PRESIDENT’S MESSAGE

COL Melissa Givens

Happy New Year GSACEP members! 2018 was an event filled year and 2019 is already looking exciting for the chapter. The ACEP Scientific Assembly in San Diego was an incredible event, celebrating 50 years of ACEP.

GSACEP rocked the exhibitor area with a History of Military Medicine display that was a multi-media, hands on dynamic showcase of the integral role of military medicine in the history of Emergency Medicine. I personally want to thank all those who contributed to making the display a success. The chapter is currently exploring ways we can make portions of the display part of more permanent exhibits in a variety of venues to keep our history alive.

For those not able to attend Scientific Assembly, ACEP has been gracious enough to extend deeply discounted access to Virtual ACEP recognizing that many of our government service members may have limited access to CME due to the nature of our service requirements. Please look for details on our website for this special, members only offer.

2018 also brought back Government Services Symposium (GSS). We recognize the need for our members to have a conference that is dedicated to the unique concerns of government service emergency medicine physicians, and the chapter leadership is committed to providing venues such as GSS to facilitate collaboration among our members. GSS is headed to Nashville this year and we hope to see you there! The conference is a wonderful opportunity to share best practices across the government services domains and also forge professional friendships that transcend the challenges of government service life.

2018 was also a year of major transition for GSACEP. Bernadette Carr retired after more than 20 years of devoted service as the GSACEP Chapter Executive. Bernie was a stalwart of stability while the chapter members and leadership dealt with over a decade of war. Her skill and flair as a chapter exec is unparalleled, and we could always count on Bernie for insightful and often colorful words of wisdom when addressing chapter business. Bernie was a champion for GSS (formerly called Joint Services Symposium) and worked tirelessly behind the scenes to make each conference an event filled with opportunities to network and pursue opportunities to continually improve upon emergency care provided with the government service realm.

Her impact on the chapter is far reaching, and her nurturing mentorship of countless chapter leaders will continue to pay dividends for years to come. In honor of Bernie’s legacy, GSACEP has created the Bernadette Carr scholarship. This scholarship will provide financial support for registration and travel to Government Services Symposium for a deserving GSACEP member annually. We will miss you Bernie but you will always be a cherished part of the GSACEP family.

We were told that we wouldn’t see much trauma. We were told that winter was coming and the violence would be decreasing, and anyway, there hadn’t been a real mass casualty at the facility for almost two years. We were told that after a recent staffing downsize, four trauma teams would be adequate. But they were wrong.

That morning started like any other. Sometime after breakfast we received a call that there was an explosion during a routine training exercise. A vehicle borne IED was detonated next to a convoy sending the nearest vehicle down a 20-foot embankment. The initial report stated that we would be receiving two casualties. A few minutes later the number increased to six, and then up to nine and back down to four. Accurate pre-hospital information is notoriously hard to come by.

Due to inclement weather conditions the helicopters that would normally bring some of the patients straight to the next level of care were forced to land at our facility. We ultimately received eight critically injured patients at the same time.

The first patient through the door had injuries to all four extremities with two tourniquets in place. The next had an open femur fracture. The next was unconscious with evidence of a severe head injury. The next had bilateral partial lower extremity amputations. Seemingly every patient had severe life-threatening injuries. The last patient through the door had shrapnel wounds to his left shoulder and midback. Though I never learned his name, he is the patient that I will always remember.

Our resources were spread thin and initially he was taken care of by two medics, an operating room nurse and an operating room tech. I was called over shortly after his arrival. At the beginning, he was able to talk to us via a translator and complained of severe abdominal pain. However, he quickly became combative, preventing us from obtaining IV access or accurate vitals. We decided to sedate him using intramuscular ketamine after which we were able to get a peripheral IV line, do a quick primary survey and conduct an eFAST exam. He was breathing on his own with no airway concerns. No blood was seen in the abdomen. No pericardial effusion was seen and good lung sliding was noted bilaterally. He had central pulses, but cold extremities, and we no longer felt a radial pulse. We were never able to get a pulse ox reading. A warming blanket was placed. Blood was called for but not immediately available, as the emergency release blood in our first cooler was being used by other patients.

Five minutes later his breathing became labored. An oropharyngeal airway was attempted but the patient had trismus and bagging proved difficult. The general surgeon and anesthesiologist were called over from trauma bay 1.

Blood had still not arrived. Lactated Ringer’s was started. We had no choice but to paralyze and intubate the patient given his respiratory status. Unsurprisingly, we lost pulses almost as soon as the paralytics took effect. A central line was placed while compressions were started and the thoracotomy kit was brought over. Blood finally arrived, but the rapid infuser malfunctioned. The chest was opened and several lung injuries were identified and clamped. A moderate amount of clotted blood was evacuated from the chest and a subclavian injury was suspected, but not confirmed. A right sided chest tube was placed and a diagnostic peritoneal aspirate was negative.

Unfortunately, despite our best efforts we were unable to bring him back. His PEA turned into fine ventricular fibrillation and his pupils became dilated. After another thirty minutes of internal cardiac massage and defibrillation, time of death was called at 11:35, sixty minutes after he arrived in the department and forty-five minutes after we lost pulses.

