December 2014 - California ACEP

lifeline
a forum for emergency physicians in california
EMRs
Electronic Documentation
Page 14
TABLE OF CONTENTS |
4
14
A Measure
of Success...
4
PRESIDENT’S MESSAGE
10 ADVOCACY UPDATE
EMPAC Scores BIG in 2014 General Election
11 December 2014 Advocacy Fellow Bio
13 Intubation Tips
14 PRACTICE MANAGEMENT UPDATE
EMRs
20 ANNOUNCEMENTS
EMRs
California ACEP
Board of Directors &
Lifeline Editors Roster
21 UPCOMING MEETINGS & DEADLINES
22 CAREER OPPORTUNITIES
DECEMBER 2014
Index of Advertisers
2014-15 Board of Directors
Michael Osmundson, MD, MBA, FACEP, President
Marc Futernick, MD, FACEP, President-Elect
Lawrence Stock, MD, FACEP, Vice President
Aimee Moulin, MD, FACEP, Treasurer
Chi Perlroth, MD, FACEP, Secretary
Thomas J. Sugarman, MD, FACEP, Immediate Past President
John O. Anis, MD, FACEP, Member-At-Large
Vikant Gulati, MD
Kevin Jones, DO
Jeffrey Leinen, MD, FACEP
Stephen Liu, MD, FACEP
John Ludlow, MD, CAL/EMRA Representative
Cameron McClure, MD, FACEP
Valerie Norton, MD, FACEP
Mark Notash, MD
Maria Raven, MD, MPH, FACEP
Vivian Reyes, MD, FACEP
Eric Snyder, MD, FACEP
EGO
Page 11
EMA
Back Cover
EMMA
Page 17
IEPC
Page 17
Anaheim Regional Medical Center
Page 22
Front Line Emergency Care Specialists
Page 22
Advocacy Fellowship
Aimee Moulin, MD, FACEP, Director
Carrieann Drenten, MD, Advocacy Fellow
Glendale Adventist Medical Center
Page 22
Marin Emergency Physicians
Page 22
Watsonville Emergency Medical Group
Page 22
Yosemite Emergency Medical Foundation
Page 7-9
Lifeline Medical Editor
Richard Obler, MD, FACEP, Medical Editor
Lifeline Staff Editors
Elena Lopez-Gusman, Executive Director
Ryan P. Adame, MPA, Deputy Executive Director
Lucia Romo, Education Coordinator
Kelsey McQuaid, MPA, Government Affairs Associate
Nathalie Nguyen, MA, Program Associate
WELCOME new members!
Mark Bernardi
Philip A Buss
Simon Chi
Alex D Doo, Medical Student
Mary Ann Gallup, MD
Anne L Godbout, MD
Divesh Goel
David Harrison, MD
Evelyn Lee, MD
Manuel Montano, MD
Amy Y Ngan
Glenn Owen Siegfried, MD
Garrett Sterling, MD
Allen Wang
100% GROUPS
Central Coast Emergency Physicians
Front Line Emergency Care Specialists
Pacific Emergency Providers, APC
Emergent Medical Associates
Napa Valley Emergency Medical Group
Emergency Medicine Specialists of
Orange County
Newport Emergency Medical Group, Inc
at Hoag Hospital
University of California, Irvine Medical
Center Emergency Physicians
DECEMBER 2014 | 3
PRESIDENT’S MESSAGE |
A Measure
of Success...
By Michael Osmundson,
MD, MBA, FACEP
As the leaves turn, the air gets cooler and snow starts falling in the
mountains, it’s the time of year to reflect on the year that has passed,
celebrate successes, and learn from mistakes. Thankfully, our chapter
has had plenty to celebrate in 2014. Once again, our board, staff and
committees have worked tirelessly to deliver real value to California’s
Emergency Physicians and our patients.
LEGISLATIVE AND ADVOCACY
This year was a particularly active year for proposed legislation that
would affect the practice of Emergency Medicine and delivery of
care to our patients. The Government Affairs Committee and staff
monitored thousands of proposed legislation and successfully lobbied on issues important to Emergency Physicians. A list of our
successes include:
• Successful sponsored legislation:
a. AB 58 (Wiekowski) - Informed Consent exemption for
Emergency Medicine Research
b. SB 191 (Padilla) - Maddy Fund Reauthorization
• We successfully lobbied against bills that would have
negatively affected our practice and our ability to care for
patients. These bills were either defeated or we successfully
lobbied to change them to make them more favorable to
our practice:
a.
b.
c.
d.
e.
AB 446 (Mitchell) - mandatory HIV testing
AB 633 (Salas) - good samaritan law
AB 689 (Bonta) - flu vaccines
AB 790 (Gomez) - mandatory child abuse reporting
AB 974 (Hall) - emergency contact notification prior to transfer
4 | LIFELINE a forum for emergency physicians in california
f. SB 364 (Steinberg) - mental health
g. AB 1975 (Hernandez) - trauma designation review
h. AB 2214 (Fox) - mandatory geriatric CME
i. AB 2406 (Rodriguez) - "abuse" of EMS services
j. AB 2533 (Ammiano) - balance billing ban
k. SB 491 (Hernandez) - Scope of practice, nurse practitioners
l. SB 492 (Hernandez) - Scope of practice, optometrists
m. SB 493 (Hernandez) - Scope of practice, pharmacists
n. SB 809 (DeSaulnier) - CURES
o. SB 1256 (Mitchell) - health care credit cards
p. SB 1266 (Huff) - epi-pens in schools
q. SB 1276 (Hernandez) - charity care
The Ammiano (subject of last month’s President’s Message) and
Hernandez bills were particularly dangerous to our ability to protect the financial viability of our practice. California ACEP took the
lead in opposing these important bills and they were defeated
or amended. On the positive side, reauthorization of the Maddy
Fund was another successful defense of this important program
that protects our ability to continue to care for the most vulnerable patients. We also toured legislators in many of our EDs to
help them understand our issues and see the excellent work we
do despite myriad constraints including operational, financial,
legislative and statutory.
In addition to our lobbying efforts in the legislature, California ACEP
worked to change the regulatory environment to make it easier to
care for our patients and to protect the financial viability of our
practices. Some important regulatory issues we worked on include:
a.
b.
c.
d.
e.
f.
g.
Procedural sedation
DMHC Financial Solvency Standards Board
DMHC fair payment enforcement
EMSA/OSHPD Community Paramedicine Pilot Project
DOI network adequacy
DOI fair payment enforcement
DOI & DMHC enforcement of health plan EOB compliance
Our most important political win was the defeat of the Anti-MICRA
efforts sponsored by trial lawyers: Proposition 46. California ACEP
joined a broad coalition to defeat Prop 46. Many of our Board Members participated in the “No On 46” Campaign, gave presentations
and responded to media inquiries. Conservatively, the defeat of
Prop 46 saved every Emergency Physician in the state thousands of
dollars per year, limited our exposure to unwarranted malpractice
claims and protected our patients' access to high-risk specialists.
This year was a particularly active and successful one for legislative and regulatory advocacy activity. These are real wins for our
patients and for Emergency Physicians. All Emergency Physicians
in California benefit from these wins, whether they supported or
participated in our efforts not. But more on that later…
This year, we had another successful Annual Assembly in June.
