Annals audio for July: POSTED!

July’s audio/podcast for Annals of EM is now posted here. Highlights:

-Early vs late rhythm analysis in OOHCA
-Ground based EMS transports and complications
-When do sepsis patients become septic? Usually NOT on arrival. Time to change the metric?
-Botulism outbreak
-Diethylene glycol outbreak
-Much, much more!

Enjoy, and email with any comments or questions any time,

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ACEP Clinical Policies Committee to Develop Independent tPA Policy

The ACEP Board Directors accepted a recommendation last week from its Clinical Policies Committee to begin working on a tPA policy exclusive to ACEP instead of a joint project with the American Academy of Neurology.

The 2013 Council had asked that ACEP reconsider its current “Clinical Policy: Use of Intravenous tPA for the Management of Acute Ischemic Stroke in the Emergency Department,” which had been developed with the AAN and published in February 2013.

After an open 60-day comment period in early 2014 and a subcommittee review of the comments and literature findings, the Clinical Policies Committee recommended to pursue an independent policy, which will include updated evidence and grading criteria. The Board unanimously approved this recommendation.

Once the draft is developed, it will be available for members to review and comment for 60 days prior to the Committee’s presentation to the Board. An estimated timeline was not available.

Additionally, the Board confirmed its commitment to the clinical policy development process and agreed to add three methodologists to the committee, additional meetings, and another staff person to ensure a robust review process.


ACEP Clarifies Campaign Rules

By James M. Cusick, MD, FACEP
Chair, Candidate Forum Subcommittee of the ACEP Council

ACEP is a member-driven organization with a representative body of our peers – the ACEP Council – chosen through component bodies, including our chapters (1 representative per 100 members), our Sections of Membership, and other aligned organizations.

Each year, this body democratically votes to establish ACEP policy and elect leadership positions. Candidates present themselves to the Council through written statements, scheduled speeches, and unrehearsed Question and Answer sessions during the Candidate Forum, which is open to all members. Elections must be fair, follow guidelines applicable to all, and be free of undue influence or pressure on candidates.

The ACEP Council’s Candidate Forum Subcommittee recently performed its annual review of the campaign rules to ensure a fair campaign and elections process for all Board of Directors and President-elect candidates. The changes were approved by the Council Steering Committee.

This year, restrictions on the use of social media were substantially relaxed to allow forms of communication most of us use on a daily basis.

In addition, protections were incorporated into the rules to keep candidate interviews in ACEP publications. Our goal is to avoid candidates being put in the position of commenting on College policy without adequate preparation and to ensure that the campaign process is fair and equal for all candidates.

Certain candidates may unfairly benefit from coverage in non-ACEP publications, while some may be disadvantaged. In order to ensure a fair election, campaign questions and the vetting of candidates is the responsibility of ACEP, its Council and its Council Committees.

If there are specific questions you would like asked of the candidates prior to the election, please send them to The Candidate Forum Subcommittee will consider them, the selected questions will be posed to candidates and their responses will be made public.

Elections will occur during the Council meeting on Oct. 26 in Chicago. The Nominating Committee has selected the final slate of candidates for 2014:

President-Elect Candidates
Jay Kaplan, MD, FACEP
Robert O’Connor, MD, FACEP
Rebecca Parker, MD, FACEP

Board of Directors Candidates (4 positions to be filled)
Stephen Anderson, MD, FACEP (WA)
Jon Mark Hirshon, MD, FACEP (MD)
Hans House, MD, FACEP (incumbent – IA)
Mark Mackey, MD, FACEP (incumbent – IL)
John Rogers, MD, FACEP (incumbent – GA)
Mark Rosenberg, DO, FACEP (NJ)



June audio is up!

