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How to Create a Business Plan

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Yes! NYC Emergency Management engages with the private and nonprofit sectors to coordinate assets and resources during an emergency. NYC Emergency Management also works with umbrella organizations from a variety of industries who sit with us in the Emergency Operations Center during disasters, and help with information sharing and situational awareness. Please contact us if you are interested in learning more.

Emergency subtitles English

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Oakland is experiencing a network outage that is affecting key services. Several non-emergency systems within the City of Oakland are currently impacted or offline. Thank you for your patience while we work to restore services.

Please report active infrastructure emergencies to OAK311 by dialing 311 or (510) 615-5566. Emergencies includes downed trees or tree limbs, flooding or sewer overflows, and street signal outages. Please report all non-emergency issues online at this page.

The second edition of Radiopaedia's acclaimed Emergency Radiology Course has arrived! The course features brand new live recorded lectures by Dr Andrew Dixon and A/Prof Craig Hacking plus an hour of bonus content. Review questions, English subtitles and a certificate are provided. This course teaches key concepts in the interpretation of emergency imaging (course trailer, lecture topics) and is ideal for health professionals involved in the emergency care of patients including doctors, nurses, radiographers and medical students.

The Conference attracts over 3,000 elected officials, first responders, emergency managers, and decision makers from across Texas. The Conference provides jurisdictions an opportunity to see and learn about innovative products and services from numerous organizations.

Women who have had unprotected sex and do not wish to become pregnant due to concerns about Zika virus infection should have ready access to emergency contraceptive services and counselling. Pregnant women should practice safer sex (including correct and consistent use of condoms) or abstain from sexual activity for at least the entire duration of pregnancy.

The work of the Task Forces culminates in a final report delivered to municipal decision-makers. The report includes detailed recommendations on how the municipality can become flood resilient through various planning, operations, public outreach, and emergency management activities in the short and long terms. In addition, the report details site-based recommendations examining each stretch of the community's waterfront considering:

Welcome to the LAC+USC Emergency Medicine Residency family. The residency program started in 1971 and has since trained over 800 emergency physicians and leaders, practicing all over the world. Our graduates receive exceptional clinical training while serving the mission of improving the health and lives of patients in our East Los Angeles community. The 6 major aims of our residency program are as follows:

Watch ACEP Geriatric Emergency Medicine discuss how to have our emergency medicine providers age in place. Think you may be aging out of night shifts? Hear about policies at different institutions to address our aging workforce.

- [Maura] You'll hear from Katren Tyler, from UC Davis, who's gonna talk about physiologic challenges in emergency medicine. Then we'll have a panel discussion with three individuals talking about the policies or lack thereof that they have at their institutions around age shifts and aging.

