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Emergency medicine, “Where Are Ye?”
EDITORIALS
We need further research to fine-tune our prehospital and hospital medical and surgical response to the injured patient. But most important, we need to assure a basic and universal foundation, urban, suburban, and rural, for emergency medical systems before we commission the design of a plafond for the institution of health care. Trauma care must remain a subset of the emergency medical system that addresses the total health care needs of the American public 24 hours a day, seven days a week, wherever care is needed. John C Johnson, MD, FACEP EmergencyCenterfor Trauma& Critical Care PorterMemorial Hospital Valparaiso, Indiana
Emergency Medicine, "Where Are Ye?" See relatedarticle, p 201. I approached attending the Third National Injury Control Conference with great anticipation. Held in Denver in April 1991, the conference had as its focus "setting a national agenda for injury control for the 1990s." This process included direction for future funding, deciding areas of emphasis for injury control, and looking at which medical factions should maintain control of the ill and injured patients in America. There were seven panels, each with position papers focusing on all aspects of injury control, including prevention and rehabilitation. In this issue of Annals, the two trauma panel executive summaries, on acute trauma care and trauma systems, are included. When I first saw the summaries (albeit earlier versions), I wondered if emergency physicians participated in the development of our nation's injury control position papers. Among approximately 150 conference faculty, only three were emergency physicians. Among the trauma care and system contributors there were only two emergency physicians. Of the more than 800 registrants at the meeting, who were there to speak and critique the position papers, only a handful were emergency physicians. Emergency medicine input and representation was sorely lacking. In fact, at the Acute Care treatment panel, which was composed of 17 individuals, the panel moderator noted that there was one emergency physician invited but he never commented and therefore, there was no input generated from emergency medicine. As one might expect, the spirit of the document reflects the spirit of its authors, even though the executive summary has been modified somewhat (eg, trauma surgeon has been altered to trauma physician). For the changes that have been made, emergency medicine owes much to Drs Arthur Kellerman and Ricardo Martinez, both of whom represented our speeialty's interest with vigor. Yes, there were a few of us in the audience who spoke out about the focus of the position papers and their lack of emphasis on the fact that practicing emergency physicians are responsible for the acute
care of well over 90% of the victims of injury in the United States.
84/169
Why weren't we included? Who's to blame? The Centers for Disease Control? The American College of Surgeons? The Feds? I suggest we had better look in the reinor to solve this one. It became quite obvious that if we wait for an invitation to come to this dance, we're going to end up being a wallflower. Federal agencies respond to political clout and constituency pressure. We need to be banging on the doors of the CDC as well as those of our legislators and other federal agencies demanding considerations for emergency medicine and the 90 million patients treated by emergency physicians annually. We should be leading the charge on issues that affect our specialty, not accepting a token seat on a panel that sets the national agenda for research, funding, and care. The responsibility is ours! And no, it's not too late. As interested individuals and specialty societies, our concerns must become known. I have found the CDC Injury Control Division to be most receptive and interested if they are aware of our issues. I laud those surgical societies that have demanded trauma care legislation and federal funding. We should learn from their success and join them in the effort. There is a welcome place for emergency medicine. Please let us take our seat at that table. The executive summaries in this issue read well. They address appropriate issues that injury control faces. I suggest that all who are interested in this area read the complete position paper that will be published by the CDC. In fact, read it twice; once from the focus of trauma care and once from the frame of reference of emergency medicine's responsibility to the issues of trauma care and trauma systems. Trauma care is a system approach, not a specialty's disease. In order to reduce morbidity and mortality, the system must be inclusive, not exclusive. Research must occur at the bench and in the field. Rural, urban, and trauma center care must be addressed. The time is now; the agenda's on the table. Society is ready for improved trauma care. Our governments are passing legislation and providing funding to solve this societal disease. Other medical specialties have made major commitments to the problems of injury control. The national agenda is being written. Emergency medicine, "where are ye?" Harvey W Meislin, MD, FACEP Section of EmergencyMedicine Arizona Health Science Center Tucson
Opportunity Knocks. What Will We Do? See related article, p 201. The release of the National Agenda for the 1990s by the Centers for Disease Control represents another quantum leap in the evolution of care of the injured patient. More importantly, it changes the focus from trauma centers to trauma systems and from acute care to injury prevention. As such, another milestone is passed and another opportunity dawns. What will emergency physicians do?
