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  • Workflows | RUEM

    Workflows This is your Services Page. It's a great opportunity to provide information about the services you provide. Double click on the text box to start editing your content and make sure to add all the relevant details you want to share with site visitors. Ambulance Offload Our current goal is to get our APOT times under 25 minutes. The nursing team and provider team are to work together to meet this goal. Click here for the APOT workflow. Bed Escalation Follow this link for the internal guideline regarding bed request escalation. Dialysis There is now a dialysis hotline available for all dialysis needs. You may reach the hotline 24/7 at 951-486-4960. All routine STAT dialysis Hemodialysis (HD) Continuous renal replacement therapy (CRRT) Prolonged intermittent renal replacement (PRRT), or peritoneal. Difficult Airway There is a difficult airway cart located in the trauma bay. Inventory List *** Photo of the cart Field Delivery When a baby is born in the field and arrives to our ED, please call the neonatologist right away so that they can place admission orders. Do NOT discharge the patient in EPIC. The rest of this workflow is directed toward the MUCs, RNs, and NICU team. There is nothing else to do from the "provider" standpoint. General Surgery Pathway Consult the surgery team if a patient has had a recent procedure, surgery, or was discharged from their service within 30 days and is returning to the ED for a related chief complaint. General Surgery Pathways Appendicitis ​ Diverticular Disease Gallbladder GI Bleed (Critical) Hernia Pancreatitis SBO/Bowel Perforation Hip Fracture Pathway Follow this link for the Hip Fracture Pathway. Homeless Care Plans By law, homeless patients require: Medical Screening Exam Referral to behavioral health when needed. This may be an outpatient referral, but screening and follow-up plan must be documented. Provided with a prescription for necessary medications. Documentation that the patient is stable for discharge. Make sure the following care decisions and good documentation for every homeless patient are met: Medically stable ​ Have mental health resources when needed Have the capacity to be discharged (alert, awake, and able to care for themselves). The RUHS Social Services teams are working on further protocols to ensure all other facility requirements are met and hardwired. The patient does not need to stay in an ED bed while other arrangements for discharge planning are being made. The hospital has many other requirements they will be working to meet. More details for the CAL ACEP website can be found in this link. Intranasal Versed Attached is a set of guidelines for the use of intranasal Versed. Please note that when this medication is used on its own, it is not considered procedural sedation, however, if it is used along with opioids, it is then considered procedural sedation. Non-Accidental Trauma Regarding Pediatric Forensics: RUHS Forensic Pediatricians are always on call (either Dr. Grant or Dr. Massi), and the operator should know who is on call and should have their information. They would like to be called for any uncertain cases. NAT Pathway Outpatient Follow-Up Visit from Triage *** Opioid Use Disorder This is your Services Page. It's a great opportunity to provide information about the services you provide. Double click on the text box to start editing your content and make sure to add all the relevant details you want to share with site visitors. Palliative Care Emergency Medicine team role and goals: Will work to discuss end of life goals with then patient (prior to intubation/deterioration) and next of kin whenever possible to document this. Review available POLST prior to intubation/MICU admission whenever possible. Work to ensure patient's plans are consistent with the level of care requested. Will convey patient/family wishes (when known) to the admitting team during handoff. Will place palliative consult for any patient with anticipated potential death within 6 months (e.g. most PCU and MICU admissions; most COVID+ PCU and ICU admissions over 60 years of age). Palliative Care Pathway Radiology Guidelines Refer to the RUHS Intranet for full radiology guidelines. Quick Guide for ED radiology SART SART patients requiring Medical Clearance prior to Forensic Medical Examination Patients presenting to the Emergency Department prior to reporting a sexual assault to law enforcement (self-presenting) Patient presenting to the Emergency Department via ambulance Patients presenting to the Emergency Department for a Forensic Medical Examination who have medical complaints including pain, bleeding, strangulation, and/or are intoxicated upon presentation. Pediatric patients SART patients presenting for the sole purpose of receiving a Forensic Medical Examination will receive a Medical Screening examination by the SANE Department of Nursing - Sexual Assault Response Team Page 2 of 2 Subject: Medical Screening/ Medical Clearance Document No. SART-102 SART patients with emergent/urgent medical needs or conditions will be referred to the Emergency Department following Forensic Medical Examination for further evaluation and/or treatment. SART also can assist in management of domestic violence cases. SART can be contacted by calling the hospital operator and requesting a page. Complete SART Screening Guideline Service Agreements This is your Services Page. It's a great opportunity to provide information about the services you provide. Double click on the text box to start editing your content and make sure to add all the relevant details you want to share with site visitors. Sports Concussion For all adult and pediatric patients seen in the ED with a concussion, please refer to Sports Medicine. Place a discharge order for an "Ambulatory Referral to Sports Med" Click on "Referral Override" Select "Perris Clinic", Dr. Uziel Sauceda Regardless of insurance type, Dr. Sauceda will arrange follow-up (including Kaiser). You can also message Dr. Sauceda directly through EPIC Excuse patient from sports for a minimum of 7 days and require medical clearance prior to return to sports. *** Make the picture for here into a document or something STEMI Program Internal STEMI guidelines Strangulation Strangulation Evaluation Guidelines Strangulation workflow Stroke Use the stroke order set Do not admit until LVO has been ruled out Go to CT with patient if within TPA/TNK window (look at CT head to ensure there is no ICH and start calling neurology/pharmacy for TPA/TNK) LKWT must be within 24 hours for patient to qualify for neuroIR and 4.5 hours for patient to qualify for TPA Pediatric Stroke Pathway Trauma Trauma Activations MICN will activate field calls if criteria is met ED Attending should, when in doubt, activate pre-arrival (err on the side of activation) Trauma and ED senior need to make sure introductions are made when possible prior to major trauma arrival and tasks are assigned by the Trauma Senior and understood by the team. If the trauma senior or attending is not present, the ED senior should coordinate roles. If patient's condition changes in the ED, activation should me made or upgraded as appropriate. Life threatening injuries should be activated as major traumas. If a patient does not meet activation criteria but requires a work-up (CT scans) to investigate for traumatic injuries, when appropriate, the ED will expedite the care (e.g. bypass labs for CT if indicated, expedite CT, etc). When appropriate, trauma activations can/should be used outside the protocol to facilitate expedited care as well (access additional nursing, lab, CT, and other resources). For medical arrests with associated signs/suspicions of trauma, trauma activation will occur (e.g. elderly fall with significant bruising/trauma) For cardiac arrest in custody, if there is no clear medical indication (e.g. asthma, chest pain prior to arrest, ingestion), it should be activated as a trauma. If the cause is unknown (found down), activate. Consult/minor trauma: place a consult and call trauma nurse (ext. 18132) and ask for a "minor trauma consult". See consult criteria. All trauma transfers out of our facility to be approved by trauma service/attending. If patient meets criteria for stroke or RRT/Sepsis, please activate in parallel to trauma activation/work up. ​ Transfers This is your Services Page. It's a great opportunity to provide information about the services you provide. Double click on the text box to start editing your content and make sure to add all the relevant details you want to share with site visitors. Get in Touch This is a Paragraph. Click on "Edit Text" or double click on the text box to start editing the content.

  • Education | RUEM

    Education 1. Bilirubin 2. HIV/ PrEP 3. MAT Outpatient Lecture 4. MAT in The ED 5. PEP + PrEP 6. Splints 7. Vaccines

  • Residents | RUEM

    Resident in Charge Plan Administrative Fellowship Resident Login Resident in Charge will be an assigned role for PGY2&3s. Goal : To enhance the EM PGY2-3 Resident Experience by further developing leadership skills, department awareness, and managing ED throughput and patient care prioritization. Following times will delineate the RIC: 7a-1p 1p-5p 5p-12a 12a-7a The R.I.C will do the following: ​ 1. Sign in at the start of each shift on the white board as the RIC along with the phone number to be reached at. 3. Is the point person for communication with the ED Charge Nurse 5. Is the initial point of contact for the MUC for all transfer calls 7. The R.I.C. will round with the ED charge nurse at the start of their R.I.C. assignment. 2. Sits to the far left of the physician work area in the main ED (where the attending has traditionally sat) 4. Is the initial point of contact for the MICN to field Base station calls 6. All outside hospital transfer requests and base station decisions will be made jointly in real time with the supervising ED attending. Orientation Information NEW EM INTERN ORIENTATION AGENDA July 2, 2018 Administrative Fellowship Administrative Fellowship Dr. Mesisca is looking for an admin fellow to work after graduation at Kaiser Moreno Valley and RUHS and spend time learning how to recruit and build physician and PA teams, improve ED operations and efficiency, work with hospital administration and consulting services on throughput collaboratives, attend regional trauma and EMS meetings, learn to manage site finances with understanding of billing and contract negotiations. This is one year commitment sponsored by CEP America (now called Vituity). Most fellows go on to become Assistant Medical or Medical Directors. ADMINISTRATIVE ELECTIVE ​For EM residents interested in an EM administration elective at RUHS please inquire with Dr. Mesisca.

  • ED2 Exclusions | RUEM

    ED 2 Exclusions The following chief complaints exclude the patient from placement in ED 2. ​ ** Please obtain HR and O2 for ESI 3 prior to ED2 ** Please refer to a Provider if the patient is borderline or you are unsure of the appropriateness of the patients location ESI of 1 or 2 Non-ambulatory elderly patients Any patient >65 years old with an ESI 3 or less Pediatric patients under 6 months (consult a provider if questionable) Pediatric patients with a suspicion of/or requiring a head CT Includes LOC​ Chest pain >40 years old or any patient with a cardiac history Abdominal pain >50 years old Psychiatric complaints with high suspicion of needing a BERT consult and/or PSA 1:1 (includes DTO, DTS, GD) ETOH or drug related complaints Any patient who appears under the influence/incapacitated/ altered. ​ Trauma patients that meet trauma activation criteria or trauma center criteria. Significant mechanisms, including MVAs​ Eye complaints

  • Events & Meeting Schedule | RUEM

    2020-21 EVENTS Event 1 Date and Time Event 2 Date and Time Event 3 Date and Time Event 3 Date and Time Event 3 Date and Time Event 3 Date and Time 01/ Just In! Display Content In Repeating Layouts Keep your visitors in the know. Want to make this content your own? Just add your images, text and links, or connect to data from your collection. 02/ Did You Know? You Can Customize This Content Keep your visitors in the know. Want to make this content your own? Just add your images, text and links, or connect to data from your collection. 03/ Breaking News! You Can Click Here To Edit The Text Keep your visitors in the know. Want to make this content your own? Just add your images, text and links, or connect to data from your collection. 04/ Trending! Connect Data From Your Collection Keep your visitors in the know. Want to make this content your own? Just add your images, text and links, or connect to data from your collection.

