Representative's Handbook - October 26, 2021 Virtual Meeting

Page created by Sergio Norris
Representative's Handbook - October 26, 2021 Virtual Meeting
Representative’s Handbook

    October 26, 2021
     Virtual Meeting
Representative's Handbook - October 26, 2021 Virtual Meeting
          ‌ edicine‌R
                    ‌ esidents’‌A
                                ‌ ssociation‌


             Table‌‌of‌‌Contents‌ ‌
Representative's Handbook - October 26, 2021 Virtual Meeting
October 17, 2021

Dear EMRA Program Representatives,

Welcome to EMRA at ACEP21! We are excited to see and hear from you all again, although we
wish it was in person. We are hoping that you are all staying safe, and we sincerely thank you for
your continued commitment to make EMRA the best organization it can be!

This past year, emergency physicians and residents have faced many challenges: the continued
stress of COVID, vaccine rollouts, workforce concerns, nursing shortages, and more. Through it
all, EMRA members have continually shown how resilient we all are and has shown why
emergency medicine is the best specialty.

Over the past year, EMRA has continued to advocate for our medical students and residents.
When the ACEP Workforce Report showed concerning trends in the job market, our president RJ
Sontag was quick to ensure that the voice of young physicians was heard in this important
conversation about our future. EMRA was quick to join the ACEP Taskforce to help brainstorm
different solutions to workforce issues. We then held our own EMRA town hall to hear directly
from residents around the country. Based on that conversation and our Policy Compendium,
EMRA continues to advocate for our residents’ best interests. ACEP now has multiple different
task forces creating actionable solutions to many different workforce issues, and you can bet
that we have resident leaders sitting on all of these committees.

While the wheelhouse of the speaker and vice speaker centers mainly around EMRA policy,
EMRA has had so many other amazing accomplishments this year including big wins at our
Leadership and Advocacy Conference in Washington, DC; amazing new EMRA/MobilEM guides
regarding pain management, trauma, urgent care, PEM, and ECGs; and amazing virtual
programming from all of our EMRA committees. I encourage you all to read the other updates
below from our amazing EMRA leaders.

During our Representative Council meeting, you will hear updates from our leadership and
liaisons at ACEP, ABEM, and CORD. We will also elect new board members and are pleased to
present one new resolution for consideration. Resolutions are written by EMRA members and
are the foundation of our organization, the advocacy priorities of EMRA and its Board of
Directors, and the guides toward the future of our specialty. As your Council officers, we extend
our gratitude to the fellows, residents, and medical students that authored these resolutions.
One of EMRA’s greatest strengths is our highly engaged Representative Council.
Representative's Handbook - October 26, 2021 Virtual Meeting
Throughout this conference, take time to enjoy the rest of the programming offered. EMRA
committees have been working hard to produce extraordinary virtual sessions and activities, all
of which are free to members! Each of you, by taking on the responsibility of serving as a
Program Representative, provides a leadership service that advances our advocacy efforts and
challenges EMRA to continue to grow and strengthen our member benefits and the work we do
on behalf of our specialty and patients. Thank you for everything you do, for your patients and
for our specialty.


Tracy and Ashley

Tracy Marko, MD, PhD
Speaker of the Council

Ashley Tarchione, MD
Vice Speaker of the Council
Representative's Handbook - October 26, 2021 Virtual Meeting
Emergency Medicine Residents’ Association

            EMRA Representative Council and Business Meeting
                 October 26, 2021 10:00am – 3:30pm ET
                             Virtual Meeting

Credentialing begins – 9:00am EST


10:03am     Recognizing EMRA 25 Under 45 Recipients

10:05am     Welcome Message
            Tracy Marko, MD, PhD, MS
            EMRA Speaker of the Council

10:10am     Liaison Q&A
            ACEP - American College of Emergency Physicians
            Alison Haddock, MD, FACEP
            Vice President
            Former EMRA Board Member

10:25am     Liaison Q&A
            ABEM – American Board of Emergency Medicine
            Marianne Gausche-Hill, MD, FACEP

10:40am     Liaison Q&A
            CORD – Council of Emergency Medicine Residency Directors
            Boyd (Bo) Burns, DO, FACEP
            Board of Directors

                               Call to Order – 11:00am

11:00am     Information on proceedings
            Tracy Marko, MD, PhD, MS
            EMRA Speaker of the Council
Representative's Handbook - October 26, 2021 Virtual Meeting
11:10am   Moment of Silence
          A time to honor EMRA members lost in the past year

11:15am   President's’ Address: State of the Association
          RJ Sontag, MD
          EMRA President

11:25am   Parliamentary Review
          Sophia Spadafore, MD
          EMRA Representative to the AMA

11:30am   Voting Overview
          Ashley Tarchione, MD
          EMRA Vice Speaker of the Council

11:40am   Quorum Report

11:45am   Elections
          Order of Elections:
                 • President-Elect
                 • Vice-Speaker of the Council
                 • Secretary-Editor
                 • Member at Large
                 • Director of Education

1:00pm    Approval of Minutes from CORD21 Meeting
          April 12, 2021 - Virtual Meeting

1:05pm    Reports and Resolutions
          Reference Committee Report

3:00pm    Announcements and Adjourn
Representative's Handbook - October 26, 2021 Virtual Meeting

                     Representative Council Meeting Minutes
                                  April 12, 2021
                                 Virtual Meeting

COUNCIL OFFICERS: Tracy Marko, MD, PhD, MS, Ashley Tarchione, MD

BOARD OF DIRECTORS Hannah Hughes, MD, MBA; RJ Sontag, MD; Priyanka
Lauber, DO; Deena Khamees, MD; Angela Cai, MD, MBA; Breanne Jaqua, DO, MPH;
Sophia Spadafore, MD; Chiamara Anokwute, Maggie Moran, Nicholas Cozzi, Nick
Salerno, Yev Maksimenko


