Category Archives: Emergency Medicine

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Attention Deficit Hyperactivity Disorder (ADHD) is a condition characterized by functionally impairing levels of poor focus and/or hyperactive-impulsive behavior. While initially thought of as a childhood disorder, studies have shown that in 60% of cases, symptoms persist into adulthood. It affects 3% to 5% of adults. This perspective piece aims to highlight the occurrence of ADHD in medical learners (ie, medical students and residents) and practicing physicians. It reviews what has been published about the prevalence of ADHD in these groups, why the rates in residents and practicing physicians may be higher than what has been reported in the scientific literature, the consequences of untreated ADHD in these groups, and a potentially helpful, innovative educational tool to help medical learners and physicians with ADHD with an important aspect of their training and practice the reading of scientific articles. Dr. Ims team concludes that although it has received less attention in the scientific literature than depression, anxiety, and burnout in medical learners and physicians, ADHD has numerous and significant consequences for these individuals that can have a negative effect on medical training, practice, and ultimately patient care. This makes it imperative to support medical learners and physicians with ADHD via evidence-based treatments, program-based accommodations, and innovative educational tools.

The multiple challenges, physical and emotional, associated with pursuing a career in the medical profession are well-documented.1,2 Recent studies have documented significant rates of depression, anxiety, psychological distress, and burnout among medical students,35 with some research noting higher rates of these conditions among medical students (58% depression, 27.233.8% anxiety, 49.6% burnout) compared to age-matched population samples.68 Significant rates of depression, anxiety, and burnout have also been reported among medical residents (7% to 47% depression,915 18% to 56% anxiety,918 and 37% to 85% burnout)9,1114,19 and practicing physicians (22% to 40% depression,6,9 44% anxiety,9 and 37% to 73% burnout).6,9

While increasing attention has been appropriately paid to these concerning levels of depression, anxiety, and burnout in medical students, residents, and practicing physicians, comparatively little attention has been devoted to the occurrence of symptoms of attention deficit hyperactivity disorder (ADHD) in medical learners and physicians. ADHD is a neurodevelopmental disorder characterized by a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development.20 Symptoms of ADHD can include not seeming to listen when spoken to, easy distractibility, forgetfulness, making careless mistakes in work or school, procrastination, difficulty sustaining attention, difficulty completing tasks, excessive fidgetiness or restlessness, impulsivity, becoming easily bored or impatient, and blurting out answers or interrupting others.20 Although originally conceptualized as a childhood disorder, research has shown that ADHD persists in up to 60% of adults who experienced symptoms as children.21 Evidence from genetic, neuroimaging, and neurological studies reveals difficulty in executive functioning in ADHD associated with lack of availability of dopamine and norepinephrine in the prefrontal cortex.2225

The purpose of this perspective piece is to highlight the occurrence of ADHD in medical learners and physicians, including its reported prevalence in these groups, why reported rates may reflect underestimates, consequences of untreated symptoms, accommodation-based interventions to date, and a potentially helpful innovative educational tool to assist with a vital aspect of their medical training and practice.

While several studies have reported on the prevalence of ADHD in medical students,2632 some of these studies focused primarily on the non-medical use of prescription stimulants rather than on ADHD per se,3032 and the published literature on ADHD in medical residents and practicing physicians is scant. For example, for medical students, disability-related registry data from the Association of American Medical Colleges (AAMC) suggest an ADHD prevalence of 0.9% to 1.4%,4,26 while other studies, mostly employing self-report methodology, have reported prevalence rates of 3.5%,27 4.5%,28 5.5%,30 9%,31 12.7%,32 and 24.4%.29 For medical residents, rates of ADHD are largely unknown; one survey of emergency medicine residency program directors33 noted that 3 of 4644 (0.06% of) residents were known by program directors to have ADHD. Another study, also a cross-sectional survey of emergency medicine residency program directors,34 noted that 4 of 104 programs reported having one or more residents with known disability due to ADHD. For practicing physicians, data from the 2019 AAMC National Sample Survey of Physicians indicate a prevalence of ADHD of 0.32%.35

At first glance, the lower reported rates of ADHD in medical learners (particularly residents) and practicing physicians compared to published rates of depression, anxiety, and burnout in these groups and compared to ADHD prevalence estimates of 3% to 5% in the general adult population36,37 - may seem intuitive, since having ADHD would ostensibly constitute a significant barrier to successfully completing the rigorous level of focused study, clinical rotations, scholarly activities, and other tasks necessary to complete medical training. In essence, then, it could be argued that medical residents and practicing physicians represent a sample that is pre-selected not to have ADHD.

However, five factors warrant consideration before presuming that rates of ADHD among medical residents and practicing physicians are sufficiently negligible to obviate concern about this diagnosis in these groups. First, it is possible that a significant number of medical residents and practicing physicians with a confirmed diagnosis of ADHD do not report having this diagnosis out of fear of being stigmatized or scrutinized by colleagues or supervisors, or because of concern about legal or licensing ramifications.38,39 Second, many medical residents and practicing physicians, despite long experiencing symptoms of ADHD, may not seek formal evaluation and treatment for these symptoms, either because of lack of recognition by themselves, family members, or friends that these symptoms represent ADHD (eg, symptoms are exclusively attributed to personality traits or are dismissed because the individual was accepted into medical school) or an internal belief that as a future or current medical provider, having a neurodevelopmental disorder warranting treatment is unacceptable.3941 Third, even when medical residents and practicing physicians do seek evaluation and treatment for ADHD, they may face resistance by mental health providers to diagnosing and treating the condition due to cognitive and affective biases on the part of psychiatrists about prescribing medications like stimulants.42,43 Fourth, as with many mental health conditions, significant inter- and intra-individual variability affects assessment of severity and functional impairment of ADHD symptoms,44 and many medical residents and practicing physicians, prior to medical training, may have compensated for ADHD symptoms by relying on strong intellectual ability, the flexibility of teachers/professors, the support of significant others, and selected areas of study or activities that either provide a level of structure protective against academic, athletic, or social floundering, or are sufficiently void of tight deadlines and/or the need to regularly prioritize or multi-task that goals are achieved successfully despite the presence of inattentive symptoms.38,40 These compensatory mechanisms then become challenged when the volume and complexity of material to be learned and applied increase dramatically during medical training.38,44,45 Finally, although varying across studies, reported prevalence rates of ADHD in medical students27,28,3032 are comparable to rates in the general adult population, making a precipitous drop (on the order of 1015 times less) in such rates among residents and practicing physicians difficult to reconcile.

The consequences of experiencing untreated ADHD symptoms, while not extensively studied for medical learners and providers, are likely numerous and significant for these groups, if we extrapolate from general studies in adults with ADHD.21,37,46 These conceivably include difficulty engaging in effective and efficient study, poor academic performance,47 tardiness for or absence from clinical duties (due to forgetfulness or disorganization),43 poor sleep (due to inefficient completion of coursework, poor time management, and baseline sleep difficulties associated with having ADHD),44 relationship difficulties (due to inattentive or impulsive symptoms causing conflicts or less dedicated free time),21 secondary anxiety,21 secondary depression,21 and increased substance use as a means to manage poor focus, sleep deprivation, or stress.21 Moreover, one study found that medical students with ADHD (among other cognitive/learning disabilities), compared with matched cohort controls, had lower United States Medical Licensing Examination (USMLE) Step 2 scores, were less likely to graduate on time, and were less likely to match into a residency program on their first attempt.48 Ultimately, untreated ADHD symptoms in medical learners and providers have the potential to adversely impact patient care, if knowledge and skills critical to serving as a competent physician are not mastered (for students and residents), if careless mistakes are made in the process of performing procedures, interpreting test results, or prescribing medications (in the case of residents and practicing providers), or if associated depression, anxiety, substance abuse, or burnout hinder sufficient motivation, concentration, energy, and persistence to provide medical care.

