EPIC Georgia College Of Emergency Physicians The Newsletter of the Georgia College of Emergency Physicians Spring 2009 Viewpoint from the President OFFICERS by Maureen Olson, MD, FACEP President Maureen Olson, MD, FACEP [email protected] ur country has completed a very long and arduous President-Elect election cycle. Throughout the process I continually Robert Cox, MD, FACEP Oheard people, including the political pundits, ask ques- [email protected] tions like, “What will this candidate do on this issue? What is Secretary/Treasurer this candidate’s plan to solve this problem?” As I followed Matthew J Watson, MD, FACEP [email protected] these discussions, I kept thinking we were asking the wrong Immediate Past President questions and have placed the focus in the wrong direction. Stephen Holbrook, MD, FACEP Intuitively we all know that we elect our leaders both state and [email protected] federal and, therefore, they work for us. We are their employer. [email protected] Maureen Olson, MD Executive Director Yes, that would include the President of the United States and Tara M. Morrison, CAE the Governor of Georgia. As an employer shouldn’t it be our responsibility to tell [email protected] them what we need them to do? By electing officials are we really saying do what BOARD OF DIRECTORS you want and let us know how it goes? Matt Bitner, MD [email protected] Would it surprise you to know that as I speak with legislators both on the federal Benjamin Holton, MD, FACEP and state level many of them have no idea what EMTALA is, why it was adopted, nor [email protected] what the unintended consequences have been? Many were not around at the time of Matthew Keadey, MD, FACEP this legislation. Yet, many of us sit back and wait to see what will happen. Do you matthew_keadey@ emoryhealthcare.org really want a health care reform policy without physician input? Physicians are prob- John Rogers, MD, FACEP ably in the best position to recognize unintended consequences and address them. For [email protected] example, emergency medicine physicians provide a large amount of uncompensated Jeffrey Linzer Sr., MD, FACEP care. The federal government has maintained there is no funding available for this. [email protected] Using some creative thinking, why not fund it from the back end by allowing practic- Matt Lyon, MD, FACEP [email protected] ing emergency medicine physicians to not pay federal income tax? Even at that we Angela Mattke, MD are still going to be providing uncompensated care, but it is a start in recognizing we [email protected] are the only specialty held responsible under EMTALA. We spend our whole career Robert Risch, MD, FACEP asking questions. We ask, “What can I do for you today? What symptoms are you [email protected] having? How are you feeling?” Yet we fail to do the same when it comes to our spe- Vida R. Skandalakis, MD, FACEP cialty. [email protected] EDITOR I was speaking with an emergency physician recently who asked me why he should Matthew J. Watson, MD, FACEP join ACEP/GCEP. He asked what they do for him besides lobby in Washington. We welcome your comments or suggestions at: “How do they help me in my daily practice?” I turned the questions around and Georgia College of Emergency Physicians asked, “What do you need them to do for you? What benefits do you need provided 6134 Poplar Bluff Circle, Suite 101 Norcross, GA 30092 for you?” Lastly, I asked if he has made his thoughts known to the ACEP leadership. (770) 613-0932 • Fax (305) 422-3327 continued on page 2 www.gcep.org 1 Spring 2009 From the President: continued from page 1 As we are the employer of our federal and state elect- Our “Commitment to Excellence” program for groups ed officials, we are also the employer of our state and achieving 100% membership continues and we have national professional organization. I happen to think added more than 200 new physician members. This membership in our specialty organization says a great gave us another seat on the ACEP council. This will be deal about you and your group as practicing emergency our third year of providing a pre-hospital component to physicians regarding your commitment to the continual our summer conference. More initiatives are in the improvement of our professional specialty. We have sev- works. eral groups who now have achieved 100% membership. It speaks very highly about their commitment to the Regardless of which governing body we discuss, we practice of high quality emergency medicine. If your each have an obligation to tell them what we need them group has not achieved that status yet, it is time. That to do. You are the employer. We can’t expect elected being said ACEP/GCEP does have a responsibility to officials to know and understand the