Category Archives: Emergency Medicine

Emergency Medicine

The anti-abortion endgame Erin Hawley admitted to the Supreme Court. – Slate

Somewhat lost in the debate around abortion pills and oral arguments that took place at the Supreme Court in FDA v. Alliance for Hippocratic Medicine on Tuesday was one deeply uncomfortable truth: The very notion of what it means to practice emergency medicine is in dispute, with anti-abortion doctors insisting upon a right to refuse treatment for any patient who doesnt meet their test of moral purity. Indeed, the right asserted is that in the absence of certainty about which patients are morally pure, the doctors want to deny medication to all patients, nationwide.

In public, the plaintiffs in this casea group of doctors and dentists seeking to ban medication abortionhave long claimed they object to ending unborn life by finishing an incomplete or failed abortion at the hospital. But in court, they went much further. Their lawyer, Erin Hawley, admitted at oral argument that her clients dont merely oppose terminating a pregnancythey are pursuing the right to turn away a patient whose pregnancy has already been terminated. Indeed, they appear to want to deny even emergency care to patients whose fetus is no longer alive, on the grounds that the patient used an abortion drug earlier in the process. And they aim todeploy this broad fear of complicity against the FDA, to demand a nationwide prohibition on the abortion pill to ensure that they need never again see (and be forced to turn away) patients whove previously taken it. This is not a theory of being complicit in ending life. It is a theory that doctors can pick and choose their patients based on the moral distress they might feel in helping them.

It should come as no surprise that the same judge who tried to ban mifepristone in this case, Matthew Kacsmaryk, has also attempted to legalize anti-LGBTQ+ discrimination in health care nationwide. This is the ballgame: weaponize subjective religious beliefs against secular society to degrade the quality of care for everyone. If you cant persuade Americans to adopt hardcore evangelical views, exploit the legal system to coerce them into it anyway.

Alliance for Hippocratic Medicine is at once embarrassingly frivolous and existentially important. Dont let the jokes about how silly the Comstock Act seems, or how speculative the theory of standing is, get in the way of taking a serious look at the claims on offer. The plaintiffs say they are terrified that one day, a patient may walk into their emergency room suffering complications from a medication abortion prescribed by some other doctor. This patient may need their assistance completing the abortion or simply recovering from the complete abortion, which these plaintiffs deem complicity in sin. And they say the solution is either a total, nationwide ban on mifepristone, the first drug in the medication abortion sequence, or a draconian (and medically unnecessary) set of restrictions that would place mifepristone out of reach for many patients. (The U.S. Court of Appeals for the 5th Circuit ruled to reinstate those restrictions at their behest.)

It is a twisted line of logic, one that should never have reached the Supreme Court in the first place. But it is also a product of the courts past indulgence of outlandish claims about moral complicity. As was made plain in the oral arguments and briefing, activist doctors are no longer satisfied with personal conscience exemptions already granted under state and federal law; they now insist that nobody, anywhere, should have access to the abortion pill, in order to ensure that they themselves wont have to treat patients who took one. At a minimum, they say, they should be able to radically roll back access to the pill in all 50 states to reduce the odds that one of these handful of objectors might someday encounter a patient who took it. This extremist argument lays bare the transformation of the idea of complicity from a shield for religious dissenters to a sword for ideologues desperate to seize control over other peoples lives and bodies.

At oral arguments, several justices pressed Hawley, who argued on behalf of Alliance for Hippocratic Medicine, with an obvious retort: Why cant her clients simply refuse to treat these hypothetical someday patientson the grounds that they cannot help end the life of a fetus or embryo? After all, federal law guarantees doctors the right not to have to provide an abortion if doing so is contrary to his religious beliefs or moral convictions. Justices Amy Coney Barrett and Brett Kavanaugh secured assurances from Solicitor General Elizabeth Prelogar, early in the arguments, that under no circumstances could the government force any health care provider to ever participate in an abortion in violation of their conscience. Justice Elena Kagan asked Prelogar: Suppose somebody has bled significantly, needs a transfusion, or, you know, any of a number of other things that might happen. Would the plaintiffs object to treating them? Prelogar said the record was unclear.

Hawley, who is married to far-right Republican Sen. Josh Hawley, then approached the lectern and cleared up any confusion: Yes, she insisted, treating a patient who has undergone a medication abortion violates the conscience of the plaintiff physicians even if there is no live fetus or embryo to terminate anymore. Completing an elective abortion means removing an embryo fetus, whether or not theyre alive, as well as placental tissue, Hawley told Kagan. So the plaintiffs dont object just to taking a life. They also object to the mere act of removing leftover tissue, even from the placenta.

