MISSOURI EPIC by jennyyingdi


									                                MISSOURI EPIC
                                           EMERGENCY PHYSICIANS INTERIM COMMUNIQUE
                                                Missouri College of Emergency Physicians
                                                                                    January 2010

President’s Message                1    President’s Message
                                        The tortuous road leading to significant healthcare reform is be-
Current MoCEP Board                3    ing aggressively routed and paved this year.       Great political
                                        pressure exists in Washington DC to have healthcare reform
EMF Grant Information              4    mapped out and a bill signed before the stroke of midnight on
                                        New Year’s Eve. As we go to press with this newsletter, both
MoCEP New Members                  5    the Senate and House have pushed their healthcare reform bills
                                        out of committee and are now fervently working to reconcile both
Battle of the Belt                 6    into one bill to send before President Obama. Reconciling each
                                        of the 1000+ page bills is not easy. Emergency physicians are
Rural Survey Update                6
                                        very fortunate that ACEP has strong powerful resources in
PAD Law Passes                     8    Washington DC working on both our behalf and that of patients
                                        who seek our care. The national ACEP PAC raised over 1 mil-
Legislative Issues                 9    lion dollars this year making emergency medicine the 4th largest
                                        medical specialty PAC in the country. All medical specialties are
EM Resident Updates               11    battling to make sure their voice is heard and interests are pro-
                                        tected as reform moves forward.
Resident Listing              12 & 13
                                        Whether you want reform or not, some iteration will likely be in
Open Letter from the ACEP     14 & 15   place before the end of the year. Many of us bring both our pro-
                                        fessional and personal views when we debate what healthcare
ShowMeResponse.org                15    reform should ultimately look like. At the national ACEP council
                                        meeting in Boston this past October, opinions from all 300+
Resident Research Grant           16
                                        emergency physicians representing their individual states were
                                        widely divergent. Much like the general public and politicians,
State Advisory Council on         17
EMS                                     emergency physicians can not agree what healthcare should
                                        look like in the future. If you read both the Senate and House
A Personal Experience in          18    versions of the healthcare reform bills, you notice individual
Washington DC
                                        states are given great leeway in how to enact key principals of
R.R. Hannas Recipients            19    healthcare reform. Thus state politics will likely play an even
Disaster;                         20
                                        greater role than national politics in how healthcare reform ulti-
                                        mately transforms in each individual state.
Are We Prepared?
Missouri ITLS                     21    Missouri emergency physicians will need to come together and
                                        play a more active role with state legislators in the future to make
Legislative Chart for House       23    sure we have appropriate resources to perform our vital role
and Senate Bills
                                                                                         Continued on Page 2
Page 2                                                                                       MISSOURI EPIC

Continued from Page 1
in society. Please trust that your MoCEP board of directors and our executive director, Betsy Ledg-
erwood have and will continue to carefully monitor Missouri legislative activities that pertain to emer-
gency medicine. If you recently received your ACEP annual dues statement, you may have noticed
a new voluntary $50.00 Missouri Emergency Physician Political Action Committee billing line. Funds
collected allow us as emergency physicians to improve our lobbying and support for Missouri state
politicians who support our interests and those of the patients we treat.

We compete with much larger PACs such as the trial lawyers, pharmacists, etc. in Jefferson City on
many issues each year. These other professional groups often provide their PACs with hundreds
and sometimes thousands of dollars on average per individual member.

Every dollar that goes to our Emergency Medicine PAC, helps support emergency physician/
medicine advocacy efforts here in the state of Missouri.

MoCEP has been busy this past year on many fronts. Reading through this newsletter details only a
few of those efforts. You may have noticed on the front page the MoCEP logo has been updated.
As we become more involved in political and community activities, it is important to have a logo that
brands our organization well.

We continue to strongly support the highly successful Missouri Battle of the Belt program. This pro-
gram was recently taken over by MoDOT and MoCEP looks forward to continuing our support as a
cosponsor of this program. MoCEP recently conducted a study on rural emergency departments
here in Missouri. Larry Slaughter M.D., one of our board members obtained a grant from National
ACEP to support this effort. We hope to more strongly connect MoCEP with the many rural EDs
here in Missouri currently providing invaluable emergency medical services to their local communi-

Legislatively over the past year we won a few battles, held steady on some, and lost a few. Al-
though the Medicaid (MO HealthNet) payment update, which was to increase another 15% (as part
of a multi-year plan to move Medicaid fees to Medicare’s level) did not occur, we were able to hold
steady and not suffer a reduction as many other medical services/providers did. With monthly state
tax revenue still running nearly 10% behind previous year’s average receipts, we may see a second
round of $500 million in state budget cuts needing to be made in January. Fortunately, Missouri
from a deficit spending perspective is not comparable to states like Illinois and California. Compared
to the rest of the country, Missouri is aggressive with trying to keep its’ budget balanced. This
means cuts happen more swiftly and we must always be ready to protect the current funding of
emergency medicine in our state.

A motorcycle helmet bill allowing any person over the age of 21 to ride a motorcycle without protec-
tive headgear unfortunately was passed overwhelmingly by both the House and Senate. Fortu-
nately, several state groups, many individuals, along with MoCEP and MSMA (Missouri State Medi-
cal Association) lobbied Governor Nixon aggressively to veto this bill…and he did. One of our Mo-
CEP members was cited in a newspaper article reporting:
       Dr. Greg Folkert gave an emotional appeal, talking about losing his own father to a motorcy-
       cle accident when Folkert was 10 years old. "I was a boy who became a man dogged by
       never knowing who my father was," said Folkert, a Washington University/Barnes-Jewish
       Hospital Emergency Medicine resident who finishes his residency in a couple of months.
       "Please Gov. Nixon, don't repeal this law."                                Continued on Page 3
MISSOURI EPIC                                                                                                           Page 3

Continued from Page 2
MoCEP continues to work on encouraging more physician members to become politically active. At a
recent board meeting, it was decided to support matching scholarships, up to $1,000.00 for each of the
four residency programs (max $4,000/year), to send residents to the ACEP Leadership and Advocacy
conference held in Washington DC each spring. In addition, beginning July 2010, MoCEP is going to
trial providing residency programs ½ the cost for their incoming 1st year residents covering a 3 or 4 year
ACEP/EMRA/MoCEP membership period. This will cost MoCEP a few thousand dollars each year but
will provide an opportunity to all EM residents being trained in Missouri to have MoCEP/ACEP/EMRA
membership throughout their residency. Less than half of EM residents being trained in our state are
MoCEP/ACEP/EMRA members. We believe this exposure will encourage resident to become more edu-
cated on local and statewide emergency medicine initiatives here in Missouri . In addition, we hope to
recruit more EM residents to help MoCEP lobby in Jefferson City and advocate for emergency medicine
throughout the state.

You may have noticed in the papers recently statewide efforts have mounted to overturn the 2005 mal-
practice reforms we as physicians fought hard to put in place. In fact, on January 14th, the Missouri Su-
preme Court will hear arguments against the constitutional validity of Missouri’s current medical malprac-
tice tort reform laws. MoCEP recently filed an Amicus Brief for this upcoming Supreme Court trial sup-
porting the importance of keeping our current Missouri medical malpractice tort reform laws in place.

