Announce Quincy Moore and Ayesha Khan

Dr. Monica Saxena JD, MD joins us to discuss the recent overturning of Roe v. Wade. How will this affect access to abortions, particularly for marginalized communities? What relevance does this ruling have to the role of the EM physician in caring for emergencies in pregnancy?  What role with the emergency department play in states that allow and don't allow abortions? What actions may we take for our patients, in the ED and outside the ED?
Objectives
 
1. Explore the changing landscape of safe abortion access in the US
2. Learn how your practice in the emergency department may be affected by the decision to overturn Roe v. Wade, including implications for pregnancy related complaints that include terminataion of pregnancy as treatment (for both states where abortions remain legal and where they do not).
3. Learn what resources exist for you and your patients to navigate safe abortion access in the post-Roe era
4. Learn how you can help restore access to safe abortions 
 
Take Home Points
1. The Supreme Court decision means that regulations or lack of regulation around abortion will be left up to the states. This creates a lot of variation as well as uncertainty.
 
2. Termination of pregnancy is the indicated medical procedure for many complications of pregnancy. In states where termination of pregnancy is banned after a certain amount of weeks or band altogether, the emergency physician may have to wait to intervene until  her patient is unstable or may have to transfer her.
 
3. EMTALA is a federal law which supersedes any state law, however it necessitates the stabilization of patients. In some interpretations, a woman with an emergency related to her pregnancy may have to be unstable prior to the physician intervening.
 
4. The legality around abortion is changing rapidly. The result is that medical decisions are sometimes being legislated in the emergency department. This is dangerous for patients and physicians.
 
5. These laws promote health equity and social injustice as they differentially affect states where there is a larger population of people of color and indigenous peoples.
 
6. Physicians interested in helping can do so in the following three ways:

a) Advocate for a change with your national college. For us that is the American College of Emergency Physicians and the Society of Academic Emergency Medicine

 


b) familiarize yourself with what options your patients have and where they can turn to for resources. It may be possible to get training in medical abortion depending on where you live


 


c) states where abortion remains legal will see an Increasing volume of patients seeking termination of pregnancy. There may be scope to to set up innovative programs for medical termination in the emergency department


 
Resources
Abortion providers near you: https://abortionfinder.org/ 
Teleabortions: https://mychoix.co/
Emergency Medicine and Reproductive Health in a Post-Row Landscape  Kelli L. Jarrell et al
Monica Saxena: saxenam@stanford.edu
 
Guest
Monica Saxena is an assistant professor of Emergency Medicine at Stanford School of Medicine. She is also a JD who has been involved in reproductive rights and women's health for more than a decade. Dr. Saxena initiated an ED protocol for elective termination of first trimester pregnancy in the ED.
 
Contributors:
Payal Modi

Dr. Seth Berkowitz and Economist Hunt Alcott join us to discuss nutrition, food insecurity, and their relevance to emergency medicine. What questions can we ask to identify food insecurity quickly? What resources can we offer patients? How might it affect our clinical decision making?  
 
Objectives:
Explore how nutrition affects the health of patients in the ED Identify factors that contribute to patient’s nutritional status Understand how to effectively and efficiently address nutrition with ED patients

Take-home points:
Food insecurity can play a critical role in the health outcomes of ED patients in the following ways: Food insecurity can lead to poor quality diet with health consequences Patients with food insecurity may have competing demands. If you are worrying about paying for meals, you might have to decide between food and important issues like housing or medications, all of which can affect your health. High levels of stress related to food can put a strain on a patient’s mental and physical health. Know your hospital and community’s ability to address food insecurity. If a patient screens positive on the Hunger Vital Sign, you can link them to community resources like food pantries, SNAP or WIC. Consider screening your patients for food insecurity using the Hunger Vital Sign (see link in references).  Low income neighborhoods have less access to lots of things, including grocery stores. Many stores in these neighborhoods limit options for healthy eating. Nutrition education for your patients can make a difference. Recognize that nutrition education may be the limiting factor as to why your patients are not eating nutritious food, so taking a moment to talk about it can make a difference. Be mindful of how food access may affect your treatment plan for your patient, particularly with food-sensitive conditions like diabetes.  Additional Resources:
Food Deserts and the Causes of Nutritional Inequality, Alcott et al.   Health effects of dietary risks in 195 countries, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017, The Lancet.  The Hunger Vital Sign Gattu RK, Paik G, Wang Y, Ray P, Lichenstein R, Black MM. The Hunger Vital Sign Identifies Household Food Insecurity among Children in Emergency Departments and Primary Care. Children (Basel). 2019;6(10):107. Published 2019 Oct 2. doi:10.3390/children6100107 SNAP-ED  
Guests:
Dr. Seth Berkowitz is an assistant professor in the division of general medicine and clinical epidemiology of medicine at the University of North Carolina and has done extensive research on food insecurity and its relation to human health, particularly in low-income patients and patients suffering from type II diabetes.
Hunt Allcott is an Associate Professor of Economics at NYU whose research includes investigation on consumer behavior.  He recently co-authored a 2018 study entitled “Food Deserts and the Causes of Nutritional Inequality”. 
 
