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Jennifer Casaletto, MD, FACEP
Board of Directors and Councillor, North Carolina College of Emergency Physicians
Political satirist Paul Paulsen once proclaimed, “Assuming either the Left Wing or the Right Wing gained control of the country, it would probably fly around in circles.” While we might be very close to verifying the veracity of Paulsen’s prediction on a federal level, you’ll be happy to know that our 51%-49% Red-Blue divided ACEP Council came together to accept 32 and defeat 5 resolutions during its annual two-day meeting. Three resolutions were referred to the ACEP Board of Directors for further consideration addressing: generic injectable drug shortages, development of ACEP policy regarding immigration, and revision of ACEP policy regarding the qualifications of expert witnesses.
For those members unfamiliar with the Council, it is a deliberative body of ACEP members representing the 53 chartered ACEP chapters (50 states, District of Columbia, Government Services, and Puerto Rico), the Sections of Membership (Young Physicians, EMS, etc.), Emergency Medicine Residents Association (EMRA), Council of Residency Directors (CORD), Association of Academic Chairs of Emergency Medicine (AACEM), and Society for Academic Emergency Medicine (SAEM). The Council debates and votes on resolutions submitted by no less than two members or component bodies. Ultimately, the actions of the Council are considered and ratified by the ACEP Board of Directors (BOD). In addition, the Council elects the members of the Board of directors and the ACEP President-Elect.
Three cases of coagulopathy in patients reporting synthetic cannabinoids use have been reported in North Carolina. See the NC DHHS Provider Memo for more details and recommendations (including case reporting info) and the most recent CDC Health Alert Network (HAN) which includes multiple states reporting more than 200 cases through May 2018.
Click the links below for additional information:
The Injury and Violence Prevention Branch, NC Division of Public Health has posted an update of provisional data on opioid-related poisoning deaths (NC OCME), opioid overdose emergency department visits (NC DETECT), and statewide harm reduction data (NCHRC).
All reports are posted to the website linked here and below.
NC DETECT Opioid Overdose ED Visits Reports
- May 2018 Opioid Surveillance ED Data
- May 2018 Opioid Overdose Emergency Department Visits Heat Maps
- County Reports (For counties with average visits > 9): 2018 Opioid Overdose Emergency Department Visits +
NC OCME Poisoning Deaths Surveillance Reports
NC Harm Reduction Slides
CDC Clinical Action Outbreak Alert: Potential Life-Threatening Vitamin K-Dependent Antagonist Coagulopathy Associated With Synthetic Cannabinoids Use
Please see the CDC Clinical Action Outbreak Alert regarding bleeding problems associated with synthetic cannabinoids use. We are not aware of any similar cases in North Carolina. Clinicians caring for patients with suspected suspect vitamin K-dependent coagulopathy associated with synthetic cannabinoid use are encouraged to contact the Carolinas Poison Center at 1-800-222-1222 for questions about diagnostic testing or management.
The North Carolina Healthcare Association is soliciting applications to participate in The North Carolina Emergency Department Peer Support Program for Improving Response to Opioid Overdose. Please see the request for application and the application below. All acute care hospitals with accredited emergency departments are eligible for application. Health systems are encouraged to work together and select one site for which to submit an application. The award is dependent and contingent upon selection and subject to the availability of funds. All questions may be submitted to Jai Kumar at email@example.com, until May 20th, 2018. The application period will run until March 30th, 2018 until 5:00pm. Incomplete or late applications will be ineligible for consideration.
Required for Submission:
- Completed application form with all questions answers and required signatures.
- Completed budget and budget justification. Include all sources of revenue for your peer support programs, staffing allocations, and all relevant program expenses.
- Letters of support or commitment documentation from key community partners: LME/MCO; Hospital Administration.
- An organizational chart for the program.
- Narrative explaining need, willingness to engage, commitment to data submission, and community readiness.
- Applications should be no more than 4 pages excluding attachments.
- Electronic application submissions only.