Time critical diagnosis (TCD) and treatment efforts continue at the state level. Several of our MoCEP
members sit on various committees working on state guidelines dealing with care of acute MI, Stroke,
and Trauma patients. Under the guidance of the late Dr. Bill Jermyn (a MoCEP board member), legisla-
tion was enacted in 2008 to develop statewide coordinated efforts to improve systems and care provided
to patients suffering acutely from MI, CVA, and trauma. Current information on efforts behind TCD is
available on the MO Department of Health and Senior Services website.

Our next board meeting will be held at the MoCEP office in Jefferson City on January 27th at 10:00am.
After the meeting, board members will go over to the state capitol and visit with our legislators discussing
issues important to emergency physicians. All MoCEP members are invited to attend our board meeting
and then make visits with their legislators. We provide talking points on important issues being discussed
during the legislative session and can “show you the ropes” with getting around the capitol. Please
RSVP to our MoCEP office if you want to attend so we make sure there is adequate room for everyone.
Check out the MoCEP website from time to time to keep apprised on your organization’s efforts. Please
consider becoming more involved with MoCEP and its various activities. Encourage your emergency
medicine colleagues who are not current ACEP/MoCEP members to join-about half of eligible EM physi-
cians in Missouri are not members. Together we will continue the advancement of Emergency Medicine
to the betterment of all citizens here in Missouri!
        Happy Holidays!                      -Rob Poirier M.D., FACEP
              MoCEP Board Members

                                    Officers             Name:                         Board Members:
                                    President            Robert Poirier, MD, FACEP     Douglas Char, MD, FACEP

                                    Vice President       Brian Robb, DO, FACEP         Chad Boulware, DO
                                    Sec/Treasurer        Michael Szewczyk, MD, FACEP   Charles W. Sheppard, MD, FACEP
                                    Past-President       Randall Jotte, MD, FACEP      Ted McMurry, MD, FACEP
                                                                                       Lynthia Andrews, DO, FACEP
                                    Resident Board Members:                            Larry Slaughter, MD, FACEP
                                    Jonathan Heidt, MD    St. Louis                    Barry Spoon, DO, FACEP
                                    Daniel Baker, DO      Joplln                       Sebastian Rueckert, MD, FACEP
Page 4                                                                              M I S SO UR I E P IC

 Emergency Medicine Foundation

                          EMF Grant Applications are Now Available!

 The Emergency Medicine Foundation is pleased to announce the 2010-2011 on-line grant applica-
 tions are now available at www.emfoundation.org. Deadline for all proposals is Jan. 12, 2010.
 Grants range from $2,400 for a medical student grant to a $150,000 two-year fellowship.

 How do you donate to EMF?

 Donate On-line
 To make a secure on-line donation, go to www.emfoundation.org and click on the Donate Now but-
 ton. Click on Chapter Challenge and type in your chapter’s name.

 Donate via Mail
 P.O. Box 619911
 Dallas, TX 75261-9911
 Make sure to note your chapter name.

 Donate via Phone
 (800) 798-1822
 Ask for Membership Services and let them know you would like to make a donation to EMF in
 honor of your chapter.

  A MoCEP     Board Meeting is planned at the MSMA Annual Convention
                          for Sat. 3/27/10 at 10am
                     All members are invited to attend
M I S SO U R I E P IC                                                                                 Page 5

                                 TO ALL OF OUR NEW MEMBERS
           NEW MEMBERS:                                              ACEP MEMBERS MOVED INTO MO
           Elizabeth Bassett                                          Robert Honegger, MD
           Don E. Keen                                               Evelyn W. Young, MD
           Thaison Paul Tran                                         Justin D. Moody, DO
           David A. Horwitz                                          Stephen Paul Stewart, MD
           Roger Charles Merk, MD                                    Stephen Y. Liang, MD
           Evan Ross Cameron                                         Joseph Spennetta, MD
           Anthony J. Scalzo, MD                                     Christopher J. Waldschmidt, MD,FACEP
           Joan A. Veits, MD                                         Ryan C. Jacobsen, MD
           Laurie E. Byrne, MD                                       Nicholas M. Mohr, MD
           Scott M. Campbell                                         Brandie Anne Niedens, MD
           Joshua Stilley                                            Jacob L. Spain, MD
           Charles P. Coyne, III                                     Bryan Stork, MD
           Kevin Hardiman                                            Joseph Walline, MD
           Gilbert Louis Mobley, MD                                  Devin N. Boss, DO
           Tiffini Battiste, DO                                      Scott Geiger, DO
           Bernadette Johnson, MD                                    Cassandra Haddox, DO
           Brandie Anne Niedens, MD                                  Daniel Hagen, DO
           Tara Schulte, DO                                          Sarah Kennedy, MD
           Swetha Sridhar, MD                                        Steven A. Lorber, MD
           Jennifer Watts, MD                                        Jeremiah Ostmeyer, MD
           Kris Kuhl                                                 Peter David Panagos, MD, FACEP
           Laura E. Marble, MD                                       Jennifer Rupert, MD
           Samantha Whiteside                                        Maria Scarbrough, MD
           Andrew Abbeg, MD                                          Kelly R. Brown, MD
           Joaquin Pascual Guzon, MD                                 James Willis Coker
           Brett E. Haugen, MD                                       David A George, DO, FACEP
           Timothy J. Koboldt                                        Stephen Jeremy Perchellet, MD
           Aalap Mehta, DO                                           Joshua J. Hillen, MD
           Delwin S. Merchant, MD                                    Roberto A. Moran, MD
           Chalmer Luke Morris, DO                                   Kimberly Anne Randell, MD
           Aaron Stavinoha, MD                                       Chris Ellis Bowser, MD
           Emily Ann Tilzer, MD                                      Phat Luong
           Randall J. Young, MD                                      Joseph A. Aldrich, III, DO
           Curtis M. McGeeney, MD                                    Jason D. Meyers, MD
           Emily Ann Tilzer, MD                                      Alina H. Waring, MD

            All MoCEP Members are invited to attend MoCEP’s next Board Meeting
                                     Wednesday, January 27th at 10:00am
                   MoCEP Office, 213 E Capitol Ave., Jefferson City, Terrace Conference Room

 After the meeting, board members will go over to the state capitol and visit with our legislators dis-
cussing issues important to emergency physicians. We provide talking points on important issues
being discussed during the legislative session and can “show you the ropes” with getting around the
Please RSVP to Margie 573-636-2144 at our MoCEP office if you want to attend so we make sure
there is adequate room for everyone. Let her know if you want an appointment with one of your leg-
islator, which she will try to arrange.
Page 6                                                                                       M I S SO UR I E P IC

                  Winners of Battle of the Belt Challenge Announced

                 You’re Never Too Cool to Buckle Up. That was the message of the winning video
                 for the 2008 Battle of the Belt challenge. For the third year, more than 125 Missouri
                 high schools competed against each other to increase safety belt use and save


St. Joseph Academy ‐ Highest Overall Seat Belt Usage
Blue Eye High School ‐ Most Improved Seat Belt Usage
Washington High School – 1st place Video/Public Service Announcement
Joplin High School – 2nd place Video/Public Service Announcement
Statewide, only 62 percent of Missouri teens report wearing their seat belt. Young drivers between
the ages of 15 and 18 comprise 5.4 percent of Missouri's 4.2 million licensed drivers and are in-
volved in 15 percent of the traffic crashes in the state.

