Emergency Medicine Conference Research Articles

What the Fika? Implementation of Swedish Coffee Breaks During Emergency Medicine Conference.

In this study we aimed to investigate the effects of incorporating Swedish-style fika (coffee) breaks into the didactic schedule of emergency medicine residents on their sleepiness levels during didactic sessions. Fika is a Swedish tradition that involves a deliberate decision to take a break during the workday and usually involves pastries and coffee. We used the Karolinska Sleepiness Scale to assess changes in sleepiness levels before and after the implementation of fika breaks. The study design involved a randomized crossover trial approach, with data collected from emergency medicine residents over a specific period. This approach was done to minimize confounding and to be statistically efficient. Results revealed the average sleepiness scale was 4.6 and 5.5 on fika and control days, respectively (P = 0.004). Integration of fika breaks positively influenced sleepiness levels, thus potentially enhancing the educational experience during residency didactics.

Point of Care Ultrasound Use Following Ultrasound Simulation In Emergency Medicine Conference

Point of Care Ultrasound Use Following Ultrasound Simulation In Emergency Medicine Conference

Change in Attendance During a Virtual Emergency Medicine Conference Day

Change in Attendance During a Virtual Emergency Medicine Conference Day

Why is naloxone prescription not more common in emergency departments? A survey of physician practices and attitudes.

Emergency physicians (EPs) have a singular opportunity to prescribe naloxone and decrease fatal overdoses in opioid users. We surveyed EPs patterns of naloxone prescription and identified barriers to prescribing naloxone. Surveys were conducted at an emergency medicine conference from 2018 to 2019. We used a Likert scale for all questions and a chi-square or chi-square for trend tests to determine statistical significance. Emergency medicine conferences and emergency departments. Forty-one EPs were surveyed. Oral survey. Prevalence of naloxone prescription and EP attitude toward naloxone. 65.0 percent of residents and 33.3 percent of attending physicians had never prescribed naloxone to patients. 90.2 percent believed ED naloxone prescription is safe, 82.9 percent did not refrain from prescribing due to ethical concerns, and 73.2 percent believed it is not a waste of resources. Many resident physicians had never prescribed naloxone despite agreeing it was safe, ethical, and a productive use of resources. The time needed to counsel patients on naloxone use was a barrier to prescription, and various interventions are needed to make this practice more common.

Spotlighting the Imbalance: Gender Disparities Among Speakers and Awardees at Pediatric Emergency Medicine Conferences.

Gender disparities exist among national speakers and award recipients. Pediatric emergency medicine (PEM) represents the intersection of pediatrics, a female-dominated specialty with approximately 58% women, and emergency medicine, a male-dominated specialty. We describe the proportion of women speakers and award recipients at two national PEM conferences, the American Academy of Pediatrics (AAP) Section on Emergency Medicine (SOEM) and the Advanced PEM Assembly (APEMA), to the AAP National Conference and Exhibition (NCE), a national pediatric conference. Data from SOEM and APEMA, obtained from 2016-2021 was compared to the 2021 NCE. Invited speakers, abstract presenters, and award recipients were identified. Gender was determined by searching each individual's name for self-identification. Gender proportions were compared across conferences, speaker type, and year. Compared to the NCE, a significantly smaller proportion of women were invited speakers at APEMA (NCE 59.9% vs. APEMA 38.8%, p<0.001), but similar proportions of women were invited speakers (53.9%, p=0.178) and awardees at SOEM (50% vs. 50%, p=1.0). A larger number of women were SOEM abstract presenters than invited speakers (63.3% vs. 53.9%, p=.041). Between 2016-2021, the proportion of women invited speakers (SOEM, p=0.744; APEMA, p=0.947) or abstract presenters (SOEM, p=0.632) did not significantly change. As compared to NCE, women are underrepresented as speakers at APEMA, but not at SOEM. Abstract presenters are more likely to be women as compared to invited speakers. While awards appear equally distributed, recipients do not mirror the proportion of women in PEM. Conference organizers and leaders in PEM should ensure gender equity in national recognition.

Paramedic supportive discharge programmes to improve health system efficiency and patient outcomes: a scoping review protocol

IntroductionDischarging older adults with frailty home from the emergency department (ED) poses unique challenges due to multiple interacting physical and social problems. Paramedic supportive discharge services help overcome these challenges...

