Category Archives: Emergency Medicine

Providence Fire Rescue ambulances. (WJAR){}

A new unique partnership is already proving to be a difference-maker in a local emergency room.

This is for patients with serious, chronic illnesses who are rushed to the Miriam Hospital in Providence.

It combines palliative and emergency care.

"This is a pretty new field," said Dr. Leah McDonald with HopeHealth Hospice & Palliative Care. "I'm trained in emergency medicine and palliative care, so I am in the ED five days a week working as part of the ED team to see patients down there."

And please, she says, don't mix up hospice and palliative care --they're different.

"Palliative care is a medical specialty that provides an additional layer of support for patients with chronic and life-limiting illnesses," said McDonald. "A typical patient may be an elderly patient with heart failure; one whose been in and out of the hospital frequently over the past year."

Currently, many hospitals in Rhode Island and across the country offer palliative care to patients who are admitted.

This one starts from the point of entry.

"The goal with this is really to start patient-centered care from the minute they get here," said McDonald. "Research has shown that embedding a physician within the ED really increases consults to the palliative care services."

"If we can potentially target treatment outside of the hospital and alleviate some of the symptoms that lead to hospitalization the goal would then be to keep them home," she added.

They're now six months into this pilot program and Miriam and Hope Health says patients love it and it is making a difference.

The hope is that this spreads to other hospitals.

See more here:

Unique program at Miriam Hospital combines palliative and emergency care - WJAR

Emergency Medicine

Ending Affirmative Action Would Be Bad for Our Health – Progressive.org

April 27, 2023 medical

Harvard and the University of North Carolina at Chapel Hill are among the higher ed institutions involved in a U.S. Supreme Court battle over affirmative action that is expected to be decided this spring or summer. As a former appellate defender in the Gratz v. Bollinger affirmative action case in 1993, as well as an emergency medicine physician serving under-insured patients, I know firsthand how affirmative action can affect health equity and social justice.

White women are affirmative actions largest beneficiaries, and have been since the 1960s when conservatives attempted to change the affirmative action narrative. Even after President Lyndon Johnson passed Executive Order 11246 to improve equal employment opportunity, white women remain the top beneficiaries of affirmative actionand its greatest opposition.

Affirmative action remains a hot button issue, despite the fact that Black and Latino students at the nations top universities are more underrepresented today than they were thirty-five years ago. At Harvard, for example, 43 percent of white students are legacies, athletes or related to donors or employees.

Centuries of racism in this country have resulted in unequal access to education, a social determinant of health. Yet private and public colleges and universities are still under scrutiny for using race as one of the many complex variables in the college admissions process. Education opens doors to employment for many fields, but especially highly specialized ones in medicine and healthcare. Diversity amongst physicians and healthcare professionals leads to improved care and financial outcomes across the board. In effect, outlawing affirmative action threatens the health of all Americans.

For too many patients, a diverse healthcare system may mean the difference between life and death. Without more diversity, patients may be on the receiving end of bias, such as when doctors mislabel some pain patients as drug seekers, or brush off a womans chest pain as anxiety.

Diversity is about far more than offering soul food in the college cafeteria for Black History Month. Higher education institutions and medical organizations should make meaningful investments into outreach, recruitment and mentoring programs for students and faculty who are underrepresented in medicine. Criterion for board promotions, especially in majority-white boardrooms should also be reassessed from a lens of diversity, equity and inclusion. This is of particular importance as states such as Florida and Iowa are cracking down on diversity, equity, and inclusion initiatives in education.

Private and public institutions job is to ensure that it remains a tool for expanding access to education and healthcare. People of all races thrive in diverse healthcare environments and improved health for marginalized patients benefits everyone. This is how affirmative action lays the foundation for health equity and social justice in medicine.

This column was produced for The Progressive magazine and distributed by Tribune News Service.

Katrina Gipson is an assistant professor of emergency medicine at Emory University School of Medicine. She is the founding program director of the health policy fellowship at Emory and a public voices fellow of The OpEd Project and AcademyHealth.

April 26, 2023

12:29 PM

Opinion | Public Health: Lack of Trust, Loss of Workers – Medpage Today

April 27, 2023 medical

The following is a transcript of an Instagram Live event where Jeremy Faust, MD, editor-in-chief of MedPage Today, and Megan Ranney, MD, MPH, incoming dean of the Yale School of Public Health in New Haven, Connecticut, discuss professional issues in public health, including how the sector has changed after the COVID-19 pandemic (note that errors in the transcript are possible).

Faust: We're talking about public health today: the field, the good, the bad, where we're headed, where we've been. Who better to join us than my good friend Megan Ranney?

Dr. Ranney is a practicing emergency physician currently serving as the Warren Alpert Endowed Professor in the Department of Emergency Medicine at Rhode Island Hospital and Alpert Medical School at Brown University. But she's also departing that role, where she was also academic dean at the School of Public Health, to become the dean of the School of Public Health at Yale University as that school bridges out from its past as part of the Medical School at Yale and now becomes its own separate entity. It's sort of a reboot.

You have a background in gun safety research and have been a rational voice to not just me, but to millions of Americans. So, Dr. Ranney, thanks for joining us today.

Ranney: It's a total pleasure, Jeremy. It's an honor to be here.

Faust: I'm always very formal with my guest -- Dr. This and That -- we'll go back and forth a little bit. I'm very conscious about making sure that I use the word doctor equally to everyone who has that title. You and I are such good friends, it'll be a little weird not to go back and forth. So Megan, thanks for coming on the show.

Let's talk about where we've been. It's 2023. Public health wasn't really on people's radars in 2020, would you say so? What do you think the through line of that has been? What do you think the average American thinks when they think of public health?

Ranney: You're exactly right. Prior to COVID, when I told people that I had a deputy dean position at the School of Public Health, or that I was a public health professional, they kind of said, what's that? Nevermind if I talk about epidemiology or biostatistics. It's like I was speaking a foreign language.

Now, I think there are few Americans, few people worldwide, who don't at least know of the concept of public health. But I think there's still a lot of confusion about what we do and the scope of our work, the impact of it, and the ways in which we work with communities, with educators, with for-profit and not-for-profit businesses. I think folks' view of what public health is is a little skewed by thinking it's all about COVID.

Faust: Yeah. This is a question that I have, maybe not for the audience, but you teach in both medical school and a school of public health, which are very, very different disciplines. One's really about patient care and one's about understanding the system in which healthcare is delivered and all the challenges that a society may face.

Do you think that people who don't practice medicine who are in a school of public health or have a career in the health professions are kind of missing something by not seeing what we see, which is that this is what it's like on paper, but in real life it's a different story?

Ranney: I would say the same in the opposite direction, that many healthcare providers are missing the view of people who practice public health every day.

