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| September 17, 2020 |
EPICWelcome to the next edition of EPIC, GSACEP's newsletter. We are happy to present the following articles in this issue:
A reminder that is you are interested in working with us on this newsletter, know someone who should be highlighted in our member spotlight, or want to submit something to be considered for publication, including stories from deployment, educational opportunities and case reports, please contact the editors. Active Duty Joint Service Consultant UpdateThe EM Consultants/Specialty leaders, COL Bonnie Hartstein, Army, CAPT Brendon Drew, Navy, and LtCol Matt Streitz, Air Force, are working collaboratively to tackle EM specific issues within the Services and DHA. Most recently we stood up the Emergency Services Clinical Community, in collaboration with the Trauma and Critical Care Clinical Community, working to establish tri-Service clinical practice guidelines, building on products already developed in the Navy to expand to all Services. Dr. Drew headed up the team since its recent inception, and will hand the reigns over to LTC Eric Chin, Deputy Army Consultant, as the group continues work focusing on ED staffing standards and sepsis. On September 3rd, the second annual Joint Services Symposium in Emergency Medicine (JSSEM), the only military-sponsored joint EM training event focused on preparing a ready medical force, held its 2020 meeting- virtual due to COVID. It was attended by over 130 service members from the Army, Air Force, and Navy, and brought the best aspects of JSSEM to the online world. If you missed it, the conference video and lightning competition lectures can be found on AMEDD Blackboard - CAC-card enabled. And, if you'd like CME credits for JSSEM, register here. The symposium also highlighted the achievements of some of our most outstanding colleagues. The JSSEM EM Consultant’s Award winners for 2020 are:
Congratulations to all and see you at JSSEM 2021! GSACEP Strategic PlanGSACEP Board of Directors and ex officios met on September for a 4 hour intensive Strategic Planning session facilitated by Dr. Linda Lawrence and Dr. Julio Lairet. We developed a GSACEP Mission Statement: The Government Services Chapter of American College of Emergency Physicians promotes quality emergency care and enhances the development of emergency physicians who serve our nation from training through retirement.
We formed 3 working groups to focus on Career Transitions, Chapter Engagement and Chapter Advocacy initiatives. There will be two additional strategic planning sessions this year. Stay tuned for GSACEP Committee re-structuring and new opportunities to engage with GSACEP later this year and in 2021!
Navy Reserve Emergency Medicine UpdateGreetings Shipmates, GSACEP members, and fellow emergency physicians! As the current specialty leader for EM for Navy Reserve Medicine, I appreciate the opportunity to discuss what is happening with Navy Reserve Emergency Medicine. I also want to once again thank LCDR Andrea Austin, who allowed me the opportunity to help teach my fellow Navy Reserve colleagues about to deploy to KAF, Afghanistan Role 3 this past February before the pandemic hit the US. What a great honor to teach and mentor those about to deploy downrange, especially those deploying for the first time. I highly recommend to all to share your knowledge and experience with those more junior and/or less experienced than yourself. We are now 7 months into the CORONAPOCALYPSE in the US. I want to thank all of you for doing what you do every day in your military and civilian jobs, and to recognize those that have deployed in support of the COVID pandemic as well as those who are downrange in support of our forces and allies around the world. The work you all do as emergency physicians is critical to taking care of civilians, military members and their families around the globe. What you do truly matters! This past spring, I, as well as many of my Navy Reserve EM colleagues, had the honor of deploying to New York as part of the COVID-19 response. We worked at both the Javits Center as well as many hospitals throughout the New York City area. It was an incredible experience, working with our colleagues from the Army, Air Force, National Guard, and Public Health Service as well as civilian colleagues taking care of thousands of patients flooding the Emergency Departments and hospitals in the area. I am sure it was the largest mobilization of military medical assets to a single area that the world has ever seen. What an honor it was to be able to serve there! Navy Reserve Medicine, like the DHA, is undergoing rapid and sweeping changes. These changes not only affect our active duty colleagues, but the Reserves and National Guard as well. Coupling these planned changes with a worldwide pandemic has required further adjustments and course deviations from the original plans. Our country and world will never be the same after this pandemic ends, and military medicine is no exception. Stay tuned! Deployments are still at a high OPTEMPO for Navy Reserve Emergency Medicine, although it appears the AFG Role 3 mission that the Navy has led for over a decade is being transitioned from the Navy to the Army. Good luck to our siblings in the Army. Feel free to reach out to us for information on deployments to KAF as we have many members who have deployed there over the last decade, some more than once! BZ to CDR Gardner, LT Reeder, and LT Warner for serving with the last Navy