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  • July 18, 2018 12:29 PM | Sally Winkelman (Administrator)

    Ben Ho, MD
    WACEP Board Member

    For many of us summer in Wisconsin means time spent outside, whether on a trail, by the lake, in our yards, or if we are lucky, somewhere on a tropical vacation.  As we enjoy the activities that we love, however, we knowingly expose ourselves to a number of seasonal environmental factors: heat, UV light, and of course, ticks and mosquitoes.  We may know these arthropods best as nuisances that crash our barbecues and hitchhike on our trail walks.  As vectors for important communicable diseases, however, their significance goes much beyond this.

    Earlier this spring, the Department of Health and Human Services and the Center for Disease Control published a review of vectorborne pathogen transmission in Morbidity and Mortality Weekly Report.  Using data from the National Notifiable Disease Surveillance System, the authors reported on trends in both tick- and mosquito-borne illnesses from 2004, the first year that arboviral illnesses became notifiable, to 2016, within the United States and its Territories.  The report not only indicates a global increase in the incidence of vectorborne illnesses throughout the United States, but also identifies unique patterns of transmission at the local level.  Two general patterns are evident.  Tickborne illness reports rose steadily, doubling over the 13-year study period, and their greatest impact was on the eastern half of the country.  While Lyme disease accounted for more than 82% of tickborne illness reports, other diseases such as anaplasmosis, ehrlichiosis, Rocky Mountain Spotted Fever, and babesiosis also increased in identification.  The occurrence of mosquito-borne illnesses, on the other hand, was punctuated by epidemics, and was much more geographically dispersed.  While endemic outbreaks of Zika, Dengue, and chikungunya were limited to the Territories, local transmission in the Southeast was likely due to infected travelers returning home from these areas.

    A number of messages can be taken from this report.  Although Lyme disease might be the illness that we consider most commonly in Wisconsin, the world of vectorborne diseases includes many more pathogens.  In fact, if the next twelve years is anything like the last, we should expect increasing incidences of all kinds of different tick- and mosquito-borne illnesses.  The epidemiology of these diseases is unique, largely because transmission depends heavily on environmental factors such as the geographical range of their hosts, the feeding cycles of their vectors, temperature, and rainfall patterns.  Regions that were once too cold for ticks may eventually see Lyme disease; mosquito-borne illnesses once limited to tropical climates may creep further into the continental U.S., encouraged by heat waves, deforestation, flooding patterns, and human travel.  It already appears that the physical range of A. aegypti is increasing, setting the scene for outbreaks of dengue, Zika, and chikungunya in years to come.  To make matters worse, there are not many vaccines available to protect us (Rosenberg et al., 2018).  As the world around us changes, so will the diseases that we see and treat.

    Despite these challenges, there are several things that we can do as physicians and health advocates to address the growing threat of vectorborne illnesses.  As with everything in medicine, awareness of these diseases and having appropriate clinical suspicion based on history and physical exam will not only aid in diagnosis and treatment of our patients, but also improve reporting of disease transmission.  We can also reinforce common-sense strategies to limit transmission of these diseases to our patients: wearing long-sleeves and pants in tick and mosquito habitat, avoiding exposure during mosquito feeding times, keeping outdoor spaces clear of leaf litter and standing water, performing frequent tick checks on fellow humans and pets, and protecting ourselves with Deet and permethrin.  The world may indeed be changing, but our process of limiting risks and exposures to vectors have not.

    As a final point – have you ever wondered how effective the combination of Deet and permethrin is in deterring mosquito bites?  A study done in the 1980’s by the U.S. Air Force compared mosquito bite rates on control subjects wearing no protection verses subjects treated with 35% Deet and/or permethrin at a remote test site in Alaska.  Subjects using both 35% Deet and permethrin-treated clothing experienced only one mosquito bite per hour; subjects using no protection experienced on average 1,188 mosquito bites per hour, with a maximum rate reported at 3,360 bites per hour (Lillie et al., 1988).  There are two clear take-aways from this study: 35% Deet combined with permethrin offer excellent protection against mosquitoes, and never volunteer as a research subject for the Air Force.

    References:

    Rosenberg R, Lindsey NP, Fischer M, Gregory CJ, Hinckley AF, Mead PS, Paz-Bailey G, Waterman SH, Drexler NA, Kersh GJ, Hooks H, Partridge SK, Visser SN, Beard CB, Petersen LR. 2018. Vital signs: trends in reported vectorborne disease cases – United States and Territories, 2004-2016. MMWR-Morbid Mortal W. 67(17): 496-501.