Emirates Society of Emergency Medicine - ESEM2022 - Abstracts

Abstracts of the Emirates Society of Emergency Medicine Conference 2022 (ESEM22) held from 7 – 10 December 2022 in Abu Dhabi – United Arab Emirates

Gender distribution in speakers at emergency medicine conferences.

Gender distribution in speakers at emergency medicine conferences.

Formalized Storytelling in Emergency Medicine

Storytelling is an effective tool for medical education. The authors describe a formalized storytelling program for physicians. A conceptual model is proposed for why storytelling events are an effective modality across the domains of reflective practice, professional development, and physician wellness. Formalized storytelling is a novel strategy for professional development in medicine. In this paper, we describe a storytelling program for emergency physicians and propose a conceptual model for why storytelling events are an effective way to address the imperatives of reflective practice, professional identity development and physician wellness. Since 2015, groups such as Airway-Stories have held events for emergency physicians to help them relate and reflect on stories told by colleagues in a relaxed setting. These storytelling events are live forums in which physicians can share stories about experiences of patient care with an audience of their peers. The events were initially held at local venues in order to create physical and emotional distance from the clinical workplace, but have since proliferated to include many academic emergency medicine conferences and, during Covid-19 lockdowns, international videoconferences. Participants have primarily included emergency medicine faculty and residents, though more recently; these events have integrated other disciplines and health professions in medicine. The narrative topics span the breadth of clinical scenarios and have provided a forum for reflection in a group setting. The stories from these events have involved expressions of pride, humor, gratitude, as well as sadness and regret, along with a variety of authentic emotions that are otherwise not given expression in a formal curriculum or during physician meetings or conferences. Given the unscripted nature of these events, it has been somewhat surprising that the narratives have almost without exception manifested professional virtue and evinced the core humanistic values of medicine. There have been few if any stories with cynical or demoralizing themes. This observation has led us to believe that formalized storytelling events are a way to tap into these positive narratives and that they hold promise in supporting medical professionalism.

Emergency Medicine Physicians Would Prefer Using Cannabis Over Opioids for First-Line Treatment of a Medical Condition if Provided With Medical Evidence: A National Survey.

Objective: To determine emergency medicine (EM) physicians’ preferences for using medical cannabis versus opioids if medical cannabis was legalized.Methods: We surveyed US physicians at the largest national EM conference (American College of Emergency Physicians’ Annual Conference) held in San Diego, CA from October 1 to 4, 2018. Of the thousands of conference participants approached, 539 US physicians completed the anonymous written survey, which represented 15.2% of the US physicians attending the conference.Results: The mean age of the participants was 39.6 ± 10.9 years, men composed 57.5% of the participants, and whites made up 72.8% of the respondents. Participants practicing in medically legal (54.8%) and medically plus adult-use legal cannabis states (23.1%) totaled 77.9%. A majority (70.7%) of the participants believed that cannabis has medical value. EM physicians preferred cannabis over opioids as a first-line treatment addressing a medical condition provided that medical studies found that cannabis was equally effective (p < 0.001, X2 = 36.8 [95% CI 2, 415]), and overwhelmingly preferred cannabis over opioids if it were more effective (p < 0.001, X2 = 90.8 [95% CI 2, 415]). Physicians appeared to prefer opioids over cannabis if medical studies found that cannabis was less effective though it was not significant (p > 0.05). Subgroup analyses showed that belief in the medical value of cannabis significantly increased the odds ratio of choosing cannabis over opioids if cannabis was equally or more effective than opioids.Conclusion: Our study shows that EM physicians believe cannabis has medical value and would prefer using cannabis over opioids if provided with equivalent findings. We believe our findings reflect EM physicians’ experience of the opioid epidemic and suggest the need for further study of this potential therapeutic.

Evaluating Nontechnical Skills in US Emergency Departments Using Simulation: Validating and Contextualizing a UK Assessment Tool.