TELLERS AND CREDENTIAL CHAIR: None present as the meeting was in a virtual

SERGEANT-AT-ARMS: None present as the meeting was in a virtual setting


GUESTS: Boyd Burns, DO; Mary Nan S. Mallory, MD, MBA; Mark S. Rosenberg, DO,

STAFF: Cathey Wise, CAE; Todd Downing; Valerie Hunt; Alyssa Ceniza, Heather Deja


Albert Einstein Medical Center Philadelphia, AMITA Health Resurrection Medical
Center, Ascension St. John Hospital, Aventura Hospital and Medical Center, Beaumont
Health, Boston University Medical Center, Brandon Regional Hospital Emergency Med,
Brown University, CMU, Cooper University Hospital, Denver Health, Desert Regional
Medical Center, Eastern Virginia Medical School, Emory University, EMRA Medical
Student Council, FSU Emergency Medicine, Geisinger Medical Center, George
Washington University, Georgetown University Hospital/MedStar Washington Hospital
Center, Harvard affiliated emergency medicine residency at MGH/BWH, Hennepin
Representative's Handbook - October 26, 2021 Virtual Meeting
County Medical Center, Hofstra SOM/Northwell-LIJ, Icahn School of Medicine at Mount
Sinai, Kaiser Permananete San Diego Emergency Medicine Program, Kent hospital in
Warwick RI, Kings County/SUNY Downstate EM residency, Loma Linda University,
Medical College of Georgia, Midwestern University, Prisma Greenville Health System,
Regions (Healthpartners institute), Riverside Regional Medical Center, Rush University
Medical Center, Rutgers New Jersey Medical School, SAUSHEC Brooke Army Medical
Center, Sparrow Hospital/MSU Emergency Medicine Residency Program, Spectrum
Health/Michigan State University, St. Joseph's University Medical Center, Paterson NJ,
The MetroHealth System/ Case Western Reserve University, UC Davis, UC San Diego,
UCF HCA Osceola Regional, UCF Ocala, UCLA Ronald Reagan | Olive View
Emergency Medicine Residency Program, UConn Emergency Medicine, UCSF,
University hospital columbia Missouri, University of Chicago Emergency Medicine,
University of Florida - Jacksonville, University of Louisville, University of Maryland
Medical Center, University of Miami/Jackson Memorial Hospital, University of Nebraska
Medical Center, University of Oklahoma Department of Emergency Medicine, University
of Pittsburgh Medical Center, University of Texas at Austin Dell Emergency Medicine
Residency, University of Wisconsin, UPMC Pinnacle, UT Southwestern Emergency
Medicine, VCU, Washington University St Louis, WellSpan York Hospital, Wellstar
Kennestone-Emergency Medicine, Wyckoff Heights Medical Center,

Dr. Marko called the meeting to order at 11:00am EST. She thanked the program
representatives for their dedication to their programs and to EMRA.

Dr. Marko provided opening remarks to the Council. She introduced the liaisons to
provide updates.

Dr. Rosenberg, President-Elect of the American College of Emergency Physicians
(ACEP), participated in a moderated Q&A with Dr. Marko.

Dr. Mallory, President of American Board of Emergency Medicine (ABEM) participated
in a moderated Q&A with Dr. Marko.

Dr. Burns, Council of Emergency Medicine Residency Directors (CORD) Board of
Directors, participated in a moderated Q&A with Dr. Marko.

Dr. Marko led a moment of silence for our colleagues who we have lost since our last

Dr. RJ Sontag provided the President’s Address to the Council.

Dr. Spadafore presented an overview of the use of parliamentary procedure and its
importance in the deliberations of the Council.

Dr. Marko introduced the electronic voting system.

Dr. Marko stated that a quorum is present.
Representative's Handbook - October 26, 2021 Virtual Meeting
A motion was made to approve the minutes from the EMRA Representative Council
Meeting held on October 26, 2020 virtual meeting at the ACEP Academic Assembly.
The motion was seconded and adopted by a voice vote of the Council.

Student Doctor Chiamara Anokwute was elected by the Medical Student Council into
the position of EMRA Board of Directors. This was voted on as a voting position was
elected successfully into the position.

Suzannah Alexander announced updates to PEER.

Dr. Marko presented the sunset committee report. It was voted on and it was retired.

Dr. Marko introduced the reference committee and the Reference Committee’s
proposal for the Consent Agenda. She informed the Council the
recommendations was TO ADOPT AS AMENDED:

S’21-01: Unconscious Bias and Cultural Sensitivity Education

S’21-03 Accountable Organizations to Resident and Fellow Trainees

S’21-04 Voting for Hospitalized Patients with the Capacity to Vote

S’21-06: Increasing Evidence Based Domestic Violence Screening in the Emergency

S’21-07 Equal Consideration for Osteopathic Med Students

S’21-08: Residency Application Process Improvement

S’21-09: Single Payer Healthcare System for All

S’21-10 Supporting Voter Registration Efforts in the Emergency Department

Dr. Marko then called for any extractions and received motions to extract the
following resolutions:

S’21-01: Unconscious Bias and Cultural Sensitivity Education

S’21-05 Equity in the Standardized Letter of Evaluation by International Students

S’21-08: Residency Application Process Improvement

S’21-09: Single Payer Healthcare System for All

There was a motion to accept the Consent Agenda, which was seconded and
passed by an electronic vote. The following resolutions were adopted as

S’21-03 Accountable Organizations to Resident and Fellow Trainees

S’21-04 Voting for Hospitalized Patients with the Capacity to Vote
Representative's Handbook - October 26, 2021 Virtual Meeting
S’21-06: Increasing Evidence Based Domestic Violence Screening in the Emergency

S’21-07 Equal Consideration for Osteopathic Med Students

S’21-10 Supporting Voter Registration Efforts in the Emergency Department

Dr. Marko introduced resolution S’21-1: Unconscious Bias and Cultural Sensitivity
Education. After discussion, there was a motion TO ADOPT the Amended Resolution,
seconded, and passed via the electronic voting system.

