What's Up October 2017


October 2017 Newsletter

Gun Violence: What Will It Take to Study the Problem?

Zach Jarou, MD (President-Elect)

September was a month marked by natural disaster. Unfortunately, October is marked by man-made tragedy. On Oct. 1, a lone gunman in Las Vegas committed a horrific act of mass murder, killing 59 innocent victims and injuring more than 525 concertgoers. One year ago, at the 2016 ACEP Scientific Assembly, coincidentally held at the Mandalay Bay Hotel and Conference Center where this month's shooting took place, the EMRA Representative Council passed a resolution to study the impact of gun violence.

Among industrialized countries, the United States has the highest rate of gun-related mortality. Firearms kill more than 30,000 American each year. Yet a recent JAMA study showed that relative to other leading causes of death, firearm-related injury research over the past decade has been underfunded by more than $1 billion. Since 1996, Congress has passed annual appropriations bills that prohibit the CDC from using injury prevention funds to "advocate or promote gun control" — the so-called Dickey Amendment, named for former Congressman Jay Dickey, R-Arkansas. Language applying similar restrictions to NIH has been included in appropriations bills since 2012.

In the wake of the Sandy Hook Elementary School shooting, President Barack Obama ordered for re-interpretation of the Dickey Amendment, saying "research on gun violence is not advocacy; it is critical public health research." He called upon agency leaders to develop a research agenda to answer the questions with the greatest potential public health impact. Despite this re-interpretation, CDC leaders, with a much smaller budget than the NIH, have avoided firearms research, possibly fearing further funding cuts.

However, Dickey himself may have had a change of heart. In 2015, he wrote a letter to Congress expressing regret about the unintended consequences of the amendment that bears his name: "Research could have been continued on gun violence without infringing on the rights of gun owners, in the same fashion that the highway industry continued its research without eliminating the automobile... Doing nothing is no longer an acceptable solution." He co-authored an editorial in the Washington Post in the same year, stating: "Our nation does not have to choose between reducing gun-violence injuries and safeguarding gun ownership... gun-violence research can be created, organized and conducted with two objectives: first, to preserve the rights of law-abiding citizens and legal gun owners, and second, to make our homes and communities safer."

As emergency physicians, we know that responding to mass casualty incidents and disaster management are part of our unique skill set, but we also must recognize our professional obligation to be involved in patient education, harm reduction, and injury prevention. After all, it was a landmark study by emergency physician Dr. Arthur Kellermann linking gun ownership to homicide in the home that prompted the Dickey Amendment in the first place.

I don't pretend to have all the answers to this complex issue, but I will commit myself to learning as much as I can about evidence-based approaches to effectively reduce gun-related violence. I pledge that I won't be afraid or "too busy" to talk to my patients about firearm ownership and safety. And most important, in the words of Dickey, "if we are to be successful, those of us on opposite sides of this issue will have to do a better job of respecting, understanding and working with each other." I hope you will join me.

Stark DE, Shah NH. Funding and Publication of Research on Gun Violence and Other Leading Causes of Death. JAMA. 2017;317(1):84-6.
Rubin R. Tale of 2 Agencies: CDC Avoids Gun Violence Research But NIH Funds It. JAMA. 2016;315(16):1689-91.
Kellermann AL, et al. Gun Ownership as a Risk Factor for Homicide in the Home. New Engl J Med. 1993;329(15):1084-91.
Former Rep. Jay Dickey Calls to End Federal Ban on Gun Violence Research. Website of U.S. Congressman Mike Thompson. https://mikethompson.house.gov/newsroom/press-releases/thompson-former-rep-jay-dickey-calls-to-end-federal-ban-on-gun-violence. Published December 2, 2015. Accessed October 6, 2017.
Dickey J, Rosenberg M. How to protect gun rights while reducing the toll of gun violence. Washington Post. December 25, 2015.

#FOAMed Highlight of the Month: Check out the awesome feed of what happened at the @feminemtweets #FIX17 conference! And tune into #ACEP17 for awesome updates from @emresidents and @ACEPNow.


Take Part in Virtual Reference Committee

Scott Pasichow, MD, MPH (Vice-Speaker)

Virtual Reference Committee is live! View the resolutions here and make sure your voice is heard! Any EMRA member can comment, and resolution comments are used to modify resolutions and guide the Representative Council in passing or rejecting resolutions. Comment now - the deadline is Oct. 20!


EMRA Presents 4 New Resources

EMRA strives to be there for you at every stage of your training — and a key way we do that is by offering unparalleled on-shift resources. This fall we're bringing you 4 new books to tuck in your pocket!