- [Maura] This is not a webinar, it is a Zoom link, but it is a Zoom talk that has CME with it, so, please turn off your microphone if you're not speaking, we will have the opportunity for questions. Hopefully our questions, we'll have time to ask them after each talk, but if we don't we'll then just put them all at the end. So importantly, none of the speakers here or planners have any disclosures and Nicole at some point will put into the chat, how to get CME for this talk. Some of you probably are wondering whether we should be having this talk at all, because if you have read anything about the workforce of emergency medicine over the past couple of years, you have heard that in the next eight years, we will have a surplus of emergency physicians. More than 7,000 emergency physician surplus. And as such, you're probably wondering, should we actually even be encouraging longevity in emergency medicine, given this pending surplus? And this is a publication by Dr. Marco and colleagues that did projections of the emergency medicine workforce. It's important to note that they had a number of assumptions about the workforce in the coming years to make this projection. So they had assumptions around emergency physician attrition rates. They had assumptions around growth of residencies and graduating residents and the numbers of encounters that would be seen by NPs and PAs, as well as the growth in ED visits. And there's already some evidence that some of those assumptions maybe incorrect, really challenging to project these assumptions, but this very recent publication from Cameron Gettel and all looked from 2013 to 2019. And they're seeing annual attrition rates of about 5%. Now that's inclusive at temporary and permanent attrition, but already seeing that pre pandemic, we are having attrition rates that exceed the attrition rates that they're estimating in the publication by Dr. Marco and colleagues. So one point where we may not actually have that same surplus and then hard not to remember that at the end of the match this year, we had 7.5% over 2,000 spots, almost 3,000 spots in our residency programs that were unmatched and went to the soap. So some concerns over their projections around the growth of residency spots and graduating residents. And this is all pre pandemic, right? So we don't know what the impact of pandemic will be on our attrition rates, on our ED visits, and on applications going forward. So that's the rebuttal to the global workforce argument about why we should even be having this conversation about longevity, but it's also important to remember these are individual conversations for individual physicians. They're conversations for me, for Dr. Tyler, for Dr. Binder, for all of our panelists, for you, and even for our residents now who are looking forward to hopefully a lifelong career in emergency medicine. And these are conversations that right now impact a large percentage of our workforce. So the median age of emergency physicians in the United States is 50, and 20% of emergency physicians in the United States are over the age of 65. So impacts a lot of our emergency physicians, but also if you're developing policies around older individuals and say night shifts, it's also important to know how many people are gonna be impacted now and in the upcoming decade, and make sure that your policies are addressing the demographic shifts. So the first two parts of this talk are focused on night shifts. Why are we focusing on night shifts? Well, for many of us night shifts get harder as we age. In our 30s, not so hard. In our 40s, a little bit more difficult. I worked the night shift this weekend, I was in rough shape yesterday. And many report, like Mark DeBard in this article or this editorial, "To retire or not?" Then in the 50s and 60s it becomes particularly difficult. So I'm gonna turn over the microphone and the screen to Dr. Katren Tyler. She's gonna talk about physiologic challenges in emergency medicine. She is going to talk specifically about chronotrophy, shift work and aging. So if you don't know, Dr. Tyler, Katren grew up in Australia, so she actually completed two emergency medicine residency programs, one in Australia, one in the US. She has been very active in geriatric emergency medicine, but also very active in wellness. And she actually has a leadership role in her health system around physician wellness.