- Applications must be submitted no later than March 30th, 2018
ATTN: Jai Kumar, MPH, Director of Planning & Development, NC Hospital Foundation, firstname.lastname@example.org
Please review the information regarding caring for individuals with sickle cell disease in the emergency department.
NC HealthConnex Poised for Growth; Adds Three of the State’s Largest Health Care Systems and a Regional Health Information Exchange
Duke Health, Novant Health, and Carolinas HealthCare System have signed agreements to connect to NC HealthConnex, North Carolina’s state-designated Health Information Exchange (HIE). Additionally, Coastal Connect, a regional HIE in southeastern North Carolina, has formally agreed to connect to NC HealthConnex. This connection will add five hospitals and more than 100 data contributors, acute and ambulatory, to the growing statewide HIE. Read the full press release more information.
Take a moment to review the June 2017, NC Health Information Exchange Authority and NC HealthConnex Update. The Update includes information on HIE Legislation in the 2017 Appropriations Act, including connection timeline revisions, and an update on current participation and connection. You may view the June 2017 Update here.
The North Carolina state-operated health information exchange, called NC HealthConnex, is a secure electronic network that facilitates conversations between authorized health care providers by allowing them to access and share health-related information statewide. This electronic health information is compiled by the North Carolina Health Information Exchange Authority (NC HIEA). Please visit the following links to learn more information: NC HIEA and NC HealthConnex.
Please review the memo from Megan Davies, MD, State Epidemiologist and Chief, Epidemiology Section, and Wendy Holmes, RN, Head, Immunization Branch, regarding a case of measles in Wake County with potential exposures at multiple venues. As noted, clinicians who suspect measles should immediately contact their local health department or the state Communicable Disease Branch (919-733-3419; available 24/7) to discuss laboratory testing and initiate control measures.
North Carolina Medical Board is launching a new effort to address potentially unsafe opioid prescribing in an attempt to reduce patient harm from misuse and abuse of these medications. The Board emailed licensed physicians and physician assistants (PAs) about the new Safe Opioid Prescibing Initiative this week.
Using data provided in accordance with state law by the NC Department of Health and Human Services (NCDHHS), the Board will investigate prescribers who meet one or more of the following criteria established by NCMB:
1) The prescriber falls within the top one percent of those prescribing 100 milligrams of morphine equivalents (MME) per patient per day.
2) The prescriber falls within the top one percent of those prescribing 100 MMEs per patient per day in combination with any benzodiazepine and is within the top one percent of all controlled substance prescribers by volume.
3) The prescriber has had two or more patient deaths in the preceding twelve months due to opioid poisoning.
The Board will determine the appropriateness of prescribing through standard methods, including review of patient records, independent expert medical reviews and written responses from the prescriber.
NCMB recognizes that prescribers identified through the stated criteria may be practicing and prescribing in accordance with accepted standards of care. Given the known risks of opioids and the rising incidence of unintentional overdose deaths, the Board has an obligation to verify that care and prescribing is clinically appropriate.
Physicians and others who treat chronic pain are encouraged to review current standards of care by reading NCMB’s position statement on use of opiates for the treatment of pain. Cases that result in public action against the prescriber universally involve one or more significant departures from accepted standards of care.
Additional information may be found on the NCMB website here.
Please review the updated version of North Carolina’s Zika virus guidance for clinicians and laboratories. This version has been updated to include more specific information about risk of exposure in areas with active transmission and links to updated laboratory biosecurity information and guidance. Procedures for receiving approval and submitting specimens for testing have not changed.
Please review the update from Megan Davies, MD, State Epidemiologist, here. The North Carolina Division of Public Health is working with local health departments to investigate and control an outbreak of mumps in the Charlotte region. The memo is intended to summarize information regarding mumps diagnosis, management and prevention and to encourage clinicians to promptly report suspected mumps cases.