  • EMS/Disaster Resources | RUEM

    EMS/Disaster Resources APOT Our current goal is to get our APOT times under 25 minutes. The nursing team and provider team are to work together to meet this goal. Click here for the APOT workflow. Base Station Base Station Physician Handbook *** REMSA Protocols *** Trauma Criteria Link *** ​ ED Disaster Response Guide This is a paragraph area where you can add your own text. Just click “Edit Text” or double click here to add your own content and make changes to the font. It's a great place to tell a story about your business and let users know more about you.

  • Resources | RUEM

    Resources 1. Behavioral Health and Addiction Services 2. CHC Resources by Clinic (including podiatry schedule) 3. Housing Insecurity 4. Lactation Help 5. Suspected Child Abu se Reporting Form Reporting Policy

  • RESEARCH | RUEM

    Research Introduction to RUHS Research Process As research is part of the curriculum at RUHS, it is important to know how to start the process. See PDF below for an introduction to the RUHS research process. Do not forget to obtain patient consent when including their case in your research. Consent forms are available in English and Spanish. English Consent Form Spanish Consent Form Research Publications Bureaucratic Barriers To Medical Marijuana Research Are Crumbling Minahan News Article Nosocomial methicillin-resistant Staphylococcus aureus bacteremia in incarcerated patients with severe COVID-19 infection. Randa l l M, Minahan T, Mesisca M, Gnass S Transthoracic Right Heart Echocardiography for the Intensivist Maxwell A. Hockstein, MD, Korbin Haycock, MD, RDMS, RDCS, Matthew Wiepking, MB, MBedSc, BCh, BAO, Skyler Lentz, MD, Siddharth Dugar, Matthew Siuba, DOe Quantifying systemic congestion with Point-Of-Care ultrasound: development of the venous excess ultrasound grading system Haycock- VEXUS Score Rapid Integrated Healthcare Response for the First US Evacuees from Wuhan, China, During the COVID-19 Pandemic Michael Mesisca DO, Geoff Leung MD, Jonelle Morris RN, Matthew Chang MD, Roderick Verbeck PsyD, Stephanie Loe MD, Jennifer Cruikshank RN, MBA1, Arnold Tabuenca MD, Rhyan Miller LMFT, Cameron Kaiser MD, MPH, Kim Saruwatari MPH, Andrew Pachon MD and Melanie M Randall MD

  • Protocols + Workflows | RUEM

    Protocols + Workflows 1. Animal Bite Reporting 2. Asthma Treatment 3. Bili Screening 4. DM Treatment 5. Downtime Protocol 6. e C onsults Cheat Sheet Tip Sheet WorkFlow For Providers 7. HTN Treatment 8. Lead Screening

  • Clinical Documents | RUEM

    Clinical Documents 1. Clinic Phone Numbers 2. Downtime Protocol and Forms

  • Forms | RUEM

    Forms 1. Downtime 2. School Physical (ENG + SPN) 3. Seizure DMV 4. Sport Phys ical Form English Spani sh 5. Suspicious Injury Reporting Form ​ 6. Pregn an cy Veri fication 7. Reportable Disea ses ​ Animal Bite Reporting TB and/or STI Reporting

  • Transitional Status | RUEM

    Transitional Status

  • Services | RUEM

    Service Agreements This is your Services Page. It's a great opportunity to provide information about the services you provide. Double click on the text box to start editing your content and make sure to add all the relevant details you want to share with site visitors. ICU Admission Call ICU admission at the time ICU level of care is identified while pending workup and stabilization. Specifically for the following diagnoses: DKA Intubated ICH requiring Q1h neurochecks CVA (no LVO) requiring TPA/TNK ROSC On Pressors ED RN charge nurse to notify ICU charge at the time of intensivist consult for bed preparation and ICU transfer. ​ Neurosurgery Neurosurgery will not provide recommendations unless a formal consult is placed. Intracranial Hemorrhage Pathway Non-traumatic ICH: Consult neurosurgery immediately. CTA head and neck indicated if any concern for AVM/aneurysm. If CTA is not done, may be requested prior to admit to see if patient needs neuroIR for coiling. Neurosurgery will inform the ED within 15 minutes of CTA completed if need to transfer. If the resident does not respond within 15 minutes, escalate the call to NSx attending. NSx should advise of transfer prior to MICU consult. Osteomyelitis In the setting of osteomyelitis without sepsis: hold antibiotics if the patient is SIRS positive. Follow sepsis protocol. Pediatric Neurosurgery For patients 15 yo or younger, consult adult in-house. Neurosurgery will avoid reflexively recommending to transfer but can advise to call LLUMC Peds Neurosurgery for direction. We have had cases where adult neurosurgery wrote to transfer, but LLUMC was able to coordinate close follow-up. We want to avoid conflicting recommendations. LLUMC is on-call for Peds Neurosurgery, but currently just by phone. Discuss management with them regarding need for transfer or potential for outpatient follow-up (e.g. mass). ​ Neurology Continuous EEG is available from 0700-0000 (this should mostly be done in the ICU) Spot EEG is available almost 24/7. Respiratory therapist will set it up with approval of neurologist on call. Obstetrics ​​ OB (Per Chair Dr. Johnson) would like all pregnant patients with opiate addiction that warrant admission (mainly inmates) to be admitted to their service (potentially for suboxone therapy). Please refer to this memo regarding psychiatric care of pregnant patients. For previable PROM (second trimester with rupture of membranes) please consult OB while the patient is in the department. Orthopedics Discharge Consults The orthopedic team prefers to be called for all cases that will ultimately need surgical care (even if discharged), so they can pre-op the patient and arrange follow-up. ​ Reductions Orthopedics prefers to be called for all cases that will ultimately need surgical care (even if discharged) so they can pre-op the patient and arrange follow-up. ​ Would Cultures Call ortho prior to ordering or performing a wound culture on any post-operative ED visits. They want to avoid unnecessary cultures of post-op wounds. ​ If patient does not meet SIRS criteria, hold off on antibiotics for osteomyelitis Sedation ED will perform sedation for all reductions unless there are significant contra-indications/unsafe conditions (E.g. unstable vitals; airway management concerns) that prevent performing sedation in the ED. ​ Orthopedic Contacts ​ Pediatrics Goal from consult for admit order is 60 minutes. Family Medicine residents have been instructed to receive the consult at the first point of contact and see the patient (even within the last hour of on-call time). If they cannot see the patient, they will sign the patient/consult out to the oncoming resident. The ED will not routinely call a second resident to perform the consult. Bronchiolitis pathway Status epilepticus order set is available in EPIC. The pediatric attendings are available after hours for telephone consultation. The pediatrician can then make telephone recommendations OR the family medicine resident may be asked to see the patient to obtain information to the pediatrician on call. Hyperbilirubinemia: see hour specific calculator linked. ​ Psychiatry ED psychiatry workflow*** MSE of Agitated or Intoxicated Patients Ensure your MSE note addresses the assessment of the chief or associated complaints. ​ Placement and care of severely agitated patients: anyone under a 5150 hold needs a sitter order and a legal hold order. ​ Patients arriving from custody that are very agitated and aggressive OR who were extricated from their cells CANNOT be placed in a security cell. They must be placed in a medical, resuscitation bed. Do NOT place severely agitated patients into the G beds or into security cells until they have been stabilized. ​ Children CANNOT be placed inb G beds (except fort the single rooms). Severely agitated patients should be medicated parenterally. Past behavior should be considered when deciding to medicate for acute agitation. For depressed, suicidal, intoxicated, or delusional patients, please address SI, HI, and grounds to hold or not hold them against their will on MSE notes. Capacity to refuse care (treatment, studies, admission, can be addressed later), but the MSE needs to include if they are a danger to themself, to others, gravely disabled, and/or a flight risk. For patients with a primary medical complaints, but also showing signs of agitation, intoxication, or mental illness, the above needs to be addressed in the MSE note. ​ If patient does not have a psychiatric illness but lacks capacity to leave, please them on a medical incapacity hold (i.e. dementia, encephalopathy, delirium, etc). There is an order available for this in EPIC. ​ Restraint order and documentation Document when giving IM/IV medications (uncooperative, violent, etc). Medical Clearance This is largely a clinical determination. There are no specific labs required, but caution needs to be taken to exclude underlying acute medical issues. POCT Covid test if they are symptomatic. Covid test is not necessary if patient is not showing any symptoms. New onset psychosis or mental status changes typically require more medical work-up. Caution to assess for any signs of trauma or other injuries in altered patients, even with a psychiatric history, should be taken. ​ Unstable vital signs (e.g. severely elevated blood pressure) and severely elevated blood sugars (>350) are challenging for ETS to manage without onsite medical staff at all hours; care should be taken to stabilize patients as much as reasonably possible prior to clearance to ETS. Patient should be "transferred" to ETS and not discharged. Transfer paperwork should be completed (in EPIC discharge section and by the MUC) with accepting physician given report and documented in the medical record. EPIC note should be completed at the time of transfer with documentation that the patient is "medically stable for ETS". Outpatient Psychiatric Support For outpatient psych support (close follow-up) for patients of all ages that do NOT need admission for medical or *** ​ Psychiatry This is your Services Page. It's a great opportunity to provide information about the services you provide. Double click on the text box to start editing your content and make sure to add all the relevant details you want to share with site visitors. General Surgery Consult the surgery team if a patient has had a recent procedure, surgery, or was discharged from their service within 30 days and is returning to the ED for a related chief complaint. General Surgery Pathways Appendicitis ​ Diverticular Disease Gallbladder GI Bleed (Critical) Hernia Pancreatitis SBO/Bowel Perforation ​ Trauma Trauma Activations MICN will activate field calls if trauma activation criteria is met ​ ED Attending should, when in doubt, activate pre-arrival (err on the side of activation) Trauma and ED senior need to make sure introductions are made when possible prior to major trauma arrival and tasks are assigned by trauma senior and understood by the team. If patient's conditions changes in the ED, activation should be made or upgraded as appropriate. Life threatening injuries should be activated as major traumas. If a patient does not meet activation but requires a work-up (CT scans) to investigate for traumatic injuries, when appropriate, the ED will expedite the care (e.g. bypass labs for CT if indicated, expedite CT, etc.) When appropriate, trauma activation can/should be used outside the protocol to facilitate expedites care as well (access additional nursing, lab, CT, and other resources). For medical arrests with associated signs/suspicion of trauma, trauma activation will occur (e.g. elderly fall with signs of significant bruising/trauma). For cardiac arrest in custody, if there is no clear medical indication (e.g. asthma, chest pain prior to arrest, ingestion), it should be activated as a trauma. If cause is unknown (found down), activate. Consult/minor trauma: place a consult and call trauma nurse (ext 18132) and ask for a minor trauma consult. See consult criteria. All trauma transfers out of our facility to be approved by a trauma service/attending. If patient meets criteria for stroke or RRT/sepsis, please activate in parallel to trauma activation/workup. Airway ED senior will direct trauma airway management with ED attending supervising, present, and at the head of the bed. ​ ED senior will coordinate and make sure all necessary equipment is set-up and ready; can direct the RT on equipment needs. Airway requires continual re-assessment throughout the patient's stay (before, during, and after CT when appropriate). Difficult Airway Cart is located in the trauma bay. Airway divert: directing a trauma patient to a non-trauma center should only occur if the patient can NOT be ventilated or oxygenated. Low GCS alone is not an indication to route a non-trauma center. ​ ​ Get in Touch This is a Paragraph. Click on "Edit Text" or double click on the text box to start editing the content.

