Board Certification

AAEM Board Member Howard Blumstein, MD FAAEM, and AAEM President Joseph Wood, MD JD FAAEM sent the following letter to the editors of Child Magazine in response to an article entitled, “Crisis in the ER,” published in the June/July 2002 issue of the magazine. Dr. Blumstein and Dr. Wood felt strongly that the article presented misleading information on the state of care available to children in the nation’s emergency departments. The text of the letter is reprinted below.

To The Editor:

On behalf of the members of the American Academy of Emergency Medicine, we feel it necessary to respond to your article “Crisis in the ER” regarding the care of children in the nation’s emergency departments published in your June/July 2002 issue.

The article makes several valid points. It is well known, for example, that many emergency departments lack equipment necessary for the care of seriously ill or injured patients. Additionally, there are concerns regarding the skill of some emergency physicians and nurses who are inexperienced in caring for children. Unfortunately, the article contains some misleading information regarding emergency care for children in the United States.
Three sensational cases were used to illustrate bad care that children sometimes receive in emergency departments. In two of the three cases described, the physicians in question had backgrounds that suggested they should never have been practicing emergency medicine (no background data is provided in the third case). This is hardly a representative sample of the care most Americans will receive upon arrival in their local emergency department.

The article also contends that the average emergency medicine trainee spends, on average, just 13% of their time caring for children. This simply cannot be the case, as this would violate the minimum standards set by the Residency Review Committee for Emergency Medicine (the body with oversight responsibilities for emergency medicine training programs). In addition, this same committee pays special attention to ensuring that trainees have adequate experience in the resuscitation of seriously ill or injured children. The quality of care provided by board-certified emergency physicians to children is excellent. Steering your readers away from emergency departments can be dangerous; the overwhelming majority of private pediatrician’s offices are ill equipped to address life threatening emergencies. Those very same offices send their difficult cases to the ED for assistance and better care.

The crisis in emergency care extends beyond just children. Across the country there are thousands of physicians working in emergency departments who are neither trained nor formally certified in emergency medicine. We do agree, however, with many of the recommendations made in the article. We encourage you readers to contact their local hospital and collect a variety of information, including:

Does the emergency department have appropriate equipment for pediatric care?
Are all doctors working in the ED certified by the American Board of Emergency Medicine or the American Osteopathic Board of Emergency Medicine?
Is there a separate pediatric care area?

We would like to suggest a separate resource, www.911emergency.org, a web site devoted to listing hospitals across the country with emergency staff who are either board certified or recent graduates of emergency medicine programs. We encourage your readers to check whether their local hospital is listed on this site and inquire, if not, why?

Sincerely,
Joseph P. Wood, MD JD
President, AAEM

Howard Blumstein, MD
AAEM Board of Directors