Research suggests that even when adults are properly diagnosed and treated for ADHD, over time about half of them discontinue treatment (specifically stimulant medications, the first-line treatment for ADHD), with the most common reason being lack of perceived effectiveness.49,50 This underscores the need to not only increase awareness of the possibility that symptoms of ADHD may adversely impact the lives of some medical learners and providers, but to develop effective, durable interventions to support these individuals during and after their medical training.

Accommodation-based interventions for medical students and residents with ADHD, guided by interpretations of the Americans with Disabilities Act (ADA) of 1990 and subsequent Americans with Disabilities Amendments Act (ADAAA) of 2008, have been reported or suggested in the literature to include task management strategies (such as detailed instruction and templates for guiding task completion), environmental modifications (such as quiet, distraction-free environments for testing, learning, charting, or phone calls), and self-management strategies (such as frequent reorientation to tasks, pacing of workflow, use of timers and alarms to help with time management, and scheduling explicit time each day to organize tasks using tools like checklists and filing systems).21,51 Other accommodation-based strategies have included direct daily feedback to residents regarding time management, task prioritization, and areas for improvement, review of daily task lists by residents, guidance by the resident to staff members as to when and how to provide instruction and non-urgent teaching, assistance by faculty for residents to develop a comprehensive reading plan, time allowance by faculty for residents personal health-care appointments, and coordination between residents care providers, program supervisors, and residents regarding helpful accommodations and any changes in these over time.52

While these accommodations have likely provided significant benefit to medical students and residents struggling with ADHD, little to no mention is made in the literature about one particular task area that is a crucial part of medical training and practice, and likely an area of challenge for learners and physicians with ADHD: the reading of scientific articles.

Scientific article reading and application of information contained therein has long been part of training and practice in many disciplines, including medicine. At the medical student level, it may receive less emphasis compared to textbooks, course packs, and pocket reference guides, but the practice may gain more salience during clinical rotations, when attending physicians either ask medical students about their knowledge of the literature in a given area or provide brief teaching points during rounds that reference recently published studies. At the resident level, scientific article reading becomes more important, as two of the general competencies that residents are expected to demonstrate based on the Accreditation Council for Graduate Medical Education (ACGME) guidelines,53 medical knowledge and practice-based learning and improvement, require that residents appraise and evaluate scientific evidence and demonstrate knowledge about established and evolving biomedical, clinical, and cognatesciences and the application of this knowledge to patient care, respectively.21 These skills can practically come into play when residents staff cases with attending physicians, during which time there is discussion about evidence-based approaches to patient care and any recent changes in the relevant evidence base. For practicing physicians, scientific article reading is often required to meet continuing medical education (CME), self-assessment, and cognitive component requirements for board re-certification as dictated by the American Board of Medical Specialties.54 It is also an integral part of conducting research, which, for physicians in academic settings, is either a requirement of employment (for tenure track faculty) or a partial requirement for promotion (for clinical or instructional track faculty).

While the specific content of scientific articles varies based on medical specialty, subspecialty, journal featuring the article, writing style of the author(s), and other factors, these articles generally have several features in common that may pose challenges for medical learners and physicians with ADHD. First, scientific articles are often lengthy, typically spanning several pages. It is well-documented that individuals with ADHD struggle with sustained attention, particularly with subject matter that is experienced as more mundane and not personally stimulating (eg, a resident or faculty member needing to read an article that is outside their area of subspecialty interest).20 Second, scientific articles are typically written in the third person style, which avoids use of I or you pronouns, providing less immediate engagement for readers in general and becoming problematic for individuals with ADHD, who are more inclined to become easily bored due to under-release of dopamine and norepinephrine in the prefrontal cortex.2225 Third, scientific articles frequently contain jargon or concepts that are not immediately comprehensible to readers who are unfamiliar with the particular subject matter of those articles. Neuropsychological studies have shown that adults with ADHD exhibit poorer performance on tasks higher in complexity or time requirements, as would characterize the reading of scientific articles containing jargon or concepts needing clarification via looking up of such terminology;55 moreover, recent studies have suggested impaired reading comprehension abilities in ADHD, with particular difficulty picking out main ideas from material that is read.56 Fourth, scientific articles are presented, with rare exceptions, in small-font text format with minimal illustrations. Neuropsychological studies have revealed that adults with ADHD struggle with tasks requiring use of verbal memory (responsible for encoding much of information presented in written form), focused attention, sustained attention, and abstract verbal problem solving with working memory.57 As a result, it has been recommended that individuals with ADHD have information presented to them in multimodal (eg, visual and auditory) forms and in a well-structured and highly interesting way in order to engage interest, avoid waning of attention, and enhance encoding and consolidating of memory processes.58 Most of these methods of information presentation are not provided by scientific articles.

Given the likely aforementioned numerous challenges associated with reading scientific articles for medical learners and physicians with ADHD, and the already heavy demands on time, concentration, energy, and sleep for medical learners and providers in general (making timely, consistent, and thorough reading of scientific articles challenging), we propose the development of an innovative educational tool for presenting relevant information from scientific articles. This consists of a 5-minute recorded video summary in which an engaging speaker presents the relevant information from a scientific article using a brief PowerPoint (Microsoft Corporation, Redmond, Washington, United States)59 presentation shared using videoconferencing (eg, Zoom [Zoom Video Communications, Incorporated, San Jose, California, United States])60 technology. Use of a limited number of slides, underlining, bolding, and graphics when possible are employed to highlight the salient aspects of the visually presented information, and regular eye contact, engaged facial expression, variable vocal tone, and insertion of periodic commentaries similarly are used to de-monotonize verbally expressed material. Information is thus presented in both written and oral form, providing visual and auditory engagement of the learner, while keeping the session brief to prevent waning of attention over time. The recording would be captured in a video file that can be easily accessed from the learners desktop computer, laptop computer, smartphone, or other electronic device, and can be listened to (without being viewed) while exercising, driving, or engaging in other activities for convenience. The recording can be paused, stopped, re-wound, and re-played at the learners convenience (eg, to clarify content that may have been missed the first time, or to review particularly complex material), in line with the benefit of repeating presentation of instructions or other information to individuals with ADHD to address forgetfulness, distractibility, or difficulty following through. The video summary, while brief, would allow presentation of information on study limitations, discussion points, and other material that would not typically be captured in article abstracts.