Dr. Marko introduced resolution S’21-8 (Residency Application Process Improvement).
After discussion, there was a motion TO ADOPT the amended resolution, seconded,
and passed via the electronic voting system.

Dr. Marko introduced resolution S’21-5: Equity in the Standardized Letter of Evaluation
by International Students. After discussion, there was a motion TO ADOPT the
Amended Resolution, seconded, and passed via the electronic voting system.

Dr. Marko introduced resolution S’21-9: Single Payer Healthcare System for All. After
discussion, there was a motion TO ADOPT the amended resolution, seconded, and
passed via the electronic voting system.

Adjourned at 2:40pm
                                           DIRECTORS (AS APPLICABLE).

3               Healthcare Equity and Addiction Treatment for Incarcerated Patients
5                        Authors: Jessica Adkins, MD and Alexander Ulintz, MD
6                        on behalf of the Social Emergency Medicine Committee

 8   WHEREAS, In 2020, 2.1 million people were incarcerated in the United States1, each of them
 9   protected under the Eighth Amendment's prohibition against cruel and unusual punishment,
10   which requires the government to provide them with adequate health care as demonstrated by
11   the Supreme Court’s decision in Brown vs. Plata2, 3; and
13   WHEREAS, An estimated 65% of incarcerated people in the U.S. had an active substance use
14   disorder, according to the National Institute on Drug Abuse4, yet multiple studies have shown
15   those with opioid use disorder have disproportionately low rates of buprenorphine treatment for
16   their addiction compared to non-incarcerated people5, 6; and
18   WHEREAS, The opioid overdose crisis is a greater threat than ever, with 93,000 deaths in the
19   U.S. in 2020 representing the largest death toll from overdose ever recorded in a 12-month
20   period (75% of which were opioid-related)7; and
22   WHEREAS, Multiple studies have indicated an increased risk of opioid overdose death (OOD)
23   soon after release from prison, including a 2018 North Carolina study that found a 40-fold
24   increased risk of OOD in the first two weeks after release compared to the general state
25   population’s risk of OOD8, and a 2010 meta-analysis that found a three- to eight-fold increased
26   risk of drug-related death in the first two weeks after release when compared to the following 9
27   weeks9; and
29   WHEREAS, EMRA has preexisting policy upholding that “EMRA supports evidence-based
30   policy reforms of the criminal justice system that contribute to individual and public health”
31   (EMRA Policy IV.-III.) and that “EMRA: ...Should support adoption of proven strategies in opioid
32   harm reduction including enhanced public distribution of naloxone…” (EMRA Policy IV.-XI.);
33   therefore, be it
                                           DIRECTORS (AS APPLICABLE).

36   RESOLVED that EMRA Policy Section IV: III. Emergency Medicine to Support Evidence-Based
37   Policy Reforms of the Criminal Justice System be amended to:
39                 III. Emergency Medicine to Support Evidence-Based Policy Reforms of the
40                 Criminal Justice System and Equitable Health Care for Incarcerated
41                 Patients
42                 EMRA supports evidence-based policy reforms of the criminal justice system that
43                 contribute to individual and public health.
45                 EMRA recognizes that incarcerated people form a vulnerable patient population
46                 with higher rates of chronic medical conditions including substance use
47                 disorders. As front-line practitioners in caring for patients who present while
48                 under the custody of law enforcement, EMRA:
49                 1.      supports required screening of people under custody of law enforcement
50                 to identify medical conditions including substance use disorders, and prompt
51                 treatment of these conditions.
52                 2.      upholds that addiction treatment including buprenorphine, counseling,
53                 and other evidence-based treatment must be provided to incarcerated people
54                 who are prescribed such treatment and give consent for treatment.
55                 3.      advocates for rehabilitation initiatives that support the comprehensive
56                 medical needs of patients upon release from incarceration. These needs include
57                 addiction treatment such as buprenorphine and naloxone to reduce the risk of
58                 relapse, reincarceration, and overdose death.
60   References:

61      1. Kang-Brown J, Montagnet C, Heiss J. People in Jail and Prison in 2020. New York: Vera
62         Institute of Justice.
63         2021 Published June 2021. Accessed August 28, 2021.
64      2. Eber GB. Using the constitution to improve prisoner health. Am J Public Health.
65         2009;99(9):1541-1542. doi:10.2105/AJPH.2009.168112
66      3. Kennedy A. Brown v. Plata. Legal Information Institute.
67 Published May 23, 2011.
68         Accessed September 10, 2021.
69      4. NIDA. Criminal Justice DrugFacts.
70 Published June 1,
71         2020. Accessed September 3, 2021.
72      5. Nunn A, Zaller N, Dickman S, Trimbur C, Nijhawan A, Rich JD. Methadone and
73         buprenorphine prescribing and referral practices in US prison systems: results from a
74         nationwide survey. Drug Alcohol Depend. 2009 Nov 1;105(1-2):83-8. doi:
75         10.1016/j.drugalcdep.2009.06.015.
76      6. Mancher M, Leshner AI, eds. Medications for Opioid Use Disorder in Various Treatment
77         Settings. In: Medications for Opioid Use Disorder Save Lives. Washington (DC): National
78         Academies Press (US); 2019.
79         Accessed September 1, 2021.
                                           DIRECTORS (AS APPLICABLE).