- [Katren] Thanks so much Maura, I'm very excited to be here this morning. And so I've subtitled my talk "Otherwise known as when did I start hating night shifts," because I think all of us have been on a bit of a path in how we have approached shift work over time. So let me just, yep, alrighty. So I do not have any financial disclosures. As Maura mentioned, I am from Australia. So therefore I am legit allowed to put up pictures of koalas. I am a PGY 30 so I do have a substantially extended exposure to night shift. And I just wanna sort of focus back a little bit on sort of Maslow's Hierarchy of Needs, and this particular diagram is of course, a little bit tongue in cheek with our wifi and battery down the bottom, but I think that, although I did make the mistake of taking my teenagers on a vacation over spring break without wifi. Pro tip, don't do that. But physiologic needs, I think we sometimes overlook the importance of some of these things and how they sort of play into how we feel about ourselves and sort of our life's work. So just a super brief overview of what this talk of, what this very brief overview of a talk is gonna be. I'm gonna talk about the sort of the general burden of shift work, especially night shifts, but not restricted in any way to age. I'm gonna talk a little bit about systems based responses and the shared responsibility, especially what that looks like in some other industries that have tackled this I think a little better than medicine has. What aging and shift work might look like. And then what some possible solutions are, and more importantly, what we at UC Davis chose to do. And just as a side note, there was no night shifts until the Industrial Revolution. Until we had all night lighting there may occasionally have been people who were guarding the carpet, but there were very few people who were actually up all night deliberately. And if I could just ask everybody to mute at the moment, 'cause it's not a webinar, so thanks so much. So the physiologic burden of shift work. So, there's a lot of play in the lay literature about early birds and night owls. And you've probably seen quite a bit of literature about that. This document, I'm going to refer to several times in the talk and it's from the Federal Aviation Authority and it is a circular advisory around fatigue mitigation strategies and sleep in aviation. So I have come to think of sleep as really being, and fatigue management, as really being a patient safety issue. And when I'm talking about fatigue management in medicine, I'm speaking specifically about shift work, about on-call work, extended duration shift work, which is when you have a longer shift, and also some of the condensed work weeks, which is what the nursing staff actually do when they're doing those consecutive 12 hour shifts. And I think that we have sort of undervalued the role of fatigue management and fatigue in general, as a cognitive critical safety process. This study, I have some blown up slides of these images, but this is looking not just at healthcare workers. This is a cross section of the US population. Just looking, the top margin icon is sleep duration, and you can see that most people there are averaging between six and 10 hours. And chronotype. And so I didn't really know that much about what chronotype was before I started looking into this literature, but it turns out that this is actually how they come to describe whether you are a morning person or an evening person. And the measurement that they use is the time of the mid-sleep on weekends. And if you think about when, if you are left to your own devices, you don't have to go to work. You're on vacation. You don't have to get your kids anywhere. You don't have to do anything with the dogs. You don't have to pick up your mother from her doctor's appointment, whatever it is that you normally are very busy with your life doing, it is what time you would choose to go to bed left to your own devices and then what time you would wake up in the morning. And they measure it using the mid-sleep which is halfway through that point. So that you can see that most people are falling between that two to four hours, which is halfway through an eight hours sleep. So they're mostly going to bed between 10 and 11 o'clock at night. So this particular image was really eyeopening for me. So, the first thing is is that there's a lot of natural variation right, in when people's chronotype are. And you can see that some people are going to be awake. You know, some people have a much earlier chronotype, especially as you get older, which means that you want to go to bed earlier and you wanna get up earlier. The thing that was important to me is that when we're in our 20s and 30s which is when we're mostly choosing a career in medicine and choosing which specialty we do, and specifically we're choosing emergency medicine, which has a large component of swing shifts, it's usually when our chronotype is close to being its earliest. So that means that we have a better tolerance for staying up late and then sleeping in late. But over the decades, as you are practicing emergency medicine into your, first into your 40s, and then into your 50s, there's a decline and, well, not really a decline, your chronotype moves earlier, which means that you wanna go to bed earlier, get up earlier. And so that makes it harder to do those later shifts, whatever they look like, and it's particularly hard to do night shifts. So late chronotypes actually very well suited to emergency medicine because as we know, the swing shifts are when the patients come, I just pulled these two completely random emergency department profiles off the internet, but I can guarantee you that all of your emergency departments look like this, the very few patient arrivals overnight, most of the arrivals start picking up around 10 or 11 in the morning and then increase over time and dropping off in the evening. But we're not actually that unusual in that 30% of the United States workforce has alternate rotating or extended shifts that are outside of the 8:00 AM to 6:00 PM range, 12% include night shifts. And as I mentioned, the nursing staff are doing a compressed work week with a 12 hour schedule. So when you add on overtime to what the nurses are doing, that actually becomes quite a burdensome schedule. Morningness what we call early chronotype and so they have a decreased total sleep duration on night shifts, and early chronotype generally does not do well with late shifts or night shifts, are quite difficult. Eveningness is the late chronotype. And those people generally don't do that well with a regular day shift. So like even in non-medicine life, it can be difficult for people with a late chronotype to function with an 8:00 AM to 6:00 PM type schedule. So, evening shifts actually might be protective for those patients, not patients, people with a late chronotype. So just re-emphasize, we're not nocturnal mammals, although I keep this slide in the talk because I do think the bats feet are just so adorable hanging on to the rock. One of the things that happens when we are facing working against our chronotype is that we get this sort of social jet lag. So one way to think about it is, what time is it in the brain? Our circadian asynchrony is what the whole population experiences whenever they travel and also every time we switch to or from daylight saving where there's always some getting used to the time period in the week following the change. For shift workers, it's something that we are painfully familiar with. And this was a study that I just really like this quote, "Physicians feel moodier, drowsier, and more restless after night duty." And I think, certainly, I used to tolerate night shifts fantastic. It was really my preferred shift. And now as I got older, it became something that I had much less tolerance for. So shift workers are often working against their chronotype. We don't allow people to schedule for their chronotype and social jet lag is the misalignment of the biological and social time. So just thinking about what some of the sequelae of shift work are, and again, this is not terribly specific to healthcare because there's remarkably little information about it considering how many hospitals are in operation around the world. So firstly, there's the circadian desynchronization, the sleep disruption, and so the dirty little secret of shift work is the cognitive impairment that I think we have really failed to address in medicine. So these, if you think of these things as sort of stepwise progression, anyway, firstly there's insufficient sleep opportunities. 041b061a72


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