The Annals of EM June audio is posted and available. Highlights:

-How important is isolated vomiting in children as a predictor of TBI?
-The yield of ‘clearance’ laboratory testing for pediatric psych patients
-Confirming femoral lines with a saline flush—it works
-Should hydromorphone dosing be weight-based?
-Intranasal fentanyl for EMS
-Transgender populations in the ED: the experience
-Incidence of delayed anaphylaxis in the ED

And much much more…

Email any time at


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Annals Clinical Case: Female With Lower Abdominal Pain and Bleeding

AnnalsMay 2014, Annals of Emergency Medicine

By Justin McNamee, DO; Nilesh Patel, DO; and Joseph Affortunato, DO

Department of Emergency Medicine
St. Joseph’s Regional Medical Center, Paterson, New Jersey

A 26-year-old woman presented to the emergency department, complaining of a 3-day history of lower abdominal pain and vaginal bleeding. She reported positive home pregnancy test results and that her last menstrual period was 17 weeks ago. On examination, the patient appeared comfortable and was afebrile, with a blood pressure of 131/67 mm Hg, pulse rate of 100 beats/min, and respiratory rate of 16 breaths/min.

Click here to read the full case, see the images and get the diagnosis.

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ACEP Clinical Policy Review: Seizures

Clinical Policy: Critical Issues in the Evaluation and Management
of Adult Patients Presenting to the Emergency Department With Seizures

By J. Stephen Huff, MD, FACEP

In the April 2014 issue of the Annals of Emergency Medicine, the American College of Emergency Physicians (ACEP) published a clinical policy focusing on seizures. This is a revision of a 2004 clinical policy with the same name.

This clinical policy can also be found on ACEP’s website www.acep.

Dr. J. Stephen Huff

Dr. J. Stephen Huff

org and was accepted for abstraction on the National Guideline Clearinghouse website,

This clinical policy takes an evidence-based approach to answering four frequently encountered questions with regards to decision making associated with seizures in the emergency department. Recommendations (Level A, B, or C) for patient management are provided based on the strength of evidence using the Clinical Policies Committee’s well-established methodology:

Level A recommendations represent patient management principles that reflect a high degree of clinical certainty; Level B recommendations represent patient management principles that reflect moderate clinical certainty; Level C recommendations represent other patient management strategies based on Class III studies, or in the absence of any adequate published literature, based on consensus of the members of the Clinical Policies Committee.

During development, this clinical policy was reviewed and expert review comments were received from emergency physicians, neurologists, and individual members of the American Epilepsy Society, the American Academy of Neurology, the Epilepsy Foundation of America, the National Association of Epilepsy Centers, and ACEP’s Quality and Performance Committee. The draft was also open to further comments through various ACEP communication pieces. All responses were used to further refine and enhance this policy; however, their responses did not imply endorsement of this clinical policy.

This revision of the clinical policy on critical issues in the evaluation and management of adult patients with seizures in the emergency department focused on selected critical questions. Key to this policy revision was employing updated nomenclature for classification of seizures. Seizures can be thought of as provoked or unprovoked. Provoked seizures are secondary to electrolyte disturbances, toxins, infections, central nervous system mass lesions, withdrawal syndromes, or other etiologies. These provoked seizures, also known as acute symptomatic seizures, by definition occur at the time of or within seven days of acute neurologic, systemic, metabolic, or toxic processes. Unprovoked seizures occur in the absence of acute precipitating factors. Seizures from such processes as stroke, brain injury, and other CNS insults that occurred more than seven days in the past are also classified as unprovoked seizures. Epilepsy is defined by recurrent unprovoked seizures.

The question of initiating treatment with antiepileptic drugs for the adult patient presenting to the ED following a first generalized seizure who has returned to baseline clinical status was one critical question. The short-term recurrence risk of this group of patients is unknown but thought to be low. After literature review and grading the evidence, level C recommendations were developed for subgroups of patients. Appropriate clinical assessment by emergency physicians of patients is important since presumptive assignment of the seizure as provoked or unprovoked drives the treatment recommendation. However, it is unclear if seizures can be precisely identified as provoked or unprovoked using information available during an emergency department evaluation. Additionally, patient safety should remain a paramount concern for the practicing physician. Though the evidence supports discharging an adult patient who has returned to baseline status following a first unprovoked seizure, supporting articles assumed a safe support system for the discharged patient. Consideration of social issues or other factors may prompt consideration for admission.

