At least a third of the people in the room with me today were not even born when I attended my first ever Scientific Assembly of the American College of Emergency Physicians (ACEP) in 1975. That meeting was held in Las Vegas, which makes it all the more remarkable that I remember any of it. (Can you say "Palomino"?)
At that time I had recently completed a surgical internship, and even more recently eschewed a promising neurosurgery residency to become one of those new "ER Docs" who limited their practice to the hospital "Emergency Room." I was one of about 5,000 early members of the College, all of whom were "second-career" emergency physicians like me. The specialty of emergency medicine was not yet recognized in the house of medicine (AMA), and the American Board of Emergency Medicine was merely a dream in the heads of the hardy pioneers who founded ACEP. They established the College to support the continuing medical education of us second career docs. In the absence of any formal body of knowledge or curriculum that was a daunting task.
Although details might vary from one ER Doc to the next in those days, my breadth of medical knowledge contained Swiss cheese-like holes that required rapid filling before I could safely treat emergency department patients while practicing (literally) this "newest specialty in medicine." I felt very comfortable diagnosing surgical or neurologic disease and managing victims of traumatic injury. But hand me an electrocardiogram, and I had difficulty knowing which end of the paper was up, let alone recognizing subtle indications of what nowadays is termed "acute coronary syndrome."
Over the ensuing years the College succeeded in winning support for the formal recognition of the specialty of emergency medicine by defining a body of knowledge and core content. The American Board of Emergency Medicine became a reality, and I eventually became not only a diplomate but an oral examiner. Training of emergency physicians progressed from the pick up games of those early ACEP meetings to a formal curriculum adroitly taught by ACGME-accredited residencies in emergency medicine. The specialty rapidly became so popular that positions in EM residencies were among the most sought after in the entire house of medicine. In those days we boasted that emergency medicine attracted the "best and brightest" graduates of the US medical education system.
My naval career gradually drew me away from the emergency department as I became more involved in executive and operational medicine. But recently I decided that my previously home-grown emergency medicine skills were long overdue for refreshment...a decision driven in no small part by approaching retirement from the Navy. So I signed up for and endured trans-Pacific travel in the very back of a JAL 777 to attend a course entitled, "Essentials of Emergency Medicine 2010" in San Francisco.
Wow! Talk about the best and brightest! The quality of evidence-based knowledge and education here blows me away. We're talking major leagues here, folks. Looking back on my early days as a leader in the specialty, I feel as if I'm awakening from a long sleep to find a dream come true. In those very early ACEP Scientific Assemblies we had to rely on educators from other specialties to teach us the various aspects of our "specialty in breadth." Those presenters were often irrelevant to ED practice, simply reflecting their own specialty perspective (or bias).
Today a cadre of emergency medicine superstars, most of them from one program as USC LA County, presented topic after topic, fully researched and developed to a depth of understanding and practical relevance to the emergency physician, and more importantly the ED patient, that we barely fathomed in those early days. These are indeed, in every sense of the term, the best and the brightest stars in the house of medicine. I must add that the audience, hailing from throughout the U.S., Canada, and abroad, contains many similar luminaries.
This experience moves me to extreme optimism about the quality of emergency care available to U.S. citizens and beyond, now forty plus years after those early visionaries of ACEP devoted their time and energies, sometimes against formidable opposition, to achieve that very end. Names like Wiegenstein, Mills, Rupke, Krome, Mangold, Rosen, Hannas, Haeck, Riggs, Podgorny and many others resonate deeply in my mind this evening. The best and brightest of today truly do stand on the shoulders of those bold-thinking, dedicated giants from the early days of our specialty.
For my own part, a highlight of my attendance at "Essentials" yesterday was the EKG session. Looking at the first of a series of practice EKGs, I recognized -- within mere seconds -- that I was holding it upside down. Now what was that cardiac rhythm...?
2 comments:
My father-in-law has been in the fire service since around the same time as your early ED days. One of our favorite family fun activities is to get him, my husband (a volunteer firefighter/EMT from the 1990s) and my brother-in-law (a pretty young professional & volunteer firefighter) all in the same room to watch old episodes of Emergency!
My brother-in-law will start shaking his head at some strange thing they are doing or old piece of equipment, while my father-in-law is reminiscing about when it was new in his department.
I remember the time Johnny Gage started his own IV on that show, which seemed far-fetched to me. Then one day an Arizona paramedic did just that.
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