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UC Irvine
Western Journal of Emergency Medicine: Integrating Emergency Care with Population
Health
Title
MEMC Abstracts Special Issue
Permalink
https://escholarship.org/uc/item/1349952d
Journal
Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health, 23(5.1)
ISSN
1936-900X
Author
Lam, Jordan
Publication Date
2022
Copyright Information
Copyright 2022 by the author(s).This work is made available under the terms of a Creative Commons Attribution License,
available at https://creativecommons.org/licenses/by/4.0/
Peer reviewed
eScholarship.org Powered by the California Digital Library
University of California
ADVANCED
ADVANCED
Western Journal of Emergency Medicine
West
ADVANCED
ADVANCED
Volume 23, September 2022 Supplement
MEMC Abstracts Special Issue
Open Access at www.westjem.com ISSN 1936-900X
ADVANCED
Supplement to
ADVANCED
Western Journal of Emergency Medicine:
Integrating Emergency Care with Population Health
ADVANCED
VOLUME 23, September 2022 Supplement
ADVANCED MEMC 2022
Jointly Organized by the American
ADVANCED
Academy of Emergency Medicine
(AAEM), and the Mediterranean
Academy of Emergency Medicine
(MAEM)
WHEN WHAT WHERE
PAGES S1-S17
SATURDAY CALIFORNIA ACEP'S THE WESTIN
SEPTEMBER 23 ANNUAL ASSEMBLY PASADENA
A Peer-Reviewed, International Professional Journal
ACOEP stands with all emergency
physicians and providers on the
front line. We thank you for your
tireless work and effort.
www.acoep.org
Western Journal of Emergency Medicine:
Integrating Emergency Care with Population Health
Indexed in MEDLINE, PubMed, and Clarivate Web of Science, Science Citation Index Expanded
Andrew W. Phillips, MD, Associate Editor Mark I. Langdorf, MD, MHPE, Editor-in-Chief Shadi Lahham, MD, MS, Deputy Editor
DHR Health-Edinburg, Texas University of California, Irvine School of Medicine- Kaiser Permanente- Irvine, California
Irvine, California
Edward Michelson, MD, Associate Editor
Susan R. Wilcox, MD, Associate Editor
Texas Tech University- El Paso, Texas Shahram Lotfipour, MD, MPH, Managing Editor
Massachusetts General Hospital- Boston, Massachusetts
University of California, Irvine School of Medicine-
Dan Mayer, MD, Associate Editor Irvine, California Elizabeth Burner, MD, MPH, Associate Editor
Retired from Albany Medical College- Niskayuna, New York University of Southern California- Los Angeles, California
Michael Gottlieb, MD, Associate Editor
Wendy Macias-Konstantopoulos, MD, MPH, Associate Editor Rush Medical Center-Chicago, Illinois Patrick Joseph Maher, MD, MS, Associate Editor
Massachusetts General Hospital- Boston, Massachusetts Niels K. Rathlev, MD, Associate Editor Ichan School of Medicine at Mount Sinai- New York, New York
Gayle Galletta, MD, Associate Editor Tufts University School of Medicine-Boston, Massachusetts
Donna Mendez, MD, EdD, Associate Editor
University of Massachusetts Medical School- Rick A. McPheeters, DO, Associate Editor University of Texas-Houston/McGovern Medical School- Houston Texas
Worcester, Massachusetts Kern Medical- Bakersfield, California
Yanina Purim-Shem-Tov, MD, MS, Associate Editor Danya Khoujah, MBBS, Associate Editor
Gentry Wilkerson, MD, Associate Editor
Rush University Medical Center-Chicago, Illinois University of Maryland University of Maryland School of Medicine- Baltimore, Maryland
Resident Editors Quincy Tran, MD, PhD Infectious Disease
Elissa Schechter-Perkins, MD, MPH William D. Whetstone, MD
AAEM/RSA University of Maryland University of California, San Francisco
Boston University School of Medicine
John J. Campo, MD Disaster Medicine
Harbor-University of California, Los Angeles Christopher Kang, MD Ioannis Koutroulis, MD, MBA, PhD Neurosciences
Medical Center Madigan Army Medical Center George Washington University School of Medicine Antonio Siniscalchi, MD
and Health Sciences Annunziata Hospital, Cosenza, Italy
Tehreem Rehman, MD
Advocate Christ Medical Center Education Kevin Lunney, MD, MHS, PhD Pediatric Emergency Medicine
Danya Khoujah, MBBS University of Maryland School of Medicine Paul Walsh, MD, MSc
ACOEP University of Maryland School of Medicine University of California, Davis
Justina Truong, DO Robert Derlet, MD
Kingman Regional Medical Center Jeffrey Druck, MD Founding Editor, California Journal of Emergency Muhammad Waseem, MD
University of Colorado Medicine Lincoln Medical & Mental Health Center
Section Editors University of California, Davis
John Burkhardt, MD, MA Cristina M. Zeretzke-Bien, MD
Behavioral Emergencies University of Michigan Medical School Stephen Liang, MD, MPHS University of Florida
Leslie Zun, MD, MBA Washington University School of Medicine
Chicago Medical School Michael Epter, DO Public Health
Maricopa Medical Center Injury Prevention Jacob Manteuffel, MD
Marc L. Martel, MD Mark Faul, PhD, MA Henry Ford Hospital
Hennepin County Medical Center ED Administration, Quality, Safety Centers for Disease Control and Prevention
David C. Lee, MD John Ashurst, DO
Cardiac Care Northshore University Hospital Wirachin Hoonpongsimanont, MD, MSBATS Lehigh Valley Health Network
Fred A. Severyn, MD Eisenhower Medical Center
University of Colorado School of Medicine Gary Johnson, MD Tony Zitek, MD
Upstate Medical University International Medicine Kendall Regional Medical Center
Sam S. Torbati, MD Heather A.. Brown, MD, MPH
Cedars-Sinai Medical Center Brian J. Yun, MD, MBA, MPH Trevor Mills, MD, MPH
Harvard Medical School Prisma Health Richland
Northern California VA Health Care
Clinical Practice Taylor Burkholder, MD, MPH
Cortlyn W. Brown, MD Laura Walker, MD Erik S. Anderson, MD
Mayo Clinic Keck School of Medicine of USC
Carolinas Medical Center Alameda Health System-Highland Hospital
León D. Sánchez, MD, MPH Christopher Greene, MD, MPH
Casey Clements, MD, PhD University of Alabama Technology in Emergency Medicine
Mayo Clinic Beth Israel Deaconess Medical Center Nikhil Goyal, MD
Chris Mills, MD, MPH Henry Ford Hospital
Patrick Meloy, MD William Fernandez, MD, MPH
University of Texas Health-San Antonio Santa Clara Valley Medical Center
Emory University Phillips Perera, MD
Shada Rouhani, MD Stanford University Medical Center
Nicholas Pettit, DO, PhD Emergency Medical Services Brigham and Women’s Hospital
Indiana University Daniel Joseph, MD Trauma
Yale University Legal Medicine Pierre Borczuk, MD
David Thompson, MD Melanie S. Heniff, MD, JD Massachusetts General Hospital/Havard
University of California, San Francisco Joshua B. Gaither, MD Medical School
University of Arizona, Tuscon Indiana University School of Medicine
Kenneth S. Whitlow, DO
Julian Mapp Greg P. Moore, MD, JD Toxicology
Kaweah Delta Medical Center Madigan Army Medical Center Brandon Wills, DO, MS
University of Texas, San Antonio Virginia Commonwealth University
Critical Care Statistics and Methodology
Christopher “Kit” Tainter, MD Shira A. Schlesinger, MD, MPH Jeffrey R. Suchard, MD
Harbor-UCLA Medical Center Shu B. Chan MD, MS
University of California, San Diego Resurrection Medical Center University of California, Irvine
Gabriel Wardi, MD Geriatrics Stormy M. Morales Monks, PhD, MPH Ultrasound
University of California, San Diego Cameron Gettel, MD J. Matthew Fields, MD
Yale School of Medicine Texas Tech Health Science University
Thomas Jefferson University
Joseph Shiber, MD Soheil Saadat, MD, MPH, PhD
University of Florida-College of Medicine Stephen Meldon, MD Shane Summers, MD
Cleveland Clinic University of California, Irvine
Brooke Army Medical Center
Matt Prekker MD, MPH James A. Meltzer, MD, MS
Hennepin County Medical Center Luna Ragsdale, MD, MPH Robert R. Ehrman
Duke University Albert Einstein College of Medicine
Wayne State University
David Page, MD Musculoskeletal
University of Alabama Health Equity Juan F. Acosta DO, MS Ryan C. Gibbons, MD
Emily C. Manchanda, MD, MPH Pacific Northwest University Temple Health
Erik Melnychuk, MD Boston University School of Medicine
Geisinger Health Rick Lucarelli, MD
Mandy J. Hill, DrPH, MPH Medical City Dallas Hospital
UT Health McGovern Medical School
Official Journal of the California Chapter of the American College of Emergency Physicians, the America College of Osteopathic Emergency Physicians, and the California Chapter of the
American Academy of Emergency Medicine
Available in MEDLINE, PubMed, PubMed Central, CINAHL, SCOPUS, Google Scholar, eScholarship, Melvyl, DOAJ,
EBSCO, EMBASE, Medscape, HINARI, and MDLinx Emergency Med. Members of OASPA.