Of course, these doctors must remove dead fetal tissue and placentas all the timefrom patients who experienced a spontaneous miscarriage. By their own admission, the plaintiffs regularly help women complete miscarriages through surgery or medication. Those women they will gladly treat. Other women, thoughthe ones who induced their own miscarriage via medicationare too sinful to touch. Before the plaintiffs can administer even lifesaving emergency treatment, they need to know the circumstances of this pregnancy loss: Spontaneous miscarriages are OK; medication abortions are not.

Justice Ketanji Brown Jackson, too, zeroed in on this admission. She told Hawley that she had thought the objection was to participating in a procedure that is ending the life [of the fetus]. Hawley told her no: Any participation in an abortion, even through the indirect treatment of a patient without a live fetus, violated the doctors conscience. So, wait. What about handing them a water bottle? Jackson asked. Hawley dodged the question, declining to say whether helping a patient hydrate would constitute impermissible complicity in sin.

All this is reminiscent of Little Sisters of the Poor, a case about a Catholic charitable group that was afforded an exemption from the Affordable Care Acts contraception mandate. The Little Sisters were asked to check a box signaling to the government that they could not comply with the mandate, at which point the government would step in to cover their employees. But the Little Sisters refused, viewing this actionthe checking of a box to opt out of coverageas complicity in abortion because it would in turn trigger government payment for contraception (which they viewed as abortifacients). The Supreme Court and the Trump administration ultimately indulged the Little Sisters claim.

Here, we have emergency room physicians asserting that they will not participate in lifesaving medical intervention unless they approve of the reason for the pregnancy loss. Presumably, if the pregnant patient is an unwed mother, or a gay or transgender person, the doctor would be similarly complicit in sin and decline service. Seen through this lens, since one can never know which sins one is enabling in the ER, each and every day, a narrow conscience exemption becomes a sweeping guarantee that absolutely nobody in the country can ever have access to basic health care, let alone miscarriage management. (Of course, these plaintiffs might focus only on one set of sins they see as relevant.) In a country effectively governed by Kacsmaryk and his plaintiff friends, a gay person suffering a stroke could be turned away from any hospital because of his sexual orientation, all to spare a doctor from a glancing encounter with prior sin. As Tobias Barrington Wolff, a professor of law at the University of Pennsylvania Law School, put it to us in an email, this unbounded view of complicity is part of enacting the social death of people and practices you abhor, which in turn can contribute to the material death of people and practices you abhor.

One of the most exhausting lessons of post-Roe America is that being pro-life definitively means privileging the life of the presumptively sin-free unbornor even their dead remainsover the life of the sin-racked adults who carry them. This is why women are left to go septic or to hemorrhage in hospital parking lots; it is why C-sections are performed in nonviable pregnancies, at high risk to mothers; its why the women who sued in Texas to secure exceptions to that states abortion ban are condemned by the state as sinners and whores. And its whyin the eyes of the Alliance for Hippocratic Medicineit is a greater hardship for a physician to waste precious moments scrubbing in, scrubbing out of emergency surgery, as Hawley put it, so long as they dont believe that the emergency warrants their professional services, than it is for a pregnant person, anywhere in the country, including in states that permit abortion, to be forced to give birth.

At oral argument, Hawley explained that her clients have structured [their] medical practice to bring life into the world. When they are called from their labor and delivery floor down to the operating room to treat a woman suffering from abortion drug harm, that is diametrically opposed to why they entered the medical profession. It comes along with emotional harm. The emotional harm alleged here is that unless these doctors approve of the specific circumstances of the ER visit, they violate not only their own medical preference but also their religious convictions. But they will never truly know enough about the sins of their patients to be able to shield themselves against being a link in a chain of subjective lifelong sin. And to be a doctor, especially an emergency physician, should be to understand that your patients private choices and spiritual life are not really open to your pervasive and vigilant medical veto. This deep-rootedsuspicion of patients deemed insufficiently pure for lifesaving treatment didnt begin with the availability of medication abortion. It will assuredly not end there.

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The anti-abortion endgame Erin Hawley admitted to the Supreme Court. - Slate

Emergency Medicine

Atrium Health Floyd EMS Named Georgia’s Service of the Year – Coosa Valley News

Atrium Health Floyd EMS was named the Georgia EMS Service of The Year during the Georgia Emergency Medical Services Association (GEMSA) awards held Tuesday night in Buford. It marked the fourth time Atrium Health Floyd has earned statewide the award.

Individual honorees for Atrium Health Floyd EMS include:

We strive to provide a team-driven, servant leadership culture within Atrium Health EMS, said Bud Owens, executive director of the service and Atrium Healths EMS leader for the Georgia market. That focus has worked, and our teammates are the best in the industry. They constantly strive to serve our patients, families and communities with a focus on excellence in everything they do. That is why we are successful. They are truly an elite few and I am so proud of them.

Atrium Health Floyd EMS provides emergency ambulance and non-emergency transport services to residents throughout Floyd County, northwest Georgia and Cherokee County in Alabama. It is the designated 911 responder for the majority of Floyd County and all of Chattooga County and Cherokee County, Alabama.