Another critical question addressed treatment of ED patients with generalized convulsive status epilepticus who continue to have seizures despite receiving optimal dosing of a benzodiazepine. There are remarkably few randomized prospective studies on this problem and none that consider the causes of status epilepticus. Large prospective studies are in the planning stages. Until these studies are completed, recommendations for specific drugs must reflect current lower levels of evidence. Many different medications are recommended and no medication or class of medications is clearly superior.

Designation of a seizure as provoked or unprovoked at some level is arbitrary and may change with the clinical course or as additional studies are performed. Emergency physicians play a critical role in determining whether a seizure is provoked or unprovoked. If there is an underlying medical condition, identification and treatment of that process is the primary consideration. It is hoped that future studies will focus on seizure recurrence of patients presenting to the ED with seizures, and study outcomes over days or another time frame relevant to emergency medicine.

Critical Questions and Recommendations

Question 1:  In patients with a first generalized convulsive seizure who have returned to their baseline clinical status, should antiepileptic therapy be initiated in the ED to prevent additional seizures?

Level C recommendations.

(1) Emergency physicians need not initiate antiepileptic medication* in the ED for patients who have had a first provoked seizure. Precipitating medical conditions should be identified and treated.
(2) Emergency physicians need not initiate antiepileptic medication* in the ED for patients who have had a first unprovoked seizure without evidence of brain disease or injury.
(3) Emergency physicians may initiate antiepileptic medication* in the ED, or defer in coordination with other providers, for patients who experienced a first unprovoked seizure with a remote history of brain disease or injury.

* Antiepileptic medication in this document refers to medications prescribed for seizure prevention.

Question 2: In patients with a first unprovoked seizure who have returned to their baseline clinical status in the ED, should the patient be admitted to the hospital to prevent adverse events

Level C recommendations. Emergency physicians need not admit patients with a first unprovoked seizure who have returned to their clinical baseline in the ED.

Question 3: In patients with a known seizure disorder in which resuming their antiepileptic medication in the ED is deemed appropriate, does the route of administration impact recurrence of seizures?

Level C recommendations. When resuming antiepileptic medication in the ED is deemed appropriate, the emergency physician may administer IV or oral medication at their discretion.

Question 4: In ED patients with generalized convulsive status epilepticus who continue to have seizures despite receiving optimal dosing of a benzodiazepine, which agent or agents should be administered next to terminate seizures?

Level A recommendations. Emergency physicians should administer an additional antiepileptic medication in ED patients with refractory status epilepticus who have failed treatment with benzodiazepines.
Level B recommendations. Emergency physicians may administer intravenous phenytoin, fosphenytoin, or valproate in ED patients with refractory status epilepticus who have failed treatment with benzodiazepines.
Level C recommendations. Emergency physicians may administer intravenous levetiracetam, propofol, or barbiturates in ED patients with refractory status epilepticus who have failed treatment with benzodiazepines.

Dr. Huff is Professor of Emergency Medicine and Neurology, University of Virginia, Charlottesville, Virginia

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ER Visits Up Since Implementation of ACA

Nearly half of emergency physicians responding to a poll are already seeing a rise in emergency visits since January 1 when expanded coverage under the Affordable Care Act (ACA) began to take effect.  In an online poll conducted by the American College of Emergency Physicians (ACEP), 86 percent expect emergency visits to increase over the next three years.  More than three-fourths (77 percent) say their ERs are not adequately prepared for significant increases.

“Emergency visits will increase in large part because more people will have health insurance and therefore will be seeking medical care,” said Alex Rosenau, DO, FACEP, president of ACEP.  “But America has severe primary care physician shortages, and many physicians do not accept Medicaid patients, because Medicaid pays so low.  When people can’t get appointments with physicians, they will seek care in emergency departments.  In addition, the population is aging, and older people are more likely to have chronic medical conditions that require emergency care.”

The data suggest that states that expanded Medicaid are more likely to see increases in the volume of Medicaid emergency patients.  Dr. Rosenau said that policymakers need to make sure there are adequate resources to care for growing numbers of emergency patients.