Editorial and Publishing Office: WestJEM/Depatment of Emergency Medicine, UC Irvine Health, 3800 W. Chapman Ave. Suite 3200, Orange, CA 92868, USA
Office: 1-714-456-6389; Email: Editor@westjem.org
Volume 23, Issue 4 Supplement: September 2022 i Western Journal of Emergency Medicine
Western Journal of Emergency Medicine:
Integrating Emergency Care with Population Health
Indexed in MEDLINE, PubMed, and Clarivate Web of Science, Science Citation Index Expanded
Editorial Board
Amin A. Kazzi, MD, MAAEM Edward Michelson, MD Kenneth V. Iserson, MD, MBA Robert M. Rodriguez, MD
The American University of Beirut, Texas Tech University University of Arizona, Tucson University of California, San Francisco
Beirut, Lebanon
Edward Panacek, MD, MPH Khrongwong Musikatavorn, MD Robert Suter, DO, MHA
Anwar Al-Awadhi, MD University of South Alabama King Chulalongkorn Memorial UT Southwestern Medical Center
Mubarak Al-Kabeer Hospital, Hospital, Chulalongkorn
Jabriya, Kuwait Francesco Della Corte, MD University, Bangkok, Thailand Robert W. Derlet, MD
Azienda Ospedaliera Universitaria University of California, Davis
Arif A. Cevik, MD “Maggiore della Carità,” Novara, Italy Leslie Zun, MD, MBA
United Arab Emirates University Chicago Medical School Rosidah Ibrahim, MD
College of Medicine and Health Francis Counselman, MD Hospital Serdang, Selangor, Malaysia
Sciences, Al Ain, United Arab Emirates Eastern Virginia Medical School Linda S. Murphy, MLIS
University of California, Irvine Samuel J. Stratton, MD, MPH
Abhinandan A.Desai, MD Gayle Galleta, MD School of Medicine Librarian Orange County, CA, EMS Agency
University of Bombay Grant Medical Sørlandet Sykehus HF, Akershus
College, Bombay, India Universitetssykehus, Lorenskog, Norway Nadeem Qureshi, MD Scott Rudkin, MD, MBA
St. Louis University, USA University of California, Irvine
Bandr Mzahim, MD Hjalti Björnsson, MD Emirates Society of Emergency
King Fahad Medical City, Riyadh, Icelandic Society of Emergency Medicine, United Arab Emirates Scott Zeller, MD
Saudi Arabia Medicine University of California, Riverside
Niels K. Rathlev, MD
Brent King, MD, MMM Jacob (Kobi) Peleg, PhD, MPH Tufts University School of Medicine Steven H. Lim, MD
University of Texas, Houston Tel-Aviv University, Tel-Aviv, Israel Changi General Hospital, Simei,
Pablo Aguilera Fuenzalida, MD Singapore
Christopher E. San Miguel, MD Jaqueline Le, MD Pontificia Universidad Catolica de
Ohio State University Wexner Desert Regional Medical Center Chile, Región Metropolitana, Chile Terry Mulligan, DO, MPH, FIFEM
Medical Center ACEP Ambassador to the Netherlands
Jeffrey Love, MD Peter A. Bell, DO, MBA Society of Emergency Physicians
Daniel J. Dire, MD The George Washington University Baptist Health Sciences University
University of Texas Health Sciences School of Medicine and Health Vijay Gautam, MBBS
Center San Antonio Sciences Peter Sokolove, MD University of London, London, England
University of California, San Francisco
David F.M. Brown, MD Jonathan Olshaker, MD Wirachin Hoonpongsimanont, MD,
Massachusetts General Hospital/ Boston University Rachel A. Lindor, MD, JD MSBATS
Harvard Medical School Mayo Clinic Siriraj Hospital, Mahidol University,
Katsuhiro Kanemaru, MD Bangkok, Thailand
Douglas Ander, MD University of Miyazaki Hospital,
Emory University Miyazaki, Japan
Advisory Board Editorial Staff
Elena Lopez-Gusman, JD Mark I. Langdorf, MD, MHPE, Isabelle Nepomuceno, BS Cassandra Saucedo, MS
California ACEP FAAEM, FACEP Executive Editorial Director Executive Publishing Director
American College of Emergency UC Irvine Health School of Medicine
Physicians
Robert Suter, DO, MHA Visha Bajaria, BS Jordan Lam, BS
Jennifer Kanapicki Comer, MD American College of Osteopathic WestJEM Editorial Director WestJEM Publishing Director
FAAEM Emergency Physicians
California Chapter Division of AAEM UT Southwestern Medical Center
Stanford University School of Medicine Anuki Edirimuni, BS Anthony Hoang, BS
Shahram Lotfipour, MD, MPH WestJEM Editorial Director WestJEM Associate Publishing Director
Katie Geraghty FAAEM, FACEP
American College of Osteopathic UC Irvine Health School of Medicine
Emergency Physicians Zaynab Ketana, BS Rubina Rafi, BS
Jorge Fernandez, MD, FACEP CPC-EM Editorial Director CPC-EM Publishing Director
Kimberly Ang, MBA UC San Diego Health School of Medicine Associate Marketing Director
UC Irvine Health School of Medicine
Avni Agrawal, BS
Randall J. Young, MD, MMM, FACEP Stephanie Burmeister, MLIS WestJEM Associate Publishing Director
California ACEP WestJEM Staff Liaison Associate Marketing Director
American College of Emergency
Physicians
Kaiser Permanente June Casey, BA
Copy Editor
Official Journal of the California Chapter of the American College of Emergency Physicians, the America College of Osteopathic Emergency Physicians, and the California Chapter of
the American Academy of Emergency Medicine
Available in MEDLINE, PubMed, PubMed Central, Europe PubMed Central, PubMed Central Canada, CINAHL, SCOPUS, Google Scholar, eScholarship, Melvyl, DOAJ,
EBSCO, EMBASE, Medscape, HINARI, and MDLinx Emergency Med. Members of OASPA.
