AMERICAN COLLEGE OF EMERGENCY PHYSICIANS PEDIATRIC EMERGENCY MEDICINE COMMITTEE

Tuesday, October 27, 2015
Boston Convention and Exhibit Center, Room 162 A, B
9:00 — 10:30 am Eastern

— Meeting Minutes —

Committee Members Attending
Madeline Joseph, MD, FACEP (Chair) • Michael Gerardi, MD, FACEP • Lee Benjamin, MD, FACEP (out-going Chair) • Debra Perina, MD, FACEP (Board Liaison) • Jeff Bullard-Berent, MD, FACEP (Pediatric EM Section Chair) • Chris Amato, MD, FACEP • Jahn Avarello, MD, FACEP • Alex Aroyo (guest) • Steve Baldwin, MD • Kathleen Brown, MD, FACEP • Paul Eakin, MD • Phillip Friesen, DO • Marianne Gausche-Hill, MD, FACEP • Alan Heins, MD• Douglas Holtzman, MD, FACEP, FAAP • James (Jim) Homme, MD • Tim Horezcko, MD • Paul Ishimine, MD, FACEP • Carrie Karsters (guest) • Sharon Mace, MD, FACEP• Kurtis Mayz, JD, MD, MBA • Jennifer Mitzman (guest) • Lauren Olivera, DO • Audrey Paul, MD, PhD • Dennis Pauze, MD, FACEP • Nadia Pearson, DO • Emory Petrack, MD • David Rayburn, MD, MPH • Josh Rocker, MD, FAAP, FACEP • Emily Rose, MD • Tim Ruttan, MD • Moh Saidinejad, MD
Joelle Simpson, MD, MPH • Mike Stoner, MD • Jonathan Valente, MD, FACEP • Jessica Wall, MD • Muhammad Waseem, MD, MS • Dale Woolridge, MD, PhD, FACEP • Lindsay Peters, ACEP Staff • Dan Sullivan, ACEP Staff

I. Welcome (Dr. Joseph)

II. Brief Introductions of Attendees
– Appreciation to Dr. Benjamin, outgoing Chair
– Appreciation to Dr. Perina, Board of Directors liaison

III. Board Liaison Report (Dr. Perina)
The Clinical Emergency Data Registry (CEDR) is very important and represents a big win for ACEP and emergency medicine physicians. She encouraged the Committee to get involved with CEDR. Elements to note include:
• CEDR will dovetail in with MOC.
• Reporting quality measures to CMS. Pediatric quality measures will be developed.
– The Pediatric EM Committee will be called upon to create quality pediatric EM measures, and for advice on how to include children in general quality measures
• Drs. Mace, Perina, and Brown all spoke to support CEDR.

All Pediatric EM Committee items that were sent to the October 2015 ACEP Board of Directors were approved. The Board approved without any questions, and with commendation. Briefly, those items include the following:

• Mental Health Emergencies in Pediatrics (Objective 2)
Will be submitted to Annals or another journal for publication consideration

• Develop resources to encourage emergency medicine residents to enter pediatric emergency medicine and improve competency of training. Address patient age limits and determine conditions that span all age groups. (Objective 9)
Informational update memo sent to Board.

• Develop screening tools to help identify students at risk for committing violent acts and actions that can be taken to address bullying and psychiatric distress (Objective 11)
Will be submitted to Annals or other journal for publication consideration

• Policy Evaluation/Sunset item
Evaluation and Treatment of Minors (Objective 14C)
Sent to Board for Comment; they have until November 6 to comment.

Lastly, Dr. Perina encouraged members to reach out to her, Committee Chair Madeline Joseph, and staff liaisons, Ms. Peters and Mr. Sullivan.

IV. How the Committee Works / Review Expectations of Committee Members (Dr. Joseph)
Dr. Joseph provided a brief overview of how the committee works:

• ACEP Committees provide important leadership to ACEP members, its Board and Council. Each Committee is appointed by the President to assist with activities for the year. ACEP has more than 30 committees and task forces working on issues such as ethics, emergency medicine practice, pediatric emergency care, disaster medicine and more.