80      7. Ahmad FB, Rossen LM, Sutton P. Provisional drug overdose death counts. National
81         Center for Health Statistics. 2021.
82      8. Shabbar I. Ranapurwala, Meghan E. Shanahan, Apostolos A. Alexandridis, et al. 2018:
83         Opioid Overdose Mortality Among Former North Carolina Inmates: 2000–2015.
84         American Journal of Public Health 108, 1207-1213,
86      9. Merrall EL, Kariminia A, Binswanger IA, et al. Meta-analysis of drug-related deaths soon
87         after release from prison. Addiction. 2010;105(9):1545-1554. doi:10.1111/j.1360-
88         0443.2010.02990.x
90   EMRA Policy:
91     1. Section IV: Public Health, III. Emergency Medicine to Support Evidence-Based Policy
92        Reforms of the Criminal Justice System (
93        emra/governing-docs/policycompendium.pdf)
94     2. Section IV: Public Health, XI. Opioid Harm Reduction
95        (
96        docs/policycompendium.pdf)
98   Financial Note: None
EMRA 2021 Board Candidates





EMRA Representative Council and Business Meeting
               October 26, 2021
                Virtual Meeting
EMRA President
RJ Sontag, MD
Mid-Ohio Emergency Services
EMRA President-Elect
Angela G. Cai, MD, MBA

Hello EMRA!

This is an annual update from your President-Elect. For those of you who don’t know me, I am a
fresh residency graduate of Kings County/SUNY Downstate in Brooklyn, an Innovation Fellow at
USACS based out of DC and working clinically in Maryland, and a new mom. This is my 3rd
year on the board (previously Director of Health Policy), and I still love it!

EMRA does so much (see Dr. Sontag’s President End of Year Report for a snapshot). Here, I
would like to highlight some priorities I intend to carry forward as I become your President.

Shaping the Workforce of the Future

    ●   With the tough market last year, EMRA offered to our nationwide network to make
        personal connections for anyone still looking for jobs late in the season. Things are
        looking up this year, but we intend to remain a connecting resource for all job-seeking
        EM residents.
    ●   EMRA is updating our career transition resources, so that you are empowered to identify
        your career path, negotiate your contract, and make an informed decision about how
        ownership and employment models impact your career.
    ●   Since EMRA co-sponsored the ACEP Workforce Study, we have secured a trainee voice
        at the subsequent multi-organizational workgroups tackling the specific solution

Ensuring Organizational Sustainability

    ●   EMRA has a mostly new all-star staff including our Interim Executive Director, Bob
        Ramsey. We are in the process of recruiting the next Executive Director.
    ●   EMRA needs to prioritize our resources (including our small but mighty staff) according
        to your greatest needs in light of EMRA’s tremendous growth in members, dollars, and
        programs. We will accomplish this through our triennial strategic planning next year
        where we will examine the core components of our broad educational, leadership
        development, and advocacy missions.

The fundamental reason why EMRA exists and why I am here is to promote your wellbeing. In
my mind, we get there by advocating for your professional fulfillment, fair treatment, and
connecting with each other in the process. I look forward to meeting and continuing to represent
you over the next year. Reach out anytime.

Yours truly,

Angela G. Cai
EMRA President-Elect | 704-779-1908
EMRA Immediate Past President
Hannah Hughes, MD, MBA
University of Cincinnati

EMRA’s end-of-year financials are notable for the following:

      ●   Total assets of $6.41M, up 30% compared to end of FY20, with a total member equity of
      ●   Total revenue of $2.75M, higher than budgeted due to product sales but 9% lower than
          end of FY20 predominantly due to job market consolidation and decreased advertising
      ●   Total direct expenses of $2.26M, lower than budgeted due to labor and 28% lower than
          end of FY20 predominantly due to savings from lack of travel
      ●   For FY21, the contribution to member equity was $1.57M, as compared to $70K the year
          prior, which will allow EMRA to continue to reinvest into its members and the future of
          emergency medicine

In summary, EMRA remains financially strong allowing it to serve its mission - Best doctor. Best
leader. Best speciality!

Hannah R. Hughes, MD, MBA
Immediate Past President | EMRA
Chair | EMRA Finance Committee


EMRA Secretary / Editor-in-Chief EM Resident
Priyanka Lauber, DO
Lehigh Valley Hospital

Hello Representative Council,

Thank you for being involved!

Here are some of the updates from your Editor-in-Chief of EM Resident, Secretary, and one of
the EMRA Board of Directors.

EM Resident has had another record-breaking year with increased online and print
engagement. Our print magazine is distributed to over 18,000 members and we have helped
publish more than 300 authors. Our online presence has climbed to roughly 85,000 visits per

We are grateful and thankful to continue maintaining a strong editorial team that includes
dedicated residents, fellows, and faculty editors who are content experts in various Emergency
Medicine subjects including cardiology, critical care, toxicology, pediatric EM, ultrasound, EMS,
and social EM.

EM Resident continues to also provide a platform for the series “Heart of EM” - a section where
residents and medical students have a national platform to share their experiences and
thoughts. This has been extremely well received, especially in the times of COVID. Authors can
submit their names or request to remain anonymous.
Over the past year, EM Resident has addressed a multitude of topics including workforce
shortage, health policy, and various educational topics to advance our collective Emergency
Medicine knowledge. We are a true platform for advocacy for EMRA and for residents.

So far this year, we have advocated for residents and medical students during times of COVID
PPEs and contract negotiations. We continue to work to protect the terms “resident” and
“fellow”, opposing the expansion of GME
funding to NP and PAs training programs, and much more.

EMRA continues to support Board members, like myself, to become involved and represent our
organization on state and national panels. These national panels are essential for advising and
encouraging residents and medical
students to become the best leaders and doctors they can be while maintaining Emergency
Medicine to be the best specialty it can be.

Finally, EM Resident continues to be a thriving publication for residents, medical students, and
faculty by residents! We are grateful to currently be experiencing a record number of article
submissions. We continue to maintain a personalized, individual interaction with every author
thanks to our wonderful editorial team. Thankful for EMRA and our editorial team that continues
to make EM Resident as successful as it can be.