  • EMRA EKG Guide: The inaugural EMRA EKG Guide will quickly become your go-to resource for on-shift EKG interpretation. It describes the diagnostic criteria and important clinical features for can't-miss EKG findings — all organized for fast and efficient referencing. With an educational grant from Doctors For Emergency Services (DFES), EMRA is pleased to offer the EMRA EKG Guide to all resident members. The book exemplifies DFES's commitment to resident education, said Charles Reese IV, MD, FACEP, chair of the Department of Emergency Medicine at Christiana Care and vice president of the board of DFES. "Education is a core responsibility we take very seriously," Dr. Reese said. "It's an almost sacred goal that has been part of our group's philosophy since it was founded more than 40 years ago."
  • PressorDex®, 3rd ed.: In PressorDex®, 3rd edition, editor-in-chief John Greenwood, MD, and a team of nearly 100 authors, editors, and reviewers bring you the latest clinical recommendations for vasoactive agents, pressors, continuous infusions, and other drugs for the critically ill patient. Use this book to ensure you're selecting the right medications and dosages, even during the busiest shift in the ICU.
  • Basics of Emergency Medicine, 3rd ed.: Editor-in-chief Joseph Habboushe, MD, MBA, and associate editor Eric Steinberg, DO, FACEP, have assembled a clinical guide that will help you handle the most common chief complaints efficiently and quickly. This pocket-size guide focuses on the 22 most common chief complaints you'll see on shift.
  • Basics of Emergency Medicine: Pediatrics, 2nd ed.: This resource aims to erase some of the stress of caring for our youngest patients. Led by editor-in-chief Joseph Habboushe, MD, MBA, and associate editor Eric Steinberg, DO, FACEP, the team of authors and editors offers considerations for the most common pediatric complaints — along with considerations for child abuse, an overview of neonatal emergencies, and ultra-useful pediatric medication charts, normal vital signs, and likely diseases per age group.


Committee and Division Spotlight: Who's Meeting When at ACEP17?

All EMRA Committees and Divisions will meet during ACEP17 to plan the next year of projects, network with new members, and share best practices in their areas of interest. Go find your people in Washington, D.C.!

8-10 am
Diversity & Inclusion Committee: Treasury, 4th floor
Editorial Committee: Woodley Park, 3rd floor
Informatics Committee: Mount Vernon, 3rd floor
Research Committee: Ledroit Park, 3rd floor
Simulation Division: L'Enfant Plaza, 3rd floor
Sports Medicine Division: Pentagon, 4th floor
Ultrasound Division: Judiciary Square, 3rd floor

10 am - Noon
Critical Care Division: Judiciary Square, 3rd floor
Education Committee: Maple, 2nd floor
Health Policy Committee: Mint, 4th floor
International Division: Mount Vernon, 3rd floor
Pediatric EM Division: Woodley, 3rd floor
Prehospital & Disaster Medicine Division: Ledroit Park, 3rd floor
Wellness Committee: Plaza, 3rd floor
Wilderness Medicine Division: Treasury, 4th floor

Get involved with EMRA's Committees and Divisions! Join any Committee or Division anytime!


Membership Benefit Highlight: PEER IX Discounts

Shehni Nadeem, MD (Director of Membership)

Is 2018 the year of your qualifying exam? Ready to own the In-Service Training Exam? EMRA resident members (and students) get the new, transformed PEER at a 40% discounted rate of $175! PEER's practice tests are thought to most closely resemble actual board exams! All 20 categories of the EM Model (core measures) are covered. They're "weighted" to reflect the distribution on your board exam. The acuity frames — critical, emergent, and lower — are covered in the same fashion as ABEM's actual boards. Moreover, PEER gives you explanations on each answer choice, leads you to related evidence to support the answer, and gives you the breakdown of how your actual peers performed on each question. You will definitely want to take these practice tests before Test Day to maximize your chance of success! Don't have time for a full test? No worries, you can also get a question emailed to you daily to develop your skills longitudinally!

Know of a benefit your co-residents would enjoy? Email your new membership benefit idea to membershipdir@emra.org!


ACEP Section Connection: NEW! Musculoskeletal Exam Series

Nida F. Degesys, MD (ACEP Representative)

Funded by an ACEP Section Grant, the ACEP Sports Medicine Section has created a library of video tutorials to assist emergency physicians in their evaluation and diagnosis of musculoskeletal conditions in the ED. These videos provide overviews of high-yield, ED-focused physical exams of the musculoskeletal system. They can be used for quick reference in the ED, or as an instructional module for emergency medicine residency programs.

Remember, as part of your EMRA membership you can join one ACEP Section for free (in addition to free membership in the Young Physicians Section)! EMRA members can join additional ACEP Sections at a discounted rate.