I think of the two disciplines as being kind of an overlapping Venn diagram. So, two circles that share a lot, and which can both be enhanced by talking to each other and by having some shared training, but they're not completely overlapping. Not all things in healthcare are public health, and not all things in public health are healthcare.

In fact, you and I would both say there's a lot that we do in the healthcare system that unfortunately is not informed by those basic principles of public health.

Faust: That's fair. My soapbox on this is that -- I don't have an MPH, that's a master's in public health -- but I also feel like medical students who are applying to residency and want to be competitive often take a research year, which is very prestigious, and then you can go down into a field that's competitive.

Stopping to get a master's in public health, people do it, but it's not necessarily held in the same kind of prestige ... I kind of wish that was different, because I think it's a skillset that is far more applicable and long-lasting than 9 or 10 months in a lab where maybe the project worked or didn't work.

Ranney: I completely agree with that, and I think that the MPH deserves to be elevated overall.

We had a good discussion yesterday with some folks at a Department of Health training the public health workforce and about how we really need to use that MPH to not just teach people the basics of sensitivity and specificity and how to program and how to understand basic environmental determinants of long-term health, but also to use it as a chance to teach people how to be leaders within the field of public health.

And I do think it's an essential skill set for physicians to understand the ways in which society, the environment, climate, the design of streets, the design of houses, economic systems, how all of that impacts health, and understand, on the other hand, how to use data, what good data sources look like, what they don't, and how do you analyze them.

One of my colleagues here at Brown works with some folks at Yale and they teach a class on napkin math. So, how do you start from an incomplete data set and do your best to get reliable and reproducible answers? Those are essential skill sets for healthcare providers, or at least for healthcare leaders, to have.

But I agree. We do have a ways to go in terms of elevating the perceptions of the rigor and the leadership value of that Master's. It's something I look forward to taking on in my new role at Yale.

Faust: What are some of the things that someone getting an MPH would learn?

Ranney: You learn about basic statistics, biostatistics, epidemiology. You learn how to track disease risk factors, preventive factors, how to create data sets, how to analyze those data sets. You learn about the basics of the healthcare system, both globally and nationally, how it's funded, how it's structured.

You learn about environmental health; everything from toxins -- in that disaster in East Palestine with the train overturning, there were public health professionals that were part of that response team that were thinking about the long-term effects.

Then you learn about communication, leadership, policy -- all the things that go into creating a functioning public health system, which of course is about more than a governmental public health system. It's about setting up the structure to keep society healthy, both physically and socially and emotionally.

Faust: I think that, from the perspective of an emergency epidemiology perspective, which is the perspective that I bring, we've never been in a better place than we are now in terms of who knows what. The workforce is amazing.

I suspect that the same is true with the MPH with who's coming in and what kind of work is being done. I mention that because the title of this conversation is a little doom and gloom -- loss of trust, lack of trust -- things are bad. But do you sense a difference in students that are coming out of public health schools in this country today?

Ranney: We've certainly seen a huge rise in the number of applications to schools of public health over the past couple of years as people have been so personally affected through the COVID pandemic, through mental health problems, through gun violence, through the effects of structural racism.

So yes, in some ways. But I will also say that I hear a lot from my colleagues in public health a little bit of the doom and gloom that is the title of this conversation, which are the same things that we have paid attention to in the healthcare workforce over the past 3 years. The burnout, the effect of misinformation, the effect of workplace violence, the stressors of declining funding -- those are present for public health as well.

So although I see a lot of bright potential, I also think it would behoove us to pay attention to those warning signs, because we actually know that we're losing a lot of people -- particularly young people -- from the public health workforce.

It's the same thing that we're facing, Jeremy, in emergency medicine, right? We had 500 residency slots that didn't fill this year. We're seeing that somewhere around 50% of people who are in governmental public health in their first 5 years of that job have left due to the same confluence of factors that we're facing in healthcare.

And let's be clear, healthcare in the healthcare system cannot work if we don't have a strong public health system to partner with.

Faust: This idea of a mass exodus of public health workers -- nearly half of all public health workers in state and local agencies left their position over the last half a decade, which is from a Health Affairs report. I think that some of it might have been early retirement and some of it might have been burnout.

What's your sense of that? From the people that you know who left, do you have a sense of why?

Ranney: There's certainly an early retirement portion. The same thing as we've seen with the nursing workforce in healthcare, where we've had a lot of people that were getting towards the end of their tenure who've said, "You know what? Now's a good time to leave."

There are a lot of people who have had childcare challenges. There was the ridiculous work hour expectations, the lack of a break for the last 3 years, that has just made people burnt out and crispy. Just as those of us in emergency medicine or intensive care had to work more than before during COVID waves. Similarly, many of our public health colleagues were called to do more over the last 3 years and really have reached the end of their ropes.

There's also an element of that misinformation and workplace violence. I've talked to reporters about, I know you've had these too, stories about people who I've taken care of who were vehemently opposed to the idea that they actually had COVID as they were sitting there with an oxygen saturation of 70%. And I'm like, "No, no, you can't leave the hospital, I swear."

Public health workers have experienced that too. I've had colleagues who have left because they were tired of experiencing personal attacks on themselves, fearing for themselves, fearing for their family, and if anything, I think particularly some of our governmental public health workers have been more exposed to that.

Lastly, there's been a disturbing trend in many states of reducing the scope of practice of public health professionals. Just as with healthcare, people that go into public health do it because they care. They do it because they want to create a healthier society. Then they're working in a state that says that they can't do their job anymore, that's putting laws in place that reduce their ability to track the incidence of disease, to track risk factors, to provide interventions for substance use disorder or HIV or COVID.

That gets really dispiriting after a while when you know the thing to do, you know how to do it, and you're literally not allowed to. It has created this sense of moral injury for many.

Faust: One of my readers asked a question adjacent to this, which was: what can someone who's not in the field do to say to the CDC or their local public health agencies, "Hey, we want you to track COVID and infectious diseases. Don't shut down your website that tells us what's going on in the wastewater or a case count or hospitalizations or mortality."

You and I can write emails to people we know and various apparatuses in the healthcare structure, but what can my readers do who aren't doing this every day?

Ranney: I think that they can actually be in touch with their elected officials.

Ultimately, a lot of that ability to track and publish that data on a public-facing website depends on permission to access data and then to share it. So you need both those permissions for data access, which are being withdrawn as we speak as the public health emergency comes to an end. So reminding your legislators how important that is. There's also the funding involved in having the workforce to allow that to happen. This is a place where legislative advocacy really can make a difference.

