Health Policy Journal Club: Socially Constructed Criticisms EMRA

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white-resident"> <div class="ocean-mask"></div> <div class="wave"></div> </div> </div> </div> <div class="body-wrapper"> <div class="container"> <div class="col-md-12"> <div> <div class="col-lg-9 col-sm-12 general-text"> <div itemscope itemtype="http://schema.org/Article" class="article-img row"> <div class="col-md-8 col-sm-12 block no-padding-d"> <div class="image-block"> <img src="/siteassets/emresident/images/series/hpjc/hpjc-0520.jpg?w=600" itemprop="image" title="hpjc-0520.jpg" /> </div> </div> <div class="col-xs-12 no-padding-d"> <div class="general-text article-heading"> <span class="subtitle" itemprop="keywords"> <a href="/emresident/articles/categories/topics/health-policy/health-policy-journal-club">Health Policy Journal Club,</a> <a href="/emresident/articles/categories/topics/health-policy">Health Policy,</a> <a href="/emresident/articles/categories/topics/health-policy/advocacy">Advocacy</a> </span> <h1 itemprop="name">Health Policy Journal Club: Socially Constructed Criticisms</h1> <div class="col-md-8 no-padding-d"> <span class="info"> <strong itemprop="datePublished">5/6/2020</strong> <a href="/emresident/authors/jasmeen-kaur" itemprop="author"> <strong>Jasmeen Kaur </strong> </a> </span> </div> <div class="col-md-4 no-padding-d share-this-right">  <div class="addthis_inline_share_toolbox_dmno float-right"></div> </div> </div> <div class="gradient-line-purple heading"></div> <div itemprop="articleBody" class="general-text"><h3 class="p1">Socially constructed categorizations continue to limit quality of care for minorities</h3> <p class="p1">Your race or ethnic background may play a role in analyzing whether you receive pain treatment when seeking emergency medical services. Considerable evidence suggests systematic disparities in hospitals in which racial/ethnic minorities receive care and associated disparities in patient outcomes compared with hospitals frequented by White patients. However, racial/ethnic treatment disparities in the field of Emergency Medical Services (EMS) remains relatively less understood.</p> <p class="p1">EMS treats an estimated 16 million sick and injured individuals annually, often with acute morbidity and mortality. <a rel="noopener" href="https://www.ncbi.nlm.nih.gov/pubmed/31730566" target="_blank"><span class="s1">A </span><span class="s1">recent retrospective study </span></a>determined that racial/ethnic minorities were more likely to experience disadvantages in EMS treatment in Oregon. Hispanic and Asian patients who requested EMS services for traumatic injuries were less likely to have their pain assessed and all racial/ethnicity patients were less likely to be treated with pain medications when compared with White patients.</p> <p class="p1">Of more than 25,000 EMS encounters from 2015-2017, Hispanic patients were 21% less likely and Asian patients were 31% less likely to receive pain assessment and pain medication when compared with White patients. The adjusted likelihood of receiving any pain medications demonstrated that Black patients were 32% less likely, Hispanic patients were 21% less likely, and Asian patients were 24% less likely when compared with White patients. The results imply that race/ethnicity, a socially constructed categorization scheme rooted in relationships of power, continues to limit quality medical treatment for minorities.</p> <p class="p1">Previous research suggests mechanisms driving racial/ethnic disparate treatment may operate at the patient, provider, and institutional level. The authors of this study postulate, at the patient level, limited English proficiency is likely relevant to receiving lower quality medical treatment in emergency medicine.</p> <p class="p1">At an institutional level, clinical situations that require medical professionals to perform under high levels of cognitive load have been shown to create environments that are conducive to racial/ethnic treatment disparities through activation of heuristics and stereotypes known to contain bias. It may be likely that EMS personnel maybe adjusting their clinical actions similarly. To mitigate treatment disparities, agencies could explore diverse training and recruitment options. Regulators might consider creating local policies overseeing EMS agencies to make data available that EMS treatment is being provided equitably. These data could ultimately impact the care of minorities by EMS.</p> <hr /> <p class="p1"><a rel="noopener" href="https://www.ncbi.nlm.nih.gov/pubmed/31490537" target="_blank"></a><strong>Abstract: </strong>Kennel J, Withers E, Parsons N, Woo H. <a rel="noopener" href="https://pubmed.ncbi.nlm.nih.gov/31730566/" target="_blank">Racial/ethnic disparities in pain treatment: evidence from Oregon Emergency Medical Services agencies</a>. <em>Med Care</em>. 2019;57(12):924-929.</p> <p><strong>BACKGROUND: </strong>Despite the critical role that EMS plays in the health care system, racial/ethnic treatment disparities in EMS remain relatively unexamined.</p> <p><strong>OBJECTIVE: </strong>To investigate racial/ethnic treatment disparities in pain assessment and pain medication administration in EMS</p> <p><strong>RESEARCH DESIGN: </strong>A retrospective analysis was performed on 25,732 EMS encounters from 2015 to 2017 recorded in the Oregon Emergency Medical Services Information System using multivariate logistic regression models to examine the role of patient race/ethnicity in pain assessment and pain medication administration among patients with a traumatic injury</p> <p><strong>RESULTS: </strong>Hispanic and Asian patients were less likely to receive a pain assessment procedure and all racial/ethnic patients were less likely to receive pain medications compared with white patients. In particular, regarding the adjusted likelihood of receiving a pain assessment procedure, Hispanic patients were 21% less likely [95% confidence interval (CI), 10%-30%; P<0.001], Asian patients were 31% less likely (95% CI, 16%-43%; P<0.001) when compared with white patients. Regarding the adjusted likelihood of receiving any pain medications, black patients were 32% less likely (95% CI, 21%-42%; P<0.001), Hispanic patients were 21% less likely (95% CI, 7%-32%; P<0.01), and Asian patients were 24% less likely (95% CI, 1%-41%; P<0.05) when compared with white patients.