Click Here to read the rest of this ACEP News Release

Click Here to watch an interview with ACEP President Dr. Alex Rosenau

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May Annals of EM audio is now posted!

The May audio is now posted here. Highlights:

-Impact of a Senior ED
-ACEP clinical policy about geriatric ED facilities
-Is trauma mortality affected when the police transport patients?
-What do seniors think a geriatric ED should accomplish?
-Screening for delirium in the ED, a systematic review
-The role of insurance status in ED transfers
-Access to time-sensitive ED care in Pennsylvania: limited
-Banning diversion: a qualitative assessment of the Massachusetts policy
-EMS use of noninvasive positive pressure ventilation: systematic review

All this and more…. Email any time at


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ACEP Mid-Year Update

Dr. Alex M. Rosenau


By Alexander M. Rosenau, DO, CPE, FACEP

As we come upon the halfway point of my Presidency, I’d like to offer ACEP members an update and share news about exciting things we’re working on for the coming months. For me, the past six months have been intense, as I’ve connected with individual members, groups, organizations and legislators in concert with our strong Board of Directors, expert staff and amazing volunteer physician members. Dialogue, conflict management for a better result, as well as bringing together the right folks for both the challenges at hand and those just over the horizon are daily activities. I’ve cherished every minute. Emergency physicians enjoy a tremendous relationship with each other, and I know we’ve done some things in the past six months to make our bond even stronger – and to appreciate our past even more. In all things emergency medicine, my mantra is “them is us and us is them,” meaning that the common bond we share is much stronger than the forces tugging at us in disparate directions. When you read this update, please know that I will continue to work hard for you over the next six months, and I welcome any feedback. I hope to see you at our Leadership and Advocacy Conference next month and ACEP14 this fall, and please don’t forget to say, “Hey.”

Report Card Garners Major Media Attention
Although we don’t like the results we saw from the release of the 2014 State-by-State Report Card on Emergency Medicine, an overall grade of D-Plus nationwide could have a positive impact on health care moving forward.  Our Report Card fostered many a conversation with state legislators.  Media outlets have pointed out what we already knew – that several states don’t have the resources and policies in place to support high-quality emergency care. Stories about the Report Card appeared in major newspapers, including The Washington Post, The Chicago Tribune, The New York Daily News, Forbes, The Huffington Post, The Los Angeles Times, San Francisco Chronicle, The Philadelphia Inquirer, Houston Chronicle and The Seattle Times, to name a few. Along with print stories, nearly 800 broadcast stories aired on news organizations including ABC’s World News Tonight with Diane Sawyer, MSNBC, CNN, Fox News’ Your World with Neil Cavuto, Fox Business News, CNBC’s Kudlow and Kramer, WNBC New York, and Telemundo as well as dozens of local television stations across the country.  The estimated audience reach was 72.2 million people. Our dedicated spokespersons will continue to make sure the results of this study resonate nationwide. Keep up with the progress at

ACEP Working on Several Federal Advocacy Efforts
One of the most critical federal advocacy projects we’re currently working on is the support of H.R. 36/S.961, the “Health Care Safety Net Enhancement Act of 2013,” introduced by my 911 key contact, Rep. Charlie Dent (R-PA) in the House and Sen. Roy Blunt (R-MO) in the Senate. The bill provides medical liability relief for physicians providing care under the EMTALA mandate. The House bill continues to gain support and reached nearly 70 co-sponsors last month. Our advocacy team is working diligently on SGR repeal in concert with a number of allies. Although the CBO rated an SGR fix the most affordable ever, Congress failed to settle the offset funding issue and we didn’t get the permanent fix. The previous work of our Washington office in collaboration with our specialty and AMA allies assured prevention of a seriously damaging 24 percent cut in Medicare reimbursements for one year; also extending dozens of other expiring health care-related provisions. ACEP will continue to work with the AMA and other medical specialty societies to encourage members of Congress to take action this year on the permanent repeal of the SGR. We’ve also been working very closely with the Emergency Medicine Action Fund (EMAF) to address regulatory reform under the Affordable Care Act, including areas related to quality measures reporting and reimbursement.

