Latest News 

  • October 24, 2019 3:10 PM | Sally Winkelman (Administrator)

    The Wisconsin Chapter, ACEP Nominating Committee is now accepting nominations of any member in good standing interested in serving in WACEP leadership.

    WACEP's Board of Directors meets quarterly and provides ongoing strategic oversight as the organization works to advance the effectiveness, sustainability and mission of the Chapter. Board members are expected to participate in all Board meetings, the annual Spring Symposium, and various other activities related to the organization's strategic priorities.

    Nominations are being accepted for the positions listed below (terms begin January 1, 2020):

    • (2) Directors-at-Large on the Board of Directors (4-year term)
    • (4) Councillors to ACEP (3-year term)
    • President-Elect (this is a 3-year commitment, one year each as President-Elect, President and Immediate Past President)
    • Secretary/Treasurer (1-year term)

    If you or any of your colleagues are committed to serving in a leadership capacity and being a resource for information, education, networking and advocacy, we encourage you to get involved Nominations close November 25, 2019. Submit nominations here.

  • October 21, 2019 4:02 PM | Sally Winkelman (Administrator)

    President's Message, October 2019
    Jeff Pothof, MD, FACEP
    WACEP President

    It was well over a year ago when one of my colleagues and fellow flight physician, David Hindle, launched a new conference at our staff meeting.  Entitled “Awesome and Amazing,” it was a case conference that highlighted some of the best medical care teams in the flight program delivered to critical patients.  It seemed like such an obvious thing to share and an effective tool to promote learning and collaboration on our teams, but also 180 degrees opposite from what we as clinicians typically experience.

    I think it’s just human nature to focus on those things that aren’t quite perfect or still need a little fine tuning.  I postulate the rigors of medical education and the hoops we all jump through predispose us to being hypercritical of ourselves.  I’ve been to many a lecture hall to discuss cases at the monthly M&M case review conference.  Most cases would not be well described by the “awesome” adjective.  I’ve looked at the blinded data during performance reviews and must secretly admit that there is a twinge of self-disappointment when I’m not a top performer on any single metric.  I’m not arguing that we shouldn’t learn from our mistakes, and I’m not saying that we shouldn’t continue to hold ourselves to a very high standard.  I do think we’d all be well served by just as frequently looking back to those awesome and amazing moments that seemingly come out of nowhere during our careers.

    I encourage you to take a moment to reflect back to a time when you were part of something that was “awesome and amazing.”  Think about a time when you added immense value and where your presence on a shift or in a room made an inflection point in someone else’s life trajectory.  Anyone who’s committed themselves to a career in emergency medicine has these moments.  I find that looking back to those times helps make that overnight shift that just won’t end a little shorter, or that case where you wish you could have a do-over sting just a little bit less. 

    So, without overly inflating our egos, I embolden all of you to spend a little more time thinking about the awesome and amazing things you’ve done in addition to the things you strive to be better at.  It’s an important balance that paints a more accurate portrait of who we are as emergency physicians.

  • October 18, 2019 4:17 PM | Sally Winkelman (Administrator)

    Editor’s Note: This article appeared in the August 2018 issue of Medigram, a monthly publication of the Wisconsin Medical Society

    Physicians are required by law to report information to entities or individuals such as county health officials or law enforcement in certain situations. Most recently, that includes threats of school violence, which was enacted as part of a school safety law earlier this year.

    Both HIPAA and Wisconsin confidentiality laws allow disclosure of protected health information where such disclosure is required by law. Failure to report as required can result fines, civil or criminal liability and/or professional discipline. Physicians should check with their legal counsel or risk manager if they have questions about when they are required to report information to others and how to do so.

    The following is a summary of some of the more common mandatory reporting obligations applicable to Wisconsin physicians.