</p> <p><strong>CONCLUSIONS: </strong>Racial/ethnic minorities were more likely to experience disadvantages in EMS treatment in Oregon. Hispanic and Asian patients who requested EMS services in Oregon for traumatic injuries were less likely to have their pain assessed and all racial/ethnicity patients were less likely to be treated with pain medications when compared with white patients.</p> <p class="p1"><strong>PMID: 31730566</strong></p> <hr /> <h3><strong>EMRA + PolicyRx Health Policy Journal Club: </strong>A collaboration between <a rel="noopener" title="Policy Prescriptions" href="http://www.policyprescriptions.org/" target="_blank">Policy Prescriptions</a> and EMRA</h3> <p><em><img style="float: left; margin: 0 21px 0 0;" src="/siteassets/emresident/images/series/hpjc/health-policy-rx-logo-150x150.jpg" alt="" width="150" height="150" />As emergency physicians, we care for all members of society, and as such have a unique vantage point on the state of health care. What we find frustrating in our EDs - such as inadequate social services, the dearth of primary care providers, and the lack of mental health services - are universal problems.</em> <em>As EM residents and fellows,  we learn the management of myocardial infarctions and traumas, and how to intubate, but we are not taught how health policy affects all aspects of our experience in the ED. Furthermore, given our unique position in the health care system, we have an incredible opportunity to advocate for our patients, for society, and for physicians. Yet, with so many competing interests vying for our conference education time, advocacy is often not included in the curricula.</em> <em>This is the gap this initiative aims to fill.  Each month, you will see a review of a new health policy article and how it is applicable to emergency physicians.</em>  </p></div> <div class="additional-content"></div> </div> </div>   <div class="addthis_inline_share_toolbox"></div> <div> <div id="disqus_thread"></div><noscript>Please enable JavaScript to view the <a href="http://disqus.com/?ref_noscript">comments powered by Disqus.</a></noscript> </div> </div> <div class="col-lg-3 col-sm-12"> <div class="block emradblock col-lg-12 col-md-12 col-sm-12 col-xs-12"> <a id="EMRMediumRectangleROS"></a> <div class="leaderboard-ad container-fluid only-desktop"> <div class="centered-block"> <div class="gradient-border inline"> <div class="ad-box">  <ins data-revive-zoneid="2270" data-revive-id="5d3cba222eaaeee40162c5d04d22e1b8"></ins> <script async="" 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href="/emresident/articles/categories/committee/education-committee"> Education Committee <span class="total">10</span> </a> </li> <li style="padding-left: 0px"> <a href="/emresident/articles/categories/committee/government-services"> Government Services <span class="total">4</span> </a> </li> <li style="padding-left: 0px"> <a href="/emresident/articles/categories/committee/health-policy-committee"> Health Policy Committee <span class="total">8</span> </a> </li> <li style="padding-left: 0px"> <a href="/emresident/articles/categories/committee/informatics-committee"> Informatics Committee <span class="total">3</span> </a> </li> <li style="padding-left: 0px"> <a href="/emresident/articles/categories/committee/medical-student-council"> Medical Student Council <span class="total">7</span> </a> </li> <li style="padding-left: 0px"> <a href="/emresident/articles/categories/committee/pediatrics-committee"> Pediatrics Committee <span class="total">4</span> </a> </li> <li style="padding-left: 0px"> <a href="/emresident/articles/categories/committee/research-committee"> Research Committee <span class="total">6</span> </a> </li> <li style="padding-left: 0px"> <a href="/emresident/articles/categories/committee/simulation-committee"> Simulation Committee <span class="total">3</span> </a> </li> <li style="padding-left: 0px"> <a href="/emresident/articles/categories/committee/social-em-committee"> Social EM Committee <span class="total">7</span> </a> </li> <li style="padding-left: 0px"> <a href="/emresident/articles/categories/committee/wilderness"> Wilderness Committee <span class="total">5</span> </a> </li> </li> </ul> </div> <div class="categories-sidebar"> <div class="title">Division</div> <ul> <li class="tiered-filters"> <li style="padding-left: 0px"> <a href="/emresident/articles/categories/divsion/international-committee"> International Committee <span class="total">8</span> </a> </li> <li style="padding-left: 0px"> <a href="/emresident/articles/categories/divsion/prehospital-and-disaster-medicine"> Prehospital and Disaster Medicine Committee <span class="total">5</span> </a> </li> <li style="padding-left: 0px"> <a href="/emresident/articles/categories/divsion/simulation"> Simulation Division <span class="total">2</span> </a> </li> <li style="padding-left: 0px"> <a href="/emresident/articles/categories/divsion/sports-medicine-committee"> Sports Medicine Committee <span class="total">5</span> </a> </li> </li> </ul> </div> <div class="categories-sidebar"> <div class="title">Topics</div> <ul> <li class="tiered-filters"> <li style="padding-left: 0px"> <a href="/emresident/articles/categories/topics/advancement-of-em"> Advancement of EM <span class="total">114</span> </a> </li> <ul> <li style="padding-left: 10px"> <a href="/emresident/articles/categories/topics/advancement-of-em/administration--operations"> Administration & Operations <span class="total">61</span> </a> </li> <ul> <li style="padding-left: 20px"> <a href="/emresident/articles/categories/topics/advancement-of-em/administration--operations/admin-ops-literature-review"> Admin Ops Literature Review <span class="total">8</span> </a> </li> </ul> <li style="padding-left: 10px"> <a