One might question how the 5-minute video summary (5MVS) differs from the use of video abstracts offered by some scientific journals. Key differences include: (1) Video abstracts provide a video summary of the background, methods, results, and conclusions of the article being presented a visual form of the article abstract, as the title implies. The 5MVS, however, includes not only these elements of the article, but discussion of the strengths and limitations of the article via commentaries designed to enhance reader engagement. The longer duration of the 5MVS (five minutes) compared to video abstracts (typically one to three minutes) facilitates this inclusion of additional information. (2) Video abstracts are typically presented by the author(s) of the featured article, to provide an overview of the research from the standpoint of the authors, who presumably are in the best position to describe the context, motivation, and intent behind the study. The 5MVS, on the other hand, is presented by a physician who is not one of the articles authors, providing potentially greater objectivity in disseminating the articles findings, particularly with use of commentaries on the strengths and limitations of the article, as noted above. (3) While both video abstracts and the 5MVS can be viewed by any medical learner or physician, the 5MVS is specifically designed to help medical learners or physicians with ADHD through intentional use of visual enhancements (such as text bolding, underlining, italicizing, coloring, and use of easy-to-follow pictures and schematics), engaged facial affect, variation in vocal pitch/tone, and insertion of periodic commentaries, with the goal of capturing and maintaining attention through multiple modes of information presentation. (4) Video abstracts are customarily offered by the scientific journals featuring the articles on which the video abstracts are based, as a means of enhancing reader interest in the articles featured, whereas the 5MVS would be made available independent of an articles particular journal affiliation, with the goal of providing readers with ADHD an avenue to process and retain the important content of scientific articles more effectively and efficiently.

The effectiveness of the 5MVS tool could be assessed via real-time and cumulative approaches. Real-time approaches could entail including a limited number (eg, three) of multiple choice questions at the end of the 5MVS designed to assess understanding, retention, and application of the material presented, with responses by each individual viewer (including percent correctly answered) tracked and recorded in a central database, akin to how retention of material from maintenance of certification articles is assessed and tracked by the American Board of Medical Specialties.54 Cumulative approaches could involve, for example, assigning a group of residents with ADHD six articles to read in four weeks; half of the residents would have access to 5MVSs of these articles, and half would not (all residents would have access to the full-length articles, which could feature topics relevant to the medical field but unlikely to have been previously read by the residents). The two resident groups could be matched on demographic, specialty, ADHD severity, comorbid psychiatric and learning conditions, and other variables. At the end of the six weeks, the residents would take a multiple-choice quiz designed to assess understanding, retention, and application of material from the six articles. Those who had access to the 5MVSs could then be compared to those who did not in terms of quiz scores.

One might question the utility of the 5MVS in terms of helping medical learners and physicians to critically appraise scientific literature, rather than merely read it. Two points are noteworthy here: (1) The 5MVS includes commentaries by the presenter regarding the strengths and limitations of the article, to both increase engagement of the viewer as well as encourage the viewer to critically evaluate the articles findings; and (2) The 5MVS is not intended to replace other approaches aimed at encouraging medical learners and physicians to critically assess scientific literature, including the use of journal clubs, workshops, clinical and methodological critiques, listserv discussions, and other approaches.61,62 That stated, to the extent that some of these approaches utilize articles or other formats that may lend themselves to video summarization (eg, workshops, clinical and methodological critiques), the 5MVS could prove valuable in helping medical learners and physicians with ADHD improve their development of critical appraisal skills.

Residency training programs and medical institutions could provide training of interested providers (perhaps residents and faculty with a passion for teaching) in the construction and implementation of the 5MVSs, incorporating the aforementioned elements to optimize the educational experience for all learners, including those with ADHD. One potential barrier to this would be time constraints on the part of busy residents and faculty physicians. This might be addressed by providing a certain percentage of protected time for residents and/or faculty members to devote to the creation of this tool for learners. Another potential barrier could be technology constraints, although most academic institutions currently have the capability of employing videoconferencing technology, and current costs associated with acquiring such technology do not appear prohibitive for most organizations.63 It would also be important to achieve an acceptable balance between making a presentation stimulating and engaging (through use of visual techniques, tone of voice, insertion of commentaries, and other methods as above) and maintaining objectivity in how scientific information is presented, so as not to inadvertently introduce bias in presentation of the material.

While receiving less published attention than depression, anxiety, and burnout, untreated ADHD in medical learners and physicians has numerous and significant consequences that can adversely impact training, practice, and ultimately patient care. Standard, first-line treatments for ADHD (ie, stimulant medications) provide benefit, but nearly half of adults with ADHD discontinue treatment over time due to lack of perceived effectiveness, and accommodation-based interventions, while helpful and important, do not specifically address a crucial facet of medical training and practice the reading of scientific articles. We propose an innovative educational tool for helping medical learners and physicians with ADHD acquire relevant information from scientific articles, taking into account constraints imposed by the disorder and learning approaches that are more likely to be effective in light of these challenges. Future research should examine both the perceived effectiveness of this tool among medical learners and providers with ADHD who have used it and objective data (using validated measures of information comprehension, retention, and conceptual application) comparing the effectiveness of this tool with standard approaches to the reading of scientific articles. As noted by Duong and Vogel (2022),39 a growing community of physicians is challenging the notion that neurodivergence (defined as having a neurodevelopmental condition such as ADHD that may produce challenges functioning in a neurotypical society but may also offer strengths) is incompatible with a medical career, particularly if individuals with these conditions are properly supported via evidence-based treatments, program-based accommodations, and innovative educational tools.

The authors report no conflicts of interest in this work.

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Emergency Medicine

I’m an ER pediatrician. Here are 7 things I never let my kid do – TODAY

March 15, 2023 medical

Kids will be kids, and accidents happen, but certain activities carry more risk than others. Injury is still the leading cause of death for children and teens in the United States, according to the U.S. Centers for Disease Control and Prevention, and unfortunately, many of these are preventable.

We spoke to pediatricians who are also parents about things theyd never let their children do because of the heightened risk of injury or death, and how to make sure your child is as safe as possible.

Motor vehicle crashes are a leading cause of unintentional injury and death in the U.S., per the CDC. Children should always be in the backseat with the proper restraints, the experts note.

This means using the appropriate size and type of restraints whether thats a car seat, booster seat, seatbelt for their age, height and weight, Dr. Brent Kaziny, medical director of emergency management at Texas Childrens Hospital, tells TODAY.com.

While it may be obvious to buckle up younger children, parents also need to be vigilant about school-aged children and preteens, the experts say.

Even if a child seems large enough to ride in the passenger seat, stick to this hard and fast rule. My kids will not ride in the front seat before the age of 13, which is the recommended age that kids can move to the front, Dr. Katie Lockwood, a primary care pediatrician at Childrens Hospital of Philadelphia, tells TODAY.com.

The (front) airbags are potentially dangerous to children, whose skeletons are still developing and arent the right size to be in the front, says Lockwood, adding airbags can cause rib fractures, punctured lungs and injuries to the head, neck and spine.

No matter how much pressure kids put on their parents because their friends ride in the front, Lockwood stresses that 12-year-olds and younger go in the back, no matter how short the drive.

Unfortunately, the highs of this beloved backyard accessory may not be worth the lows. Some trampolines are riskier than others, the experts say.

Dr. Ee Tay, apediatric emergency medicine specialist at Hassenfeld Childrens Hospital at NYU Langone, tells TODAY.com that public trampolines or trampoline parks are out of the question for her kids. Theres just so many broken bones and orthopedic injuries, says Tay, adding that the uncontrolled environment and greater number of kids increases the risk of collisions and falls.

It depends on the weight of the child, how hard they can bounce, how high they can jump, if theres another child next to them. ... Its just very unpredictable, says Tay. Other trampoline-associated injuries include lacerations, concussions and spinal injuries.