group downrange at KAF Role 3, taking care of both trauma patients as well as COVID patients! To CAPT Brannon, who agreed to deploy downrange again instead of retiring, thanks for your patriotism and example to the rest of us, reminding us why we do this job. All, including our non-Navy colleagues, please keep on the lookout for deployments that fit your interest or time frames. Many are interested in deploying, but have specific requests, requirements, time frames, and/or goals. Often, at least in the Navy, you are afforded the opportunity to volunteer for deployments that fit your goals. On a personal note, I am excited to be joining my fellow colleagues who work for the VA. As a per diem employee in my primary job, when I returned from deployment my shifts had been cut to make room for newly hired full-time personnel. This gave me the opportunity to explore other options, which led me to my new job at the VA in Phoenix, starting in October. I am honored, as a veteran, to be able to serve my fellow veterans! Feel free to reach out to me if you have questions, regardless of your branch of service. My contact information is below. V/R CAPT Butler “Navy Reserve Emergency Medicine- a ready medical force ensuring a medically ready force” Deployment CornerCPT Joshua Stein The views expressed are the author's and do not reflect those of the US Army or DoD Responding to a pandemic while deployed presents unique problems and unique solutions. Deployed to Afghanistan for much of 2020 I was able to see COVID-19 expose deficiencies and discrepancies within the public health and medical care communities that may have otherwise gone unrecognized. Through a combination of aggressive public health controls and luck we were able to prevent an outbreak of COVID-19 at our installation. While an exhaustive account of the experience goes beyond the scope of his format, it is my hope that a few anecdotes may better prepare readers for their upcoming deployments. Emergency Physicians know better than to say, “that’s not my job.” Part of our ethos is: any patient, anytime. We are comfortable wearing many different hats, however “Public Health Emergency Officer” is a novelty sombrero we may not have anticipated putting on. Even if you cannot spell “RNA virus,” people will look to you as a de facto leader during a time of a novel medical threat. Most of us do have something of a sentinel mentality and are more in tune to postings on the CDC, WHO, or ProMedMail than other providers, but our public health training is often confined to somewhat mundane (though important) topic such as STIs, rabies, and foodborne outbreaks. How are we qualified? We are qualified because it is understood that we are better at incorporating and assimilating new information than anyone else in the medical community. That said, although you may be the expert in your little corner of the globe, you are not in charge and you are not alone. You work for command, and you work with the local PA, and you have a great team around you. The commander of your installation or area of operations owns any public health response in a time of pandemic or otherwise. You may be the subject matter expert, but you cannot and should not attempt to micromanage every detail. Providing guidance about what is ideal, okay, or unacceptable for worksite restrictions, housing arrangements, quarantine policies or other efforts will yield better results; the commander and senior enlisted personnel will do a better job of finding space for housing, enforcing policies, and producing buy-in across your installation than you would ever be able to do. Most EM providers recognize that the PA assigned to the local unit is better at all things military. He or she is the best communicator, liaison, and advocate between the local medical asset and command. This individual knows how to press the buttons and pull the levers of action within a military unit, and also speaks medicine. In addition to these assets, one advantage for infection control in a deployed environment is control of movement. Unlike areas with free movement of people, our installation relied almost exclusively on air transportation for movement, which allowed for exact accounting of new personnel and an easy checkpoint for both screening and quarantine. Our local policy included tiered testing and quarantine procedures based on the inbound personnel’s point of origin. Although this was somewhat controversial because of the subsequent need to quarantine some flight crews, it ultimately proved to be a high-yield strategy to prevent cases from entering our installation. Additionally, your own team probably has some not-so-hidden talents: an ICU nurse who has worked on infection control projects or JCO compliance teams, surgeons who have forgotten more about hand hygiene and surgical site infections than you could ever learn, a scrub tech who already knows quite a lot about cleaning and cleaning solutions. These individuals can provide phenomenal insight into how to safely maintain operations of gyms, DFAC’s, and other highly utilized areas. COVID-19 brought issues to light that may have otherwise remained unrecognized. Most relevant to future deployments were issues related to equipment standardization. During discussions about oxygen delivery platforms we realized that certain items were not interchangeable between medical teams within NATO. Specifically, oxygen canister regulators were often country specific. This could have impeded a “commingled” approach to oxygen