FEATURE
Critical Care Medicine Specialization and Certification within Emergency Medicine: Past, Present and Future Casey Carr, MD Assistant Professor; Director, Student and Resident Critical Care Education; Co-Director, Cardiac Arrest Programs; Division of Critical Care, Department of Emergency Medicine, UF
THE PAST Historically, there has been a consistent link between emergency medicine (EM) and critical care medicine (CCM). The specialties have significant clinical overlap – shock, respiratory failure and airway management are common threads between the two fields, and there are obviously many more. Certification of emergency medicine physicians to practice critical care medicine similarly has a long, and somewhat controversial, history.
certification of emergency medicine, the American Board of Emergency Medicine (ABEM) sought a pathway for emergency physicians who completed critical care postgraduate training to become board-certified. This lack of access to certification was almost certainly based on inter-specialty agreements during ABEM efforts to become a ABMS recognized specialty board—all EM-based certificates that were considered “hospital based” were removed after reported considerable political backlash.
For more than two decades after American Board of Medical Specialties (ABMS) approved of the board
The result of this lack of certification pathway led CCM trained EM physicians to seek the European
Diploma in Intensive Care Examination, which was used as a surrogate for certification after completing fellowship training.
THE PRESENT In 2011, decades of advocacy led to fruition. The American Board of Internal Medicine (ABIM) and ABEM agreed to co-sponsor board certification in CCM. In 2012, the American Board of Surgery (ABS) followed suit, and the American Board of Anesthesia (ABA) followed soon after in 2013. Neurocritical Care certification via the United Council for Neurologic Subspecialties (UCNS) had long allowed emergency physicians to complete
Daunting Diagnosis: A By Karen Estrine, DO, FACEP, FAAEM Editor-in-Chief ◀ CONTINUED FROM PAGE 8
The CT scan shows extensive inflammatory changes of the abdominal wall including an air-fluid level and subcutaneous gas concerning for superimposed infection with a gasforming bacteria. The inflammatory changes are associated with a large, incarcerated ventral hernia and bowel perforation. The patient was hemodynamically unstable, requiring sepsis protocol and emergent general surgery consultation. The patient underwent an initial
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exploratory laparotomy for a necrotizing soft tissue infection, and multiple subsequent surgeries including resection of the transverse colon, multiple debridements of the anterior abdominal wall, open cholecystectomy, multiple wound wash-outs, and wound vac placement. The patient additionally underwent hyperbaric treatment. Hematology was consulted for further treatment of her ovarian cancer. The patient’s prognosis is poor.
