Harold A. Thomas

The 2005 Model of the Clinical Practice of Emergency Medicine: The 2007 Update

2007 EM Model Review Task Force Harold A. Thomas, MD, Chair Michael S. Beeson, MD Louis S. Binder, MD Patrick H. Brunett, MD Merle A. Carter, MD Carey D. Chisholm, MD Douglas L. McGee, DO Debra G. Perina, MD Michael J. Tocci, MD From the American Board of Emergency Medicine, East Lansing, MI (Thomas, Perina); Council of Emergency Medicine Residency Directors, Lansing, MI (Brunett); Residency Review Committee for Emergency Medicine, Chicago, IL (Binder); Society for Academic Emergency Medicine, Lansing, MI (Chisholm, McGee); American College of Emergency Physicians, Dallas, TX (Beeson, Carter); and the Emergency Medicine Residents’ Association, Dallas, TX (Tocci).

ANAPHYLAXIS: PATHOPHYSIOLOGY, CLINICAL PRESENTATIONS AND TREATMENT

Anaphylaxis and anaphylactoid reactions are abrupt, often life-threatening episodes, secondary to the liberation of certain chemical mediators, and their effects on target organs. The number of agents known to trigger such reactions is expanding, with the most common fatal reactions secondary to penicillins, iodinated contrast material (ICM), and hymenoptera stings. Limited studies point to upper airway obstruction and circulatory collapse as the causes of death in man. It is felt that the frequency of cardiovascular involvement is not widely appreciated, and that hypotensive patients can be markedly hypovolemic. The primary goals of treatment should be aimed at preventing or reversing complications, and include immediate attention to the airway, cardiac monitoring, and establishment of intravenous access. The cornerstone of pharmacologic therapy is epinephrine. A comprehensive review of the pathophysiology, symptomatology, and treatment is presented.

Issues of Concern to Emergency Physicians in Pre-Retirement Years: A Survey

BACKGROUND Many members of the American College of Emergency Physicians are now over the age of 50. Little is known regarding age-specific issues that may impact the careers of emergency physicians in the latter stages of their professional lives. OBJECTIVES To determine issues of concern regarding aging and retirement among a cohort of emergency physicians in pre-retirement years. METHODS A survey of a randomized sample of 1000 American College of Emergency Physicians members over the age of 55 years was conducted with two separate mailings in the fall of 2006 and winter of 2007. The survey instrument consisted of 30 questions relating primarily to issues of health, finances, and the ability to practice emergency medicine. Four open-ended questions were included at the end of the survey, relating to means of promoting career longevity. RESULTS There were 802 usable responses received (response rate 80%). The average respondent was 57 years old and worked 30 clinical and 12 non-clinical h per week. The average estimated time to complete retirement was 7.8 years. Respondents generally viewed themselves as competent clinicians with improved ability to relate to patients and staff and little decline in procedural skills. However, a substantial proportion reported age-related concerns. Seventy-four percent reported less ability to recover from night shifts, 44% reported a higher level of emotional exhaustion at end of shift, 40% reported less ability to manage heavy patient volume, 36% reported less ability to handle stress of emergency medicine, 28% reported health limitations on ability to practice, 28% reported memory somewhat or considerably worse, and 25% reported less ability to incorporate new modalities of diagnosis and treatment. With regard to retirement-related issues, 42% reported concerns about adequate financial preparations and 44% reported concerns regarding loss of identity upon retirement. The practice modifications most commonly reported to impact career longevity were the reduction or elimination of night shifts, a reduction in the number of hours per shift, and an increase in physician and support staffing. CONCLUSIONS Respondents to this survey generally viewed themselves as competent, empathic practitioners. Yet a substantial percentage acknowledged at least some degree of cognitive or physical decline. The results suggest a role for the national organizations in emergency medicine in endorsing practice modifications that promote career longevity and clinical competence among its senior members.

Report of the Task Force on Residency Training Information (2007-2008), American Board of Emergency Medicine

The American Board of Emergency Medicine (ABEM) gathers extensive background information on emergency medicine residency training programs and the residents training in those programs. We present the eleventh annual report on the status of US emergency medicine residency programs.

Report of the Task Force on Residency Training Information (2008-2009), American Board of Emergency Medicine

The American Board of Emergency Medicine (ABEM) gathers extensive background information on emergency medicine residency training programs and the residents in those programs. We present the 2009 annual report on the status of US emergency medicine residency programs.

Report of the Task Force on Residency Training Information (2009-2010), American Board of Emergency Medicine

The American Board of Emergency Medicine (ABEM) gathers extensive background information on emergency medicine residency training programs and the residents in those programs. We present the 2010 annual report on the status of US emergency medicine training programs.