-- Priyanka Lauber, DO


EMRA Resident Representative to ACEP
Nicholas Cozzi, MD, MBA
FDNY/Northwell Health

Dear 2021 EMRA Representative Council,

It has been an honor and privilege to represent the nearly nineteen thousand emergency
medicine physicians-in-training to ACEP’s Board of Directors. Each day I have committed
myself to being intentional in building relationships based on mutual respect, buy-in, and
common mission. This year represented my first year as Resident Representative to ACEP.
Through it all I have strived to remain true to representing you each day.

Our first initiative was working towards furthering EM as BEST LEADER and BEST
SPECIALITY. We developed and cultivated meaningful relationships with ACEP Committees
and Sections by nominating EMRA representatives to each Committee and Section. This serves
to create opportunities for networking and learning, all while fostering opportunities for our
members to develop skills and career development within emergency medicine. In total, we
have successfully nominated representatives to eighty-seven percent of ACEP Committees and
Sections with fifty-five percent of our representatives being female. As we forge new paths in
diversity, equity, and inclusion, we are proud to nominate members who will help us realize a
more representative membership. Moreover, we were intentional in our nominations with
ensuring a warm-handoff and continuity between EMRA Committees and ACEP Committees
and Sections. We have much more work to do in this regard but this serves as an important first
This year powered innovation and a realization of the challenges and opportunities within the
evolving emergency medicine workforce discussion. As the Resident Representative to EMRA, I
remain committed to intentional involvement and representing you each day in my
conversations with ACEP Board Members and in Board Meetings. I am often reminded and
remain cognizant of how our decision impacts physician trainees and those within medical
school. One shining example I try to be mindful of is how our decisions impact the resident
physician working at 3AM taking care of patients.

The year brought upon new ACEP Task Forces which include: Telehealth, Adverse Impact of
Health-Insurer Reimbursement, and ED Accreditation. Each of these Task Forces include EMRA
representation as we embark on shaping the future of our speciality. Additionally, we
successfully nominated a member to the Emergency Care Quality Measures Consortium
(ECQMC). These are meaningful opportunities for our members to build, create, and lead at the
national level. Thank you to those who have answered the call to serve. We are proud and
thankful for you.

There is much work ahead and we need your voice, your passion, and your ideas. I would love
to meet you and get your insight as I work to continue representing our membership to the
American College of Emergency Physicians.

Nicholas P. Cozzi, MD MBA
PGY-4, Emergency Medical Services
FDNY/ Northwell Health | 773-573-0556


EMRA Director of Education
Deena Khamees, MD
McGovern Medical School at UT Health Science Center at Houston

It is such a pleasure to address the Representative Council; thank you for all the care and effort you
show our EM community! Here on the Education side of EMRA, we’ve been busy this past year,

The oldies but goodies, our EMRA Guides, have been a huge achievement this year. We updated
handy pocket guides such as our Airway Card, Adult Infusion Card, and Ventilator Cards. These
couldn’t be more timely with the volumes of COVID-related respiratory failure we’re unfortunately
seeing nationwide.

We’ve also introduced a brand-new card, the ECG Interpretation Card. For those demanding more
than a card - we hear you! We’ve teamed up with fan-favorite Dr. Amal Mattu and colleagues Drs.
Berberian and Brady to bring you the Emergency ECGs Kindle book with over 100 cases and 400
annotated images to sharpen those rhythm reading skills.

We’ve updated EM Fundamentals (2nd ed), Basics of EM (4th ed), and Basics of EM: Peds (3rd ed)
and if that weren’t enough, rolled out two additional new guides - the PEM Fundamentals Guide and
the Urgent Care Guide. I particularly love the Urgent Care Guide for helping with that critical
question, “When do I transfer to a higher level of care?” Don’t let the name fool you; this guide is the
new best friend of every new residency grad and those working critical access hospitals where a
consult may mean a transfer.

We continue to ride the soundwaves via EMRA*Cast with 2 new podcasts every month, reaching
110,000 downloads! The episodes cover an incredible range of topics with one thing in common - it
matters to EM residents and medical students. If you haven’t yet, check it out; I guarantee you find
something interesting. EMRA*Cast recruits a new cohort of podcast hosts (our “Casters”) every two
years; be on the lookout next year for your chance, or an interested co-resident!

COVID introduced us to our first ever virtual EMRA 20 in 6 Competition at ACEP 2020 and virtual
Quiz Show at CORD 2021! This was an exciting and nerve-wracking time for all of us - we wanted
to be true to the programming we all love but also lean in and embrace our virtual platform.
Congratulations to 20 in 6 2020 Winner Dr. Sarah Carpenter for “Those Who Show Up” - you
definitely showed up and we loved it! Tune in to this year’s competition on Wednesday, October 27
at 2:30pm eastern.

Speaking of those who showed up - special thanks to the Education Committee leadership for the
incredible masterminding of virtual Quiz Show, our annual pub-style medical and pop culture-based
trivia show, and the amazing resident teams who competed.

And last, but not least, two VIP Guests we’re bringing to this ACEP - two new Telehealth videos
(created after you made it a priority) explaining the how-to’s and how-not-to’s of telemedicine,
because we’re watching out for your educational future and know you are, too.

Deena Khamees, MD


EMRA Director of Health Policy
Maggie Moran, MD
Brooke Army Medical Center

To the Representative Council,

Thank you for your continued involvement and investment in what keeps EMRA great, our

Please allow me to update you on my role and progress over the last year.

The Federal Government Affairs (FGA) Committee monitors and analyzes legislative and
regulatory priorities of Congress and prepares ACEP to promote its own regulatory and
legislative priorities. The National Emergency Medicine Political Action Committee (NEMPAC) is
a “voluntary, nonprofit, unincorporated association operating as a separate segregated fund of
ACEP.” EMRA’s Director of Health Policy sits at these tables and advocates for trainees from
medical school through fellowship. In my opinion, our biggest win of the year was the passing of
ACEP-developed Dr. Lorna Breen Health Care Provider Protection Act through the Senate.
EMRA relies on the Representative Council to provide direction for our advocacy priorities.