While he does see many trampoline injuries, Kaziny says he thinks there are ways to do it safely. Trampolines that are in-ground or have enclosure nets are safer, and parents should always supervise trampoline sessions, minimize the number of kids jumping at once, and make sure there aren't significant differences in age or weight among kids, says Kaziny. (The same applies to bounce houses.)

The American Academy of Orthopaedic Surgeons recommends children under 6 do not use trampolines at all, and the American Academy of Pediatrics recommends children only use them in supervised training programs for gymnastics or other sports.

My kids will never, ever go on an ATV. ... They are so dangerous, says Tay, adding that the all-terrain vehicles cause many preventable accidents among children. This applies to both riding and driving ATVs, though most are built for just one person.

Motor sports have become increasingly popular in the U.S., and ATV-related injuries are on the rise, TODAY.com previously reported.

ATVs do not require any training or a license, Tay points out, and children often dont have the ability to properly judge speed or distance. They just kind of go at it, says Tay. The heavy machines can also flip easily.

Although ATVs do come in youth sizes, Kaziny says he commonly sees parents get an ATV that the child won't outgrow too quickly. The child ends up being on something thats really not age appropriate ... from a size and power perspective, says Kaziny.

The AAP recommends that no one under the age of 16 ride or operate an ATV, and that this is the most effective way to reduce ATV-associated injury or death.

If parents choose to let their child ride an ATV, Kaziny recommends making sure it is age-appropriate, the child is wearing a helmet and other protective equipment, and that they follow safety measures.

Drowning is another leading cause of unintentional injury among children. More children ages 1 to 4 die from drowning than any other cause of death (per the CDC), says Lockwood, adding that these often occur in swimming pools but also bathtubs (especially among infants) and natural water sources.

The experts encourage parents to teach their children how to swim as early as possible but even after kids learn, parents should remain vigilant and set rules.

As kids get older and they know how to swim, they have increased confidence," which can lead kids to take more risks, such as swimming alone, Lockwood says. So it's important to remember your child can still drown, even if they know how to swim.

I teach my kids from a young age not to swim alone and that they should always have an adult whos watching them, Lockwood continues. She stresses parents should ensure there is always one designated and sober "water watcher."

Even if the child is swimming in their own pool at home, the experts warn that tragedies can happen. Its shocking how quickly a kid can end up getting themselves in trouble if youre not really paying attention, says Kaziny. He recommends that all home pools should have child-resistant barriers, like locking gates.

I dont let my kids ride anything with wheels without wearing a helmet, says Lockwood. This includes bikes, scooters, skateboards, rollerblades and hoverboards.

"Kids have a disproportionately large head compared to their body, so theyre more likely than adults to fall and hit their head," explains Lockwood. Resulting injuries range from bumps and lacerations to concussions and severe brain bleeds that cause permanent damage.

Tay agrees: There are too many injuries that we see in the ER for something that can be very easily prevented with (head) protection.

Children should also wear helmets while skiing, snowboarding, ice skating, horseback riding and during water sports. "If they make a helmet for it, you should wear one," says Kaziny.

Lockwood encourages parents to remind children that no matter how good they are at something, accidents happen and other people can cause crashes.

"I also try to model that good behavior by always wearing a helmet myself," adds Kaziny.

Parents can prevent a lot of ER visits by teaching kids how to behave appropriately around animals, especially ones they do not know.

We have a rule at my house. ... If we see an animal we want to interact with, that we do it in a safe and controlled way and make sure the owner is OK with it, says Kaziny.

Children may feel more confident approaching animals if they have pets at home, but Kaziny recommends teaching kids about boundaries with animals. For example, a child cant kiss or hug any dog because they do this to their own dog.

One of the common types of injuries that we see is when the child gets right up in the animal's face then the child gets bitten on their face, says Tay, adding that she also sees bites occur when children approach an animal while it is eating.

"I would not let my kids go to someones house without verifying if they own guns, and if they do that theyre safely stored," says Lockwood. Safely stored means they are locked in a safe and out of reach of children which is especially important as kids get older and hang out without parental supervision, she explains.

Firearm injury has now exceeded motor vehicle collision injury as a cause of child mortality, Dr. MarcAuerbach, professor of pediatrics and emergency medicine at Yale School of Medicine, tells TODAY.com. Unfortunately we have seen a large number of both unintentional firearm injuries and in the older child or teenage population, related to suicide or homicide."

Fortunately, firearm-related injuries and deaths in children are preventable, says Kaziny. Families that own firearms should always practice firearm safety and store them appropriately, and parents should feel empowered to ask about firearms in any home their child will be.

Auerbach also encourages parents to have early conversations with children so they can really understand how dangerous and life-threatening firearms can be.

Caroline Kee

Caroline Kee is a health reporter for TODAY Digital. She previously worked for Healthline and Buzzfeed News.

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I'm an ER pediatrician. Here are 7 things I never let my kid do - TODAY

Emergency Medicine

Over 550 Emergency Medicine Positions Unfilled in This Year’s Match – Medpage Today

March 15, 2023 medical

In this year's Match, 555 positions in emergency medicine went unfilled -- more than double the 219 unfilled positions last year and only 14 unfilled spots in the 2021 Match, according to preliminary data.

This year's data were shared across social media but not officially by the National Resident Matching Program (NRMP), and most of the spots will likely be filled in the Supplemental Offer and Acceptance Program (SOAP). Nonetheless, emergency medicine physicians are concerned about the recent trend.

"It's a radical change," said Robert McNamara, MD, chair of emergency medicine at Temple University in Philadelphia and chief medical officer of the American Academy of Emergency Medicine (AAEM). "If you go back 3 or 4 years, emergency medicine was one of the most competitive specialties."

The reasons for the jump in unfilled positions -- the exact spots and programs were also posted on social media -- are multifactorial, according to a joint statement from several emergency medicine groups published on the American College of Emergency Physicians (ACEP) website. Reasons include workforce projections, increased clinical demands, emergency department boarding, economic challenges, the COVID-19 pandemic, the corporatization of medicine, and others.

"It's still a great profession, we just don't have the narrative we did 15 to 20 years ago," said Ryan Stanton, MD, an emergency medicine physician in Lexington, Kentucky, and an ACEP board member. "It's a negative narrative. We hear about struggles with payers, and threats of continued cuts. Students listen to that."

McNamara placed special emphasis on workforce issues -- in particular, a study by ACEP that warned of future challenges with emergency physician oversupply -- and on the increasing involvement of corporate entities.

"Emergency medicine residents always have among the highest debt of any specialty," McNamara said. "They have a strong sense of social justice and often don't come from privileged backgrounds ... so they're likely to accumulate debt."

Residents carrying a lot of debt who suspect they won't be able to get a job when they graduate may be deterred from entering the specialty, he noted.

Additionally, fewer graduates are finding placement with physician-owned groups, and instead more are working for corporate entities, which can impact physician autonomy, he added.

"Doctors who work for these companies don't like it," McNamara said. "They're burning out. They get treated like a money-making machine, like a cog in the wheel. ... Emergency medicine is a 24/7/365 specialty, and with the nature of the things we see, you can't do a difficult specialty long-term if you feel someone is taking advantage of you."