Between 2005 - 2007, 56 teens in mid-Missouri were killed in vehicle crashes. Thirty-eight of those
young people were not wearing a seat belt.

"Buckling your seat belt only takes seconds and it is one of the easiest and most important things
you can do to prevent serious injury or death if involved in a crash," said Matt Myers, central region
coordinator for the Missouri Coalition for Roadway Safety. "This is an important message for teens
and parents alike."

For more information on the Battle of the Belt Program and other winners go to:

Rural Survey Update

Recently the Missouri College of Emergency Physicians completed a survey of rural Emergency De-
partments in the state. I’d like to thank everyone that participated. Your dedication to serving your
communities is evident in your response. Our surveyor reported a response rate 300% higher than
average for this type of survey.

The survey provided a unique view into the challenges that our rural Emergency Departments face.
Lack of an ambulance service, and adequate staffing were concerns raised by many institutions.
Many of the challenges are the same as those seen at the biggest institutions in the state such as
boarding inpatients, reimbursement, and placement of mentally ill patients.

Most importantly the survey has given MoCEP an avenue to communicate with those who serve our
rural populations. The Board’s hope is that by working together we can advance Emergency care in
the state of Missouri. Our plan, in the coming months, is to establish a dialogue to accomplish this
goal. We look forward to talking with you. If you have any questions please don’t hesitate to contact
me at larry.slaughter@yahoo.com
Page 8                                                                                         M I S SO UR I E P IC

 Public Access Defib Law Passed Legislature
 PAD passed and has been approved by the Governor. HB 819 was added to HB 103 and became
 effective Aug. 28, 2009.

 Congrats to AHA and Bonnie Linhardt.

    190.092. 1. This section shall be known and may be cited as the "Public Access to Automated
 External Defibrillator Act".
     2. A person or entity who acquires an automated external defibrillator shall ensure that:
     (1) Expected defibrillator users receive training by the American Red Cross or American Heart
 Association in cardiopulmonary resuscitation and the use of automated external defibrillators, or an
 equivalent nationally recognized course in defibrillator use and cardiopulmonary resuscitation;
     (2) The defibrillator is maintained and tested according to the manufacturer's operational guide-
     (3) Any person who renders emergency care or treatment on a person in cardiac arrest by using
 an automated external defibrillator activates the emergency medical services system as soon as
 possible; and
    (4) Any person or entity that owns an automated external defibrillator that is for use outside of a
 health care facility shall have a physician review and approve the clinical protocol for the use of the
 defibrillator, review and advise regarding the training and skill maintenance of the intended users
 of the defibrillator and assure proper review of all situations when the defibrillator is used to render
 emergency care.
    [2.] 3. Any person or entity who acquires an automated external defibrillator shall notify the
 emergency communications district or the ambulance dispatch center of the primary provider of
 emergency medical services where the automated external defibrillator is to be located.
    [3.] 4. Any person who [has had appropriate training, including a course in cardiopulmonary re-
 suscitation, has demonstrated a proficiency in the use of an automated external defibrillator, and
 who] gratuitously and in good faith renders emergency care [when medically appropriate] by use of
 or provision of an automated external defibrillator[, without objection of the injured victim or victims
 thereof,] shall not be held liable for any civil damages as a result of such care or treatment, [where
 the person acts as an ordinarily reasonable, prudent person would have acted under the same or
 similar circumstances] unless the person acts in a willful and wanton or reckless manner in provid-
 ing the care, advice, or assistance. The person or entity who provides appropriate training to the
 person using an automated external defibrillator, the person or entity responsible for the site where
 the automated external defibrillator is located, the person or entity that owns the automated exter-
 nal defibrillator, the person or entity that provided clinical protocol for automated external defibrilla-
 tor sites or programs, and the licensed physician who reviews and approves the clinical protocol
 shall likewise not be held liable for civil damages resulting from the use of an automated external
 defibrillator[, provided that all other requirements of this section have been met]. Nothing in this
 section shall affect any claims brought pursuant to chapter 537 or 538, RSMo.
M IS S O U R I E P I C                                                                                  Page 9

 Legislative Issues of Interest

 July 2, 2009—Gov. Nixon vetoes bill to repeal Missouri helmet law; cites increased health care
 costs to taxpayers, public safety as primary concerns

 JEFFERSON CITY, Mo. - Gov. Jay Nixon today vetoed Senate Bill 202, legislation that would have re-
 pealed Missouri's helmet law for motorcycle riders. In vetoing the bill, Gov. Nixon cited two primary
 concerns: the significantly increased health care costs that could have resulted from the repeal, and the
 safety of Missouri's motorcycle riders.
 "In terms of lives and of dollars, the cost of repealing Missouri's helmet law simply would have been too
 high," Gov. Nixon said. "By keeping Missouri's helmet law intact, we will save numerous lives, while
 also saving Missouri taxpayers millions of dollars in increased health care costs. Keeping our helmet
 law in place was the safe and cost-effective choice for Missouri."
 Universal helmet laws, such as the law Missouri has had since 1967, require all motorcycle riders to
 wear a helmet at all times while riding. According to data from the National Highway Traffic Safety Ad-
 ministration (NHTSA), the economic consequences of repealing such a law are clear. When Florida re-
 pealed its universal helmet law in 2002, the cost to treat patients diagnosed with head injuries as a re-
 sult of motorcycle accidents doubled, reaching a total of $44 million. [Traffic Safety Facts, NHTSA,
 2008] Nationally, one academic study estimated that the total cost to treat motorcycle accident victims
 who were not wearing a helmet is $250,231,734 a year more than the cost of treating victims who were
 wearing a helmet [Economic Impact of Motorcycle Helmets: From Impact to Discharge, Journal of
 Trauma-Injury, Infection & Critical Care, 2006] Data from health care providers and insurance compa-
 nies indicate that the taxpayers ultimately must pay for a significant portion of these increased treat-
 ment costs. After the Florida repeal, 16 percent of injured motorcyclists admitted to a hospital for treat-
 ment were either under-insured or uninsured, and the costs for another 21 percent of those admitted
 were billed to either charitable or public sources, such as Medicaid. [Traffic Safety Facts, NHTSA,
 2008] The public safety implications of eliminating or weakening a universal helmet law also are devas-
 tating. The NHTSA reports that helmets reduce the likelihood of a motorcycle fatality by 37 percent; but
 without a helmet law, riders more often choose not to wear protective headgear. As a result, when
 states repeal their helmet laws, motorcycle fatalities skyrocket. [Traffic Safety Facts, NHTSA, 2008] Ac-
 cording to an NHTSA report, in the 30 months following Florida's repeal of its universal helmet law in
 2002, the number of motorcycle fatalities jumped sharply. That year, the state had projected 242 motor-
 cycle fatalities in light of increased registration of motorcycle riders. In fact, however, 301 motorcycle
 riders died in Florida in 2002 - 24 percent more than expected. For the two years before and after Flor-
 ida's repeal, fatalities per 10,000 motorcycle riders increased 21 percent in that state, compared with
 13 percent nationally. [Evaluation of the Repeal of the All-Rider Motorcycle Helmet Law in Florida, Na-
 tional Highway Traffic Safety Administration, 2005] In other states where universal helmet laws have
 been repealed, the trend is similar. According to the NHTSA, fatalities increased by 31 percent in the
 year following the repeal of the Texas helmet law in 1997. When Arkansas repealed its helmet law the
 same year, fatalities increased by 21 percent. [What Happens When a Helmet Law is Repealed? Traf-
 fic Safety Facts, NHTSA, 2008] In addition to Senate Bill 202, the Governor vetoed four other pieces of
 legislation today. Those bills, along with their subject matter, are listed below:
 *       Senate Committee Substitute for Senate Bill 542, relating to the state treasurer;
 *       House Bill 373, relating to the general educational development revolving fund;
 *       House Bill 306, relating to certain hotel and motel taxes; and
 *       House Committee Substitute for House Bill 89, relating to traffic violations.
 The Governor's veto messages on these bills can be viewed at http://governor.mo.gov/actions/.
Page 10   MI S S O U R I E P I C
M I S SO U R I E P IC                                                                                Page 11