href="/emresident/articles/categories/topics/advancement-of-em/diversity-and-inclusion"> Diversity and Inclusion <span class="total">18</span> </a> </li> <li style="padding-left: 10px"> <a href="/emresident/articles/categories/topics/advancement-of-em/research"> Research <span class="total">31</span> </a> </li> <ul> <li style="padding-left: 20px"> <a href="/emresident/articles/categories/topics/advancement-of-em/research/rapid-research-review"> Rapid Research Review <span class="total">9</span> </a> </li> </ul> </ul> <li style="padding-left: 0px"> <a href="/emresident/articles/categories/topics/awards"> Awards <span class="total">26</span> </a> </li> <ul> <li style="padding-left: 10px"> <a href="/emresident/articles/categories/topics/awards/attending"> Attending <span class="total">2</span> </a> </li> <li style="padding-left: 10px"> <a href="/emresident/articles/categories/topics/awards/award-winners"> Award Winners <span class="total">20</span> </a> </li> <li style="padding-left: 10px"> <a href="/emresident/articles/categories/topics/awards/educational-courses"> Educational Courses <span class="total">2</span> </a> </li> <li style="padding-left: 10px"> <a href="/emresident/articles/categories/topics/awards/grants"> Grants <span class="total">6</span> </a> </li> <li style="padding-left: 10px"> <a href="/emresident/articles/categories/topics/awards/residency-leadership"> Residency Leadership <span class="total">2</span> </a> </li> <li style="padding-left: 10px"> <a href="/emresident/articles/categories/topics/awards/spring"> Spring <span class="total">2</span> </a> </li> <li style="padding-left: 10px"> <a href="/emresident/articles/categories/topics/awards/travel-scholarships"> Travel Scholarships <span class="total">3</span> </a> </li> </ul> <li style="padding-left: 0px"> <a href="/emresident/articles/categories/topics/benefits"> Benefits <span class="total">5</span> </a> </li> <ul> <li style="padding-left: 10px"> <a href="/emresident/articles/categories/topics/benefits/acep-member-benefits"> ACEP Member Benefits <span class="total">2</span> </a> </li> </ul> <li style="padding-left: 0px"> <a href="/emresident/articles/categories/topics/career-planning"> Career Planning <span class="total">78</span> </a> </li> <ul> <li style="padding-left: 10px"> <a href="/emresident/articles/categories/topics/career-planning/board-certification"> Board Certification <span class="total">7</span> </a> </li> <li style="padding-left: 10px"> <a href="/emresident/articles/categories/topics/career-planning/interviewing"> Interviewing <span class="total">5</span> </a> </li> <li style="padding-left: 10px"> <a href="/emresident/articles/categories/topics/career-planning/job-search"> Job Search <span class="total">3</span> </a> </li> <li style="padding-left: 10px"> <a href="/emresident/articles/categories/topics/career-planning/practice-environments"> Practice Environments <span class="total">25</span> </a> </li> <ul> <li style="padding-left: 20px"> <a href="/emresident/articles/categories/topics/career-planning/practice-environments/community"> Community <span class="total">2</span> </a> </li> <li style="padding-left: 20px"> <a href="/emresident/articles/categories/topics/career-planning/practice-environments/international"> International <span class="total">10</span> </a> </li> <li style="padding-left: 20px"> <a href="/emresident/articles/categories/topics/career-planning/practice-environments/locum-tenens"> Locum Tenens <span class="total">2</span> </a> </li> </ul> </ul> <li style="padding-left: 0px"> <a href="/emresident/articles/categories/topics/clinical"> Clinical <span class="total">1005</span> </a> </li> <ul> <li style="padding-left: 10px"> <a href="/emresident/articles/categories/topics/clinical/addiction-medicine"> Addiction Medicine <span class="total">4</span> </a> </li> <li style="padding-left: 10px"> <a href="/emresident/articles/categories/topics/clinical/airway"> Airway <span class="total">44</span> </a> </li> <ul> <li style="padding-left: 20px"> <a href="/emresident/articles/categories/topics/clinical/airway/surgical-airway"> Surgical Airway <span class="total">1</span> </a> </li> </ul> <li style="padding-left: 10px"> <a href="/emresident/articles/categories/topics/clinical/behavioral-health"> Behavioral Health <span class="total">5</span> </a> </li> <li style="padding-left: 10px"> <a href="/emresident/articles/categories/topics/clinical/cardiology"> Cardiology <span class="total">159</span> </a> </li> <ul> <li style="padding-left: 20px"> <a href="/emresident/articles/categories/topics/clinical/cardiology/ecg"> ECG <span class="total">2</span> </a> </li> <li style="padding-left: 20px"> <a href="/emresident/articles/categories/topics/clinical/cardiology/ecg-challenge"> ECG Challenge <span class="total">48</span> </a> </li> </ul> <li style="padding-left: 10px"> <a href="/emresident/articles/categories/topics/clinical/consults"> Consults <span class="total">6</span> </a> </li> <ul> <li style="padding-left: 20px"> <a href="/emresident/articles/categories/topics/clinical/consults/consult-corner"> Consult Corner <span class="total">5</span> </a> </li> </ul> <li style="padding-left: 10px"> <a href="/emresident/articles/categories/topics/clinical/critical-care"> Critical Care <span class="total">229</span> </a> </li> <ul> <li style="padding-left: 20px"> <a href="/emresident/articles/categories/topics/clinical/critical-care/critical-care-alert"> Critical Care Alert <span class="total">103</span> </a> </li> <li style="padding-left: 20px"> <a href="/emresident/articles/categories/topics/clinical/critical-care/critical-care-devices"> Critical Care Devices <span class="total">11</span> </a> </li> <li style="padding-left: 20px"> <a href="/emresident/articles/categories/topics/clinical/critical-care/critical-care-roadblock"> Critical Care Roadblock <span class="total">4</span> </a> </li> <li style="padding-left: 20px"> <a href="/emresident/articles/categories/topics/clinical/critical-care/critical-care-ultrasound"> Critical Care Ultrasound <span class="total">14</span> </a> </li> <li style="padding-left: 