Joseph E. Tonna, MD
Editor, The Unit
For those of you who weren’t able to attend the ACEP Critical Care Section Meeting, you missed a great example of the rich history and membership of our section—and a wonderful educational discussion. As we have done for a few years now, our section meeting Tuesday afternoon covered the business happenings over the previous year, including introductions, updates from the Chairs, representatives, elections, and a discussion of issues related to boarding. For those of us who remember, the discussions from not many years back revolved around whether we as emergency physicians would ever have a path to legitimate board certification within the house of medicine. This year, the discussions were entirely around when emergency medicine would form an autonomous independent pathway to board certification. How far we’ve come in such a short time!
The meeting kicked off with our Board Liaison Dr. Stephen H. Anderson presenting awards from ACEP to our section including “Outstanding Section Newsletter Award of Distinction,” awarded to Dr. Nick Mohr and his team for their work over the past two years and the 2015 “Service to College Award” to Drs. Marcolini and Zhou for their work on innovatED. Lastly, Dr. Anderson introduced CEDR (Clinical Emergency Data Registry). The registry, developed by ACEP, is the first emergency medicine specialty wide national data registry. Piloted in 2015, it will allow for aggregation of specialty wide data both for understanding practice patterns, trends and outcomes in emergency medicine and also allow for individual hospital data reporting to meet the Centers for Medicare and Medicaid Services (CMS) and other certification body requirements. Given the volume of healthcare that goes through the emergency department, the focus on big data, and the burden of outcome metric reporting, it is exciting to be a part of an effort to leverage this data on a national and specialty level for understanding and improving clinical care.
We heard updates from our new Chair, Dr. Ayan Sen on the Section Grant—Project PICC: Promoting an International Collaboration in Critical Care, an EMRA update from Dr. Krystle Shafer and a Society of Critical Care Medicine (SCCM) update from Dr. Wessman.
After the business meeting, our educational meeting this year kicked off with a panel discussion on sepsis. I, for one, felt a welling up of pride in my chest when I listened to the members of that panel. The panel comprised Jay L. Falk, MD, FACEP; Emanuel P. Manny Rivers, MD; Tiffany M. Osborn, MD, FACEP; Nathan I. Shapiro, MD; Todd Slesinger, MD, FACEP—emergency physicians, researchers and members of our own section who have previously and continue to define sepsis care nationally. Dr. Rivers led off the discussion, and calmly took us through the past 30 years of sepsis research.
To begin with, we were treated with a unique and insightful look into the decades of preliminary work that underpinned the 2000 Early Goal Directed Therapy (EGDT) study. While many clinicians don’t understand the 20+ years of studies that prepared the way for EGDT, even fewer can say that they had it explained to them by a major contributor. I, for one, was surprised at the sheer volume of preliminary work that Dr. Rivers has contributed to the field. It very much put the EGDT study into perspective.
For anyone who entered into medicine during the first part of the EGDT-era, we were part of the omnipresent push to resuscitate sepsis with bundled and “aggressive” interventions, defined by Dr. River’s landmark study. National guidelines were really only updated in the last 5-7 years to reflect EGDT; then in the last 24 months, it seems that all I hear is “EGDT has been disproven,” with the publication of the ProCESS, ARISE and ProMISe studies. As emergency intensivists we may better than anyone understand the way in which EGDT and the collective “protocol vs regular care studies” are not contradictory but complimentary, and it was a unique experience to be in a small room with authors from EGDT (Rivers) and ProMISe (Osborne), as they shared a stage, voiced their friendship and that same message. The fact that these authors are members of our own section only exemplifies just how historically significant and groundbreaking our membership is. I think I speak for many of us when I saw that I am humbled and honored to be a new small part of our great history.
After Emanuel Rivers, Tiffany Osborne took the stage and went through her perspective on sepsis care, including her participation in the ProMISe study and the role Dr. Rivers played in her training as a researcher. The panelists shared personal stories of the devastation of inadequately treated sepsis, and talked about their view of the future of sepsis care in light of the recent studies. By the end of the hour, all in attendance had not only learned about the legacy of studies that have brought us to where we are today, from contributing authors, and members of our own section.
After the Sepsis Panel, we heard three excellent brief talks from young members of our section (Sara E. Crager, MD - Fluid Responsiveness; Jenelle A. Holst, MD – Pulmonary Hypertension; Harman Singh-Gill, MD - High-flow Nasal Cannula), with a wonderful happy hour sponsored by Teleflex.
Moving forward through the year, I would like to introduce my Assistant Editors, Raghu Seethala, MD whom you know from last year, and Susan R. Wilcox, MD. Both have articles in this edition and will be working with me to bring you updates, educational pieces, job information, fellowship review and debates throughout the coming 48 months. We solicited involvement from members interested in writing topics, and again ask for your suggestions, requests and involvement. I can be contacted directly via email, twitter: @JoeTonnaMD or through Margaret Montgomery, our staff liaison.
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