distribution. Additionally, while developing facilities for quarantine and isolation, it was recognized that at baseline there were inadequate facilities for supporting “quarters” or patients who required a period of convalescence during more typical communicable threats such as influenza or pneumonia. I hope these brief anecdotes help to frame some of the challenges and paths to solutions you may face in coming deployments. Though most inbound providers will receive some COVID-19 related infrastructure, it is only through iterative changes that we improve. My COVID DeploymentCPT John Cruz, D.O. Upon recognition of the impending situation with COVID, initial guidance from the very top was that no medical personnel of any kind were allowed to enter or leave the country until the scope of the problem had been fully appreciated. As part of the draw down resulting from the peace treaty with the Taliban, I was set to re-deploy with my unit upon completion of our initial mission. The unit went back to the United States; I, however, stayed put. I was approached by my Battalion Commander for recommendations on where I would best fit under the circumstances and we decided that as an EM physician, an Emergency Department would make the most sense. Thus, I was reassigned to the nearby Role 3. Upon arrival, the protocols for screening and management of suspected patients were in their infancy. At the time, there had been no reported cases in American troops across all bases in country, even as the number of positive cases within the native population was growing exponentially. There was an overwhelming sense of “when” not “if” we would be affected. Gyms closed down. All MWR facilities and non-DFAC dining facilities/coffee shops/vendors were closed. Local nationals were no longer allowed on base without specific exception. Masks became mandatory to enter the DFAC, and seating in the DFAC itself was expressly forbidden. Twice daily, a base-wide announcement was made overhead to report to the Role 3 to be screened if you felt unwell. And report to the Role 3 they did. Any Influenza-Like Illness (ILI) patient was swabbed for COVID and sent to specifically reserved barracks regardless of testing results for 14 days. The patient’s unit was contacted and all close contacts were placed on a 14-day quarantine in their own barracks. If these quarantined patients developed symptoms during that time, they were brought to the Role 3 for screening. Once per day, an EM physician would round at the isolation barracks to take vitals. A tent was set up outside of the Role 3 facility to treat any traumas being brought in from outside bases, as every patient was considered contaminated regardless of exposure until it could be proven that they did not have COVID. During my time there, we successfully treated 3 patients involved in a low altitude helicopter crash and 3 patients involved in an IED attack from within the tent and in full PPE. The structure and its contents were decidedly makeshift and the conditions were far from ideal, but we made it work. Eventually it was felt that the medical facilities in country could make their own determination of needs and the ban on medical personnel re-deployment was lifted. I saw exactly zero cases of COVID during my additional two months in country. On my way home, I was both confused and excited when I was allowed to sit inside the DFAC at another base and eat with colleagues. It seems the regulations across the different bases were far from uniform. When our flight landed in the United States, we were shuttled to a remote site for 14 days of quarantine with our travel cohort. Luckily, I arrived a few weeks after the “Military Times” article highlighted that the initial quarantine site had left much room for improvement. We were not allowed outside the cordoned area, except for the two-hour block allotted for exercise each day. Hot chow was delivered for breakfast and dinner, MREs for lunch. Conditions were frustrating and boring at worst, perfectly adequate at best. After 14 days, we were transported back to CRC for the crux of the re-deployment. Ultimately, I was able to return to my home base where I have since seen countless cases of COVID, both sick and not-so sick. I learned many things through this unconventional deployment experience which will be invaluable to my career moving forward. I feel confident that the processes in place when I left became much more refined over time to the benefit of the soldiers who ultimately did contract the virus. Austere and operational medicine opportunities for emergency physicians and medical studentsENS Ivan L. Yue, MS4 The opinions and assertions expressed herein are those of the author(s) and do not necessarily reflect the official policy or position of any military medical center, the United States Navy, or the Department of Defense. Introduction Wilderness and austere medicine are not usually well covered by medical school curriculums, despite their importance to military medicine. Deployed military physicians often find themselves in austere environments, advising medics/Corpsmen, and using skills that combine operational skills with expeditionary medical decision making. I am a 4th year Navy student at the Uniformed Services University (USU) F. Edward Hebert School of Medicine, recently accepted to an emergency medicine internship program through the US military residency match. I wanted to share my unique medical school experience with austere and operational training opportunities and