ANNALS OF EMERGENCY MEDICINE 2 1 : 2 FEBRUARY1992
We need further research to fine-tune our prehospital and hospital medical and surgical response to the injured patient. But most important, we need to assure a basic and universal foundation, urban, suburban, and rural, for emergency medical systems before we commission the design of a plafond for the institution of health care. Trauma care must remain a subset of the emergency medical system that addresses the total health care needs of the American public 24 hours a day, seven days a week, wherever care is needed. John C Johnson, MD, FACEP EmergencyCenterfor Trauma& Critical Care PorterMemorial Hospital Valparaiso, Indiana
Emergency Medicine, "Where Are Ye?" See relatedarticle, p 201. I approached attending the Third National Injury Control Conference with great anticipation. Held in Denver in April 1991, the conference had as its focus "setting a national agenda for injury control for the 1990s." This process included direction for future funding, deciding areas of emphasis for injury control, and looking at which medical factions should maintain control of the ill and injured patients in America. There were seven panels, each with position papers focusing on all aspects of injury control, including prevention and rehabilitation. In this issue of Annals, the two trauma panel executive summaries, on acute trauma care and trauma systems, are included. When I first saw the summaries (albeit earlier versions), I wondered if emergency physicians participated in the development of our nation's injury control position papers. Among approximately 150 conference faculty, only three were emergency physicians. Among the trauma care and system contributors there were only two emergency physicians. Of the more than 800 registrants at the meeting, who were there to speak and critique the position papers, only a handful were emergency physicians. Emergency medicine input and representation was sorely lacking. In fact, at the Acute Care treatment panel, which was composed of 17 individuals, the panel moderator noted that there was one emergency physician invited but he never commented and therefore, there was no input generated from emergency medicine. As one might expect, the spirit of the document reflects the spirit of its authors, even though the executive summary has been modified somewhat (eg, trauma surgeon has been altered to trauma physician). For the changes that have been made, emergency medicine owes much to Drs Arthur Kellerman and Ricardo Martinez, both of whom represented our speeialty's interest with vigor. Yes, there were a few of us in the audience who spoke out about the focus of the position papers and their lack of emphasis on the fact that practicing emergency physicians are responsible for the acute
care of well over 90% of the victims of injury in the United States.
84/169
Why weren't we included? Who's to blame? The Centers for Disease Control? The American College of Surgeons? The Feds? I suggest we had better look in the reinor to solve this one. It became quite obvious that if we wait for an invitation to come to this dance, we're going to end up being a wallflower. Federal agencies respond to political clout and constituency pressure. We need to be banging on the doors of the CDC as well as those of our legislators and other federal agencies demanding considerations for emergency medicine and the 90 million patients treated by emergency physicians annually. We should be leading the charge on issues that affect our specialty, not accepting a token seat on a panel that sets the national agenda for research, funding, and care. The responsibility is ours! And no, it's not too late. As interested individuals and specialty societies, our concerns must become known. I have found the CDC Injury Control Division to be most receptive and interested if they are aware of our issues. I laud those surgical societies that have demanded trauma care legislation and federal funding. We should learn from their success and join them in the effort. There is a welcome place for emergency medicine. Please let us take our seat at that table. The executive summaries in this issue read well. They address appropriate issues that injury control faces. I suggest that all who are interested in this area read the complete position paper that will be published by the CDC. In fact, read it twice; once from the focus of trauma care and once from the frame of reference of emergency medicine's responsibility to the issues of trauma care and trauma systems. Trauma care is a system approach, not a specialty's disease. In order to reduce morbidity and mortality, the system must be inclusive, not exclusive. Research must occur at the bench and in the field. Rural, urban, and trauma center care must be addressed. The time is now; the agenda's on the table. Society is ready for improved trauma care. Our governments are passing legislation and providing funding to solve this societal disease. Other medical specialties have made major commitments to the problems of injury control. The national agenda is being written. Emergency medicine, "where are ye?" Harvey W Meislin, MD, FACEP Section of EmergencyMedicine Arizona Health Science Center Tucson
Opportunity Knocks. What Will We Do? See related article, p 201. The release of the National Agenda for the 1990s by the Centers for Disease Control represents another quantum leap in the evolution of care of the injured patient. More importantly, it changes the focus from trauma centers to trauma systems and from acute care to injury prevention. As such, another milestone is passed and another opportunity dawns. What will emergency physicians do?
ANNALS OF EMERGENCY MEDICINE 2 1 : 2 FEBRUARY1992