EM Resident Updates

The Emergency Medicine Resident Association (EMRA), which represents over 9000 members, holds
biannual council meetings in conjunction with the ACEP Scientific Assembly in the fall and the SAEM
meeting in the spring. These meetings allow the gathering of resident representatives from various pro-
grams around the country to discuss issues that are of importance to residents and to vote on resolutions
which pertain to these matters. During the ACEP Scientific Assembly in Boston, several resolutions
were debated – including live animal use in training, and the new Institute of Medicine recommendations
on work hour regulations. A new board of directors was also chosen during this meeting. Each residency
program is allowed one representative to vote on resolutions at the council meetings. If you are inter-
ested in more information, please email the EMRA regional representative at region4@emra.org.

The Missouri College of Emergency Physicians allows a resident to represent each program at the Board
of Directors meetings. Increasing resident involvement in emergency medicine policy issues at both the
national and state level have become a priority. As the national debate on healthcare reform evolves, it
is becoming quite evident that the environment future leaders in medicine are currently practicing in will
become drastically altered. It is essential that residents are trained and educated on how to become ac-
tive participants in the legislative process rather than allow change to occur without their involvement.
As the health care debate continues to evolve, residents in Missouri are very fortunate to have a Board
of Directors who are committed to resident training in advocacy and health policy. The MoCEP Board of
Directors will soon be providing all Emergency Medicine residents with a copy of the EMRA Advocacy
Handbook. This handbook was written by residents and published this past spring at the ACEP Leader-
ship and Advocacy conference. The book is intended to serve as a primer for advocacy training. A
PowerPoint lecture series based on the handbook is being developed and is currently under review by
the EMRA Health Policy committee.

The MoCEP Board of Directors has established annual grant funding for Missouri EM residency pro-
grams providing up to $1,000.00 matching funds for each program in support of resident travel/housing
to the Leadership and Advocacy (L&A) conference in Washington DC. The experience obtained at the
L&A conference is outstanding, inspiring future emergency medicine leaders here in Missouri.

Finally, the MoCEP Board of Directors has committed 3 years of funding to pay 50% of the cost of a 3 or
4 year resident membership to ACEP/MoCEP/EMRA for new interns starting in July if the individual pro-
gram also commits 50% funding. By exposing residents early to the activities of ACEP, EMRA, and Mo-
CEP, it is anticipated that young physician involvement and awareness of legislative awareness will im-
prove. Through this commitment, MoCEP membership is expected to grow, resulting in a greater voice
for Missouri on the national stage. The emergency medicine residents in Missouri are thankful for these
opportunities and are looking forward to the year ahead!
Page 12                                                                                                           M I S SO UR I E P IC

Washington University/Barnes-Jewish/Children’s Hospital
2009 Emergency Medicine New Resident Listing
              Name:                                 Coming from:

PGY-1         Thomas Belanger                       St. Louis University School of Medicine
PGY-1         Joseph Burkett                        Wayne State School of Medicine
PGY-1         Sarah Hoper                           University of Iowa, Carver College of Medicine
PGY-1         Steven Katz                           University of Tennessee, Memphis
PGY-1         Sarah Kennedy                         University of Virginia School of Medicine
PGY-1         Albert Kim                            Northwestern University, Feinberg School of Medicine
PGY-1         Nicholas Krehbiel                     University of Kansas, School of Medicine
PGY-1         Peta-Gay Laird                        University of Michigan Medical School
PGY-1         Sreeja Natesan                        Saint George's University
PGY-1         Melanie Sutter                        Washington University School of Medicine
PGY-1         Neda Tahmasebi                        Washington University School of Medicine
PGY-1         Molly Tran                            Washington University School of Medicine

Washington University/Barnes-Jewish/Children’s Hospital
2009 Emergency Medicine Residency Graduate Locations
Name                              Where they have gone:

Erica Casey                       Duke University, International Medicine Fellowship, Durham, NC
Sara Cross                        Shawnee Mission Medical Center, Shawnee Mission, KS
Gregory Folkert                   St. Joseph's Hospital West County, Barnes-Jewish West County, St. Louis
Michael Fullenkamp                Premier Medical Group, Omaha, NE
Alisa Hayes                       University of Missouri Hospital, Columbia, MO
Ryan Petersen                     Mercy Hospital, Roseburg, OR
Evan Schwarz                      University of Texas, Southwest, Toxicology Fellowship, Dallas, TX
Alan Taylor                       Methodist Hospital, Memphis, TN
Jose Vega                         Kaiser Permanente, San Diego, CA
Brian Weisenberg                  St. Anthony's Medical Center, St. Louis, MO
Brian Wessman                     Washington University School of Medicine, Critical Care Fellowship, St. Louis

Inaugural Emergency Medicine Resident Class at St. Louis University
            Name                                      Where they are from

PGY-1       Andrew (Andy) Abbeg, D.O.                     Nova Southeastern University College of Osteopathic Medicine
PGY-1       Tina Khosla, M.D.                             University of Missouri Kansas City School of Medicine
PGY-1       Aalap Mehta, D.O.                             Kirksville College of Osteopathic Medicine
PGY-1       Maria Louisa Scarbrough, M.D.                 University of Illinois College of Medicine
PGY-1       Brett Haugen, M.D.                        University of Iowa Roy J. and Lucille A. Carver College of Medicine

PGY-1       Emily Tilzer, M.D.                        University of Missouri Kansas City School of Medicine
PAGE 13                                                                                                    Page 13

Truman Medical Center/University of Missouri-Kansas City School of Medicine
Emergency Medicine Residency
             Name                         Coming From
    PG-1     David Biller                 University of Kansas School of Medicine (Kansas City)
    PG-1     Michael Donohue              University of Minnesota School of Medicine (Minneapolis)
    PG-1     Sarah Farnan                 University of Missouri-Kansas City School of Medicine
    PG-1     Sandeep Guttikonda           University of Missouri-Kansas City School of Medicine
    PG-1     Aaron Kaus                   University of Kansas School of Medicine (Kansas City)
    PG-1     Antoinette Koomson           University of Illinois College of Medicine (Chicago)
    PG-1     Julie Rowell                 University of Louisville School of Medicine
    PG-1     Jennifer Rupert              University of Missouri-Kansas City School of Medicine
    PG-1     Ted Sibley                   University of Minnesota School of Medicine (Minneapolis)
    PG-1     Jennifer von Fintel          University of Kansas School of Medicine (Kansas City)