• ACEP committees are members appointed by the President to assist the Board of Directors in its work and serve as work groups with specific responsibilities assigned by the President. Committee members serve for a specific period of time and are accountable to the President for achievement of assigned objectives. Task forces operate much like committees, but once their work is complete they are deactivated.

• The majority of committee work is accomplished through e-mail and conference calls.

Dr. Joseph also indicated her expectations of committee members: she wants each member to be involved with at least two objectives. Ideally, members will volunteer to work on objectives they are passionate about.

V. Review of Committee 2014-15 objectives (Dr. Joseph)

1. Work with the CDC as part of a panel of experts in the development of guidelines for Mild Traumatic Brain Injury (ongoing objective)
Madeline Joseph, MD, FACEP (Lead)
Ann Dietrich, MD, FACEP
Status: Ongoing in 2015-16

2. Work with the AAP to finalize the clinical report on mental Health Emergencies in Pediatrics (ongoing objective)
Sharon Mace, MD, FACEP (Lead)
Entire Committee for review
Status: Objective completed.

3. Be integrally involved with the National Pediatric Readiness Survey and work with the Public Relations Committee to assure that emergency medicine is appropriately represented when results are made available to the public (ongoing objective)
Marianne Gausche-Hill, MD, FACEP (Lead)
Kathleen Brown, MD, FACEP
Mohsen Saidinejad, MD
Isabel Barata, MD, FACEP
Lee Benjamin, MD, FACEP
Timothy Ruttan, MD
Status: Ongoing in 2015-16

4. Develop and disseminate education materials regarding topical anesthetics for children as directed by Amended Resolution 48(13) Topical Anesthetics in the ED (ongoing objective)
Sharon Mace, MD, FACEP (lead)
Paula Whiteman, MD, FACEP
Jahn Avarello, MD, FACEP
Brett Rosen, MD
Aderonke Ojo, MD, MBBS
Jonathan Valente, MD, FACEP
Emily Rose, MD
Status: Ongoing in 2015-16. Anticipate completion in Q1 or Q2, 2016.

5. Work with AAP to develop strategies for strengthening communication and optimizing resource utilization between general emergency medicine and pediatric emergency medicine and produce a paper on the systemization of health care of pediatric emergency services and optimizing interfacility transfers.
Joseph, Madeline (MD, FACEP) (Lead)
Barata, Isabel (MD, FACEP)
Benjamin, Lee (MD, FACEP)
Brown, Kathleen (MD, FACEP)
Carr, Brendon (MD)
Cohen, Ariel (MD)
Dietrich, Ann (MD, FACEP)
Edgerton, Elizabeth (MD, MPH)
Gausche-Hill, Marianne (MD, FACEP)
Gerardi, Mike (MD, FACEP)
Ishimine, Paul (MD, FACEP)
Mickalide, Angela (PhD, MCHES)
Ojo, Aderonke (MD, MBBS)
Paul, Audrey (MD, PhD)
Pines, Jesse (MD, MBA, FACEP)
Rosen, Brett (MD)
Ruttan, Timothy (MD)
Saidinejad, Mohsen (MD)
Shook, Joan (MD, FACEP)
Valente, Jonathan (MD, FACEP)
Woolridge, Dale (MD, PhD, FACEP)
Dan Sullivan (ACEP Staff)
Lindsay Peters (ACEP Staff)
Status: Ongoing in 2015-16

6. Work with the AAP to complete development of the medication safety guidelines (ongoing objective)
Lee Benjamin, MD, FACEP (Lead)
Paula Whiteman, MD, FACEP
Dale Woolridge, MD, PhD, FACEP
Status: Ongoing in 2015-16. Anticipate completion in Q1 or Q2, 2016.

7. Work with AAP on the Emergency Information Form (ongoing objective)
Steve Baldwin (Lead)
Ariel Cohen
Muhammad Waseem, MD
Status: Ongoing in 2015-16. Anticipate completion in Q1 or Q2, 2016.