I'll say, Jeremy, you and I have had a lot of conversations over the past few years and before about citizen science as well. I do think that this is also a place where, for better or for worse, sometimes citizens who have an interest and a skillset can partner to help create alternative data sets. We saw it for PPE [personal protective equipment], we've certainly seen it for firearm injury tracking -- the gun violence archive, which is privately funded, serves as really my best source of injury data. We saw it for COVID in those early days, the COVID tracking project, which was created by The Atlantic, served as this amazing source of data.

So I would say to your readers: do not underestimate your own power to create local change.

Faust: To add to that, the idea of long COVID really came from patients ringing the bell, saying, "Hey, we're bringing something to the attention of the medical field." I think that that's another example of how you don't have to be in the field to influence it. I think that's been a good story.

Let's talk a little bit about trust in people like you and me, doctors, healthcare professionals, people in this space. One of my readers asked a question that's adjacent to this: Trust is something that is hard to win and easy to lose. We go on TV or we write things and it can go well or not well. So for both of us, let's do this. What's something that you got right early on or during the pandemic, and what's something that you didn't get right and you take it back and say, "Oops, that was not right."

Ranney: It's a great question. I think that I called out earlier than many -- not most, but earlier than many -- the fact that COVID was likely airborne, which we now know to be true and that surface disinfection was less important. That, honestly, mask wearing made a difference, which despite a Cochrane Review that was deeply flawed, we actually know from the data around COVID that masks, particularly well-fitting masks, did make a difference at the height of those Omicron, Delta, and earlier waves.

I'm proud of calling that out relatively early and continuing to share my voice in that realm.

One thing that I did get wrong is that the early data on the vaccines strongly suggested that they stopped transmission. That they didn't just reduce severe disease and hospitalization, but that they also stopped infection and transmission. We had been so lucky to not have mutations at that point, and I did not anticipate the degree to which that was going to change.

I will say that the data changed, but I think that probably many of us, myself included, overemphasized that and created a false sense that these vaccines are magic, when really they're just regular old vaccines just like the flu vaccine, which is tremendous particularly for high-risk populations, but doesn't fully stop infection or transmission.

How about you?

Faust: Alright, very fair. Things I got right? I have to think about it, I feel like I haven't gotten much right.

Ranney: That's not true! I think you and I wrote a nice piece together once or twice.

Faust: I'll start with the thing I think I kind of got wrong early, which is that the early data sets coming out of China and elsewhere really showed that this was a disease of the elderly, and that's who we had to worry about. In fact, there were so few deaths of young people that I wasn't sure if there would really be a bump in what we call "all-cause mortality" in people who were not in a geriatric population. So I thought, "Well, we might see a few deaths, but that would probably be a statistical anomaly in younger people. We really have to worry about the older folks."

In fact, I set out to study that question thinking that we might not find anything in the younger groups. And you know what? We did find something. We found out that younger adults, people in the 25-to-44 age group, actually had a massive increase in their mortality. Even though it was just going from a little bit to a little bit more, which doesn't seem like as much, right?

So one in a thousand people usually die, and then it becomes one in 900 or something like that. That doesn't seem like much, but that's a huge, huge difference of life you're losing. Decades of life. It is a big relative difference, even though actually, the raw number of deaths certainly was highest in that older, sicker population.

I was wrong about that, and I'm actually happy that I was the one to go find that out and correct. So your priors, we call it "bias," can ask a research question. I thought it was one of those situations where I thought, "Let me be the person to ask this, because if I don't find what I'm looking for, that's okay." And we went with it. So that was a turnaround.

I think another thing that I probably got right pretty early on was not necessarily that it was airborne, I actually was late on that, but I was thinking it was airborne enough [to be] precautionary. I wasn't sure how airborne it was, and I'm still confused about how this virus transmits, because you'll have a roommate on a cruise ship not get it from somebody, and then half of a choir in Washington got it.

We have to learn about the airborne-ness of this virus. It's in the air, it's airborne, but it's not so clear that it's constant.

But I think that I was safe on that. Like, okay, it's airborne enough. Even if it isn't, which it is, putting a mask on keeps people like me from touching their face all the time, which I'm sure is how I was getting sick. I mean, I haven't had a healthier stretch of my life than 2020 because the hand hygiene was up, the hand hygiene was great, the masking kept all the junk out of my face, my allergies were better that year, it was great.

Ranney: Yes. I'm also going to call out my state, Rhode Island; we put kids back in school in September of 2020, and I think I gave a lot of leeway to folks that were not putting kids back in school, both nationally and globally. Bangladesh, for example, did not put kids back in school for another 2 years after that.

I think that it's a space where we could have advocated more strongly. We didn't have complete knowledge; we were worried appropriately about teachers and their health in the pre-vaccine era. Luckily, some of our colleagues came up with nice studies showing that masking, ventilation, et cetera, did make a difference. It's a space where I think that the public health community and the physician community could have sounded the alarm.

Many of us talked about the potential negative downstream effects of the COVID pandemic. Yes, we were healthier in some ways, but less healthy in others -- gun violence and mental health amongst them. Both are problems that existed before COVID, but certainly got exacerbated.

I was a local advocate for getting kids back to school, but I think that we could have been stronger nationally and internationally.

Faust: I'll add to this point. It's super-important because this was an area where public health officials and experts got a lot of heat. The approach that I took was that the idea is not to open schools, but to keep them open. You can keep schools open by taking a more aggressive approach on things like routine rapid testing.

So there was this weird disconnect where the people who wanted to open the schools the most were willing to do the least to achieve that. I think people like us were fighting an uphill battle to say, "No, both things are true. You can take this thing really seriously and do a lot of testing and do some masking and ventilation, and that's what's going to keep the kids in school." As opposed to some groups who were saying, "Oh my God, it's too unsafe. Kids have got to go home." They didn't think about the possible consequences of that.

So I think that even within our own field, there was this debate about how to do it, and I think we were right about it. The idea that you aggressively track it, you aggressively address it, with the aim of keeping those doors open.

Ranney: I think there's also a reality in looking back, and this is another place where I think we could have been clearer, is that the information was bound to change.

This was an emerging pandemic. We had literally nothing. We got nothing out of China, right? We had nothing when we started trying to fight it. And I think being clear about how the scientific method works, how we ask questions, the fact that we converge on truth, and that we were going to have to make choices with incomplete information, that we would do our best to make those choices accurately, but that it is inevitable in a pandemic that things change.

I mean, heck, Jeremy, you and I could probably sit here and go back and forth about things that we've done in emergency medicine over the course of our career that have changed substantially. We were all in that emergency state. I don't think there was any intentional not sharing of the fact that we were doing the best we could with the data that we had.

But I do think that that's an important part of the conversation going forwards, about making sure that everybody understands the basics of the scientific method, and that we continue to be clear that we're making our best possible recommendations, and these are the reasons why.