ACEP Now Launched
When the calendar flipped to 2014, ACEP turned its monthly publication up a notch. We wanted to blend the needs of our membership with an edgy editorial vision related more closely to the world we work in. Beginning with a round-table discussion cover story and a compelling piece on breaking down racial barriers in the ED, the new-look ACEP Now hit mailboxes in mid-January and began receiving rave reviews from ACEP members.  I hope you like the direction of our new medical editor-in-chief Kevin Klauer, DO, EJD, FACEP, and our new publishing partner, Wiley Press. The new ACEP Now is not only bigger, it features more incisive opinions, “you are there” real articles regarding our decision making and advice from some of emergency medicine’s most  renowned physicians. The news from ACEP and events related to the College will always be a part of the magazine, so none of that has changed. What has changed is the attention to detail and open dialogue when opinions differ on controversial issues. If you haven’t seen ACEP Now lately, grab a copy soon. Your feedback is welcome at .

Strategic Plan Taking Shape
In leading the annual Board retreat in December, top-level goals and objectives for the college from now until 2017 were debated, prioritized and built for impact. Goal 1: Care transitions and reform of the health care delivery system continue at full gallup. Goal 2 received particular attention with the formation of the Membership Engagement Task Force, the Membership Bylaws Task Force and the Residency Visit Task Force. Your fellow member leaders of these groups, their Board of Director Liaisons, and assigned top level staff are poised for success in member engagement and satisfaction.  Here’s an overview of the Strategic Plan:

Goal 1 – Reform and Improve the Delivery System for Emergency Care

  • Objective A – Identify, support, and promote delivery models that provide effective and efficient emergency medical and acute care in different environments.
  • Objective B – Promote quality and patient safety, including development and validation of quality measures.
  • Objective C – Pursue strategies for ensuring fair payment and practice sustainability.
  • Objective D – Pursue solutions for workforce issues that ensure access to high quality emergency care.
  • Objective E – Advocate for meaningful liability reform at the state and federal levels.
  • Objective F – Communicate the value of emergency medicine as an important component of the health care system.

 Goal 2 – Enhance Membership Value and Member Engagement

  • Objective A – Increase total membership and transitioning resident retention.
  • Objective B – Provide robust educational offerings, including novel delivery methods.
  • Objective C – Support member well-being.
  • Objective D – Ensure adequate infrastructure to support growth.

Building Bridges and Strengthening Relationships

My other mantra is to connect ACEP with others who share our passion for quality health care. If we build bridges and enhance our synergy with other health care organizations, we benefit and so do our patients. We’re currently working to provide input to ABEM for recognition of Clinical Ultrasound for subspecialty certification. This will improve education, continue to allow Ultrasound use for patient care by all members meeting ACEP guidelines and validate point of care as a reimbursable item. This contributes to our value. Our relationship with CORD continues to grow, as does our joint work with CORD and SAEM in GME matters. EMRA has a new executive director and our relationship with EMRA could not be stronger. We’re proud to announce the recent ACEP/SEMPA Advanced Practice Provider Academy drew rave reviews and more than 300 physician assistant and nurse attendees. I participated as our two organizations penned a new five-year management service contract in New Orleans last month. I directed a new task force be formed to reach out to identify opportunities for collaboration with the Society of Hospitalist Medicine.  When it comes to building bridges, there are many organizations whose activities, benchmarks and plans have relevance to us. That is just one reason our executive director, Dean Wilkerson, has been such an asset to our organization for the past decade. We meet by phone at least weekly, communicate via email most days. Your Board members are out and about on a national scale gathering information, forming relationships and honing the judgment that all of you expect your elected leaders to use. I personally appreciate their diplomacy and expert work.