Nontechnical skills (NTS) in medicine are the "cognitive, social, and personal resource skills that complement technical skills contributing to safe and efficient care." We aimed to (1) evaluate the validity and reliability of a 12-element United Kingdom emergency medicine (EM) NTS assessment tool in the context of United States (US) EM practice and (2) identify behaviors unique to US clinical practice. This was a mixed methods study conducted in 2 phases, following Kane's validity framework. The intended use of the NTS tool is to provide formative assessment of US EM physicians (EPs) from a video of simulated clinical encounters. In phase I, a focus group assessed the appropriateness of each aspect of the tool in the context of US EM practice by reviewing and identifying the NTS of an EP in a simulated clinical scenario. In phase II, EPs (N = 208) attending a national EM conference evaluated an EP's behaviors in 1 of 2 video simulations. Reliability in the form of internal consistency was calculated using Cronbach α. All participants suggested exemplar behaviors for the 12 elements in the context of their own clinical practice and generated new assessment elements. Internal consistency was acceptable (α > 0.7) for all categories, except teamwork and cooperation. Participants proposed 4 novel behavioral elements and suggested US exemplar behaviors for all 12 original elements. This tool can be used to assess US EP's NTS for the purpose of formative assessment. Refinement of exemplar behaviors and inclusion of novel US-specific elements may optimize usability.

Intrahospital transport of critically ill patients: A survey of emergency nurses.

Despite the frequency of its occurrence, few Chinese studies examined the status of intrahospital transport (IHT) of critically ill emergency room patients. To investigate the current status of IHT of critically ill patients and emergency nurses' perception of IHT across China; explore the perceived associations of written protocols with adverse events during IHT; and compare regional differences in IHT of critically ill patients across China. A self-report questionnaire was conducted among the attendees of a large emergency medicine conference in Beijing in May 2015. The data, collected through convenience sampling, were analysed using descriptive statistics. Categorical variables were compared using the chi-squared test. Of the 528 participants from 142 hospitals whose data were analysed, 19.3% considered all nurses competent enough to perform IHT of critically ill patients without special training, and 7.6% even considered nursing students capable of the task. The absence of written transport protocols was perceived to be significantly associated with the occurrence of adverse events such as oxygen supply depletion and incorrect destination. Hospitals in the western region were less likely to have established written IHT protocols and emergency checklists than those in the eastern region. Safe IHT of critically ill patients in the emergency department involves enormous challenges. The results of this survey can facilitate a preliminary understanding of the characteristics and current situation of IHT in emergency settings across China. The establishment of standard transport protocols may help reduce the incidence of adverse events.

Low Fidelity Trainer for Fiberoptic Scope Use in the Emergency Department.