8. Contribute to the ACEP-AAP project regarding access to care (new objective)
Subcommittee members:
Kathleen Brown, MD, FACEP (Lead)
Isabel Barata, MD, FACEP
Ann Dietrich, MD, FACEP
Paul Ishimine, MD, FACEP
Kyle Marshall, MD
Timothy Ruttan, MD
Mohsen Saidinijad, MD
Status: Ongoing in 2015-16.

9. Develop resources to encourage emergency medicine residents to enter pediatric emergency medicine and improve competency of training. Address patient age limits and determine conditions that span all age groups. Work with the Academic Affairs Committee as needed (new objective)
Peds EM Committee is lead
Ann Dietrich, MD, FACEP (ACEP Lead)
Kyle Marshall, MD
Kurtis Mayz
Emily Rose, MD
Ariel Cohen
Chris Amato
Gillian Schmitz, MD, FACEP (Chair, Academic Affairs Committee) gillianmd@gmail.com
AAC reps to Peds Committee:
Jacqueline Cappiello Dziedzic: jcdziedzic@lumc.edu
Doug Trocinski: dtrocinski@nc.rr.com
Daniel Dire: dire@uthscsa.edu
Status: Ongoing in 2015-16.

10. Develop educational products to inform the public about the importance of pediatric vaccinations. Work with AAP and Public Relations Committee as needed (new objective)
Paul Eakin, MD, FAAP, FACEP (Lead)
Arwen Declan, MD
Sanjay Mehta, MD, MEd, FACEP
Lauren G. Oliveira, DO
Gerald Schwartz, MD, FACEP
Status: Ongoing in 2015-16.

11. Develop screening tools to help identify students at risk for committing violent acts and actions that can be taken to address bullying and psychiatric distress (ongoing objective)
Muhammad Waseem, MD, MS (Lead)
Audrey Paul, MD, PhD
Gerald Schwarz, MD, FACEP
Denis Pauze, MD, FACEP
Paul Eakin, MD
Isabel Barata, MD, FACEP
Doug Holtzman, MD, FACEP
Status: Objective completed.

12. Explore development of a policy statement or information paper on the treatment of pediatric patients at “minute clinics/retail clinics” (new objective)
Mohsen Saidinejad, MD (Lead)
Alan Heins, MD
W. Scott Russell, MD
Phillip Friesen
Andrew Sloas
Status: Ongoing in 2015-16. Anticipate completion in 2016.

13. Work with the Maintenance of Certification/Maintenance of Licensure Subcommittee as needed to develop Maintenance of Certification and pediatric safety/quality products. (MOC/MOL Subcommittee lead) (new objective)
Richard M. Cantor, MD, FACEP (Lead)
Ariel Cohen, DO
Jahn Avarello, MD, FACEP
Kiyetta H. Alade, MD
Samuel H-F Lam, MD, FACEP
Kurtis Mayz, JD, MD, MBA
Brian P. Sanders, MD
Status: Ongoing in 2015-16.

14. Revise the following policy statements as part of the policy sunset review process:

a) Corporal Punishment of Children (ongoing)
Nadia Pearson, MD (Lead)
Douglas Holtzman, MD, FACEP
Status: Ongoing in 2015-16. Anticipate completion in Q1 or Q2, 2016.

b) Emergency Information Form for Children with Special Health Care Needs (ongoing)
Sanjay Mehta, MD, MEd, FACEP
Steve Baldwin
Status: Ongoing in 2015-16. Anticipate completion in Q1 or Q2, 2016.

c) Evaluation and Treatment of Minors (ongoing)
Lee Benjamin, MD, FACEP (Lead)
Paul Ishimine, MD, FACEP
Madeline Joseph, MD, FACEP
Sanjay Mehta, MD, MEd, FACEP
Status: Objective completed.