Having a little bit of humility, particularly in these emergency situations about how stuff may change down the road, but we're doing the best we can with what we've got.

Faust: One of my readers reminded me of something that I forgot about you, even though we're good friends, which is that you are a history of science major, so you might have a longer view on this. Do you think that the prestige of science has been worse in the past?

Ranney: Oh yeah, this is not a historical anomaly. I do think that the history of science -- I adore it. I could talk about it all day. But we look back at the plague, and you go back further to the Greeks and Romans. You look at Galileo and Copernicus, you look at the history of hand washing and belief in germ theory. You look at the history of vaccines and over and over throughout recorded history, the way in which we interpret science has been deeply influenced by the society in which we live.

There's been really good evidence that gets dismissed because of societal biases, and there have been mistakes made.

There have been periods of deep distrust in medicine. I mean, that's what the Flexner Report came out of in the early 1900s, trying to professionalize medical schools. It caused a lot of harm to particularly medical schools that were training Black physicians and women physicians, that Flexner Report, but it was created out of a fear that medicine was turning into snake oil salesmen.

So there have been many points throughout history where science and medicine and public health have been deeply distrusted.

I see this as cyclical, but it's also a space for us to lean into and to do better around creating trust. I do want to highlight, though, that we can be doom and gloom, but actually trust in public health and in public health institutions is not all that bad. People trust public health and healthcare practitioners way more than they trust a lot of other institutions in America.

I think we've seen across the board decline in trust of government, of higher education -- you know, name an institution and it's less trusted than it was. The NIH and the CDC are trusted equivalently to the American Cancer Society. No one would say that they are political; it's just I think that we're living in a world in which folks don't trust each other right now.

I don't want to get too down on what we've done, because we've really had some tremendous successes and saved a lot of lives.

Faust: There's this poll out of the Harvard T.H. Chan School saying that 26% of people trust their state and local public health officials. We had PR for this event and in our mentions people said, "Oh, how could we trust you guys?"

But I'll tell you, the other day, when there was an emergency on the plane that I was on and they said, "Is there a doctor on board?" and I rang in, nobody said, "Don't trust that person. They're a doctor." Everyone on the plane was very glad that a doctor was on board and that I could help the person and help figure out not to land the plane, but we're going to help this person anyway.

When push comes to shove, I think people do have trust, but we know this, depending on how a question is asked and in what situation, people answer differently.

I'll just throw another thing in about the history of science and how much we've learned. You look back at landmark studies from decades ago, things that really informed our practice, and they were decent, but a lot of these even in The New England Journal of Medicine or JAMA or The Lancet -- the best journals in the world -- would never get published today. They're not nearly rigorous enough.

So I think we've made a lot of progress. And I think that anytime we overturn anything that we thought was true and now isn't, I'm always packaging it as: that is the process. We want to own those things, because that's what science is about. Science is not about an established body of knowledge; it's about an evolving body of knowledge. I think that when we have that message out front, people actually do understand that.

Ranney: I agree.

Faust: My last question for you is really about the fact that you said something about politics, which is interesting because on one hand, this should cut across all political divides. I think you have really been excellent in your work on always trying to reach both sides of the political spectrum and not being political, but at the same time, there's a saying that health and science are political. How do you thread that needle so that work gets done, because it takes politics, without alienating half of the country?

Ranney: I think it really is a both/and. Of course, health and politics are deeply intertwined because health and societal structures are deeply intertwined. There's no way to fully separate them out.

We do know that states with certain policies and laws in place have lower mortality rates -- whether it's maternal mortality, child mortality, elderly mortality, lower rates of chronic disease, lower rates of obesity -- than states without those legislative decisions. So there's a very real impact of legislation and of politics on health.

At the same time, you can respect that people's decision-making may not be informed entirely by health and/or they may be prioritizing different aspects of health. To me, part of being a great physician or a great public health professional is balancing those realities and meeting people where they are, prioritizing the things that they prioritize.

Again, this is a space where I think some states did better than others during the worst of the COVID pandemic.

I will frequently say that there is going to be 10% or 15% of society who is never going to get on board with something that creates greater health. But the vast majority of us, if you ask us, we care about our own health, about our kids' health, about our parents' health, about our community's health, but we're going to put it in the context of we also need to pay our rent, right? We need to make sure there's food on the table. We need to make sure that we're safe when we walk outdoors.

It's making people realize that that's part of health and working to advance those things that are deep priorities of every community and are not unique to a political party. It's finding ways to create bridges across supposed political divides.

I will also say, of course, that politicians need to create drama and controversy, because that's how they get attention in fundraising. Not all politicians, but many. That's not my job in public health or in medicine. I'm not about trying to create drama. I'm about trying to work with communities where they're at to meet the needs that they identify.

Emily Hutto is an Associate Video Producer & Editor for MedPage Today. She is based in Manhattan.

Go here to see the original:

Opinion | Public Health: Lack of Trust, Loss of Workers - Medpage Today

Emergency Medicine

UAB: Emergency department crowding has reached a crisis point – AL.com

April 27, 2023 medical

The University of Alabama Board of Trustees applied for an Emergency Certificate of Need from the state to temporarily expand UABs Emergency Department (ED) and resolve its extreme overcrowding earlier this month.

A Certificate of Need, or CON, is required before any health facility in Alabama can partake in major capital expenditures or expansions according to the National Conference of State Legislatures.

UAB CEO Brenda Carlisle said overcrowding in the ED had reached a crisis point in the request.

UAB requested permission from the state to temporarily lease two mobile emergency facility units and renovate parts of the hospitals waiting room to add 25 additional patient care areas as an interim solution in the letter.

These additions will cost just over $10 million which UAB plans to source from their cash on hand the letter says.

UAB is also working on a more permanent expansion plan that would add 60 additional treatment spaces at the cost of $73 million.

This plan is still awaiting full approval from the UA Board of Trustees according to UAB spokesperson Alicia Rohan.

For the more permanent expansion Gov. Kay Ivey recently proposed dedicating $50 million of the states Education Trust Fund to UAB as the Lede previously reported.

This proposal came after UAB President Dr. Ray Watts stressed the severity of their EDs overcrowding in a special meeting called by the University of Alabama System Board of Trustees in early April specifically to address the issue.

Over the last five years UAB has experienced a 20 percent increase in patients and at least 25 percent of those patients require hospital admission according to the request letter.

It adds that UAB is overburdened in part because they are the only American College of Surgeons verified Level I trauma center in the state.

This issue is only compounded by a 40% spike in UAB trauma numbers alone over the last decade which can largely be attributed to Birmingham gunshot victim numbers doubling over that time period according to a report from AL.coms Amy Yurkanin.