Graduate Class of 2009
   Name                            Where they have gone
   Aaron Barksdale, MD             Truman Medical Center-Hospital Hill, Kansas City, MO
   Alison Benson, MD               North Kansas City Hospital, KCMO Community Practice
   Tim Chilcote, MD                Shawnee Mission Medical Center, Shawnee Mission KS Community Practice
   Shawn Cox, MD                   St. Luke’s Hospital, Kansas City, MO Community Practice
   Brandon Farmer, MD              Central Texas Medical Center, San Marcos, TX Community Practice
   Megan Glenn, DO                 Truman Medical Center-Lakewood, Kansas City MO Community Practive
   Ryan Jacobsen, MD               Truman Medical Center-Hospital Hill, Kansas City MO Academic Practice
   Dawn Lewis, MD                  Charlie Norwood VA Medical Center, Augusta, GA Community Practice
   Brandon Shirai, MD              Hawaii Medical Center, Honolulu, HI Community Practice

Freeman Health System Joplin, MO
2009 Graduates:
 Name                          Where they have gone
 Coye McMillian, DO            Hillcrest Baptist Medical Center. Waco, TX
Current Residents:
            Name                             Coming from
 PGY4       Amanda DeTar, DO                 Kansas City University of Medicine and Biosciences
 PGY4       Eric Hogan, DO                   Oklahoma State University College of Osteopathic Medicine
 PGY3       Daniel Baker, DO                 Kansas City University of Medicine and Biosciences
 PGY3       Matthew Grounds, DO              Kansas City University of Medicine and Biosciences
 PGY2       Jason Kent, DO                   Kansas City University of Medicine and Biosciences
 PGY2       Michelle Parlett, DO             Kansas City University of Medicine and Biosciences
 PGY2       Tiffani Battiste, DO             Oklahoma State University College of Osteopathic Medicine
 PGY1       Sam Brewer, DO                   Kirksville College of Osteopathic Medicine
 PGY1       Scott Geiger, DO                 Touro College of Osteopathic Medicine
Make sure the American people and Congress get the facts about emergency care and
address these issues in health care reform legislation. Spread the word to your family,
friends and colleagues and ask them to send this message to everyone they know.

An Open Letter from America's Emergency Physicians
As the physicians on the front lines of emergency care, we see the tragic problems of a failing health care system. We
care for people who are ravaged by untreated disease; help worried mothers on weekends with sick children, unable to
access a system that's open 9 to 5, weekdays only; and treat the victims of heart attack, stroke and injuries whose very
lives depend on our care.
The role of emergency medicine has been badly misrepresented during the health care reform debate. The American
College of Emergency Physicians supports comprehensive reform, including universal coverage. But it is vitally impor-
tant that reform legislation not be based on erroneous perceptions, but instead address the critical problems harming
emergency patients. It is time to debunk the myths, focus on the real problems and outline solutions to ensure that
health care reform will protect and enhance everyone's access to quality, timely emergency care.
Myth: Emergency medical care is expensive and inefficient. Reducing emergency care will "bend the cost curve" on
our nation's rising health care costs.
Fact: The 120 million annual visits made to emergency departments account for only 3% of all health care
spending. In addition, emergency departments are equipped with state-of- the-art diagnostic equipment and highly
trained physicians who can draw on many hospital resources quickly, providing coordinated, efficient patient care. The
fixed costs of being open 24/7 are high, but the variable costs for seeing patients in the emergency department are the
same as anywhere else care is provided.
Myth: Emergency departments are crowded with patients seeking non-urgent care.
Fact: Only 12.1% of emergency patients have non-urgent conditions that could wait 2 to 24 hours for medical
care, according to the Centers for Disease Control and Prevention (CDC). While this percentage may be slightly
higher in some hospitals, the reality is that crowded conditions and longer wait times are primarily caused by patients
being "boarded," or forced to stay in the emergency department - often on gurneys lining the hallways - long after they
have been seen and admitted to the hospital.
Myth: Your local emergency department will always be there when you need it.
Fact: Hundreds of emergency departments have closed nationwide because of an overburdened emergency
care system. Those remaining must accommodate an average increase of 3 million more patient visits each year.
Every 60 seconds emergency care is delayed when an ambulance is diverted to a distant hospital because a nearer
one is unable to accept more patients. In addition, 75% of emergency department directors report significant problems
getting needed on-call specialists, such as neurosurgeons and orthopedists, to provide vital on-call services to emer-
gency patients.
Myth: The need for emergency care will decrease when health care reform is enacted.
Fact: With a growing and aging population, our role in providing care to the sick and injured any time day or
night, and our front line responsibility in responding to natural and man-made disasters, will be in even
greater demand in the future. Since enacting its universal health care legislation, Massachusetts has experienced an
increase in emergency department patients. Emergency medicine is an essential community service that is vitally im-
portant to our nation's health care system.
To help ensure our country has a strong emergency care system, the American College of Emergency Physicians sup-
ports comprehensive health care reform that includes:
•   Every person in America must have meaningful and affordable health insurance coverage provided
through a combination of employer and individually mandated insurance. It should be means-tested, allowing
those in need to receive coverage or financial support to buy insurance. A combination of private sector and govern-
mental solutions may be needed to achieve universal coverage. America is experiencing a dramatically rising tide of

                                                                                                 Continued on Page 15
    Page 15                                                                                                   M I S SO UR I E P IC

Continued from Page 14
uninsured and underinsured patients. Emergency physicians are the only doctors in the country required by federal law
to treat all patients regardless of their ability to pay. It is a responsibility we embrace proudly, but many emergency de-
partments and physician groups are closing under the burden of uncompensated care.

•    Health care costs must be reduced. Significant medical liability reform is needed to eliminate unnecessary, expen-
sive tests known as "defensive medicine." Liability reform can also help increase the availability of critically needed on-
call specialists. Widespread adoption of electronic health records could substantially cut costs and improve patient care if
there were complete integration of data between the emergency department and other medical settings. Administrative
and overhead costs must be reduced.

• Quality and patient safety must be improved by eliminating the practice of "boarding" admitted patients in
emergency department hallways until they are transferred to an in-patient hospital bed. This can be achieved by
establishing quality standards that define how quickly admitted patients are moved to their appropriate care settings, with
such information reported and available to the public.

•   A national surge capacity plan must be developed and resources provided to prepare our nation's hospital
emergency departments for public health crises such as the H1N1 pandemic, a terrorist attack or other catastro-
With so much at stake, America can no longer ignore the crisis in its emergency medical care system or make health
reform decisions based on myths. Go to www.acep.org/realities for information on protecting your access to quality,
timely emergency care.
We must act now.

