Moving the Front Line
Words and signs of frustration, cynicism, burnout and outrage are commonplace in emergency medicine. However, out of crisis comes opportunity. Day to day Emergency Medicine is spent preparing for and managing medical and often social crises, usually one patient, one event at a time. When crises are predictable to a degree, opportunities develop to intervene. Savvy emergency physicians are seizing the opportunity to impact their communities in assorted ways.
In northern New Hampshire, new drivers face not only inexperience and challenging roads, but also moose, up to seven feet tall and more than a thousand pounds. Every year several drivers and passengers are killed or injured in moose collisions. Emergency Room Physician, Dr.Campbell McLaren has taken that fact and his experience treating victims into the community. Dr. McLaren's presentation helps to prepare drivers for this unusual threat. He sees the need to contribute to the safety of our communities and believes that we can do so with the skills and knowledge possessed by emergency physicians.
Sudden death is a daily challenge to all emergency medicine, accounting for more than 360000 deaths annually and half estimated to be due to ventricular fibrillation. Defibrillation is the only treatment for this condition and must be carried out withing minutes to be successful. The evolving technology of automatic external defibrillators provides an opportunity to save lives otherwise lost due to prolonged response times. Promoting this life saving technology and helping to bring it into the community is a tremendous role for emergency physicians and departments. ED physician, David Barash of Access CardioSystems, is a principal in a company that seeks to make this technology more available in the community. Emergency physician involvement in training, supervision, promoting and integrating this technology in their communities is crucial.
In the aftermath of September 11, the local chamber of commerce hosted a program aimed at helping their members prepare and cope with disaster. I was asked to speak about workplace health and safety. Drawing upon the knowledge of what happens when prevention fails, I was able to touch on disaster planning, injury prevention and public access defibrillation. Businesses should assess their risks and become active in planning. Motor vehicle crashes make up the largest proportion of the six thousand work- related fatal injuries and more than 60 percent of victims did not use seat belts, something we can easily attest to..
Sudden death occurs on the job and in public places such as airports, sporting events and malls. Strategically placed defibrillators integrated with EMS can make a significant difference in survival from otherwise certain death.
Seat belts, defibrillators and disaster plans are all things that fall within the expertise of emergency medicine and have value to the community.
Dr. John Meade, ED medical director on the Gulf Coast of Alabama, sees the importance of community involvement."Emergency physicians are often seen as nomads with no relations or ties to the medical staff, hospital or community." Physicians joining their group are expected to participate in the community. The group actively sponsors charities and fund-raisers. Dr. Meade and others in the group have given talks on water safety, childhood injury prevention, chest pain and stroke..
ACEP Board Member, Dr. Sue Nezda, points out the need to reach out to our greatest allies...our patients and community leaders through public meetings. Outreach meetings are often attended by hospital board members, business leaders, media and other community leaders.
Tom Scaletta, MD FAAEM, AAEM Board member, points out that emergency physicians ought to do more outreach and education about ED utilization, disaster preparedness and injury prevention. Emergency physicians are well practiced at the art of relaying medical information quickly and accurately to folks that we have just met. Building relations with the community strengthens job security when this gets reported back to hospital administrators.
Emergency Physician and former National Highway Traffic Safety Administration Administrator, Dr. Ricardo Martinez, promotes the concept of "Creating the future."Dr. Martinez feels that Emergency Physicians have a unique position on the front line of health care and have demonstrated leadership in a number of community and public health areas.
Dr. Mike Mello of the Injury Prevention Center at Rhode Island Hospital points out the practical opportunities that involvement in injury prevention can provide. Networking within the state and community helps to promote the altruistic image of his hospital and department. "When you testify on the side of the angels, you become known by legislators...who then seek out your input and connect on other issues."
The interface between the community and acute health care uniquely positions emergency medicine for a sentinel role. Forty percent of emergency department visits are injury related and many can be prevented. Four million visits are the result of motor vehicle crashes. Falls in older individuals can lead to serious injury, disability and death. Many community and workplace related injury and illnesses appear in emergency departments first. Not to mention issues related to access, uninsured and the myriad of public health and societal issues that present every day in every community. Only through connecting with the community on these issues will the voice of emergency medicine be heard with the opportunity to influence the future.
The barriers to connecting with the community are varied, some cultural, philosophical as well as practical. Public outreach requires a skill set not often promoted in medical schools and residency. Some view this as counter to their reasons for emergency medicine as a career, such as scheduled time and personal freedom, obvious reasons to be respected. Financial and logistical support would greatly facilitate outreach. Opportunities to network and develop skills in this area have been limited.
Emergency medicine has successfully grown up as a specialty that fills voids in health care. Making voids into opportunity is a hallmark of emergency medicine. There are few professions that have the chance to witness individual and community crises first hand. As witnesses, the opportunity and motivation is often there to make a positive impact. Who better to make the case to the public at large than those with first hand knowledge, leading to relationship building and positive impact on our practices, communities and ourselves.
Community outreach can be a powerful and rewarding extension for emergency medicine as these examples show. Moving the front line from the bedside to the world at large provides the chance for us to make a difference.
Published in Emergency Physician Monthly June 2002