Nearly 200 Emergency Physicians attended to soak in the diverse
education offerings. Highlights included EM Residency simulation
competition, cadaver procedure labs, and clinical and practice
management topics. Attendance is low-cost - $125 - and it is a great
opportunity to connect with colleagues and level up your learning.
Please make plans to join us on April 21, 2015 for next year’s Legislative Leadership Conference in Sacramento and on June 12, 2015 for
the next Assembly at the Hilton Los Angeles/Universal City.
California ACEP introduced two important public health initiatives:
Safe Prescribing Guidelines and PECARN Rules for pediatric head
CT. Through Board-appointed task forces, California ACEP produced
toolkits for successful implementation of rational narcotic prescribing guidelines and an evidenced-based approach to limiting
unnecessary pediatric head CT. Each program includes scripting for
patients and learning materials for physicians, ED staff and patients.
These important and useful toolkits can be found on our website at
californiaacep.org/publichealth.
California ACEP proudly supported the important film Code Black
which has received critical acclaim and is entering general release.
This film will reach a broad audience and give them insight into
the great care Emergency Physicians provide our patients. Set in
LAC+USC ED and starring many California ACEP members, Code
Black will be an important tool for educating the public, legislators
and policy makers on the challenges we and our patients face in our
Emergency Departments.
EDUCATION AND MEMBER OUTREACH
Once again California ACEP sponsored our annual Legislative Leadership Conference. More than 100 emergency physicians attended
the conference. This year we had two exceptional Keynote Speakers:
the Governor and Lt. Governor. This was an unprecedented opportunity to interact with Governor Brown and Lt. Governor Newsom
and help them appreciate our perspective on policy. It’s clear given
the access we have to legislators and senior executives in the Capital that California ACEP is able to “punch above our weight class”
in Sacramento. For an organization of our size we have considerable political influence. This is due to the tireless efforts of staff, the
Board and our Government Affairs Committee. The Governor was
surprisingly candid when he told the group that although he admired our efforts on behalf of our patients, larger constituencies
like the teachers' union dwarf California ACEP and our influence
is limited by our size. In other words: the political influence of an
organization is determined by the size of its membership and the
political importance of its work (luckily we have this one in spades).
Imagine if we were as strong as we could be: all emergency physicians in California should be members of California ACEP.
RETURN ON INVESTMENT (ROI)
As Governor Brown pointed out, an organization’s political
influence is directly tied to the size of its membership and the importance of its work. As California’s safety net providers, the political
importance of the work we do should be a given. But the opposite
is true: although emergency physicians are held in high esteem
by the public, policy makers continue to view the ED as the mostexpensive, least efficient place to deliver care. This view permeates
the bills proposed in the legislature and the regulations written by
government agencies. Given the mistaken view that success means
limiting ED visits, it’s no coincidence that this year saw several bills
that would directly undermine the financial solvency of our practice. California ACEP will continue to stop legislation that harms
our ability to care for patients. Additionally, we will work to reverse
the perception that the ED is the core of the problem. Instead, we
know the ED is core to any successful solutions to evolve healthcare
delivery, lower expense and improve outcomes for our patients. In
the coming years, California ACEP will make sure that policy makers
understand this as well.
DECEMBER 2014 | 5
By successfully lobbying to defeat Prop 46, the Ammiano and Hernandez bills and reauthorizing the Maddy Fund, California ACEP has
protected tens of thousands of dollars of income for every Emergency Physician in the state. This alone pays for your membership many
times over. With the educational opportunities, the PECARN & Safe
Prescribing toolkits, and member outreach activities, membership in
California ACEP has an incredible ROI. Considering that membership
in California ACEP by every EP in the state would considerably increase the size of the organization and further increase our political
influence and that membership ROI is so positive, there is no reason
to expect and accept anything short of 100% membership.
In addition to organizational/membership size and political importance of its work, money is critical to political relevance. Member
dues and donations to the California Emergency Medicine Action
Fund (CEMAF) drive the funding for our advocacy efforts. CEMAF
donors pledge a few cents/patient to the Fund. Many of California’s
Emergency Physician practices support CEMAF, but many do not.
Non-members benefit alike with members from our Chapter’s efforts, and practices that don’t participate in CEMAF benefit greatly
from the support of those that do. Participating in CEMAF traditionally has had a strong ROI, and as we’ve already seen, this year was
LEGISLATIVE
LEADERSHIP
APRIL 21
SACRAMENTO
6 | LIFELINE a forum for emergency physicians in california
no exception. For the few pennies/patient donated to CEMAF, we
returned dollars. Imagine what we could accomplish if every practice participated in CEMAF. Non-membership and non-participation
in CEMAF is neither wise nor morally justifiable. Unwise, because by
not joining, one limits the strength of the organization that produces the benefits. Immoral because one accepts benefits that others
have worked and sacrificed to produce.
HOW YOU CAN HELP
If you aren’t a member, you have to join! If you are a member, please
help recruit your colleagues to our Chapter. Help communicate the
value of membership. If your practice doesn’t contribute to CEMAF,
please contact me to find out more about this important program.
I invite you to join a committee (more on this next month). Join us
for Legislative Leadership Conference and the Annual Assembly.
Consider running for the Board this Spring. It’s time to flex the political muscle we deserve. Please join me in making 2015 the year
we achieve 100% membership and participation in CEMAF. I look
forward to working with you. n
CALIFORNIA
ACEP
JUNE 12
LOS ANGELES
UNIVERSAL CITY
38 Annual
EMERGENCY MEDICINE
IN YOSEMITE
th
January 14 – 17, 2015
Registration is Now Open at
www.yosemitemef.org
Early Bird Closes
November 15, 2014
Sponsored by (YMEF)
Yosemite Medical Education Foundation
Co-sponsored by CaliforniaACEP
American College of Emergency Physicians
California Chapter
“This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint
providership of the Center for Emergency Medical Education and Yosemite Medical Education Foundation.”
“The Center for Emergency Medical Education is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.”
The Center for Emergency Medical Education designates this live activity for a maximum of 13.0 AMA PRA Category 1 CreditsTM.
Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Approved by the American College of Emergency Physicians for a maximum of 13.00 hour(s) of ACEP Category I credit.
Approved for 13.0 credits of AOA Category 2-A credits.
2015 Emergency Medicine in Yosemite
January 14 – 17, 2015
Sponsored by Yosemite Medical Education Foundation (YMEF)
Co-Sponsored by CaliforniaACEP
(13.0 AMA PRA Category 1 Credits™)
“This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing
Medical Education through the joint providership of the Center for Emergency Medical Education and Yosemite Medical Eductation Foundation.”
“The Center for Emergency Medical Education is accredited by the Accreditation Council for Continuing Medical Education to provide continuing
medical education for physicians.”
The Center for Emergency Medical Education designates this live activity for a maximum of 13.0 AMA PRA Category 1 Credits™
Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Approved by the American College of Emergency Physicians for a maximum of 13.00 hour(s) of ACEP Category 1 credit.
Approved for 13.0 credits of AOA Category 2-A credits.
