Editorial

Community Paramedicine: 911 Alternative Destinations Are a Patient Safety Issue

Author Affiliation Nick T. Sawyer, MD, MBA University of California, Davis, Department of Emergency Medicine, Sacramento, California; California American College of Emergency Physicians Board of Directors John D. Coburn, MD The Permanente Medical Group, South Sacramento Kaiser, Department of Emergency Medicine, Sacramento, California; California American College of Emergency Physicians Board of Directors Under-triage is a […]

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Management of Sickle Cell Disease Super Utilizers

Author Affiliation Gary A. Johnson, MD SUNY Upstate Medical University, Department of Emergency Medicine, Syracuse, New York   Much attention has been directed toward super utilizers of emergency department (ED) and hospital services. Often these patients have a chronic illness with significant potential for acute morbidity. In many settings, adults with sickle cell disease (SCD) […]

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Blog and Podcast Watch: Cutaneous Emergencies

Andrew Grock, MD, et al.

The WestJEM Blog and Podcast Watch presents high quality open-access educational blogs and podcasts in emergency medicine (EM) based on the ongoing Academic Life in Emergency Medicine (ALiEM) Approved Instructional Resources (AIR) and AIR-Professional series.

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Growing a Specialty-Specific Community of Practice in Education Scholarship

Volume 16, Issue 6, November 2015.
Jeffrey N. Love, MD, et al.

Emergency medicine (EM) educators have many
masters. These include our hospital administrations who
expect efficient patient care reflecting the priorities of safety
and quality, the accreditation council for graduate medical
education which has introduced a new competency-based
standard by which our learners must be educated, and last but
not least, our learners that are using new educational modalities
based on expanding digital platforms. To be successful,
educators must satisfy each of these masters against the
backdrop of increasing regulations, decreasing funding and
information technology that appears to decrease our time with
patients and perhaps learners in clinical practice.

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Emergency Medicine: On the Frontlines of Medical Education Transformation

Volume 16, Issue 6, November 2015.
Eric S. Holmboe, MD

Emergency medicine (EM) has always been on the frontlines of healthcare in the United States.
I experienced this reality first hand as a young general medical officer assigned to an emergency
department (ED) in a small naval hospital in the 1980s. For decades the ED has been the only site
where patients could not be legally denied care. Despite increased insurance coverage for millions of
Americans as a result of the Affordable Care Act, ED directors report an increase in patient volumes
in a recent survey.1
EDs care for patients from across the socioeconomic spectrum suffering from a
wide range of clinical conditions. As a result, the ED is still one of few components of the American
healthcare system where social justice is enacted on a regular basis. Constant turbulence in the
healthcare system, major changes in healthcare delivery, technological advances and shifting
demographic trends necessitate that EM constantly adapt and evolve as a discipline in this complex
environment.

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Epinephrine for Anaphylaxis: Underutilized and Unavailable

Volume 16, Issue 3, May 2015
Larissa S. Dudley, MD

Anaphylaxis is a rapidly progressing, potentially life threatening allergic reaction that has been increasing in prevalence, most commonly triggered by foods, medications, and insect stings. Allergies in children are increasingly more common. Unfortunately, anaphylactic reactions are under-recognized, due to overlooked or under-appreciated symptoms, and therefore under-treated with epinephrine.1 For several years, epinephrine has been established as the drug of choice for anaphylaxis.2 Even a few minutes delay in the recognition and treatment of anaphylaxis can lead to hypoxia or death. Therefore, healthcare professionals and laypeople alike should be able to recognize the signs and symptoms of anaphylaxis and have accessible resources to initiate treatment.

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Ethical and Legal Issues

The Alameda Model: An Effort Worth Emulating

Volume XV, Issue 1, February 2014
Aimee Moulin, MD, et al.