  • Students | RUEM

    Students Goals Tools Orientation Every student must schedule and resident must be oriented with the GME office, have a badge and computer access prior to the start of their rotation. PA students and fellows must have an orientation scheduled with one our site lead PAs prior to the start of their first shift. This should be scheduled and done prior to the first scheduled shift. Goals of the Rotation Goals 1. Seek out all procedures. 4. Become familiar with common medication dosage. 7. Learn how to present cases to physicians 2. Seek out chief complaints you are less familiar or comfortable with. 5. Learn evidence based orders. 8. Recognize your limitations 3. All charts with medical complaints must have a solid differential diagnosis. 6. Learn ED time management including budgeting time to document while maintaining patient flow. 9. All charts will be completed prior to leaving the shift Procedures to be familiar with: Paracentesis Pelvic Exam Rectal/Prostate Exam Stool Guaiac Airway management/ Intubation Orho reductions & splinting Eye Exams: visual acuity, EOMI, peripheral vision, pupils, Fundoscopic exam, tonometry (for intraocular pressure), fluorescein staining & Wood’s lamp Ultrasound : eFAST, Ocular, Abdomen (i.e. Gallbladder), Testicular, etc. Peripheral IV IO’s Foley Catheter NG/OG Tubes I&D Toe Nail Removal Lumbar Puncture Central Line *Roberts & Hedges’ Clinical Procedures in Emergency Medicine is the go-to resource for all ED procedures* *Opportunities to perform procedures in the emergency department are abundant and we love to get students involved. Know the indications, contraindications, and technique for these procedures: Be familiar with interpreting EKG's CXR's CT's Tools: Tools Presenting a Patient EMRA Med Student Survival Guide Orientation Orientation STEP 1 ORIENTATION CHECKLIST Before your first shift you must review all the materials listed in this checklist; failure to do so may result in cancellation of your rotations (students) and additional shifts (residents). Click here for Checklist STEP 2 Schedule orientation Offservice Residents schedule orienation with Dr. Mark Thomas PA Fellows Orient with site lead PAs ​ Contact Amy Russell for scheduling STEP 3 ORIENTATION PPT Start Here Review this PPT Click HERE for PPT STEP 4 Come prepared & Ready to Learn Arrive at least 20 minutes prior to your shift with your orientation checklist completed, scrubs and stethoscope. Contact Amy Russell with any questions

  • Downtime | RUEM

    Downtime Protocol 1. RUHS Downtime Protocol Updated 10.22.23 2. Registration Form 3. Retail Pharmacy Downtime Procedure 4. Rooming Form English ​ Spanish 5. Provider Note/Physical Form Updated 5/2023 6. Lab Order Form

  • HOME | RUEM

    RUHS: History of Caring "Because You Matter" Emergency Medicine Resident Website View Now Scroll Down Department Calendar What's coming up? View Calendar > in the spotlight ER Doctor's Balloon Art Dr. Stephanie Loe, MD READ ABOUT IT COVID 19 Response COVID-19 Status Report

  • Scribes | RUEM

    Medical Scribes The Scribe Role The role as a scribe is to document in the patient's electronic chart the reason for their visit and any pertinent information. This includes medical/surgical/family history, physical exam, imaging/lab results, procedures done by the providers, and treatment plan . Scribes are able to positively affect productivity, revenue, patient volume and efficiency. Being a scribe is also a great way to get clinical experience and work sided by side to a provider. Emergency Department Scribe Performance Surveys These surveys are available for emergency medicine providers to complete in order to help the lead teams gather feedback on scribe performance. Wajiha Akif Sumaya Alaama Raneem Alaraj Bayaske Amerina Michelle Armenta Alyssa Bruns Danielle Catacutan Allyssa Chan Preston Dam Katherine Damar Melissa de Leon Olivia Dinh Andrew Dong Rafik Gewaid Kiara Hemsley Lloyd Kao Ibrahim Khan Alyssa Kumari Tri Ly Catherine Mah Meghan Minahan Samantha Monroy Fiona Monte Nezam Newman Joel Oswari Dhrasti Parmar Rutu Patel Jacqueline Reliford Emily Reyes Alexis Rodriguez Evelyn Salazar Ashwinii Saravanan Peyton Shalhoub Celena Supapo Maire-Colleen Tansey Andrew Velasquez Bridget Villanueva Eden Yu Saher Zaidi

  • Class of 2025 | RUEM

    EM Residency RUH EM Residents Class of 2024 (Photo missing Moses Lee) Salomon Alvarado Hometown: Burbank, CA Undergraduate Education: University of California, Riverside Major: Biology Medical School: Western University of Health Sciences Hidden Talents: Driving manual transmission cars, grafting roses Favorite Hobbies: Traveling, hiking, having Korean BBQ with friends Interesting Fact: Survived two major earthquakes in El Salvador and moved to the US permanently at the age of 8 Arjun Bakshi Hometown: Irvine, CA Undergraduate Education: University of California, Irvine Major: Cognitive Psychology Medical School: Western University of Health Sciences Hidden Talents: Having food in my mouth when the waiter comes and asks if everything is okay. Favorite Hobbies: Hiking, weight lifting, running, mixed martial arts, napping, traveling. Interesting Fact: I used to make lenses for glasses Tristen Burt Hometown: Simi Valley, CA Undergraduate Education: California Lutheran University Major: Biochemistry and Molecular Biology Medical School: Western University of Health Sciences Hidden Talents: Can make uncanny cricket noises appropriate for any social pause Favorite Hobbies: Boardwalk rollerblading, TV/commercial side acting, music, hiking/backpacking, skiing, crypto trading, any outdoor activity Interesting Fact: During medical school I worked as an on/off full time musician Scott Cruise Hometown: Salem, Oregon Undergraduate Education: Oregon State University Major: Animal Science Medical School: Western University of Health Sciences of the Pacific-Northwest Hidden Talents: I love to cook and learn new recipes Favorite Hobbies: Hiking, snowboarding, wakeboarding, video games, and learning about the stock market Interesting Fact: In high school I was ranked 3rd in the world for Call of Duty Black Ops 2 Moses Lee Hometown: Torrance, CA Undergraduate Education: University of California, Berkley Major: Psychology/ISF Medical School: Western University of Health Sciences Hidden Talents: Always getting in the slowest line at a grocery store Favorite Hobbies: Travel, food, cooking, piano, guitar, soccer, hiking Interesting Fact: I completed three years of orthopedic residency prior to becoming an EM resident Ruben Marchosky Hometown: Phoenix, AZ Undergraduate Education: Arizona State University Major: Biological Sciences Medical School: Western University of Health Sciences Hidden Talents: Building things Favorite Hobbies: Golf, camping, fishing, hiking, reading spy novels, cooking, hanging out with my wife and two tiny dogs Intersting Fact: I fonce ate 23 slices of pizza in an eating contest... and still lost. If I ever see that girl again, I'd be open to a rematch ​ Michael Millard Hometown: Shelton, WA Undergraduate Education: Western Washington University Major: BA Theatre - Acting concentration; BS Biochemistry Medical School: Western University of Health Sciences- COMP Hidden Talents: Can almost consistently dunk a basketball Favorite Hobbies: Theatre/film/comedy, anything outdoors, anything competitive (or anything that can be made competitive), music, cooking, and travel. Interesting Fact: Performed Improv comedy in Chicago before medical school Christopher Pann Hometown: Thousand Oaks, CA Undergraduate Education: California Polytechnic State University Major: Molecular and Cellular Biology Medical School: Western University of Health Sciences Hidden Talents: Knowing exactly where every item is in my house Favorite Hobbies: Watching science fiction and fantasy movies and shows (i.e Doctor Who, Lord of the Rings, The Hobbit, anything Marvel), baking, skiing, spending time with family, visiting amusement parks Favorite Place traveled to: Ecuador Interesting Fact: I used to teach mindfulness meditation and was a personal trainer Daniel Roth Hometown: Danville, CA Undergraduate Education: University of California, Davis Major: Exercise Biology Medical School: Drexel University Hidden Talents: I make sourdough loaves with personalized designs carved in them Favorite Hobbies: Skiing, cooking, golf Interesting Fact: I have donated 5 gallons of blood and might be donating bone marrow this year! Nikolaos Sarantopoulos Hometown: Walnut, CA Undergraduate Education: University of California, Irvine Major: Biological Sciences Medical School: Western University of Health Sciences Hidden Talents: I am always the last one eating at AYCE Favorite Hobbies: Laughing at my own jokes, coffee enthusiast, camping, weightlifting, watching anime Interesting Fact: I have been in a plane while in free fall