The low fidelity trainer for fiberoptic scope is designed to train emergency medicine (EM) residents PGY I-IV, and medical students interested in EM. Fiberoptic intubation is a skill that Emergency Medicine (EM) providers should be familiar with, though it is a rarely encountered procedure in the clinical setting. Approximately 1% of endotracheal intubations are performed using fiberoptic intubation.1,2 The success rate of first attempt fiberoptic intubation is about 50%. When fiberoptic intubation is used as a rescue device it has been shown to be about 70 % successful.1 Despite being an important skill for emergency physicians to have, fiberoptic intubation competency is not required during emergency medicine residency1 and resident physicians have limited exposure to learning this life-saving skill.Given that fiberoptic intubation is a rarely performed procedure in the clinical setting, the most practical way for EM learners to gain proficiency would be through simulation. The use of fiberoptic trainers in anesthesiologist resident training has shown improvement in first pass success and overall skills with using the fiberoptic scope.3-6 Simulation has also been shown to improve resident procedural knowledge and skills in many other fields.7-11 Simulation offers training with seldom performed procedures, and there is evidence that simulation does improve patient outcomes and reduce errors.2,12-14 In order to help EM learners gain confidence and increase their comfort in using the fiberoptic scope, we developed a low fidelity training model that allows the learner to practice fiberoptic intubation. By the end of this training session, learners will be able to 1) list indications, contraindication, and complications in performing fiberoptic intubations, 2) know how to use and maneuver a fiberoptic scope, and 3) be able to successfully intubate the trainer model. The training model consists of a large 55-gallon tote with polyvinyl chloride (PVC) pipes enclosed in the tote. The pipes were arranged in various manners: several pipes simulated the oropharynx and trachea, and others were arranged into a series of mazes, to require the learner to manipulate the scope through the maze to reach the end. The multiple stations within the model provided ample opportunity for the learner to acquire confidence with the fiberoptic scope and the movements required to maneuver the scope into position. The model was used in our weekly Emergency Medicine conference during a low fidelity simulation day. The residents were split into groups consisting of 5-6 learners. The residents and medical students were given a brief 5-minute lecture on fiberoptic intubation, which reviewed indications for fiberoptic intubation, and a demonstration on how to operate the fiberoptic scope. Following the briefing, each group had approximately 25-30 minutes to practice using the simulated fiberoptic scope model. Each learner in the group was then encouraged to practice navigating the other mazes at their own discretion. Residents and medical students were given a survey before and after using the fiberoptic training model to assess their knowledge and confidence in performing the procedure. The use of the fiberoptic trainer was successful in helping learners to become more familiar with the fiberoptic scope and learn the skills to maneuver the scope successfully through the trainer. Each resident performed a survey prior to and after the fiberoptic instruction and training. They were asked to rate their confidence in identifying airway landmarks, perform the procedure without supervision, and identify correct supplies needed for procedure. All areas increased in confidence except in identifying correct supplies for PGY-II (-0.1), and PGY-III (-0.4). The greatest increase was amongst PGY-I residents in confidence identifying airway landmarks, with an increase of 4.2. As with any simulation model, this model does not perfectly recreate human anatomy. For example, in our model there were no simulated secretions or blood. The actual appearance of the anatomy will be very different from that which was used in our model, which may lead to an unsuccessful intubation attempt. The scenarios in which we were using the trainer was a low stress environment, unlike the usual emergency setting. Despite this, there was an increase in learner confidence in using a fiberoptic scope to manage emergency airways. It also offered a unique experience and gave the learners an opportunity to learn how to manipulate the fiberoptic scope that a traditional high fidelity model may not offer. Future comparisons could be made between a low fidelity simulation and high fidelity simulation device, and the addition of simulated secretions could help increase learning and confidence in fiberoptic intubations. Difficult airway management, Fiberoptic intubation, fiberoptic use in emergency department.

Experiences of Workplace Violence Among Healthcare Providers in Myanmar: A Cross-sectional Survey Study.

BackgroundHealthcare providers face enormous threats to personal safety from workplace violence (WPV). Prior investigations estimate a highly varied prevalence of WPV in the United States and around the world, including both verbal and physical assault. Little is known about WPV in Myanmar. Only a single prior study has evaluated WPV experiences among physicians in Myanmar, reporting an unusually low prevalence of verbal (8.7%) and physical (1.0%) assault. Given this much lower prevalence compared with similar studies in other low- and middle-income countries (LMICs), we embarked on a study to identify the prevalence of WPV in a separate cohort of healthcare providers in Myanmar.MethodsThis was a cross-sectional analysis of WPV prevalence among healthcare providers who attended a national emergency medicine conference in Myanmar in November 2018. The survey instrument was adapted from a validated survey from the Joint Program on Workplace Violence in the Healthcare Sector (International Labour Office, International Council of Nurses, World Health Organization, and Public Services International), which had been used in other global settings.ResultsSixty-three participants completed the survey questionnaire, including 35 women (55.6%) and 26 men (41.3%). Among them, 25 (39.7%) were primary care providers. Overall, the combined prevalence of WPV in the previous 12 months was found to be 47.6% (n = 30; 95% CI: 34.9-60.6%). The prevalence of verbal assault was 47.6% (n = 30; 95% CI: 34.9-60.6%), and that of physical assault was 4.8% (n = 3; 95% CI: 1.0-13.3%). Twenty-four participants (42.4%) reported that they were encouraged to report violence in the workplace, and five (8.1%) reported they had received training on how to manage WPV. Respondents who were 30-34 years in age and those working in private facilities were significantly less likely to report WPV on univariate analysis.ConclusionAlthough our cohort comprised a limited sample of a select group of providers, we found a dramatically higher prevalence of WPV experiences among healthcare providers attending an emergency medicine conference in Myanmar when compared with a prior investigation. Very few participants had received training on WPV, and less than half reported a work culture where WPV reporting is encouraged. To combat healthcare provider shortages, more investigation is required into WPV to understand its impact and identify amelioration strategies.