EMRA’s Director of Health Policy is also responsible for planning and executing the Heath
Policy Primer each year at the Leadership and Advocacy Conference. This Primer helps to
make policy and advocacy approachable to trainees, who bring the drive to get involved and the
thirst for information on how. Planning has already started for programming the Health Policy
Primer 2021.

EMRA’s policy and advocacy direction rely on members, like you! Trainees who have passion
for bettering the landscape of medicine and the understanding that we have the power to shape
that landscape, even now!

Thank you for your time and your continued involvement. I can be contacted at at any time.


Maggie Moran, MD


EMRA Director of Leadership Development
Yevgenly Maksimenko, MD, MA, DiMM, FAWM, NRP.LP, FP-C
EMS and Disaster Medicine Fellow
San Antonio Uniformed Services Health Education Consortium

Dear 2021 EMRA Representative Council,

Welcome to ACEP 2021 and thank you for all you do. My name is Yev and I hold the newly
created EMRA Board of Directors position, Director of Leadership Development. I wanted to
update you about the new position and what the EMRA committees are up to!

Director of Leadership Development
In 2020, the EMRA board had decided to reorganize the structure and responsibilities of certain
board members. With this in mind, the position of Director of Leadership Development came to
replace the Director of Membership. Along with this change, the responsibilities for EMRA
Committees and Leadership Academy were transferred from the EMRA President-elect to the
Director of Leadership Development, and the membership duties went to the President-elect.
The goal of this reorganization was to create a dedicated position to support our committees,
which are one of the biggest and most productive aspects of the EMRA. Furthermore, it allowed
our president-elect to focus on supporting members and growing our membership, especially in
the difficult times of COVID-19. I have been humbled to be voted in as the first Director of
Leadership and hope to build this into a sustainable and effective position for years to come.

EMRA Committees Update
Our committees have been as strong as ever. With the new leadership class of 2021-2022, we
now have over a 100 leaders in positions of chair, chair-elect, vice chair and assistant vice chair.
Adapting to the ongoing pandemic, EMRA committees have produced too-many-to-count high
quality webinars, mentoring sessions, EM Resident articles and interactive events throughout
the year. Furthermore, the virtual attendance and member involvement at ACEP 20 and CORD
21 have never been higher, showing that the combination of virtual and in-person programming
may be the wave of the future. While we hope to be able to host all of our programming in
person one day, due to the ongoing health risk to our members EMRA pivoted to hybrid
programming at ACEP this year, hosting the majority of its programming virtually, with only the
EMRA MedWAR taking place in person. At the EMRA board of directors, we are committed to
our committees and are looking forward to continuing their growth.

Leadership Development and Committee Leader Selection Updates
With the creation of the Director of Leadership Development position, one of the identified goals
was to add a component of leadership growth to the EMRA leader position. We were able to
accomplish this by introducing the Leadership Development series, which are interactive
sessions focused on concepts of leadership that directly benefit EMRA leaders. The first
session at CORD 21, led by the ACEP President-elect, Dr. Gillian Schmitz, was incredibly
valuable and well-received. The second session will be hosted by Dr. Aisha Terry will take place
shortly before ACEP 21. We hope to continue these sessions on a bi- or tri-annual basis.

We also aimed to improve on the committee leader selection process, by identifying biases and
removing systemic barriers in the process to make it as equitable and holistic as it can be. We
look forward to releasing the updated committee leader application at ACEP 21.

EMRA/ACEP Leadership Academy Update
Our leadership academy entered its 4th year and continues to be one of the premier leadership
courses available to EM residents and EM-bound medical students. Our leadership team has
done an incredible job to select over 75 students from a competitive group of applicants, and
continues to innovate and improve the curriculum to bring the best leaders in Emergency
Medicine to the course participants. We look forward to selecting the next class starting at
CORD 22.

Parting Thoughts
Thank you for making it through this long update. I want to again thank you for your dedication
to emergency medicine, representing your residency, and EMRA. With your help we can
continue to advocate for the residents’ voice and provide opportunities to develop the future
leaders of emergency medicine.

Very respectfully,

Yev Maksimenko, MD, MA, DiMM, FAWM, NRP/LP, FP-C
Capt., USAF, MC
Director of Leadership Development


EMRA Ex-Officio Member
Breanne Jaqua, DO, MPH
Mercy St. Vincent Medical Center

Dear RepCo,

It has been a pleasure serving with the EMRA Board of Directors and I thank you for the
opportunity to provide a brief update.

EMRA has been a fierce advocate for parental leave policies for medical students, residents,
and fellows, as noted in the following excerpt from the EMRA Policy Compendium V.VI.
Family and Medical Leave Policy:
“EMRA believes that access to maternity/paternity leave should be equal for men and women
with newly born or adopted children. EMRA further believes that individuals taking maternity and
paternity leave should be paid for the totality of these leaves. EMRA should work with local,
state, and federal policymakers to advocate for paid parental leave for physicians,
physicians-in-training, and all persons.”

The ACGME recently had an open public comment period for proposed changes to the
Institutional Requirements. If these proposed changes are approved for adoption, it would codify
a minimum of 6 weeks of paid medical/parental/caregiver leave of absence for trainees in
ACGME accredited programs. EMRA provided public comment in support for this language in
alignment with EMRA’s policy compendium.

In July 2021 my term as the Resident Representative with the ACGME’s Emergency Medicine
Review Committee expired. I will continue to serve the EMRA Board of Directors as an
Ex-Officio member through Fall of 2022. [The above comments are provided for EMRA
members for general reference only. Please note that I am not a spokesperson for the ACGME,
and this report does not constitute in any way an official or unofficial statement from the

Respectfully submitted,

Breanne Jaqua, DO, MPH
Ex-Officio Member of the EMRA Board of Directors


EMRA Representative to the AMA
Sophia Spadafore, MD
Mount Sinai School of Medicine - New York

Dear Representative Council,

What a year it has been! Although policy meetings have been virtual there has not been a
decrease in the amount of hot topics discussed.