perhaps provide examples of how to productively fill the latter part of medical school while building towards a career in emergency medicine. Electives U.S. Naval Hospital This Navy hospital is unique in that it is on an island in the middle of the Pacific Ocean with a local population that is grappling with poor healthcare literacy and access. While there, I spent time at the Navy’s hyperbaric chamber and attended lectures by one of the submarine tender’s undersea/dive medical officer (DMO), who is a Navy physician with additional training in dive, hyperbaric, and radiation medicine. I also toured the sole Naval helicopter squadron’s medical facilities with the squadron’s flight surgeon. The emergency department physicians had strong relationships with the dive medicine doctors on the island because dive emergencies require quick communication between the hyperbaric chamber and the emergency department. This experience gave me unique insight into the field of dive medicine, something I did not encounter elsewhere in my medical education. Naval Hospital Guam’s website is: https://www.med.navy.mil/sites/usnhguam/ Marine Corps Base During this elective, I shadowed the unit’s two physicians. The senior medical officer happened to also be a board-certified emergency medicine physician. At the medical clinic, we saw Marines for their urgent care issues, performed special physical exams to qualify them for special military duties (such as jumping out of airplanes and diving), and attended meetings where the medical officer gave strategic advice to the military commanders about the unit’s unique medical challenges. In addition to learning more about operational medicine, I learned about how we can influence the wellbeing of Marines as they face the challenges of a foreign environment. Medical students can best set up this rotation by looking up an Army or Marine Corps unit and calling their medical office’s phone number or by finding an active duty medical officer and asking them to help make a connection. The 1st Marine Division’s website is https://www.1stmardiv.marines.mil/ Courses All three courses mentioned below are open to military and military associated or government service medical professionals, including those working for other agencies such as Federal Bureau of Investigation (FBI), Department of Homeland Security (DHS), National Park Service (NPS), etc. If interested in these courses or if you have further questions, please contact the co-director of these courses, Dr. Wedmore at ian.wedmore.ctr@usuhs.edu. Cold Weather Medicine and Avalanche Course This is a ten-day course that teaches patient care skills in a mountainous setting and includes high angle rescue, ice climbing, avalanche risk mitigation, and other medical considerations in subzero environments. There were two emergency medicine residents and two board certified emergency medicine physicians who attended the course with me. Almost every day starts with a morning session of didactics and hands on training in the classroom, followed by more than five hours of practical application outside in the alpine environment. The course’s final exercise included treating, stabilizing, and moving a patient over multiple miles through snow and down ice cliffs. I found the physical and mental challenge of combining mountaineering skills and medical knowledge very refreshing. The medicine and operational skills taught in the course are directly applicable to physicians working with emergency medical services with alpine terrain and to military providers embedded in units that engage in mountain warfare. Dive Medicine and Water Rescue Course The dive medicine course is a ten-day course held in collaboration with the Army’s Special Forces Dive School in Key West, that introduces students to diving, marine medicine, and water rescue. Training includes daily didactics as well as practical exercise in the water in full diving equipment. Students can earn their open water, advanced, and water rescue diving certifications through this course. Medical training includes diagnosis, treatment, and prevention of dive related accidents. Students also spend a day visiting the local hospital with a hyperbaric chamber and have the opportunity to learn about hyperbaric medicine. Military Mountain Medicine Course This is a ten-day course at either Joint Base Lewis-McChord in Washington or at Camp Ethan Allan in Vermont. This course was designed to provide training in wilderness medicine, with daily didactic and practical exercises. Students learn to combine operational medicine with tactical skills, including orienteering, mountaineering, and patient transport. Students should be in good physical fitness shape and able to score good or higher on their respective military branch’s physical fitness assessment prior to coming to this course. Conclusion Military physicians are often called upon to advise medics/Corpsmen or participate in patient care in austere settings. Naturally, military emergency medical physicians often have additional interests in wilderness medicine. There are many opportunities to further nurture wilderness medicine skills within and outside our military medical system. In addition to the experiences mentioned above, I recommend getting involved with the Wilderness Medicine Society to further explore courses and conferences that are wilderness medicine related. I hope to continue pursuing these opportunities as I progress through residency and to continue sharing these opportunities with my peers