Nick Jouriles, MD, FACEP
President American College of Emergency Physicians

    Disasters Call for Heroes. Answer the Call.
    The Missouri Department of Health and Senior Services is pleased to announce Show-Me Response, a
    Registry of Volunteer Healthcare Professionals www.ShowMeResponse.org

    The Missouri Department of Health and Senior Services, Center for Emergency Response and Terrorism
    (CERT), announces the December 1, 2008 activation of Show-Me Response, an online registration pro-
    gram for healthcare professionals who are interested in volunteering in the event of a natural disaster or
    other large-scale public health crisis in Missouri. During a public emergency, healthcare volunteers are
    essential to help coordinate and deliver services for medical assessment and treatment, medication dis-
    pensing, immunization, counseling, special needs sheltering, and more.

    When volunteers register for Show-Me Response, they make themselves available for contact in the
    event of a disaster should their area of expertise be needed. Once contacted, each volunteer will be able
    to choose the type and level of participation. The system is safe and secure, and any information a volun-
    teer provides will be privacy protected.

    Show-Me Response will collect and check licensing and credential information so data can be readily
    available for the Missouri Department of Health and Senior Services staff to assist in the notification and
    activation of qualified medical volunteers.

    Healthcare professionals can register as volunteers on the Show-Me Response web site at

    For additional information, please contact ShowMeResponse@dhss.mo.gov or contact:

    Carole Schutz, MS, RN, Program Coordinator PO Box 570 Jefferson City, MO 65102-0570
    Office 573-526-0577
Page 16                                                                                        MISSOURI EPIC

Three are Recipients of the Resident/Student Research Grant

The goal of the Missouri College of Emergency Physicians’ Medical Student/Resident Research
Grant is to facilitate the academic growth and research expertise of medical students/residents in
emergency medicine and to promote research in emergency medicine.

After review of the submissions by a panel appointed by the Missouri College of Emergency Physi-
cians Board of Directors, there were three that qualified for partial funding of their research from the
Missouri College of Emergency Physicians’ Resident Grant. The recipients are:

Jonathan Heidt, MD from Washington University for his project “Geriatric Syndrome Screening in
Emergency Medicine: A Prospective, Home-Based Reliability Assessment.” The objectives are: “1)
To validate the MMSE screening results in the ED by re-testing subjects three-weeks after ED dis-
charge when recovering from the presenting illness.; 2) To conduct an observational pilot trial of
Geriatric Technician case-finding for occult cognitive dysfunction, visual deficits, frailty, or deficient
immunization status for geriatric emergency department patients.; 3) To quantify EM physician re-
sponse to cognitive dysfunction screening results using documented recognition of informed physi-
cians compared with uninformed physicians.:

Stacey House, MD. PhD from Washington University for her proposal “Role of Heparins on the In
Vitro Bioavailability and Cardioprotective Properties of Human Recombinant Fibroblast Growth Fac-
tor 2: Development of a Novel Therapeutic for Acute Myocardial Infarction.” She writes that “This re-
search will provide valuable evidence necessary for the development of FGF2 as a potential novel
therapeutic agent for acute myocardial infarction. This study will be the first to elucidate the cardio-
protective efficacy of human recombinant FGF2 when given during early reperfusion in an in vitro
model of acute myocardial infarction. In addition, this study will be the first to determine the tissue
distribution of human recombinant FGF2 given intravenously, and will provide valuable information
as to the effect of heparins on this tissue distribution. The cardioprotective efficacy of human recom-
binant FGF2 when co-administered with heparins will also be investigated. These studies are abso-
lutely necessary to develop FGF2 as a treatment for acute myocardial infarction.”

T. Paul Tran from University of Missouri-Kansas City School of Medicine for his proposal entitled
“Influence of Socioeconomic Status upon Post-Myocardial Infarction Outcome Disparities, within
Separate Black and White Patient Cohorts.” He writes that “This is an ongoing study being re-
searched at St. Luke’s Hospital in Kansas City with Drs. Gary Gaddis, John Spertus, and Mike
Weaver that I have the privilege of working on.” “The object of our study is to examine socioeco-
nomic status as an independent variable when examining post-MI outcomes and to see if there re-
mains a disparity among black and white patient cohorts. Past studies have examined SES in rela-
tion to health outcomes, but not with the same parameters we are using to approach the issue. We
look specifically at SES with regards to access to healthcare and affordability of healthcare. It is our
hope that with our data we can better utilize healthcare resources in improving post-MI outcomes in
all patients.”

For more information on the Missouri College of Emergency Physicians Resident/Student Grant
please go to www.mocep.org
MISSOURI EPIC                                                                                  Page 17

From the State Advisory Council on EMS:

The Time Critical Diagnosis regulations continue to be reviewed. The Trauma Regulations that are
in effect now will be reopened for updates only. The addition will be the Level IV hospitals and defi-
nitions to make the trauma regulations match the Stroke/STEMI regulations. One of the trauma sur-
geons questioned the fact that emergency boarded physicians did not have to keep current ATLS
credentials to work in the Level IV hospitals. In the previous trauma regulations, board certified
emergency physicians did not have to repeat ATLS certification once they (emergency physicians)
had taken the ATLS course. As of this time, this piece of the regulation will remain the same, board
certified emergency physicians are not required to take ATLS once they are certified. The trauma
surgeon questioned this very closely and made the offhand comment that some board certified
emergency physicians were not providing adequate trauma care to their patients. The surgeon
would not comment further, but this is a serious remark and in discussing this with the surgeon, he
would not give specific case but continued to cast the impression that there are board certified emer-
gency physicians that are not adequately treating trauma patients. This is the kind of remark that
surfaces during regulation discussions and could very well be used later to reverse the ATLS re-
quirement for emergency physicians.

The regulation packages for Stroke and STEMI are also well on the way and should be published
and start the approval process in the spring. Emergency physicians will be key partners in all of
these endeavors and should read and understand the regulations and the effects on the pre-hospital
and emergency department patient care. These regulations will have outcome reviews to make sure
that all the participants are meeting the requirements of the regulations at their designation levels
(Level I, II, III, IV).

If any emergency physicians have time to participate in the Time Critical Diagnosis discussions
please call Beverly Smith at DHSS, 573-526-0723 to be put on the list serve for notification.

Lindy Andrews, MD

                                    MAKE PLANS NOW TO ATTEND THE
                              2010 LEADERSHIP AND ADVOCACY CONFERENCE
                                           MAY 16-19, 2010
                                           WASHINGTON, DC
                              FOR MORE INFORMATION GO TO WWW.ACEP.ORG
Page 18                                                                                      MISSOURI EPIC

A Personal Experience in Washington DC

The following is an account by Chet Schrader, M.D. one of the emergency medicine chief residents
at Barnes-Jewish Hospital/Washington University School of Med.

This summer, the idea of Health Care reform turned into action while I was in Washington, DC, tak-
ing a month to do an internship with the American College of Emergency Physicians.

In July, I traveled to the nation’s capitol to assist individuals who speak on Emergency Physicians’
behalf on a regular basis: Gordon Wheeler, Associate Executive Director; Hilary Smith, Congres-
sional and Political Affairs Assistant; Angela Franklin, Quality Measures/HIT Director, Lupe Gonza-
les, DC Operations Manager; Laura Gore, Public Relations Director; Brad Gruehn, Congressional
Affairs Director; Pamela Jay, Public Affairs Administrative Assistant; Julie Lloyd, Public Relations
Manager; Elaine Salter, Public Relations Coordinator; Jeanne Slade, Political Action Director; and
Barbara Tomar, Federal Affairs Director.