Wednesday, January 14th (Yosemite Lodge Mountain Room)
9:30 AM
1:00 PM 5:30-6:30 PM 6:30 PM 7:15-7:30 PM 7:30-8:30 PM Brunch (Yosemite Lodge Mountain Room): Ryan McGarry M.D.
“Preserving Humanism in the Complex Healthcare Milieu: Lessons Learned as
a Filmmaker and Emergency Physician”
Group Hike: (Mirror Lake) Guided by Karen Amstutz, Park Ranger (Meet in Ahwahnee Lobby)
Reception (Curry Village Pavilion)
Dinner (Curry Village Pavilion)
Welcome and Introductions (Curry Village Pavilion)
Paul Amstutz: “Rock Climbing in Yosemite—History, Personalities and Technique”
F
A
C
U
L
T
Y
LEFT TO RIGHT ABOVE
David Schriger, M.D. | Ed Fieg, M.D. | Tsuyoshi Mitarai, M.D. | Aaron Bair, M.D. | Vik Gulati, M.D. | Ed Panacek, M.D.
LEFT TO RIGHT BELOW
Rolando Valenzuela, M.D. | Ryan McGarry, M.D. | William Mallon, M.D. | Judith Crowell, M.D. |
James Manning, M.D. | Gary Wolf
Thursday, January 15th (Yosemite Lodge Garden Terrace)
7:45-8:45 AM Graham Billingham, M.D. “Emerging Trends in ED Malpractice” (1 Hour CME)
8:45-9:45 AM William Mallon, M.D. “Novel Oral Anticoagulants: An Update” (40 minutes CME)
“Fleck Signs of Importance in EM Plain Films” (20 minutes CME)
9:45-10:15 AM BREAK: Visit Exhibitors & Sponsors (Yosemite Lodge Mountain Room)
10:00 AM Spousal Program (Yosemite Lodge Bar): Watercolor
10:15-11:15 AM Judith Crowell, M.D. “Dermatology Update for Veteran EPs: Case Studies” (1 Hour CME)
11:15-12:15 PM Vik Gulati, M.D. “Pediatric Head Trauma: How Much of a Work-Up is Enough? Using the
Evidence and Shared Decision Making” (1 Hour CME)
1:30 PM Group Hike: (Vernal Falls to bridge) Guided by Karen Amstutz, Park Ranger
(Meet in Happy Isles parking lot)
5:00 PM Wine and Cheese Reception (Ahwahnee Solarium): Photography by Jeff Grandy
5:30-6:30 PM TBA (Ahwahnee Solarium)
6:30-7:30 PM TBA (Ahwahnee Solarium)
Friday, January 16th (Yosemite Lodge Garden Terrace)
7:45-8:45 AM Jim Manning, M.D. “Endovascular Resuscitation is on the Horizon” (1 Hour CME)
8:45-9:45 AM Ed Panacek, M.D. “Sepsis 2015: Update and Case Studies” (1 Hour CME)
9:45-10:15 AM BREAK: Visit Exhibitors & Sponsors (Yosemite Lodge Mountain Room)
10:00 AM Spousal Program (Yosemite Lodge Bar): How to Invest Intelligently in Your Ongoing Beauty:
Part 5: Judith Crowell, M.D., Dermatologist
10:15-11:15 AM Tsuyoshi Mitarai, M.D. “High Risk Pulmonary Embolism” (1 Hour CME)
11:15-11:45 AM Ed Fieg, M.D. “The Low Risk PE: Does the Work-Up do More Harm than Good?”
(½ Hour CME)
11:45-12:15 PM David Schriger, M.D. “Code Green: How do we resuscitate Emergency Medicine?”
(½ Hour CME)
1:00 PM Group Hike: Yosemite Falls to the top of the Lower Falls - Guided by Karen Amstutz,
Park Ranger (Meet in Trailhead parking lot)
5:00 PM Wine and Cheese Reception (Ahwahnee Solarium)
5:45-6:45 PM Gary Wolf: Gold Rush in the Yukon Territory
6:45-7:30 PM Karen Amstutz: “The Raven, the Trickster—A Most Intelligent Bird”
Saturday, January 17th (Yosemite Lodge Garden Terrace)
7:45-8:15 AM Rolando Valenzuela, M.D. “Event Medicine: What is It?” (½ Hour CME)
8:15-9:45 AM Ryan McGarry, M.D. “Code Black,” Award Winning Documentary film about emergency
medicine at USC-LAC Hospital (1 ½ Hour CME)
9:45-10:00 AM BREAK
10:00-11:00 AM Aaron Bair, M.D. “Airway Technology: Gear & Techniques for Difficult Airway Management”
(1 Hour CME)
11:00-12:00 PM Gary Wolf “The Future of Self-Collected Human Data: Implications for Emergency Medicine”
(1 Hour CME)
12:00-1:00 PM ED Panacek/David Schriger, M.D. “Review of the Recent Literature: Results that Could
Change Your Practice” (1 Hour CME)
ADVOCACY UPDATE |
EMPAC Scores BIG in
2014 General Election
By Elena Lopez-Gusman & Kelsey McQuaid, MPA
With the major focus of the 2014 General Election centered on a number of
ballot initiatives, California’s elections turned out to be more surprising. Record
low voter turnout for a non-presidential general election (approximately 30%)
had a resounding effect on Assembly and State Senate. Democrats came up
short in their efforts to maintain their supermajority in the Assembly and regain
their supermajority in the State Senate.
As a part of the process in determining which candidates EMPAC
should support, your advocacy staff interviewed a wide array of
candidates for statewide office and toured numerous others in
emergency departments around the state. In total, EMPAC contributed to twenty five candidates during the general election. Of those
twenty five candidates, all but one candidate was elected. That’s a
success rate of 69%!
Building relationships with elected officials early and throughout
their careers is extremely important. You never know when one of
our allies will be elected to leadership or become a vocal champion
of our causes in committee and on the floor of the legislature. For
example, EMPAC has been a long-time supporter of Senator Alex
Padilla, who last year helped renew the Maddy Fund.
During the General Election, EMPAC-supported candidates had a
strong showing. Statewide candidates Insurance Commissioner
Dave Jones, Attorney General Kamala Harris, and Lieutenant Governor Gavin Newsom were all reelected. Likewise, Senator Alex Padilla
won his very competitive race for Secretary of State.
From San Diego to Los Angeles to San Francisco to the North Coast,
EMPAC-supported candidates for the Assembly and State Senate
had strong showings. In the 6th Senate District (Sacramento), EMPAC supported Dr. Richard Pan, pulled off an upset against fellow
Democratic Assembly Member Roger Dickinson. The polls showed
Dr. Pan behind just days before the election.
Other successful EMPAC candidates in highly contested sameparty races included Ben Allen, who will now represent the 26th
Senate District in Los Angeles, and David Chiu, who will represent
the 17th Assembly District in San Francisco.
In addition to our support of candidates, EMPAC contributed
$100,000 to the No on 46 campaign. Proposition 46 was defeated
by a large margin in every county of the state.