20px"> <a href="/emresident/articles/categories/topics/clinical/critical-care/deep-dive-in-critcare"> Deep Dive in CritCare <span class="total">9</span> </a> </li> <li style="padding-left: 20px"> <a href="/emresident/articles/categories/topics/clinical/critical-care/sepsis"> Sepsis <span class="total">21</span> </a> </li> <li style="padding-left: 20px"> <a href="/emresident/articles/categories/topics/clinical/critical-care/shock"> Shock <span class="total">9</span> </a> </li> <li style="padding-left: 20px"> <a href="/emresident/articles/categories/topics/clinical/critical-care/ventilator-management"> Ventilator Management <span class="total">7</span> </a> </li> </ul> <li style="padding-left: 10px"> <a href="/emresident/articles/categories/topics/clinical/dermatology"> Dermatology <span class="total">10</span> </a> </li> <li style="padding-left: 10px"> <a href="/emresident/articles/categories/topics/clinical/ems"> EMS <span class="total">53</span> </a> </li> <ul> <li style="padding-left: 20px"> <a href="/emresident/articles/categories/topics/clinical/ems/disaster-medicine"> Disaster Medicine <span class="total">13</span> </a> </li> <li style="padding-left: 20px"> <a href="/emresident/articles/categories/topics/clinical/ems/prehospital-care"> Prehospital Care <span class="total">21</span> </a> </li> </ul> <li style="padding-left: 10px"> <a href="/emresident/articles/categories/topics/clinical/endocrinology"> Endocrinology <span class="total">12</span> </a> </li> <li style="padding-left: 10px"> <a href="/emresident/articles/categories/topics/clinical/ent"> ENT <span class="total">7</span> </a> </li> <li style="padding-left: 10px"> <a href="/emresident/articles/categories/topics/clinical/event-medicine"> Event Medicine <span class="total">2</span> </a> </li> <li style="padding-left: 10px"> <a href="/emresident/articles/categories/topics/clinical/gastroenterology"> Gastroenterology <span class="total">16</span> </a> </li> <li style="padding-left: 10px"> <a href="/emresident/articles/categories/topics/clinical/geriatrics"> Geriatrics <span class="total">4</span> </a> </li> <li style="padding-left: 10px"> <a href="/emresident/articles/categories/topics/clinical/hematology"> Hematology <span class="total">21</span> </a> </li> <li style="padding-left: 10px"> <a href="/emresident/articles/categories/topics/clinical/immunology"> Immunology <span class="total">1</span> </a> </li> <li style="padding-left: 10px"> <a href="/emresident/articles/categories/topics/clinical/infectious-disease"> Infectious Disease <span class="total">134</span> </a> </li> <ul> <li style="padding-left: 20px"> <a href="/emresident/articles/categories/topics/clinical/infectious-disease/covid-19"> COVID-19 <span class="total">81</span> </a> </li> </ul> <li style="padding-left: 10px"> <a href="/emresident/articles/categories/topics/clinical/informatics"> Informatics <span class="total">19</span> </a> </li> <ul> <li style="padding-left: 20px"> <a href="/emresident/articles/categories/topics/clinical/informatics/security"> Security <span class="total">1</span> </a> </li> <li style="padding-left: 20px"> <a href="/emresident/articles/categories/topics/clinical/informatics/telemedicine"> Telemedicine <span class="total">3</span> </a> </li> </ul> <li style="padding-left: 10px"> <a href="/emresident/articles/categories/topics/clinical/international-em"> International EM <span class="total">25</span> </a> </li> <li style="padding-left: 10px"> <a href="/emresident/articles/categories/topics/clinical/nephrology"> Nephrology <span class="total">16</span> </a> </li> <li style="padding-left: 10px"> <a href="/emresident/articles/categories/topics/clinical/neurology"> Neurology <span class="total">53</span> </a> </li> <li style="padding-left: 10px"> <a href="/emresident/articles/categories/topics/clinical/obgyn"> OB/GYN <span class="total">25</span> </a> </li> <li style="padding-left: 10px"> <a href="/emresident/articles/categories/topics/clinical/oncology"> Oncology <span class="total">3</span> </a> </li> <li style="padding-left: 10px"> <a href="/emresident/articles/categories/topics/clinical/ophthalmology"> Ophthalmology <span class="total">17</span> </a> </li> <li style="padding-left: 10px"> <a href="/emresident/articles/categories/topics/clinical/orthopedics"> Orthopedics <span class="total">27</span> </a> </li> <li style="padding-left: 10px"> <a href="/emresident/articles/categories/topics/clinical/osteopathic"> Osteopathic <span class="total">3</span> </a> </li> <li style="padding-left: 10px"> <a href="/emresident/articles/categories/topics/clinical/pain-management"> Pain Management <span class="total">26</span> </a> </li> <li style="padding-left: 10px"> <a href="/emresident/articles/categories/topics/clinical/palliative-care"> Palliative Care <span class="total">14</span> </a> </li> <li style="padding-left: 10px"> <a href="/emresident/articles/categories/topics/clinical/patient-interactions"> Patient Interactions <span class="total">21</span> </a> </li> <li style="padding-left: 10px"> <a href="/emresident/articles/categories/topics/clinical/pediatric-em"> Pediatric EM <span class="total">100</span> </a> </li> <li style="padding-left: 10px"> <a href="/emresident/articles/categories/topics/clinical/pharmacology"> Pharmacology <span class="total">1</span> </a> </li> <li style="padding-left: 10px"> <a href="/emresident/articles/categories/topics/clinical/psychiatry"> Psychiatry <span class="total">9</span> </a> </li> <ul> <li style="padding-left: 20px"> <a href="/emresident/articles/categories/topics/clinical/psychiatry/mental-health"> Mental Health <span class="total">3</span> </a> </li> </ul> <li style="padding-left: 10px"> <a href="/emresident/articles/categories/topics/clinical/pulmonary"> Pulmonary <span class="total">18</span> </a> </li> <li style="padding-left: 10px"> <a href="/emresident/articles/categories/topics/clinical/radiology"> Radiology <span class="total">7</span> </a> </li> <li style="padding-left: 10px"> <a href="/emresident/articles/categories/topics/clinical/rheumatology"> Rheumatology <span class="total">1</span> </a> </li> <li