EDITORIALS
Establishing Standards for Emergency Cardiac Care: A Recognized Role for Emergency Physicians The American H e a r t Association's (AHA) 1992 National Conference on Cardiopulmonary Resuscitation (CPR) and Emergency Cardiac Care (ECC) was held in Dallas in February. The purpose of the conference was to review research relating to CPR/ECC over the last six years (since the 4th National Conference in 1986), reach a consensus about this investigation, and establish new national guidelines. An elaborate process of literature review, committee work, task forces, and consensus building had occurred in the 12 to 18 months before this national meeting and will continue to develop until final concensus is reached. There were seven conference cosponsors: The American H e a r t Association, American College of Cardiology, American Red Cross, American Academy of Pediatrics, E u r o p e a n Resuscitation Council, H e a r t and Stroke Foundation of Canada, and the National H e a r t , Lung and Blood Institute. The conference format of "state-of-the-art presentations," combined with "panel discussions," permitted participation by the distinguished audience list of 500 invited guests from 33 countries: 1 cardiologists, pediatricians, internists, emergency physicians, surgeons, lawyers, educators, ethicists, nurses, paramedics, emergency medical technicians, basic life support/advanced cardiac life support instructors, and national affiliate faculty from the AHA and the American Red Cross. The cross section of national and international contributors and researchers was impressive. Difficult and controversial issues concerning all aspects of CPR were dissected and discussed: prehospital and in-hospital resuscitation, basic life support, advanced cardiac life support, new and old interventions, cerebral resuscitation, pediatric and neonatal issues. Aspects of clinical care, barriers to b y s t a n d e r CPR, injury prevention in pediatrics, international differences in CPR, and new ethical concerns were addressed on many levels. Despite the notable absence of the American College of Emergency Physicians as a cosponsoring organization, there were 14 faculty members, panelists, and presenters who are practicing emergency physicians. In addition, 59 (20%) of the approximately 292 physicians in attendance were emergency physicians, with several very active discussants offering thoughtful insights from the emergency medicine perspective. Articles from emergency medicine peer review journals were often cited and played a prominent role in the presentations. In addition, publications by emergency medicine researchers in other journals, most notably JAMA and Circulation, were widely quoted for their work. In the 1985 conference, 16% of the articles cited were from the emergency medicine literature. 2 It seemed that in this conference the percentage was even higher. The AHA has provided the organizational structure and administrative focus for these national conferences in ECC and CPR for nearly 30 years. Recently, emergency medicine researchers, teachers, and clinicians have played an increasing role. This presence of emergency medicine is predictable and a p p r o p r i a t e because emergency physicians are the p r i m a r y physician providers of emergency cardiac
SEPTEMBER 1992
21:9
ANNALS 0F EMERGENCY MEDICINE
care and CPR (including early intervention with thrombolytics); emergency physicians represent the vast majority of physician advisors, teachers, and base station control physicians for prehospital providers; emergency medicine plays a prominent role in the teaching of basic life support and advanced cardiac life support in our communities and medical schools nationwide; and perhaps most importantly, emergency medicine plays a maj or role in the investigation of and advancement of knowledge about cardiac and cerebral resuscitation. Added to this is the need for a b r o a d e r perspective regarding trauma, injury prevention, hypothermia, near-drowning, and electrical injuries, all areas of expertise in our clinical practice and investigative interest. Emergency medicine has played an important role in fostering resuscitation research. 2 This should continue and in the future might include: • Cosponsorship of future National Conferences on CPR by ACEP • Encouragement of collaborative research projects with physicians from other specialties • Creation and funding of emergency medicine research awards at scientific meetings outside of emergency medicine • Expansion of funding mechanisms to support research activities, such as forging ties with industry and jointly exploring areas of complementary needs and resources • Establishment of a mechanism to identify- and continually re-evaluate emergency medicine research priorities • Creation of mechanisms to encourage and support emergency medicine research activities in nonacademic centers, possibly through collaboration with and guidance from established research organizations, such as academic medical centers and the ACEP and SAEM Research Committees • Implementation of educational and training programs for emergency medicine researchers F o r any specialty to p r o s p e r over time, it must have a strong academic base. The classical path to academic recognition includes dedication to patient care, medical education, and research. While excelling in the first two areas, emergency medicine is weakest in the last. It is fortuitous that medicine is now moving into the age of resuscitation because emergency physicians are the key links in medical care for these situations. Resuscitation research will require the collaboration of, and will benefit from the perspectives brought to it by, emergency physicians. Thus, the opportunity of academic acceptance is knocking on our door. Emergency medicine should continue its effort to make sure we are well p r e p a r e d . Ben Honigman,MD, FACEP University of ColoradoSchoolof Medicine Denver James E Manning, MD University of North CarolinaSchoolof Medicine ChapelHill Norman S Abramson, MD University of Pittsburgh Schoolof Medicine Pittsburgh 1. American Near, Association: Currentsin EmergencyCardiacCare.Dallas, AHA, Summer 1992, vol 3. 2. Abramson NS: Emergency medicine: The future is research.