Two Clinical Policies Reviewed
ACEP reviewed two Clinical Policies recently. In response to the Council- and ACEP Board–adopted Amended Resolution 32(13), the “Clinical Policy: Use of Intravenous tPA for the Management of Acute Ischemic Stroke in the Emergency Department” is being reviewed. The Clinical Policies Committee, as per council, accepted comments until March 24. Findings and any recommendations regarding the policy will be reported to the ACEP Board in June. Also, per the resolution, future clinical policies will include a 60-day comment period before finalization. A Clinical Policies Subcommittee of ACEP completed a draft clinical guideline in late March, “Clinical Policy: Critical Issues in the Evaluation and Management of Adult Patients with Suspected Acute Non-Traumatic Thoracic Aortic Dissection.” It’s open for comments until May 28, 2014. To view the draft policy and comment form, go to For questions, please contact Rhonda Whitson at

Quality Measures and Reimbursement
ACEP has accepted donated emergency medicine quality measures from other organizations, and we’re developing our own for member benefit (both for CMS incentive and avoidance of CMS penalty). These steps, in addition to our continuing education on reimbursement and coding, add value to your bottom line and salary. We’ve had several recent articles, webinars and a spring conference devoted to Reimbursement and Coding, helping you prepare for reimbursement issues, the eventuality of ICD-10 and PQRS benefits in concert with ABEM.

ACEP’s Official Mobile App Improved
The official ACEP mobile app, an essential resource for members and other emergency care providers, received an upgrade early in 2013 to make navigation easier and to improve the design. The next phase of upgrades is currently being implemented. This includes the addition of several links to education resources from ACEP’s bookstore, audio recordings from the monthly Education on Demand newsletter and a section where emergency medicine news published in ACEP Now can be found. You can also find a secure Member Directory, a personalized Member Guide that reflects your chapter and sections, an events calendar and ACEP’s clinical policies. If you don’t have ACEP’s app on your phone, download it today for iPhone or Android devices.

EMF Continues Endowment Push

Since October, EMF has launched a new logo and continues the momentum of the ACEP $1 million match to bring the endowment to maturity with a corpus of $2.5 million. To help achieve this goal, for every dollar contributed to EMF before June 30, EMF will match it with a contribution of 50 cents toward the endowment. EMF has a new board and a new Strategic Plan. It’s Goals and Objectives are to:

  • Goal 1 – Position EMF as the principal sponsor of scientifically rigorous research and education to to improve the care of the acutely ill and injured and policy research that aligns with emergency care priorities
  • Goal 2:  Increase EMF’s capacity to engage more people in emergency medicine research and award more grants
  • Goal 3 – Position EMF as the premier 501(c)(3) emergency medicine foundation
  • Goal 4 – Increase EMF revenue to fund more research grants and education projects

Please go to, and make EMF your charity of choice.

Annals Added to eCME Options
In collaboration with ACEP’s online education program, articles from the Annals of Emergency Medicine are being offered as a CME component. As of April 2014, there were 13 Annals-based articles available to members. ACEP looks forward to seeing this educational offering become a robust element of ACEP’s overall online education program. Learn more at

Concurrent with the inauguration of the eCME program, Annals announced that it would continue its relationship with long-time publisher, Elsevier. The five-year contract runs through December 2018, and provides a solid and stable financial basis for journal revenues. The contract provides a generous editorial office stipend along with a guaranteed minimum royalty, enabling Annals to contribute substantially toward the overall financial success of the College.

ACEP Continues to Add Value, Enhance Image
The continued strength of our specialty requires us to do some heavy lifting in areas such as keeping prudent layperson as a recognized part of the ACA, working toward an SGR fix and changing perception about the cost of emergency care. Working together, we will make progress. As a result, our place in the House of Medicine will be enhanced. And we’re building strong connections with others while providing service to our chapters as they protect the interests of our members. Chapter efforts in Washington state and most recently in Virginia underscore the need for our teamwork. We believe that Steve Stack will become the AMA’s first ever Emergency Physician President.  We have a real chance for the AMA to continue its re-invigoration with a clear view of EM’s contribution to the house of medicine because of his upcoming service.  If you have any membership dollars available in your professional budget, I hope you consider making this year one in which you might become an AMA member to bolster our ACEP delegation at the AMA.  There are certain things that are more do-able when we have a strong delegation within the AMA, whether advancing our cause within the house of medicine or in our negotiations at the RUC.

