Jolion McGreevy

Ethical issues in the response to Ebola virus disease in United States emergency departments: a position paper of the American College of Emergency Physicians, the Emergency Nurses Association, and the Society for Academic Emergency Medicine.

The 2014 outbreak of Ebola virus disease (EVD) in West Africa has presented a significant public health crisis to the international health community and challenged U.S. emergency departments (EDs) to prepare for patients with a disease of exceeding rarity in developed nations. With the presentation of patients with Ebola to U.S. acute care facilities, ethical questions have been raised in both the press and medical literature as to how U.S. EDs, emergency physicians (EPs), emergency nurses, and other stakeholders in the health care system should approach the current epidemic and its potential for spread in the domestic environment. To address these concerns, the American College of Emergency Physicians, the Emergency Nurses Association, and the Society for Academic Emergency Medicine developed this joint position paper to provide guidance to U.S. EPs, emergency nurses, and other stakeholders in the health care system on how to approach the ethical dilemmas posed by the outbreak of EVD. This paper will address areas of immediate and potential ethical concern to U.S. EDs in how they approach preparation for and management of potential patients with EVD.

Ethical Issues in the Response to Ebola Virus Disease in US Emergency Departments: A Position Paper of the American College of Emergency Physicians, the Emergency Nurses Association and the Society for Academic Emergency Medicine

The 2014 outbreak of Ebola Virus Disease (EVD) in West Africa has presented a significant public health crisis to the international health community and challenged US emergency departments to prepare for patients with a disease of exceeding rarity in developed nations. With the presentation of patients with Ebola to US acute care facilities, ethical questions have been raised in both the press and medical literature as to how US emergency departments, emergency physicians, emergency nurses and other stakeholders in the healthcare system should approach the current epidemic and its potential for spread in the domestic environment. To address these concerns, the American College of Emergency Physicians, the Emergency Nurses Association and the Society for Academic Emergency Medicine developed this joint position paper to provide guidance to US emergency physicians, emergency nurses and other stakeholders in the healthcare system on how to approach the ethical dilemmas posed by the outbreak of EVD. This paper will address areas of immediate and potential ethical concern to US emergency departments in how they approach preparation for and management of potential patients with EVD.

Fantastic Learning Moments and Where to Find Them

Introduction Experiential learning is crucial for the development of all learners. Literature exploring how and where experiential learning happens in the modern clinical learning environment is sparse. We created a novel, web-based educational tool called “Learning Moment” (LM) to foster experiential learning among our learners. We used data captured by LM as a research database to determine where learning experiences were occuring within our emergency department (ED). We hypothesized that these moments would occur more frequently at the physician workstations as opposed to the bedside. Methods We implemented LM at a single ED’s medical student clerkship. The platform captured demographic data including the student’s intended specialty and year of training as well as “learning moments,” defined as logs of learner self-selected learning experiences that included the clinical “pearl,” clinical scenario, and location where the “learning moment” occurred. We presented data using descriptive statistics with frequencies and percentages. Locations of learning experiences were stratified by specialty and training level. Results A total of 323 “learning moments” were logged by 42 registered medical students (29 fourth-year medical students (MS 4) and 13 MS 3 over a six-month period. Over half (52.4%) intended to enter the field of emergency medicine (EM). Of these “learning moments,” 266 included optional location data. The most frequently reported location was patient rooms (135 “learning moments”, 50.8%). Physician workstations hosted the second most frequent “learning moments” (67, 25.2%). EM-bound students reported 43.7% of “learning moments” happening in patient rooms, followed by workstations (32.8%). On the other hand, non EM-bound students reported that 66.3% of “learning moments” occurred in patient rooms and only 8.4% at workstations (p<0.001). Conclusion LM was implemented within our ED as an innovative, web-based tool to fulfill and optimize the experiential learning cycle for our learners. In our environment, patient rooms represented the most frequent location of “learning moments,” followed by physician workstations. EM-bound students were considerably more likely to document “learning moments” occurring at the workstation and less likely in patient rooms than their non EM-bound colleagues.

Pathologic C-spine fracture with low risk mechanism and normal physical exam

Cervical spinal fracture is a rare, but potentially disabling complication of trauma to the neck. Clinicians often rely on clinical decision rules and guidelines to decide whether or not imaging is necessary when a patient presents with neck pain. Validated clinical guidelines include the Canadian C-Spine Rule and the Nexus criteria. Studies suggest that the risks of a pathologic fracture from a simple rear end collision are negligible. We present a case of an individual who presented to an emergency department (ED) after a low speed motor vehicle collision complaining of lateral neck pain and had multiple subsequent visits for the same complaint with negative exam findings. Ultimately, he was found to have a severely pathologic cervical spine fracture with notable cord compression. Our objective is to discuss the necessity to incorporate clinical decision rules with physician gestalt and the need to take into account co-morbidities of a patient presenting after a minor MVC.

Cutting Edge or Cutting Corners? Innovative Care

Despite an ever-increasing body of scientific evidence, clinical situations often arise for which there are no well-accepted therapies. A physician may respond, for example, by using a drug “off-label” (i.e. to treat a condition for which it is not FDA-approved) or develop a new procedure with the aim of providing more benefit to the patient with less harm than standard approaches permit [1]. An innovative therapy is an unproven treatment approach used in clinical practice for the benefit of a patient. It contrasts with clinical research, which aims at testing the efficacy of an investigational therapy. However, since clinical practice and research often take place in the same facility under the supervision of the same physicians and the use of a novel therapy may both benefit a patient and generate new scientific knowledge, it is not always clear whether a novel therapy is innovative or investigational.