With over 180 teammates consisting of Paramedics, EMTs, telecommunicators, mechanics, support staff and leadership, the bottom-up leadership culture of the organization is recognized across multiple states, the GEMSA news release stated. Over 600 hours of community service and community benefit have been logged during 2023 by teammates who have graciously served the northwest Georgia and northeast Alabama communities through health fairs, educational programs, event coverage, support of athletic events and programs to benefit the health of communities served.

The Joe Lane Cox Excellence in EMS Award recognizes a worthy individual who is not employed in EMS but donates their time and efforts to continue the improvement of EMS on the local, state and national levels.

In her role as emergency preparedness coordinator, Holcomb is constantly going out of her way to include EMS in every aspect of her job and to any benefit of the community, according to the GEMSA news release. Her main goal is to have the community comfortable with EMS and to educate the public on the capabilities of an EMS service.

Eickleberry received the Georgia Emergency Medical Technician of The Year for her skill, knowledge and dedication to her teammates and her community.

She is an advanced EMT who serves in a dual role with capabilities of running her own AEMT truck and is confident enough to support any need her paramedic partner may need, according to the news release.

She often buys groceries and other items to help someone less fortunate. She has also been known to cook a meal for a patient in need.

The amount of kindness and compassion she shows to all she meets is a testament to her servant leadership qualities, the news release stated.

Atrium Health Floyd EMS held the most nominations statewide and was recognized with placement in the top three in 12 of the 13 award categories.

Other Atrium Health EMS nominees were Dr. Kevin Hardwell,Greg Goedert, Ben Fleming, Amber Eason, Cristy Harris, Megan Dozier, Darby Hopper, Daniel Herring, Dusty Johnson, Robby Hill and Don Taylor.

The statewide awards come after Atrium Health Floyd EMS also earned recognition on the regional level.

Paramedic Dusty Johnson was named the Danny Hall Memorial Paramedic of the Year by Northwest Georgia Region 1 EMS.

Johnson has been a teammate at Atrium Health Floyd since 2018 and serves as both a responder and an instructor for EMS.

Dusty has invested himself in the people he works with and those whom he treats. Being a great paramedic is more than performing emergency medicine on a scene. It is also about helping others reach the same high standard, a nomination letter for Johnson stated.

Amber Eason and Ben Fleming earned the Richard Gray M.D. Excellence in Trauma award. Gray was the trauma surgeon at Floyd Medical Center when it became Georgias first designated trauma center in 1981.

They were honored for their response to an incident when a woman was seriously injured after possibly being hit by a train on June 17, 2023.

The patients survival was due to the care and work of Amber, Ben and the Rome-Floyd Fire Department, according to the nomination letter.

Atrium Health Floyd EMS teammates were also recognized last year as Hospital Heroes by the Georgia Hospital Association for their response to a tragic wreck in Chattooga County in October 2022.

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Atrium Health Floyd EMS Named Georgia's Service of the Year - Coosa Valley News

Emergency Medicine

Emergency department intervention aids in long-term smoking cessation – News-Medical.Net

An opportunistic emergency department stop smoking prompt, comprising brief advice by a trained professional, an e-cigarette starter kit, and referral to local stop smoking services can help smokers quit, with a significant proportion of them still not smoking 6 months later, finds research published online inEmergency Medicine Journal.

Some 6.4 million people in the UK still haven't stubbed out for good, and of the large numbers of people attending emergency departments, a substantial proportion are more likely to be smokers and have poorer overall health, explain the researchers.

While initiatives in emergency departments to help people stop smoking have shown promise, it's not clear how well they work over the long term and what elements of them are most effective.

In a bid to find out, the researchers compared usual care with the real-world effectiveness of a brief intervention based in an emergency department to help smokers quit over a 6 month period in the Cessation of Smoking Trial in the Emergency Department (COSTED).

Between January and August 2022, they recruited 972 (out of 1443 screened) adult daily smokers attending the emergency department for medical treatment or accompanying someone who needed it.

Half the participants (484) were randomly allocated to the intervention arm and given brief smoking cessation advice of up to 15 minutes and an e-cigarette starter kit plus advice on its use (up to 15 minutes), as well as a referral to local stop smoking service.

The advice was delivered by a dedicated stop smoking advisor while the patient was waiting to be seen or after discharge. It was tailored to their presenting condition-;for example, discussing how not smoking improved wound healing for patients with cuts.

The local stop smoking service routinely followed up with a phone call offering support and, if taken up, advice on how to quit, as well as free provision of nicotine replacement therapy (NRT).

The rest of the participants (488) were randomly allocated to the comparison arm of the trial and given written details of local NHS stop smoking services but weren't referred directly.

Those reporting that they had stopped smoking at the 6 month assessment were asked to take a carbon monoxide test to biochemically confirm this.