  • About | RUEM

    Hey There This is your About Page. It's a great opportunity to give a full background on who you are, what you do, and what your website has to offer. Double click on the text box to start editing your content and make sure to add all the relevant details you want to share with site visitors. All About Me This is your About page. This space is a great opportunity to give a full background on who you are, what you do and what your site has to offer. Your users are genuinely interested in learning more about you, so don’t be afraid to share personal anecdotes to create a more friendly quality. Every website has a story, and your visitors want to hear yours. This space is a great opportunity to provide any personal details you want to share with your followers. Include interesting anecdotes and facts to keep readers engaged. Double click on the text box to start editing your content and make sure to add all the relevant details you want site visitors to know. If you’re a business, talk about how you started and share your professional journey. Explain your core values, your commitment to customers and how you stand out from the crowd. Add a photo, gallery or video for even more engagement. Call 123-456-7890 Email info@mysite.com Follow

  • EMPA Fellowship | RUEM

    EMPA Fellowship APPLY NOW Fellowship Details SEMPA Fellowship Guidelines SEMPA Fellowship Standards WWW.SEMPA.ORG Current RUHS EM Fellows To read about our different EM fellows just click on the arrow! Featured BloG post READ ABOUT IT Rodney Koenig 7 Ways My EMPA Job Made Me a Better Person

  • Tools | RUEM

    Tools Chest Pain EM Basic eMEDHome ERCast Life in the Fast Lane EKG Summary EMCRIT EMRAP EMS & ARMC Lectures Video Procedures

  • Test | RUEM

    About Us Finding Inspiration in Every Turn This is your About Page. This space is a great opportunity to give a full background on who you are, what you do and what your website has to offer. Double click on the text box to start editing your content and make sure to add all the relevant details you want site visitors to know.

  • EDUCATION | RUEM

    Education Residents View EMPA Fellowship View Students View

  • Advanced Providers | RUEM

    Advanced Providers (AP) RUHS Advanced Provider Site Lead Giselle Ludi, PA-C ​ Undergraduate Studies: B.S Nutrition Sciences CSUSB Graduate Studies: M.S. PAS Western University of Health Sciences Experience: RUHS ED Operations Committee Co-lead ​ Life passions: Travel in family Medicine passions: Education Hobbies: Hanging out with my kids and puzzles. RUHS Advanced Provider Assistant Site Lead Alyssa Weiner, PA-C Undergraduate studies: B.S Kinesiology San Diego State University Graduate studies: M.S. PAS Western University of Health Sciences Experience: Urgent care, occupational medicine Passions: Serving underserved and multicultural communities, international medicine. Sharing my passion for healthy food and fitness with my patients and those around me Hobbies: Spending time with family, friends, traveling the world, anything outdoors. Kristofer Abejuela, PA-C Undergrade Studies: Cal Poly Pomona Graduate Studies: Western University of Health Sciences​ Experience: Workman's Comp, Urgent Care, Family Practice, Jail Medicine Passions in Life: Family, Economics, Basketball. Passions in Medicine: Giving back to the underserved community Hobbies: Self improvement, finance, i nternational travel Michael Davalos, PA-C Hometown: San Ysidro Undergraduate Studies: BS Biology from UCSD Graduate Studies: MSPAS from Western University of Health Sciences Experiences: Urgent Care, Family Practice Passions in life: Travel, EDM, Sushi Passions in medicine: Orthopedic injuries Hobbies: Traveling, beer, cinephile, anglophile Amy Robker, PA-C Undergraduate Studies: University of Utah and Arizona, BS in Human Development Graduate Studies: MSPAS Baylor College of Medicine Experiences: Urology, Emergency Medicine, previous CNA Passions in life: Family, Enjoys being a mother as well as caring for pets Passions in medicine: Enjoyment obtained from providing care Hobbies: Baking extravagant cakes and dancing Tiffany Mendoza, PA-C Hometown: Turlock, CA Undergraduate Studies: B.S Psychology Fresno State University Graduate Studies: Loma Linda University Experiences: Emergency medicine, Urgent Care, and a sprinkle of family practice, (former EM scribe and EM Tech) Passions in Life: Being a mom, working in underserved communities, and education Passions in Medicine: Empowering patient's through education and serving in areas with a medical need Hobbies: Roller skating (quad squad), dancing, homemade lattes, and anything festive. Troy Oesterle, PA-C Hometown: Phoenix, AZ Undergraduate Studies: University of Arizona... BEAR DOWN! Graduate Studies: University of California - Davis Experience: ED scribe, Prior EMPA fellow at RUHS Passions: Juggling while riding my unicycle, paddle boarding, baseball Erin Routledge, NP-C Undergraduate Studies: University of Oklahoma, BSN Graduate Studies: Azusa Pacifica University, MSN FNP Experiences: Emergency Medicine, Correctional Health Passions in medicine: connecting with my patients Passions in life: spending time with family and friends Fun fact: I have always wanted to have my own television talk show where I could bring happiness to others through conversation and laughter. Avo Serafino, PA-C Hometown: Born in CT, Raised in CA Undergraduate Studies: University of California, Riverside, Neuroscience Graduate Studies: Marist college, NY MPAS Experiences: ED Medical Scribe Hobbies: I have a huge collection of board games, and we would be more than happy to host game night for anyone interested! Passions: Family, board games David Wisdom, PA-C Hometown: Kansas City, MO Undergraduate Studies: Truman State University, BS Biology Graduate Studies: University of Missouri, MS Health Administration University of Mount Union, MS Physician Assistant Studies Experience: Volunteer EMT with the fire department Passions: Working out, running, biking, snowboarding ​ Vivian Acevedo, PA-C Undergrade Studies: BS in Health Science and minor in Nutrition from Chapman University Graduate Studies: Masters in Medical Science from Chapman University Experience: Urgent Care and Emergency Medicine Passions in Life: Nutrition and Fitness Passions in Medicine: Educating underprivileged patients about the importance of nutrition and the role it places in acute and chronic illnesses. Hobbies: Working out and spending time with friends and family. Kurt Harris, PA-C Hometown: Oceanside, CA Undergraduate Studies: PA certificate from RCC Graduate Studies: subsequent Master's at A.T Still Experiences: Emergency Medicine, Paramedic, EMT Passions in life: Football, baseball, hockey- specifically Chargers, Braves, and Kings Passions in medicine: Teaching, procedures Hobbies: Fishing Kimberly Henshaw, PA-C Hometown: NY born, Moreno Valley raised Undergraduate Studies: RCC, UCSD BS animal Physiology and Neuro Graduate Studies: MS at St. Francis Medical Sci PA, RCC PA Cert Experiences: ED, ER tech Passions in Life: Family, Initially was interested in becoming a Veterinarian Passions in Medicine: Helping people Hobbies: wine connoisseur, motorsports Nancy Peterson, NP-C Hometown: Lufkin, Texas Undergraduate Studies: Loma Linda University Graduate Studies: Loma Linda University Experience: Emergency Medicine, ICU, Correctional Health Passions in Life: Travel, Family, Animals Passions in Medicine: Orthopedic Injuries, Emergency Medicine Hobbies: Travel, Hiking, Beaches, Wine Connoisseur (Prefers Reds) Alyssa Schulz, PA-C Undergraduate studies: Bachelor of Science Biology University of California Irvine Graduate studies: Case Western Reserve, Cleveland, Ohio Experiences: Women's health Passions: My mom! Who dedicated her career to emergency medicine as an ER nurse Hobbies: Pilates, rollerblading, paddle boarding and hanging by the beach! Willie Landeros-Rivera, PA-C Hometown: Born & raised in LA, now lives in Riverside, CA Undergraduate Studies: Biola University, B.S Biochemistry Graduate Studies: Cal Baptist University, MS Physician Assistant Studies Experience: ER tech- RUHS, Scribe- RUHS ED, EMT- LA and OC Passions: The Lakers, chess, church Alexandra Steinmann, PA-C Undergraduate: Georgetown University, Washington DC Graduate: Midwestern University, Glendale, AZ Experience: Emergency medicine PA, PA at Riverside county correctional facilities Passions: running, hiking, medical education