practice of medi- provide its members with services and benefits. cine. Nor can we expect board members of our organi- zation to know and understand each state’s or local WHAT DO YOU NEED? We have just completed our group’s needs. These need to be communicated to the contract negotiations to offer health insurance at group appropriate board of directors. rates to members of GCEP. More information will be coming. We are continuing to develop our educational It all comes down to definition again. Do you define programs for physicians around the state especially governing bodies as an entity designated with the task those practicing in rural and small towns in Georgia. of providing benefits and services that you and your community can not provide for yourselves? Or do you define it as being obligated to take care of and antici- pate all your needs with little or no input or effort on your part? A case can be made for both. The first leaves you in control and the second allows you a more passive role. ATLANTA,, G GA DEPARTMENTEP E OF EMERGENCYEE GE C MEDICINEE ICI E Emory University, ŽŶĞ ŽĨ ŽƵƌ ŶĂƚŝŽŶ͛Ɛ ůĞĂĚŝŶŐ D programs, is expanding our practice at Emory-affiliated hospitals in the Atlanta suburbs. This creates a unique Make a Difference opportunity for outstanding emergency physicians to All of our meetings are open. combine community EM practice with an academic Department of Emergency Medicine. We offer excellent If you are interested in being salary & benefits and emphasize career development. Applicants must be residency trained and/or board more involved, please visit the certified in EM. Emory is an equal opportunity, GCEP website at www.gcep.org affirmative action employer. Women and minorities are encouraged to apply. For further information please visit our web site at http://www.emory.edu/em or contact: Katherine Heilpern, M.D. Chair Department of Emergency Medicine Get involved! 531 Asbury Circle, Suite N340 Atlanta, GA 30322 GCEP is here to serve the emergency Phone: (404)778-5975 Fax: (404)778-2630 physicians and emergency patients of Georgia. Email: [email protected] If you would like to get involved, please visit us at www.gcep.org Emory is an equal opportunity/affirmative action employer 2 The EPIC Don’t Underestimate Pain in Children by Jeffrey Linzer Sr., MD, FAAP, FACEP Associate Professor of Pediatrics and Emergency Medicine, Emory University School of Medicine here is an unfortunate misperception that chil- need for pain control. IV morphine is one of the main- dren, especially young children, do not “feel” stays of pain management. Subcutaneous administration Tpain the same way as adults. Recent studies have should be avoided because of the increased chance for shown that pain in childhood may have life long conse- emesis. Intranasal fentanyl (1.7 mcg/kg, maximum ini- quences1 and that children’s pain experience is at a much tial dose 60 mcg) has been shown to be as effective as higher level than previously thought.2 Even infants IV morphine (0.1 mg/kg) in adolescents with muscu- should receive pain management. loskeletal trauma.7 The nonsteroidal antiinflammatory agent ketoralac (IM: 1 mg/kg; 30 mg maximum, IV: 0.5 While children may have a hard time expressing their mg/kg; 15 mg maximum) is approved for children two pain, using validated standardized tools can be of great years and older. It is a useful alternative to opiates. help. Among the more commonly used scales are the Numeric pain scale, FACES scale and FLACC Scale For Properly managed pain in the ED will provide for bet- Children. ter patient care and a happier family. The Numeric pain scale uses a References visual acuity score of 0-10 with 0 1. Howard RF. Current Status of Pain Management in Children. JAMA. being no pain and 10 the worse 2003;290:2464-2469. pain. Originally published in 2. My Treatment, Pediatric Pain. The National 1988, The Wong-Baker FACES Pain Foundation. Pain Scale is useful in children 3 http://www.nationalpainfounda- 3 tion.org/MyTreatment/articles/Pediatric_ and older. The scale consists of Pain_Introduction.asp accessed 3/27/2009. five faces with varying looks of 3. Wong DL, Hockenberry-Eaton M, Wilson discomfort and are scores 0-10. D, Winkelstein ML, Schwartz P. Wong’s The child is asked, “Which face Essentials of Pediatric Nursing, ed. 6, St. best says how you’re feeling?” The Louis, 2001 Mosby. p 1301. FLACC Scale For Children is an 4. Malviya S, Voepel-Lewis T, Burke C, observational score used in non- Merkel S, Tait AR. The revised FLACC obser- verbal children six months of age vational pain tool: improved reliability and and older.4 A score is picked from validity for pain assessment in children with cognitive each of five categories: face, legs, impairment.