Board Meeting Minutes

American Academy of Emergency Medicine
Minutes of Board of Directors Conference Call
July 22, 2005

In Attendance: A. Antoine Kazzi, MD; Joseph Wood, MD, JD; William Durkin, Jr., MD; Robert McNamara, MD; Howard Blumstein, MD; Anthony DeMond, MD; Stephen Hayden, MD; James Li, MD; Kevin Rodgers, MD; Ghazala Sharieff, MD; Richard Shih, MD; Mark Reiter, MD. Absent: Tom Scaletta, MD; Tracy Boykin, MD; Larry Weiss, MD. Staff: Kay Whalen, Janet Wilson.

Approval of May 25-26-2005 Minutes

Dr. Kazzi welcomed everyone to the call and drew the board's attention to the first agenda item. He asked if there were modifications to the draft minutes that had been included in the agenda materials. Dr. McNamara said that he had been asked to "compose an affidavit" rather than "write a letter" of support in the Rhode Island case. Dr. DeMond moved and Dr. Durkin seconded that the draft May 25-26, 2005 minutes be approved as amended. MOTION PASSED UNANIMOUSLY.

New Cases

Dr. McNamara then reported on a case in Indiana in which a restrictive covenant was being enforced. After a lengthy discussion, Dr. McNamara moved and Dr. DeMond seconded that AAEM and the AAEM Foundation should pursue and support the case in Indiana. The executive committee will be empowered to make decisions in this case. MOTION PASSED UNANIMOUSLY.

Both Drs. Wood and McNamara identified the need for clarity on AAEM's role in this case.

Government Affairs Committee Report

Dr. McNamara then reported that the AAEM government affairs committee was recommending support of companion bills that would provide grant funding to states that establish or support an existing state controlled substance monitoring program. After discussion, Dr. McNamara moved and Dr. Reiter seconded that AAEM support S. 518 and H.R. 1132. MOTION PASSED 9-1-1.

Treasurer's Report

Dr. Durkin then presented the June 30, 2005 financial report. He reported that, at this point, AAEM should finish the year near budget. Dr. Durkin moved and Dr. Wood seconded that the AAEM June 30, 2005 financial reports be accepted as presented. MOTION PASSED UNANIMOUSLY.

Challenger Courses

Dr. Reiter reported that AAEM/RSA had negotiated an agreement that would provide AAEM/RSA members with a discount on the Challenger courses. The AAEM/RSA wanted to know if AAEM was also interested in extending such a discount to its members. Dr. McNamara moved and Dr. DeMond seconded that the AAEM education committee be asked to evaluate the benefits of offering a discount on the Challenger courses to AAEM members. MOTION FAILED 5-6-1.

Next, Dr. Reiter moved and Dr. Durkin seconded that AAEM enter into an agreement so that a $50 discount on the Challenger courses be offered to AAEM members. MOTION PASSED 9-2.

Emeritus Requests

Ms. Whalen referred to the emeritus membership requests in the agenda materials from Dr. John Sawyers and Dr. Stephen Helton. Both members met the qualifications for emeritus status. Dr. Wood moved and Dr. Shih seconded that Drs. Sawyers and Helton be granted emeritus status. MOTION PASSED UNANIMOUSLY.

State Chapter Approval

Ms. Whalen then presented draft state chapter bylaws submitted by AAEM members in the state of Iowa. She also reported that state chapter leadership has already been identified. Dr. Durkin moved and Dr. McNamara seconded that the draft AAEM Iowa State Chapter Bylaws be approved as submitted. MOTION PASSED UNANIMOUSLY.

EMS Position Statement

Dr. DeMond then presented a draft position statement that had been recommended by the AAEM EMS committee. The intent of the committee is that this statement would supersede the February 19, 1998 position statement on this issue. The board discussed this statement at length and made a minor modification to the statement recommended by the committee. Dr. McNamara moved and Dr. DeMond seconded that the following position statement be adopted:

Proposed Language of
Updated AAEM Position Statement on Emergency Medical Services (2005)

The American Academy of Emergency Medicine believes that patients requiring emergency care need universal access to both high quality pre-hospital and emergency department based medical care. AAEM recognizes the vocation of pre-hospital medicine to include patient advocacy and transportation of patients to facilities best able to deliver the services they require. AAEM also recognizes the roles of EMS Medical Directors or EMS physicians as being rooted in Public Health. The responsibility of EMS physicians serving the community should be independent from the financial or political interests of any private institution or other entity within a health care delivery system.