Wellness Tips & Tricks: Take the Win

Jayram Pai, MD (EMRA Wellness Committee)

"Take the win." Emergency medicine is a hectic, high-stress field. In a single shift, you could have anything and everything thrown at you (literally; know when to duck) from a trauma to a STEMI to a cardiac arrest, all within a few hours. As a co-worker aptly put it, "A patient death in OB-GYN is a huge deal. In our job, that's a Tuesday morning."

Our field is inherently filled with high intensity situations, and we are often burdened with seeing some of the worst patient outcomes in medicine. Emotional burnout is real, and it can often pose a real problem as time goes on. Losing perspective can become all too easy. So don't lose perspective. How? Chart-stalk that ROSC you sent upstairs. Even if they didn't make it, maybe you gave the family enough time to say goodbye. Go upstairs to visit the ICU patient you admitted a few days ago, the one who came in looking unbelievably sick and now is close to discharge. We see a lot of horrible things in our job; don't lose sight of all the good you do.


Emergency Medicine Job Interview Do's and Don'ts

You scored a job interview for an emergency medicine position! Now what? To help you with the interview process, emCareers.org has compiled a list of "do's and don'ts" for before, during, and after your next interview.


Health Policy Journal Club: ED Visits Rise After Medicaid Expansion

The EMRA + PolicyRx Health Policy Journal Club investigates the correlation between Medicaid expansion and emergency department utilization. Check out the journal club posting now! If you would like to participate in the Health Policy Journal Club, please email the EMRA Health Policy Committee at healthpolicyctte@emra.org or contact Vidya Eswaran, MD, at vidya.eswaran@gmail.com.


Little Bits of EM Info: 20 in 6 Resident Lecture Competition

You don't have time to sit through endless lectures and long-winded educational sessions, right? But we know you can afford 6 minutes to learn something new, and that's why the 20 in 6 Resident Lecture competition, sponsored by Hippo EM, is a must-attend event at ACEP17! Little chunks of education all rolled together in one big event.

Each of our 15 competitors chose a topic close to their hearts. Come encourage them! Show up Tuesday, Oct. 31, at 1 pm in the Marriott Marquis Liberty Ballroom Salon L.


What Could Possibly Happen at EMRA Resident SIMWars?

There's a series of unfortunate events that will happen soon at the EMRA Resident SIMWars, sponsored by CEP America, Laerdal, B-Line Medical, and Gaumard — and it all takes place in front of a live audience. Fortunately for the spectators, it will be tons of fun to watch the mayhem! Teams are flying in from all across the nation, and we hear they're gearing up to take down defending champs NYU Bellevue. The writers are putting the finishing touches on some very surprising cases, and the actors are rehearsing their roles. Now all we need is you at ACEP17 on Monday, Oct. 30. We guarantee commotion, pandemonium, and total chaos like only EMRA can do! Oh, and let's not forget, you'll learn something, too!


Get Some New iDEAS with CORD

Request time off now for CORD Academic Assembly in San Antonio, Texas, April 22-25! Dedicated to "iDEAS: innovation, Development, Education, Academics," the CORD conference offers a full resident track and chief resident programming as well. Plus, EMRA's Quiz Show, Representative Council Meeting, C&D spring meetings, Board of Directors meetings and — most notably — 2 all-new EMRA events debuting in San Antonio. Don't miss this incredible opportunity!


Upcoming Events

Oct. 14-17: ABEM Fall Oral Certification Exam
Oct. 19: Late EMRA Rep Council Fall Resolutions Due
Oct. 26-Nov. 1: EMRA Events @ ACEP Scientific Assembly, Washington, D.C.
Nov. 6-11: ABEM Qualifying Exam
Nov. 10: CORD CPC Case Submission Deadline
Dec. 1: CORD Advances in Education Research and Innovation Forum Abstracts Due
Dec. 5: EM Resident Articles Due
Jan. 15: EMRA Committee & Division Vice-Chair Applications Due
Jan. 15>: EMRA Medical Student Council Applications Due
Jan. 15: EMRA Spring Awards Applications Due
EMRA Hangout: First Thursday of every month
EMRA-Cast: Listen at your convenience


Submit an Update

What's Up? is the official e-newsletter of the Emergency Medicine Residents' Association. Targeted to EMRA’s membership of physicians in training and medical students, the monthly newsletter provides organizational news and updates, information on EMRA events and products, and other news, announcements, and updates that are relevant to EMRA's members.

Do you have an update that you'd like to share with your colleagues? Contact presidentelect@emra.org for more information.

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