    Threats of School Violence—Physicians and other health care professionals who believe in good faith, based on a threat made by an individual seen in the course of professional duties regarding violence in or targeted at a school, that there is a serious and imminent threat to the health or safety of a student or school employee or the public must “immediately inform, by telephone or personally, a law enforcement agency of the facts and circumstances contributing to” that belief. (Wis. Stat. § 175.32)

    Child Abuse and Neglect—Physicians and other health care professionals who have reasonable cause to suspect that a child seen by them in the course of professional duties has been abused or neglected or has been threatened with abuse or neglect must “immediately inform, by telephone or personally,” the county department or local law enforcement of the facts and circumstances giving rise to that suspicion. (Wis. Stat. § 48.981)

    Conduct of Colleagues—Physicians must make a written report to the Wisconsin Medical Examining Board if they have reason to believe a Wisconsin licensed physician:

    • Has engaged in acts constituting a pattern of unprofessional conduct under Wis. Admin Code § MED 10.
    • Has engaged in acts that create an immediate or continuing danger to one or more parties or to the public.
    • Is medically incompetent.
    • Is or may be mentally or physically unable to safely to engage in the practice of medicine or surgery. (Wis. Stat. § 448.115)

    Elder Abuse—Physicians and other health care professionals must file a report with the county department, elder-adult-at-risk agency, local law enforcement, the Department of Health Services or the state board of aging and long-term care if they have reasonable cause to believe that an individual over the age of 60 seen in the course of professional duties, or another elder-at-risk, is at imminent risk of serious bodily harm, death, sexual assault or significant property loss, or if requested to make such a report by the patient. (Wis. Stat. § 46.90)

    Sexual Contact by a Therapist—A therapist who has reasonable cause to suspect a patient or client he or she has seen in the course of professional duties is a victim of sexual contact by another therapist must ask the patient if he or she wants them to report the information and must, if authorized by the patient, report the suspicion to the Department of Safety and Professional Services or the local district attorney within 30 days. (Wis. Stat. § 940.22)

    Danger to Others—Physicians, like all individuals, have a duty of reasonable care in light of foreseeable harm. This may, under certain circumstances, require physicians to warn or take reasonable actions, such as notifying law enforcement or potential targets, if they believe a patient, individuals or the public is at risk of serious and imminent harm as a result of information obtained in the course of providing professional services. Where such a duty may exist, Wisconsin law specifies that it is satisfied by doing one or more of the following: contacting law enforcement, contacting the applicable county department or taking other action a reasonable health care professional would consider as fulfilling a duty to warn a third party of substantial probability of harm under the circumstances (Wis. Stat. § 51.17). Physicians are encouraged to discuss such matters with their legal counsel or risk manager.

    Other—Physicians are required by law to report certain other events or acts to state or local officials, including the following:

  • October 14, 2019 11:00 AM | Sally Winkelman (Administrator)

    Wisconsin ACEP is pleased to be partnering with Hubbard, Wilson & Zelenkova LLC (HWZ) for lobbying and legislative services. The firm is led by seasoned lobbyists with vast experience and exceptional relationships with policymakers across the political spectrum and on both sides of the aisle.  HWZ represents groups and organizations including trade associations, healthcare interests, Fortune 500 companies, trade unions, and state and national non-profits. 

    Greg Hubbard has over 15 years experience representing a wide range of interests and has successfully lobbied on landmark issues in energy, telecommunications, taxation, natural resources and land use.  Formerly, Greg worked for several republican legislators including as Chief of Staff to former Senate Majority Leader Mary Panzer.  During contentious legislative redistricting efforts in 2001, he provided analysis and advice to Assembly and Senate Republican leadership.  Greg is a graduate of the University of Wisconsin-La Crosse. 

    AJ Wilson is a principal at Hubbard Wilson & Zelenkova with nearly two decades of experience in and around the Wisconsin State Capitol. AJ represents clients ranging from trade associations and national non-profits to trade unions and Fortune 500 companies on legislative, regulatory, and procurement issues.  Prior to lobbying, AJ was Chief of Staff to Assembly Democratic Leader Jim Kreuser and spent over seven years in the Wisconsin Legislature developing strategy, crafting legislation, and maintaining critical relations between legislative leadership, members, state agencies, and the Governor's office.  AJ is a graduate of the University of Wisconsin-Madison and earned his JD from the University of Miami School of Law. 