In 2009 Alameda placed 11.0 involuntary holds per 1,000 population, while the next highest county in California only placed 6.4 per 1,000 population.5 This may suggest instead that some of Alameda’s mental health patients would not have been placed on an involuntary hold in other California counties in the first place, increasing the proportion of lower acuity psychiatric emergencies and thus accounting for the high discharge rate.

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Ethical and Legal Issues

Response to Moulin and Jones: “The Alameda Model: An Effort Worth Emulating”

Volume XV, Issue 1, February 2014
Scott Zeller, MD

As Moulin and Jones correctly indicate, there is no delineation of the relative acuity of the study patients to those seen in other emergency settings in California. However, we are unaware of any established metric to provide such a comparison for this patient population, and no such categorization was noted in any of the other boarding time studies cited in the article.

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Prescription Drug Monitoring Programs: Examining Limitations and Future Approaches

Volume 16, Issue 1, January 2015
Christopher A. Griggs, MD, MPH et al.

Prescription drug abuse is a leading cause of accidental death in the United States. Prescription drug monitoring programs (PDMPs) are a popular initiative among policy makers and a key tool to combat the prescription drug epidemic. This editorial discusses the limitations of PDMPs, future approaches needed to improve the effectiveness of PDMPs, and other approaches essential to curbing the rise of drug abuse and overdose.

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A BOLD IDEA: The “Population” Specialist

Volume 15, Issue 7, November 2014
Judith E. Tintinalli, MD, MS

Emergency medicine today is very different from emergency medicine of the 1970s, when our practice was limited to the physical confines of the emergency department (ED) and the ambulance.

So—WHO ARE WE ANYWAY?

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Social Media, Public Scholarship, and Injury Prevention

Volume 15, Issue 5, August 2014
Debra Houry, MD, MPH et al.

This marks the Emory Center for Injury Control’s fifth special issue on injury prevention and control. Each year we have tried to identify important themes for injury prevention and public health, such as bridging research to practice, multidisciplinary collaborations, and vulnerable populations. This year our focus is on using social media in injury prevention practice and research.

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Ethical and Legal Issues

Increasing Suicide Rates Among Middle-age Persons and Interventions to Manage Patients with Psychiatric Complaints

Volume XV, Issue 1, February 2014
Bharath Chakravarthy, MD, MPH et al.

The Centers for Disease Control and Prevention (CDC) has published significant data and trends related to suicide rates in the United States (U.S.). Suicide is the 10th leading cause of death in U.S. adults, and rates are increasing across all geographic regions. There is a significant increase in the suicide rate among adults in the 35–64 age range. We present findings from the CDC’s Morbidity and Mortality Weekly Report (MMWR) with commentary on current resources and barriers to psychiatric care.

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Technology in Emergency Care

Social Media Guidelines and Best Practices: Recommendations from the Council of Residency Directors Social Media Task Force

Volume XV, Issue 1, February 2014
Malford T. Pillow, MD, MEd et al.

Social media has become a staple of everyday life among over one billion people worldwide. A social networking presence has become a hallmark of vibrant and transparent communications. It has quickly become the preferred method of communication and information sharing. It offers the ability for various entities, especially residency programs, to create an attractive internet presence and “brand” the program. Social media, while having significant potential for communication and knowledge transfer, carries with it legal, ethical, personal, and professional risks. Implementation of a social networking presence must be deliberate, transparent, and optimize potential benefits while minimizing risks. This is especially true with residency programs. The power of social media as a communication, education, and recruiting tool is undeniable. Yet the pitfalls of misuse can be disastrous, including violations in patient confidentiality, violations of privacy, and recruiting misconduct. These guidelines were developed to provide emergency medicine residency programs leadership with guidance and best practices in the appropriate use and regulation of social media, but are applicable to all residency programs that wish to establish a social media presence.

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Technology in Emergency Care

Electronic Medical Record Utopia May Be Right Before Our Eyes

Volume XV, Issue 1, February 2014
Clark Rosenberry, MD et al.