    Lillie TH, Schreck CE, Rahe AJ.  1988.  Effectiveness of personal protection against mosquitoes in Alaska.  J Med Entomol. 25(6): 475-478.

  • July 17, 2018 12:17 PM | Sally Winkelman (Administrator)

    ACEP’s Quality Division is hosting a webinar “Hear from the Authorities: CMS moving from Volume to Value. The near and long term future of MACRA policy and MIPS scoring.” on Jul 25, 2018 at 1:00 PM CDT. 

    Register: https://attendee.gotowebinar.com/register/2256949217905190401

    After registering, you will receive a confirmation email containing information about joining the webinar.

  • July 16, 2018 10:32 AM | Sally Winkelman (Administrator)

    July 12, Wisconsin Health News

    Workers’ compensation premiums for businesses are set to decline by 6.03 percent this October, according to a statement from the Department of Workforce Development.  

    That could result in an estimated $134 million in annual savings for businesses, the Tuesday statement noted. It’s the third year that workers’ compensation rates have declined, following an 8.46 percent decrease last year and a 3.19 percent decline in 2016. 

    “A safe workplace results in a more productive and profitable one for employers,” Ted Nickel, insurance commissioner, said in a statement. "Employers are recognizing the relation between their employees' safety and the savings that ensue as premiums continue to decline." 

    Mark Grapentine, senior vice president of government relations for the Wisconsin Medical Society, said the report shows that “good news keeps coming” for the state’s workers’ compensation program. 

    “We’re already a national model, with faster return to work, fantastic patient satisfaction and ready access to the highest-quality healthcare in the nation – all at a cost per claim that is below the national average,” he wrote in an email. “Another significant insurance rate reduction is just more evidence that Wisconsin’s system is win-win for both businesses and their employees.” 

    Grapentine added that there’s room for improvement, pointing to a need for the state’s on-the-job injury rate drop below the national average. He added that healthcare providers are “always striving to find better ways to improve care.” 

    Chris Reader, director of health and human resources policy, also lauded the announcement. He said the reduction follows a national trend as employers and workers have invested in and focused on safety. But he noted that costs for medical treatment for workplace injuries are on the rise. 

    “Had Wisconsin enacted a medical fee schedule like almost every other state, medical costs also would have been kept in check and the insurance reduction today would have been even greater," he wrote in an email. 

    Reader also argued that the rate reduction doesn’t mean much to fully-insured employers who don’t pay insurance costs and are left footing “incredibly high medical bills.” 

    Proposals to establish a fee schedule haven't gained traction with lawmakers.

  • July 16, 2018 10:31 AM | Sally Winkelman (Administrator)

    The annual Wisconsin Health News CEO Roundtable is August 14 in Madison. A panel of the state’s leading health system and hospital leaders will discuss the most pressing issues facing their industry. Panelists include: 

    • Dr. Sue Turney, CEO, Marshfield Clinic Health System 
    • Robert Van Meeteren, CEO, Reedsburg Area Medical Center 
    • Dr. Alan Kaplan, CEO, UW Health 

    Register now (link).

  • June 27, 2018 12:09 PM | Sally Winkelman (Administrator)

    The Wisconsin Supreme Court issued its ruling today in the Ascaris Mayo v. Wisconsin Injured Patients and Families Compensation Fund case to uphold the $750,000 cap on noneconomic damages, thus restoring medical malpractice caps in Wisconsin.

    In January, a coalition of medical specialty organizations jointly filed an amicus brief with the Supreme Court in support of the cap. The collaborative efforts of Wisconsin’s medical community resulted in a major victory for physicians and helped preserve access to healthcare across Wisconsin.

    An amicus brief was filed on behalf of the Wisconsin Chapter of the American College of Emergency Physicians, the Wisconsin Academy of Family Physicians, the Wisconsin Academy of Ophthalmology, the Wisconsin Orthopaedic Society, the Wisconsin Psychiatric Association, the Wisconsin Radiological Society, the Wisconsin Society of Anesthesiologists, and the Wisconsin Society of Plastic Surgeons by Guy DuBeau and Axley Brynelson, LLP.

    The case centers around Ascaris Mayo, who lost her limbs after a Milwaukee emergency room failed to identify an untreated infection. A court awarded her economic damages as well as $15 million intended to compensate for pain and suffering.

    The state’s Injured Patients and Families Compensation Fund, which covers large medical malpractice claims in the state, moved to reduce the $15 million to $750,000. An appeals court backed the award and ruled the law unconstitutional.

    Chief Justice Patience Roggensack wrote the majority opinion upholding the law, in part because she said the Legislature acted rationally when creating the law.