Please review the updates to Zika guidance for North Carolina clinicians and laboratories here. The main changes are related to risk of sexual transmission from male travelers who developed symptoms consistent with Zika during travel to an area with active transmission or within two weeks after return.
Reducing the Stigma – A Case Study Approach to Understanding the Biopsychosocial Challenges of Sickle Cell – April 26, 2016
Southern Regional AHEC is working with Paula Tanabe, Ph.D., RN, FAEN, FAAN and her group at Duke to provide an educational event on April 26. This inter professional event is designed for emergency physicians, nurses, mid-level providers, and social workers who work with the sickle cell patient in the emergency department. Using an interactive case study approach, participants will learn comprehensive approaches to identify stigma, use the new VOC tool, access centralized case management system, additional resources available, and provide best practice care for the sickle cell patient in the emergency department. The education provided will be beneficial for emergency departments wishing to send a team to the education (MD, mid-level provider, Nurse, Social Worker) or individual practitioners who are interested in attending. Multiple Credits are being provided for the event.
Please review the updated guidance for Zika virus diagnosis, management and reporting from the NCDHHS, Division of Public Health, here.
Please review the health advisory regarding severe respiratory illnesses reported to CDC among young to middle-aged adults with influenza A/H1N1 infections here.
The primary purpose of this advisory is to remind clinicians to treat suspected influenza in high-risk outpatients, those with progressive disease, and all hospitalized patients with antiviral medications as soon as possible, regardless of negative rapid influenza diagnostic test (RIDT) results and without waiting for RT-PCR testing results. Early antiviral treatment works best, but treatment may offer benefit even when started more than 48 hours after symptom onset in hospitalized patients.
No increase in severe influenza infections has been noted so far in North Carolina; influenza activity in the state remains low overall. Influenza surveillance data for North Carolina are updated weekly at flu.nc.gov.
Please review the memo from Zack Moore, MD, MPH, Medical Epidemiologist, which provides guidance regarding monitoring and management of people who are exposed to birds infected with the highly-pathogenic avian influenza A H5 viruses recently identified in the United States.
CDC Health Alert Network – Recommendations for Laboratory Testing for Acetyl Fentanyl and Patient Evaluation and Treatment for Overdose with Synthetic Opioid
Please review the CDC Health Advisory regarding Recommendations for Laboratory Testing for Acetyl Fentanyl and Patient Evaluation and Treatment for Overdose with Synthetic Opioid dated June 20, 2013. Read the full advisory here.
Recently, a number of intravenous drug users have overdosed on a new, non-prescription injected synthetic opioid, acetyl fentanyl. Acetyl fentanyl is a fentanyl analog previously undocumented in illicit drug use that is up to five times more potent than heroin. CDC recommends increased vigilance by public health agencies, emergency departments, state laboratories, medical examiners, and coroners for patients with symptoms consistent with opioid overdose and laboratory results showing an enzyme-linked immunosorbent assay (ELISA) positive for fentanyl.
CDC also recommends that public health officials work with laboratories to carry out ELISA screens for fentanyl, and if the results of these screens are positive for fentanyl, conduct gas chromatography-mass spectrometry (GC/MS) confirmatory testing on specimens to confirm or rule out fentanyl and its analogs, including acetyl fentanyl.
Emergency Physicians Are Experts in Managing Childhood Emergencies – Michael J. Gerardi, MD, FAAP, FACEP
Please review the article by Michael J. Gerardi, MD, FAAP, FACEP, President of the American College of Emergency Physicians, on Emergency Physicians Are Experts in Managing Childhood Emergencies here.
Please review this health alert from Megan Davies, MD, Acting State Health Director, regarding the possible use of heroin mixed with clenbuterol.
Please review the letter from Megan Davies, MD, State Epidemiologist, informing all North Carolina health care providers of changes in public health monitoring for travelers from Liberia; providing guidance for management of ill travelers from Liberia; and encouraging continued screening of patients for recent international travel.
The Michigan College of Emergency Physicians will hold its Observation Medicine Conference September 10-11, 2015, in Nashville, TN. More information here.