This combination of overcrowding and the severity of cases that come to UABs ED often leads to vulnerable patient populations receiving delayed care according to statements made in the request by Dr. Marie-Carmelle Elie, chair of the Department of Emergency Medicine at UAB.

She added that the overcrowding had also placed UAB in the top 25% of hospitals nationwide where patients leave without being seen or even leave in the middle of medical care, only to return later with worse symptoms.

The hospitals resources simply cannot meet current ED demand, said Elie.

Link:

UAB: Emergency department crowding has reached a crisis point - AL.com

Emergency Medicine

ENRICH study leads to first positive surgical trial in the deadliest … – Emory News Center

April 27, 2023 medical

The results of a promising surgical treatment for hemorrhagic strokes, led by researchers at Emory University School of Medicine since 2017, were announced Saturday in a late-breaking clinical trial presentation at the American Association of Neurological Surgeons (AANS) meeting in Los Angeles.

The ENRICH (Early MiNimally-invasive Removal of ICH) trial demonstrated a positive surgical outcome in the treatment of intracerebral hemorrhage (ICH). A randomized, multi-center clinical trial, ENRICH compared standard medical management to early minimally invasive parafascicular surgery (MIPS), using the NICO Corporations BrainPath and Myriad technology.

Each year, two million people suffer hemorrhagic strokes, which are considered the deadliest, most costly and debilitating form of stroke. Hemorrhagic stroke occurs when a weakened vessel ruptures and bleeds into the surrounding brain, leading to the accumulation of toxic blood within the brain. Unfortunately, up to 50% of people who suffer from hemorrhagic strokes will die within 30 days.

Research suggests that removal of blood from the brain within 24 hours after bleeding starts could help reduce brain damage and death. Right now, the standard of care for patients is to give them medicine or monitor and see what happens, often called the watch and see" approach. This can mean blood stays in the brain for longer, increasing the risk for complications.

ENRICH is the first, randomized clinical trial to meet its primary endpoint, while improving outcomes for these deadly strokes, says Gustavo Pradilla, MD, co-lead investigator for ENRICH, associate professor of neurosurgery at Emory University School of Medicine and chief of neurosurgery for Grady Memorial Hospital.

This trial will help to change how we treat hemorrhagic stroke moving forward, says Pradilla, who presented the findings at the AANS meeting.

The BrainPath device is a tool used to help surgeons get to the site of bleeding in the brain by carefully moving through its delicate folds and fibers. It gently moves aside brain tissue to create a path to the bleeding site. Once it gets there, the Myriad device, an automated suction and resection tool, can remove the clot.

The 37 participating sites did a great job with the trial and carefully randomized and expertly managed the enrolled patients, says co-prinicipal investigator Dan Barrow, the Pamela R. Rollins Chairman and Professor of Neurosurgery at Emory University.We want to thank our brave patients and their families for entrusting us with their care and agreeing to participate in a trial to advance scientific knowledge for the benefit of others.Their selfless behavior is necessary to advance the scientific basis of medical care.

Other participating trial sites included: Mayo Clinic, Johns Hopkins University, Washington University, Cleveland Clinic Foundation, University of Southern California, Brigham and Women's Hospital, Vanderbilt University, University of North Carolina and Penn State University.

At Emory, the ENRICH research team was comprised of a cross-disciplinary team from the neurosciences and emergency medicine. In addition to Barrow and Pradilla, supporting Emory faculty members on this research include: co-principal investigator Jonathan Ratcliff, MD; Michael Frankel, MD; Jason W. Allen, MD, PhD; David Wright, MD; and Alex Hall, MS, RN.

For more information on the ENRICH trial, please visit: https://clinicaltrials.gov/ct2/show/NCT02880878

Originally posted here:

ENRICH study leads to first positive surgical trial in the deadliest ... - Emory News Center

Emergency Medicine

‘Do something!’ We Need an Emmett Till Moment – New York … – Amsterdam News

April 27, 2023 medical

Do something was the plea from Dr. Jason Smith, whose medical team treated eight people injured in the first of two mass shootings in Louisville, Kentucky, in one week. The surgeons remarks about an April 10 incident that left five dead were directed at policymakers on the local, state. and national levels.

In a news conference with the Louisville acting chief of police, Smith said they barely had [time] to adjust their operating table schedule. There has been so much violenceat least 42 homicides.

For evidence, look no farther than Louisvillenext mass shooting. Just days later at Chickasaw Park, gun violence left two dead and four injured; many physicians from across the nation could have made Smiths remarks. As an emergency medicine doctor for more than 30 years in urban, suburban, and rural hospitals, I would have added that the situation is worse today than three decades ago.

In 1991, when I was a resident, the shooting deaths of four people at Michigans Royal Oak Post Office was nationwide news for days. Going postal had already become an expression based on a rash of murders at U.S. post offices. Although I am on the frontline of this violence, including the shootings at the Royal Oak Post Office, I never thought that firearms would become the leading cause of deaths among children and teens.

Now incidents with four or more dead are too common. in a Kaiser Family Foundation poll, roughly half of U.S. adults (54%) reported that they or a family member have had first-hand experience with gun violence. On the same day as the Chickasaw Park shooting, a birthday party in Alabama ended with four dead and more than 28 shot.

For years, gun violence looked like something that happened in somebody elses neighborhood. Today, mass shootings happen anywhere and anytime in a bank, a private elementary school, a park, and most recently during a 16th birthday party, a wrong turn into a driveway, or a knock on a door.

We can do something. America must see what Smith and I routinely see. They need to see what gun violence really looks like. We need an Emmett Till moment.

In 1955, the open-casket funeral of Emmett Till drew international attention to the savagery of Jim Crow segregation, spurring a national Civil Rights Movement. A 14-year-old Black boy had been kidnapped, beaten, mutilated, shot, lynched, and thrown in the Tallahatchie River in Drew, Mississippi. Jet magazine published a photo of Tills brutalized body.

Now almost 68 years later, we must do something to stop the gun violence. Opening the casket of someone who was shot by an assault rifle in a mass shooting may be the shock the nation needs. It may be the photograph that launches a bigger, broader movement to overwhelm the clout of gun manufacturers and other entrenched influences.

This shocking picture requires planning. Conversations among loved ones is a good starting point. Quick approvals with doctors and journalists based on these conversations is another key ingredient. It literally will require the blood, sweat, and tears of the entire village.

But is it worth the collective trauma?

History books are filled with images that inspired our nation to change. In addition to Emmett Tills body, photographs of fighting in Vietnam helped to end the 20-year war. Who can forget seeing a Buddhist monk set on fire? What about the front-page image of a South Vietnamese general firing a pistol into the head of a Viet Cong officer? And how about the picture of a naked child fleeing a napalm attack?