Editorial and Publishing Office: WestJEM/Depatment of Emergency Medicine, UC Irvine Health, 3800 W. Chapman Ave. Suite 3200, Orange, CA 92868, USA
Office: 1-714-456-6389; Email: Editor@westjem.org
Western Journal of Emergency Medicine ii Volume 23, Issue 4 Supplement: September 2022
MEMC 2022 - Jointly Organized by the American Academy of
Emergency Medicine (AAEM) and the Mediterranean Academy of
Emergency Medicine (MAEM)
XIth Mediterranean Emergency Medicine Congress, Malta 21-24 September, 2022
The XIth Mediterranean Emergency Medicine Congress (MEMC), jointly organized by
the American Academy of Emergency Medicine (AAEM) and the Mediterranean Academy of
Emergency Medicine (MAEM) will be held in Malta 21-24 September, 2022.
We strive to grow the global development of our specialty around the Mediterranean basin, and
indeed around the world. We endorse physician wellness, residency training, and quality, lifelong
education in emergency medicine. All patients should have access to care by qualified emergency
physicians and systems of care. MEMC22 is an opportunity to share the very best practices from
high-resource countries with mature systems, countries that have recently achieved specialty status,
and low- resource countries delivering care even in austere environments.
Our sessions cover aspects such as acute cardiac conditions, critical care, basic and advanced
ultrasound, immigrant and refugee health, tactical and military medicine, trauma resuscitation,
toxicology, prehospital care systems, and much more.
The Journal of Emergency Medicine (JEM) is sponsoring the oral abstract competition, and the
Western Journal of Emergency Medicine (WestJEM) is sponsoring the research poster competition.
The 50 abstracts with the highest scores by the Abstract Review Committee are published. WestJEM
is publishing here the top 25 population health related abstracts, and JEM is publishing the top 25
clinical abstracts. The primary authors of the top three scoring abstracts will deliver ten-minute oral
presentations during the opening ceremony.
Our curriculum for the Congress is impactful to both new and seasoned physicians, residents and
medical students. as well as to nurses, researchers and scientists, prehospital providers, pharmacists,
nutritionists, and anyone involved in the delivery of emergency care.
We are delighted to contribute to the MEMC22 in Malta and invite you to explore all that this
historic city and its surrounding areas have to offer. We welcome you, your families, and colleagues
to the best international conference of the year!
Mark I. Langdorf, MD, MHPE, FACEP, FAAEM
Professor of Clinical Emergency Medicine
University of California, Irvine
Editor-in-Chief, Western Journal of Emergency Medicine
v Table of Contents The Western Journal of Emergency Medicine:
S1 Abstracts Integrating Emergency Care with Population Health
would like to thank the Mediterranean Academy of
Emergency Medicine and the Academic Research and
Educational Organization for helping to make this
collaborative special issue possible.
Western Journal of Emergency Medicine v Volume 23, Issue 4 Supplement: September 2022
MEMC Abstracts - Table of Contents
1 Implementation of Vertical Split Flow Model for Patient Lee, MD; Jeanette Kurbedin, DO; Sabena Vaswani, MD
Throughput at a Community Hospital Emergency
Department 13 ICU admission Risk Factors of Latinx/Hispanic COVID-19
Adrian A. Cotarelo; Alex Hsieh; Alexander W. Arena, MD; patients at a US Mexico Border Hospital
Anthony Oraha, MD; Mary E. McLean, MD FAAEM; Norman Andrew LaFree, MD; Christian A. Tomaszewski, MD;
Mok; Raffaele Milizia Christopher Johln Coyne, MD MPH FAAEM; Faith C.
Quenzer, DO MPH
2 Efforts to Diversify Faculty Within Emergency
Departments: A National Survey of Department Heads 14 Effectiveness of face mask mandates in 4 suburban
Alexis Jones; Darian Harris; Evrim Oral; Jessica Fox; Lisa US communities during the SARS-CoV2 Omicron
A. Moreno, MD MS MSCR FAAEM FIFEM; Stacey Rhodes, surge
MD MS Julie McCarthy; Robert Partridge, MD; Stephen K. Epstein,
MD MPP; Tiffany Zike; Timothy McDonald
3 Emergency Nurses’ Perceptions of Opioid Use Disorder
and Its Treatment in the Emergency Department 15 Proportion of Emergency Department Visits for Alcohol
Christiana K. Prucnal; Dawn Williamson; Elizabeth A. Abuse Increased After the Arrival of COVID-19
Samuels; Kristina Monteiro; Margaret Samuels-Kalow, MD Barnet Eskin, MD; Claire DeLong, DO; John R. Allegra, MD
PhD
4 Effect of the COVID-19 Pandemic on ED Adult Psychiatric
Visits 16 Cluster analysis of regional use patterns among critically
Barnet Eskin, MD; Crystal Bauman, MD; John R. Allegra, MD ill emergency patients in Korea
PhD Sung Min Lee, MD; Tag Heo
5 Utilization of Telehealth Solutions for Patients with 17 Modeling Advanced Practice Provider Productivity in the
Opioid Use Disorder Using Buprenorphine: A Scoping Emergency Department
Review Bryan Stenson, MD; David T. Chiu, MD; Joshua W. Joseph,
Aileen Guillen; Bharath Chakravarthy, MD MPH FAAEM; MD MS FAAEM; Leon D. Sanchez, MD MPH FAAEM; Peter
Minal Reddy; Soheil Saadat S. Antkowiak, MD MPH
6 Variation in Trauma Team Response Fees in United 18 Impact of a Best Practice Alert on the Implementation of
States Trauma Centers Expedited Partner Therapy
Arianna Neeki; David Wong; Fanglong Dong; Jan Serrano; Andrew Gutting; Emily Ager, MD; Fahmida Ahmed; Keith E.