  • Residents | RUEM

    EM Residency View Now Class of 2024 Read More Class of 2025 Read More

  • Attendings | RUEM

    Attendings Attendings Michael Mesisca, D.O., M.S., C.C.H.P.-P Medical Director/Department Chairman Department of Emergency Medicine RUHS Director, RUHS Disaster Medicine Team Medical Director, RUHS Ancillary Services C.M.O. Correctional Health RUHS 2015 KPMV PROFOUND ED OPERATIONAL CHANGES 2015 KPMV SEPSIS TURNAROUND KPMV PERFORMANCE IMPROVEMENT BLOG POST 2016 KPMV Distingushed Practice Award Nominee Hometown: Arcadia Undergraduate Education: BS Neuroscience Claremont McKenna College Medical Education: Western University of Health Sciences Residency Program: Arrowhead Regional Medical Center Emergency Medicine 2012 Passions in life include Family, Surfing, Soccer, Coaching, the Ocean, Drumming and Pearl Jam Passions in Medicine include Leadership and Operations improvement; Critical Care; Public Health and Wellness; Correctional Health. Awarded Emerging Leadership Award from the RUHS Medical Staff, June 2020 RUHS 2017 PROFOUND ED OPERATIONAL CHANGES Mesisca Mark Thomas, D.O. Assistant Medical Director and Vice Chairman Hometown: Garden Grove, Ca Undergrad Degree: BS/BA Biology/Psychology UC Irvine Medical School Degree: Western University of Health Sciences Residency Program: LLUMC EM 1992 Passions in life include Family, Skiing, Mountain Biking and Travel Passions in Medicine include Education Fairuz Harfouche-Despujos, M.D. Attending Physician, Throughput Team Lead Hometown: Portuguesa, Venezuela Undergraduate Education: University of Nevada, Las Vegas Medical Education: University of Nevada, Reno Medical School Residency Program: LLU EM Passions: Wellness, cooking Passions in medicine: site operations and throughput Korbin Haycock, M.D. Attending Physician Hometown: Scottsdale AZ Undergraduate Education: La Sierra University, Riverside CA Medical Education: Loma Linda University Residency Program: Loma Linda EM Passions in life: Celtic Football Club, Motorcycles, Passions in Medicine: Resuscitation, Echocardiography, POCUS Current Research: VExUS, Sepsis, Intrarenal Doppler in resuscitation, Pulmonary ultrasound in CHF. Pulmonary ultrasound in COVID, Hemodynamics in shock Joel Labha, D.O. Attending Physician Hometown: Dubai, U. A. E. Undergraduate degree and university: Pacific Union College Medical school: Western University Residency Program: Arrowhead Regional Medical Center Passions in life: Family, Soccer, Music Passions in medicine: Education, Personal Growth and Development Current research: How to deliver the perfect dad-joke every time: a prospective, randomized, double-blind, meta-analysis... of sorts. Susan Munden, M.D. Attending Physician Hometown: East Lansing, Michigan Undergrad Degree: UC Irvine Biology Medical School Degree: UC Irvine Residency Program: UC Irvine 1997 Passions in life include animals and having many pets Passions in Medicine include teaching Michi Nitahara, M.D. Attending Physician Hometown: Redondo Beach, CA Undergraduate Education: University of California, Santa Barbara Medical Education: Lewis Katz School of Medicine -Temple University Residency Program: LLU EM Passions in life: Singing, hiking, surfing, and traveling Passions in Medicine: Resident wellness, airway management, and teaching Melanie Randall, M.D. Attending Physician Hometown: Loma Linda Undergrad Degree: BS Stanford University Medical School Degree: LLU School of Medicine Residency Program: LLUMC 2011 Current Research: Pancreatitis in children Passions in Medicine include Congenital Cardiac Disease David Englander, M.D. Attending Physician Undergrad Degree: BS Penn State Medical School Degree: Lewis Katz School of Medicine - Temple University Residency Program: Int Med 75/Emergency Med 77 Current Research: Stroke Care and Transfers Passions in life include Politics and Social Justice Passions in Medicine include Stroke Controversies Eugene Hu, M.D. Attending Physician Hometown: Baton Rouge, Louisiana Undergrad: Rice University, Houston, TX Med school: Louisiana State University Health Sciences Center - New Orleans Residency: Loma Linda University Medical Center Passions in life: being a dad, baking Resident Projects: Spiked Helmet Sign, Bilateral Tonsillitis Abscess, Bilateral, Asymmetrical Hip Dislocation Stephanie Loe, M.D. Attending Physician Hometown; Cypress, CA Undergrad: UCLA B.S. Biology Med School: Wayne State University School of Medicine (Detroit, MI) Residency: Loma Linda Emergency Medicine Current Research: COVID-19 Passions in Life: pets, family, travel, challenges Passions in Medicine: International Mission Trips, Disaster Medicine John Naftel, M.D. Attending Physician Hometown: Ontario, CA Undergraduate: UCLA with one semester at USC Medical School: David Geffen UCLA Residency: Rotating Internship one year (formally Internal Medicine) Passions in life: Spouse, outdoor adventures, equestrian, dogs, food and wine, history Passions in medicine: Beside, clinical dialogue with learners, what’s new in science, what’s just been disproven in accepted “truths” Humberto Ochoa, M.D. Attending Physician Hometown: Cenotillo, Mexico; Later moved to San Bernardino Undergraduate Education: University of California, Riverside Medical Education: University of Utah, Medical School Residency: IM Internship: U of Las Vegas (83-84) Kern Medical Center (84-86) Riverside County EMS Medical Director from 1992-2014. Attending at RUHS since 1987. Passions in Medicine: Teaching, Sharing clinical experience, Patient compassion Passions in Life: Golf, Soccer, Military History, Cooking, Foodie, Hot-tubbing with the family Amy Russell, M.D. Attending Physician Hometown: Huntington Beach, CA Undergraduate degree and university: UC San Diego Medical school: Lewis Katz SOM at Temple University Residency Program: Loma Linda University Passions in life: Friends/family, beach going, board sports, dogs Passions in medicine: Shock resuscitation and medical education Michael Flores, D.O. Attending Physician Hometown: Rancho Cucamonga Degree: BS in Biology, CSUSB Medical School: Western University of Health Sciences Residency: ARMC Life passions: Bitcoin, programming, finance, gaming, snowboarding, BBQing and hanging with the family. Medicine passions: Resuscitation and education. Christie Knox, D.O. Attending Physician Hometown- none really, grew up in the military and have lived in various states & overseas Undergraduate- University of Oklahoma, Norman, OK, B.S. in Zoology Medical school- Touro University, California Residency- ARMC Passion in life - finding humor in everything Passion in medicine- the continuous challenge and learning Thomas Minahan, D.O. Attending Physician Hometown: Bellflower, California Undergraduate degree and university: UC Riverside, BS Biochemistry Medical school: Western University Residency Program: Midwestern University Passions in life: Family, Family, Family Passions in medicine: All things Epilepsy related Current research: Utility of Instant EEG ability in the ER Timothy Nesper, M.D. Associate Residency Director, Emergency Medicine LLUMC, Assistant Clinical Professor LLUMC ​Hometown: San Clemente, CA Undergrad Degree: UCSB Bio Science Medical School Degree: Keck School of Medicine, USC Residency Program: LAC/USC 1986 Current Research: Passions in life include Family, Faith and Friendship Passions in Medicine include Team Work, Teaching, Patient Wellness Andrew Pachon, M.D. Attending Physician Hometown: Rancho Cucamonga, CA Undergraduate degree and University: Claremont McKenna College, BA Psychology Graduate School: University of Southern California, Master of Public Administration Medical School: University of Illinois at Chicago Residency: Loma Linda University, EM Passions in Life: Family, Woodworking, Do-It-Yourself Projects, Cake Decorating Passions in Medicine: Prehospital & Disaster Medicine, Resuscitation Current Research: Prehospital quality improvement, Disaster Medicine Rolando Sy, M.D. Attending Physician Hometown: Philippines Undergraduate degree and Universities: University of Santo Tomas & SFSU (Degree: Biology) Medical School: UCI Residency: RUHS Family Medicine Passions in Life: Fishing, Basketball, Running Passions in Medicine: Helping the indigent population Loe

  • Class of 2024 | RUEM

    EM Residency RUH EM Residents The Inaugural Class of 2021 Umron Alkotob Hometown: South Plainfield, NJ Undergraduate Education: Indiana University Major: Biology with a minor in Chemistry Medical School: A.T Still University of Osteopathic Medicine Hidden Talents: Recipe Development Favorite Hobbies: Working out, surfing, tennis, and cooking Favorite Place Traveled to: Still searching for it Interesting Fact: I enjoy heist movies and am a bit of a sneaker head Kevin Dales Hometown: Newport Beach, CA Undergraduate Education: UC Berkeley Major: Molecular and Cell Biology Medical School: Touro University California Hidden Talents: I'm good at fixing random things Favorite Hobbies: Hiking, exploring, computers, board games Favorite Place traveled to: Glacier National Park Interesting Fact: I've been to 22 National Parks and hope to visit them all Alexander Gau Hometown: Walnut, CA Undergraduate Education: UC Irvine Major: Neuroscience Medical School: Western University Hidden Talents: Make music and must require at least 10-12 hours of sleep per day Favorite Hobbies: Boxing Favorite Place traveled to: Japan Interesting Fact: I recently bought a new dog from Korea Charles Lewsadder Hometown: Stewart, FL Undergraduate Education: Florida State University Major: Biology Medical School: Kansas City University Hidden Talents: Rock climbing Favorite Hobbies: Rock climbing, playing guitar, golf, and volleyball Favorite Place traveled to: Berma Interesting Fact: I craft my own beer Jackson Lu Hometown: Rowland Heights, CA Undergraduate Education: Albany College of Pharmacy and Health Sciences Major: Microbiology Medical School: Western University Hidden Talents: Cooking Favorite Hobbies: Food and Fitness Favorite Place Traveled to: Hawaii Interesting Fact: The darker the humor, the funnier Raj Patel Hometown: Moorpark Undergraduate Education: UC San Diego Major: Human Biology, BS Medical School: Touro University California Hidden Talents: I can sleep in any position Favorite Hobbies: Running, watching anime, anything outdoors Favorite Place traveled to: Tanzania ​ Carl Rhodes Hometown: Zionsville, IN Undergraduate Education: Purdue University Major: Computer Science Medical School: Chicago College of Osteopathic Medicine Hidden Talents: Fixing your Wifi Favorite Hobbies: Gym, playing with my dog, cooking (& eating) Favorite Place Traveled to: Dominican Republican Interesting Fact: I used to be a software engineer for Cerner! Oscar Salaiz Hometown: West Covina, CA Undergraduate Education: UC Santa Barbara Major: Biopsychology Medical School: Western University Hidden Talents: Coaching my kids sport teams Favorite Hobbies: Running, surfing, lifting weights, and playing soccer Favorite Place traveled to: Ecuador Interesting Fact: I used to teach mindfulness meditation and was a personal trainer Jonathan Tom Hometown: Arcadia, CA Undergraduate Education: University of Southern California Major: Biological Sciences Medical School: Western University Hidden Talents: Finding water on any golf course Favorite Hobbies: Golf, traveling, playing with my dog Favorite Place Traveled to: Interlaken, Switzerland Interesting Fact: The Houston Astros cheated in the World Series in 2017

  • MEET OUR TEAM | RUEM

    Meet Our Team Attendings View Advanced Providers View Nursing Leadership View Publications View Residents View PA Fellows View Scribes View