Here is a summary of important policy passed at the June AMA-RFS meeting:
      ● Guidelines for the new AMA health equity plan which seeks to prevent and address
          systematic racism, biases, and microaggressions
      ● Support of global vaccine dissemination and a temporary waiver of the Trade Related
          Aspects of Intellectual Property agreement, which allows easier global manufacturing
      ● Setting standards for vaccine mandates
      ● Call to Congress to provide PPE to tribal communities in concordance with trust and
          treaty laws and to advocate for better fitting PPE, as current designs are more likely to
          cause pressure ulcers and inadequate protection amongst varying body types
      ● Identification of broadband internet access as a social health determinant and
          advocacy for universal broadband access to further improve access to Telehealth and
          remove health barriers
      ● Urge collaboration with the Department of Health and Human Services on
          information-blocking regulations (the regulations that make our notes immediately
available to patients) and advocate to prevent the release of such information if this
          may cause distress to the patient
      ●   Establishing a set of operating principals for Urgent Care Centers to follow
      ●   Advocacy for and endorsement of medical treatment for opioid use disorder at
          correctional facilities
      ●   Opposition of to the use of sedative/hypnotic and dissociative agents for solely law
          enforcement purposes

In addition to this exciting policy, we had the most representation of EM residents and fellows of
any AMA-RFS meeting in recent history. We also have had 3 EM trainees on the RFS governing
council (including myself as I was elected Speaker in June!)

The ACEP workforce report was widely discussed in our specialty, but I ensured it was also
discussed within the house of medicine and the AMA is acutely aware of what is going on. I
have worked with the EM Section Council within the AMA to ensure these conversations
continue. Some concrete steps have been taken, such as ACEP joining the AMA Scope of
Practice partnership and the AMA committing funds to research the effect of private equity on

Lastly, I have served as your parliamentarian and helped lead the Health Policy Academy
fellows throughout the year. We have a new ambitious plan for representing EMRA at ACEP
Council, if anyone is interested in knowing more please let me know!

All the best,


EMRA Medical Student Council Chair
Chiamara Anokwute
Indiana University School of Medicine

Hello EMRA family!

It has been an honor to serve as your 2021-2022 Medical Student Council Chair. My role
involves serving as the medical student voice on the EMRA Board of Directors and presiding
over the workings of the EMRA MSC.

The MSC has a very strong history of collaboration with residents and EMRA Committees. We
also serve as the pipeline for future resident leaders in EMRA. If you have any collaboration
ideas or questions about medical student involvement in EMRA, please do not hesitate to
contact me via the information below. On behalf of the MSC, we are always grateful to find ways
to advocate on behalf of EMRA’s members.
This year’s MSC has been hard at work since March, advocating for EM bound medical
students everywhere in the midst of the pandemic. We have worked hard to improve existing
programs and create new projects to increase the value of EMRA membership for existing and
potential student members. Some highlights from this group over the past few months
• Organized and hosted the virtual Spring and Fall Medical Student Forums (MSF).
       These forums included sessions with program directors from across the country as well
       as specific advising sessions tailored to each step of an EM-bound student’s career.
       • Brought EMRA medical student members the well sought after Residency Fair in an all
       virtual format that included over 200+ EM residency programs.
       • Collaborated with CORD/CDEM Faculty to develop a targeted Hangout session
       addressing “EM Away Rotations & SLOEs in 2021-2022: Let’s Talk About the New
       Consensus Statement!”
       • Continued to develop our regional representative system that maintains contact with all
       EMIGs from across the country and also internationally.
       • Continue to recognize EMIGs doing extraordinary work at different schools across the
       country by awarding the EMIG of the Year Award.
       • Served as key liaisons for all existing EMRA Committees.
       • Provided student specific input on the All EM Organizations “Consensus Statement on
       the 2021-2022 Residency Application Process for US Medical Students Planning
       Careers in Emergency Medicine in the Main Residency Match” which helped to guide the
       2021-2022 application cycle for all EM bound students.
       • Provided student specific input on the CDEM/CORD “Recommendations on
       Program-Sponsored Events During the 2021-2022 Interview Season” which will help
       guide the 2021-2022 interview season for all EM bound students.
       • Provided student specific input during ACEP’s Strategic Planning Sessions.

The MSC is grateful for all of your support for EMRA’s medical student members. The EMRA
family continues to show its support for its medical student members, particularly during the
second application cycle that has been upturned by the COVID-19 pandemic. EMRA continues
to be committed to the development of future leaders within emergency medicine starting when
they are medical students. Please reach out to us at any point in the future as we would love to
find ways to advocate on behalf of all of our members.


-- Chiamara Anokwute
EMRA Medical Student Council Chair
Parliamentary Procedure at a Glance
                (Based on The Standard Code of Parliamentary Procedure by Alice Sturgis)

                         Principal Motions (Listed in Order of Precedence)

      TO DO THIS                YOU SAY THIS             May You     Must You Be   Is The Motion   What Vote is
                                                         Interrupt   Seconded?      Debatable?      Required?

*Adjourn the meeting        "I move the meeting be          NO          YES            YES          MAJORITY
                            adjourned"                                             (RESTRICTED)

*Recess the meeting         "I move that the                NO          YES           YES**         MAJORITY
                            meeting be recessed

Complain about noise,       "I rise to the question of     YES           NO            NO             NONE
room temperature, etc.      personal privilege"

Postpone temporarily        "I move that this motion        NO          YES            NO            MAJORITY
(Table)                     be tabled"                                                              (REQUIRES
                                                                                                   IF IT WOULD

End debate                  "I move to vote                 NO          YES            NO          TWO-THIRDS

*Limit debate               "I move that each               NO          YES           YES**        TWO-THIRDS
                            speaker be limited to a
                            total of two minutes per

*Postpone consideration     "I move to postpone this        NO          YES           YES**         MAJORITY
of an item to a certain     item until 2:00pm..."