style="padding-left: 10px"> <a href="/emresident/articles/categories/topics/clinical/simulation"> Simulation <span class="total">13</span> </a> </li> <li style="padding-left: 10px"> <a href="/emresident/articles/categories/topics/clinical/social-em"> Social EM <span class="total">53</span> </a> </li> <li style="padding-left: 10px"> <a href="/emresident/articles/categories/topics/clinical/space-medicine"> Space Medicine <span class="total">3</span> </a> </li> <li style="padding-left: 10px"> <a href="/emresident/articles/categories/topics/clinical/sports-medicine"> Sports Medicine <span class="total">11</span> </a> </li> <li style="padding-left: 10px"> <a href="/emresident/articles/categories/topics/clinical/toxicology"> Toxicology <span class="total">101</span> </a> </li> <ul> <li style="padding-left: 20px"> <a href="/emresident/articles/categories/topics/clinical/toxicology/medications"> Medications <span class="total">12</span> </a> </li> <li style="padding-left: 20px"> <a href="/emresident/articles/categories/topics/clinical/toxicology/recreational-drugs"> Recreational Drugs <span class="total">10</span> </a> </li> <li style="padding-left: 20px"> <a href="/emresident/articles/categories/topics/clinical/toxicology/toxins"> Toxins <span class="total">7</span> </a> </li> </ul> <li style="padding-left: 10px"> <a href="/emresident/articles/categories/topics/clinical/trauma"> Trauma <span class="total">42</span> </a> </li> <ul> <li style="padding-left: 20px"> <a href="/emresident/articles/categories/topics/clinical/trauma/blunt"> Blunt <span class="total">2</span> </a> </li> <li style="padding-left: 20px"> <a href="/emresident/articles/categories/topics/clinical/trauma/traumatic-brain-injury"> Traumatic Brain Injury <span class="total">2</span> </a> </li> </ul> <li style="padding-left: 10px"> <a href="/emresident/articles/categories/topics/clinical/ultrasound"> Ultrasound <span class="total">87</span> </a> </li> <ul> <li style="padding-left: 20px"> <a href="/emresident/articles/categories/topics/clinical/ultrasound/guided-procedures"> Guided Procedures <span class="total">5</span> </a> </li> <li style="padding-left: 20px"> <a href="/emresident/articles/categories/topics/clinical/ultrasound/pocus-for-the-win"> POCUS For the Win <span class="total">8</span> </a> </li> </ul> <li style="padding-left: 10px"> <a href="/emresident/articles/categories/topics/clinical/undersea-and-hyperbaric"> Undersea and Hyperbaric <span class="total">2</span> </a> </li> <li style="padding-left: 10px"> <a href="/emresident/articles/categories/topics/clinical/urology"> Urology <span class="total">24</span> </a> </li> <li style="padding-left: 10px"> <a href="/emresident/articles/categories/topics/clinical/vascular"> Vascular <span class="total">5</span> </a> </li> <li style="padding-left: 10px"> <a href="/emresident/articles/categories/topics/clinical/visual-diagnosis"> Visual Diagnosis <span class="total">20</span> </a> </li> <li style="padding-left: 10px"> <a href="/emresident/articles/categories/topics/clinical/wilderness-medicine"> Wilderness Medicine <span class="total">28</span> </a> </li> </ul> <li style="padding-left: 0px"> <a href="/emresident/articles/categories/topics/editorial"> Editorial <span class="total">133</span> </a> </li> <ul> <li style="padding-left: 10px"> <a href="/emresident/articles/categories/topics/editorial/editors-forum"> Editor's Forum <span class="total">55</span> </a> </li> <li style="padding-left: 10px"> <a href="/emresident/articles/categories/topics/editorial/heart-of-em"> Heart of EM <span class="total">13</span> </a> </li> <li style="padding-left: 10px"> <a href="/emresident/articles/categories/topics/editorial/opinion-editorial"> Opinion-Editorial <span class="total">15</span> </a> </li> </ul> <li style="padding-left: 0px"> <a href="/emresident/articles/categories/topics/emra"> EMRA <span class="total">115</span> </a> </li> <ul> <li style="padding-left: 10px"> <a href="/emresident/articles/categories/topics/emra/leadership-reports"> Leadership Reports <span class="total">79</span> </a> </li> <ul> <li style="padding-left: 20px"> <a href="/emresident/articles/categories/topics/emra/leadership-reports/acep-representative"> ACEP Representative <span class="total">2</span> </a> </li> <li style="padding-left: 20px"> <a href="/emresident/articles/categories/topics/emra/leadership-reports/acgme-rc-em"> ACGME RC-EM <span class="total">11</span> </a> </li> <li style="padding-left: 20px"> <a href="/emresident/articles/categories/topics/emra/leadership-reports/presidents-message"> President's Message <span class="total">48</span> </a> </li> <li style="padding-left: 20px"> <a href="/emresident/articles/categories/topics/emra/leadership-reports/speaker-report"> Speaker Report <span class="total">8</span> </a> </li> <li style="padding-left: 20px"> <a href="/emresident/articles/categories/topics/emra/leadership-reports/treasurers-report"> Treasurer's Report <span class="total">3</span> </a> </li> </ul> <li style="padding-left: 10px"> <a href="/emresident/articles/categories/topics/emra/membership"> Membership <span class="total">3</span> </a> </li> <li style="padding-left: 10px"> <a href="/emresident/articles/categories/topics/emra/op-ed"> Op-Ed <span class="total">32</span> </a> </li> </ul> <li style="padding-left: 0px"> <a href="/emresident/articles/categories/topics/events--activities"> Events & Activities <span class="total">21</span> </a> </li> <ul> <li style="padding-left: 10px"> <a href="/emresident/articles/categories/topics/events--activities/acep-scientific-assembly"> ACEP Scientific Assembly <span class="total">6</span> </a> </li> <li style="padding-left: 10px"> <a href="/emresident/articles/categories/topics/events--activities/cord-academic-assembly"> CORD Academic Assembly <span class="total">2</span> </a> </li> <li style="padding-left: 10px"> <a href="/emresident/articles/categories/topics/events--activities/em-wellness-week"> EM Wellness Week <span class="total">1</span> </a> </li> <li style="padding-left: 10px"> <a href="/emresident/articles/categories/topics/events--activities/emra-medwar"> EMRA