Louis P. Tran, MD; Mason Chan; Michael M. Neeki, DO; Kocher, MD MPH; Rachel Solnick, MD; Roland C. Merchant,
Pamela R. A. Lux, DO FAAEM MD; Zoe Curry
7 Analysis of Time-to-Disposition Intervals During Early 19 Metal Detectors Improve Patients’ Sense of Safety in the
and Late Parts of a Shift Emergency Department
Anne Grossestreuer; Bryan Stenson, MD; David T. Chiu, MD; Devon Fiorino, MD; Joshua Easter, MD MSc; William Peter
Joshua W. Joseph, MD MS FAAEM; Lakshman Balaji; Leon Kehr, MD
D. Sanchez, MD MPH FAAEM; Peter S. Antkowiak, MD MPH
20 The Role of Call-Back Systems in Older Patients
8 Slack Intern Curriculum Supports Intern Preparedness Discharged from the Emergency Department
and Bridges Curriculum Gaps due to COVID-19 Cassandra Saucedo; Darius Martins, MD; Jennifer Roh,
- Slack Intern Curriculum; Alisa Hayes; Daniel Axelson; FAAEM
Frosso Adamakos, MD FACEP FAAEM; Herman Lee, DO;
Jonathan Chan, MD; Michaela Salvo, MD; Moira Davenport, 21 Impact of Shared Visits with Midlevel Providers or
MD; Tazeen Abbas; Thaddeus Schmitt, MD Residents on Resource Use and Admission Rate
Bryan Stenson, MD; David T. Chiu, MD; Joshua W. Joseph,
9 Serious Medical Outcomes due to Single Substance MD MS FAAEM; Leon D. Sanchez, MD MPH FAAEM; Nathan
Opioid Exposures McDonald; Peter S. Antkowiak, MD MPH; Terrance Lee, MD
Aaron Frey, DO; Christopher P. Holstege, MD FAAEM; Kawai
Tanabe; Moira Smith; Saumitra Rege; Will Goodrich 22 Variation of Emergency Medicine Resident Productivity
During the COVID-19 Pandemic
10 Patterns of SSRI Exposures Reported to the U.S. Poison Arjun Dhanik, MD; Bryan Stenson, MD; Daniel L. Shaw, MD;
Centers David T. Chiu, MD; Jake Hoyne, MD; Joshua Kolikof, MD;
Avery Michienzi; Christopher P. Holstege, MD FAAEM; Ryan Leon D. Sanchez, MD MPH FAAEM; Nathan McDonald;
Cole; Saumitra Rege Peter S. Antkowiak, MD MPH
11 Characterization of Oxycodone Misuse using National 23 Point-of-Care Ultrasound Interpretation of Cardiac
Survey Data. Standstill in Children
Christopher P. Holstege, MD FAAEM; Kawai Tanabe; Moira Angela Chen, MD; Kevin Hu
Smith; Saumitra Rege; Will Goodrich
24 Utilization and Cost Savings of an Emergency
12 Incorporating a Resident-Driven Mentorship Program into Department Acetaminophen Route Pathway
Emergency Medicine Clerkship Rotations David Arastehmanesh, MD; David T. Chiu, MD; Nadia
Arlene S. Chung, MD MACM FAAEM; Daniel Novak, DO; Eric Eshraghi, MD
Western Journal of Emergency Medicine vi Volume 23, Issue 4 Supplement: September 2022
Western Journal of Emergency Medicine:
Integrating Emergency Care with Population Health
Indexed in MEDLINE, PubMed, and Clarivate Web of Science, Science Citation Index Expanded
This open access publication would not be possible without the generous and continual financial support of our society sponsors, department and chapter subscribers.
Professional Society Sponsors
California Chapter Division of
American College of Osteopathic Emergency Physicians
American Academy of Emergency Medicine
California ACEP
Academic Department of Emergency Medicine Subscriber
Albany Medical College Conemaugh Memorial Medical Center INTEGRIS Health Mayo Clinic
Albany, NY Johnstown, PA Oklahoma City, OK Jacksonville, FL
Allegheny Health Network Crozer-Chester Medical Center Kaiser Permenante Medical Center Mayo Clinic College of Medicine
Pittsburgh, PA Upland, PA San Diego, CA Rochester, MN
American University of Beirut Desert Regional Medical Center Kaweah Delta Health Care District Mercy Health - Hackley Campus
Beirut, Lebanon Palm Springs, CA Visalia, CA Muskegon, MI
AMITA Health Resurrection Medical Detroit Medical Center/ Wayne State Kennedy University Hospitals Merit Health Wesley
Center University Turnersville, NJ Hattiesburg, MS
Chicago, IL Detroit, MI
Kent Hospital Midwestern University
Arrowhead Regional Medical Center Eastern Virginia Medical School Warwick, RI Glendale, AZ
Colton, CA Norfolk, VA
Kern Medical Mount Sinai School of Medicine
Baylor College of Medicine Einstein Healthcare Network Bakersfield, CA New York, NY
Houston, TX Philadelphia, PA
Lakeland HealthCare New York University Langone
Baystate Medical Center Eisenhower Medical Center St. Joseph, MI Health
Springfield, MA Rancho Mirage, CA New York, NY
Lehigh Valley Hospital and Health Network
Bellevue Hospital Center Emory University Allentown, PA North Shore University Hospital
New York, NY Atlanta, GA Manhasset, NY
Loma Linda University Medical Center
Beth Israel Deaconess Medical Center Franciscan Health Loma Linda, CA Northwestern Medical Group
Boston, MA Carmel, IN Chicago, IL
Louisiana State University Health Sciences
Boston Medical Center Geisinger Medical Center Center NYC Health and Hospitals/ Jacobi
Boston, MA Danville, PA New Orleans, LA New York, NY
Brigham and Women’s Hospital Grand State Medical Center Louisiana State University Shreveport Ohio State University Medical
Boston, MA Allendale, MI Shereveport, LA Center
Columbus, OH
Brown University Healthpartners Institute/ Regions Hospital Madigan Army Medical Center
Providence, RI Minneapolis, MN Tacoma, WA Ohio Valley Medical Center
Wheeling, WV
Carl R. Darnall Army Medical Center Hennepin County Medical Center Maimonides Medical Center
Fort Hood, TX Minneapolis, MN Brooklyn, NY Oregon Health and Science
University
Cleveland Clinic Henry Ford Medical Center Maine Medical Center Portland, OR
Cleveland, OH Detroit, MI Portland, ME
Penn State Milton S. Hershey
Columbia University Vagelos Henry Ford Wyandotte Hospital Massachusetts General Hospital/Brigham and Medical Center
New York, NY Wyandotte, MI Women’s Hospital/ Harvard Medical Hershey, PA
Boston, MA
State Chapter Subscriber
Arizona Chapter Division of the Great Lakes Chapter Division of the American Academy of Emergency Medicine
American Academy of Emergency Medicine American Academy of Emergency Uniformed Services Chapter Division of the
California Chapter Division of the Medicine American Academy of Emergency Medicine
American Academy of Emergency Medicine Tennessee Chapter Division of the Virginia Chapter Division of the
Florida Chapter Division of the American Academy of Emergency Medicine
American Academy of Emergency Medicine
International Society Partners
Emergency Medicine Association of Turkey Norwegian Society for Emergency Medicine Sociedad Chileno Medicina Urgencia
Lebanese Academy of Emergency Medicine Sociedad Argentina de Emergencias Thai Association for Emergency Medicine
Mediterranean Academy of Emergency Medicine
To become a WestJEM departmental sponsor, waive article processing fee, receive print and copies for all faculty and electronic for faculty/residents, and free CME and faculty/fellow position
advertisement space, please go to http://westjem.com/subscribe or contact:
Stephanie Burmeister
WestJEM Staff Liaison
Phone: 1-800-884-2236
Email: sales@westjem.org
Western Journal of Emergency Medicine vii Volume 23, Issue 4 Supplement: September 2022
Western Journal of Emergency Medicine:
Integrating Emergency Care with Population Health
Indexed in MEDLINE, PubMed, and Clarivate Web of Science, Science Citation Index Expanded
This open access publication would not be possible without the generous and continual financial support of our society sponsors, department and chapter subscribers.
