The hennepin technique

CORRESPONDENCE The Organization Is Us To the Editor: Dr Malak's charge that 'ACEP Must Address the Economics of Emergency Medicine" (April 1984;13:301) prompts a response from this College officer. He posits that, based on the number of placement ads in this journal, something must be amiss economically in our specialty. I see the issue from another point of view. With many part-time practitioners being replaced by career emergency physicians and with a number of new positions being created, I see no evidence that the "continuous turnover of emergency physicians" is economically based. Dr Malak cites three areas as contributing to economic problems in this specialty: dominance by "entrepreneurs," lack of departmental status, and absence of membership involvement in decisions made by ACEP at the state and national levels. Although I no longer have a clear understanding of what "entrepreneur" means, the more generic issue of contract medicine is a reality in our specialty, where we must choose between physicians and hospitals as our employers. Unfortunately emergency medicine appears to be at the cutting edge of the coming wave of "The Monetarization of Medical Care. "I Dollars are the driving force for hospitals seeking to contain costs in the face of increasing governmental intrusion. A number of hospitals cannot support full-time emergency department coverage by a community-based group of emergency physicians. Those hospitals look to larger, sometimes multistate, groups for that coverage at less cost. We are competing with each other for contracts, and our hospitals are competing with each other and with freestanding emergency centers for patients. Twice in my memory we have looked to ACEP to protect the "little guys" from the "big guys." On both occasions the College learned that restraint of trade legislation precludes ACEP's intervention on behalf of either party. Rather than problems with "entrepreneurs" and lack of departmental status, I believe Dr Malak is really talking about our basic need for recognition, security, and due process, all of which take time, patience, and commitment on the part of the individual emergency physician. ACEP, JCAH, and the AMA cannot provide this security. Rather,

we need to earn our own recognition by sitting on hospital committees, eating meals in the doctors' dining room, going to the annual hospital dinner dance, participating in EMS meetings, attending state ACEP business meetings, and participating in the county and state medical societies. Emergency physicians tend to be very lifestyle-oriented in that we work hard seeing patients and prefer to pursue personal interests when we aren't scheduled. But we must invest time in "joining the club" if we expect to be recognized and respected by the management and the medical staff of our hospitals. The allegation that fresh voices are barred from the leadership of ACEP cannot be substantiated by my experience. What I can substantiate is apathy and indifference by the vast majority of practicing emergency physicians to issues that do not have immediate financial or lifestyle consequences. I am delighted to offer my personal assistance to Dr Malak and his associates who wish to be involved in ACEP activities. The annual meeting, October 15 and 16, 1984, at the Hyatt Regency Hotel in Dallas, is open to all College members, who are welcome to air their opinions before any of the six reference committees that will meet on October 15. The business of the Council is to consider any and all resolutions submitted by College members or chapters. Resolutions submitted by August 31 were sent to chapters for review and discussion before the annual meeting. Every member should participate in these chapter review sessions in the future, because that is how your representatives will get an understanding of how to represent your feelings when voting on the issues. I look forward to receiving resolutions on the issues raised in Dr Malak's letter so that this debate may continue among our peersat the annual Council meeting.

Ronald D Crowell, MD, FACEP Speaker of the Council American College of Emergency Physicians Dallas

The Hennepin Technique To the Editor: Several years ago a technique for reducing shoulder dislocations was published in Annals from the emergency medicine group at Hennepin County Medical Center in Minneapolis. They reported a success rate with this technique of approximately 84%, and reported that it required very little or no anesthesia. The technique has been tried in many institutions throughout the country, both academic and nonacademic. It is an absolutely outstanding technique and, in fact, at national conferences, including the CREM meeting, I have found that two-thirds of the audiences have used the technique successfully. I believe the technique 182/981

should carry a name which demonstrates a significant contribution from the specialty of emergency medicine. I believe it should be called the Hennepin Technique. Orthopedic surgeons and other members of the surgical community would, in time, recognize it as an emergency medicine contribution.

Robert R Simon, MD Assistant Professor of Medicine UCLA Emergency Medicine Center Los Angeles

Annals of Emergency Medicine

13!10 October 1984