d) Immunization of Adults and Children in the ED (w/Public Health & Injury Prevention Committee – lead) (new)
Isabel Barata, MD, FACEP (indicated interest)
Dale Woolridge, MD, PhD, FACEP (indicated interest)
Alan Heins, MD
Gerald Schwartz, MD, FACEP
Status: Objective completed.

e) Guidelines for Care of Children in the Emergency Department (new)
Marianne Gausche-Hill, MD, FACEP (Lead)
Timothy Ruttan, MD
Sanjay Mehta, MD, MEd, FACEP
Kathy Brown
Lee Benjamin
Isabel Barata, MD, FACEP
Status: Ongoing in 2015-16. Anticipate completion in 2016.

VII. 2015-2016 NEW Committee Objectives (Dr. Joseph & Subctte chairs)

Note that many of these objectives carry over from last year, and were noted also in the 2014-15 objectives. Because they are ongoing, they receive additional attention here.

1. Work with the CDC as part of a panel of experts to complete the development of guidelines for Mild Traumatic Brain Injury. (carry over objective)
Dr. Joseph indicated the project was almost complete. Much of this work can be used in different ways, possibly with CEDR. She anticipated that these guidelines will be completed and published in 6-9 months.
Because the project is owned by the CDC and is far along in the process, this objective is not receiving any new committee members,

2. Be integrally involved with the National Pediatric Readiness Survey and work with the Public Relations Committee to assure that emergency medicine is appropriately represented when results are made available to the public. (carry over objective)
Dr. Benjamin provided update along with Dr. Gausche-Hill. ACEP is working with AAP, EMSC, ENA to have unified voice to speak to public. Next steps are to take data and improve quality of care. A group of stakeholders will meet in Chicago in November to discuss next steps.

New members are welcome to join this objective. It is a “lifetime” objective.

Dr. Gausche-Hill recounted that papers based on the Readiness Survey data have been published, and those papers were highly publicized in national and local newspapers. Furthermore, the Readiness web portal is open, so hospitals can constantly go in and get information on pediatric readiness.

Dr. Brown also noted that NEDARC will re-open portal on November 1. Hospitals can voluntarily log in and see gap report, compare current readiness to earlier readiness. This will enable hospitals to measure their outcomes. Additionally, she noted that ACEP is working on developing pediatric readiness with specific quality measures

ACEP is working on developing measures (developmental measures) for the registry. And AAP and ENA will ask for organizational approval (along with ACEP) for support.

Dr. Gausche-Hill concluded by saying that the Readiness Survey team is working with ACEP to develop MOC with data based on readiness data. EM physicians can work together to improve readiness, and earn MOC credit. Overall, it is a very good idea and development will continue.

3. Work with the American Academy of Pediatrics (AAP) to develop strategies for strengthening communication and optimizing resource utilization between general emergency medicine and pediatric emergency medicine. Develop an information paper on the systemization of pediatric emergency services and optimizing inter-facility transfers. (carry over objective)
This objective is closely related to Objective #2. Dr. Joseph is serving as the chair for this objective, and the objective is open to receive new members. The subcommittee is working to complete a white paper on the topic.

Objectives 2 and 3 are closely related

4. Work with the AAP to complete development of the medication safety guidelines. (carry over objective)
Dr. Benjamin reported that the document is almost completed, with the anticipated completion in Q1 or Q2, 2016. Because of this, new members are not being solicited to join the objective. The subcommittee is preparing the document for submission to Board, and then for publication. The primary work at the moment is to shorten the document.

5. Work with AAP on the Emergency Information Form. (carry over objective)
Dr. Baldwin reported that the subcommittee plans to focus on 1 – 2 key elements in the overall document. AAP will have near-final draft in next many months, with the anticipated completion in Q1 or Q2, 2016. The document will largely recapitulate what is already out in literature, and focus on updates. The subcommittee will need people to review the draft that comes from the AAP in a few months. Anticipated completion is in Q1 or Q2, 2016.

6. Contribute to the ACEP-AAP project regarding access to care. (carry over objective)
Dr. Brown reported that revision of a joint statement with AAP was underway. COPEM will review it in next 2 months.

