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Critical Care Medicine:
An Evolving Subspecialty

 

   As resuscitation professionals, emergency medical physicians are charged with supervising the delivery of in hospital advanced life support. Emergency physicians deal with intubated, post cardiac arrest, septic, and other critical patient populations on a daily basis. The overcrowding of the nation's emergency rooms poses yet another challenge to critical care. Emergency rooms are not too infrequently utilized as a "boarding" or "holding" area for patients awaiting an intensive care bed. Current research also supports the role of the emergency medicine provider in delivering critical care. Goal directed therapy for septic shock has been shown to decrease patient mortality. EP's must therefore be comfortable with central line insertion and hemodynamic monitoring. The American College of Emergency Physicians is currently engaged in active dialogue about the credentialing of critical care physicians. Currently, pathways to board certification or a "CAQ" (certificate of added qualifications) in critical care exist through the American Boards of Internal Medicine, Anesthesiology, and Surgery.
  

   The politics of this lively debate are beyond the scope of this website. Currently, Emergency Medicine Physicians seeking additional expertise and/or credentialing in critical care medicine can examine the following options. Some EP's choose to sit for the European Society of Intensive Care Medicine's (ESICM) board examination. Emergency Physicians are eligible to sit for the exam following completion of an either 1 or 2 year post graduate fellowship in critical care. The ESICM's examination, though not equivalent to board certification, is widely perceived as a measure of added competency. Current medical literature supports the use of intensivists, or qualified intensive care physicians, to direct patient care in the nation's critical care units. Emergency medicine doctors serve as intensivists in a variety of locations. The American College of Emergency Physicians supports the credentialing of EM docs in critical care. Interested student doctors can join the critical care medicine section of ACEP and other organizations to support the creation of a Certificate of Added Qualifications in Critical Care Medicine for ER docs. Other specialty organizations lend support to ACEP's efforts. Groups like the Society for Academic Emergency Medicine and the Society for Critical Care Medicine encourage emergency physician input and involvement in intensive care policies. The SAEM actually maintains a list of fellowships that actively recruit ER doctors for critical care training. Though EP's cannot sit for the board examination, they can reap the benefits of rigorous and structured education in critical care medicine. If you are interested in learning more about this debate, check out the following links:

 

C3 Med
The Coalition for Critical Care in the Emergency Department

This is a Yahoo! Discussion group that is actively moderated by emergency medicine and critical care physicians. Doctors from the Interdisciplinary Fellowship in Critical Care Medicine at Pittsburgh often post here.

 

The Society for Critical Care Medicine
Has an active emergency medicine section; members can receive subscription to the Critical Care Medicine Journal

 

The European Society for Intensive Care Medicine
This site contains information about the European Intensive Care Diploma (EDIC) and eligibility requirements.

 

 

Description of the University of Pittsburgh's Critical Care Fellowship

 

 

R Adams Cowley Trauma Center's Fellowship in Surgical Critical Care
at the University of Maryland School of Medicine

 


 FAQ From The Critical Care Section of The American College of Emergency Physicians

 

Henry Ford Hospital's Internal Medicine/Emergency Medicine/Critical Care
Residency Program

(Six years and three board certifications!)

 

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