MedWAR <span class="total">3</span> </a> </li> <li style="padding-left: 10px"> <a href="/emresident/articles/categories/topics/events--activities/leadership-and-advocacy-conference"> Leadership and Advocacy Conference <span class="total">6</span> </a> </li> </ul> <li style="padding-left: 0px"> <a href="/emresident/articles/categories/topics/fellowships"> Fellowships <span class="total">12</span> </a> </li> <ul> <li style="padding-left: 10px"> <a href="/emresident/articles/categories/topics/fellowships/education-fellowships"> Education Fellowships <span class="total">2</span> </a> </li> <li style="padding-left: 10px"> <a href="/emresident/articles/categories/topics/fellowships/global-em-fellowships"> Global EM Fellowships <span class="total">2</span> </a> </li> <li style="padding-left: 10px"> <a href="/emresident/articles/categories/topics/fellowships/health-policy-fellowships"> Health Policy Fellowships <span class="total">1</span> </a> </li> <li style="padding-left: 10px"> <a href="/emresident/articles/categories/topics/fellowships/pediatric-fellowships"> Pediatric Fellowships <span class="total">2</span> </a> </li> </ul> <li style="padding-left: 0px"> <a href="/emresident/articles/categories/topics/health-equity"> Health Equity <span class="total">3</span> </a> </li> <li style="padding-left: 0px"> <a href="/emresident/articles/categories/topics/health-policy"> Health Policy <span class="total">149</span> </a> </li> <ul> <li style="padding-left: 10px"> <a href="/emresident/articles/categories/topics/health-policy/advocacy"> Advocacy <span class="total">45</span> </a> </li> <li style="padding-left: 10px"> <a href="/emresident/articles/categories/topics/health-policy/affordable-care-act"> Affordable Care Act <span class="total">7</span> </a> </li> <li style="padding-left: 10px"> <a href="/emresident/articles/categories/topics/health-policy/health-policy-journal-club"> Health Policy Journal Club <span class="total">79</span> </a> </li> <li style="padding-left: 10px"> <a href="/emresident/articles/categories/topics/health-policy/legislation"> Legislation <span class="total">9</span> </a> </li> <li style="padding-left: 10px"> <a href="/emresident/articles/categories/topics/health-policy/regulatory"> Regulatory <span class="total">2</span> </a> </li> </ul> <li style="padding-left: 0px"> <a href="/emresident/articles/categories/topics/leadership"> Leadership <span class="total">182</span> </a> </li> <ul> <li style="padding-left: 10px"> <a href="/emresident/articles/categories/topics/leadership/committees-and-divisions"> Committees and Divisions <span class="total">4</span> </a> </li> <li style="padding-left: 10px"> <a href="/emresident/articles/categories/topics/leadership/emra-board-of-directors"> EMRA Board of Directors <span class="total">40</span> </a> </li> <li style="padding-left: 10px"> <a href="/emresident/articles/categories/topics/leadership/emra-spotlight"> EMRA Spotlight <span class="total">127</span> </a> </li> <li style="padding-left: 10px"> <a href="/emresident/articles/categories/topics/leadership/representative-council"> Representative Council <span class="total">9</span> </a> </li> </ul> <li style="padding-left: 0px"> <a href="/emresident/articles/categories/topics/med-education"> Medical Education <span class="total">85</span> </a> </li> <ul> <li style="padding-left: 10px"> <a href="/emresident/articles/categories/topics/med-education/board-review"> Board Review <span class="total">2</span> </a> </li> <ul> <li style="padding-left: 20px"> <a href="/emresident/articles/categories/topics/med-education/board-review/questions"> Questions <span class="total">1</span> </a> </li> </ul> <li style="padding-left: 10px"> <a href="/emresident/articles/categories/topics/med-education/course"> Course <span class="total">2</span> </a> </li> <li style="padding-left: 10px"> <a href="/emresident/articles/categories/topics/med-education/med-ed-fellowship-director-interview-series"> Med Ed Fellowship Director Interview Series <span class="total">10</span> </a> </li> <li style="padding-left: 10px"> <a href="/emresident/articles/categories/topics/med-education/podcasts"> Podcasts <span class="total">2</span> </a> </li> </ul> <li style="padding-left: 0px"> <a href="/emresident/articles/categories/topics/medical-students"> Medical Students <span class="total">201</span> </a> </li> <ul> <li style="padding-left: 10px"> <a href="/emresident/articles/categories/topics/medical-students/advising"> Advising <span class="total">60</span> </a> </li> <ul> <li style="padding-left: 20px"> <a href="/emresident/articles/categories/topics/medical-students/advising/away-rotations"> Away Rotations <span class="total">8</span> </a> </li> <li style="padding-left: 20px"> <a href="/emresident/articles/categories/topics/medical-students/advising/dual-degree-programs"> Dual Degree 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href="/emresident/articles/categories/topics/medical-students/match/rank-list"> Rank List <span class="total">1</span> </a> </li> <li style="padding-left: 20px"> <a href="/emresident/articles/categories/topics/medical-students/match/residents-program-interviews"> Residents Program Interviews <span class="total">4</span> </a> </li> </ul> <li style="padding-left: 10px"> <a href="/emresident/articles/categories/topics/medical-students/medical-student-council"> Medical Student Council <span class="total">29</span> </a> </li> </ul> <li style="padding-left: 0px"> <a href="/emresident/articles/categories/topics/mentorship"> Mentorship <span class="total">4</span> </a> </li> <li style="padding-left: 0px"> <a href="/emresident/articles/categories/topics/non-clinical"> Non Clinical <span class="total">68</span> </a> </li> <ul> <li style="padding-left: 10px"> <a href="/emresident/articles/categories/topics/non-clinical/empower"> EMPower <span class="total">29</span> </a> </li> <li 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href="/emresident/articles/categories/topics/wellness/financial"> Financial <span class="total">10</span> </a> </li> <ul> <li style="padding-left: 