Spring Conferences in Full Swing, LAC Coming Up
ACEP’s busy spring conference lineup began in February with the Reimbursement and Coding Conferences in New Orleans. With the upcoming changes in coding and the implementation of the Affordable Care Act, payment topics have become even more popular and necessary. More than 200 emergency physicians participated in the February 2014 conference. Your next chance to brush up on your knowledge in this area is March 2015 when the R/C Conferences move to Las Vegas.

The 2014 Advanced Pediatric Emergency Medicine Assembly was held in New York City in March and drew more than 550 four-day registrants. This is the highest number in four years.

ACEP’s newest offering, the Advanced Practice Provider (APP) Academy, recently wrapped up. More than 300 attendees received a crash course in emergency department essentials. Held in conjunction with SEMPA, this conference is vital for emergency department providers who might be new to the ED or need help in certain areas. The demand for this conference was high and feedback positive, so ACEP and SEMPA have decided to hold a second installment of Phase I in August. The conference has also been renamed Emergency Medicine Academy.

ACEP’s Leadership and Advocacy Conference will be May 18-21 in Washington, D.C. If you’ve never been to this conference, you’re missing one of the best three days of education and networking available. Thought-provoking, inspiring and challenging sessions by nationally recognized speakers and key decision makers will provide you the inside information and skills you need to maximize your impact as an emergency medicine leader and advocate. Invited Speakers for the Conference include: U.S. Sen. Ron Wyden (D-OR); U.S. Rep. Andy Barr (R-KY); Amy Walter, Political Analyst for the Cook Political Report; Patrick Conway, MD, Deputy Administrator for Innovation & Quality & CMS Chief Medical Officer. Please plan to come to Washington, D.C., next month to network with ACEP leaders and advocate for your specialty.

Please remember the elevator speech when you run into your hospital leaders and legislators:
We are 4% of the physician workforce seeing 28% of all acute care visits. We are the doctors of first contact, unscheduled, federally mandated care regardless of financial status. We are over 32,000 ACEP members seeing 130 million patient visits, 24/7/365 for about 4% of the national healthcare dollar. Our customers include primary care docs who send their patients to us for complex medical diagnostic work-ups. We are the portal of entry for 75% of all hospital admissions. We are the hub of the enterprise, and are working toward being masters of transitions of care. We are not only expected to be the admittors, but also the admitting avoidance service through our work in care coordination.  And we do this in a room, in a hallway, in ‘copters and ambulances during disasters large and small every shift of every single day.

Thanks for the Past Six Months
I started my EM practice in the 1980s, and there are many reasons I value membership and the friends I’ve made over the years. I can pick up a phone and dial a colleague anywhere for advice. Like all families and all democratic groups filled with the riches of a knowledge-based constituency, we will have disagreements and some conflict. It’s all for a better result and a strong organization, as long as we stick together. The knowledge I’ve gained in reimbursement and coding and practice management has paid me back every dollar I ever contributed to ACEP, EMF and NEMPAC. The education I’ve received at conferences has made my practice better and improved the care of my patients. I was proud to join ACEP then, and I’m proud to be its President today. ACEP is growing. ACEP is dynamic. ACEP gives you a good return on your dues investment dollars. Your partners, your colleagues are the members of the committees, task forces, sections, Board, Council, and technical expert panels that create our future. Let’s connect. See you at LAC and ACEP14.


Alexander M. Rosenau, DO, CPE, FACEP
President, American College of Emergency Physicians

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April Annals Audio posted!

Apologies for the delay, but here it is, better than ever! Highlights:

-Advance directives and EMS cardiac arrests in Oregon: do they agree?
-Organ donation after cardiac arrest? Ethical and practical issues
-Is outpatient ED care profitable?
-Reimbursement effect of the ACA
-A Standardized Mortality Rate for EM
-Bells Palsy in the ED: how often do we have it right?
-Does it matter which thrombolytic or dose, for ischemic stroke?

And much more…. Email anytime at


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