Ten years ago, a journalist asked to take a photo of the operating room table right after a shooting victim was taken to the morgue. He wanted to show the blood and bits left on the ceiling, table, walls, floor, and medical team. His editors and my hospital declined the idea. We had not even discussed the idea with the parents whose hopes and dreams for their child were dashed.

Now, given the increased frequency and brutality of mass shootings, I would answer yes to a journalist who wants my help in requesting a photographing of a loved one killed by gun violence. Ask yourself, your family, and friends: What can each of us do?

Will you help to stop gun violence? If readers are interesting in doing something contact Dr. Valda Crowder, Director, Health Committee for Black Women for Positive Change; email: drvaldac@gmail.com.

Valda Crowder, MD, MBA, is a board-certified emergency medicine physician who serves as medical director of emergency medicine at UPMC Community Hospital in Harrisburg, Pennsylvania, and is director of the Health Committee for Black Women for Positive Change.

Like Loading...

More here:

'Do something!' We Need an Emmett Till Moment - New York ... - Amsterdam News

Emergency Medicine

Spotlight on Dartmouth Ski Patrol: Winters at the ‘Way – The Dartmouth

April 27, 2023 medical

One writer investigates the culture and commitment of the student patrollers keeping the Dartmouth Skiway safe.

by Marius DeMartino | 4/26/23 2:15am

Formed more than sixty years ago by the College, the Dartmouth Ski Patrol is a community organization for students interested in ensuring the safety of those on the Dartmouth Skiway. Every winter, these students, who are trained in various forms of emergency medicine, each patrol the mountain for about 10 hours a week, according to patroller Kiki Levy 24. For many Dartmouth students, joining Ski Patrol (SkiPa) is the natural next step of years spent skiing at home.

Sam Frohlich 25, who grew up skiing on the West Coast, saw Ski Patrol as the perfect opportunity to integrate skiing into his life at Dartmouth and to explore new interests.

I had been considering going into medicine, and I thought [Ski Patrol] could be a cool way to see if emergency medicine would pique my interest, Frohlich said. It started out as interest, but I very quickly got invested in joining patrol.

In fact, Renesa Khanna 24, Ski Patrols training officer for the upcoming year, said she came to Dartmouth specifically for SkiPa after she patrolled at Winter Park Resort in her home of Colorado. Khanna expressed that while the exclusive nature of skiing makes it hard to get more diversity in a ski patrol club, the overall atmosphere of the group is very welcoming.

People love to be outside doing things, and its easy to get a group to rally and organize, Khanna added.

However, not all of the Dartmouth ski patrollers spent their childhoods on the mountain. Meghan OKeefe 24, the incoming student director of SkiPa, was initially nervous about joining because she thought she lacked the proper experience.

I skied growing up but never raced. We didnt go that often it was very expensive, so I was definitely apprehensive about being good enough. I really took a leap by trying out, she said.

Jacob Schnell 26, one of Ski Patrols newest members, echoed this sentiment.

Growing up [in Atlanta], I couldnt ski very much. Being able to do it for at least two shifts a week has forced me to go to the Skiway more, Schnell said.

Even with years of skiing experience, the process of becoming a patroller is no bunny hill. According to OKeefe, the recruitment process begins the first week of fall term, freshman year.

[Candidates] show up for interviews based on skiing equipment knowledge, skiing ability and a general interview. Thirty people from these initial applications will take a medical class to get their [Outdoor Emergency Care] certification, OKeefe said.

During their freshman fall, candidates take the OEC class, which allows them to become certified to patrol on any mountain in the U.S. Taking 120 hours to complete, the course prepares patrollers to care for patients out in the wilderness, with a mix of self-study and hands-on practical work.

It was one of the more intense terms Ive had at Dartmouth, Frohlich said. The medical training is pretty much like another class, with four hours a week and homework for each class. The defining part of my freshman fall was grinding so that I could make patrol.

After the arduous OEC class, potential patrollers take a final exam, after which only about fifteen are selected for a ski test at the start of winter term. Even then, those that make it through all of these obstacles still arent full patrollers they only earn the title of apprenti. On their first year on patrol, apprenti do not respond directly to calls themselves, rather they learn by helping out on the mountain. Before their sophomore winter, they return early to the Skiway to get vested and become full patrollers.

After the vest test a final demonstration of skills learned during their apprentice year the fledgling patrollers get to don Ski Patrols signature red jackets.

Its a very long process, so everyone that goes through it is an absolute trooper, OKeefe said.

Levy commented on how different the process was for the patrollers in the Class of 2024, adding that it was no less difficult.

There was no way for there to be a fair process because so many people were off-campus, so it had to be remote, Levy said. We had a more extensive interview process, and they actually admitted students first and had us complete OEC afterwards.

During the winter season, the patrollers spend plenty of time together according to Levy, each patroller is on duty at least ten hours a week and they find ways to make it fun.

We have a lot of silly day-to-day things to pass the time, like the Sunday morning shift makes a charcuterie board every time, OKeefe said. Starting new traditions has been really fun too we use our feed money from the DOC to [organize] a formal where we all wear something nice to eat pizza.

Despite its size of roughly sixty people, it does feel tight-knit and cohesive according to Frohlich, the incoming administrative officer of SkiPa.

It feels like one big group when we have social gatherings, theres a lot of turnout and people really buy into it, Frohlich added.

Schnell said that as a freshman, its exciting to have access to a community of outgoing people.

I feel welcome in most spaces, just because I likely know someone from patrol there, he said. Even in the fall, walking around and knowing some older people was a nice feeling, being a newer person on campus.

It also doesnt hurt to have a community of outdoorsy people eager for other adventures. Several of the patrollers recounted a recent excursion to Tuckermans Ravine one persons idea that snowballed into a thirty-person trip, according to Levy.

According to OKeefe, the patrollers are also in tune with the Upper Valley, working with local patrollers that volunteer at the Skiway.

Its a really good way for everyone to connect with the community where we live and get out of the Dartmouth bubble, OKeefe said. An annual banquet, held last weekend, even gave the senior patrollers a chance to thank and say goodbye to the community volunteers.

I love the community banquet, Levy said. At Dartmouth, you can get caught up in everything centering around students, so one of my favorite things about patrol is getting experience outside of that and putting energy into friendships with people outside of Dartmouths campus.

Whether on the slopes or on the Green, Ski Patrol provides a tight-knit community for its members many expressed how glad they were to have been exposed to such a fun group of people with similar interests.

I just like being around other people that like to ski, Schnell said. Its a community of people who like doing that in their spare time and are down to go to other mountains too.