My first exposure to the legislative workings of DC began with MoCEP partly sponsoring myself and
three other resident colleagues, allowing us to attend ACEP’s Leadership & Advocacy Conference.
Throughout the conference in April 2009, we learned skills that allowed us to spend time with our
Congressional leaders and ask for their support on ACEP’s foremost legislative priority – the Access
to Emergency Medical Services Act of 2009.

The Access bill set out to address three main components:

(1) Bipartisan Commission on Access to Emergency Medical Services: Following the recom-
mendation of the IOM, the bill creates a commission that will examine factors, such as emergency
department crowding, the availability of on-call specialists, and medical liability issues, which affect
delivery of emergency medical services.

(2) Emergency/Trauma Physician Payments: Authorizes an additional payment through Medicare
to all physicians who provide EMTALA-related care, including on-call specialists whose services are
needed to stabilize the patient. The additional funding would help ensure emergency and other phy-
sician specialists are able to continue providing care to the growing Medicare population. These
payments would neither increase Medicare beneficiaries' co-payments nor negatively impact any
other physicians' Medicare payments.

(3) Emergency Department Boarding/Diversion: CMS would develop hospital boarding and di-
version standards, working through consensus-based organizations such as the National Quality Fo-
rum (NQF) and Hospital Quality Alliance (HQA).

With the emphasis this summer on health care reform, the time spent in DC focused on a different
approach. With the release of the Senate HELP Committee and House Tri-Committee bills, we pri-
marily focused on reviewing the bills and making sure the interests of emergency physicians and
the patients we treat, are protected and advanced.

                                                                                    Continued on Page 19
MISSOURI EPIC                                                                                 Page 19

Continued from Page 18

By working with members of the House Energy & Commerce Committee, our group was able to in-
troduce an amendment to the legislation including language to authorize the Emergency Care Coor-
dination Center (ECCC) and the Council on Emergency Care within the ECCC. This amendment
would help establish emergency care regionalization pilot projects; support and expand emergency
medicine and pediatric emergency medicine research; and provide financial support to economically
challenged trauma centers. The legislation already had contained a quality provision that focused
attention on ED crowding and boarding.
Health care reform is far from finished. When I left DC this summer, we were still advocating for the
same provisions to be included in the Senate Finance Committee Bill. In a meeting, with Senator
Stabenow’s (D-MI) staff, we were encouraged that the same amendment placed in the House bill
would be offered. However, we were surprised to learn that they were unsure of the overall support
of an amendment, because those legislators on the Finance Committee “were not hearing from
Emergency Physicians”. Lobbyists are very important to ACEP and its’ members, but it is even
more important that ACEP members regularly contact their state legislators on issues pertinent to
The amendments offered by ACEP still have to make it through multiple stages of bill reconciliation,
but we’re hopeful all amendments go through.
Nevertheless, it was an exciting time in DC, and one that will serve as invaluable experience for me
in future state, local, and national endeavors. Meeting with Congressional staff, representing ACEP
at CMS briefings, and even participating in the constant rumor-mill of DC was quite an eye-opening
experience – one that I’d recommend to all who could find the time to do it.

  2009 R.R. Hannas, M.D., Award Recipients

  Christopher Watkins       Kansas City University of Medicine & Biosciences
  Samuel Brewer             A.T. Still University of Health Sciences
  Ketan Patel               St. Louis University
  Brandon G. Gaynor         University of Missouri – Kansas City School of Medicine
  Laurel Beth Barrett       Washington University School of Medicine
  Kari Cooper               University of Missouri – Columbia School of Medicine

  The award, entitled the R. R. Hannas, M.D. Emergency Medicine Award, is named after Dr. Han-
  nas, one of the “founding fathers” of Emergency Medicine, who has practiced Emergency Medi-
  cine in Kansas City on and off for approximately thirty years. Dr. Hannas was chairman of the
  committee that originally founded the American Board of Emergency Medicine (ABEM). He
  served on the Board for twelve years and was the organization’s fourth president. He was instru-
  mental in helping to organize the fifth Emergency Medicine program in the country at Northwest-
  ern University, and he is also a past president of the American College of Emergency Physicians
  The award consists of a certificate suitable for framing and $250.00. The Medical School Dean,
  at the recommendation of the Director of Emergency Medicine, select award winners. MoCEP is
  proud to be able to provide this award to a senior medical student at graduation.
Page 20                                                                                       MISSOURI EPIC

Disaster; are we prepared?

Recent times have made preparation for disasters of all types paramount for the protection and well
being of our communities and loved ones. The best method of protecting ourselves and others is to
prepare for the worst in advance.
As emergency physicians we are all aware of the emergency preparedness drills that our hospitals
have in place by mandate. We may have even sat in a formative meeting or been contacted by
phone during the drill. This is a necessary step in the development of disaster preparedness. As
emergency physicians, we need to recognize that our role is by definition, the forefront of prepara-
tion for disaster management. If and when anything occurs, we will be called to assist in managing
all areas of the disaster including providing direct medical care.
Recently, I had the opportunity to interview several of my colleagues and discovered that, outside
the basic tenets of our training, and the hospital’s established disaster management plan, our roles
as emergency medicine physicians were not clear or established. Other than being notified, the next
step or action was unclear. Certainly all of us stand ready to respond to the call, and do what is
asked of us. What we need to do next is unclear.
The mechanics of disaster preparedness and management are numerous and extensive. The first
step is recognition of the situation and identification of its potential damage. The next steps include
management, containment, and informative interaction with the public though most of us, as emer-
gency medicine physicians have had some training in these areas, time and sophistication of terror-
ism has somewhat blurred our training and methods. The question to all of us, is how many of us
can recognize all or most of the modern agents of mass concentration? How many of us have been
recently trained in decontamination protocols? How many of us are skilled in handling the media
and preventing mass hysteria?
Recently, I had the opportunity to take a course which provided training in these areas with an over-
view of the newest biological and chemical agents of destruction. The course lasted 4 days. The
first 2 days involved basic disaster life support, tenets, reviewing of all hazards, including recogni-
tion, distribution patterns and management techniques. The course continued through the delinea-
tion of a disaster paradigm and the methodology of mass triage. Time was spent on refreshing the
participants in nuclear and radiologic events. All areas were explored both through lecture, power
point and small group discussions. The next course involved the psychosocial aspects of terrorism
and disaster, which included a discussion on debriefing and exposure management of self and staff.