The National Library of Medicine (NLM) announces a funding opportunity for small projects to improve access to disaster medicine and public health information for health care professionals, first responders and others that play a role in health-related disaster preparedness, response and recovery. If you are interested in submitting a proposal, please note the deadline is July 6, 2015 at 12 pm ET. Contract awards will be offered for a minimum of $15,000 to a maximum of $30,000 each for a one-year project. The solicitation notice can be found on FedBizOpps.gov.
The last round of Project Lazarus clinical trainings are as follows:
- Salisbury: April 30th www.prolazsalisbury.eventbrite.com
- Jacksonville: May 7th www.prolazjacksonville.eventbrite.com
- *Rocky Mount: May 12th www.prolazrockymount.eventbrite.com*
- Roxboro: May 19th www.prolazroxboro.eventbrite.com
- Nags Head: www.prolaznagshead.eventbrite.com
- *Statesville: www.prolazstatesville.eventbrite.com*
*Denotes that this training will offer 3 prescribed credits of AMA Category 1 through the NC Academy of Family Physicians.*
The North Carolina College of Emergency Physicians Standards for Medical Oversight and Data Collection are online casino österreich.
Please see the memo from Megan Davies, MD, State Epidemiologist, regarding two unusual presentations of influenza virus infection that have been reported during the current flu season.
Please see the CDC Health Advisory regarding an on-going multi-state measles outbreak associated with travel to Disneyland in California.
Please see the Health Alert regarding Wallcur simulated IV saline solutions administered to patients. This is being issued for two primary reasons: (1) to alert clinicians and staff to this issue and encourage steps to eliminate the possibility of simulated products being administered to patients, and (2) to encourage clinicians to report any suspected exposure of patients to these products.
This memo (Influenza Update for NC Providers 1_5_2015) is intended to provide clinicians with updated epidemiologic information regarding the 2014–15 influenza season and to reinforce important prevention and control measures for the remainder of the season.
Influenza activity has been widespread in North Carolina since late November. So far, the predominant virus circulating in North Carolina and nationally has been the influenza A (H3N2) virus. H3N2-predominant seasons have been associated with more severe illness and mortality than H1N1- or B-predominant seasons, especially among older people and young children. Approximately two-thirds of H3N2 viruses characterized by CDC so far this season have not been well matched to the vaccine virus component, meaning that vaccine effectiveness against these viruses may be reduced. In this context, the use of influenza antiviral drugs as a second line of defense against the flu becomes even more important, especially for persons at high risk for complication and those with severe or progressive illness.
Additional guidance and weekly surveillance updates are available at www.flu.nc.gov.
The Virginia College of Emergency Physicians is holding their 2015 annual meeting, February 6-9, 2015, at the Omni Homestead Resort in Hot Springs, VA. More information can be found here.
2nd Annual “Improving Healthcare for Individuals and Families Living with Sickle Cell Disease” Conference – September 19-20, 2014
The 2nd Annual “Improving Healthcare for Individuals and Families Living with Sickle Cell Disease” conference will be held September 19 & 20, 2014. The conference is co-sponsored by Duke University Schools of Nursing and Medicine, University of North Carolina Chapel Hill School of Nursing, and the National Institute of Health, National Institute on Minority Health and Health Disparities. For agenda and registration information, please visit here.
The NC Medical Board’s new policy statement on use of opiates for the treatment of pain has been officially released. You may access the position statement here
The Toward Accountable Care (TAC) Consortium and Initiative is pleased to announce the release of its latest specialty toolkit for those physicians interested in learning more about how their practice fits into the value-based model called an accountable care organization (ACO).
TAC Consortium member, the North Carolina College of Emergency Physicians, helped identify NC emergency medicine physicians to serve on a workgroup, which was instrumental in the development of the Accountable Care Guide for Emergency Medicine Physicians. Workgroup members included: Jennifer Raley, MD, Wake Emergency Physicians, PA; Timothy Reeder, MD, ECU Emergency Medicine, Michael Moulton, MD, Eastern Carolina Emergency Physicians, PA; Jill Benson, MD, Wake Emergency Physicians, PA.