Thanks to generous contributions to EMPAC by California ACEP
members like you, emergency physicians have become a force
to be reckoned with in California politics. As strong as our results
have been in the 2014 election cycle, the strength and influence of
our opponents in Sacramento cannot be underestimated. Without
10 | LIFELINE a forum for emergency physicians in california
member involvement and contributions from all of our members,
we will not be able to continue to develop and elect emergency
medicine champions.
For more information on how to make a contribution to EMPAC,
please contact us at [email protected], or by calling the Chapter office at (916) 325-5455. n
Candidates Supported by EMPAC
in the 2014 General Election:
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Lieutenant Governor Gavin Newsom
Insurance Commissioner Dave Jones
Senator Alex Padilla (Secretary of State)
Mike McGuire (SD 2)
Assembly Member Richard Pan, MD (SD 6)
Former Assembly Speaker Bob Hertzberg (SD 18)
Senate President Pro Tempore Kevin de Leon (SD 24)
Ben Allen (SD 26)
Senator Holly J. Mitchell (SD 30)
Senator Joel Anderson (SD 38)
Jim Wood (AD 2)
David Chiu (AD 17)
Assembly Member Rob Bonta (AD 18)
Assembly Member Rudy Salas (AD 32)
Assembly Member Das Williams (AD 37)
Assembly Member Raul Bocanegra (AD 39)
Assembly Member Matt Dababneh (AD 45)
Assembly Member Adrin Nazarian (AD 46)
Assembly Member Jimmy Gomez (AD 51)
Miguel Santiago (AD 53)
Assembly Member Sebastian Ridley-Thomas (AD 54)
Assembly Member Anthony Rendon (AD 63)
Assembly Member Brian Maienschein (AD 77)
Assembly Speaker Toni Atkins (AD 78)
Assembly Member Lorena Gonzalez (AD 80)
DECEMBER 2014 ADVOCACY
FELLOW BIO
Dr. Carieann Drenten recently completed her residency training in
Emergency Medicine at UC Davis Medical Center in Sacramento, California
where she also served as chief resident. Dr. Drenten completed research
during her residency evaluating the efficacy of the PESI and an augmented
score in the evaluation of patients with confirmed PE.
The California ACEP Advocacy
Fellowship provides an unparalleled
opportunity for early-career
physicians to develop and train as
leaders and advocates. The yearlong program allows for one to
three fellows per year to train closely
with the California ACEP staff and
Advocacy Fellowship Director, with
clinical job placement assistance, and
funding for continuing education,
and other important Chapter and
College related meetings. For more
information, please contact the
Chapter at [email protected].
B
efore starting her residency training,
Dr. Drenten attended the University
of Arizona where she earned a dual
degree with a Bachelor of Sciences degree
in Molecular and Cellular Biology and Bachelor of Arts degree in Italian Language and
Culture. She then continued on at the University of Arizona to study medicine.
Dr. Drenten is currently a partner of California Emergency Physicians, working at Sutter
Medical Center and Sutter Memorial Hospital. Her advocacy interests currently lie
with the mental health patient population
frequently seen in the emergency department. She started with a multidisciplinary
work group on research at UC Davis using
a new evaluation tool with the goal to improve access to care for this population by
developing consistent care plans that will
be accessible to multiple EDs and clinics in
a region to improve care and hopefully reduce need for frequent ED visits. She is also
active with the DOJ working to improve the
CURES program and physician access and
utilization.
Dr. Drenten is supported by her husband
Brendon and her adorable puppy CJ. She
currently lives in Midtown Sacramento and
enjoys cycling, hiking, backpacking, and frequent trips to the dog park. n
DECEMBER 2014 | 11
ANNUAL
ASSEMBLY
2015
JUNE 12
LOS ANGELES
UNIVERSAL CITY
INTUBATION
By Marc Futernick, MD, FACEP, California ACEP President-Elect
California ACEP would like to thank Valley Emergency Physicians for
permission to re-print this article.
NO DESAT is an acronym created by Dr. Richard Levitan, a nationally
recognized authority on airway management, for Nasal Oxygenation
During Efforts at Securing a Tube. This very simple concept will allow
you to have more time to intubate while maintaining adequate
oxygenation. Although nasal oxygenation is a key component
of hypoxia prevention during intubation, there are a variety of
techniques that should be used to maximize patient safety.
When we intubate, we want to prevent oxygen desaturation
throughout the procedure. This can be achieved by extending
the period of time your patient maintains adequate oxygen
levels despite not breathing or receiving artificial respiration, such
as during Rapid Sequence Intubation. Fortunately, we are learning a
great deal about maximizing apneic oxygenation (as this is called)
and the techniques to achieve it are very easy to implement. I
believe we should all be doing these things routinely.
Pre-oxygenation is critical in extending the amount of time a
patient can be apneic and maintain normal oxygen saturation.
In the past, this has typically been achieved by using 100% nonrebreather mask, or bag-valve-mask for those that require assisted
ventilations. (Note: do not use the BVM instead of the NRB mask
for spontaneously breathing patients. It only delivers high flow
oxygen during bagging.) For most patients, these techniques will
achieve high levels of oxygen saturation and will allow adequate
oxygenation for routine intubations.
However, many patients are difficult to oxygenate adequately
(severe pulmonary pathology), or have physiology that causes
them to desaturate quickly (morbid obesity or severe medical
illness such as sepsis), or have an anticipated difficult airway (poor
anatomy, c-spine, angioedema). For all of these patients, additional
techniques should be employed to maximize the time during which
you can perform the intubation before the oxygen level drops.
Pre-oxygenation with CPAP or BIPAP has been found to be very
useful for the patient who is difficult to get well-oxygenated
prior to the intubation procedure. Another excellent technique is
to add nasal cannula oxygen during pre-oxygenation, which
fills the nasopharynx with 100% oxygen and provides an additional
reservoir of oxygen to draw upon.
This leads us to NO DESAT, which refers specifically to the use of
high flow nasal oxygenation during the intubation procedure.
It has been shown in multiple studies that this technique
significantly extends the time that an apneic patient maintains
adequate oxygenation, allowing you more time to safely intubate.
The technique is to leave the nasal cannula in place, with high
flow oxygen running, while the intubation is performed. The only
modification you might need to make in your ED to implement this
today is to have 2 oxygen ports available. (There are double port
stems that can be purchased if 2 ports are not accessible. The quick
solution is to use a tank for the second O2 source.) High flow nasal
oxygenation can be irritating, so it’s best to start at 5-6 L/minute,
and to turn it up to 15L/min once the patient is sedated or induced.
Dr. Levitan strongly advocates for nasal oxygenation during preoxygenation as well as during the intubation procedure. Click
on this link to log in to Medscape to see an interview where he
discusses the merits of this strategy:
http://www.medscape.com/viewarticle/823961
If you don’t have a Medscape account, you can quickly sign up for a
free account using the same link.
In summary, pre-oxygenation is an important part of the
intubation procedure. It enhances patient safety by allowing
the operator more time to intubate before hypoxemia ensues. In
combination with pre-oxygenation, the use of nasal oxygenation
delivered via nasal cannula will maximize the time that a
patient can endure apnea without oxygen desaturation. The
techniques outlined here do not require special equipment or skills,
and I encourage you to use them on a routine basis in your practice.