Competent emergency medical care begins in the field. In this setting, patients are best served by a team consisting of certified or licensed emergency medical technicians and first responders at the various levels of training, as provided by the resources and regulations of their municipality and State. Each EMS system should operate under the medical oversight of a qualified physician familiar with emergency care.

The ideal system is best conceived and maintained in an environment where EMS medical directors and the local emergency physicians with whom they collaborate are well trained, and the latter are part of a stable Emergency Medicine practice in the community which they serve. Medical oversight will better ensure that local EMS receives the best guidance in the evaluation, training and implementation of the latest technologies, skills and practices most appropriate for local citizens. Moreover, emergency medicine specialists have the best training to help achieve integration of an EMS system into its community's larger overall system of emergency care.

In the modern era, the Medical Director must have state licensures, board certification in emergency medicine by ABEM or AOBEM and possess expertise in EMS systems. Medical Director positions should be vested with the authority to intervene in any issues that impact or are the result of the delivery of out of hospital patient care. Therefore, subsystems within EMS over which the physician should have advisory roles or absolute authority include scope of practice, quality management, dispatch protocols, education, protocol development and disaster or mass gathering planning. Fellowship training now offered in Emergency Medical Services provides the most comprehensive instruction available in all aspects of EMS.

Finally, municipal leaders and EMS agencies should recognize EMS oversight services as a vocation and necessity for public health. As such, Medical Directors should be supported with the necessary resources to function effectively given the size and demographics of the system. These include but are not limited to supportive legislation, a budget for the position to include a reasonable stipend for labor and/or expenses, legal protections for specified duties, as well as reasonable due process to prevent the arbitrary dismissal of physicians without justification. Such an approach will nurture the same quality of services in the pre-hospital setting as is expected from other areas of health care delivery, and the same citizen benefit delivered by other physicians in the public service sector.

MOTION PASSED UNANIMOUSLY.

At this point, Dr. Sharieff left the call.

Universal Coverage and National Healthcare Position Statement

The board then discussed the draft position statement submitted by AAEM member, Kenneth Weinberg, MD. The draft position statement will be sent to the government affairs committee for their review and recommendation.

Young Physicians Section

Dr. Kazzi then drew the board's attention to a request that AAEM establish a young physicians section. After listening to the board's thoughts on this issue, he asked Dr. Reiter to contact these AAEM members on behalf of AAEM and AAEM/RSA to determine the possible parameters of this proposed section. Dr. Rodgers will also communicate with these individuals to gather more information based on this request.

At this point, Dr. McNamara left the call and Dr. Li joined the call.

President's Report

Dr. Kazzi reported that planning and registration for the Mediterranean Congress were ahead of the previous year's pace. However, fundraising efforts have not been as successful to date. Therefore, while AAEM should not incur a net loss on this meeting, neither will there be a large net income.

Next, Dr. Kazzi presented a request from the Inter-American Conference organizers for a total commitment of $10,000 from the AAEM 2006 budget. Dr. DeMond moved and Dr. Reiter seconded that the 2006 AAEM budget include $10,000 for the 2006 Inter-American Conference. MOTION PASSED UNANIMOUSLY.

Dr. Kazzi asked that anyone interested in serving in a liaison role with ACOEP contact him.

Dr. Kazzi then directed the board's attention to the request from SAEM to partner with other organizations in emergency medicine (including AAEM/RSA) to sponsor a booth at the SNMA meeting. Dr. Kazzi moved and Dr. DeMond seconded that AAEM participate with other emergency medicine organizations at future SNMA meetings. MOTION PASSED 9-0-1.

AAEM Services

Dr. Durkin reported that the AAEM Services board had met via conference call the previous day. The board had unanimously agreed to ask Drs. Li, Reiter and Boykin to prepare a plan outlining how new templates will be developed. The AAEM Services board will negotiate any new contracts with EvolveMed.

Dr. Kazzi asked Ms. Whalen to determine the structure and terms of the AAEM Services board.

At this point, Dr. Durkin and Ms. Whalen left the call.

Practice Guidelines Committee

Dr. Hayden reported that AAEM had received 54 responses from the practice guidelines survey and provided a brief overview of the results. The committee plans to draft a process template on this important issue. The committee plans to meet in Nice.

Executive Director's Report

In Ms. Whalen's absence, Ms. Wilson reported that AAEM's paid full voting membership is 11% ahead of 2004's pace. AAEM/RSA membership is over 50% ahead of the AAEM Resident Section membership in 2004. Ms. Wilson also reminded the board that the AAEM officer and director nominations will be due November 18, 2005.

In the interest of time, the conference call meeting was adjourned.

Respectfully submitted,

Kay Whalen
Executive Director