    “We conclude that the Legislature's comprehensive plan that guarantees payment while controlling liability for medical malpractice through the use of insurance, contributions to the fund and a cap on noneconomic damages has a rational basis,” she wrote. “Therefore, it is not facially unconstitutional.”


  • June 20, 2018 1:27 PM | Sally Winkelman (Administrator)

    Join the Wisconsin Society of Addiction Medicine on Saturday, September 29, 2018 in Madison for a high-impact workshop day designed to provide education on high quality, evidence-based practices.

    The case-based learning format is designed for front line clinicians and trainees who have faced and will face the challenge of helping patients with substance use disorders. Clinicians who will benefit include nurse practitioners, physician assistants, primary care providers, emergency room providers, and other sub-specialists. Two morning and one afternoon options are available, including:

    • The ASAM Treatment of Opioid Disorder Course: Focus on Buprenorphine
    • Naltrexone in Treatment for Alcohol and Opioid Use Disorders: Case Studies and Practical Applications
    • Buprenorphine 2.0: I Have My X-DEA, So Now What? Case Studies and Practical Applications

    Learn more and register.

  • June 19, 2018 11:25 AM | Sally Winkelman (Administrator)

    FitWell is a wellness initiative of the Wisconsin Chapter, ACEP, that encourages members to exercise and share their successes. The contest is open to Wisconsin EM physicians, EM residents, medical student members of an EMIG, and APPs. One contest participant will be randomly selected to win a WACEP braded fleece, and $200 to be applied toward a gym/club membership of their choice. Contest Guidelines include:

    • On Twitter or Instagram using hashtag #fitwellWACEP, post pics of yourself being active, during a workout, or tips on how to squeeze physical activity into your busy day. Make sure your posts are public!
    • Tag your EM friends on your posts and your entries will count double!
    • One entry per post with unlimited entries.
    • All entries must be posted by August 31, 2018. Winner will be chosen by random drawing on September 1st.

    Questions? Contact us at WACEP@badgerbay.co.

  • June 19, 2018 10:27 AM | Sally Winkelman (Administrator)

    Suzanne Martens, MD
    State of Wisconsin EMS Medical Director

    The Advancing a Healthier Wisconsin Endowment has awarded funding to the Wisconsin EMS Association, which will help expand a Milwaukee County pilot project for dispatcher-assisted CPR instructions statewide. 

    The Milwaukee County Dispatcher Assisted Bystander CPR program was created to increase the overall cardiac arrest survival rate within the Milwaukee County. Through the program, dispatcher assisted bystander CPR pre-arrival instructions are made available to all callers in the County. 

    Out-of-hospital cardiac arrest is a significant health problem. In Milwaukee County, only 10% of out-of-hospital cardiac arrest patients survive to hospital discharge. When CPR is started by bystanders, the odds of survival double, however, bystander CPR is attempted on only 19% of cardiac arrest victims in the County. This rate could be improved if every 911 caller received CPR coaching. With the implementation of dispatcher assisted CPR instructions in Seattle, Washington, the rate of bystander CPR doubled and survival rates for the entire County increased. 

    2017 Wisconsin ACT 296Dispatcher Assisted CPR, mandates that by May 21, 2021, every Public Safety Answering Point (PSAP) will provide dispatcher assisted CPR in one of two methods, either by dispatcher training or call transfer to a trained PSAP. This program will also include monitoring and continuous quality improvement. Act 296: 

    • affords protection from civil liability in performance of dispatcher assisted CPR;  
    • provides $250,000 for fiscal year 2017-18 in funding for emergency dispatcher CPR; 
    • specifies that DHS must include a proposal for funding an emergency dispatcher CPR training in its 2019-21 biennial budget request; 
    • creates a 0.5 full-time equivalent position in DHS to administer the emergency dispatcher CPR training grant program. 

    The bill was strongly supported by members of the WI EMS Advisory Board, as well as representatives from the American Heart Association, and its enactment was recognized on the HeartRescue Project website

    The Milwaukee County EMS dispatch pre-arrival instructions for CPR are freely available. PSAPs that pursue training will require assistance and medical oversight. EM and EMS physicians will be asked to support these programs and their community. Start asking questions and becoming involved now. Three years is not a lot of time to enact this vital public safety program, and sooner is better.

  • June 18, 2018 2:32 PM | Sally Winkelman (Administrator)

    Lisa Maurer, MD, FACEP

    At the risk of addressing a sensitive topic perhaps not ideally discussed via email newsletter, WACEP needs feedback from our members on how, or if, we should be involved in possible future Wisconsin firearm regulations.  

