Mediterranean Journal of Emergency Medicine & Acute Care

5

Authors: Laurie A. Boge, Charles Wyatt, Dana R. Sherman, Michael Cecilia, Luigi X. Cubeddu, Robert C. Goldszer, David A. Farcy

Introduction: For patients presenting to an emergency department with a chief complaint of chest pain, current American Heart Association guidelines recommend that time from emergency department arrival to completion of electrocardiogram be 10 minutes or less. The aim of this study is to evaluate if differences still exist amongst a diverse patient population presenting to a busy urban emergency department with a chief complaint of chest pain. Methods: This retrospective study looked at 3,419 patients who presented to the Emergency Department with any complaint of chest pain during the medical screening examination. Arrival time and time of first electrocardiogram along with age, gender, race, ethnicity and primary language were extracted from electronic health records. Results: For all patients, the mean time to electrocardiogram was 12.5 minutes (95% CI: 12.1-12.7) and 49.9% of all patients received an electrocardiogram within 10 minutes of arrival. Mean time for men was 11.6 minutes and for women 13.3 minutes (P<0.0001); in addition 54% of men and 44.4% of women had electrocardiogram done within 10 minutes of arrival (P<0.0001). No differences were found with regards to primary language, race or ethnicity of patients. Mean time to electrocardiogram for patients less than 40 years old was 14.6 minutes, which was significantly longer than patients equal or older than 40 years, who’s mean time was 11.9 minutes (p<0.0001). The effect of age was observed across gender, race, ethnicity and primary language spoken by the patients. Conclusions: Patient presenting to the emergency department with chest pain are subject to several biases that potentially create health disparities. In this study we show that younger patients and women had a delay in time to electrocardiogram showing biases are still an issue.

11

Authors: Sarah El Halabi, Rawad El Hayek, Karine Kahil, Marwa Nofal, Samer El Hayek

The general lack of awareness of mental health in the Middle East and North Africa (MENA) region, particularly within its Arab countries, accounts for limited mental health services and stigmatization of psychiatric conditions in the region. Suicide is a drastic consequence of mental health neglect. Suicidal attempts are one form of presentation to emergency departments (ED) in healthcare centers across the Arab countries in the MENA region. We collected data from various research studies in the region to narrate such presentations. This epidemiological country-by-country summary includes the characteristics of suicidal attempts in the Arab region, with a focus on methods, causes, and management of cases. The summary demonstrates that suicidal attempts in this part of the world share sociocultural and logistic grounds. The prominent archetypes of suicidal attempts are middle-aged Arab women ingesting poisonous substances secondary to familial or interpersonal stressors. We also link these presentations to the Arab culture and its associated beliefs, which at times can dictate privacy and stigmatization of mental health and suicide. Even though religion plays a role in mollifying suicidal attempts, it might exacerbate stigma regarding suicide among Arab societies. Lastly, we recommend management measures that enhance suicide risk detection in the ED and provide an ameliorated understanding of suicidal ideations and behaviors of patients in the Arab countries of the MENA region.

2-3

Authors: Amin Kazzi

Peter Rosen, MD, FAAEM, one of the main founding fathers and mothers in the field of emergency medicine, passed away in Tucson, Arizona, on the 11th of November 2019 from complications of chronic diseases, with his best friend and wife Ann at his side. He was 84 years old.Dr. Rosen dedicated decades of his life advocating and promoting the field of emergency medicine as a medical discipline and academic specialty, one that stands in parity with all other primary categorical specialties.

6

Authors: Mohamad Ali Cheaito, Brigitte Kazzi, Eveline Hitti, Kamal Badr, Salah Zeineldine, Ziad Kazzi, Amin Kazzi

International medical graduates (IMGs) are graduates of medical schools located outside the United States (U.S.) and Canada. IMGs face various challenges on the road to U.S. residency training. These challenges include sitting for the United States Medical Licensing Examinations (USMLEs) to obtain certification from the Educational Commission for Foreign Medical Graduates (ECFMG). After that, IMGs are faced with a foreign application process whereby they must apply for and secure a position in a residency program through the Electronic Residency Application System (ERAS) and the National Resident Matching Program (NRMP). Once accepted into a residency program, IMGs who are not US citizens or legal permanent residents are challenged with securing a visa to be able to practice in the U.S. In this article, we elaborate on these processes and highlight the challenges IMGs may face along the way.