    Ramie Zelenkova has over a decade of experience in lobbying and grassroots advocacy and has worked to maintain strong relationships with legislative members on both sides of the aisle.  Ramie represents a variety of clients including nonprofits, professional associations, trade associations and Fortune 500 companies in areas such as healthcare, long-term care, education and child welfare.  Ramie’s experience includes an extensive background representing client interests before the Wisconsin Department of Health Services with particular experience representing client interests related to the delivery of Medicaid programs. Ramie is a graduate of the University of Wisconsin- Madison.  

    Katie White is Associate at HWZ with ten years of combined government affairs and legislative experience. Katie has crafted and advanced policies and political strategies for diverse clients and interests ranging from education, healthcare, and long-term care to agriculture and energy.   She provides extensive knowledge of the legislative process and excellent relationships with policymakers.  Prior to lobbying, Katie worked for Wisconsin Senator Rob Cowles.  She received her Bachelor’s degree in Political Science from the University of Wisconsin-Madison. 

  • October 03, 2019 2:09 PM | Sally Winkelman (Administrator)

    Annual turnover rate for nurses is 17.5%, and while limited department-level data exists, annual RN turnover rate in the Emergency Department is estimated at 21.5%, the second highest of any medical specialty.  

    To better understand department-level data on turnover rates and the factors associated with them, the Studer Group, together with representatives from ACEP and ENA, have created the 2019 Emergency Department Nurse Retention Study.

    Please ask your ED RN Managers to complete a brief, 90-second survey to help with the study. Responses will be confidential and aggregate data will help gain better insight into the problem and gather solutions.  Begin survey.

  • September 27, 2019 2:59 PM | Sally Winkelman (Administrator)

    Outbreaks of hepatitis A virus (HAV) have been reported across the U.S., with Minnesota being the most recent state affected. During these outbreaks, 24,952 individuals have become ill, and 60% of them needed to be hospitalized.

    As of this writing, the Department of Health Services (DHS) has not detected HAV outbreaks in Wisconsin. However, most Wisconsin adults are not immune to HAV, making the state vulnerable to an outbreak unless HAV vaccination is scaled up. Because the current outbreaks of HAV are predominantly impacting communities with identifiable risk factors, including unstable housing, recent incarceration, and injection drug use, targeted efforts to vaccinate high-risk individuals could substantially reduce the risk of HAV outbreaks in the state. A single dose of HAV vaccine has been shown to control outbreaks of hepatitis A and provides up to 95% seroprotection in healthy individuals for up to 11 years.

    Emergency departments are a critically important partner for providing HAV vaccine to patients in need because this setting provides care for many high-risk individuals who may not seek routine preventive care elsewhere.

    We are asking you and your staff to work with your patients and clients to reduce the spread of hepatitis A infection. Please share the following information widely.

    What can you do to help prevent hepatitis A infections?

