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SAEM endorses Institute of Medicine report on the future of emergency care in the US

The Society for Academic Emergency Physicians (SAEM) is the largest organization in the world focused on improving the science and teaching of emergency care. Its mission is to improve patient care through research and education.

SAEM endorses the IOM recommendation that funding and grants to study emergency care should be increased as there is currently limited research bridging the gap between the science and the delivery of optimal emergency care. Research on optimizing the healthcare delivery model during normal operations and during disasters has traditionally been underfunded.

Academic medical centers often serve as the safety net for the community and smaller hospitals by providing sub-specialty care not available elsewhere and serving as the resource for training and education of providers in the region. Funding for education and training of an adequate workforce will allow academic centers to address a workforce deficit in emergency medicine trained providers and educate more physicians on emergency care during medical school years.

The IOM report on emergency medical services describes a fragmented system with disparate care delivery. EMS is a critical early link in emergency preparedness for disasters. Substantial research efforts are needed to provide a stronger scientific basis for out-of-hospital emergency care, with a focus on systems, care protocols and maintaining competencies.

The IOM report on emergency care for children describes a system where the majority of hospitals and EMS systems have inadequate training and equipment to care for children. Increased research and education on the providing optimal care for children is needed to address this gap.

SAEM applauds the work of the Institute of Medicine on the Future of Emergency Care report and looks forward to active participation in addressing emergency care needs:

Medical Education

• Medical students should receive education in the emergency care of all patient populations, preferably as a structured clinical EM clerkship. Physician licensure should incorporate proficiency in basic concepts of emergency care
• Residency training in EM/Pediatric EM is the "gold standard" for practitioners in EDs. Increased funded GME slots are necessary to address a workforce deficit.
• Residency training in emergency medicine provides an excellent foundation for fellowship training in critical care medicine.
• Currently, the majority of critical care fellowship training programs are not open to EM physicians.

Clinical Research

• Gaps and delays in the implementation of knowledge and advances in care limit the ability to provide optimal emergency care.
• Despite the NIH translational research mandate, there is limited research bridging the gap between the science and the delivery of optimal emergency care.
• Federal funding mechanisms should target the research of acute phase topics and include emergency care experts. Basic Science Research
• Future advances in addressing the major causes of deaths and disability (cardiovascular, stroke and injury) require significant advances in the underlying basic science of these conditions.
• There is an inadequate supply of basic science researchers with experience in the actual care of emergency patients. This impedes the ability to identify scientific questions critical to this patient population.
• Programs preparing EM researchers for a successful career in the science of discovery require significant expansion.

ED operations in Academic Medical Centers

• Increased charity care populations coupled with increased costs related to elder and sicker patients threaten academic medical centers as the safety net for the community and smaller hospitals.
• Overcrowding has a disproportionate impact on tertiary referral centers' ability to provide timely clinical care and adversely impacts the unique mission of academic medical centers.
• Overcrowding and diminishing reimbursement place stress on academic medical centers and threaten the training of a broad range of future emergency medical care providers.

EMS

• Emergency medical services (EMS) systems provide critical early links in our country's emergency preparedness, disaster management, and medical safety net systems.
• Substantial research efforts are needed to provide a stronger scientific basis for the delivery of out-of-hospital emergency care. Efforts should focus on systems, providers, and specific care protocols.
• The optimal cost-effective education and training of EMS personnel require specific research, including assessment of initial and ongoing competency.

Pediatric Emergency Care

• Quality training in pediatric emergency care is a key component of the Emergency Medicine residency curricula.
• Ongoing funding of pediatric emergency medicine education, training, and research in this subspecialty is important in order to assure optimal care of children with a wide range of urgent illnesses and injuries.
• Research is needed targeting the optimization of care for children in all settings (prehospital, community EDs, and tertiary care centers) as well as epidemiologic and prevention measures.

Critical Care

• Demand for critical care services is increasing to crisis levels, and the current and projected intensivist supply is inadequate.
• Providing emergency physicians access to critical care fellowships and certification would help alleviate the critical care crisis.
• Such physicians would strengthen the prehospital –> emergency department –> ICU critical care continuum, and improve the care of critically ill patients.

For further information about SAEM's endorsement of the IOM Report or the Society for Academic Emergency Medicine, please contact:

MaryAnn Schropp - SAEM Executive Director
517-485-5484
mschropp@saem.org

James W. Hoekstra, MD - 2006-2007 SAEM President
336-716-4626
jhoekstr@wfubmc.edu

Judd E. Hollander, MD - 2006-2007 SAEM President Elect
215-662-2767
hollandj@uphs.upenn.edu

Carey D. Chisholm, MD - 2006-2007 SAEM - IOM Task Force Chair
317-962-5556
cchisholm@clarian.org

Visit our website: www.saem.org

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