There are a variety of additional techniques to improve the safety of
intubation that I will address in my next installment. Stay tuned. n
DECEMBER 2014 | 13
PRACTICE MANAGEMENT UPDATE |
EMRs
By Pha Le, DO, FACEP
ELECTRONIC DOCUMENTATION
Documentation is the second most important activity we perform in the ER; the most important
being that of patient care. Despite this fact, we devote very little time in the curriculum formally
teaching this art in our emergency medicine residency. Instead, we learn this very much like an
artisan learns a trade; by watching our mentors chart and emulating their methods. Now that
we are out in practice, we have an additional layer of complexity in this task. We are now asked
to document using computers. The difficulties in generating a good chart is now multiplied by
the various challenges of the many platforms used to perform this task. The goal of this article is
to discuss some of the challenges and to provide some tips on charting, especially in the age of
computer documentation. The goal of this article is not to teach documentation. I would refer you
to the CMS guide to documentation for that instruction. I would also recommend the ACEP guide
to documentation that can be accessed on the ACEP.ORG portal. We hope that the following
discussion will aid our members in the approach to documentation and the EMR.
14 | LIFELINE a forum for emergency physicians in california
Documentation is such an important task
because it is a record of the events that
occur during a patient encounter. It is used
as a historical document, a legal document,
and a billing document. It is imperative
that all physicians recognize all three uses
of the chart. Therefore, charting should
be methodical and meticulous, like any
procedure performed in the care of the
patient. The chart should read like a story
of the ER visit. It should have a beginning
and an end. It should be clear to the reader
the reasons for tests to be obtained, the
reason for the practitioner to reach a certain
impression as the diagnosis, and the reason
for the disposition. A good example of this
is the chest pain chart. It should be clear to
the reader why the patient is discharged or
admitted. As our charts become more and
more scrutinized, care should also be given
to explanations of the "why" of ordering
tests, especially invasive or costly ones.
As a billing document, we are bound
by the rules of CMS. We are required to
have particular elements in our charts in
order to bill. If a chart does not have the
required elements, you will not get paid
the optimal amount. E & M billing is based
on level of complexity of the Evaluation
(E) and Management (M) of the case. The
Since charts are on the computer, there is already Software to
easily sift through the charts looking for cut and paste sections.
Apparently, the attorney general has classified chart cloning as a
crime because it actually affects Medicare payments.
chart should reflect the case's complexity.
The more complex the case, the more is
paid, if the chart meets the requirements
of elements documented. The level of
complexity range from level 1 to critical
care. Once the chart reaches the level
of critical care, additional elements are
required. Please refer to appendix A for the
specific guidelines.
Some of us know the pain of the fact that
the chart is a legal document. It becomes
one when a lawyer has to look at it for
various reasons. The most dreaded reason
for the involvement of the lawyers is when
there is litigation. This is another area
where documenting all the “what, why, and
how” is so important. It is also well known
that when a lawyer reads the chart, if you
did not document it, it did not happen.
This consideration adds a tremendous
amount of stress to our profession. It adds
cost to our medical care system, both
real and opportunity costs. However, it
is something that must be done. Having
tools to decrease this risk and decrease the
time spent documenting in this area would
be very helpful. Medilegal risk is not just a
function of documentation; however, it is
an important part of the case. For example,
litigation in a case with good care, bad
outcome and poor documentation, may
have a very different judgment from the
jury if the same case had been reviewed
and found to have great documentation of
the good care rendered. This is where the
medical decision making (MDM) portion of
the chart is so crucial. In the future, we will
hope to provide our members with some
macros that contain MDM for patients with
some common chief complaints that we
discharge. These patients often need more
documentation. We will try to capture this
in a short text block that may help shorten
the time spent in this portion of the chart.
Before EMR, charting was thought of
as being "simpler". We believe this is a
perception rather than a truth. We believe
that charting now is more complex because
DECEMBER 2014 | 15
PRACTICE MANAGEMENT UPDATE |
who have moved from paper
T-sheets to computers. With
the development of Dragon
by Nuance, dictating directly
into the charts has been able
to speed this up a little more,
especially for some who do
not type or who type slowly.
The trick is actually making
sure your EHR interfaces
well with dragon. Virtually
all of them do now.
the scrutiny is higher. We can read our
colleagues' chart in real time. The lawyers
can see clearly when things are done with
time stamps. However, the tenets of proper
charting and the uses of the chart has not
changed. In some ways, EMR has improved
patient care. It allows for more rapid access
to past visits. Quick access to records
reduces redundancy, and errors. It avoids
errors related to handwriting and allergies.
EMR creates new obstacles for all
emergency physicians. For those who do
not type, using a platform that requires
typing increases time spent charting
tremendously. Even dictating into the chart
costs more time than writing in shorthand.
Completing the chart on the computer
is a challenge for some docs that are not
familiar with computers. Every EMR has
its own challenges. However, they all cost
more time than writing, especially those
The
most
common
EMR
platforms
are
Meditech, Cernerworks,
Epic, T-systems, and
McKesson. We are all
bound by the decisions
of our facility which
program to use.
However, questions
to ask before going
live should be the following.
Does the system work well with dragon?
Can we produce our own templates prior
to going live? How can scribes access the
charts? How can addenda be placed? Are
the data easily imported? Understanding
the details of these questions prior to going
live will make your life a lot easier. Before
going live, your group should appoint
one or a group of “super users”. These
individuals are appointed to help build the
platform to confront the idiosyncrasies of
the specific practice setting or the practices
of the group. “Building the system” is not
always possible. Some systems force you
to use their “out of the box” system, and
save your “favorites” as you go. This group
of practitioners should also spend time to
use the “test” or “playground” environment
in order to trouble shoot. This is an
environment on the computer where the IT
department have created fake patients so
that the practitioners can practice. The more
time spent in these dry runs with these fake
patients, the more seamless the transition
will be. That being said, “Go live”dates of EMR
16 | LIFELINE a forum for emergency physicians in california
are often a disaster. Therefore, up-staffing
is absolutely necessary. Additionally, there
should be a contingency plan in place, in
case the system freezes or crashes.
EMRs are here to stay. Hopefully,
in ten years, there will be more
universality of the charting
platform. We envision a future
where pictures and videos will
be a seamless part of the EMR.
Additionally, the chart will be
so well designed that there
will not be a need for scribes.
Even after everyone is accustomed to
the system, we still hate to type. We hate
looking for old records. We hate the task
of importing past information and dates.
Enter the role of the scribe. The use of
scribes can significantly reduce the time
spent documenting. They come with
cost and risk. However, when employed
appropriately, the time saved can improve
quality of life at work for the physician,
generate more revenue by ensuring
proper documentation to optimize billing,
and increase revenue by increasing the
physician's ability to see more patients.
Whenever anyone tries to initiate a scribe
program at their site, the question of cost
is always a deterrent for some physicians.
Think of it this way, no organization has
voluntarily given up their scribes once a
program has begun. They add value to the
practice. The cost is substantial, but the
value is much more. They can take notes
as you talk to, the patients. They search
the medical record for old notes, old visits,
and old tests and import them or bring it
to your attention for your review. They look
for results of tests ordered and import that
into the chart. They call the lab when tests
are delayed. They can even go and tell the
patients information when you are too
busy. The benefits stated earlier are well
documented. So if you are in or entering
a practice that uses an EMR and you are
looking to improve your performance,
investigate how a scribe program can
change your practice.