Professional Society Sponsors
California Chapter Division of
American College of Osteopathic Emergency Physicians
American Academy of Emergency Medicine
California ACEP
Academic Department of Emergency Medicine Subscriber
Prisma Health/ University of South University of Alabama Medical Center University of Illinois at Chicago University of Washington -
Carolina SOM Greenville Northport, AL Chicago, IL Harborview Medical Center
Greenville, SC Seattle, WA
University of Alabama, Birmingham University of Iowa
Regions Hospital Emergency Medicine Birmingham, AL Iowa City, IA University of Wisconsin Hospitals
Residency Program and Clinics
St. Paul, MN University of Arizona College of University of Louisville Madison, WI
Medicine-Tucson Louisville, KY
Rhode Island Hospital Tucson, AZ UT Southwestern
Providence, RI University of Maryland Dallas, TX
University of California, Davis Medical Baltimore, MD
Robert Wood Johnson University Center Valleywise Health Medical Center
Hospital Sacramento, CA University of Massachusetts Phoenix, AZ
New Brunswick, NJ Amherst, MA
University of California, Irvine Virginia Commonwealth
Rush University Medical Center Orange, CA University of Michigan University Medical Center
Chicago, IL Ann Arbor, MI Richmond, VA
University of California, Los Angeles
St. Luke’s University Health Network Los Angeles, CA University of Missouri, Columbia Wake Forest University
Bethlehem, PA Columbia, MO Winston-Salem, NC
University of California, San Diego
Spectrum Health Lakeland La Jolla, CA University of North Dakota School of Wake Technical Community
St. Joseph, MI Medicine and Health Sciences College
University of California, San Francisco Grand Forks, ND Raleigh, NC
Stanford San Francisco, CA
Stanford, CA University of Nebraska Medical Center Wayne State
UCSF Fresno Center Omaha, NE Detroit, MI
SUNY Upstate Medical University Fresno, CA
Syracuse, NY University of Nevada, Las Vegas Wright State University
University of Chicago Las Vegas, NV Dayton, OH
Temple University Chicago, IL
Philadelphia, PA University of Southern Alabama Yale School of Medicine
University of Cincinnati Medical Center/ Mobile, AL New Haven, CT
Texas Tech University Health Sciences College of Medicine
Center Cincinnati, OH University of Southern California
El Paso, TX Los Angeles, CA
University of Colorado Denver
The MetroHealth System/ Case Denver, CO University of Tennessee, Memphis
Western Reserve University Memphis, TN
Cleveland, OH University of Florida
Gainesville, FL University of Texas, Houston
UMass Chan Medical School Houston, TX
Worcester, MA University of Florida, Jacksonville
Jacksonville, FL University of Washington
University at Buffalo Program Seattle, WA
Buffalo, NY
State Chapter Subscriber
Arizona Chapter Division of the Great Lakes Chapter Division of the American Academy of Emergency Medicine
American Academy of Emergency Medicine American Academy of Emergency Uniformed Services Chapter Division of the
California Chapter Division of the Medicine American Academy of Emergency Medicine
American Academy of Emergency Medicine Tennessee Chapter Division of the Virginia Chapter Division of the
Florida Chapter Division of the American Academy of Emergency Medicine
American Academy of Emergency Medicine
International Society Partners
Emergency Medicine Association of Turkey Norwegian Society for Emergency Medicine Sociedad Chileno Medicina Urgencia
Lebanese Academy of Emergency Medicine Sociedad Argentina de Emergencias Thai Association for Emergency Medicine
Mediterranean Academy of Emergency Medicine
To become a WestJEM departmental sponsor, waive article processing fee, receive print and copies for all faculty and electronic for faculty/residents, and free CME and faculty/fellow position
advertisement space, please go to http://westjem.com/subscribe or contact:
Stephanie Burmeister
WestJEM Staff Liaison
Phone: 1-800-884-2236
Email: sales@westjem.org
Western Journal of Emergency Medicine viii Volume 23, Issue 4 Supplement: September 2022
Call for Section Editors
• Behavioral Emergencies • Trauma Care
• Emergency Cardiac Care • Ultrasound
• International Medicine
• Pediatric Emergencies
• Public Health
Send CV and letter of interest to Editor@WestJEM.org
NEW: HEALTH EQUITY SECTION
Call for
Reviewers and Manuscripts
Send CV and letter of interest to Editor@WestJEM.orgCall for Reviewers!
Please send your CV and letter of interest to
editor@westjem.orgDepartment of Emergency Medicine
Position: Ultrasound Director
The Department of Emergency Medicine at the University of California, Irvine School of Medicine
is seeking applicants for a faculty position in the Health Sciences Clinical Professor Series, at the
Assistant, Associate, or Full Professor rank.
The University of California, Irvine Medical Center is a 472-bed tertiary care hospital with all
residencies. The ED is a progressive 35-bed Level I Trauma Center with 50,000 patients, in
urban Orange County. The ED has collegial relationships with all services and offers excellent
salary and benefits with an incentive plan.
Criteria for the Health Sciences Clinical Professor Series:
The incumbent will be expected to teach residents and medical students; provide direct patient
care; perform research and/or creative work; and public and University service. Candidates must
have demonstrated capabilities for teaching and research or creative work suitable for this series.
Candidates must possess an M.D. or D.O. degree, board certification in Emergency Medicine,
and be eligible for a California Medical License. Fellowship sub-specialization in Ultrasound is
also required.
The successful candidate will be expected to engage in the following:
- Maintain function and peak performance of all 6 ultrasound trollies, 4 boom-mounted
machines, and 8 handheld units
- Review all EM resident scans for competency and graduation requirements
- Optimize documentation templates
- Maintain Clinical Ultrasound Accreditation Program through ACEP
- Monitor credentialing progress for each new faculty and nurse practitioner
- Administer annual “bootcamp” for all new EM faculty, residents, and fellows
- Provide Chair with quarterly faculty ultrasound metrics
- Work with hospital IT to troubleshoot workflow and middleware issues
- Establish and maintain an active transesophageal echo program
- Oversee ultrasound quality assurance
Academic rank, step, and salary will be based upon the candidate’s training, qualifications, and
experience.