Facilities have created more emergency medicine residency spots in recent years, he pointed out, noting that, in a way, the specialty is a victim of its own success. "Once you attract talented doctors, you want more," he said. "Some hospitals say, wow, they have an emergency medicine residency, I want one too. We just created too many."

He said it's not just corporations pushing to create new positions, but academic centers as well.

Stanton was particularly concerned about the creation of new residency positions. "There are no guardrails on the number of programs, whether they're produced by HCA or the expansion of academic programs," he said. "You can open up a residency program as long as you meet ACGME [Accreditation Council for Graduate Medical Education] criteria."

"A residency program is not a cost-effective staffing strategy. It is an educational opportunity," he added. "Any program expanding simply to find a cheap workforce is doing it for the wrong reasons."

Bryan Carmody, MD, of Eastern Virginia Medical School in Norfolk, who posts frequently about Match data, noted in a blog post last fall that even while emergency medicine residency positions are up -- they more than doubled in the past 15 years -- the number of applicants took a significant dip last year, and fell again in this year's Match cycle.

"Regardless of why, the what is clear," Carmody wrote. "There are unquestionably fewer emergency medicine applicants. So the next question is, if you care about emergency medicine, what -- if anything -- should you do about it?"

In the joint statement, ACEP, AAEM, and others noted that they convened a Match Task Force to identify the factors that have led to the increase in unfilled positions, and to develop a strategy to mitigate the crisis.

"Although these are challenging results, emergency medicine remains a vibrant and appealing specialty for many, with almost 2,500 new trainees already joining the emergency medicine family," the group wrote.

McNamara said there are no easy solutions. "We have to restore emergency medicine to a practice where physicians can enjoy the job," he said. "It's not going to be good for a while."

Kristina Fiore leads MedPages enterprise & investigative reporting team. Shes been a medical journalist for more than a decade and her work has been recognized by Barlett & Steele, AHCJ, SABEW, and others. Send story tips to k.fiore@medpagetoday.com. Follow

Over 550 Emergency Medicine Positions Unfilled in This Year's Match - Medpage Today

Emergency Medicine

Libyas Emergency Medicine and Support Center serves the people affected by the Turkeys Stricken Areas – EIN News

March 15, 2023 medical

LIBYA, TRIPOLI, March 14, 2023 /EINPresswire.com/ -- The Emergency Medicine and Support Center (EMSC) is a specialist center responsible for the provision of humanitarian assistance, medical care, and relief aid to people affected by war and natural disasters, in addition to the treatment of wounded victims and providing healthcare to all with impartiality.

Upon the instructions of His Highness, the Prime Minister of the National Unity Government, EMSC strives to provide medical care and relief aid to people affected by Turkey's stricken areas. The EMSC worked, together with the National Safety Authority, the Criminal Investigation Department, the Medical Treatment Support and Development Agency, and the Military Medicine Division, to dispatch a joint team for relief and rescue consisting of 106 medical and paramedical personnel. The team is divided into four groups and serves as humanitarian assistance.

The first group was stationed in Adana province and was assigned the task of coordinating logistics and follow-up.

The second group stationed in Jumhoriet district, Antakya, and Hatay province also contributed to rescue operations. The group recovered 69 bodies and pulled out six people alive. The location of 380 bodies was also determined, and the relevant Turkish authorities were informed.

In all duration, coordinates were provided to the authorities and were used by other foreign agencies to recover the bodies.

The third group was stationed in the Hattay Field Hospital, where first aid, advanced medical aid, resuscitation, and minor operations were provided to more than 600 cases. The group was the only one that worked hand in hand with Turkish personnel.

In addition, the fourth group conducted a field investigation of cases in camps set up for the displaced people near the epicenter of the earthquake in Jumhorit, district of Hatay Province. The group provides treatment and medication to more than 40 patients inside the aforementioned camps.

About Emergency Medicine and Support Center:

The Emergency Medicine and Support Center (EMSC) is a specialist center that provides services for the provision of humanitarian assistance, medical care, and relief aid to people affected by war and natural disasters such as flood disasters and earthquakes. Additionally, to the treatment of wounded victims and providing healthcare to all with impartiality. Consequently, the Libyan team, which consists of EMSC personnel, focuses on the treatment of Syrian cases as well as Arabic-speaking Turkish patients and other cases in general.

http://emsc.ly/

Tarek ElhamsharyEmergency Medicine and Support Centeremail us here

Libyas Emergency Medicine and Support Center serves the people affected by the Turkeys Stricken Areas - EIN News

Emergency Medicine

In rural Mississippi, E.R. staff are being trained to care for moms and deliver babies – WBHM

March 15, 2023 medical

Two medical teams wait patiently in the hallway outside of a hospital room at theMississippi Center for Emergency Servicesat the University of Mississippi Medical Center in mid-February. Its quiet as they slip on blue gloves and consult with their team on tasks. One will help the mother. The other will receive the baby.

Dr. Tara Lewis presents todays patient and students listen carefully as she lays out the scenario, making note of the patients age, symptoms and whats missing from her chart. Then, as the patient Victoria Tubby screams through the door, they ready themselves. Its time to deliver a baby.

But this is no ordinary hospital room, and Victoria is no ordinary patient. For starters, shes not a real person. Shes a high-tech mannequin that simulates a woman in labor. She bleeds, screams and has a removable belly and placenta.

And the delivery of her baby a slippery, 5-pound doll is all part of aSTORK training simulationunderway at MCES.

As hospitals in rural Mississippi continue to cut maternal and neonatal services, residents are strapped to find options in an emergency like going into labor. The STORK programlaunchedin May to prepare paramedics and health care providers for those rising gaps in care.

Lewis, an emergency medicine physician, said the response to STORK has been overwhelmingly positive. At its creation, the plan was to teach 10 classes in a year, but demand turned it into two per month. By the end of the programs first year, more than 400 people will have attended a STORK session, whether at the MCES or at a hospital across the state.

The training had real-world effects almost immediately.

Weve had people reach out to us that we have trained that have delivered babies the next day in their E.R., Lewis said.

Giving birth in an emergency room doesnt seem ideal for most mothers, but across the Gulf States, hospitals have had todownsize, opting to preservecritical careover maternity care and leaving pregnant people to rely heavily on emergency services. Over the past year,as many as four hospitalshave suspended labor and delivery services the most recent being Singing River hospital in Gulfport, Mississippi.

We see people having to drive two to three hours to get obstetric health care in the Delta specifically, Lewis said.

Most of the Mississippi Delta qualifies as amaternity care desert, according to the latest March of Dimes report meaning there are barely any obstetric providers for mothers in the region. Mississippis poor health care system also affects babies. With only one childrens hospital in the entire state, even patients with the least critical care needs can expect to travel hundreds of miles.

Adam Bandy, whos part of the pediatric transport team at MCES, said long ambulance trips are common and his job can take him into some deeply rural areas.

Make sure you pack your lunch because were probably going to be gone for 5 to 6 hours on this trip, Bandy said. Thats a routine trip. Thats not if theres any kind of complications or if we have to provide any kind of next level of care.

Bandy points to hub cities, such as Jackson and Hattiesburg as having adequate facilities for patients, but in places like Greenwood or Gulfport, sometimes the nearest hospital with a pediatric unit isnt in the state.

Well go to Louisiana, Alabama [and] Tennessee on occasion, and we will transfer either from here to there, or we will bring them from there for resources since Jackson has the only childrens hospital in the state of Mississippi, he said.