Contributors:
Bobby Needleman Dennis Hsieh Shannon Moffett Tony Spadaro

Drs. Otis Warren and Shannon Smith-Bernardin join us to discuss how alcohol relates to social issues. What more can we do for patients that are brought in drunk? What solutions exist at both the individual ED and healthcare system level? 
Objectives: 
Understand the challenges in treating alcohol use disorder in the emergency department Understand alcohol use in the context of social determinants of health Learn about diversion/sobering centers and their potential impact on the treatment of alcohol use disorder and emergency departments Take-home points: 
Alcohol use disorder is a chronic disease that should be treated as such. Many of the drivers of alcohol-related ED encounters, however, are driven by social factors.  Sobering centers are an alternative to the emergency department or jail for people who are acutely intoxicated on alcohol. Diversion is a triage system that is based on an agreement between law enforcement and EMS allowing for diversion of intoxicated patients to sobering centers if they meet certain criteria.   
Additional resources: 
Warren O, Smith-Bernardin S, Jamieson K, Zaller N, Liferidge A. Identification and Practice Patterns of Sobering Centers in the United States. J Health Care Poor Underserved. 2016;27(4):1843‐1857. doi:10.1353/hpu.2016.0166
Smith-Bernardin SM, Kennel M, Yeh C. EMS Can Safely Transport Intoxicated Patients to a Sobering Center as an Alternate Destination. Ann Emerg Med. 2019;74(1):112‐118. doi:10.1016/j.annemergmed.2019.02.004
Smith-Bernardin S, Carrico A, Max W, Chapman S. Utilization of a Sobering Center for Acute Alcohol Intoxication. Acad Emerg Med. 2017;24(9):1060‐1071. doi:10.1111/acem.13219
 
Guests:
Shannon Smith-Bernardin
Dr. Smith-Bernardin is a professor at UCSF and has a PhD in nursing and health policy. She has extensive experience with sobering centers and diversion programs and has studied their safety, effectiveness, and implementation.
 
Otis Warren
Otis Warren is an Associate Professor of Emergency Medicine at Brown University. Dr. Warren has been a champion for sobering centers in and around Providence, RI. He and Dr. Smith-Bernadin authored "Identification and Practice Patterns of Sobering Centers in the United States" in the Journal of Health Care for the Poor and Underserved, helping launch the national debate on diversion of intoxicated patients away from emergency departments and to sobering centers.
 
Contributors:
Charles Zhang Harrison Alter Livia Santiago-Rosado Austin Tam

Across the US, LatinX and Black people are dying from COVID-19 at twice the rate of their white counterparts. In this special episode of Announce, hosts Drs. Ayesha Khan & Quincy Moore explore some of the issues underlying these disparities and what EM providers need to be aware of to combat them.
 
Additional Resources:
As a doctor, how do I tell a black family of five, struck by the virus, to ‘social distance’ in a two-bedroom apartment? -- Garth Walker  
COVID-19 Racial Disparities in U.S. Counties, The Foundation for AIDS Research.
 
Vahidy FS, Nicolas JC, Meeks JR, et al. Racial and Ethnic Disparities in SARS-CoV-2 Pandemic: Analysis of a COVID-19 Observational Registry for a Diverse U.S. Metropolitan Population. medRxiv. January 2020:2020.04.24.20073148. doi:10.1101/2020.04.24.20073148
 
Guests:
Dr. Garth Walker is an emergency physician in Chicago whose research focuses around health disparities and social determinants of health.
 
Dr. Italo Brown is an emergency physician at Stanford with an interest in health equity, and barbershop-based health initiatives.
 
Dr. Moises Gallegos is an emergency medicine physician at Stanford. He is a Faculty Fellow at the Hispanic Center of Excellence. 
 
Contributors:
Quincy Moore  
Ayesha Khan  
 

Drs. Sheryl Heron and Camara Phyllis Jones join us to discuss race and how it affects our practice in the ED.
 
Objectives: 
Debunk misunderstandings about the biological basis of race Analyze the relationship between race, social determinants of health, and health outcomes Discuss interventions that work to improve racial health disparities Predict how race may play a role in current policy and public health problems  
Take-home points: 
Race is a social, not biological, construction  Ancestry is poor marker genetics, and race a poor indicator of ancestry Racial health disparities are driven by racial disparities in social determinants of health Residential segregation is a large driver of disparities in SDH Working deliberately to treat racial groups similarly on individual and population levels is necessary to ameliorating racial health disparities  
Additional resources: 
 
Allegories on Race and Racism. Camara Jones, TEDxEmory
https://www.youtube.com/watch?v=GNhcY6fTyBM
 
Cohan D, Racist Like Me — A Call to Self-Reflection and Action for White Physicians. N Engl J Med 2019; 380:805-807
 
Jones CP. Levels of Racism: A Theoretical Framework and a Gardener’s Tale. Am J Public Health 2000; 90:1212-1215 
 
Williams DR, American A, Wyatt R. Racial Bias in Health Care and Health Challenges and Opportunities. JAMA 2015;314(6):555–6
 
Washington, HA. Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present.  Harlem Moon an imprint of DoubleDay Publishing 2007
 
Guests:
 
Sheryl L. Heron, MD, MPH, FACEP Sheryl Heron is a Professor and Vice Chair of Administrative Affairs in Emergency Medicine and an Assistant Dean of Medical Education and Student Affairs at Emory University. While her accomplishments are too numerous to list, her 20 year career in emergency medicine, academia and public health, has led to national recognition as an expert on diversity and inclusion in medicine. Dr. Heron has also lectured and published extensively on diversity and inclusion in medicine. Most recently, she served as co-editor of the textbook, Diversity and Inclusion in Patient Care.
 
Camara Phyllis Jones, M.D., M.P.H., Ph.D Jones is a former president of the American Public Health Association and Adjunct Professor at the Morehouse School of Medicine and Emory Rollins School of Public Health. She has also served as the Research Director on Social Determinants of Health and Equity in the Division of Adult and Community Health at the CDC. As a family physician and epidemiologist, Dr. Jones’s work focuses on the impacts of racism on the health and well-being of the nation. From TED talks to National Symposia, Dr. Jones’ allegorical pedagogy has elevated the national dialogue on race and health.
 
Contributors:
John Lewis
Dan Gingold
Sean Schnarr
Jenny Tsai

Our team took a breather for the holidays. Tune in February 1st for another episode!