Application Instructions - To be considered for the position, interested candidates should visit:
https://recruit.ap.uci.edu/JPF07727, complete an online application profile and upload application
materials electronically.MEMC Abstracts 2019
1 Implementation of Vertical Split Flow Model
for Patient Throughput at a Community 2 Efforts to Diversify Faculty Within
Emergency Departments: A National Survey
Hospital Emergency Department of Department Heads
Adrian A. Cotarelo; Alex Hsieh; Alexander W. Arena, Alexis Jones; Darian Harris; Evrim Oral; Jessica Fox;
MD; Anthony Oraha; Mary E. McLean; Norman Mok; Lisa A. Moreno; Stacey Rhodes
Raffaele Milizia
Objectives:
Objectives: The objective of this study was to evaluate 1. To determine how diverse are emergency
the impact of vertical split flow (VSF) implementation on departmental faculty nationally
emergency department (ED) patient length of stay (LOS) and 2. To determine what modalities emergency medicine
throughput at a community hospital. department faculty are utilizing to achieve diversity within
Background: Hospitals have implemented innovative their departments
strategies to address overcrowding by optimizing patient flow 3. To determine how effective those modalities
through the ED. Vertical split flow (VSF) refers to the concept have been in achieving diversity in emergency medicine
of assigning patients to vertical chairs instead of horizontal departments
beds based on patient acuity. Background: There has been a growing amount of
Methods: This was a retrospective cohort study of all evidence that clinician bias, racism, inequality, stereotyping,
emergency severity index (ESI) level 3 patients presenting to a and discrimination has indeed contributed to health inequities.
community hospital ED over a three month period before and These variables have been proven to have negative effects
after VSF implementation between 2018 and 2019. A vertical on patient care and health outcomes. Countless studies have
area with 10 chairs was separated from the existing ED space shown that diversifying the physician workforce can produce
and staffed by reassigned advanced practice providers. On better patient outcomes and decrease the number of health
arrival, ESI level 3 patients were assigned to the vertical disparities. Patients are more likely to communicate a higher
area if they could maintain sitting position during treatment, level of care satisfaction when treated by health professionals
did not require cardiac monitoring or airborne precautions, who share the same racial, ethnic, or cultural background as
and presented no detectable risk of harm to self or others. them. Although many health centers, hospitals, and divisions
Unpaired t-tests compared time intervals between cohorts are determined to promote diversity among their faculty and
with the primary outcome being ED LOS, as defined by the staff, minority representation has made very little progress.
electronic medical record timestamps for patient arrival to This study aims to determine how diverse are Emergency
disposition. Secondary outcomes examined throughput using Medicine departments nationwide, how is diversity being
time from patient arrival to bed placement and provider promoted, and how effective are those methods.
assignment. Methods: This is a national convenience sampling
Results: In total, 5,262 patient visits in the pre- of 263 Emergency Medicine department heads including
intervention and 5,376 in the post-intervention group medical directors, section chiefs, and department chairs. A
were included in the analysis. There were no significant REDCap based questionnaire was developed and distributed
demographic differences between the two groups. There was a to the listserv. Participation was tracked and weekly follow-
significant reduction in mean overall LOS in minutes between up reminders were sent to participants. Interim analysis was
the pre-intervention group (M=283, SD=1.9) and post- conducted on participants. All statistical analyses were carried
intervention group (M=251, SD=1.8), t(10545)=12, pMEMC Abstracts 2022
asked how successful their efforts were to diversify their staff, should support generalizability and determine which staff
3 respondents reported that their efforts were very successful development measures generate improved outcomes.
and 20 reported either partially or not very successful. There
4
was an association between the type of location (suburban Effect of the COVID-19 Pandemic on ED
vs urban) and the number of physicians of color hired when Adult Psychiatric Visits
looking at programs that hired 3 or more physicians of color.
Barnet Eskin; Crystal Bauman; John R. Allegra
3 Emergency Nurses’ Perceptions of Opioid
Use Disorder and Its Treatment in the Objectives: Our goal was to determine whether the
Emergency Department proportion of ED visits for specific psychiatric conditions,
namely anxiety disorders, depression, self-harm/suicidal
Christiana K. Prucnal; Dawn Williamson; Elizabeth A. thoughts, bipolar disorder, and psychotic disorders, changed
Samuels; Kristina Monteiro; Margaret Samuels-Kalow after the arrival of COVID-19.
Background: In March 2020, the COVID-19 pandemic
Objectives: To describe the knowledge and attitudes of reached the New York tri-state area, which, at the time, was
emergency nurses regarding caring for patients with opioid one of the regions in the United States (US) that the virus
use disorder in the emergency department. most severely affected. ED visits dramatically declined, likely
Background: Many eligible patients with opioid use due to social isolation mandates and fear of exposure to the
disorder do not receive available emergency department virus. Quarantining at home, fear of becoming sick, and job
services for treatment and harm mitigation. While prior study disruptions caused the level of stress in the population to
examined contributing provider factors, little is known of increase. In a previous US study, the proportion of ED visits
nursing factors. This study describes knowledge and attitudes for some psychiatric conditions increased.
of emergency nurses regarding patients with opioid use Methods: Design: Retrospective cohort. Setting:
disorder and their evidence-based treatment services in the EDs of 28 hospitals within 150 miles of New York City.
emergency department setting. Hospitals were teaching and non-teaching in rural,
Methods: Anonymous email surveys with novel and suburban and urban areas. Total annual ED volumes were
previously validated questions based on The Theory of 12,000 to 122,000. Population: Consecutive ED patients
Planned Behavior Framework were distributed to emergency = 21 years old from March 1 to November 30 in 2019 and
department nurses at a large, urban tertiary-care hospital. Chi- 2020. Data analysis: We tallied the number of patients in
Square and independent samples t-tests were used in analyses. 2019 and 2020 with anxiety disorders, depression, self-
Results: More than one third of nurses completed the harm/suicidal thoughts, bipolar disorder, and psychotic
questionnaire (39%, 85/218). Most showed willingness disorders, identified using International Classification of
and confidence screening for substance use disorder (95% Disease codes (version 10). We calculated the proportion of
and 88% respectively). Higher confidence providing these visits to total ED visits in 2019 and 2020. We report
buprenorphine and take-home naloxone was significantly the changes in these proportions from 2019 to 2020, along
associated with having worked fewer years (8.33 v. 15.62 , with 95% CIs.
p=0.01 and 7.38 v. 12.03, p=0.03 respectively). Confidence Results: Total ED visits decreased 27%, from 844,017
administering buprenorphine was significantly associated with in 2019 to 618,195 in 2020. In 2019 and 2020 combined, the
receiving in-service training (p=0.03). Staff with knowledge of number of patients were: 13,151 with anxiety disorders, 6884
take-home naloxone, positive attitudes toward syringe service with depression, 8886 with suicidal ideation/self-harm, 3252
programs, and a belief in a biopsychosocial basis of addiction with bipolar disorder, and 7129 with psychotic disorders. The
were significantly younger and had worked significantly changes [with 95% CIs] in the proportion of visits from 2019
fewer years than those not indicating these beliefs. Specific to 2020 were: anxiety disorders -1% [-4,+3%], depression -5%
educational gaps were identified. [-10,-1%], self-harm/suicidal thoughts +23% [+18,+29%],
Conclusion: Emergency nurses display willingness bipolar disorder +14% [+6, +22%], and psychotic disorders
to champion evidence-based care for patients with opioid +23% [+18,+29%].
use disorder. Younger age and having worked fewer years Conclusion: The proportion of adult ED visits for self-
were significantly associated with positive attitudes towards harm/suicidal thoughts, bipolar disorder, and psychotic
recovery science, harm mitigation, and services knowledge. disorders increased following the arrival of COVID-19,
Having worked fewer years was significantly associated with whereas the proportions for anxiety and depression changed
greater confidence performing treatment and harm mitigation. minimally. These results are somewhat different from
In-service training was significantly associated with greater the findings in the previously reported study. Our study
confidence administering buprenorphine. Further study highlights the need for continued surveillance of the impact of
Volume 23, Issue 4 Supplement: September 2022 S2 Western Journal of Emergency MedicineMEMC Abstracts 2022
COVID-19 on mental health.