Those resources can be hard to come by, so STORK provides each participant with a duffle bag packed with supplies to deliver a baby or stabilize a laboring mom. If the paramedic uses anything in the bag, STORK will replace it.

Bandy was present at the February STORK training, but it isnt his first time completing the course. He said its vital to keep those skills sharp. Lewis said STORK gives health care providers the opportunity to practice skills they may not use daily. The class is made up of paramedics, flight medics, and nurses, many of whom have never had to deliver a baby.

Before the simulation, students attend a lecture to learn how to stabilize a patient, stop a hemorrhage and intubate an infant emergency procedures that could mean life or death.

In the hospital room, they pay special attention to Victoria and check her and her babys vitals on a large screen. Victoria is responsive and offers feedback to her providers while they work. She can be affirming and grateful that theyve gotten the baby out, or can be difficult, yelling out dont touch me! She sometimes goes into shock, and its a scramble to then bring her back, but participants can practice as many times as they want.

She can simulate things like seizures, postpartum hemorrhage, pre-eclampsia, abnormal presentation of the baby, Lewis said. She does it all.

Students practice multiple best- and worst-case scenarios, offer fluids and medicine and support Victoria through labor. Everyone keeps a watchful eye to help her safely deliver her baby.

You can actually get your hands on it and catch a baby and do it multiple times because that repetition kind of helps educate people, helps you get that just muscle memory of what to do, Lewis said.

This story was produced by theGulf States Newsroom, a collaboration betweenMississippi Public Broadcasting, WBHMin Alabama,WWNO andWRKFin Louisiana andNPR. Support for reproductive health coverage comes fromThe Commonwealth Fund.

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In rural Mississippi, E.R. staff are being trained to care for moms and deliver babies - WBHM

Emergency Medicine

Grit and Goals: DFCM Resident Dr. Hayley Wickenheiser on the … – University of Toronto

March 15, 2023 medical

After a storied hockey career that culminated in being inducted to the Hockey Hall of Fame, Hayley Wickenheiser pursued another childhood dream: becoming a doctor. She traces her interest in the medical field to her youth, when one of her friends was badly injured after being hit by a truck. There were 30 kids in our neighbourhood, and wed go as a pack to check on her. I remember the doctors and nurses being very kind. We were little and they made it less scary for us. It was at that point that I got a real interest in medicine, says Wickenheiser, who is in her second year of residency at the Department of Family and Community Medicine at the University of Toronto.

Wickenheiser was named to the Canadian womens national ice hockey team at the age of 15 years, but despite being laser focused on the sport during her young adulthood, she felt a pull toward medicine. I always knew I needed a life after hockey and thought that would be a good one, says Wickenheiser, who is training to become an emergency medicine physician.

She will begin her enhanced skill year in emergency medicine at DFCM in July 2023. Wickenheiser says she chose to do her residency at DFCM because of the wide breadth of topics learned and for generalist training that would allow for maximum flexibility in her career. Against a backdrop of fewer graduating medical students ranking family medicine as their first choice when applying to residency, Wickenheiser says she is very happy with her decision. Family medicine is touted as less'sexy' than specialist training, but I think it's the best kept secret in medicine and one of the most underrated routes to choose. I have zero regrets about choosing DFCMit's been amazing. From awesome professional development to preceptor teaching, it's really a choose-your-own-adventure at times. I like that.

After announcing her retirement from the sport in January of 2017, she began medical school that same year at the University of Calgary. The transition was eased by years of preparation. For close to a decade before her retirement, Wickenheiser shadowed an emergency department doctor, which helped her realize her affinity for the specialty. I dont do well sitting all day long, she says. She is quick to rattle off the things that drew her to emergency medicine: Every patient encounter is different. You have to think quickly, work in a team and be very good under pressure. It feels very much like a team sport.

At that point, Wickenheiser, who is widely regarded as the greatest female hockey player of all time, thought she would be done with the sport. Then the Toronto Maple Leafs called a few months into medical school, she says, with a laugh. As an assistant general manager for the Leafs, Wickenheiser oversees 11 staff members and is responsible for the development of not only the franchise players, but of prospects and players from the Toronto Marlies and affiliate Newfoundland Growlers. My job is to make sure its a high-functioning department where were helping the players both on and off the ice to maximize their potential and get them prepared to be successful NHL players. If they already are a successful NHL player, then help them find that one per cent here and there that can elevate their game, she says.

Her workday varies depending on her clinical responsibilities, but in general, she wakes up early and heads to the rink for a workout or because of her duties with the Leafs. If she is doing a family medicine rotation, then she will work an afternoon or evening clinic. If she is doing a hospital-based shift that runs from 8 a.m. until late afternoon, then she will adapt her schedule accordingly.

Wickenheiser says the parallels between sport and medicine are striking. Everything I learned in hockey, I use every day, says the four-time Olympic gold medallist. Medicine is a team game. Youve got to think on your feet. Youve got to handle stress. Youve got to be physically at your best. She also says that using constructive criticism to enhance performance is another common theme. In medicine, youre being told what you need to improve on all the time. Being able to handle that in a productive way is very important to your development as a physician.

One big difference between these two worlds, however, has to do with self-care and wellness. As an athlete, youre celebrated for taking care of your body. In medicine, sometimes it feels like that should be the last thing you should be doing as a physician taking care of everyone else. I think its counter intuitive. Its something I think medicine has to get a lot better at, she says.

When asked what motivates her to stay on this difficult path, Wickenheiser, who grew up on a farm in rural Saskatchewan, says hard work is part of her identity. I dont think of myself as overly smart or special in any way, but one thing I hang my hat on as an athlete and what I do in medicine, is that Im confident I can outwork just about anyone. Its the one thing I know I can control in my life even when there are other things happening that I cant. You can always control your effort.

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Emergency Medicine

Quick take: Head-up CPR, drones and hypothermic emergencies – EMS1.com

March 15, 2023 medical

BOSTON The 30th annual National Collegiate EMS Conference was held February 24-26, 2023, in Boston. The conference included 13 workshop sessions, three plenary sessions, an academic poster session, hands-on skills labs, student lecture competition, BLS and ALS competition, and several social and networking functions for over 1,200 registrants from 112 colleges and universities across the United States and Canada.

Annual awards were presented to recognize outstanding achievement by collegiate EMS organizations and individuals, including:

Following are takeaways from several conference sessions.

Presented by N. Alex Cutsumbis, BS, NRP, a graduate of the SHRS Emergency Medicine Program, and an instructor for the University of Pittsburgh and Center for Emergency Medicine paramedic education programs

The idea behind heads-up CPR came about after analyses of the impact of CPR when tilting the body. It was found that contrary to expectations, head-down CPR outcomes were poor. It was theorized that tilting the head down would increase blood flow to the heart and brain from the force of gravity. What was found in animal experiments was that tilting the head down increased intracranial pressure and decreased cerebral perfusion pressure. By tilting the head up for CPR, the ICP fell and cerebral perfusion pressure increased by statistically significant levels. Long-term outcomes were improved.

Elevated CPR is performed with an impedance threshold device and using mechanical cardiopulmonary resuscitation with a device to elevate the head and thorax. A few EMS systems have been engaged in studies and Baptist Health became the first U.S. hospital system to adopt heads-up CPR.