    Inspired by Dr. Stephen Hargarten’s presentation at WACEP Spring Symposium 2017, I believe there is room for growth in how physicians discuss firearm safety from a health perspective while steering clear of political biases.  Who better to give input than my colleagues working in Wisconsin’s EDs every day? 

    This will be a timely legislative topic for Wisconsin in the near future, judging by the fact that the Wisconsin Legislative Council released an Information Memorandum on Firearm Regulation this last session.  If we should be involved in possible future regulations, it is useful to learn about the regulation currently in place in Wisconsin.  The memorandum summarizes that Wisconsin’s constitution gives people have the right to keep and bear arms for security, defense, hunting, recreation, or any other lawful purpose.  Current regulations (including pertinent federal laws):

    • Prohibit possession of a firearm by individuals who are: convicted of a felony or domestic violence crime, involuntarily committed under chapter 51 statute, adjudicated incompetent, addicted to any controlled substance, or under the age of 18;
    • Permit background checks in specific scenarios such as purchasing a firearm from a federal firearm licensed dealer or to apply for a license to carry a concealed weapon;
    • Impose penalties for transferring firearms to an ineligible person or providing false information;
    • Provide geographic restrictions on carrying a firearm.  For example, a person may not carry a firearm onto a public or private property if the owner has notified the person not to enter while carrying a firearm, into a school zone, or in a vehicle for the case of loaded long guns; and
    • Regulate certain devices such as fully automatic firearms, armor-piercing ammunition, and special processes for obtaining silencers. 

    Our country has seen growing momentum for a particular type of firearm regulation known as “red flag laws,” where courts and police may temporarily seize an individual's firearms if they are thought to be a threat to self or others.  This type of regulation now exists in six states and is being considered in 20 more, including Wisconsin.  The specifics of the “red flag” laws vary from state to state.  Generally, police may only seize firearms owned by the individual in question, even if there may be other firearms in the home owned by others.  The individual typically has an annual opportunity to petition the court for return of their firearm, although that time interval may be shorter in some states.  Also, the definition of “thought to be a threat” can be described as “substantially likely to harm” or the more difficult to prove, “imminent danger.”  Likewise, the type of individuals permitted to make this judgement of threat varies among states.  Some states specify that immediate family members may be the ones to notify police, whereas other states include household members or other close contacts.

    To my knowledge, no state includes physicians in the list of specific contacts that may alert law enforcement for the purpose of firearm possession regarding an individual thought to pose a threat to themselves or others.  Should Wisconsin include physicians as they consider “red flag” laws?  This is ironically reminiscent of our statutes regarding involuntary holds for psychiatric disease that may render an individual an imminent threat to themselves or others.  Seeing as our state’s process of placing and removing Emergency Detention holds is so unique, should we be the pioneers of implementing a similar system for physicians alerting officers when it may be indicated to remove someone’s firearm?  On the other hand, many emergency physicians in Wisconsin suggest that the Emergency Detention process in our state should be completely revised.  Perhaps we should avoid reinforcing that system by mirroring it in another statute. 

    In summary, WACEP is looking for your opinion: if Wisconsin decides to proceed with a “red flag” firearm regulation, should physicians be among the individuals who are allowed to make the determination of threat to self or others?  Please do send us your thoughts!

  • June 07, 2018 5:17 PM | Sally Winkelman (Administrator)

    Rosalia Holzman, MD
    Univ. of WI Emergency Medicine Residency, Class of 2020

    As I have progressed through my training, I have realized more and more that I cannot expect things to change just because I believe something is wrong or unfair. It takes initiative from those who identify different issues to work towards a solution. It finally occurred to me that this includes myself. I need to speak up for what needs to change. My residency program passed along information about the ACEP Leadership & Advocacy Conference (LAC) and I knew immediately I wanted to go.

    It was an amazing experience (especially for my first national conference as an emergency intern) and I cannot wait to go back again. I met so many motivated and passionate emergency physicians that are going to change our practice and our country for the better. I sat through different sessions on the opioid epidemic, medicare reimbursement, drug shortages, and more. There was an amazing panel discussing women in leadership in emergency medicine and how women like myself need to step up to the table and make ourselves heard. We also had the opportunity to listen to the Surgeon General as our keynote speaker! 

    On top of conference sessions and discussions, we spent an entire day on Capitol Hill advocating for 3 particular issues: the opioid crisis, drug shortages, and disaster preparedness. It was an eventful day working alongside fellow Wisconsin EM physicians. This conference really opened my eyes as to everything that is being done and all of the opportunities there are for me to really advocate for my patients and my profession. I would like to thank WACEP for helping me attend the conference, and I cannot wait to get more involved!

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