Senate Budget Hurts Physicians and Patients
The North Carolina Senate released their version of the 2014-2015 state budget late Wednesday night. The Senate’s budget has many provisions of concern to us, and we believe there are more effective ways to control costs than those adopted by the Senate.
The Senate budget proposal is moving rapidly through the legislative process. We are encouraging the members of the House of Representatives to carefully consider their budget proposal and not adopt many of the provisions the Senate has proposed.
It is important to contact your House member today and let them know that the Senate budget needs to be modified to correct the following issues:
- Additional Rates Cut to Physicians
This budget not only maintains the 3 percent rate cut from last year’s budget, but it also removes the requirement that the Department of Health and Human Services develop a withhold or shared savings plan to support it. In fact, instead of correcting the Department’s misstep, the Senate endorses the rate cut and piles on an additional 2 percent cut.
- Study a Tax on Physicians
In the attempt to explore new revenue options, the NC Senate is also requiring that the Department of Health and Human Services study the feasibility of taxing all North Carolina physicians for the medical services they provide. This study is not limited to physicians enrolled as Medicaid providers.
- Prohibit any work to be done regarding ACOs and Medicaid Reform
In very clear and simple terms the Senate states that “The Department of Health and Human Services shall cease any activities related to implementing Medicaid reform based on its proposed accountable care organization (ACO) model.” This budget rejects the positive, quality-centered solutions proposed for Medicaid reform, wasting over a year’s worth of work and state resources dedicated to this goal.
Contact your Representatives today and ask them to support policies that will move NC forward by providing high quality care to our state’s most needy patients — without punishing the physicians who treat them.
Enhanced continuing education and training for physicians and health care professionals regarding the detection, treatment and cure of acute and chronic pain and its related and prevalent existence of addiction.
PALS 2014 is a multidisciplinary approach to providing education to physicians and HCPS on this subject. The IOM, in its 2011 report, called for a “population health-level strategy for pain prevention, treatment, management, education, reimbursement and research”. This live activity addresses this call to action by providing the education to the medical professionals charged with the care of pain patients in North Carolina and beyond.
Jointly Sponsored by the UNC School of Medicine and Duke University School of Medicine
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Primary Care Providers, Health Departments, Behavioral Health Providers and Hospitals
Join Forces in Community-based “Chronic Pain Initiative”
March 14, 2012, Raleigh, N.C. – Most people never dream that they could become addicted to a pain drug. Yet because of the difficulty our health care system has in determining a proper role for these medications, thousands of patients from all income levels and walks of life are running into issues of dependency. The U.S. is in the grip of an epidemic of prescription drug abuse fueled in part by legitimate prescriptions written by well-meaning physicians.
The sheer volume of the problem is staggering: According to the CDC, enough prescription painkillers were prescribed in 2010 to medicate every American adult around-the-clock for an entire month. A recent report by the Institute of Medicine suggests that the U.S may be spending as much as $635 billion annually to treat chronic pain and that long-term pain impacts more patients in the U.S. than heart disease, cancer and diabetes combined.
In an unfortunate corollary, this flood of narcotics is driving an epidemic of prescription drug overdoses. Nationally, such deaths rose five-fold between 1990 and 2007. This loss of life has had a devastating impact on families all across our state. And even when problems aren’t fatal, the inappropriate use of pain medications significantly impacts the entire community.
To address this public health challenge, a broad coalition of stakeholders has launched the Chronic Pain Initiative. This expansive partnership includes Community Care of North Carolina (CCNC), Project Lazarus, the North Carolina Hospital Association (NCHA), the North Carolina College of Emergency Physicians, local hospitals and emergency departments, local health departments, primary care doctors, faith-based programs, law enforcement, and others.