Studies have been conducted on animals and in EMS systems, and there are some conflicting results. Results include an increase in cerebral blood flow, lower ICP pressures, and increased cerebral perfusion pressure. Generally, the studies have been finding a higher probability of ROSC and favorable neurological outcomes. More research is needed.

Presented by J. Dominic Singh, BA, NRP, I/C, staff advisor to UMass Amherst EMS, chief of operations for Spencer EMS, and a career firefighter/paramedic for Amherst Fire

Non-transporting EMS is common among organizations such as fire departments, quick response services and events EMS. Collegiate EMS often provides services to support sports, concerts and other campus activities not requiring transport services. Some of the considerations for non-transporting EMS include the gear needed, scene planning and planning for egress.

Gear considerations consist of managing immediate life threats and stabilization of the patient, (e.g., stop the bleed and airway supplies). Consider lightweight equipment, including handheld suction rather than electric suction pumps. A pulse oximeter with plethysmograph is handy to have. Gear should be portable as a fully stocked ambulance is not necessary for patient stabilization. Scene planning is important and based on the venue. Preplan egress to move a patient with consideration given for narrow stairs, tight hallways and other unique features found in the venue.

Presented by Tom Leith, AB, a fourth-year medical student at the University of Michigan

Drones and unmanned aerial vehicles (UAVs) are becoming more common with both hobbyists and in public safety. In addition to being used for video and surveillance, drones are being used to deliver equipment and supplies to the scene of an incident. As more advanced drones are developed, they may be used to transport patients in the future. Some of the items being delivered by drone include AEDs and medications. Delivery can be made to lay rescuers on the scene of an incident, to rural areas, for disaster medicine, and to remote areas in wilderness EMS and search and rescue. Use of drone delivery is low cost with potentially high reward. Studies suggest that improved delivery times can lead to improved quality of life years. Drone delivery of AEDs can be more flexible than fixed-point public access AEDs.

Responders in remote locations may not be able to carry an exhaustive supply of different medications. With the increase in opioid overdoses, one medication that can be delivered by drone is naloxone. Other medications that can be delivered as needed include benzodiazepines for acute seizures and blood. Rwanda is using drones to deliver blood. In search and rescue, drones can deliver food, water, clothing, shelter and rope rescue gear. Drones are also used for surveillance, including finding people in wildfires, in avalanches, and for maritime rescue using imaging and following radio transceiver signals.

Presented by Benjamin Abo, DO, P, EMTT, FAWM, an emergency physician and toxicologist, and assistant professor for Florida State University School of Medicine

The traditional infographics and posters for heat and cold injuries do not give complete information and can be misleading. For example, heat stroke should not be defined as when a persons body stops sweating and is red and dry. Heat stroke occurs when there is an altered mental status and high body temperature. Cooling on the scene before transporting the patient is critical to survival. One way this can be performed is through cold water immersion rather than simply placing ice packs in the armpits and on the groin. Use the body bag from the ambulance with bags of ice from a convenience store. Fill the body bag with ice and water from a fire hose. Stop the hyperthermic process and then transport the patient. Hypothermia, likewise, should be treated aggressively. Patients will lose core body heat through convection and to the ground through conduction. They need to be warmed up!

The annual NCEMSF conference is held the last weekend of February and rotates among several cities. Check http://www.ncemsf.org/conference for announcements for next years conference location, information on presenting and registration. Vendors, exhibitors, graduate medical and health school programs, and alumni are always welcome.

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Quick take: Head-up CPR, drones and hypothermic emergencies - EMS1.com

Emergency Medicine

Opinion | Emergency Doctors Are Ill Prepared to Handle Psychiatric … – Medpage Today

March 15, 2023 medical

More than four decades ago, an article appeared in the American Journal of Psychiatry defining the subspecialty of emergency psychiatry (EP). Since those early days, despite some research and consolidation into a new association complementing emergency medicine (EM), the impact on meaningful access to, integration with, and quality of care for psychiatric emergencies has been inconsequential.

In point of fact, one of the factors impeding progress in EP has been, in my opinion, the lack of momentum from the very entity professing support of the critically mentally ill.

Although the American Board of Psychiatry and Neurology offers 15 psychiatric subspecialty certifications, EP is not among those accredited core areas approved by the Accreditation Council on Graduate Medical Education (ACGME). Furthermore, the current ACGME EM residency program requirements do not specify that programs ensure residents have ample experiences treating psychiatric patients. Yet, the majority of EM residents believe, as do their psychiatric counterparts, that their program should offer more education on managing psychiatric emergencies.

Based on these unsettling facts, it appears that EM, as well as psychiatric residents, are expected, in the face of adverse clinical and supervisory experiences, to develop competent skills in treating psycho-behavioral conditions through onthejob training in the ED. Good luck.

Over the last 4 years, I have written about behavioral health emergencies including the simultaneous impacts of unusual presentations, inadequate assessments, stale methodologies, violence against staff, pandemic lockdowns, anaphylactic suicide, and an equation for suicidal lethality. I have introduced an American College of Emergency Medicine (ACEP)-specific and Centers for Medicare & Medicaid Services (CMS) supported algorithm for consistent improvements in risk medical decision-making with revenue cycle management benefits. I have emphasized that the number of behavioral emergency chief complaints, now estimated to be one in every seven patients of approximately 140 million annual U.S. ED admissions, demands competent triage, admirably fast stabilization, and staff safety. These collective educational and protective factors against increasing patient and ED violence, boarding, and burnout cannot be understated.

Clearly, the pathway to positive change in EP is a noble goal from afar, but oh what a mess we've made. The need to address the current U.S. mental health crisis and to climb to even higher levels of workforce supply and proficiency is considerable. But is it too little too late? In other words, is the opportunity for significant change in youth and adult mental healthcare going, going, almost gone?

It is now sadly possible to paraphrase the inimitable Yogi Berra's baseball imagery from "It is getting late early" to "It is now very late early."

The Demand Crisis

Dwindling Supply Coupled With Inadequate Proficiency

Suggestions

It is essential to establish psychiatric emergencies as the legal and medical equivalent of medical emergencies, advocate for ACGME accreditation of current and new EP fellowships, and promote improvements in resident recruitment and training. Clearly, readily available EP expertise represents both a need for the community and advancing the field, but it remains haphazard. Beyond these steps, how do we advance prompt practical ED solutions to meet some of the crisis demands outlined above?

Past recommendations have been plentiful but far less than promised. The following are two innovative paths with direct, measurable, judicious impacts on demand and proficiency.

First, community EDs, with EP input, must immediately integrate risk triage training with local schools, including universities. Combined workshops could address the current ED psychiatry crisis and the overwhelmed mental health system thus improving the balance of patient and hospital consequences to benefits. Increasing awareness of skills required and challenges experienced in respective settings could encourage crosstalk preventative strategies, innovative diagnostic adeptness, and personalized care with timely follow-up and safety benefits.

Second, CMS has, at long last, incentivized behavioral healthcare that focuses on high-risk populations. Implementation of research supported and EP practiced AI ICD-10/CPT coding provides improved provider and hospital revenue benefit. Specifically, ACEP triage guidelines will be available where and when needed. Medical decision-making using social determinants of health on risk underscores non-stigmatizing benefits including staff satisfaction, ED flow efficiencies, and patient safety.