Once your practice begins using EMR,
you become familiar with the use of
macros. Macros are blocks of text that
are pre-generated to reduce time spent
documenting. They are most useful in
documenting procedures. We perform
these procedures the same way every time.
There is no need to type or dictate this de
novo every time. There are certain MDM
phrases that are useful. However, when
using them for this purpose, one must be
mindful that you are using the appropriate
macro for each patient. One of the biggest
pitfalls of generating a bank of MDM macros
for your practice is that you or your partners
will insert it into a chart en-bloc without
any modifications. This presents a few big
problems. First, it may not all apply to the
patient and therefore is inappropriate. This
will create conflicting information in the
chart that may actually increase your risk.
Second, it will be faulted for a violation
known as chart cloning. In the future,
charts that appear to have been copied
from other charts may not be reimbursed
or will be reimbursed at a reduced rate.
Because charts are on the computer, there
is already Software to easily sift through the
charts looking for cut and paste sections.
Apparently, the U.S. Attorney General has
classified chart cloning as a crime because
it actually affects Medicare payments. EMR
are being scrutinized because it makes
it easier to overdocument. This is not to
say that portions of charts could not be
identical to other charts. Physicians tend to
ask the same questions. Pertinent negatives
are often stated the same way. However,
there must be information in the chart
that is specific to that patient. Additionally,
over-documenting may represent cloning
and therefore will likely be scrutinized. In
the future, we would like to provide our
members with a small databank of macros.
These macros will hopefully help decrease
the time spent documenting in these areas.
Using them must come with a caveat that
the user must modify them to fit the need of
the individual chart. Additionally, all users
of macros must make sure they get to know
the entire content of the macro before
inserting it, with or without modification.
Sometimes, modifying a macro actually
takes more time than just dictating. We
Southern California
JOB OPPORTUNITIES
•
Excellent Opportunities for
Emergency Physicians
• Very Competitive Compensation
• Hospitals include Arcadia Methodist &
Glendale Memorial (Top heart programs).
• Available practice settings in the Greater
Los Angeles area.
Contact Debbie Corn for more information
(909) 634-3172 or email CV to [email protected]
DECEMBER 2014 | 17
PRACTICE MANAGEMENT UPDATE |
will aim to develop useful macros for our
members.
References
EMRs are here to stay. Hopefully, in ten
years, there will be more universality
of the charting platform. We envision a
future where pictures and videos will be
a seamless part of the EMR. Additionally,
the chart will be so well designed that
there will not be a need for scribes. For
the time being, learning to navigate the
current EMRs are imperative. Being able
to adapt to a new EMR when you change
jobs is also key to your survival and quality
of life. Invest in scribes. Invest the time to
produce a good chart. n
1. Fundementals of medical record documentation, Thomas G. Gutheil, MD. Psychiatry 2004
Massachusetts Mental Health Center, Harvard Medical School, in Boston, Massachusetts.
2. Evaluation and Management Services Guide, The Medicare Learning Network (MLN), The Center for Medicare and Medicaid services
3. 1995 Documentation guidelines for evaluation and management services, The Center for Medicare and Medicaid services
4. 1997 Documentation guidelines for evaluation and management services, The Center for Medicare and Medicaid services
5. Documentation Guidelines for Evaluation and Management Services, ACEP.ORG
6. Revving up RVUs, Michael A. Granovsky, MD, CPC, FACEP, ACEP Scientific assembly 2014
7. RVU Killers: The Most Common Reimbursement Documentation Errors, Michael A.
Granovsky, MD, CPC, FACEP, ACEP Scientific assembly 2014
Appendix A
Description
2013 Total RVU
99283
ED Visit, Level 3
1.76
99285
ED Visit, Level 5
4.93
99291
Critical Care
6.40
Level
E/M Code
MDM
History
Exam
I
99281
Straightforward
Problem focused
Problem focused
II
99282
Low
Extended problem focused
Extended problem focused
III
99283
Moderate
Extended problem focused
Extended problem focused
IV
99284
Moderate
Detailed
Detailed
V
99285
High
Comprehensive
Comprehensive
Critical Care (30-74 min)
99291
Critical Care (75+ min)
99292
Number of Required Elements for Each E/M Level
Medical Decision Making
Level
Dx Mgmt Options
Data
Level of Risk
1
0-1
Minimal
2
2
Low
History
Exam
HPI
ROS
PMFS
99281
1-3
-
-
1
99282
1-3
1
-
2-4
3
3
Moderate
99283
1-3
1
-
2-4
3
3
Moderate
99284
4+
2-9
1 of 3
5-7
4+
4+
High
99285
4+
10+
2 of 3
8+
Middle of 3 categories determine E/M code
18 | LIFELINE a forum for emergency physicians in california
You must document ALL elements required for E/M code
Type of Decision Making
Number of Diagnoses or
Management Options
Amount and/or Complexity
of Data to be Reviewed
Risk of Significant
Complications, Morbidity,
and/or Mortality
Straightforward
Minimal
Minimal or None
Minimal
Low Complexity
Limited
Limited
Low
Moderate Complexity
Multiple
Moderate
Moderate
High Complexity
Extensive
Extensive (4+ points)
High
Data (ordered/reviewed)
Value
Clinical lab tests
1
Xrays, imaging studies
1
Medical tests (e.g EKG)
1
Discuss test results with performing physician
1
Decision to obtain old records/history from someone else
1
Review/summarize old records or hx from someone else
2
Doctor’s visualization of a test/study
2
Level of Risk
Presenting Problem(s)
Diagnostic Procedure(s) Ordered
Management Options Selected
MINIMAL
• One self-limited or minor problem (e.g.
cold, insect bite, tinea corporis)
• Lab tests requiring venipuncture
• CXR
• EKG/EEG
• UA
• US
• Rest
• Gargles
• Elastic Bandages
• Superficial Dressings
LOW
• Two or more self-limited or
minor problems
• One stable chronic illness (e.g. well
controlled HTN, NIDDM, cataract, BPH)
• Acute uncomplicated illness or injury
(e.g. cystitis, allergic rhinitis, sprain)
• Physiologic tests not under stress (e.g.