  • Advanced Providers | RUEM

    Advanced Provider Onboarding Education Welcome to the Team. The Journey Begins. The first 3-12 months in the Emergency Department is like a fire hose in the face. With time and a huge investment of energy (seeing patients, asking questions, reading, listening to podcasts, asking more questions, reading and seeing more patients) we will transform you unto an elite advanced provider or young physician. Resources Provided Reading list and 3 month schedule for your education All new hires are expected to know this material within 3 months of start date. Education Guide Recommended (strongly) EMRAP access and begin with C3 content EMRAP Recommended text book Tintinalli Vituity team members, access the LMS site for the Vituity Academy and the ACE modules that match the reading. Vituity Site Recommended EM Bootcamp provided online or attendance for Vituity Team Advanced Providers within 3-6 months of hire date See "Education" section of this site for more resources. AP Scheduling Agreement AP Leadership Job Descriptions

  • PA Fellows | RUEM

    PA Fellows Danny Abad Hello, my name is Ben Juarez, and I am a native of Southern California. After honorably separating from The United States Navy, I attended Loma Linda University for my undergraduate studies and for PA school. While serving in the military, I worked as a Fire Fighter and Boat Operator; after the military, I worked as a Forensics Pathology Technician and then as an Emergency Room Technician prior to becoming an emergency medicine PA-Fellow here at RUHS. I specifically chose EM as my specialty because I enjoy the diversity of patient presentations, the fast-paced environment, and the well-controlled chaotic atmosphere only found in EM. Outside of the professional environment I truly enjoy the great outdoors (i.e., snowboarding, mountain biking, scuba diving, and hiking), playing guitar, and exercising in the gym. After the EMPA Fellowship I plan to continue to work in the ED, assist in missionary work overseas, and participate in search & rescue locally and nationally. Jonathan Moran Hi! My name is Jonathan, and I am from Tujunga, CA (San Fernando Valley). I attended UCLA for my undergraduate studies and went to California Baptist University for PA school. I was a Corpsmen (medic) in the United States Navy from 2005-2011 and I worked in EMS as an EMT from 2018-2020. With my military and civilian training in emergency and pre-hospital medicine, I found a love in emergency medicine. *** Kelly Schilling Hi, my name is Kelly Schilling. I grew up in Moreno Valley, California. I attended CSU San Bernardino, where I majored in biology. I went to PA school at Trevecca Nazarene University in Nashville, Tenessee! Yeehaw! Prior to going to PA school, I worked as a medical scribe at an urgent care, emergency room, and a family medicine clinic. I chose emergency medicine because I fell in love with it when I worked as a scribe. I love the variability of patient population, illnesses, schedules, and the people you work alongside in emergency medicine are the best kind of people. I chose RUHS as I grew up in the area. My roots and family are still here. It's great to serve the community I've known my whole life. In my free time, I love to get outside and go on strolls with my husband and our dog, Tucker. I love enjoying coffee and trying new coffeeshops with my friends and family. My days off are usually spent with my nieces, AKA my mini best friends. Kyle Swain Hi, I am Kyle, a South Lake Tahoe native. I ended up attending undergrad at San Diego State University where I graduated with my BS in Kinesiology. I returned home to Tahoe to work as a scribe in an ED and a physical therapy aide before attending PA school at Le Moyne College in Syracuse, New York. I have always been drawn to emergency medicine’s variability in pathology, acuity, and balance of procedures to critical thinking. I decided to come to RUHS given the program’s strong existing EM residency program, focus on evidence-based medicine, and mission of providing care for all comers as a county hospital.

  • Splints | RUEM

    Splinting + Casting Splinting Basics Types of Splints General Principles General Principles Goals: Immobilization, protection, and decreasing pain. Inspect (and clean skin to make sure there is no open fracture. Before casting or splinting material is applied, prepare the skin with padding such as stockinette and webril. Allow enough overhang of the stockinette and webril to roll back over the first layer of casting or splinting material to ensure that the casting or splinting material does not come in direct contact with the skin leading to irritation and maceration. This also allows for a more aesthetically appealing final product. Stockinette: Add extra on both ends. Remove wrinkles at ankle, elbow. Webril: Overlap approximately one third to one half of diameter. Add extra padding over bony prominences (radial and ulnar styloids, epicondyles, malleoli). Keep padding as smooth as possible since gathered ridges may produce pressure areas and increase risk of skin breakdown. Cast material: (Plaster of Paris or fiberglass) Use cool water - the warmer the water, the fast the material dries. Ace Bandage: Wrap the "finished product" in elastic wrap. Plaster Plaster of Paris: Cheaper and easier to mold than fiberglass. Requires special "plaster trap" in the pumping of the sink More difficult to "see through" on x-ray than fiberglass Width of plaster depends on size of patient and location of injury Unroll dry plaster to meausre needed length. Allow extra 1-2 cm to accommodate for shrinkage when wet. Use 4-8 layers, depending on location/type of cast or splint. Submerge in cool water (plaster is saturated when no bubbles rise to surface). Smooth plaster to get rid of excess water. Excessive wringing is not necessary. Wrap (place) plaster over previously placed padding. Do no wrap under tension. Smooth with palms of hands. Avoid using fingers which can create pressure points and indentations in the drying plaster. Apply ace-wrap. Do not use tension. Plaster will set in 3-5 minutes and will dry in 24 hours. Avoid exposure to water. If cast/splint gets wet, may use hair dryer. Counsel patient regarding skin maceration, infection, neurovascular compromise. Instruct patient to seek follow-up if these arise. Fiberglass Fiberglass: Knitted fiberglass impregnated with polymer resin and silicone. Lighter and more durable than plaster, but not as moldable. Use gloves to prevent resin from adhering to skin. Sets within 4-5 minutes, dries completely in one hour. Minimally interferes with radiography. Avoid opening the foil package until ready to place the splint or cast. On either end, leave a margin of ~1 cm between webril and start of fiberglass. counsel patient regarding skin maceration, injection, neurovascular compromise. Instruct patient to seek follow-up if these arise. Orthopedic Splinting Basics Splinting Wetting Techniques Splinting Basics If you have access to EM RAP: Types of Splints Types of Splints Long Arm Posterior Splint Indications: Elbow and Forearm Injuries: Distal humerus fx Both-bone forearm fx Unstable proximal radius or ulna fx (sugar- tong better) Doesn't completely eliminate supination/pronation -either add an anterior splint or use a double sugar- tong if complex or unstable distal forearm fx Forearm Sugar Tong Indications: Distal radius and ulnar fx Prevents pronation/supination and immobilizes elbow Double Sugar Tong (Sugar Tong w/ Coaptation Splint) Indications: Elbow and Forearm Injuries: Elbow and Forearm fx - prox/mid/distal radius and ulnar fx Better for most distal forearm and elbow fx because limits flex/extension and pronation/supination. Forearm Volar Splint (aka 'Cockup' Splint) Indications: ​Soft tissue hand/wrist injuries i.e sprain, carpal tunnel night splints, etc. Most wrist fx, 2nd- 5th metacarpal fx May add a dorsal splint for increased stability i.e 'sandwich splint' (b) Not used for distal radius or ulnar fx can still supinate and pronate Finger Splints Sprains dynamic splinting (budding taping) Dorsal Volar finger splints phalangeal fx, though gutter splints probably better for proximal fxs Hand Splinting The correct position for most hand splints is the position of function, a.k.a the neutral position When immobilizing metacarpal neck fractures, the MCP joint should be flexed to 90 degrees​ Radial Gutter Indications: Phalangeal and metacarpal fractures and soft tissue injuries of index and long fingers Have the patient hold an ace wrap in the "beer can" position until the splint hardens: wrist slightly extended (10 - 25deg) with fingers flexed as shown. Ulnar Gutter Indications: Phalangeal and metacarpal fractures and soft tissue injuries of the little and ring fingers Thumb Spica Indications: Scaphoid fx - (check snuffbox tenderness) De Quervain Tenosynovitis Notching the plaster (shown) prevents buckling when wrapping around thumb For thumb fx, immobilize the thumb as if holding a wine glass Stirrup Splint Indications: Similar to posterior splint Less inversion/eversion and actually less plantar flexation compared to posterior splint Great for ankle sprains 12-15 layers of 4-6 plaster Posterior Ankle Splint Indications: Distal tibia/fibula fx Reduced dislocations Severe sprains Tarsal/metatarsal fx Use at least 12-15 layers of plaster Adding a coaptation splint (stirrup) to the posterior splint eliminates inversion/eversion - especially useful for unstable fx and sprains. Types of Splints