20px"> <a href="/emresident/articles/categories/topics/wellness/financial/insurance"> Insurance <span class="total">2</span> </a> </li> <li style="padding-left: 20px"> <a href="/emresident/articles/categories/topics/wellness/financial/loan-refinancing"> Loan Refinancing <span class="total">2</span> </a> </li> <li style="padding-left: 20px"> <a href="/emresident/articles/categories/topics/wellness/financial/personal-finance"> Personal Finance <span class="total">4</span> </a> </li> </ul> <li style="padding-left: 10px"> <a href="/emresident/articles/categories/topics/wellness/medico-legal"> Medico Legal <span class="total">32</span> </a> </li> <ul> <li style="padding-left: 20px"> <a href="/emresident/articles/categories/topics/wellness/medico-legal/ethics"> Ethics <span class="total">4</span> </a> </li> <li style="padding-left: 20px"> <a 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this.$div.parent().width() * parseInt(this.o.width) / 100 : this.$div.parent().width(), h = this.relativeHeight ? this.$div.parent().height() * parseInt(this.o.height) / 100 : this.$div.parent().height(); // apply relative this.w = this.h = Math.min(w, h); } else { this.w = this.o.width; this.h = this.o.height; } // finalize div this.$div.css({ 'width': this.w + 'px', 'height': this.h + 'px' }); // finalize canvas with computed width this.$c.attr({ width: this.w, height: this.h }); // scaling if (this.scale !== 1) { this.$c[0].width = this.$c[0].width * this.scale; this.$c[0].height = this.$c[0].height * this.scale; this.$c.width(this.w); this.$c.height(this.h); } return this; }; this._draw = function () { // canvas pre-rendering var d = true; s.g = s.c; s.clear(); s.dH && (d = s.dH()); d !== false && s.draw(); }; this._touch = function (e) { var touchMove = function (e) { var v = s.xy2val( e.originalEvent.touches[s.t].pageX, e.originalEvent.touches[s.t].pageY ); if (v == s.cv) return; if (s.cH && s.cH(v) === false) return; s.change(s._validate(v)); s._draw(); }; // get touches index this.t = k.c.t(e); // First touch touchMove(e); // Touch events listeners k.c.d .bind("touchmove.k", touchMove) .bind( "touchend.k", function () { k.c.d.unbind('touchmove.k touchend.k'); s.val(s.cv); } ); return this; }; this._mouse = function (e) { var mouseMove = function (e) { var v = s.xy2val(e.pageX, e.pageY); if (v == s.cv) return; if (s.cH && (s.cH(v) === false)) return; s.change(s._validate(v)); s._draw(); }; // First click mouseMove(e); // Mouse events listeners k.c.d .bind("mousemove.k", mouseMove) .bind( // Escape key cancel current change "keyup.k", function (e) { if (e.keyCode === 27) { k.c.d.unbind("mouseup.k mousemove.k keyup.k"); if (s.eH && s.eH() === false) return; s.cancel(); } } ) .bind( "mouseup.k", function (e) { k.c.d.unbind('mousemove.k mouseup.k keyup.k'); s.val(s.cv); } ); return this; }; this._xy = function () { var o = this.$c.offset(); this.x = o.left; this.y = o.top; return this; }; this._listen = function () { if (!this.o.readOnly) { this.$c .bind( "mousedown", function (e) { e.preventDefault(); s._xy()._mouse(e); } ) .bind( "touchstart", function (e) { e.preventDefault(); s._xy()._touch(e); } ); this.listen(); } else { this.$.attr('readonly', 'readonly'); } if (this.relative) { $(window).resize(function() { s._carve().init(); s._draw(); }); } return this; }; this._configure = function () { // Hooks if (this.o.draw) this.dH = this.o.draw; if (this.o.change) this.cH = this.o.change; if (this.o.cancel) this.eH = this.o.cancel; if (this.o.release) this.rH = this.o.release; if (this.o.displayPrevious) { this.pColor = this.h2rgba(this.o.fgColor, "0.4"); this.fgColor = this.h2rgba(this.o.fgColor, "0.6"); } else { this.fgColor = this.o.fgColor; } return this; }; this._clear = function () { this.$c[0].width = this.$c[0].width; }; this._validate = function (v) { var val = (~~ (((v < 0) ? -0.5 : 0.5) + (v/this.o.step))) * this.o.step; return Math.round(val * 100) / 100; }; // Abstract methods this.listen = function () {}; // on start, one time this.extend = function () {}; // each time configure triggered this.init = function () {}; // each time configure triggered this.change = function (v) {}; // on change this.val = function (v) {}; // on release this.xy2val = function (x, y) {}; // this.draw = function () {}; // on change / on release this.clear = function () { this._clear(); }; // Utils this.h2rgba = function (h, a) { var rgb; h = h.substring(1,7); rgb = [ parseInt(h.substring(0,2), 16), parseInt(h.substring(2,4), 16), parseInt(h.substring(4,6), 16) ]; return "rgba(" + rgb[0] + "," + rgb[1] + "," + rgb[2] + "," + a + ")"; }; this.copy = function (f, t) { for (var i in f) { t[i] = f[i]; } }; }; /** * k.Dial */ k.Dial = function () { k.o.call(this); this.startAngle = null; this.xy = null; this.radius = null; this.lineWidth = null; this.cursorExt = null; this.w2 = null; this.PI2 = 2*Math.PI; this.extend = function () { this.o = $.extend({ bgColor: this.$.data('bgcolor') || '#EEEEEE', angleOffset: this.$.data('angleoffset') || 0, angleArc: this.$.data('anglearc') || 360, inline: true }, this.o); }; this.val = function (v, triggerRelease) { if (null != v) { // reverse format v = this.o.parse(v); if (triggerRelease !== false && v != this.v && this.rH && this.rH(v) === false) { return; } this.cv = this.o.stopper ? max(min(v, this.o.max), this.o.min) : v; this.v = this.cv; this.$.val(this.o.format(this.v)); this._draw(); } else { return this.v; } }; this.xy2val = function (x, y) { var a, ret; a = Math.atan2( x - (this.x + this.w2), - (y - this.y - this.w2) ) - this.angleOffset; if (this.o.flip) { a = this.angleArc - a - this.PI2; } if (this.angleArc != this.PI2 && (a < 0) && (a > -0.5)) { // if isset angleArc option, set to min if .5 under min a = 0; } else if (a < 0) { a += this.PI2; } ret = (a * (this.o.max - this.o.min) / this.angleArc) + this.o.min; this.o.stopper && (ret = max(min(ret, this.o.max), this.o.min)); return ret; }; this.listen = function () { // bind MouseWheel var s = this, mwTimerStop, mwTimerRelease, mw = function (e) { e.preventDefault(); var ori = e.originalEvent, deltaX = ori.detail || ori.wheelDeltaX, deltaY = ori.detail || ori.wheelDeltaY, v = s._validate(s.o.parse(s.