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
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!)