Twitter metrics complement traditional conference evaluations to evaluate knowledge translation at a National Emergency Medicine Conference.

Conferences are designed for knowledge translation, but traditional conference evaluations are inadequate. We lack studies that explore alternative metrics to traditional evaluation metrics. We sought to determine how traditional evaluation metrics and Twitter metrics performed using data from a conference of the Canadian Association of Emergency Physicians (CAEP). This study used a retrospective design to compare social media posts and tradition evaluations related to an annual specialty conference. A post ("tweet") on the social media platform Twitter was included if it associated with a session. We differentiated original and discussion tweets from retweets. We weighted the numbers of tweets and retweets to comprise a novel Twitter Discussion Index. We extracted the speaker score from the conference evaluation. We performed descriptive statistics and correlation analyses. Of a total of 3,804 tweets, 2,218 (58.3%) were session-specific. Forty-eight percent (48%) of all sessions received tweets (mean = 11.7 tweets; 95% CI of 0 to 57.5; range, 0-401), with a median Twitter Discussion Index score of 8 (interquartile range, 0 to 27). In the 111 standard presentations, 85 had traditional evaluation metrics and 71 received tweets (p > 0.05), while 57 received both. Twenty (20 of 71; 28%) moderated posters and 44% (40 of 92) posters or oral abstracts received tweets without traditional evaluation metrics. We found no significant correlation between Twitter Discussion Index and traditional evaluation metrics (R = 0.087). We found no correlation between traditional evaluation metrics and Twitter metrics. However, in many sessions with and without traditional evaluation metrics, audience created real-time tweets to disseminate knowledge. Future conference organizers could use Twitter metrics as a complement to traditional evaluation metrics to evaluate knowledge translation and dissemination.

Triage and Ongoing Care for Critically Ill Patients in the Emergency Department: Results from a National Survey of Emergency Physicians.

IntroductionWe conducted a cross-sectional study at the Icahn School of Medicine at Mount Sinai to elicit emergency physician (EP) perceptions regarding intensive care unit (ICU) triage decisions and ongoing management for boarding of ICU patients in the emergency department (ED). We assessed factors influencing the disposition decision for critically ill patients in the ED to characterize EPs’ perceptions about ongoing critical care delivery in the ED while awaiting ICU admission.MethodsThrough content expert review and pilot testing, we iteratively developed a 25-item written survey targeted to EPs, eliciting current ICU triage structure, opinions on factors influencing ICU admission decisions, and views on caring for critically ill patients “boarding” in the ED for >4–6 hours.ResultsWe approached 732 EPs at a large, national emergency medicine conference, achieving 93.6% response and completion rate, with 54% academic and 46% community participants. One-fifth reported having formal ICU admission criteria, although only 36.6% reported adherence. Common factors influencing EPs’ ICU triage decisions were illness severity (91.1%), ICU interventions needed (87.6%), and diagnosis (68.2%), while ICU bed availability (13.5%) and presence of other critically ill patients in ED (10.2%) were less or not important. While 72.1% reported frequently caring for ICU boarders, respondents identified high patient volume (61.3%) and inadequate support staffing (48.6%) as the most common challenges in caring for boarding ICU patients.ConclusionPatient factors (eg, diagnosis, illness severity) were seen as more important than system factors (eg, bed availability) in triaging ED patients to the ICU. Boarding ICU patients is a common challenge for more than two-thirds of EPs, exacerbated by ED volume and staffing constraints.

79 Assessing the Rate of Successful Abstract Publications in Emergency Medicine

Thousands of abstracts are presented at emergency medicine (EM) conferences annually in the form of oral and poster presentations. However, few studies have evaluated what percentage of these abstracts result in a successful publication and no studies have evaluated this among EM conferences in North America. The purpose of our study was to assess the rate of successful full-text publications resulting from two North American EM conferences.