    1. Check the immunization history of at-risk groups: Many individuals who are at risk of HAV have no consistent medical home. Checking their immunization history in the Wisconsin Immunization Registry (WIR) or in your organization’s Electornic Health Record (EHR) is a good way to make sure they are up-to-date on their vaccines, including HAV vaccine and influenza.
    2.  Provide HAV vaccine to patients who are unvaccinated and at-risk in the emergency department and urgent care clinics. Providers who do not have available vaccine may direct patients to local health departments or tribal health care clinics. Homeless individuals and injection and non-injection drug users are also at higher risk for other vaccine preventable diseases and should be brought up-to-date per the relevant CDC immunization schedule.
    3. Consider HAV infection in individuals, especially the homeless and those who use illicit drugs, with discrete onset of symptoms and jaundice or elevated liver function tests. Symptoms include nausea, vomiting, diarrhea, anorexia, fever, malaise, dark urine, light-colored stool, or abdominal pain.
    4. Promptly report all confirmed and suspect HAV cases. Please contact your local health department by telephone IMMEDIATELY upon identification of a confirmed or suspected case and report through the Wisconsin Electronic Disease Surveillance System (WEDSS) within 24 hours upon recognition of a case.
    5. Provide post-exposure prophylaxis (PEP) for close contacts of confirmed HAV cases. Susceptible people exposed to hepatitis A virus (HAV) should receive a dose of single-antigen HAV vaccine or intramuscular (IM) immune globulin (IG) (0.02 mL/kg), or both, as soon as possible within 2 weeks of last exposure. The efficacy of combined HAV/Hepatitis B virus (HBV) vaccine for PEP has not been evaluated, so it is not recommended for PEP.
    6. Ensure that all health care workers use standard precautions in patient care to protect themselves against HAV. HAV, like norovirus, is a non-enveloped virus, and it may be similarly difficult to inactivate in the environment. Alcohol-based hand rubs and typically-used surface disinfectants may not be effective.
    7. Work with community partners for a second vaccine dose as needed. Many local health departments and pharmacies have the second dose in the Hepatitis A series. Find out where the second dose can be given so you can recommend your patient seeks out their services after they leave your care.

    Who is at high risk for getting hepatitis A?

    • People who use drugs, whether injected or not (for example, cigarettes, joints, vaping products, pills)
    • People who have experienced unstable housing or homelessness
    • People who have sexual contact with someone who has hepatitis A (for example, engaging in oral-anal sex, also known as “rimming”)
    • Men who have sex with men
    • People who have close person-to-person contact with someone who has hepatitis A (for example, those who share bathroom facilities or a cell)
    • People with chronic liver disease, including cirrhosis, hepatitis B, or hepatitis C
    • Individuals in correctional and jail settings, due to the close living conditions which allow the virus to spread easily

    What is hepatitis A and how is it spread?

    Hepatitis A is a highly contagious disease that is spread from person to person and is found in the feces (poop) of people with hepatitis A virus. Hepatitis A can be easily spread if someone does not wash their hands properly after using the bathroom.

    How is hepatitis A different from other types of hepatitis?

    Hepatitis A is different from hepatitis B and hepatitis C. While all three can damage the liver, they are caused by different viruses and are spread in different ways. Most often, hepatitis A is spread by eating or drinking food or water with the virus in it. In recent outbreaks, hepatitis A has been spread by sharing drugs or drug products, or having sexual contact with someone with hepatitis A.

    What are the signs and symptoms?

    Symptoms usually start four weeks after the individual has come in contact with the hepatitis A virus. However, they can start as early as two and as late as seven weeks after the virus enters the body. Symptoms can start quickly and can include:

    • Fever
    • Fatigue
    • Loss of appetite
    • Nausea
    • Vomiting
    • Abdominal pain
    • Dark urine (pee)
    • Diarrhea (loose stools)
    • Clay-colored stools
    • Joint pain
    • Jaundice (yellowing of the skin and eyes)

    What should you know about the hepatitis A vaccine? 

    The hepatitis A vaccine is safe and an effective tool for preventing the spread of disease. It is important to use the single-antigen hepatitis A vaccine when vaccinating staff.

    One dose of single-antigen hepatitis A vaccine has been shown to control outbreaks of hepatitis A. It provides up to 95% protection against hepatitis A in healthy individuals for up to 11 years.

    What resources are available to order from DHS?

  • September 27, 2019 11:16 AM | Sally Winkelman (Administrator)

    On Wednesday, September 25, members of the Emergency Psychiatry Task Force, a collaboration between WACEP and the Wisconsin Psychiatric Association, met with staff from Attorney General (AG) Josh Kaul’s office to discuss the issue of emergency detention and how it impacts physicians and patients. 

    Attorney General Kaul is convening key stakeholders from across the state to discuss the issue of emergency and civil commitments, which will be the focus of the AG’s Annual Summit on October 31 at Union South in Madison. The summit will include representatives from the law enforcement, county administration and health care communities.