  • New Page | RUEM

    Attending Physicians Medical Director/Department Chairman for the Department of Emergency Medicine Director, RUHS Disaster Medicine Team Medical Director, RUHS Ancillary Services C.M.O. Correctional Health RUHS Michael Mesisca, D.O. , M.S., CCHPP Hometown: Arcadia Undergraduate Education: BS Neuroscience Claremont McKenna College Medical Education: Western University of Health Sciences Residency Program: Arrowhead Regional Medical Center Emergency Medicine 2012 Passions in life include Family, Surfing, Soccer, Coaching, the Ocean, Drumming and Pearl Jam Passions in Medicine include Leadership and Operations improvement; Critical Care; Public Health and Wellness; Correctional Health. Awarded Emerging Leadership Award from the RUHS Medical Staff, June 2020 Assistant Medical Cirector and Vice Chairman Mark Thomas, D.O. Hometown: Garden Grove, Ca Undergrad Degree: BS/BA Biology/Psychology UC Irvine Medical School Degree: Western University of Health Sciences Residency Program: LLUMC EM 1992 Passions in life include Family, Skiing, Mountain Biking and Travel Passions in Medicine include Education ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ Fairuz Harfouche Despujos, M.D. Attending Physician, Throughput Team Lead Hometown: Portuguesa, Venezuela Undergraduate Education: University of Nevada, Las Vegas Medical Education: University of Nevada, Reno Medical School Residency Program: LLU EM Passions: Wellness, cooking Passions in medicine: site operations and throughput Joel. Labha, D.O Attending Physician Hometown: Dubai, U. A. E. Undergraduate degree and university: Pacific Union College Medical school: Western University Residency Program: Arrowhead Regional Medical Center Passions in life: Family, Soccer, Music Passions in medicine: Education, Personal Growth and Development Current research: How to deliver the perfect dad-joke every time: a prospective, randomized, double-blind, meta-analysis... of sorts. Korin Haycock, M.D. Attending Physician Hometown: Scottsdale AZ Undergraduate Education: La Sierra University, Riverside CA Medical Education: Loma Linda University Residency Program: Loma Linda EM Passions in life: Celtic Football Club, Motorcycles, Passions in Medicine: Resuscitation, Echocardiography, POCUS Current Research: VExUS, Sepsis, Intrarenal Doppler in resuscitation, Pulmonary ultrasound in CHF. Pulmonary ultrasound in COVID, Hemodynamics in shock Stephanie Loe, M.D Attending Physician Hometown; Cypress, CA Undergrad: UCLA B.S. Biology Med School: Wayne State University School of Medicine (Detroit, MI) Residency: Loma Linda Emergency Medicine Current Research: COVID-19 Passions in Life: pets, family, travel, challenges Passions in Medicine: International Mission Trips, Disaster Medicine Eugene Hu, M.D Attending Physician Hometown: Baton Rouge, Louisiana Undergrad: Rice University, Houston, TX Med school: Louisiana State University Health Sciences Center - New Orleans Residency: Loma Linda University Medical Center Passions in life: being a dad, baking Resident Projects: Spiked Helmet Sign, Bilateral Tonsillitis Abscess, Bilateral, Asymmetrical Hip Dislocation Thomas Minahan, D.O. Attending Physician Hometown: Bellflower, California Undergraduate degree and university: UC Riverside, BS Biochemistry Medical school: Western University Residency Program: Midwestern University Passions in life: Family, Family, Family Passions in medicine: All things Epilepsy related Current research: Utility of Instant EEG ability in the ER Timothy Nesper, M.D. Associate Residency Director, Emergency Medicine LLUMC, Assistant Clinical Professor LLUMC ​Hometown: San Clemente, CA Undergrad Degree: UCSB Bio Science Medical School Degree: Keck School of Medicine, USC Residency Program: LAC/USC 1986 Current Research: Passions in life include Family, Faith and Friendship Passions in Medicine include Team Work, Teaching, Patient Wellness Melanie Randall, M.D. Attending Physician Hometown: Loma Linda Undergrad Degree: BS Stanford University Medical School Degree: LLU School of Medicine Residency Program: LLUMC 2011 Current Research: Pancreatitis in children Passions in Medicine include Congenital Cardiac Disease Humberto Ochoa, M.D. Attending Physician Hometown: Cenotillo, Mexico; Later moved to San Bernardino Undergraduate Education: University of California, Riverside Medical Education: University of Utah, Medical School Residency: IM Internship: U of Las Vegas (83-84) Kern Medical Center (84-86) Riverside County EMS Medical Director from 1992-2014. Attending at RUHS since 1987. Passions in Medicine: Teaching, Sharing clinical experience, Patient compassion Passions in Life: Golf, Soccer, Military History, Cooking, Foodie, Hot-tubbing with the family Amy Russell, M.D. Attending Physician Hometown: Huntington Beach, CA Undergraduate degree and university: UC San Diego Medical school: Lewis Katz SOM at Temple University Residency Program: Loma Linda University Passions in life: Friends/family, beach going, board sports, dogs Passions in medicine: Shock resuscitation and medical education Andrew Pachon, M.D. Attending Physician Hometown: Rancho Cucamonga, CA Undergraduate degree and University: Claremont McKenna College, BA Psychology Graduate School: University of Southern California, Master of Public Administration Medical School: University of Illinois at Chicago Residency: Loma Linda University, EM Passions in Life: Family, Woodworking, Do-It-Yourself Projects, Cake Decorating Passions in Medicine: Prehospital & Disaster Medicine, Resuscitation Current Research: Prehospital quality improvement, Disaster Medicine Rolando Sy, M.D. Attending Physician Hometown: Philippines Undergraduate degree and Universities: University of Santo Tomas & SFSU (Degree: Biology) Medical School: UCI Residency: RUHS Family Medicine Passions in Life: Fishing, Basketball, Running Passions in Medicine: Helping the indigent population Mark Thomas, D.O. Assistant Medical Director and Vice Chairman ​ ​ Hometown: Garden Grove, Ca Undergrad Degree: BS/BA Biology/Psychology UC Irvine Medical School Degree: Western University of Health Sciences Residency Program: LLUMC EM 1992 Passions in life include Family, Skiing, Mountain Biking and Travel Passions in Medicine include Education Melanie Randall, M.D. Attending Physician ​ Hometown: Loma Linda Undergrad Degree: BS Stanford University Medical School Degree: LLU School of Medicine Residency Program: LLUMC 2011 Current Research: Pancreatitis in children Passions in Medicine include Congenital Cardiac Disease Timothy Nesper, M.D. Associate Residency Director, Emergency Medicine LLUMC, Assistant Clinical Professor LLUMC ​ ​ Hometown: San Clemente, CA Undergrad Degree: UCSB Bio Science Medical School Degree: Keck School of Medicine, USC Residency Program: LAC/USC 1986 Current Research: Passions in life include Family, Faith and Friendship Passions in Medicine include Team Work, Teaching, Patient Wellness David Englander, M.D Attending Physician Undergrad Degree: BS Penn State Medical School Degree: Lewis Katz School of Medicine - Temple University Residency Program: Int Med 75/Emergency Med 77 Current Research: Stroke Care and Transfers Passions in life include Politics and Social Justice Passions in Medicine include Stroke Controversies Susan Munden, M.D. Attending Physician ​ Hometown: Undergrad Degree: UC Irvine Biology Medical School Degree: UC Irvine Residency Program: UC Irvine 1997 Current Research: Passions in life include animals and having many pets Passions in Medicine include teaching John Naftel, M.D Attending Physician Undergraduate Education: Medical School Degree Residency Program *** *** ***

  • Urgent Care Rotation | RUEM

    Family Practice Rapid Treatment Rotation Urgent Care Fellowship, Pomona Urgent Care PodCast

  • News | RUEM

    RUHS NEWS

  • Attendings | RUEM

    Attending Physicians Michael Mesisca, D.O. , M.S., CCHPP Medical Director/Department Chairman Department of Emergency Medicine RUHS Director, RUHS Disaster Medicine Team Medical Director, RUHS Ancillary Services C.M.O. Correctional Health RUHS Hometown: Arcadia Undergraduate Education: BS Neuroscience Claremont McKenna College Medical Education: Western University of Health Sciences Residency Program: Arrowhead Regional Medical Center Emergency Medicine 2012 Passions in life include Family, Surfing, Soccer, Coaching, the Ocean, Drumming and Pearl Jam Passions in Medicine include Leadership and Operations improvement; Critical Care; Public Health and Wellness; Correctional Health. Awarded Emerging Leadership Award from the RUHS Medical Staff, June 2020 Fairuz Harfouche-Despujos, M.D. Atten​ding Physician, Throughput Team Lead Hometown: Portuguesa, Venezuela Undergraduate Education: University of Nevada, Las Vegas Medical Education: University of Nevada, Reno Medical School Residency Program: LLU EM Passions: Wellness, cooking Passions in medicine: site operations and throughput Eugene Hu, M.D. Attending Physician Hometown: Baton Rouge, Louisiana Undergrad: Rice University, Houston, TX Med school: Louisiana State University Health Sciences Center - New Orleans Residency: Loma Linda University Medical Center Passions in life: being a dad, baking Resident Projects: Spiked Helmet Sign, Bilateral Tonsillitis Abscess, Bilateral, Asymmetrical Hip Dislocation Stephanie Loe, M.D. Attending Physician Hometown; Cypress, CA Undergrad: UCLA B.S. Biology Med School: Wayne State University School of Medicine (Detroit, MI) Residency: Loma Linda Emergency Medicine Current Research: COVID-19 Passions in Life: pets, family, travel, challenges Passions in Medicine: International Mission Trips, Disaster Medicine Timothy Nesper, M.D. Associate Residency Director, Emergency Medicine LLUMC, Assistant Clinical Professor LLUMC ​Hometown: San Clemente, CA Undergrad Degree: UCSB Bio Science Medical School Degree: Keck School of Medicine, USC Residency Program: LAC/USC 1986 Current Research: Passions in life include Family, Faith and Friendship Passions in Medicine include Team Work, Teaching, Patient Wellness Andrew Pachon, M.D. Attending Physician Hometown: Rancho Cucamonga, CA Undergraduate degree and University: Claremont McKenna College, BA Psychology Graduate School: University of Southern California, Master of Public Administration Medical School: University of Illinois at Chicago Residency: Loma Linda University, EM Passions in Life: Family, Woodworking, Do-It-Yourself Projects, Cake Decorating Passions in Medicine: Prehospital & Disaster Medicine, Resuscitation Current Research: Prehospital quality improvement, Disaster Medicine Amy Russell, M.D. Attending Physician Hometown: Huntington Beach, CA Undergraduate degree and university: UC San Diego Medical school: Lewis Katz SOM at Temple University Residency Program: Loma Linda University Passions in life: Friends/family, beach going, board sports, dogs Passions in medicine: Shock resuscitation and medical education David Englander, M.D. Attending Physician *Emeritus Undergrad Degree: BS Penn State Medical School Degree: Lewis Katz School of Medicine - Temple University Residency Program: Int Med 75/Emergency Med 77 Current Research: Stroke Care and Transfers Passions in life include Politics and Social Justice Passions in Medicine include Stroke Controversies John Naftel, M.D. Attending Physician *Emeritus Hometown: Ontario, CA Undergraduate: UCLA with one semester at USC Medical School: David Geffen UCLA Residency: Rotating Internship one year (formally Internal Medicine) Passions in life: Spouse, outdoor adventures, equestrian, dogs, food and wine, history Passions in medicine: Beside, clinical dialogue with learners, what’s new in science, what’s just been disproven in accepted “truths” Mark Thomas, D.O. Assistant Medical Director and Vice Chairman Hometown: Garden Grove, Ca Undergrad Degree: BS/BA Biology/Psychology UC Irvine Medical School Degree: Western University of Health Sciences Residency Program: LLUMC EM 1992 Passions in life include Family, Skiing, Mountain Biking and Travel Passions in Medicine include Education Korbin Hayccock, M.D. A​ttending Physician Hometown: Scottsdale AZ Undergraduate Education: La Sierra University, Riverside CA Medical Education: Loma Linda University Residency Program: Loma Linda EM Passions in life: Celtic Football Club, Motorcycles, Passions in Medicine: Resuscitation, Echocardiography, POCUS Current Research: VExUS, Sepsis, Intrarenal Doppler in resuscitation, Pulmonary ultrasound in CHF. Pulmonary ultrasound in COVID, Hemodynamics in shock Joel Labha, D.O. Attending Physician Hometown: Dubai, U. A. E. Undergraduate degree and university: Pacific Union College Medical school: Western University Residency Program: Arrowhead Regional Medical Center Passions in life: Family, Soccer, Music Passions in medicine: Education, Personal Growth and Development Current research: How to deliver the perfect dad-joke every time: a prospective, randomized, double-blind, meta-analysis... of sorts. Thomas Minahan, D.O. Attending Physician Hometown: Bellflower, California Undergraduate degree and university: UC Riverside, BS Biochemistry Medical school: Western University Residency Program: Midwestern University Passions in life: Family, Family, Family Passions in medicine: All things Epilepsy related Current research: Utility of Instant EEG ability in the ER Humberto Ochoa, M.D. Attending Physician Hometown: Cenotillo, Mexico; Later moved to San Bernardino Undergraduate Education: University of California, Riverside Medical Education: University of Utah, Medical School Residency: IM Internship: U of Las Vegas (83-84) Kern Medical Center (84-86) Riverside County EMS Medical Director from 1992-2014. Attending at RUHS since 1987. Passions in Medicine: Teaching, Sharing clinical experience, Patient compassion Passions in Life: Golf, Soccer, Military History, Cooking, Foodie, Hot-tubbing with the family Melanie Randall, M.D. Attending Physician Hometown: Loma Linda Undergrad Degree: BS Stanford University Medical School Degree: LLU School of Medicine Residency Program: LLUMC 2011 Current Research: Pancreatitis in children Passions in Medicine include Congenital Cardiac Disease Rolando Sy, M.D. Attending Physician Hometown: Philippines Undergraduate degree and Universities: University of Santo Tomas & SFSU (Degree: Biology) Medical School: UCI Residency: RUHS Family Medicine Passions in Life: Fishing, Basketball, Running Passions in Medicine: Helping the indigent population Michael Flores, D.O. Attending Physician *Emeritus Hometown: Rancho Cucamonga Degree: BS in Biology, CSUSB Medical School: Western University of Health Sciences Residency: ARMC Life passions: Bitcoin, programming, finance, gaming, snowboarding, BBQing and hanging with the family. Medicine passions: Resuscitation and education.