Selected abstracts from the Third European Pediatric Resuscitation and Emergency Medicine Conference, 23–24th May 2019

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110 Percentage of Studies Presented at a Conference Prior to Publication in Emergency Medicine Journals

Presenting a study as a conference poster or oral presentation can provide authors with targeted feedback and insights prior to publication. However, to the best of our knowledge there is no data demonstrating what percentage of manuscripts are actually presented at a major conference prior to being published. The primary outcome of our study was to determine the percentage of manuscripts that were presented at a major conference prior to publication. As secondary outcomes, we sought to determine the distribution of abstract presentations by publication year and conference type. Two investigators independently reviewed all publications from January 2009 to December 2018 in two major emergency medicine (EM) journals which specifically require authors to disclose any prior presentations (Annals of Emergency Medicine and Academic Emergency Medicine). Investigators included all original research manuscripts. Case reports/images, narrative reviews, summaries of other articles, letters to the editor, and consensus conference proceedings were excluded. Investigators dual extracted data on the number of authors, type of research, country of origin, number of abstract presentations, and specific conferences for the abstract presentations for each manuscript. Discrepancies were resolved by consensus with the addition of a third reviewer. Data was analyzed using Microsoft Excel and descriptive statistics were reported. 2409 manuscripts met our inclusion criteria. 1109 (49.4%) manuscripts were presented at a conference prior to publication with a mean of 1.4 presentations per manuscript. There was a trend toward decreased conference presentation rates over time, with 57.0% of manuscripts presented in 2009 versus 38.8% in 2018. Of the total conference presentations, 89.6% were presented at a national or international conference, 8.3% were presented at a regional conference, and 2.0% were presented at a local conference. 61.7% were presented at an EM conference and 38.3% were presented at non-EM conferences. Among non-EM conferences, the most common specialties were pediatrics (33.2%), toxicology (5.6%), and cardiology (5.2%). Only half of all original research manuscripts were presented at a conference prior to publication, with the majority presented at national or international EM conferences. There was a progressive decline in the number of manuscripts presented over time. Future efforts should identify the underlying reasoning for not presenting at a conference and why this trend has been increasing over time.

82 Sex Disparity in Speaking Opportunities at a Major Academic Emergency Medicine Conference: Are Women Stuck Under the Glass Ceiling?

This study investigates trends in the representation of female speakers at the American College of Emergency Physicians (ACEP) scientific assembly - the largest academic emergency medicine conference in the world. Data was collected from the American College of Emergency Physicians (ACEP) Scientific Assembly’s online database from 2016-2018. We collected information regarding each presentation given at the national conference, including the title of the presentation, speaker names, duration of the presentation, and specialty category. Speaker sex was recorded using Google searches and department Web sites. Using the Elsevier SCOPUS database, we identified h-index, number of publications, and number of times cited. Exclusion criteria were speakers who did not hold an MD or DO degree. We used SPSS software to obtain descriptive statistics and perform independent-tests. From the three years of conference data, there were a total of 939 invited speakers included in the analysis. Of the 939 invited speakers, 34.3% were women and 65.7% were men. In 2016, there were a total of 340 speakers, of whom 27.1% were female and 72.9% were male. In 2017, there were a total of 296 speakers, with women comprising 34.5% of speakers, and men making up the remaining 65.5%. In 2018, women made up 42.2% of the speakers presenting at the conference, and men made up the remaining 57.8%. Presentations given by women were shorter, on average, than presentations given by male speakers during all three years of conference data. In 2016, male presenters, on average, had statistically higher h-indices and were cited more times, on average, than their female counterparts (p-value<0.05). The average number of publications, however, did not significantly differ between men and women (p-value>0.05). In 2017 and 2018, male speakers, on average, had significantly higher h-indices, number of publications, and citations (p-value<0.05). These results demonstrate an upward trend in the representation of women speakers at the largest academic emergency medicine conference in the world. From 2016 to 2018, there was a steady increase in the proportion of female speakers, with women comprising 42.2% of all speakers at the 2018 conference. Women’s presentations also increased in length, on average, from 2016 to 2018. Despite these advancements in representation, male speakers still speak for longer, on average, and make up the majority of presenters. Although women account for a significant portion of the workforce in emergency medicine, efforts to improve female representation in academic emergency medicine are necessary. Women currently only make up 28% of the workforce in academic emergency medicine. It can be argued that improving women’s representation at scientific conferences may result in more opportunities for female engagement in academic emergency medicine.