The quantitative and qualitative demand for medical care burdened to every provider seems only to increase. I encourage you to push us to this bright, more efficient, and more capable future. Advise your electronic medical record carrier to mold their interface into new applications for hardware such as the Google Glass and inevitable subsequent comparable models, integrate highly useful software adjuncts, and foster the adoption of these progressing technologies.

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Emergency Department Access

Time to Focus on Improving Emergency Department Value Rather Than Discouraging Emergency Department Visits

Recently policymakers, payers, and the media have focused attention on avoiding ‘inappropriate’ or ‘unnecessary’ emergency department visits.1 Some states and payers have tried to institute co-pays or deny coverage for visits deemed to be non urgent with the goal of decreasing unnecessary emergency department (ED) visits.2,3 The discussion is predicated upon the ‘common knowledge’ that by diverting unnecessary ED visits, substantial healthcare spending will be avoided. This ‘common knowledge’ is wrong.

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Discourse in Emergency Medicine and Population Health

In Response to “Temperature and Violent Crime in Dallas, Texas: Relationships and Implications of Climate Change”

Volume 14, Issue 5, September 2013
Matt N. Williams, MA, et al.

To the editor:

We were interested to read Gamble and Hess’s study finding that the daily incidence of violent crime in Dallas increased with temperatures up to 90°F (32.2°C), but decreased above this threshold. On this basis, their abstract surprisingly concludes that “higher ambient temperatures expected with climate change…. are not likely to be accompanied by markedly higher rates of violent crime” (p.239). This conclusion contrasts with the findings of previous studies.1–3

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Discourse in Emergency Medicine and Population Health

In Response to “Education on Prehospital Pain Management: A Follow-up Study”

Author Affiliation Kieran Walsh, FRCPI  BMJ Learning, London, United Kingdom To the Editor: French et al should be congratulated for reporting their study of the effects of an educational intervention on prehospital care management of pain.1 Following the educational intervention paramedics certainly improved their management of pain– but there remain some unanswered questions on the intervention […]

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Using a Multidisciplinary Approach for a Multi-faceted Public Health Problem

The Emory Center for Injury Control is a multi-university consortium dedicated to studying and preventing unintentional injuries and violence. A major goal of our Center is to transcend academic boundaries and disciplines to connect research to practice. As such, we are focusing our fourth special Western Journal of Emergency Medicine issue on multidisciplinary research.

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Emergency Department Access

Advertising Emergency Department Wait Times

Advertising emergency department (ED) wait times has become a common practice in the United States. Proponents of this practice state that it is a powerful marketing strategy that can help steer patients to the ED. Opponents worry about the risk to the public health that arises from a patient with an emergent condition self-triaging to a further hospital, problems with inaccuracy and lack of standard definition of the reported time, and directing lower acuity patients to the higher cost ED setting instead to primary care.

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Sports Medicine for Emergency Medicine Physicians, Too Few to Maintain the Fellowship in Emergency Medicine

Sports medicine (SM) is a clinical subspecialty concerned with the diagnosis and treatment of injuries and illnesses sustained both in and out of the athletic arena. Historically, orthopedic surgeons provided the bulk of care for the athlete. Since the majority of issues with athletes are nonoperative musculoskeletal injuries, traumatic brain injuries, or general medical conditions, primary care providers have developed…

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Contact Information

WestJEM/ Department of Emergency Medicine
UC Irvine Health

333 The City Blvd. West, Rt 128-01
Suite 640
Orange, CA 92868, USA
Phone: 1-714-456-6389
Email: editor@westjem.org

Our Philosophy

Emergency Medicine is a specialty which closely reflects societal challenges and consequences of public policy decisions. The emergency department specifically deals with social injustice, health and economic disparities, violence, substance abuse, and disaster preparedness and response. This journal focuses on how emergency care affects the health of the community and population, and conversely, how these societal challenges affect the composition of the patient population who seek care in the emergency department. The development of better systems to provide emergency care, including technology solutions, is critical to enhancing population health.