7. Develop resources to encourage emergency medicine residents to enter pediatric emergency medicine and improve competency of training. Work with the Academic Affairs Committee as needed. (Pediatric Emergency Medicine is the lead committee.) (carry over objective)
Dr. Amato reported on this objective. The goal is to encourage EM trained residents to go into PEDS EM fellowship. EMRA Resident Magazine will publish article in up-coming issue.

One discussion is the difference in fellowship duration and training standards, which causes some confusion. The pool of candidates for Peds EM fellowship has dropped precipitously. Fellowship directors meeting may be good place to discuss this concern. .
Dr. Gausche-Hill noted that ACEP may want to work with AAP on this item. Peds – Peds EM training tracks may present barriers to EM residents. However, being Peds EM trained is a powerful marketability tool for those who complete the training.

On a separate note, the Subcommittee is engaged in discussions about developing a jointly sponsored meeting with SAEM.

Dr. Gausche-Hill will forward material to Dr. Amato.

Dr. Ishimine spoke, commenting that the problem is that there are few role models in AAP to advocate for EM Peds training. Without significant representation on AAP committee, it’s hard to argue the benefits of Peds-trained EM docs.

Dr. Joseph said that there are 15-18 PEM programs that are based in Emergency Medicine Departments, which is a significant number of programs.

Dr. Joseph re-emphasized the importance of combining this objective with a meeting composed of AAP, ACEP, SAEM stake holders in 2017-18.
There is room in this objective for new members. Help from new members needed.

Dr. Homme said there is not enough information being given about the value added by a peds-specific fellowship. He is passionate about it. Fellowship trained EM docs do bring great value to the quality of care.

Dr. Amato mused and asked if it is a matter of fellowship timing? Is it a monetary issue?

Dr. Benjamin said this is an evolving playing field. There is much room to discuss, and the subcommittee needs more members. The value proposition needs to be communicated and champions needed for this. Dr. Joseph concurred and emphasized that pediatric EM needs champions!

Dr. Wall noted that she founded the EMRA Peds division. She developed a survey for this topic, which she will email to the committee.

8. Define medical conditions that span all age groups and would be appropriate for pediatric emergency physicians to evaluate and treat. New objective
Dr. Joseph said this is a separate objective, originally derived from objective #7. It gets at scope of care for Peds EM doctors. What adult patients/conditions can Peds EM doctors comfortably treat? It is a very important objective, complex, involved, but the Committee is flexible with whatever end product is developed. Dr. Gerardi: This objective has a medical component, and work force component, and legal component, and transition age patients with specific diseases. Maybe Peds EM docs should be more comfortable with patients in transition patients.

Someone with legal background could help with this objective.

The subcommittee needs a chair and members.

The committee discussed how to develop the goal for the objective: should the goal be developed using a rational, evidence-based rationale?

Dr. Bullard-Barrent wondered out loud whether this would be a good topic to collaborate with the AAP. Topic may also work well with the SAEM pre-conference meeting as well (see objective 7).

9. Review ACEP’s policy statement, “Firearm Safety and Injury Prevention,” determine if revisions are needed specific to pediatrics. Work with the Public Health & Injury Prevention Committee as needed. (Pediatric Emergency Medicine is the lead committee.) New objective
Dr. Joseph encouraged new members to join this objective. Dr. Megan Ranney is the Public Health & Injury Prevention Ctte liaison/lead.

10. Serve as a resource to the Quality & Patient Safety Committee regarding the development of pediatric emergency medicine-specific quality measures. (Quality & Patient Safety is the lead committee.) New objective

Dr. Brown, Dr. Mace and Dr. Perina spoke in support of this objective. Dr. Brown suggested folding in pediatric measures in with general quality measure; it may not be best to develop pediatric-specific measures at first. (See additional notes in 2015-16 objective #2 on this topic.)