and future students as well. First Patient DeathTiffany Fan, UCLA David Geffen School of Medicine Pupils fixed and dilated, no active respiration, no discernible pulse — she was only 20 years old. The team ran an intense code - pushing epinephrine, performing chest compressions, monitoring vitals, engaging the defibrillator, and proceeding with intubation. There were no signs of improvement; brief runs of Vtach, only to return to asystole. As a scribe, I quickly typed away, trying to record every detail of the last moments of her life. Gradually, the air around her turned cold, her skin fading from a warm pink to a chilling blue, her heart still unable to pump on its own. Her mother arrived shortly afterwards, falling to her knees, sobbing in intense pain. As I left the hospital, I finally processed what had occurred and immediately broke into tears. I often recall this moment from 4 years ago, every heart-wrenching detail still aching in my memory – that even with the team’s best efforts, medicine failed to save this young patient’s life. As I enter my final year of school, I’ve come to learn that medicine is as much about healing and recovery as it is about mortality and palliation. It is an incredible and humbling privilege to witness both the fortitude and fragility of the human spirit first-hand, and though these moments may end in defeat, I remain motivated to intervene and support my patients through times of greatest need. Sponsored by: Train in a Military Focused Emergency Medicine Specialty Fellowship in DenverDenver Health Medical Center & University of Colorado Anschutz Medical Campus The Department of Emergency Medicine at the University of Colorado and Denver Health Medical Center has several fellowships that cater to the unique skill set needed by military emergency physicians. With a focus on combat casualty care in future battlefield environments, we are training emergency physicians to be leaders in the military and experts in civilian health care systems and hospitals. We have a 20-year long history of training military emergency physicians in specialty fellowship programs and training DoD medics (e. g. SOF Medics, Navy Corpsman, etc.) across multiple different sub-specialties. Most recently, UC Health has launched a new sustainment and training platform at UCH Colorado Springs (Memorial Hospital) for active duty Army and Air Force emergency physicians and surgeons. The CU Anschutz Center for COMBAT Research (housed within the DEM) works across campus to support DoD-funded investigators and works closely with active duty researchers across the country. The DEM ranks near the top for DoD Research funding and is commonly in the top ten in NIH Funding annually among all civilian EM Departments. Denver Health Medical Center is home to the Ernest E. Moore Shock Trauma Center at Denver Health, a world-renowned Level 1 trauma referral center for the Rocky Mountain Region, and the Denver Paramedic Division - the primary advanced life support EMS system for the city and county of Denver. The University of Colorado Anschutz Medical Campus is located at the Fitzsimons military campus and is home to the University of Colorado Hospital, a Level 1 trauma center and regional burn center, Children’s Hospital Colorado, the Veterans Affairs Medical Center, the School of Medicine, School of Public Health, and the Colorado Clinical and Translational Sciences Institute. The Department is nearby to several Army, Navy, and Air Force Reserve, Guard, and active duty units, including Buckley AFB, Fort Carson, Peterson AFB, and the USAF Academy, with several units based on the CU Anschutz campus tying the campus to its military legacy of Fitzsimons. Below are the fellowships that we offer and we are looking for applicants! Click the buttons below for more information. Anesthesiology Critical Care Medicine Fellowship The University of Colorado Anesthesiology Critical Care Medicine Fellowship is an ACGME approved fellowship providing advanced knowledge, skills, and clinical experience in multidisciplinary critical care medicine. This fellowship has a 100% critical care board certification pass rate and 100% of our graduates obtained critical care faculty or private practice positions. To date, this fellowship has not yet had a military fellow, but we are looking forward to our first one. Fellowship Director Jason C. Brainard, MD Emergency Medical Services (EMS) Fellowship The Denver Health fellowship in EMS and Disaster Medicine is a one-year ACGME accredited fellowship affiliated with Denver Health Medical Center and the Denver Health Paramedic Division (DHPD). Fellows have a unique opportunity to train as a paramedic in our program and become patched in the Denver Paramedic Division. Numerous fellows have presented research at the National Association of EMS Physicians. This program has had two fellows represented by the Army and another that was a member of the US Air Force Reserve, Medical Corps. A current faculty member of this program was a Major in the USAF (separated in 2001). Fellowship Director Lara Rappaport, MD Global Emergency Medicine/Public Health Fellowship The University of Colorado/Denver Health Fellowship in Global Emergency Medicine and Public Health is organized and supported by the University of Colorado/Denver Health Department of Emergency Medicine, in collaboration with the Colorado School of Public Health. This program includes completion of a Master’s in Public Health (MPH). This program has two current fellows both represented by