PFTs)
• Non-cardiovascular imaging studies w/
contrast (e.g. barium enema)
• Superficial needle bx
• Labs requiring arterial puncture
• Skin bx
• OTC drugs
• Minor surgery with no identified
risk factors
• PT
• OT
• IV fluids without additives
MODERATE
• One or more chronic illnesses w/ mild
exacerbation, progression, or side
effects of treatment
• Two or more stable chronic illnesses
• Undiagnosed new problem with uncertain prognosis (e.g. lump in breast)
• Acute illness with systemic symptoms
(e.g. pyelonephritis, colitis)
• Acute complicated injury (e.g. BHT w/
brief LOC)
• Physiologic tests under stress (e.g.
cardiac stress)
• Diagnostic endoscopies with no
identified risk factors
• Deep needle or incisional biopsy
• Cardiovascular imaging studies w/
contrast and no identified risk factors
(e.g. arteriogram, cardiac cath)
• Obtain fluid from body cavity (e.g. LP,
thoracentesis)
• Minor surgery w/ identified risk factors
• Elective major surgery without
identified risk factors
• Prescription drug management
• Therapeutic nuclear medicine
• IV fluids with additives
• Closed treatment of fracture or
dislocation without manipulation
HIGH
• One or more chronic illnesses with
severe exacerbation, progression or
side effects of treatment
• Acute or chronic illnesses that pose a
threat to life or bodily function (e.g.
multiple trauma, acute MI, PE, severe
respiratory distress, ARF, peritonitis)
• An abrupt change in neurologic
status (e.g. seizure, TIA, weakness,
sensory loss)
• Cardiovascular imaging studies with
contrast with identified risk factors
• Cardiac electrophysiological tests
• Diagnostic Endoscopies with identified
risk factors
• Discography
• Elective major surgery with risk factors
• Emergency major surgery
• Parenteral controlled substances
• Drug therapy requiring intensive
monitoring for toxicity
• Decision not to resuscitate or to
de-escalate care 2/2 poor prognosis
DECEMBER 2014 | 19
CEMAF
Donors
ANNOUNCEMENTS |
The California Emergency Medicine Advocacy Fund
(CEMAF) has transformed California ACEP’s advocacy efforts from primarily legislative to robust
efforts in the legislative, regulatory, legal, and
through the Emergency Medical Political Action
Committee, political arenas. Few, if any, organization
of our size can boast of an advocacy program like California
ACEP’s; a program that has helped block Medi-Cal provider
rate cuts, stop the $100 million raid on the Maddy EMS
Fund, and fight for ED overcrowding solutions – and that’s
just the last year! The efforts could not be sustained without the generous support from the groups listed below,
some of whom have donated as much as $0.25 per chart to
ensure that California ACEP can fight for emergency medicine. Thank you to our 2012-13 contributors (in al-
phabetical order):
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Acute Care Medical Group of Orange County
Alvarado Emergency Medical Associates
Antelope Valley Emergency Medical Associates
Beach Emergency Medical Associates
Berkeley Emergency Medical Group
Centinela Freeman Emergency Medical Associates
Central Coast Emergency Physicians
CEP America
Chino Emergency Medical Associates
Culver City Emergency Medical Group
Downey Acute Care Medical Group
EMP Management Group
Front Line Emergency Care Specialists
Hollywood Presbyterian Emergency Medical
Associates
Intercommunity Emergency Medical Group
Mills Peninsula Emergency Medical Group
Montclair Emergency Medical Associates
Napa Valley Emergency Medical Group
Orange County Emergency Medical Associates
Pacific Emergency Providers
Pacifica Emergency Medical Associates
Riverside Emergency Physicians
San Dimas Emergency Medical Associates
San Francisco Emergency Medical Associates, Inc.
Santa Cruz Emergency Physicians
Sherman Oaks Emergency Medical Associates
South Coast Emergency Medical Group, Inc.
Tarzana Emergency Medical Associates
Tri-City Emergency Medical Group
Valley Emergency Medical Associates
Valley Emergency Physicians
Valley Presbyterian Medical Associates
West Hills Emergency Medical Associates
20 | LIFELINE a forum for emergency physicians in california
38TH ANNUAL EMERGENCY MEDICINE IN YOSEMITE
• January 14-17, 2015, Yosemite, CA
CALIFORNIA ACEP SPONSORED CONFERENCES
• Legislative Leadership Conference, April 21, 2015
(Sacramento, CA)
• Annual Assembly, June 12, 2015
(Hilton Los Angeles/Universal City)
ENDURING MATERIALS - ONLINE CME
SonoSim* Enduring Materials - Computer Software (Modules)
Info: (310) 315-2828
www.sonosim.com
• SonoSim® Ultrasound Training Solution Aorta/IVC: Core Clinical Module
• SonoSim® Ultrasound Training Solution Bladder: Core Clinical Module
• SonoSim® Ultrasound Training Solution FAST Protocol: Core Clinical Module
• SonoSim® Ultrasound Training Solution Fundamentals of Ultrasound: Core Clinical Module
• SonoSim® Ultrasound Training Solution Intestinal/Biliary: Core Clinical Module
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*Approved for AMA PRA Category I CreditsTM
| CALIFORNIA ACEP UPCOMING MEETINGS & DEADLINES
For more information on upcoming meetings, please e-mail us at [email protected]; unless otherwise noted,
all meetings are held via conference call.
DECEMBER 2014
DECEMBER 2014
1st
2015-16 Legislative Organizational Session;
Organizational Recess Begins
Sacramento, CA
3rd
California Emergency Medical Services Authority (EMSA)
Commission Meeting
San Francisco, CA
5th-7th
CMA House of Delegates
San Diego, CA
10th at 10:00 am
Member Services Committee
Conference Call
10th
CHA Emergency Medical Services/Trauma Committee
Sacramento, CA
16th at 10:00 am
Emergency Medical Services Committee
Conference Call
18th at 10:00 am
Government Affairs Committee
Conference Call
24th-25th
Christmas Day
Chapter Office Closed
31st
New Year's Eve
Chapter Office Closed
JANUARY 2015
1st
New Year's Day
Chapter Office Closed
5th
Legislature Reconvenes from Winter Recess
Sacramento, CA
6th at 9:00 am
SUN
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FEBRUARY 2015
SUN
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Conference Call
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Government Affairs Committee
Conference Call
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38th Annual Emergency Medicine In Yosemite
Yosemite National Park, CA
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23rd at 10:00 am
Practice Management Committee
Conference Call
22
23
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27th at 10:00 am
Emergency Medical Services Committee
Conference Call
FEBRUARY 2015
5th at 10:00 am
Board of Directors Meeting
Sacramento, CA
11th at 10:00 am
Members Services Committee
Conference Call
17th at 3:00 pm
CAL/EMRA Representatives
Conference Call
DECEMBER 2014 | 21
CAREER OPPORTUNITIES |
ANAHEIM, CALIFORNIA: Anaheim Regional Medical Center’s well
established ED Physician group has an immediate part time / full
time opportunity for a Board Certified or Board eligible Emergency
Physician. We have a busy, high acuity department with 44,000
annual visits; we have a "state of the art" Critical Care Center with
computerized tracking system and physician order entry. Shifts are
9-10 hours long with double coverage during peak hours. We offer
a competitive salary based on productivity and paid malpractice.
Interested physicians E-mail your CV and references to
[email protected], [email protected], or call us at 714-999-5112.
GLENDALE, CALIFORNIA: ER position available in the fast track of
the Emergency Department at Glendale Adventist Medical Center.
Position will be paid $110/hr as an independent contractor from
12p-12a
Contact: Ron Lieberman at 323-788-5142 or
[email protected]
LOS ANGELES: Excellent opportunity to work in a high-volume,
high acuity Emergency Department with a democratic group,
with a 30 year track record. Level II trauma center and paramedic
base station. Competitive salary and full partnership opportunities
available.