In summary, over 30% of persons who die by suicide are treated in an ED, outpatient specialty, or primary care 7 days prior to death. Undoubtedly, it is only access to competent EP care -- not ED or community care alone -- that holds the potential for transformative, realistic reduction in suicide rates beyond annual Zero Suicide and CDC aspirational projections. These patients deserve definitive care. EP physicians, fellows, and non-EP clinicians deserve excellent support.

Russell Copelan, MD (Ret.), lives in Pensacola, Florida. He graduated from Stanford University and UCLA Medical School. He trained in neurosurgery and completed residency and fellowship in emergency department psychiatry at UC, Irvine and University of Colorado, Denver. He is a reviewer for Academic Psychiatry and founder of eMed Logic, a non-profit originator and distributor of violence assessments. Copelan is also a presenter for the National Association of School Psychologists (NASP) Speaker's Bureau, and a consultant to the American Association of Suicidology.

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Opinion | Emergency Doctors Are Ill Prepared to Handle Psychiatric ... - Medpage Today

Emergency Medicine

ACR, ACEP announce landmark recommendations for addressing actionable incidental findings – Newswise

March 15, 2023 medical

Newswise Washington, DC (March 13, 2023) The American College of Radiology (ACR) and the American College of Emergency Physicians (ACEP) released new landmark recommendations to help health systems, physicians and other clinicians improve patient outcomes by addressing actionable incidental findings (AIFs) in emergency department imaging.

There were more than 150 million emergency department visits in the United States in 2019. Radiologic imaging was performed in more than half of these encounters.[1] AIFs, defined as masses or lesions, detected by an imaging examination performed for an unrelated reason, are often encountered. However, the reporting and communication of these findings can be challenging.

Unlike other specialties, emergency physicians focus on addressing a patients possible life-threatening conditions and are less directly involved in follow-up care, said Susan E Sedory, MA, CAE, Executive Director and CEO of ACEP. Partnerships at the national and local level can enhance information sharing to help ensure all patients receive the ongoing, quality care they need.

The white paper, Best Practices in the Communication and Management of Actionable Incidental Findings in Emergency Department Imaging, published in the Journal of the American College of Radiology, concentrates on four areas of consensus between the specialties: 1) report elements and structure; 2) communication of findings with patients; 3) communication of findings with clinicians; and 4) follow-up and tracking systems.

Strong communication and collaboration between clinicians when addressing actionable incidental findings is key to providing optimal patient care and preventing adverse outcomes, said William T. Thorwarth Jr., MD, FACR, CEO of ACR. The recommendations created by ACR and ACEP highlight a multispecialty effort between radiology and emergency medicine that aim to improve the reporting and communication of AIFs, which will ultimately benefit the patient.

Radiologists are committed to working with our emergency department and primary care colleagues to improve follow up for incidental findings, said Gregory Nicola, MD, FACR, chair of the ACR Commission on Economics. This is a team effort to ensure that we implement and maintain these recommendations to help us provide the best possible care for patients before, during and after they visit the emergency department.

Imaging is an integral part of emergency care, and incidental findings with recommended follow up are common, said Christopher L. Moore, MD, professor of emergency medicine, Yale School of Medicine. Collaboration between emergency medicine and radiology and a systems approach are essential to ensure that actionable incidental findings dont fall through the cracks. We are proud to have brought together a diverse group, including radiologists, emergency physicians and patient advocates to develop and define best practices to address AIFs.

The recommendations listed in the white paper are meant to be best practices and are not standards.

# # #

About the American College of Radiology

The American College of Radiology (ACR), founded in 1924, is a professional medical society dedicated to serving patients and society by empowering radiology professionals to advance the practice, science and professions of radiological care.

About the American College of Emergency Physicians The American College of Emergency Physicians (ACEP) is the national medical society representing emergency medicine. Through continuing education, research, public education, and advocacy, ACEP advances emergency care on behalf of its 40,000 emergency physician members, and the more than 150 million people they treat on an annual basis. For more information, visitwww.acep.organdwww.emergencyphysicians.org.

[1] Rui, P. & Kang K. National Hospital Ambulatory Medical Care Survey: 2017 emergency department summary tables. 37 (2017).

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ACR, ACEP announce landmark recommendations for addressing actionable incidental findings - Newswise

Emergency Medicine

Men Over 65 at Greater Risk than Women of Skull Fractures from Falls – Florida Atlantic University

March 15, 2023 medical

Each year, more than 3 million people ages 65 and older are treated in emergency departments for fall injuries.

Each year, more than 3 million people ages 65 and older are treated in emergency departments for fall injuries. Head trauma is the leading cause of serious injury with skull fractures being reported as a serious outcome. According to the 2016 National Trauma Database annual report, females account for 58 percent of these falls.

Because geriatric females have an increased rate of falls and facial fractures, determining if they also are at an increased risk of skull fractures is crucial. Currently, research is sparse on the prevalence of skull fracture due to head injury in this population. Moreover, there is an overall lack of research concerning head injury management guidelines among the geriatric population.

Researchers from Florida Atlantic Universitys Schmidt College of Medicine conducted a study to assess and compare the risk of skull fracture secondary to head trauma in female and male patients ages 65 and older. They prospectively evaluated all patients with head trauma at two level-one trauma centers in southeast Florida serving a population of more than 360,000 geriatric patients.

For the study, researchers examined skull fracture due to acute trauma and compared them by sex as well as patient race/ethnicity and mechanism of injury. Among the 5,402 patients enrolled, 56 percent were female, 44 percent were male. Eighty-five percent of the head injuries sustained were due to falls, and this trend also was seen across race/ethnicity and mechanism of injury. Both females and males had a similar mean age, 82.8 and 81.1 years, respectively.

Results of the study, published in the American Journal of Emergency Medicine , showed that when comparing geriatric males and females, males had a significantly increased incidence of skull fracture secondary to head trauma, due mostly to falls. This outcome was unexpected, as previous research has indicated females are more susceptible to facial fractures. This trend also was seen across race/ethnicity, though results were only statistically significant for whites.

The high incidence of head injury and subsequent skull fractures due to falls is a cause for concern as our aging population continues living active lifestyles, said Scott M. Alter, M.D., first author, associate professor of emergence medicine, and assistant dean for clinical research, FAU Schmidt College of Medicine. As falls caused the greatest number of head injuries and subsequent skull fractures, fall prevention may be an important intervention to consider in reducing morbidity. Although fall prevention education can be addressed in the primary care setting or at assisted living facilities, the emergency department could also represent an opportunity to educate patients and to prevent future death and disability from falls in this population.

Study co-authors are Michelly R. Gonzalez; FAU medical student; Joshua J. Solano, M.D.; associate professor of emergency medicine and clerkship director; Lisa M. Clayton, D.O., chair and associate professor of emergency medicine and program director, emergency medicine residency; Patrick G. Hughes, D.O., associate professor of emergency medicine and associate program director, emergency medicine residency; and Richard D. Shih, M.D., professor of emergency medicine, all within the Department of Emergency Medicine, FAU Schmidt College of Medicine and Delray Medical Center.

This research was funded by a grant from the Florida Medical Malpractice Joint Underwriting Association awarded to Shih as the principal investigator.

-FAU-

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Men Over 65 at Greater Risk than Women of Skull Fractures from Falls - Florida Atlantic University