$.val())) + ( deltaX > 0 || deltaY > 0 ? s.o.step : deltaX < 0 || deltaY < 0 ? -s.o.step : 0 ); v = max(min(v, s.o.max), s.o.min); s.val(v, false); if (s.rH) { // Handle mousewheel stop clearTimeout(mwTimerStop); mwTimerStop = setTimeout(function () { s.rH(v); mwTimerStop = null; }, 100); // Handle mousewheel releases if (!mwTimerRelease) { mwTimerRelease = setTimeout(function () { if (mwTimerStop) s.rH(v); mwTimerRelease = null; }, 200); } } }, kval, to, m = 1, kv = { 37: -s.o.step, 38: s.o.step, 39: s.o.step, 40: -s.o.step }; this.$ .bind( "keydown", function (e) { var kc = e.keyCode; // numpad support if (kc >= 96 && kc <= 105) { kc = e.keyCode = kc - 48; } kval = parseInt(String.fromCharCode(kc)); if (isNaN(kval)) { (kc !== 13) // enter && kc !== 8 // bs && kc !== 9 // tab && kc !== 189 // - && (kc !== 190 || s.$.val().match(/\./)) // . allowed once && e.preventDefault(); // arrows if ($.inArray(kc,[37,38,39,40]) > -1) { e.preventDefault(); var v = s.o.parse(s.$.val()) + kv[kc] * m; s.o.stopper && (v = max(min(v, s.o.max), s.o.min)); s.change(s._validate(v)); s._draw(); // long time keydown speed-up to = window.setTimeout(function () { m *= 2; }, 30); } } } ) .bind( "keyup", function (e) { if (isNaN(kval)) { if (to) { window.clearTimeout(to); to = null; m = 1; s.val(s.$.val()); } } else { // kval postcond (s.$.val() > s.o.max && s.$.val(s.o.max)) || (s.$.val() < s.o.min && s.$.val(s.o.min)); } } ); this.$c.bind("mousewheel DOMMouseScroll", mw); this.$.bind("mousewheel DOMMouseScroll", mw); }; this.init = function () { if (this.v < this.o.min || this.v > this.o.max) { this.v = this.o.min; } this.$.val(this.v); this.w2 = this.w / 2; this.cursorExt = this.o.cursor / 100; this.xy = this.w2 * this.scale; this.lineWidth = this.xy * this.o.thickness; this.lineCap = this.o.lineCap; this.radius = this.xy - this.lineWidth / 2; this.o.angleOffset && (this.o.angleOffset = isNaN(this.o.angleOffset) ? 0 : this.o.angleOffset); this.o.angleArc && (this.o.angleArc = isNaN(this.o.angleArc) ? this.PI2 : this.o.angleArc); // deg to rad this.angleOffset = this.o.angleOffset * Math.PI / 180; this.angleArc = this.o.angleArc * Math.PI / 180; // compute start and end angles this.startAngle = 1.5 * Math.PI + this.angleOffset; this.endAngle = 1.5 * Math.PI + this.angleOffset + this.angleArc; var s = max( String(Math.abs(this.o.max)).length, String(Math.abs(this.o.min)).length, 2 ) + 2; this.o.displayInput && this.i.css({ 'width' : ((this.w / 2 + 4) >> 0) + 'px', 'height' : ((this.w / 3) >> 0) + 'px', 'position' : 'absolute', 'vertical-align' : 'middle', 'margin-top' : ((this.w / 3) >> 0) + 'px', 'margin-left' : '-' + ((this.w * 3 / 4 + 2) >> 0) + 'px', 'border' : 0, 'background' : 'none', 'font' : this.o.fontWeight + ' ' + ((this.w / s) >> 0) + 'px ' + this.o.font, 'text-align' : 'center', 'color' : this.o.inputColor || this.o.fgColor, 'padding' : '0px', '-webkit-appearance': 'none' }) || this.i.css({ 'width': '0px', 'visibility': 'hidden' }); }; this.change = function (v) { this.cv = v; this.$.val(this.o.format(v)); }; this.angle = function (v) { return (v - this.o.min) * this.angleArc / (this.o.max - this.o.min); }; this.arc = function (v) { var sa, ea; v = this.angle(v); if (this.o.flip) { sa = this.endAngle + 0.00001; ea = sa - v - 0.00001; } else { sa = this.startAngle - 0.00001; ea = sa + v + 0.00001; } this.o.cursor && (sa = ea - this.cursorExt) && (ea = ea + this.cursorExt); return { s: sa, e: ea, d: this.o.flip && !this.o.cursor }; }; this.draw = function () { var c = this.g, // context a = this.arc(this.cv), // Arc pa, // Previous arc r = 1; c.lineWidth = this.lineWidth; c.lineCap = this.lineCap; if (this.o.bgColor !== "none") { c.beginPath(); c.strokeStyle = this.o.bgColor; c.arc(this.xy, this.xy, this.radius, this.endAngle - 0.00001, this.startAngle + 0.00001, true); c.stroke(); } if (this.o.displayPrevious) { pa = this.arc(this.v); c.beginPath(); c.strokeStyle = this.pColor; c.arc(this.xy, this.xy, this.radius, pa.s, pa.e, pa.d); c.stroke(); r = this.cv == this.v; } c.beginPath(); c.strokeStyle = r ? this.o.fgColor : this.fgColor ; c.arc(this.xy, this.xy, this.radius, a.s, a.e, a.d); c.stroke(); }; this.cancel = function () { this.val(this.v); }; }; $.fn.dial = $.fn.knob = function (o) { return this.each( function () { var d = new k.Dial(); d.o = o; d.$ = $(this); d.run(); } ).parent(); }; })); ;(function( $, $w, $d ) { var $ks = $('.knob-scroll input'), h = function( e ) { return e.height() }; $w.on('load scroll', function(){ var d = h( $d ), w = h( $w ), s = Math.round( $w.scrollTop() / ( d - w ) * 100 ); $ks.val( s ).trigger('change'); }); function knobToScroll( val ) { var d = h( $d ), w = h( $w ); $w.scrollTop( val * ( d - w ) / 100 ); } $ks.knob({ 'thickness' : '.3', 'fgColor' : 'rgb(135, 226, 235)', 'bgColor' : 'rgb(240, 240, 240)', 'width' : '50', 'height' :'50', release : function ( val ) { knobToScroll( val ); }// Show input: }).find('input').show(); })( jQuery, jQuery( window ), jQuery( document ) ); </script><script type="text/javascript"> $('.login-link').click(function (e) { $("#login-form span:contains('LOGIN')").trigger('click'); }); </script> <script type="text/javascript" src="https://dl.episerver.net/13.5.10/epi-util/find.js"></script> <script type="text/javascript"> var disqus_shortname = 'www-emra';var disqus_identifier = '7d658ce7-dd16-4cd1-b3fd-965472f15cd3'; (function() { var dsq = document.createElement('script'); dsq.type = 'text/javascript'; dsq.async = true; dsq.src = '//' + disqus_shortname + '.disqus.com/embed.js'; (document.getElementsByTagName('head')[0] || document.getElementsByTagName('body')[0]).appendChild(dsq); })(); </script> <script type="text/javascript"> if(typeof FindApi === 'function'){var api = new FindApi();api.setApplicationUrl('/');api.setServiceApiBaseUrl('/find_v2/');api.processEventFromCurrentUri();api.bindWindowEvents();api.bindAClickEvent();api.sendBufferedEvents();} </script> </body> </html>

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