  • Nursing Leadership | RUEM

    Nursing Leadership Lisa Mackie, MSN, RN Clinical Administrator, Emergency Services Autumn Martinez, BSN, RN Assistant Nurse Manager Lori Maddox, BSN, RN Nurse Coordinator, Prehospital and Distaster Debbie Giandalia, RN Assistant Nurse Mangager Shalyn Kernop, BSN, RN Assistant Nurse Manager Maria DeLeon, BSN, RN Assistant Nurse Manager Autumn Salazar, MSN-ED, RN Nurse Coordinator, Quality and Education

  • PA Fellows | RUEM

    Meet our PA Fellows newest scroll PA Fellows 2022-2023 Ben Juarez Hello, my name is Ben Juarez, and I am a native of Southern California. After honorably separating from The United States Navy, I attended Loma Linda University for my undergraduate studies and for PA school. While serving in the military, I worked as a Fire Fighter and Boat Operator; after the military, I worked as a Forensics Pathology Technician and then as an Emergency Room Technician prior to becoming an emergency medicine PA-Fellow here at RUHS. I specifically chose EM as my specialty because I enjoy the diversity of patient presentations, the fast-paced environment, and the well-controlled chaotic atmosphere only found in EM. Outside of the professional environment I truly enjoy the great outdoors (i.e., snowboarding, mountain biking, scuba diving, and hiking), playing guitar, and exercising in the gym. After the EMPA Fellowship I plan to continue to work in the ED, assist in missionary work overseas, and participate in search & rescue locally and nationally. Grace Knerr Hi! My name is Grace and I am one of the 5 Fall 2022 fellows! I am originally from Fishers, Indiana where I grew up and went to Indiana University (go Hoosiers!). I moved to OC while I was an EMT prior to PA school. I earned my MSPA at Western University and headed right into the fellowship out of school. I have been interested in emergency medicine since I became a lifeguard at age 14. I chose to do the fellowship because I didn’t feel comfortable practicing emergency medicine without a year of support and learning at RUHS. In my free time, I enjoy doing CrossFit, reading fiction, and spending time with my cats, fiancé, and family. Tammy Nguyen Hi, my name is Tammy! I grew up in the Inland Empire, where I worked as a scribe before PA school. I witnessed the challenges and gratification of caring for acutely sick patients through scribing. Being able to practice with empathy, face uncertainty, think swiftly, and be hands-on attracted me to emergency medicine. I pursued my MSPA at Cal Baptist University and graduated in August 2021. I went straight into this fellowship, and I feel blessed to be a part of an incredible team! When I'm not in the hospital, I enjoy being outdoors and doing activities such as hiking, backpacking, fishing, free-diving, and climbing. I've also been into weightlifting lately! I embrace every opportunity for adventure and have been fortunate to visit over 15 countries and 20 national parks. I firmly believe that when you're out of your comfort zone, this is when you learn and live the most Tamar Zwick Hi my name is Tamar and I'm one of the fall EM PA fellows. I graduated from Emory PA program in 2017 and have been working as a PA in the psychiatric emergency room in Denver Colorado prior to starting the fellowship with RUHS. Prior to becoming a PA I was a paramedic, working EMS in 5 different states. While in PA school I was privileged with the experience of working in Tanzania to help develop EMS curriculum for the country; I love traveling to different areas and seeing the differences and similarities in medicine across the world. Emergency medicine has always been my passion and I'm pleased to be back in the broader EM world. In my free time I can be found spending time with family.

  • STAFF RESOURCES | RUEM

    Staff Resources Tools Operations Updates View Project COVID-19 View Project Tools Tools EM Basic Life in the Fast Lane EMCRIT eMEDHome EMRAP ERCast EMS & ARMC Lectures Video Procedures Chest Pain EKG Summary

  • Advanced Providers | RUEM

    Advanced Providers Giselle Ludi, PA-C Undergraduate Studies: B.S Nutrition Sciences CSUSB Graduate Studies: M.S. PAS Western University of Health Sciences Experience: RUHS ED Operations Committee Co-lead​ Life passions: Travel in family Medicine passions: Education Hobbies: Hanging out with my kids and puzzles. Qammer Alzubaidi, PA-C This is your Project description. A brief summary can help visitors understand the context of your work. Click on "Edit Text" or double click on the text box to start. Michael Davalos, PA-C Hometown: San Ysidro Undergraduate Studies: BS Biology from UCSD Graduate Studies: MSPAS from Western University of Health Sciences Experiences: Urgent Care, Family Practice Passions in life: Travel, EDM, Sushi Passions in medicine: Orthopedic injuries Hobbies: Traveling, beer, cinephile, anglophile Alexa Hasen, PA-C Hometown: *** Undergraduate Studies: PA certificate from RCC Graduate Studies: subsequent Master's at A.T Still Experiences: Emergency Medicine, Paramedic, EMT Passions in life: Football, baseball, hockey- specifically Chargers, Braves, and Kings Passions in medicine: Teaching, procedures Hobbies: Fishing Elaine Legaspi, PA-C Hometown: *** Undergraduate Studies: PA certificate from RCC Graduate Studies: subsequent Master's at A.T Still Experiences: Emergency Medicine, Paramedic, EMT Passions in life: Football, baseball, hockey- specifically Chargers, Braves, and Kings Passions in medicine: Teaching, procedures Hobbies: Fishing Kimberly Henshaw, PA-C Hometown: Oceanside, CA Undergraduate Studies: PA certificate from RCC Graduate Studies: subsequent Master's at A.T Still Experiences: Emergency Medicine, Paramedic, EMT Passions in life: Football, baseball, hockey- specifically Chargers, Braves, and Kings Passions in medicine: Teaching, procedures Hobbies: Fishing Alyssa Weiner, PA-C Undergraduate studies: B.S Kinesiology San Diego State University Graduate studies: M.S. PAS Western University of Health Sciences Experience: Urgent care, occupational medicine Passions: Serving underserved and multicultural communities, international medicine. Sharing my passion for healthy food and fitness with my patients and those around me Hobbies: Spending time with family, friends, traveling the world, anything outdoors. Kevin Bailey, PA-C This is your Project description. Provide a brief summary to help visitors understand the context and background of your work. Click on "Edit Text" or double click on the text box to start. Kurt Harris, PA-C Hometown: Oceanside, CA Undergraduate Studies: PA certificate from RCC Graduate Studies: subsequent Master's at A.T Still Experiences: Emergency Medicine, Paramedic, EMT Passions in life: Football, baseball, hockey- specifically Chargers, Braves, and Kings Passions in medicine: Teaching, procedures Hobbies: Fishing Kimberly Henshaw, PA-C Hometown: Oceanside, CA Undergraduate Studies: PA certificate from RCC Graduate Studies: subsequent Master's at A.T Still Experiences: Emergency Medicine, Paramedic, EMT Passions in life: Football, baseball, hockey- specifically Chargers, Braves, and Kings Passions in medicine: Teaching, procedures Hobbies: Fishing Tammy Nguyen, PA-C Hometown: Oceanside, CA Undergraduate Studies: PA certificate from RCC Graduate Studies: subsequent Master's at A.T Still Experiences: Emergency Medicine, Paramedic, EMT Passions in life: Football, baseball, hockey- specifically Chargers, Braves, and Kings Passions in medicine: Teaching, procedures Hobbies: Fishing Kimberly Henshaw, PA-C Hometown: Oceanside, CA Undergraduate Studies: PA certificate from RCC Graduate Studies: subsequent Master's at A.T Still Experiences: Emergency Medicine, Paramedic, EMT Passions in life: Football, baseball, hockey- specifically Chargers, Braves, and Kings Passions in medicine: Teaching, procedures Hobbies: Fishing

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