www.medicambulance.net
Web: www.llu.edu
Mendocino Lake Community College
MedicPatrick
Ambulance
Magee, MA, EMT-P
Perry Hookey,
EMTP,Creek
Education
1000 Hensley
Road Coordinator
Ukiah,Street,
CA 95482
506 Couch
Vallejo, CA 94590-2408
467-1047
Phone:Phone:
(707) (707)
644-1761
Fax: (707) 467-1011
Fax: (707)
644-1784
Email: pmagee@mendocino.edu
Email: Web:
perry@medicambulance.net
www.mendocino.edu
Web: www.medicambulance.net
Napa Valley College
Cori Carlson, EMS Director
Fax: (888) 519-8479
CSUS Prehosptial Education Program
Email: espoonhunter@mac.com
Derek Parker, Program Director
Web: www.cemset.org
3000 State University Drive East
Mendocino
Lake Community College
2277 Napa Highway
PatrickNapa
Magee,
MA, EMT-P
CA 94558
Phone: (707)
256-4596
1000 Hensley
Creek
Road, Ukiah, CA 95482
Phone:Email:
(707)CCarlson@napavalley.edu
467-1047
Web: www.winecountrycpr.com
Fax: (707) 467-1011
Email: Northern
pmagee@mendocino.edu
California Medical Education
Scott Rebello, Course Coordinator
Web: www.mendocino.edu
Fax: (916) 256-4301
Email: Kurgan911@comcast.net
Napa Phone:
Valley(916)
College
724-0830
Cori Carlson,
EMS Director
Email: 2coolrns@starband.net
Web: NorCalMedEd@comcast.net
2277 Napa
Highway, Napa CA 94558
Phone: (707) 256-4596
Email: CCarlson@napavalley.edu
Web: www.winecountrycpr.com
Napa Hall
Sacramento,
Compliance
TrainingCA 95819-6103
Office: (916) 278-4846
Jason Manning,
EMS Course Coordinator
Mobile: (916) 316-7388
3188 Verdedparker@csus.edu
Robles Drive, Camino, CA 95709
Phone: (916)
429-5895
http://www.cce.csus.edu
CSUS Prehospital Education Program
Derek Parker, Program Director
3000 State University Drive East, Napa Hall, Sacramento, CA
95819-6103
Office: (916) 278-4846
Mobile: (916) 316-7388
Email: dparker@csus.edu
Web: www.cce.csus.edu
6617 Madison Avenue, #12
Carmichael, CA 95608
NCTI
National College of Technical Instruction
Lawson E. Stuart, RN, CEN, EMT-P
Northern
California
Medical
Lena Rohrabaugh,
Course
ManagerEducation
333 Sunrise
Suite Coordinator
500
Scott
Rebello,Ave
Course
Roseville,
CA 95661
6617
Madison
Avenue, #12, Carmichael, CA 95608
Phone: (916) 960-6284 x 105
Phone:
(916)
724-0830
Fax: (916) 960-6296
Email:
Email:2coolrns@starband.net
jlcasa@caltel.com
Web:NorCalMedEd@comcast.net
www.ncti-online.com
Web:
Oakland Fire Department
NCTI
– National
College
of Technical Instruction
Sheehan
Gillis, EMT-P,
EMS Coordinator
Lawson
Stuart, RN, CEN, EMT-P
47 ClayE.Street
Oakland,
CA 74607Course Manager
Lena
Rohrabaugh,
Phone:
(510)Ave
238-6957
333
Sunrise
Suite 500, Roseville, CA 95661
Fax: (510) 238-6959
Phone:
(916)
960-6284
Email: sean@baycj.com x 105
Fax:
(916)
960-6296
Web:
http://www.oaklandnet.com/fire/
Email: jlcasa@caltel.com
PHI Air Medical, California
Web:
www.ncti-online.com
Graham Pierce, Course Coordinator
801 D Airport Way
Oakland
Department
Modesto, Fire
CA 95354
Phone: (209)
Sheehan
Gillis,550-0884
EMT-P, EMS Coordinator
550-0885
47Fax:
Clay(209)
Street,
Oakland, CA 74607
Email: gpierce@philhelico.com
Phone:
(510)
238-6957
Web: http://www.phiairmedical.com/
Fax: (510) 238-6959
Riggssean@baycj.com
Ambulance Service
Email:
Greg Petersen, EMT-P
Web:
http://www.oaklandnet.com/fire/
Clinical Care Coordinator
100 Riggs Ave.
PHI
Air Medical,
Merced,
CA 95340 California
Phone: Pierce,
(209) 725-7010
Graham
Course Coordinator
Fax:D(209)
725-7044
801
Airport
Way, Modesto, CA 95354
Email: Gregp@riggsambulance.com
Phone:
(209) 550-0884
Web: www.riggsambulance.com
Fax: (209) 550-0885
Santagpierce@philhelico.com
Rosa Junior College
Email:
Public Safety Training Center
Web:
http://www.phiairmedical.com/
Bryan Smith, EMT-P, Course Coordinator
5743 Skylane Blvd.
Riggs
Ambulance
Windsor,
CA 95492 Service
Phone:
(707) 836-2907
Greg
Petersen,
EMT-P, Clinical Care Coordinator
Fax:Riggs
(707) Ave,
836-2948
100
Merced, CA 95340
Email: medic9001@comcast.net
Phone:
(209) 725-7010
Web: www.santarosa.edu
Fax: (209) 725-7044
WestMed
College
Email:
Gregp@riggsambulance.com
Brian Green, EMT-P
Web:
www.riggsambulance.com
5300 Stevens Creek Blvd., Suite 200
San Jose, CA 95129-1000
Santa
Junior College Public Safety
Phone:Rosa
(408) 977-0723
Email: jonesds777@hotmail.com
Training
Center
Web:Smith,
www.westmedcollege.com
Bryan
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
WestMed College
Brian Green, EMT-P
Creek Blvd., Suite
200, San
Jose, CA 95129-1000
EMREF is a proud sponsor 5300
of Stevens
California
ITLS
courses
Phone: (408) 977-0723
Please call 916.325.5455 or E-mail Lucia Romo: Email:
lromo@californiaacep.org
for more information.
jonesds777@hotmail.com
Web: www.westmedcollege.com
Search for upcoming courses:
Search for http://cms.itrauma.org/CourseSearch.aspx
upcoming courses: http://cms.itrauma.org/CourseSearch.aspx
EMREF is a proud sponsor of California ITLS courses.
Please call 916.325.5455 or
E-mail Lucia Romo: lromo@californiaacep.org for more information.
lifeline
California Chapter, American
College of Emergency Physicians
1121 L Street, Suite 407
Sacramento, CA 95814
PRSRT STD
US POSTAGE
PAID
CPS
WWW.CALIFORNIAACEP.ORG
JANUARY 16-19, 2013
YOSEMITE LODGE AT THE FALLS
AND THE AHWAHNEE HOTEL
YOSEMITE NATIONAL PARK, CA