the Air Force. Fellowship Director Corey B. Bills, MD, MPH, FACEP Medical Toxicology Fellowship The Medical Toxicology Fellowship program is based at Rocky Mountain Poison & Drug Center (RMPDC), a department of the Denver Health and Hospital Authority. The fellowship is a two-year program during which the fellow is given ample opportunities to publish and gain valuable hands-on experience in toxicology. This program has had ten military graduates representing the Army, Air Force and Navy. Fellowship Director Christopher Hoyte, MD Research Fellowship This two-year clinical research fellowship consists of obtaining an MPH, initiating and completing a substantial research project, and working as an attending physician in the emergency department at either Denver Health Medical Center or the University of Colorado Hospital. As part of the fellowship, each fellow will participate in Emergency Medicine Scientist Training and Intensive Mentorship (EM-STIM), an established departmental research-in-progress and training program with an extensive track record of supporting early-stage scientists. To date, this fellowship has not yet had a military fellow, but are looking forward to our first one. Fellowship Directors Jason Haukoos, MD, MSc Adit Ginde, MD, MPH Ultrasound Fellowship The Ultrasound Fellowship at Denver Health Medical Center (DHMC) is a one-year curriculum designed to train emergency physicians to be leaders in emergency ultrasound. We have positions for emergency medicine and pediatric emergency medicine physicians, and have also trained hospitalist medicine physicians. This program has had 32 prior fellowship graduates practicing in academic, community and military settings. Notably, we have trained military fellows who have gone on to direct ultrasound programs with both the Army and the Navy. Fellowship Director Molly Thiessen, MD Assistant Fellowship Director Matthew Riscinti, MD CU Anschutz Center for Combat Medicine and Battlefield (COMBAT) Research The mission of this program is to improve the care of combat related injury and illness through innovation, research, and advanced development with military and civilian collaboration. The Center for COMBAT Research aims to facilitate the execution of combat and deployment-related research by navigating successful relationships with military scientists, clinical investigators, combat leaders, and field operators to produce successful innovations, material solutions, and knowledge products of high impact to the warfighter. Center Director Vik Bebarta, MD; Colonel, USAF IMA, MC Deputy Director Kathleen Flarity, DNP, PhD; Brigadier General, USAF Assistant Director Sean Keenan, MD, COL, USA Retired
Additional military focused fellowships to include Sports Medicine, Wilderness Medicine, and Administration, Operations, and Quality. Please visit the EM Fellowship Homepage below to find out more. We will miss him dearlyLinda Lawrence with edits by Liz Mesberg In late 2019, former GSACEP President, longtime ACEP member, and revered colleague Col. Chris Scharenbrock passed away. Chris was an Air Force officer and emergency physician without equal, and to all who crossed his path, he was a role model and inspiration. His career began at USAFA, and after finishing as a distinguished graduate, he went on to USUHS. He completed a transitional internship at Scott AFB and joined the Emergency Department at Nellis AFB as a GMO. He completed his EM residency at SAUSHEC, acing the in-service exam in his senior year, scoring in the 97th percentile. He maintained his clinical excellence through a career of leadership, finishing as a Master Clinician at Joint Base Andrews, recently practicing at Kaiser Napa Solana. He was the unparalleled leader and Medical Director of the ED at Langley AFB as well as the Flight Commander of Emergency Services at Travis AFB. In 2007, he was honored with the AFA Lt Gen Paul Meyers Award, and two years later became the Chief of Medical Staff as a Colonel-select, a job typically given to those more senior. His strong leadership at Travis was pivotal to rebuilding David Grant Medical Center. Chris was a combat warrior, deployed five times and inspired us with his initiative, volunteering for a 365-day Provincial Reconstruction Team to southern Afghanistan as its first Air Force physician. Those who knew him knew his love of gardening, traveling and spending his free time with his beloved family and large circle of friends. What made Chris a great officer and clinician was his resilience and commitment to his passions. His highest priority, through it all, was his family, providing love and support no matter the distance. We will miss him dearly. To honor Colonel Scharenbrock, GSACEP has submitted a memorial resolution to honor his distinguished career and life, authored by Dr. Linda Lawrence. Additionally, a bench was purchased in his memorial, and presented to his family who are deeply appreciative. Photo of his daughters sitting on the bench below. ...With Liberty and Justice for SomeCapt Joshua da Silva This is an opinion piece and the views expressed are those of the author. Feel free to reach out to the editors with any comments, concerns, or suggestions or if you are interested in submitting a piece on race or gender issues to be considered for publication. Systemic racism--what qualifies me to write about this? I am not an expert on racial disparities. I have not suffered injustice because of the color of my skin. Why is my life experience on this topic valuable? Because despite