One of his first fellows, Ake Grenvik, went on to be the first chairman/division director for the critical care program at Pittsburgh, and is appreciated by generations of critical care providers to this day. The University of Pittsburgh is the program that, as you recognize, trained a substantial portion of critical care intensivists that practice around the world today

The people who were originally interested in ACEP EM/CCM or involved in the Society of Critical Care Medicine EM Section section in the 80s were people who had trained in that Pitt program and had a foot in each arena. Those are names like Norman Abramson, Rob Levine, David Crippen, Mark Angelos, and Emanuel Rivers. These were the fellows that predated me. Each of them went out and tried to advance the prominence of emergency medicine in critical care through groundbreaking research, while CCM clinical practice at that time required internal medicine training as well as EM.

In 1991, after a resuscitation research fellowship with Dr. Safar, I accepted a position as the first EM trained full-time intensivist in an academic university based critical care fellowship program, providing trauma, transplant, and neurovascular care. During this period in the 1990s, with the advice and counsel of Dr. Grenvik, I worked with the ABEM executive director at the time, Benson Munger, to once again attempt to resurrect the EM certification pathway. We reactivated the ACEP EM/CCM section petition as well in an attempt to increase awareness of all critical care issues. However, we need to remember there were people before me who fought for the recertification the previous decade, as well trying to establish the section.

In general, the drive wasn’t successful for either goal for various reasons, including lack of the EM board certification pathway as the subtext. The majority of the issue was certification-driven during this time period. It was almost a self-fulfilling prophecy, where lack of a certification process naturally decreased the interest in CCM among EM practitioners. It was at this point that I got involved.

JT: Was the issue with certification related to a professional lack of legitimacy or to something else?

RV: People did critical care because they were passionate about the discipline. Of the people mentioned who came before me, it was very difficult to sustain a critical care practice exclusively based on their EM training alone. At that time, the available career pathways included an EM clinical practice performing critical care research or combining internal medicine with EM training to allow CCM board certification to allow a clinical critical care practice in the training institutions.