After 6 months, continuous abstinence was just over 7% (35/484) in the intervention group and just over 4% (20/488) in the comparison group, meaning that those given the prompt were 76% more likely to have stopped smoking than those merely signposted to smoking cessation services.

Self-reported 7-day abstinence at 6 months was just over 23% (113/484) in the intervention group and 13% (63/488) in the comparison group.

Those in the intervention group were also more likely to make quit attempts than those in the comparison group: 2 (14) vs 1 (03). And of those who responded to this query, nearly 40% (125/317) were using an e-cigarette daily at this point.

No serious side effects associated with taking part in the trial were reported.

The researchers acknowledge that those in the comparison group were supported rather more than perhaps would have been the case normally, and managing to obtain a carbon monoxide test to confirm trial participants had stopped smoking proved "very challenging," they add.

But they point out: "These results strengthen previous findings that [emergency department]-based smoking cessation interventions are effective. To our knowledge, the 6-month self-reported quit rate is the highest reported by any [such] smoking cessation intervention trial to date."

They conclude: "We consider that this could be rolled out to reach a large proportion of current smokers, although dedicated staff are clearly needed to deliver the intervention soas not to burden clinical staff."

And this approach is also likely to narrow health inequalities, they suggest: "Those attending [emergency departments] are generally from more deprived communities and more likely to smoke than the general population. Therefore, this intervention has the potential to address health inequalities that arise from disparities in smoking rates between different socioeconomic groups."

In a linked editorial, Drs Gina Kruse and Jon Samet of the University of Colorado and Dr Joaquin Barnoya of the Integra Cancer Institute, Guatemala City, add that "the high uptake of the trial interventions makes a compelling argument for the potential of a cessation package that includes e-cigarettes for [emergency department] patients."

But as nearly 40% of participants in the intervention arm were using e-cigarettes daily and over half at least weekly during the 6 month follow-up period, they sound a note of caution.

"We need more information on the long-term use of e-cigarettes after cessation of combustible cigarettes, owing to concerns that persistent use is likely to be seen as a favourable finding by the e-cigarette industry that would profit from continued nicotinedependence," they write.

And they conclude: "We need to measure the harms to adolescents hand in hand with the potential for benefits to combustible cigarette users if we are to generate informed policies and practices about these devices."

Source:

Journal reference:

Pope, I., et al. (2024). Cessation of Smoking Trial in the Emergency Department (COSTED): a multicentre randomised controlled trial.Emergency Medicine Journal. doi.org/10.1136/emermed-2023-213824.

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Emergency department intervention aids in long-term smoking cessation - News-Medical.Net

Emergency Medicine

Just Ask: Patients in the ER Are Willing to Get a Flu Shot – UC San Francisco

Simply asking patients to get the flu vaccine, and combining it with helpful video and print messages, is enough to persuade many who visit emergency departments to roll up their sleeves, according to a new study led by UC San Francisco.

Researchers found a 32% vaccine uptake in patients who were asked if theyd be interested in getting the flu shot and told their health providers would be informed. They saw a 41% uptake for those who were asked about receiving a flu shot and received a pamphlet, watched a three-minute video of a physician with a similar ethnic background discussing the vaccine and were told about the benefits of the vaccine in person.

The study published March 26, 2024 in NEJM Evidence.

The researchers say this type of systematic approach could lead to more underserved people receiving vaccines, especially those whose primary health care occurs in emergency departments.

Flu leads to considerable mortality in the United States annual death rates are typically in the tens of thousands, especially when combined with pneumonia but vaccination is particularly low among underserved populations and those whose primary care occurs in emergency departments. Such patients often face general vaccine hesitancy or a lack of opportunities for the flu shot.

This research arose from our desire to address the health disparities that we see every day in our emergency department, especially among homeless persons, the uninsured and immigrant populations, said first author, Robert M. Rodriguez, MD, a professor of Emergency Medicine with the UCSF School of Medicine.

Investigators in the study created flu vaccine messaging including a brief video, flyer and a scripted health provider question, Would you be willing to accept the influenza vaccine? and assessed their effectiveness among nearly 800 patients in five cities: San Francisco, Houston, Philadelphia, Seattle and Durham, North Carolina. The median age was 46. More than half the participants in the trial were Black or Latino, 16 % lacked health insurance, nearly a third had no primary care and 9% were homeless or living in severely inadequate housing. These demographic characteristics are similar to patient populations often served by urban emergency departments.

The researchers designed the clinical trial to span a single flu season between Oct. 2022 and Feb. 2023.

Overall, our study adds to the growing body of knowledge showing that a number of important public health interventions can and should be delivered to underserved populations in emergency departments, said Rodriguez, whose previous research has found the effectiveness of delivering similar COVID-19 vaccine messaging to emergency department patients.