If you are Board Certified/prepared, please send your resume to
Clayton Kazan, MD, Director of Emergency Services, St. Francis
Medical Center, Lynwood, California. Call 310. 900. 4534, fax to
310. 900. 8287 or e-mail [email protected].
Website: www.flecsmd.com.
22 | LIFELINE a forum for emergency physicians in california
MONTEREY BAY AREA: The Watsonville Emergency Medical
Group has a full time position available at our community hospital.
We are a single group, single hospital, fully democratic group at
our hospital for over 30 years. We are a well respected group and
serve on most committees at the hospital. The shifts are 8-9 hours
with daily PA support. Rapid full partnership is available based on
hours worked. Must be BC/BE in emergency medicine. New adult
hospitalist and pediatric hospitalist programs started this past year
with Lucille Packard Hospital/Stanford affiliation. We believe in
flexible scheduling to enjoy the redwoods and surfing in beautiful
Santa Cruz County on your time off.
Contact (831) 239-1487 or (831) 728-2787
Email: [email protected]
NORTHERN, CALIFORNIA: Independent democratic group, Marin
County California community hospital and Urgent Care, 23,000
combined annual census. Near San Francisco, wine country, north
coast.
Seeking part time EM board certified MD's, 8 hour shifts, single
coverage, fee for service. Opportunity for partnership. Contact
David Thompson MD, Director [email protected].
Also seeking ER experienced PA's for affiliated Urgent Care
weekend 6 hour day shifts. (with MD) Contact: Susan Bradshaw
MD, Director [email protected]
To advertise with Lifeline and to take advantage of our circulation
of over 3,000 readers, including Emergency Physicians, Groups,
and Administrators throughout California who are eager to learn
about what your business has to offer them, please contact us at
[email protected] or give us a call at (916) 325-5455.
e?
s
r
u
o
c
S
L
for an IT list:
LoREoF okffersinthegfollowing California providers
EM
Allan Hancock College
Mike DeLeo, EMT – Course Coordinator
800 S. College, Santa Maria, CA 93454
Phone: (805) 878-6259
Fax: (805) 922-5446
Email: [email protected]
Web: www.hancock.cc.ca.us
American Medical Response (AMR)
Ken Bradford, Operations
841 Latour Court, Ste D, Napa, CA 94558-6259
Phone: (707) 953-5795
Email: [email protected]
A Work Safe Environment
Steve Bristow, EMTP
3140 Aldridge Way, El Dorado Hills, CA 95762
Phone: (925) 708-5377
Email: [email protected]
Web: www.worksafeenvironment.com
California EMS Academy
Nancy Black, RN, Course Coordinator
1170 Foster City Blvd #107, Foster City, CA 94404
Phone: (866) 577-9197
Fax: (650) 701-1968
Email: [email protected]
Web: www.caems-academy.com
California EMS Education and Training
Eric Spoonhunter, EMTP, Program Director
PO Box 1146, Bishop, CA 93515-1146
Phone: (888) 519-8890
Fax: (888) 519-8479
Email: [email protected]
Web: www.cemset.org
Compliance Training
Jason Manning, EMS Course Coordinator
3188 Verde Robles Drive, Camino, CA 95709
Phone: (916) 429-5895
Fax: (916) 256-4301
Email: [email protected]
CSUS Prehospital Education Program
Derek Parker, Program Director
3000 State University Drive East, Napa Hall, Sacramento, CA
95819-6103
Office: (916) 278-4846
Mobile: (916) 316-7388
Email: [email protected]
Web: www.cce.csus.edu
ETS – Emergency Training Services
Mike Thomas, Course Coordinator
3050 Paul Sweet Road, Santa Cruz, CA 95065
Phone: (831) 476-8813
Toll-Free: (800) 700-8444
Fax: (831) 477-4914
Email: [email protected]
Web: www.emergencytraining.com
Fast Response School of Health Care Education
Erick Weldon, Director of Academics
2075 Allston Way, Berkeley, CA 94704
Phone: (510) 809-3648
Fax; (866) 628-5876
Email: [email protected]
Web: www.fastresponse.org
Loma Linda University Medical Center
Lyne Jones, Administrative Assistant
Department of Emergency Medicine
11234 Anderson St., A108, Loma Linda, CA 92354
Phone: (909) 558-4344 x 0
Fax: (909) 558-0102
Email: [email protected]
Web: www.llu.edu
Medic Ambulance
Perry Hookey, EMTP, Education Coordinator
506 Couch Street, Vallejo, CA 94590-2408
Phone: (707) 644-1761
Fax: (707) 644-1784
Email: [email protected]
Web: www.medicambulance.net
Napa Valley College
Gregory Rose, EMS Co-Director
2277 Napa Highway, Napa CA 94558
Phone: (707) 256-4596
Email: [email protected]
Web: www.winecountrycpr.com
NCTI – National College of Technical Instruction
Lawson E. Stuart, RN, CEN, EMT-P
Lena Rohrabaugh, Course Manager
333 Sunrise Ave Suite 500, Roseville, CA 95661
Phone: (916) 960-6284 x 105
Fax: (916) 960-6296
Email: [email protected]
Web: www.ncti-online.com
Oakland Fire Department
Sheehan Gillis, EMT-P, EMS Coordinator
47 Clay Street, Oakland, CA 74607
Phone: (510) 238-6957
Fax: (510) 238-6959
Email: [email protected]
Web: http://www.oaklandnet.com/fire/
PHI Air Medical, California
Graham Pierce, Course Coordinator
801 D Airport Way, Modesto, CA 95354
Phone: (209) 550-0884
Fax: (209) 550-0885
Email: [email protected]
Web: http://www.phiairmedical.com/
Riggs Ambulance Service
Greg Petersen, EMT-P, Clinical Care Coordinator
100 Riggs Ave, Merced, CA 95340
Phone: (209) 725-7010
Fax: (209) 725-7044
Email: [email protected]
Web: www.riggsambulance.com
Rocklin Fire Department
Chris Wade, Firefighter/Paramedic
4060 Rocklin Road, Rocklin, CA 95677
Phone: (916) 625-5311
Fax: (209) 725-7044
Email: [email protected]
Web: www.rocklin.ca.us
Rural Metro Ambulance
Brian Green, EMT-P
1345 Vander Way, San Jose, CA 95112
Phone: (408) 645-7345
Fax: (408) 275-6744
Email: [email protected]
Web: www.rmetro.com
Santa Rosa Junior College Public Safety
Training Center
Bryan Smith, EMT-P, Course Coordinator
5743 Skylane Blvd, Windsor, CA 95492
Phone: (707) 836-2907
Fax: (707) 836-2948
Email: [email protected]
Web: www.santarosa.edu
WestMed College
Brian Green, EMT-P
5300 Stevens Creek Blvd., Suite 200, San Jose, CA 95129-1000
Phone: (408) 977-0723
Email: [email protected]
Web: www.westmedcollege.com
Search for upcoming courses: http://cms.itrauma.org/CourseSearch.aspx
EMREF is a proud sponsor of California ITLS courses.
Please call 916.325.5455 or
E-mail Lucia Romo: [email protected] for more information.
lifeline
California Chapter, American
College of Emergency Physicians
1121 L Street, Suite 407
Sacramento, CA 95814
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