5 Utilization of Telehealth Solutions for
Patients with Opioid Use Disorder Using
Buprenorphine: A Scoping Review
Aileen Guillen; Bharath Chakravarthy; Minal Reddy;
Soheil Saadat
Objectives: A scoping review was conducted to examine
the breadth of evidence related to telehealth innovations
being utilized in the treatment of Opioid Use Disorder (OUD)
with buprenorphine and its effect on patient outcomes and
healthcare delivery.
Background: With the opioid epidemic worsening
from year to year, there is a critical need to connect with
this growing population and get them access to life-saving
interventions. Buprenorphine is shown to be associated with
lower overdose rates and a decrease in opioid-related acute
care, but has historically been underutilized in treatment for Figure 1. Prisma Flow Diagram.
OUD. Previous studies have determined that geographical
6
barriers and lack of access to DEA-waivered providers are Variation in Trauma Team Response Fees
common obstacles towards starting MAT. Telehealth presents in United States Trauma Centers
itself as a solution to this discrepancy and is becoming more
feasible to integrate into clinical practice. Arianna Neeki; David Wong; Fanglong Dong; Jan
Methods: The authors systematically searched seven Serrano; Louis P. Tran; Mason Chan; Michael M. Neeki;
databases and websites for peer-reviewed and gray literature Pamela R. A. Lux
related to telehealth solutions for buprenorphine treatment
published between 2008 and March 18, 2021. There were 69 Objectives: Investigate the variation of the trauma team
articles which met inclusion criteria. response fee (TTRF) among all levels of Trauma Centers
Results: According to the reviewed literature, (TC) Level I-IV, in different geographic regions in the U.S.
incorporation of telehealth technology with Medication (Midwest, West, South, Northeast U.S.).
Assisted Treatment (MAT) for OUD is associated with higher Background: Investigate Hospital Medical Directors
patient satisfaction, comparable rates of retention, and an (HMD) and Trauma Medical Directors (TMD) knowledge of
overall reduction in health care costs. TTRF dollar amount in their institution.
Conclusion: Utilization of synchronous Methods:Setting 525 American College of Surgeons
videoconferencing has reportedly been effective in verified trauma centers (TC) in the U.S. Level I-IV TCs.
increasing access to and usage of buprenorphine by TC’s in the continental U.S including Alaska and Hawaii.
overcoming both geographical and logistical barriers. This Data Collection Cross-sectional convenience sample. Online
has been made possible through the expansion of telehealth survey development cloud-based software, Survey Monkey.
technologies and a substantial push towards relaxed Responses from October 8, 2019 through March 11, 2020.
federal guidelines, both of which were quickly escalated Results: True costs of TTRF’s in the U.S remains elusive
in response to the COVID-19 pandemic. Future research due to inadequate data. TTRF’s were higher in level II TC’s
is needed to fully quantify the effect of these factors; in the West compared to Level I’s. No statistically significant
however, the results appear promising thus far and should difference in TTRF’s despite geographical and cost of living
urge policymakers to consider making these temporary differences. 41.3% of HMD are aware of dollar amount of
policy changes permanent. TTRF’s. 56.5% of TMD are aware of dollar amount of TTRF’s.
Western Journal of Emergency Medicine S3 Volume 23, Issue 4 Supplement: September 2022MEMC Abstracts 2022
Conclusion: Transparency in trauma costs is not common assigned a provider during the course of a shift.
practice.Trauma Centers attempts to balance responsible Methods: 50,802 cases were analyzed over the one-year
financial billing and maintaining viability is an ongoing study interval. 31,869 patients were seen in the early half
concern as trauma costs rise.Limited options are available to of a shift (hours 1-4) and 18,933 were seen in the later half
offset growing costs.Regulatory and public awareness of these (hours 5+). We ran a linear mixed model that adjusted for age,
increasing TTRF’s has resulted in a push for transparency gender, emergency severity index score, time of day, weekend
Federal and state financial support is needed to aid TC’s to arrivals, quarter of arrival and shift type.
offset growing trauma care costs.Vigilant efforts are needed in Results: Median time-to-disposition for the early group
patient advocacy to ensure all patients receive quality trauma was 3.25 hours (IQR 1.90-5.04), and 2.62 hours (IQR 1.51-
care with justified associated charges. 4.31) for the late group. From our mixed model, we conclude
that in the later parts of the shift, providers take on average
15.1% less time to make a disposition decision than in the
earlier parts of the shift.
Conclusion: Patients seen during the latter half of a shift
were more likely to have a shorter time-to-disposition than
similar patients seen in the first half of a shift. This may be
influenced by many factors, such as providers spending the
early hours of a shift seeing new patients which generate new
tasks and delay dispositions, and viewing the end of shift as a
landmark with a goal to maximize dispositions prior to sign-
out.
Figure 1. Variation in trauma yeam response fees in
United States trauma centers: an additional undisclosed
variable cost.
7 Analysis of Time-to-Disposition Intervals
During Early and Late Parts of a Shift
Anne Grossestreuer; Bryan Stenson; David T. Chiu;
Joshua W. Joseph,; Lakshman Balaji; Leon D. Sanchez;
Peter S. Antkowiak
Objectives: To assess whether time-to-disposition is
significantly different when a patient is seen by a provider
during the early half or late half of a shift.
Background: Time-to-disposition is an important metric
for emergency department throughput. We hypothesized that
providers view the shift end as a key timepoint and attempt to
leave as few dispositions as possible to the oncoming team,
thereby making quicker decisions later in the shift. This study Figure 1. Distribution of time to disposition by shift
evaluates disposition distribution relative to when patients are timing.
Volume 23, Issue 4 Supplement: September 2022 S4 Western Journal of Emergency MedicineMEMC Abstracts 2022
increased newly-matched “pre-intern” perceived preparedness
(PP) for residency in prior years, but the SIC had never been
implemented or evaluated in a pandemic with disrupted
medical education.
Methods: The SIC was constructed using topics
from 8 ACGME milestones in emergency medicine (EM),
incorporated into 8 clinical scenarios. Residency recruitment
occurred via national EM listservs; of 276 programs, 27
enrolled. Curricular implementation was on Slack workspaces.
Cases included stimulus images and clinical questions. Ample
discussion time, answers, and resources were provided.
Trends in PP were calculated with descriptive statistics and the
Wilcoxon Rank Sum test.
Results: Of 311 total pre-interns contacted, 289
(92.9%) completed a presurvey in April/May 2020, and 240
(77.2%) completed a post-survey in June/July 2020, for an
83.9% follow-through rate. Pre-interns reported statistically
Table 1. Descriptive characteristics of the data. significant increases in PP both overall and regarding 14 of 21
milestones. See Table 1.
Conclusion: Amidst the educational disruption of the
COVID-19 pandemic, pre-interns participating in the SIC
reported statistically significant increases in PP. Limitations
include absence of control or pre-pandemic data. Future
directions include adapting the SIC to other specialties’
ACGME milestones for generalizability across all fields.
Table 3. Adjusted linear mixed model coefficients.
8 Slack Intern Curriculum Supports Intern
Preparedness and Bridges Curriculum
Gaps due to COVID-19
Slack Intern Curriculum; Alisa Hayes; Daniel Axelson;
Frosso Adamakos; Herman Lee; Jonathan Chan; Table 1. Wilcoxon Rank Sum Test summary data on
Michaela Salvo; Moira Davenport; Tazeen Abbas; perceived preparedness of United States emergency
Thaddeus Schmitt medicine-bound pre-interns. Pre-curriculum surveys
Objectives: Assess the effectiveness of social media were completed in April/May of 2020, and post-
implementation of an Accreditation Council for Graduate curriculum surveys were completed in June/July 2020.