Co-authors: From UCSF, co-authors are Melanie F. Molina, MD; James Ford, MD; Mireya I. Arreguin; Cecilia Lara Chavez; and Dave V. Glidden, PhD. See paper for other co-authors.

Funding: The study was funded by the National Institute of Allergy and Infectious Diseases (RO1 AII66967-01).

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Just Ask: Patients in the ER Are Willing to Get a Flu Shot - UC San Francisco

Emergency Medicine

Enhancing CT Scanner Efficiency in ED for Trauma Team Activations – Physician’s Weekly

The following is a summary of Improving CT scanner efficiency for trauma team activations in the emergency department, published in the January 2024 issue of Emergency Medicine by Zwank, et al.

Trauma Team Activation (TTA) protocols are crucial for efficiently managing life or limb-threatening injuries in emergency departments (EDs). However, delays in stabilizing patients can lead to idle time for CT scanners, impacting overall patient care. For a quality improvement project, researchers sought to assess the impact of implementing a new policyproviding a 5-min heads-up (5-min HU) notification to CT scanner personnel once a TTA patient was stabilizedon reducing CT scanner idle time.

They conducted a prospective study at a large, urban Level I Trauma Center in November 2022. They tracked incoming TTAs and recorded time points, including TTA notification, 5-minute HU notification, and arrival at the CT scanner. Data were analyzed using a non-parametric comparison test (Mann-Whitney U).

A total of 46 TTAs were included in the analysis, with the majority resulting from blunt trauma (85%) and penetrating trauma (15%). The median time from the initial TTA announcement to CT arrival was 24.0 minutes (IQR: 9.0 min). With the 5-min HU policy, the median time from notification to CT arrival was 5.0 minutes (IQR: 4.0 min), resulting in a median of 19 minutes of CT scanner idle time saved per patient compared to the previous policy (P < 0.0001). Overall, the new policy saved 818 minutes (13.6 hours) of CT scanner time.

Implementing the 5-min HU policy in the ED for TTA patients significantly reduced CT scanner idle time, optimizing resource utilization and potentially improving care for all patients in the ED. It underscored the importance of proactive communication strategies in trauma care protocols to enhance efficiency and patient outcomes.

Reference: sciencedirect.com/science/article/abs/pii/S073567572300582X

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Enhancing CT Scanner Efficiency in ED for Trauma Team Activations - Physician's Weekly

Emergency Medicine

University Hospitals: New Urgent Care building opens in Medina | wkyc.com – WKYC.com

As of Monday, March 25, the former location at 4001 Carrick Drive is now closed and the new location at 716 North Court Street will serve as the new facility.

MEDINA, Ohio The University Hospitals Urgent Care location in Medina officially made the move to a new location.

As of Monday, March 25, the former location at 4001 Carrick Drive is now closed and the new location at 716 North Court Street will serve as the UH Urgent Care Medina location.

Our UH Urgent Care delivery model aims to provide the most convenient and valuable care for our patients, explained UH Chief Operating Officer Paul Hinchey, MD, MBA. Having easy access to urgent care locations provide a more affordable option than emergency departments for patients who dont have a primary care physician but need immediate, non-life-threating medical attention. By offering more urgent care locations, we can relieve the burden on emergency departments and reduce wait times so our emergency medicine teams can focus on critical cases.

UH says services on site include x-ray, lab, EKG, medication dispensing and more.

The new location's hours are 8 a.m. to 8 p.m. every day. Hours may differ on holidays.

"Our primary goal is to reimagine urgent care for Northeast Ohio by removing obstacles and easing access to care while delivering exceptional patient experiences, Dr. Resnick said. The expansion of UH Urgent Care in Northeast Ohio is a significant step towards fulfilling this commitment. By increasing access to urgent care services, we aim to make a positive impact on the lives of individuals and families throughout the region, providing them with the prompt and effective care they deserve in retail locations where they live, shop and work."

UH says the move to the new building will help reduce travel time of Medina residents thanks to the more centrally located facility.

Want to be among the first to know the most important local and national news? Download the free WKYC app and get updates right on your phone: Android, Apple.

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University Hospitals: New Urgent Care building opens in Medina | wkyc.com - WKYC.com

Emergency Medicine

Awareness of Urgent Care Services Among Primary Healthcare Center Patients in Al-Ahsa, Saudi Arabia – Cureus

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Awareness of Urgent Care Services Among Primary Healthcare Center Patients in Al-Ahsa, Saudi Arabia - Cureus

Emergency Medicine

Boston Medical Center Establishes Endowed Chair in Emergency Medicine with $4 Million Gift from Philanthropist and … – Boston Medical Center

BOSTON Boston Medical Center (BMC) today announced that William F. Ted and Kathy O. Truscott have donated $4 million to establish the Innovation in Exceptional Care Chair in Emergency Medicine at BMC. Mr. Truscott, the CEO of Columbia Threadneedle Investments, is a Trustee of BMC and Chair of its Philanthropic Trust. BMC Chief of Emergency Medicine Christian Arbelaez, MD, MPH, was named inaugural chair.