It is unclear if different circumstances would have led to a different outcome. What if we could have given him blood sooner? Or faster? What if he was the first in the door instead of the last? What if he was our only patient? We still may not have been able to save him. Thanks to the hard work of the team, the other patients did well and within a few hours a plane came to take them to the next level of care. In response to this incident, we have increased our trauma team trainings and reorganized our personnel to cover eight beds. We are constantly preparing for the worstcase scenario while keeping in mind that sometimes situations can exceed our capabilities. We hope the changes will allow us to be better prepared for future mass casualty events, but that doesn’t help this patient. For me, this soldier is one I will never forget.

CPT Justine Stremick

GOVERNMENT SERVICES SYMPOSIUM: FAQ

LCDR Andrea Austin interviewed by CPT Joshua Da Silva

Q: When will the conference take place? Where is it located?

A: March 2-4th, 2019 at the Springhill Suites in downtown Nashville. Come in to town early on March 1st and join us for Emergency Medicine Pub Trivia- time and location to be determined!

Q: How can I register? What are the registration rates?

A: All information for the conference, including registration and hotel reservations is through our website – Click Here. Registrations rates for a GSACEP/ACEP Member is $450, for a non-member is$550, and for a medical student is $150.

Q: Am I eligible for the member rate?

A: All 2018-2019 GSACEP members are eligible for Annual Symposium member rates. If you have questions about your membership status, please email execdirector@GSACEP.org or call (503) 542-8154

Q: How can I reserve a hotel room? What are the rates and what is the deadline?

A: The special rates for lodging will be offered through SpringHill Suites Nashville Downtown. The offer is currently open and extends to January 30, 2019. Please use the hotel website link on the GSACEP site to access reduced rate - Click Here.

Q: Are there any workshops offered?

A: Break-out sessions offered at the conference include Research Symposium and Ultrasound Workshop.

Q: What’s the policy regarding children at GSACEP19 and is daytime child care available?

A:  For the first time, we are exploring options to support parents with child care. Either email Dr. McGowan at torreemcg@me.com or mark it on your registration form and a decision will be made by Feb 1 if it can be offered.

Q: What should I wear to GSACEP19 events?

A: If you are on military orders and presenting/lecturing, please wear Service Dress Class A. If not presenting, we recommend Service Dress Class B (blues for AF). For receptions/social outings the dress is casual. We’re in Nashville, bring your cowboy boots!

Q: How may CME credits can I earn by attending the symposium?

A: “The American College of Emergency Physicians designates this live activity for a maximum of 20 AMA PRA Category 1 CreditsTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.”

Q: How do I sign up for Sim Wars? What is the deadline?

A: Sign-up by clicking here - Click Here. Final date to sign-up is TBD, but will likely close no later than Feb. 1st, 2019. For questions regarding SimWars, please email Major Rod Fontenette, roderick68@hotmail.com

Q: How do members submit research?

A: On our website - Click Here

Q: How can my organization become a conference sponsor?

A: Please fill out the on-line form on our website - Click Here. Further questions may be directed to our Chapter Executive, Ms. Liz Mesberg, at execdirector@gsacep.org

Q: What services are available for special needs and requests?

A: We will work to accommodate any special needs in conjunction with the hotel. Please direct any requests to our Chapter Executive, Ms. Liz Mesberg, execdirector@gsacep.org

Q: My question is not listed here. Whom do I contact?

A: All questions can be directed to execdirector@gsacep.org or call (503) 542-8154

GSACEP Resident Representative Message

CPT Adam Burgess

As we enter 2019 with new intern classes having matched, fellowships earned, and anticipation for the senior residents building regarding future assignments, I just wanted to take a moment to reflect on 2018. It has been a truly groundbreaking year for the resident members of GSACEP. The list of accomplishments and accolades is simply too numerous to count, but I would like to highlight several.

First, I would be remiss if I did not start by recognizing the unbelievable effort of the resident members of this Chapter, under the leadership of Dr. Torree McGowan, which resulted in the History of Military Emergency Medicine display in San Diego. To see residents from all branches of service and from programs from all corners of the country come to together to pull off this incredible feat was an amazing reminder of both the spirit of excellence and teamwork which GSACEP is renowned for.

Next, I would like to highlight the efforts and accomplishments of LT Eric Sulava, a current EM3 at Naval Medical Center Portsmouth. Eric took 1st place at the resident research competition at ACEP18 in San Diego. He then immediately deployed to Central and South America for two and half months on board the USNS Comfort in support of Operation Enduring Promise. During his deployment, Eric utilized his EM and problem-solving skills to provide humanitarian care and assistance to thousands of patients in very resource poor environments. His dedication to academic excellence and selfless service are the epitome of what GSACEP stands for.

I would also like to recognize CPT Jared Cohen, a current EM3 at San Antonio Military Medical Center. Due to Jared’s continual efforts over the last several years in helping to recruit the next generation of military medical providers, he was made the face of the Army’s newest HPSP ad campaign. Keep your eye out for him online and on selected TV spots!

Finally, I simply want to say thank you for allowing me to serve as your GSACEP Resident Representative for the last 2 years. It has truly been an honor and a privilege to represent all of you, and I am constantly humbled by the work ethic, intelligence, and dedication to selfless service which are universal among the resident members of this Chapter. I look forward to serving with you all in the future.

2019 GSACEP Award Winners

Excellence in Emergency Medicine Award

LtCol Nurani Kester

Rising Star Award

LCDR Andrea Austin

Medical Director Leadership Award

COL Mark Antonacci

Veteran’s Advocate Award

Chad Kessler