Medical Education (ACGME) milestone-based curriculum
during the spring 2020 U.S. COVID-19 surge. The hypothesis
is that pre-interns will report improvements in PP regarding 9 Serious Medical Outcomes due to Single
Substance Opioid Exposures
multiple ACGME milestone topics.
Background: Transitioning to residency involves Aaron Frey; Christopher P. Holsteg; Kawai Tanabe;
translation of academic knowledge into clinical acumen, Moira Smith; Saumitra Rege; Will Goodrich
and is complicated by variable medical school experiences.
The COVID-19 pandemic presented a new challenge by Objectives: The present study sought to evaluate the
displacing students from clinical rotations. Virtual educational recent trends in the severe outcomes to single substance opioid
modalities such as the Slack Intern Curriculum (SIC) have exposures (SSO) reported to the U.S. poison centers (PCs).
Western Journal of Emergency Medicine S5 Volume 23, Issue 4 Supplement: September 2022MEMC Abstracts 2022
Background: Misuse of prescription opioids continues to sample. Personalized evidence-based strategies, population
be a significant public health crisis globally. According to the level interventions, creation of protective environments, and
Centers for Disease Control and Prevention (CDC), there were better screening of patients are some key measure to limit this
more than 72,000 overdose deaths in the United States (U.S.), trend.
with 49,068 involving an opioid.
Methods: The NPDS was queried for single substance
opioid exposures that were reported to the U.S. PCs from
2011 to 2011. Cases with severe outcomes (SO) were defined
10 Patterns of SSRI Exposures Reported to the
U.S. Poison Centers
as exposures that resulted in either a death or major clinical Avery Michienzi; Christopher P. Holstege; Ryan Cole;
outcomes. We identified and descriptively assessed the Saumitra Rege
relevant demographic and clinical characteristics. Poisson
regression models were used to evaluate the trends in the Objectives: We sought to characterize the SSRIs
number and rates (per 100,000 human exposures) of single exposures reported to the U.S. National Poison Data System
substance opioid exposures resulting in SO. Percent changes (NPDS).
from the first year of the study (2011) were reported with the
Background: More than 20 million antidepressants were
corresponding 95% confidence intervals (95% CI). Logistic
prescribed between October and December 2020, a significant
regression was utilized to study the risk markers of severe
increase compared to the same months in the prior year.
outcomes.
In 2017, a selective serotonin reuptake inhibitors (SSRIs)
Results: Overall there were 308,202 single substance
was mentioned in 57,254 single-substance toxic exposures
opioid-related cases reported to the U.S. PCs during the
reported to United States poison centers (PCs).
study period. The proportion of cases from ACH increased
Methods: The NPDS was queried for all human
during the study period (32.9% vs 48.9%). Among cases
exposures to SSRIs reported to the U.S. Poison Centers
with severe outcomes, ages between 20 and 29 years
(PCs) between 2015 and 2020. We descriptively assessed the
(27.9%) constituted the most common age group. Males
demographic and clinical characteristics. Calls from acute
accounted for 57.4% cases. Most exposures with SO
care hospitals and hospital based EDs (ACH) were studied as
occurred in a residence (83.7%). Hydrocodone (25.6%)
a subgroup. Trends in SSRI exposures were analyzed using
was the most common opioid reported in cases followed
by oxycodone (18.7%). Intentional abuse (48.4% vs Poisson regression with percent changes being reported.
12.7%) and suspected suicides (24.7% vs 12.9%) were Results: There were 346,082 SSRI exposure calls made
more common in exposures with SO compared to those to the PCs from 2015 to 2020, with the number of calls
without SO. Similarly, non-oral routes of administration increasing from 51,791 to 62,504 during the study period.
were more common in exposures with SO (40.9% vs Single substance exposures accounted for 45.5% of such SSRI
8.1%). The rate of exposures with SO increased by 71.3% exposures. Of the total SSRI calls, the proportion of calls from
(95% CI: 63.4%, 79.9%, pMEMC Abstracts 2022 period, the frequency of SSRI exposures increased by 19.9% misuse while morphine users were 40% less likely to misuse (95% CI: 16.2%, 22.7%; p
MEMC Abstracts 2022
13
making tools, rotation advice, and the application and ICU admission Risk Factors of Latinx/
match process. Mentors were instructed to meet with their Hispanic COVID-19 patients at a US Mexico
mentees and to check-in weekly. Following the rotation, Border Hospital
students were sent an online anonymous survey consisting
of 6 multiple choice and 3 free response questions. Andrew LaFree; Christian A. Tomaszewski; Christopher
Simple descriptive statistics and qualitative methods were Johln Coyne; Faith C. Quenzer
employed for data analysis. Initial coding was performed
independently by two study authors and then reviewed by Presenter: L.E. Gomez
a third author with experience in qualitative methodology.
Suggestions were merged via consensus into a final code Objectives: To describe the association of demographics
set that was used for thematic analysis. of sex, comorbidities, age with the risk of severe (Coronavirus
Results: Six audition rotations occurred over the study Disease 2019) COVID-19 requiring intensive care unit level
period. Of the 47 students, 74% (n=35) responded to our of care, and death in a primarily Latinx/Hispanic U.S.-Mexico
survey. 97% (n=34) of participants recommended continuing border hospital operating at surge capacity.
this program, 91% (n=32) rated this program helpful, and 64% Background: According to the CDC, the Latinx/
(n=16) stated that this improved their success on the rotation. Hispanic population in the U.S. have been particularly
Preliminary qualitative analysis of students’ responses affected by severe COVID-19 complications and high
revealed the themes in Figure 1. mortality rates. Border hospitals and their emergency
Conclusion: Preliminary data suggests that students departments (ED) are particularly vulnerable to widespread
found having a mentor during their audition rotations was communicable respiratory infections and severe COVID-19
meaningful. We believe students can benefit from a resident- complications and poor outcomes such as surges of
driven mentorship program during their auditions. hospitalizations and death. Multiple factors such as
inadequate healthcare infrastructure in border areas,
access to preventative healthcare and subsequently higher
prevalence of comorbidities that increase the risk for severe
COVID-19 in the Latinx/Hispanic patient population
overall. At the U.S.-Mexico border region, there is a
paucity of research and data regarding how COVID-19
affects this predominantly Latinx/Hispanic community.
Our study seeks to identify demographic, and clinical risk
factors that make this specific community vulnerable to
severe COVID-19 complications such as intensive care unit
(ICU) utilization and death.
Figure 1. Methods: This is was a retrospective, observational chart
review of 156 hospitalized COVID-19 patients during a surge
at a border hospital. Adult patients (> 18 years) diagnosed
with SARS-CoV-2 and met admission criteria from April
10, 2020 to May 30, 2020 were included. Excluded were
pediatric patients (< 18 years of age), patients who did not
consent for treatment, pregnant women, patients who did not
meet the above inclusion criteria. Descriptive statistics of
sex, age categories of 18-49, 50-64, and > 65 years or older,
BMI, presence of at least one comorbidity (coronary artery
Figure 2. disease, hypertension, diabetes, cancer/lymphoma, current
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