Nationwide, emergency departments serve as the front door to societal challenges that impact patients and the healthcare system, including mental illness, substance use disorder, and homelessness, among other conditions plaguing historically underinvested communities. Emergency departments across the country have also seen operational challenges like overcrowding and staff shortages. Addressing these demands will involve an evolved, comprehensive, and holistic approach that includes greater access to timely care, improved healthcare system capacity, and added finances.

The Truscotts gift, funding the first philanthropically endowed chair at BMC, gives current and future endowment recipients the resources to tackle these challenges by innovating and pushing the frontiers of emergency medicine.

This extraordinary gift, along with his service to our Philanthropic Trust and Board of Trustees, exemplifies the dedication and commitment Ted has to BMC. He is truly a champion for our patients and believes deeply in our work and mission, said Alastair Bell, MD, MBA, President & CEO of Boston Medical Center Health System. This gift will further enhance BMCs innovative and equitable approach to emergency medicine, creating new operational and clinical models to meet the most pressing challenges faced by health systems across the nation.

Chief Arbelaez will leverage support to advance clinical care and health equity in emergency departments to continue BMCs work as a national model in emergency medicine.

Arbelaez leads the largest and busiest emergency department in New England, which provides expert emergency medical care to over 130,000 patients each year. In response to rising patient volume since the COVID pandemic, he helped redefine patient care in the emergency department by implementing a Rapid Assessment Zone, a nationally recognized multidisciplinary model to improve patient flow and reduce crowding.

This is a critical time for emergency medicine, said Christian Arbelaez, MD, MPH, Chief of Emergency Medicine at BMC and Chair of the Department of Emergency Medicine at Boston University Chobanian & Avedisian School of Medicine. As one of the busiest emergency departments in the country caring for patients with a range of needs, innovation is essential to improving care. What we learn and develop here at BMC with support from this gift can be applied to improve care nationwide.

In June 2023, Arbelaez spearheaded the first ever Leaders of Essential Emergency Departments Conference in Boston. The conference brought together leaders of hospitals and emergency medicine departments from across the country for a bold opportunity to reshape and improve emergency care to ensure systems across the nation are poised to provide innovative and equitable care for all.

Kathy and I believe deeply in furthering the mission of BMC and are committed to supporting the essential work that Dr. Arbelaez and his colleagues undertake every day to provide exceptional emergency medical care to all who need it, regardless of their circumstances, Mr. Truscott shares. It is a privilege to make this gift and recognize the critical role that emergency medicine plays at BMC and in our healthcare system.

About William F. Ted Truscott

Ted Truscott is CEO of Columbia Threadneedle Investments, a leading global asset manager headquartered in Boston that provides a broad range of actively managed investment strategies and solutions for individual, institutional, and corporate clients around the world.

Truscott is a corporate leader committed to service and philanthropy. Throughout his career, he has given back to non-profit organizations, both locally and nationally, with his time, expertise and generosity. In addition to his work with BMCs Board of Trustees and Philanthropic Trust, he serves on the Investment Company Institutes Board of Governors, as Chair of the Board of Trustees of Middlebury College, and as Chair of the Board of Directors of The Greater Boston Food Bank.

The Columbia Threadneedle Investments Boston Triathlon annually supports BMCs health equity programs to benefit patients. Over the eight years that Columbia Threadneedle has sponsored the Boston Triathlon, it has raised nearly $500,000 for BMC and hundreds of its employees have participated as athletes and volunteers.

About Boston Medical Center

Boston Medical Centermodels a new kind of excellence in healthcare, where innovative and equitable care empowers all patients to thrive. We combine world-class clinicians, cutting-edge treatments, and advanced technology with compassionate, quality care, that extends beyond our walls. As an award-winning health equity leader, our diverse clinicians and staff interrogate racial disparities in care and partner with our community to dismantle systemic inequities. And as a national leader in research and the teaching affiliate for Boston University Chobanian & Avedisian School of Medicine, were driving the future of care.

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Boston Medical Center Establishes Endowed Chair in Emergency Medicine with $4 Million Gift from Philanthropist and ... - Boston Medical Center

Emergency Medicine

Informed Consent & Use of AI in Emergency Medicine – Physician’s Weekly

Applying artificial intelligence in emergency medicine may lead to advancements in care, but it also poses some ethical and practical concerns.

The application of artificial intelligence (AI) in medicine promises great advancements in care. This new technology, however, poses some ethical and practical concerns for practitioners, specifically in the field of emergency medicine. Kenneth V. Iserson, MD, MBA, explores and addresses these concerns in a guide he developed and published in the American Journal of Emergency Medicine.

Dr. Iserson spoke with Physicians Weekly regarding key concerns about using AI in the emergency medical setting, specifically the importance of informed consent. Dr. Iserson explains, Informed consent is a key element of Western medical practice. It helps preserve patient autonomy.