*Have something             "I move this matter be          NO          YES           YES**         MAJORITY
referred to committee       referred to…"

*Amend a motion             "I move to amend this           NO          YES            YES          MAJORITY
                            motion by…"

*Introduce business (the    "I move that..."                NO          YES            YES          MAJORITY
Main Motion)

*Amend a previous           "I move to amend the            NO          YES            YES          MAJORITY
action                      motion that was

Ratify action taken in      "I move to ratify the           NO          YES            YES          MAJORITY
absence of a quorum or      action taken by
in an emergency             the Council..."

Reconsider                  "I move to reconsider..."      YES          YES           YES**         MAJORITY

Rescind (a main motion)     "I move to rescind the          NO          YES            YES          MAJORITY

Resume consideration of     "I move to resume               NO          YES            NO           MAJORITY
a tabled item               consideration of...?

**Debatable if no Other Motion is Pending
Parliamentary Procedure at a Glance
              (Based on The Standard Code of Parliamentary Procedure by Alice Sturgis)

                                              Incidental Motions

      TO DO THIS                 YOU SAY THIS          May You     Must You Be   Is The Motion   What Vote is
                                                       Interrupt   Seconded?      Debatable?      Required?

Vote on a ruling by the      "I appeal the Chair’s       YES          YES            YES          MAJORITY
Chair                        decision"

Consider something out       "I move to suspend the       NO          YES            NO          TWO-THIRDS
of its scheduled order       rules and consider…"

To discuss an issue          "I move that we              NO          YES            NO           MAJORITY
without restrictions of      consider informally…"
parliamentary rules

To call attention to a       "I rise to a point of       YES           NO            NO             NONE
violation of the rules or    order"
error in procedure, and to
secure a ruling on the
question raised

To ask a question            "I rise to a                YES           NO            NO             NONE
relating to procedure        parliamentary inquiry"

To allow the maker of a      "I move to withdraw my      YES           NO            NO             NONE
motion to remove the         motion"
motion from

To separate a multi-part     "I move division of the      NO           NO            NO             NONE
question into individual     question"
questions for the purpose
of voting

To verify an indecisive      "I move to divide the       YES           NO            NO             NONE
voice or hand vote by        Assembly"
requiring voters to rise
and be counted

**Debatable if no Other Motion is Pending

               PURPOSE                                       MOTION

Present an idea for consideration and       Main motion
action                                      Resolution
                                            Consider informally
Improve a pending motion                    Amend
                                            Division of question
Regulate or cut off debate                  Limit or extend debate
                                            Close debate
Delay a decision                            Refer to committee
                                            Postpone to a certain time
                                            Postpone temporarily
Suppress a proposal                         Table
                                            Withdraw a motion
Meet an emergency                           Question of privilege
                                            Suspend rules
Gain information on a pending motion        Parliamentary inquiry
                                            Request for information
                                            Request to ask member a question
                                            Question of privilege
Question the decision of the presiding      Point of order
officer                                     Appeal from decision of chair
Enforce rights and privileges
                                            Division of assembly
                                            Division of question
                                            Parliamentary inquiry
                                            Point of order
                                            Appeal from decision of chair
Consider a question again                   Resume consideration
                                            Renew a motion
                                            Amend a previous action
Change an action already taken              Reconsider
                                            Amend a previous action
Terminate a meeting                         Adjourn

             (From The Standard Code of Parliamentary Procedure by Alice Sturgis)
Parliamentary Strategy
              (From The Standard Code of Parliamentary Procedure by Alice Sturgis)

        TO SUPPORT A MOTION                                 TO OPPOSE A MOTION

1. Second it promptly and enthusiastically.         1. Speak against it as soon as possible.
                                                    Raise questions; try to put proponents on
2. Speak in favor of it as soon as possible.        the defensive.

3. Do your homework; know your facts; have          2. Move to amend the motion so as to
handouts, charts, overhead projector slides,        eliminate objectionable aspects.
etc., if appropriate.
                                                    3. Move to amend the motion to adversely
4. Move to amend motion, if necessary, to           encumber it.
make it more acceptable to opponents.
                                                    4. Draft a more acceptable version and
5. Vote against motion to table or to               offer as amendment by substitution.
postpone, unless delay will strengthen your
position.                                           5. Move to postpone to a subsequent
6. Move to recess or postpone, if you need
time to marshal facts or work behind the            6. Move to refer to committee.
                                                    7. Move to table.
7. If defeat seems likely, move to refer to
committee, if that would improve chances.           8. Move to recess, if you need time to
                                                    round up votes or obtain more facts.
8. If defeat seems likely, move to divide
question, if appropriate, to gain at least a        9. Question the presence of a quorum, if
partial victory.                                    appropriate.

9. Have available a copy of the                     10. Move to adjourn.
organization's standing rules, its bylaws, and
The Standard Code of Parliamentary                  11. On a voice vote, vote emphatically.
Procedure, in case of a procedural dispute.
                                                    12. If the motion is adopted, move to
10. If motion is defeated, move to                  reconsider, if you might win a subsequent
reconsider, if circumstances warrant it.            vote.

11. If motion is defeated, consider                 13. If the motion is adopted, consider trying
reintroducing it at a subsequent meeting.           to rescind it at a subsequent meeting.

                                                    14. Have available a copy of the
                                                    organization's standing rules, its bylaws,
                                                    and The Standard Code of Parliamentary
                                                    Procedure, in case of a procedural dispute.
You can also read