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Establishing Standards for Emergency Cardiac Care: A Recognized Role for Emergency Physicians The American H e a r t Association's (AHA) 1992 National Conference on Cardiopulmonary Resuscitation (CPR) and Emergency Cardiac Care (ECC) was held in Dallas in February. The purpose of the conference was to review research relating to CPR/ECC over the last six years (since the 4th National Conference in 1986), reach a consensus about this investigation, and establish new national guidelines. An elaborate process of literature review, committee work, task forces, and consensus building had occurred in the 12 to 18 months before this national meeting and will continue to develop until final concensus is reached. There were seven conference cosponsors: The American H e a r t Association, American College of Cardiology, American Red Cross, American Academy of Pediatrics, E u r o p e a n Resuscitation Council, H e a r t and Stroke Foundation of Canada, and the National H e a r t , Lung and Blood Institute. The conference format of "state-of-the-art presentations," combined with "panel discussions," permitted participation by the distinguished audience list of 500 invited guests from 33 countries: 1 cardiologists, pediatricians, internists, emergency physicians, surgeons, lawyers, educators, ethicists, nurses, paramedics, emergency medical technicians, basic life support/advanced cardiac life support instructors, and national affiliate faculty from the AHA and the American Red Cross. The cross section of national and international contributors and researchers was impressive. Difficult and controversial issues concerning all aspects of CPR were dissected and discussed: prehospital and in-hospital resuscitation, basic life support, advanced cardiac life support, new and old interventions, cerebral resuscitation, pediatric and neonatal issues. Aspects of clinical care, barriers to b y s t a n d e r CPR, injury prevention in pediatrics, international differences in CPR, and new ethical concerns were addressed on many levels. Despite the notable absence of the American College of Emergency Physicians as a cosponsoring organization, there were 14 faculty members, panelists, and presenters who are practicing emergency physicians. In addition, 59 (20%) of the approximately 292 physicians in attendance were emergency physicians, with several very active discussants offering thoughtful insights from the emergency medicine perspective. Articles from emergency medicine peer review journals were often cited and played a prominent role in the presentations. In addition, publications by emergency medicine researchers in other journals, most notably JAMA and Circulation, were widely quoted for their work. In the 1985 conference, 16% of the articles cited were from the emergency medicine literature. 2 It seemed that in this conference the percentage was even higher. The AHA has provided the organizational structure and administrative focus for these national conferences in ECC and CPR for nearly 30 years. Recently, emergency medicine researchers, teachers, and clinicians have played an increasing role. This presence of emergency medicine is predictable and a p p r o p r i a t e because emergency physicians are the p r i m a r y physician providers of emergency cardiac
SEPTEMBER 1992
21:9
ANNALS 0F EMERGENCY MEDICINE
care and CPR (including early intervention with thrombolytics); emergency physicians represent the vast majority of physician advisors, teachers, and base station control physicians for prehospital providers; emergency medicine plays a prominent role in the teaching of basic life support and advanced cardiac life support in our communities and medical schools nationwide; and perhaps most importantly, emergency medicine plays a maj or role in the investigation of and advancement of knowledge about cardiac and cerebral resuscitation. Added to this is the need for a b r o a d e r perspective regarding trauma, injury prevention, hypothermia, near-drowning, and electrical injuries, all areas of expertise in our clinical practice and investigative interest. Emergency medicine has played an important role in fostering resuscitation research. 2 This should continue and in the future might include: • Cosponsorship of future National Conferences on CPR by ACEP • Encouragement of collaborative research projects with physicians from other specialties • Creation and funding of emergency medicine research awards at scientific meetings outside of emergency medicine • Expansion of funding mechanisms to support research activities, such as forging ties with industry and jointly exploring areas of complementary needs and resources • Establishment of a mechanism to identify- and continually re-evaluate emergency medicine research priorities • Creation of mechanisms to encourage and support emergency medicine research activities in nonacademic centers, possibly through collaboration with and guidance from established research organizations, such as academic medical centers and the ACEP and SAEM Research Committees • Implementation of educational and training programs for emergency medicine researchers F o r any specialty to p r o s p e r over time, it must have a strong academic base. The classical path to academic recognition includes dedication to patient care, medical education, and research. While excelling in the first two areas, emergency medicine is weakest in the last. It is fortuitous that medicine is now moving into the age of resuscitation because emergency physicians are the key links in medical care for these situations. Resuscitation research will require the collaboration of, and will benefit from the perspectives brought to it by, emergency physicians. Thus, the opportunity of academic acceptance is knocking on our door. Emergency medicine should continue its effort to make sure we are well p r e p a r e d . Ben Honigman,MD, FACEP University of ColoradoSchoolof Medicine Denver James E Manning, MD University of North CarolinaSchoolof Medicine ChapelHill Norman S Abramson, MD University of Pittsburgh Schoolof Medicine Pittsburgh 1. American Near, Association: Currentsin EmergencyCardiacCare.Dallas, AHA, Summer 1992, vol 3. 2. Abramson NS: Emergency medicine: The future is research.
ACEPNews199(];9:11-12.
1125/109