Spotlight on Dartmouth Ski Patrol: Winters at the 'Way - The Dartmouth

Emergency Medicine

A California physician training program adds diversity, but where do … – Valley Public Radio

April 27, 2023 medical

Marcus Cummins grew up dreaming of becoming a doctor, but the Central Valley, California, native didnt have Black physicians to look up to. At times he doubted himself, but he credits the determination he developed as a receiver on the University of California-Davis football team to get him through his studies.

Being a collegiate athlete gave me confidence to apply myself and handle the rigorous schoolwork of medical school, said the 25-year-old husband and father of three. It was harder because I didnt have any physician role models.

This spring, Cummins will complete his fourth year of medical school at the University of California-San Francisco School of Medicines regional campus in Fresno. In March, he matched with UCSF Fresnos internal medicine residency program, where he will complete his training.

The campus is home to one of the University of Californias Programs in Medical Education, or UC PRIME, which encourages students of color to pursue medical degrees to help diversify the field and ease the physician shortage, particularly in underserved communities. The public university system launched the first training program in 2004, at its Irvine campus, and has since expanded it to all six medical schools, many with an emphasis on medically underserved communities.

Researchers have found that the program has succeeded at diversifying enrollment, but there is not enough long-term tracking to know whether these medical school graduates return to practice in regions where theyre most needed. Little is known about the long-term outcomes of UC PRIME, such as practice location or specialty, in the absence of a longitudinal, summative program evaluation across all UC PRIME programs, researchers with Mathematica wrote last fall after assessing the program through a grant from the California Health Care Foundation. (KFF Health News publishes California Healthline, an editorially independent service of the California Health Care Foundation.)

UC administrators say their data shows promising results. In its March report to the state legislature, the university system found over half of those who have completed their training are serving underserved communities, although the Los Angeles and San Francisco schools were unable to provide complete information. Participating students are trained in specialized coursework and clinical experiences to deliver culturally competent care. Depending on their individual circumstances, they may receive financial aid and scholarships as well as leadership development and mentoring.

These outcomes demonstrate that UC PRIME programs have a substantial impact on increasing the number of UC medical school graduates who pursue careers devoted to improving the health of the underserved through leadership roles as community-engaged clinicians, educators, researchers, and social policy advocates, the university system wrote.

Deena McRae, interim associate vice president of academic health sciences for the UC Office of the President, said the university will continue to enhance its tracking.

Several years ago, the California Future Health Workforce Commission recommended expanding the program, noting that graduates are likely to be from underrepresented racial and ethnic groups, likely to practice in California, and more likely to care for underserved populations than physicians who do not participate in similar programs during medical school. The medical training program also seeks to recruit students at an early age. For example, UCSF Fresnos Office of Health Career Pathways runs programs that encourage middle and high school students to pursue careers in medicine.

The state has followed through by increasing support. In 2021, the state allocated almost $13 million in new funding for UC PRIME. That amount will allow the program to grow from 396 students this year to nearly 500 by the 2026-27 academic year, UC predicted.

Sidra Suess, a Pakistani who grew up in Modesto, now practices internal medicine at Kaiser Permanente in Stockton. She completed her undergraduate work and two years of medical school at UC Davis before doing her final two years of medical school at UCSF Fresno through its San Joaquin Valley program.

Stockton is such a diverse mix and beautiful blend of cultures and languages, Suess said. I know I made the right choice to be here, and PRIME opened doors for me to do this. The tuition help, scholarships, and other support that PRIME offers can be fundamental to getting students involved and active who can do well.

Last fall, Mathematica found underrepresented medical students at UC schools more than doubled, from 16% in 2000 to 40% in 2021, an increase largely attributed to UC PRIME. Researchers credited the program for focusing recruitment efforts on individuals committed to serving underrepresented communities.

However, the report cited a lack of long-term data as an obstacle to knowing where these graduates end up practicing. One study of the programs graduates and those from several other community-focused special education tracks from the UC Davis School of Medicine found as many as 62% practiced in an underserved location, but that research relied on secondary sources.

It takes at least 11 years or more to produce a practicing physician after high school, depending on the specialty, said Kenny Banh, assistant dean of undergraduate medical education at UCSF Fresno. More time is needed to track outcomes for our graduates.

Craig Kohlruss

KFF Health News

Banh, an emergency medicine physician, stressed the importance of doctors who speak the same languages and come from the same cultures as their patients. He said rural areas in need often import foreign physicians, sponsoring their visas, but that those doctors arent necessarily committed to the region. They may accept sign-on bonuses and work for a time then leave.

Meanwhile, more than 80% of his students come from disadvantaged and underrepresented backgrounds, he said. I went into medicine to open doors for students like myself, said Banh. Students dont just walk through those alone.

In underserved regions, there tend to be fewer doctors serving patients; hospitals and health facilities likely have a harder time recruiting and retaining clinicians; and patients may have to drive long distances to access care. A 2021 report from the Healthforce Center at UCSF found that the Inland Empire had the lowest ratio of primary care physicians per 100,000 people in California while the San Joaquin Valley had the lowest ratio of specialists per 100,000 people.

Diversifying the field could also be good for patients health. For example, new research has found that Black people live longer in areas with more Black doctors.

From Selma, then Kingsburg, Inderpreet Inder Bals parents worked as immigrant farmers. She chose to pursue medicine during her third year at Fresno State, she applied to UCSF, and she is now in UCSF San Joaquin Valley PRIMEs class of 2024. It definitely lived up to everything I imagined, said Bal, who is Punjabi Sikh.

Through her mothers journey with terminal cancer, Bal realized that being a doctor didnt mean she could cure everyone, but she strives to give every patient her best. Bal said shes committed to practicing in the Central Valley one day.

This article was produced byKFF Health News, which publishesCalifornia Healthline, an editorially independent service of theCalifornia Health Care Foundation.

NASA is about to lock these 4 researchers in a simulated Mars … – Space.com

April 27, 2023 medical

When we think about sending astronauts to Mars, many of us first think of the hardware the rocket, for instance, or the habitat.

But NASA must also consider the human factors involved with Mars missions, which is why the agency is running a series of long-duration analogs here on Earth, called the Crew Health and Performance Exploration Analog (CHAPEA).

The first mission is set to commence in June, when four crewmembers will enter a 1,700-square-foot (158 square meters) habitat and live there for an entire year to simulate a Mars surface mission. And NASA has just announced who those crewmembers are.

Related: A month on 'Mars': Preparing to visit the Red Planet ... on Earth

Leading the mission is commander Kelly Haston, a research scientist studying human disease. Joining her is flight engineer Ross Brockwell, a structural engineer; medical officer Nathan Jones, an emergency medicine physician; and science officer Alyssa Shannon, an advanced practice nurse. Serving as backup crewmembers are aerospace and defense engineer Trevor Clark and U.S. Navy microbiologist Anca Selariu.