Regarding CEDR, Dr. Brown suggested including pediatric patients in with appropriate sepsis measures at present. Later, development of separate pediatric measures would be appropriate and needed, once CEDR matures and becomes more robust.

Dr. Gerardi thought that a couple of pediatric measures should be in the registry, whether evidence-based or not.

Dr. Gausche-Hill suggested that the Committee and CEDR go after “low-hanging fruit” for developing short term pediatric quality measures (including pain medication for fractures, and asthma, febrile newborn febrile, head injury, diarrhea and dehydration). Dr. Heins said that antibiotic use is another example of “low-hanging fruit”. Those measures do have some evidence behind them. Dr. Gerardi and Gausche-Hill said they would collaborate on this.

11. Explore development of a policy statement or information paper on the treatment of pediatric patients at “minute clinics/retail clinics” and the use of telemedicine services. (carry over objective)
Dr. Saidinejad reported; he has written a draft paper. Furthermore, AAP has a policy statement on this topic, dating to 2013. He reached out to the lead author on that paper, and our subcommittee can work with AAP on this item.

The subcommittee has written 2 drafts; the second draft will be circulated to group and needs some minor edits. What should urgent care centers be able to do/what level of care should they be able to provide? He asked for committee as a whole to help to review the policy statement. Once it has been reviewed by the Committee, they will send it to AAP.
New members are welcome to subcommittee.

12. Revise the following policy statements as part of the policy sunset review process:
• Corporal Punishment of Children (carry over objective)
The draft is written, but Dr. Pearson requested help and called for volunteers to assist.

• Emergency Information Form for Children with Special Health Care Needs (carry over objective)
Dr. Baldwin is moving forward with the objective. They are involved with AAP on it.
Dr. Gerardi said he will contact Dr. Baldwin about this.

• Guidelines for Care of Children in the ED (carry over objective)
Dr. Brown is working on this objective. AAP and COPEM will discuss it, and Dr. Gausche-Hill and Dr. Brown will be involved. NARC also involved. EMSC is funding agency, and may have funds to sponsor people to attend that meeting. ACEP will seek to send two participants from the Pediatric EM Committee in February 2016.

13. Serve as a resource to the EMS Committee in working with the EMS-C and other stakeholders to explore the need for new or revised guidelines and strategies’ for pediatric prehospital care. (EMS is the lead committee.) New objective
Dr. Brown said new guidelines for EMS care are being developed, and she is the EMS lead author. Dr. Gausche-Hill is also co-lead for the EMS Committee. ENA is also involved.
New subcommittee members are welcome.

14. Work with the Maintenance of Certification/Maintenance of Licensure Subcommittee as needed to develop Maintenance of Certification and pediatric safety/quality products. (MOC/MOL Subcommittee lead.) (carry over objective)
This objective requested new members. This objective can tie in to CEDR, and is a very important objective because it crosses over with other projects the Pediatric EM Committee is doing. A Chair and co-chair are needed.

15. Complete development and dissemination of education materials regarding topical anesthetics for children as directed by Amended Resolution (48)13 Topical Anesthetics in the ED. (carry over objective)
Dr. Mace is subcommittee Chair, and the paper is near completion. The subcommittee anticipates it can send the final document to the Board in Q1 or Q2 2016.

VIII. New Business (Dr. Joseph)

• Dates for the 2016 Pediatric Committee conference calls
Note: All calls take place on Thursdays, 1 pm EST
– February 11, 2016 at 1 pm EST
– Live meeting at Advanced Pediatric Assembly, Orlando, FL
Wednesday, March 9 11:00 am — 12:30 pm
– May 5, 2016 at 1 PM EST
– July 7, 2016 at 1 PM EST
– September 8, 2016 at 1 PM EST
– Live meeting at ACEP16, Las Vegas, NV

• Advanced Pediatric Assembly in March in Orlando, FL
March 8-10, 2016

• Accepting Nominees for PEMSoft / EBSCO Award for Achievement in Pediatric EM until November 9. Please contact Dan Sullivan with any questions or nominations.

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