    Emergency physician Michael Repplinger, MD, PhD and psychiatrists Tony Thrasher, DO, Molli Rolli, MD, John Schneider, MD, and Angela Janis, MD, provided the AG's office with best practices regarding how to best care for patients who arrive at the emergency department and need to be taken into custody for their safety and the safety of others.

    The group shared a series of resources including the white paper scheduled to be published in WMJ, a SMART form for working with patients in crisis and one-pager detailing the focus areas of the Task Force. Conversation also covered processes for admitting patients, transporting patients to facilities, parity, access, workforce, medical stability and models from other states. All agreed that both pre- and post-admission processes need to be revamped.

  • September 23, 2019 3:29 PM | Sally Winkelman (Administrator)

    Lisa Maurer, MD, FACEP
    Immediate Past President & Rural Outreach Coordinator

    Earlier this month, the WACEP Board of Directors held our quarterly meeting in beautiful Richland Center and paired it with educational sessions and a dinner reception for board members and regional docs. What a great experience! Shout out to all you EPs working in the truly gorgeous corners of the state. Our Chapter arranged this event to get a better understanding of what rural practice is like and attempted to connect EPs working in rural Wisconsin with colleagues at their typical receiving facilities.  

    In Richland Center, we were welcomed by the most gracious host and medical director of Richland Hospital, Dr Andy Harris. I’m sure I wasn’t the only one who was impressed and a little bit jealous of the practice environment, hospital support, and the skill of the emergency physicians who practice there.

    To paint a picture, Richland Hospital is a pristine, independent critical access hospital with 25 inpatient beds in the southwestern corner of the state, tucked among the bluffs and rivers. When transfers are needed, they partner with receiving facilities in both La Crosse and Madison. They have bedside ultrasound in the ED, 24-hour access to OB support, and are successfully continuing to build on their team of physicians dedicated to the community. Their success is in large part due to the fantastic leadership of Dr Harris, who moved from Illinois to join their staff just two years ago, and who brings a real passion for the area and for rural practice in general.  

    We had fantastic educational opportunities for everyone involved, ranging from hands-on workshop for bedside ultrasound skills to the ins-and-outs of cutting-edge stroke care for patients who arrive at non-stroke centers. See below for my personal takeaways and lessons learned.  

    On behalf of the  WACEP Board of Directors, I’d like to offer our sincere thanks to 1) the UW Emergency Medicine Ultrasound faculty; 2) Dr. Natalie Wheeler, neurologist who provided updates on transfers from the UW-Madison stroke team; and 3) UW Med Flight team whose participation hugely complimented the conversation on stroke care in rural areas.

    Personally, I can attest that the lessons I learned in rural Wisconsin directly apply to my suburban and urban community practice. I found that despite differences in transfer times, more similarities abound between my practice and those of our colleagues in rural Wisconsin.  WACEP looks forward to offering another Rural Outreach Program with similar experiences in another rural part of the state next summer.  Please let us know if your ED is interested in hosting, and what topics you’d like to see discussed with emergency physicians and specialists you interact with at your primary receiving facilities.  



    • When doing an ultrasound-guided peripheral IV, don’t try to advance the catheter off the needle as soon as you see a flash. Advance the needle just a little (3-5 mm) while visualizing it inside the vessel on ultrasound before advancing catheter off the needle. The IV should be long enough to have distal 1/3 of the catheter inside the vein when the procedure is complete.
    • When trying to decide if someone's heart has a happy squeeze or a sad squeeze in parasternal long axis view, look to see if the mitral valve leaflets are happily touching the septal intraventricular wall when the myocardium squeezes and the valve flaps open. I picture someone happy saying "yay!" with their arms up and out.

    Stroke at a Non-Stroke Center

    • Consider moving toward a CT/CTA imaging protocol right off the bat for all acute stroke. Dr. Wheeler is happy to share a protocol if you're interested.
    • If your facility's protocol is to just do noncontrast CT, consider asking your radiologist to give you a HECTS score - this may help communicate risk of ischemic stroke to your potential receiving neuro team.  

