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Hi everyone:

Regardless of the age range you care for in your ED, this entire
conversation really focuses on two issues: Scope of Practice and EMTALA.

EMTALA reigns supreme on all issues as it pertains to EM. As a physician in
an ED, you must provide stabilization to the best of your hospital's and
your personal capabilities. Since the training, expertise and experience of
EM physicians vary greatly, everyone should keep these simple principles in
mind.

As such, I give the following advice to my staff:

1) All adult patients who present for care in our ED must have an EMTALA
screening examination.
2) The extent of that screening examination is determined by your
hospital's and your personal level of comfort of managing that patient to
the point of Discharge or Transfer.

For those who feel really uncomfortable managing adult patients, the extent
of the medical screening will be much less than for say me, who trained in
adult medicine.

Lets not make this more complicated than it needs to be.

Just my two cents.

Bob Flood
Division Director, PEM
Cardinal Glennon, St. Louis


On Tue, Apr 22, 2014 at 11:02 AM, Marjan Askar <[log in to unmask]>wrote:

> I just wanted to point out that suturing a 30 year old May not be
> different than the 15 year old, but the bottom line is that those of us who
> chose to do a pediatric emergency fellowship following a pediatric
> residency, are PEDIATRIC sub specialists.
> We CHOOSE not to see adults .
> Same argument goes for a heart surgeon performing general surgery .  Are
> the able to and trsined? Yes
> They CHOOSE not to.
> This issue comes up where I work all the time.
> In the era of see as many patients as quickly as you can and keep patients
> satisfied , physician satisfaction with what they do is forgotten .
> I simply CHOOSE to take care of kids.  This is what satisfies me.
>
> Marjan Askar
> Lake Forest, IL
>
>
> Sent from my iPhone
>
> > On Apr 21, 2014, at 7:46 PM, "Linzer, Jeffrey F" <[log in to unmask]>
> wrote:
> >
> > Not to drag up too many old issues, but PEM's are emergency physicians
> first. Yes, everyone who came up the peds track did only four months of
> adult time and that won't make you an expert in figuring out whether to
> start TPA on that 52 year-old who is having an evolving stroke or not.
> However, I think doing a laceration repair on a relatively healthy 40
> year-old isn't that much different than a 15 year-old.
> >
> >
> >
> > That said, the only "legal" issue is what services you are credentialed
> by the hospital to perform (other than the occasional emergency surprise
> that may so up at your door). If you work in a dual ED (adults and kids in
> the same basic area), then the hospital is responsible for making sure you
> are qualified to perform/provide services to certain patients. The
> breakdown of peds care ending at 15, 17, 20 or 25 is purely artificial and
> based on your specific hospital's policies. In fact the AAP recognizes
> "young adults" (to age 26) under the purview of pediatrics (Guiding
> principles for managed care arrangements for the health care of newborns,
> infants, children, adolescents, and young adults. Pediatrics
> 2013;132;e1452).
> >
> >
> >
> > So with that said, as long as the hospital has said your are qualified
> to perform a service (and your malpractice carrier agrees) than you can go
> ahead and provide the service.
> >
> >
> >
> > Just my 2₵
> >
> > Jeff
> >
> >
> >
> >
> >
> > Jeffrey Linzer Sr., MD, FAAP, FACEP
> > Associate Professor of Pediatrics and Emergency Medicine
> > Emory University School of Medicine
> > Associate Medical Director for Compliance
> > EPG/Division of Pediatric Emergency Medicine
> > Children’s Healthcare of Atlanta
> >
> > [cid:[log in to unmask]]
> >
> >
> >
> >
> >
> >
> >
> >
> > -----Original Message-----
> > From: Pediatric Emergency Medicine Discussion List [mailto:
> [log in to unmask]] On Behalf Of Lisa A Drago
> > Sent: Monday, April 21, 2014 3:13 PM
> > To: [log in to unmask]
> > Subject: Adult patients in the PED
> >
> >
> >
> > Recently our adult colleagues have been requesting the PEM docs see
> young adults ( under 30) when their volume becomes unbearable. Any PEM docs
> seeing young adults in your practice and legally how are you handling this
> (separate hospital privileges?)
> >
> >
> >
> > For more information, send mail to [log in to unmask]<mailto:
> [log in to unmask]> with the message: info PED-EM-L The URL for
> the PED-EM-L Web Page is:
> >
> >                 http://listserv.brown.edu/ped-em-l.html
> >
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>
> For more information, send mail to [log in to unmask] with the
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> The URL for the PED-EM-L Web Page is:
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>

For more information, send mail to [log in to unmask] with the message: info PED-EM-L
The URL for the PED-EM-L Web Page is:
                 http://listserv.brown.edu/ped-em-l.html