The first and best section of the course was an outstanding didactic preparation for the most likely
disaster or mass casualty events. It allowed us to recognize potential threats and to initiate available
resources. The section clearly showed that these events can impact any of our cities’ or emergency
department regardless, of size. It illustrated the need for all of us, as emergency physicians to be
trained and proficient in disaster management.
The second section of the course was a much more hands on approach addressing, decontamina-
tion, fit testing, hazmat suits, and closed space rescue situations in full gear. A full scale rescue was
reenacted in a darkened school auditorium with over 60 mangled victims. Marked secondary explo-
sion incendiary devices, needed to be addressed, along with the triage and evacuation of all team
members and victims. This was one of several scenarios addressed in the course, which could oc-
cur at any one of our local hospitals, churches or schools, at any given time.
                                                                                     Continued on Page 21
MISSOURI EPIC                                                                                              Page 21

Continued from Page 20
As emergency medicine physicians we will be and need to be in the front line of those managing and
providing care in those situations. As horrifying as the thought of a mass casualty incident or disas-
ter, be it of natural origin (the new Madrid fault line) or of a terrorist origin (domestic or alien), we
must recognize that it is all too possible and assume our leadership role by participating and prepar-
ing for the worst.

We need to check our hospital decontamination rooms, review our hospital disaster plans, and dou-
ble check our own fit masks. Our role will be in the front lines whether we choose it or not, by the
very definition of our profession. Now is the time for us to plan for the potential disaster, either by
attending the basic disaster life support/Advanced disaster life support courses, ourselves by send-
ing someone from the department or by sending someone. Every day brings the possibility that is
will be needed. We at least need to become more involved in the disaster planning strategies of our
hospitals and communities, so that if called upon we may assume our anticipated position as lead-

The first portion of the course, “Basic disaster life support” is actually provided on-line. The ad-
vanced disaster life support is attendance only. Looking on-line I found over 10 pages of available
disaster management courses.

I believe that our best solution to prepare for disaster lies in familiarizing ourselves with our re-
sources. We should regularly attend scheduled planning meetings with local EMS, hospital admini-
stration and community leaders. This is truly a situation in which an ounce of prevention will out-
weigh a pound of care.

ADLS has been endorsed by the American College of Emergency Physicians as "The gold standard
in all-hazards training for medical response to mass casualty incidents." For further information on
these courses, please see the NDLSF (National Disaster Life Support Foundation) website at
www.ndlsf.org.                                                             Robert B. Smith, MD, JD

                                                       Missouri ITLS 2009
                                                       As the new year begins, we celebrate another successful
                                                       year in Missouri ITLS. International Trauma Support Inter-
                                                       national is a global organization dedicated to improving
                                                       Trauma care. The course, originally known as BTLS, was
                                                       modeled after the ATLS, when ITLS Founder John Camp-
                                                       bell, MD took the new ATLS course in 1980. He went back
                                                       to Alabama and with the support of Alabama ACEP,
                                                       founded the organization in 1982. Since that time, tens of
                                                       thousands of EMT’s Paramedics, Nurses, PA’s and Physi-
                                                        cians have been trained worldwide.
Missouri Delegation at ITLS in Charlotte, NC 11-8-09
Facing L-R, Bob Page, Brandon Kennall,     Missouri Chapter was started in 1986 with the help and
Janet Taylor, Doug Cunningingham           support of Missouri ACEP, a relationship that still exists
                                           today. ITLS is a 16 hour trauma assessment and manage-
ment course. ITLS courses are administered by chapters, most sponsored by ACEP chapters. ITLS
is constantly revising to keep up with the latest in technology and science to optimize education and
patient care. The current lineup for ITLS is ITLS basic and advanced, Pediatric ITLS, ITLS Access, a
course designed to show providers how to gain access to trapped victims without the use of heavy
hydraulic tools.                                                                   Continued on Page 22
Page 22                                                                                     MISSOURI EPIC

Continued from Page 21

Missouri holds over 50 classes annually and has coverage all over the state’s trauma regions.
Courses are administered locally through training entities by ITLS Instructor/Coordinators with over-
sight from Affiliate faculty with a Physician medical director at the course or readily available.
ITLS holds a trauma conference each year to learn the latest, roll out new information and do the
work of the business. This year in Charlotte, NC, one of our own, Brandon Kennall, ITLS Access
Instructor from Springfield, was presented with the Harvey Grant award for outstanding Access in-
structor. Missouri is in the top 10 chapters worldwide in students trained and we have been trending
upward the past 5 years.
Missouri Chapter was selected to Pilot a new offering called E-Trauma. The content and didactic
material are delivered online. After completion of the online course, participants then complete a one
day “completion course” to get their certification. The completion course includes all physical skills
and critical thinking scenarios. This course was successful as we had 19 of 19 completed the online
component and the completer course. It should save money and time but the information is still de-
livered. Furthermore, the online material can be taken stand alone for nationally recognized CEU’s.
I wish to personally thank the MoCEP Board and membership, especially Dr’s Spoon, Szewczyk,
and Margie Wilson, for their active leadership and support of trauma training for Missouri. With your
continued support, we train even more providers.

MO ITLS Coordinator
MISSOURI EPIC                                                                                              Page 23

American College of Emergency Physicians

            Annual Scientific Assembly 2010

                  September 28-October 1

                Mandalay Bay, Las Vegas, NV

                             For more information go to www.acep.org

This chart details key provisions as they relate to emergency medi-
cine in both the House and Senate bills,                                           House                Senate
Health Care Reform Provisions                                                HR 3961 HR 3962           HR 3590
Include emergency services as part of essential health care benefits pack-
                                                                                             X             X
Quality improvement measured by ED patient through-put                                       X
Statutory authorization for ECCC & ECCC Council of Emergency Medicine.
HHS annual report to Congress on ECCC activities w/focus on ED crowd-                        X
ing/boarding & delays in ED care following presentation.
Emergency care/trauma regionalization pilot project grants                                   X             X
Trauma stabilization grants                                                                  X             X
Reauthorize EMSC for 5 years                                                                               X
HHS incentive payments to states that establish medical liability reforms
(Certificate of Merit/early offer)
HHS demo project to reimburse private psych hospitals that provide EM-
                                                                                             X             X
TALA services to Medicaid beneficiaries
Require Exchange health plans to provide emergency services w/out re-
gard to prior authorization or EPs contractual relationship
Medicare physician payment reforms:
* 2010 update based on MEI                                                      *X                        * --
* Rebase SGR                                                                    *X                        * --
* Exclude non-physician items from spending target                              *X                        * --
* Allowable future growth for E&M services GDP +2%                              *X                        * --
* Increase 2010 payment by 0.5%/Decrease 2010 payment by 0.5%                   * --                      *X

HHS working group to develop ED boarding & ambulance diversion               ** Provision was included in meas-
standards & quality measures for hospitals to improve ED efficiency            ure approved by the Senate Fi-
& patient flow                                                                  nance Committee. Will be ad-
                                                                             dressed administratively (no longer
                                                                             necessary to include in legislation).

                          MISSOURI EPIC

                          213 E. Capitol Avenue, Suite 200
                             Jefferson City, MO 65101


                                                  Contact us at:
                                                  PO Box 1865
                                            Jefferson City, MO 65102
                                              Phone: 573-636-2144
                                              Fax: 573-635-6258

                                  MARK YOUR CALENDAR NOW!!!!

                     The 2010 Combined Clinical Conference on Emergency Care

               Conference Dates: August 10-13, 2010 at Tan Tar A, Lake of the Ozarks

          Sponsored by: Missouri College of Emergency Physicians; Missouri Emergency Nurses Association;
                 Missouri Emergency Medical Services Association; Missouri Ambulance Association

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