    • The list of absolute exclusions for tPA is becoming shorter and more lenient - talk with a potential receiving neurologist. Even consider calling when you patient has a low NIHSS, seeing as mild stroke syndromes oftentimes progress to moderate to severe stroke syndromes in the first 24 hours. 

    • There is a new trial exploring bolus tPA vs bolus/gtt tPA, which might make delay for transport less of an obstacle for physicians who work with EMS partners who cannot take a patient with a tPA drip going.

    Med Flight
    • Med flight physicians want to stress that they are happy to take over for complicated patients at any stage of the game—even if the patient needs procedures and is not "wrapped up in a bow."  They understand that our rural docs are often pulled in ten directions at once.

    • Capabilities of local EMS teams vary greatly.  You do not necessarily have to reserve the use of Med Flight for critical patients.  Rather, think of them for any patient that supersedes the capabilities of your local resources.

  • September 23, 2019 3:04 PM | Sally Winkelman (Administrator)

    Jeffrey Pothof, MD, FACEP

    There are a few things happening in emergency medicine that I’d like to draw your attention to as we kickoff the fall season

    First, I want to thank those that attended our rural outreach event earlier this month in Richland Center.  We had very accommodating hosts and the educational sessions and networking were superlative.  We’ll be sure to plan another event like this next year so stay tuned for more details.

    ACEP’s Scientific Assembly is drawing closer and I hope to see some of you October 27-30 in Denver.  If you find yourself in town, please make your way to Wynkoop Brewing Company at 6:00 pm local time on Monday, October 28 for our annual Wisconsin Meet-Up.  Also, know that along with Scientific Assembly comes the annual ACEP Council meeting where the future direction of the college is debated and takes form.  The WACEP delegation to the Council meeting will be reviewing many resolutions in the upcoming weeks.  If there is something that you are particularly excited about or have a strong opinion on, please reach out to us with your thoughts.

    Many of our EM groups in the state schedule shifts far out.  Given that, I want to bring to your attention our largest and most important advocacy event, Wisconsin Doctor Day, planned for January 29, 2020.  If you haven’t submitted schedule requests yet, please consider blocking that day off and hanging out with your peers in Madison for a fun day at the State Capitol.  And don't forget to sign up if you plan to attend. 

    Finally, I want to make mention of the passing of Eric Jensen, our long-term lobbyist.  Eric’s work in advocating for better ways to deliver healthcare to residents in our state demonstrated his desire to make a difference in the lives of others.  His skill in understanding health policy and strategy is only surpassed by his unmistakable smile, deep laughter, and friendship to those that had the opportunity to know him.  Our deepest condolences to Eric’s family.

  • September 18, 2019 12:32 PM | Sally Winkelman (Administrator)

    Join WACEP leader Bobby Redwood, MD, MPH for an online Twitter chat!
    Thursday, September 19, 2019 | 11:00 am - 12:00 pm CDT

    How to Participate
    - You will need to have a Twitter account set up to participate
    - Join the chat be searching for the hashtag #KeystoneSepsis. Click on the hashtag to join the conversation. You should see a few tweets using that hashtag.
    - Feel free to join the conversation as soon as you’re ready and share your message with the hashtag #KeystoneSepsis included. Let everyone know you’ve joined the chat and that you’re ready to participate.
    Ex: “Hello everyone! I’m here and ready to talk about sepsis prevention and identification. #KeystoneSepsis”

    Tips, Tricks and Important Information
    - Please use #KeystoneSepsis in all Tweets when participating.
    - If you ask a question or respond to someone in the chat, use the hashtag #KeystoneSepsis so everyone can be in on the conversation. 
    - Share tweets from the conversation with your network by re-tweeting or by commenting on posts in the chat.
    - Use other relevant hashtags in your posts, including:
    #Sepsis #SAM2019 #SepsisAwarenessMonth
    - Let people know you’ll be participating in the Twitter chat in advance. This is a nice way to let your network know you may be a bit noisy during the chat time.