Applying informed consent appropriately to the application of AI poses some challenges. Dr. Iserson elaborates, To provide this information [informed consent] to patients, physicians first must understand the big picture of how AI systems are developed, function, and integrated into clinical medicine. Key to this is the understanding that due to their source training material and programming, AI may make errors, be biased, may not produce the same answer every time, and not even a systems developers may be able to explain how it came to a decision.

He continues, Physicians must also know where in their practice AI is usedbefore they see the patients (triage), in nursing assessments, evaluation of lab and imaging results, to generate differential diagnoses, etc. Furthermore, a complete understanding of AI includes knowledge of its drawbacks. As Dr. Iserson clarifies, Limitations: A serious limitation is that if AI is baked into the system so that it is so tightly integrated that patients cannot refuse its use, informed consent will be useless. Patients and clinicians will be concerned about privacy and accuracy. Privacy issues come with knowledge about how safe the information that the AI program acquires from the patient is. Will it be used or made available to teach other AI programs or be otherwise accessible?

In addition to privacy concerns, Dr. Iserson also discussed an understanding of AIs precision, As for accuracy, they [practitioners] will need to be able to explain their system (and, of course, have a system) for resolving discrepancies between the physicians plan/diagnosis and that recommended by AI. The article suggests several that are currently in use.

Perhaps the greatest challenge in integrating AI into emergency medicine is its ever-evolving nature and the administrators involvement in its execution. Dr. Iserson addresses these concerns: Lastly, this is a rapidly developing area. Lots of money is being made, and administrators who often will decide whether to use AI may be more concerned with their own and the institutions bottom line than the efficacy and accuracy of the AI system, its applicability, the purpose for which it is being used, and the physician and patients autonomy and welfare.

When asked about the future of AI and its use in emergency medicine, Dr. Iserson shared, In the future, I see the need for incorporating honest, factual training about AI into every part of the physicians educationfrom medical school to CME. The field will constantly change, and the big players will lure medical institutions and physicians to use (sometimes inappropriately) their AI systems, probably using the same sales techniques now used by the pharmaceutical and medical equipment industries.

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Informed Consent & Use of AI in Emergency Medicine - Physician's Weekly

Emergency Medicine

Omaha emergency medicine doctor uses drug in new way to treat anxiety and depression – KETV Omaha

An Omaha doctor who served in the battlefield is now helping patients battle anxiety and depression. Dr Leslie Koenig opened Waybridge Clinic in October. The people who walk in there are not the people we see three weeks later. Theyre entirely different smiling and laughing, said Koenig, an emergency medicine physician. Koenig is a U.S. military veteran who served as a Navy doctor in Afghanistan where she used ketamine as a sedative to treat people on the battlefield. Later, in emergency rooms, she encountered mental health crises, daily.If someone is suicidal, a panic attack, where do they go: the emergency room. That was me, said Koenig.With additional training, shes now administering low dose Ketamine infusions to treat people with medication resistant anxiety, depression, chronic pain, PTSD and OCD. Each patients vital signs are monitored during the intravenous infusion and they must continue seeing their therapist and family practice doctor. Koenig is also a meditation coach and takes a holistic approach to health, encouraging people to continue seeing their therapist, eating healthy food and taking part in exercise.The clinic is located in west Omaha: Waybridge Clinic.I liken it to a gym session. You come here and do some serious work, but then you have to go and support that gym session after. You need sleep and you need the nutrition, she said. Low dose Ketamine infusions are considered an off-label use for mental health. A handful of clinics in the Omaha area offer the treatments.There are so many medications used off label. Its totally safe. Ketamine is an old medication with a new purpose. When it was first FDA approved, it was for anesthesia and what were finding out is that in low doses, it has neuroplastic benefits where you can grow new brain connections, said Koenig. With new connections, Koenig said perspective changes. "You can change your thinking," she said. She said Ketamine works on different receptors in the brain than traditional meds which are used to treat anxiety and depression. She said the new connections created by Ketamine help the brain bypass prior triggers to mental health issues, so that they no longer impact an individual. Jay Allen visited Koenig recently to talk about his life-changing recovery. He jokingly told her his face now hurts from smiling so much.I missed feeling happy. I missed laughing with my friends. I missed the positive person I used to be, said Allen, who recalls that he started feeling better after the second treatment.Allen is a military veteran and mechanical engineer who said hes excited to live again, instead of just existing from day to day. Now I can look forward and see hope, said Allen.His positive recovery and story is repeated by Jack Christian, a husband and father of three who loves creating music with his two local bands.He believes his life-long anxiety was rooted in childhood.I pretty much exhausted all my options, said Christian, who tried many prescription medications over the years and nothing seemed to pull him out of the funk.Hes had 7 low dose Ketamine treatments and after the baseline 6 treatments, some patients never need another dose. Some have an occasional booster dose. To me, its ground-breaking. Its been a godsend for me, said Christian, who now journals and practices yoga. Patients describe the infusion itself as calming and they find themselves in a place between wakefulness and sleep as the drug helps them sort through issues in their mind.Youre conscious, but youre watching your subconscious open up to you like a movie, said Christian. Allen describes the infusion as surreal.I liken it to being in a rowboat in the ocean. You can change the direction but at the end of the day, youre at the mercy of the medicine, said Allen.Both said they noticed positive changes days and weeks after the infusion and the changes are lasting. Koenig is working on trying to get health insurance companies to pay for the treatments and shes considering options for employers and non-profits to chip in. Right now, infusions are $500 a treatment, with a baseline program of 6 infusions, or $3,000.We need to destigmatize this and really make lasting change happen, said Koenig. Allen said hes forever grateful that his mom found the clinic and got him in for a consult.Im excited for whats next and I cant thank you guys enough for that, he said, hugging Koenig in her office lobby. Click here for the latest headlines from KETV NewsWatch 7