NASA first put out the call for CHAPEA participants (opens in new tab) in 2021, with requirements including a degree in a STEM (science, technology, engineering and math) field, as well as professional experience in that field, piloting experience or military training. Ultimately, the CHAPEA candidates had to pass the same physical and psychological testing as astronaut candidates to ensure they were fit for the program.

During the upcoming CHAPEA mission, the four crewmembers will live in a 3D-printed habitat called Mars Dune Alpha, which is located at NASA's Johnson Space Center in Houston. The habitat, designed by 3D-printing architecture studio ICON, includes private crew quarters, a kitchen, living areas, work areas and two bathrooms. There's also a 1,200-square-foot (111 square meters) "external" environment complete with Mars murals and red sand. There, the crew will conduct simulated spacewalks accompanied by virtual reality.

While living in Mars Dune Alpha, the CHAPEA crew will participate in the same kinds of activities that astronauts on Mars would do, from cooking to exercise to cleaning, as well as maintenance work on the habitat, crop growth and scientific research. They'll also encounter environmental stressors that astronauts might experience on Mars, such as equipment failures and communications delays with mission control due to the distance between Mars and Earth.

"The simulation will allow us to collect cognitive and physical performance data to give us more insight into the potential impacts of long-duration missions to Mars on crew health and performance," Grace Douglas, the CHAPEA principal investigator, said in a NASA statement (opens in new tab). "Ultimately, this information will help NASA make informed decisions to design and plan for a successful human mission to Mars."

While 12 months might seem like a long time to spend in Mars Dune Alpha, astronauts who travel to Mars will likely have to endure being away from home for much longer. A round-trip journey from Earth to Mars will take an estimated 21 months, given the time it takes to travel between the two planets, plus waiting for their alignment to be just right for the return. And, of course, the portion of the mission on the surface of Mars could run for weeks or even months.

Realistically, we're still a decade or two away from a human Mars mission, but preparations are well underway. And two more CHAPEA missions are scheduled for 2025 and 2026, respectively.

Follow Stefanie Waldek on Twitter @StefanieWaldek (opens in new tab). Follow us @Spacedotcom (opens in new tab), or on Facebook (opens in new tab) and Instagram (opens in new tab).

More here:

NASA is about to lock these 4 researchers in a simulated Mars ... - Space.com

Emergency Medicine

Sustaining emergency and critical care services through an equine … – Virginia Tech Daily

April 27, 2023 medical

It has been widely known in the equine community in recent years that students in veterinary colleges throughout the country are choosing to steer away from equine veterinary medicine.

In 2021, the American Association of Equine Practitioners highlighted this plight, sharing that only a small percentage of veterinary graduates were entering the equine profession. Even more disturbing is the fact that 50 percent of these graduates will leave the equine profession within five years.

This issue has caused some serious outside-the-box thinking at the Virginia-Maryland College of Veterinary Medicine as well as other veterinary colleges and private equine practices throughout the country that wish to sustain emergency and elective services that they currently offer to clients.

Michael Erskine '84, DVM '88, the Jean Ellen Shehan Professor and director of theMarion duPont Scott Equine Medical Center (EMC), is acting co-chair on a subcommittee of the American Association of Equine Practitioners' Commission on Equine Veterinary Sustainability, which focuses on the demands of emergency coverage. At the recent 2022 association convention in San Antonio, Texas, Erskine moderated a roundtable and presented a lecture on this topic.

Since the equine medical center opened its doors in 1984, its clinicians have been expected to offer outpatient and elective treatments and cover 24/7 emergency and critical care services. This expectation causes clinicians and clinical support staff enormous stress and fatigue, affecting not only their work-life balance, but also their ability to cover daytime scheduled appointments in a timely, efficient way. Due to the continuing increase in the emergency and critical care caseload, this is not a sustainable situation.

Theequine medical center has seen a substantial increase in emergency and critical care cases in recent years. In fiscal year 2022, emergency cases increased by 21.5 percent over the previous year, amounting to 739 emergency cases treated during the 12 months. There has been much discussion as to how to continue offering the current high level of emergency while being supportive of the expectations levied on clinical staff.

To sustain emergency services at the EMC, we are planning to create a dedicated emergency and critical care team, Erskine said. This team will be focused around specially trained equine clinicians who have completed advanced training in both emergency medicine and surgery."

Clinician Emily Schaefer, clinical assistant professor of internal medicine, will complete a fellowship in equine emergency and critical care this summer. EMC Advisory Council Vice Chair Shelley Duke and her husband, Phil, made this fellowship possible through their generous sponsorship.

The fellowship, a collaboration with the Ohio State University College of Veterinary Medicine, spanned three years and will culminate in Schaefer being board-certified by the American College of Veterinary Emergency and Critical Care. Schaefer will fill one of two new faculty positions generated by the program alongside Sarah Dukti, clinical assistant professor of emergency and critical care, who joined the equine medical center in March.

Philanthropic support was sought to cover three-year bridge funding to launch the emergency and critical care team. Schaefer and Dukti, both emergency-focused and highly trained clinicians, will be on-call day and night to cover emergency and critical care services and will be supported by the centers clinical staff. This dedicated team will allow clinicians to focus on outpatient appointments and elective surgeries, mitigating sometimes lengthy wait times for these services.

A generous and committed supporter of equine medical center shared her desire for all equine-focused veterinarians to have a sustainable work-life balance. Her passion encouraged her and her husband to commit support for the initial three-year bridge funding of $1.5 million to stand up the service, which is expected to be self-sustaining by the end of the three-year term.

The donor explained her reasons behind her decision to support the field of equine emergency and critical care Emergency equine medical care is at the epicenter of the crisis in veterinary medicine. I have watched with increasing dismay, then alarm, as our horses finest care providers have left equine medicine for saner, more predictable, better-paid small animal practices or positions in government.

Constant on-call demands with no let up on daily duties leave new (and not so new) veterinarians emotionally drained and physically exhausted, too often questioning their choices. Equine veterinary medicine is a calling for the practitioners I know, and they are leaving the field with regret. As a client, as the mother of a veterinarian, I can see that we need radical new thinking about the structural context that sets up emergency medicine not only for successful outcomes but for successful and sustainable careers.

I am so proud of the work EMC has done to reimagine this context, and of the courage Mike Erskine and his team have shown in their willingness to lead the way to make emergency medicine the exciting career choice it should be.

As part of the Virginia Maryland College of Veterinary Medicine, the equine medical centers mission is to offer excellent and compassionate clinical services to horses and their owners while still focusing on the education of veterinary students, clients, and equine veterinary professionals. Introducing the emergency and critical care team will allow the center to continue to fulfill this challenging mission.

Read the original here:

Sustaining emergency and critical care services through an equine ... - Virginia Tech Daily