all of the progress our nation has made since its inception, despite many people claiming systemic racism doesn’t exist anymore, my experience as a white person in this country is STILL different than that of my black and brown countrymen; a difference impossible to ignore during this year of unprecedented health disparities and political protests. Growing up, I was never overtly taught to hate another person, but the installation of bias programming is insidious. I have worked hard for what I have, but I have also enjoyed many unearned privileges. I have never felt that I wouldn’t be given the benefit of innocence when calling the police, while at the same time programs like “Stop and Frisk” were in effect, disproportionately targeting black and Latinx people. I have never once felt that my skin color would place me in danger, and I have always known that I could turn on the TV to see superheroes, role models, and even physicians who looked like me. It is disheartening to see that there are those who still cannot see the systemic racism around us, even as a viral pandemic has flooded our country and clearly exposed continuing racial gaps. In Chicago, we have seen black and white residents each forming a third of the city’s racial makeup, but the former has twice the rate of new COVID-19 infections and over three times the number of deaths. [1] In Atlanta, a city that played a huge part in the Civil Rights Movement, black people are hospitalized at a rate six times that of their white counterparts. [2] Likewise, in the Ochsner Health system in Louisiana, although black patients are only a third of the local community’s population, they account for over 75% of the hospitalizations, over 80% of those who have needed intensive care or mechanical ventilation, and over 70% of the overall deaths. This effect is statewide, with black citizens again only representing a third of the racial makeup of Louisiana but over half of the deaths. [3] It has also been shown that there are higher rates of obesity, diabetes, hypertension, and chronic kidney disease in the black population, [3] contributing to the six-fold higher hospitalization rate and twelve-fold higher death rate from COVID in this population nationwide. [4] These are symptoms of a living system of inequality, perpetuated by educational, income, and wealth gaps, as well as differences in access to healthcare and occupation. As an American, it is heart-breaking to see how my skin color bestowed privilege I didn't earn. As a physician who swore an oath to provide care free of impropriety or corruption, I--no, we--must no longer be complicit in a system that has unequally yoked skin color to opportunity and justice. To my colleagues, this is our issue too, and we must do better and take steps towards lasting reform. While this list is woefully inadequate, I suggest a few places to start:
Issues of systemic racism not only affect black people, but Indigenous people and other groups of color. My experience as a white physician is important because it can be used to call out bias and privilege. How many of our patients must die for us to take responsibility for our part in perpetuating a system of injustice? It is time to acknowledge that safety from racial bias and mistreatment has led me to an action I can no longer tolerate: silence. “But if you must and you can, then there’s no excuse”. -Phillip Pullman References September 17th is National Physician's Suicide Awareness DayThis year's theme is "One of Us". CORDEM and ACEP have both put together resource lists for physician suicide prevention.Create a safe space to talk about mental health and suicide by setting aside time at your morning report, morning huddle or faculty meeting to discuss physician mental health, depression and suicide. This allows your group to speak about it in generalities and individuals are able to speak without a spotlight on them personally. · Say the names of your colleagues who have died by suicide. Remember them, honor their memory, share their stories and lessons learned. · Be vulnerable and a role-model for your colleagues and trainees. Physicians are notoriously constricted in sharing their own emotions and experiences which may contribute to the higher rates of burnout, depression and suicide rate. We need courageous individuals to start the conversation and break the ice. By role-modeling vulnerability, you are helping to change the culture in medicine. · Access to mental health: This may take a little preparation work, but review and share how mental health care and resources are accessed locally. As you are doing the research, look for the barriers to access care; how easy is it to access care? How long does it take to get an appointment? Is confidentiality protected? Do the psychiatrist or therapists take your insurance? With the world on edge, ever present challenges and changes in healthcare which are multiplied by personal struggles, it is easy to feel overwhelmed and powerless. Unfortunately, given our tradition of stoicism and forced character separation in the workplace, it is very difficult, if not impossible, to know who is experiencing emotional or psychological pain and to what degree. Please take the time to reflect this year on National Physician Suicide Awareness Day and make a pledge to yourself and others to show kindness, vulnerability and be available to support one another. Thank you to New York ACEP for the wonderful sentiments shared above! |
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