An Omaha doctor who served in the battlefield is now helping patients battle anxiety and depression. Dr Leslie Koenig opened Waybridge Clinic in October.

The people who walk in there are not the people we see three weeks later. Theyre entirely different smiling and laughing, said Koenig, an emergency medicine physician.

Koenig is a U.S. military veteran who served as a Navy doctor in Afghanistan where she used ketamine as a sedative to treat people on the battlefield. Later, in emergency rooms, she encountered mental health crises, daily.

If someone is suicidal, a panic attack, where do they go: the emergency room. That was me, said Koenig.

With additional training, shes now administering low dose Ketamine infusions to treat people with medication resistant anxiety, depression, chronic pain, PTSD and OCD. Each patients vital signs are monitored during the intravenous infusion and they must continue seeing their therapist and family practice doctor.

Koenig is also a meditation coach and takes a holistic approach to health, encouraging people to continue seeing their therapist, eating healthy food and taking part in exercise.

The clinic is located in west Omaha: Waybridge Clinic.

I liken it to a gym session. You come here and do some serious work, but then you have to go and support that gym session after. You need sleep and you need the nutrition, she said.

Low dose Ketamine infusions are considered an off-label use for mental health. A handful of clinics in the Omaha area offer the treatments.

There are so many medications used off label. Its totally safe. Ketamine is an old medication with a new purpose. When it was first FDA approved, it was for anesthesia and what were finding out is that in low doses, it has neuroplastic benefits where you can grow new brain connections, said Koenig.

With new connections, Koenig said perspective changes. "You can change your thinking," she said.

She said Ketamine works on different receptors in the brain than traditional meds which are used to treat anxiety and depression. She said the new connections created by Ketamine help the brain bypass prior triggers to mental health issues, so that they no longer impact an individual.

Jay Allen visited Koenig recently to talk about his life-changing recovery. He jokingly told her his face now hurts from smiling so much.

I missed feeling happy. I missed laughing with my friends. I missed the positive person I used to be, said Allen, who recalls that he started feeling better after the second treatment.

Allen is a military veteran and mechanical engineer who said hes excited to live again, instead of just existing from day to day.

Now I can look forward and see hope, said Allen.

His positive recovery and story is repeated by Jack Christian, a husband and father of three who loves creating music with his two local bands.

He believes his life-long anxiety was rooted in childhood.

I pretty much exhausted all my options, said Christian, who tried many prescription medications over the years and nothing seemed to pull him out of the funk.

Hes had 7 low dose Ketamine treatments and after the baseline 6 treatments, some patients never need another dose. Some have an occasional booster dose.

To me, its ground-breaking. Its been a godsend for me, said Christian, who now journals and practices yoga.

Patients describe the infusion itself as calming and they find themselves in a place between wakefulness and sleep as the drug helps them sort through issues in their mind.

Youre conscious, but youre watching your subconscious open up to you like a movie, said Christian.

Allen describes the infusion as surreal.

I liken it to being in a rowboat in the ocean. You can change the direction but at the end of the day, youre at the mercy of the medicine, said Allen.

Both said they noticed positive changes days and weeks after the infusion and the changes are lasting.

Koenig is working on trying to get health insurance companies to pay for the treatments and shes considering options for employers and non-profits to chip in. Right now, infusions are $500 a treatment, with a baseline program of 6 infusions, or $3,000.

We need to destigmatize this and really make lasting change happen, said Koenig.

Allen said hes forever grateful that his mom found the clinic and got him in for a consult.

Im excited for whats next and I cant thank you guys enough for that, he said, hugging Koenig in her office lobby.

Click here for the latest headlines from KETV NewsWatch 7

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Omaha emergency medicine doctor uses drug in new way to treat anxiety and depression - KETV Omaha