My pathway was decided relatively early on, as I wanted to do primarily critical care. July of my internship year there was recognition that for my own personal desire, I wanted to care for a more critically ill population for a more sustained time. That was literally decided that first month of internship, when one morning I met Ake Grenvik. It was 4 a.m. While still up on call, I noticed an attending rounding in the cardiovascular ICU. I thought if the attending was up in the middle of the night rounding, that was dedication.
We talked in the X-ray viewing room, and he said, “We would love to have you. Emergency medicine folks do great in critical care. Unfortunately, we can’t offer you board certification, but we would love to have you train anyway.”
JT: You imply that advocacy was a significant portion of the initial impetus to form the section.
RV: Yes. The original intent of the section was an attempt to convene a group of interested individuals with diverse aims in critical care medicine. We began in 1994 and originally it did not succeed, as there were never enough members to achieve the 100 required members. However, ACEP was very supportive of the mission. We went on for three or four years with Gloria Thompson as the section liaison. Regardless, we had meetings every year, and finally achieved the magic number and the CCM section was born.
JT: What is our role as EM intensivists? We are people who understand the need to be fast and yet also we understand the need to be complete.
RV: As an EM/CCM physician, you often live in two different worlds. You understand the problems of two different disciplines balancing both inpatient and outpatient. We should serve as the interface, or bridge to deliver the best quality care that can be given at your institution. In some places, that means helping the ED to augment their critical care capability to improve the quality of care there. As an alternative, you may improve an ICU process to assist the ED throughout, though there is an efficiency limit, often involving nursing resources as well. Then there is the transition to the ICU, where there are often better nursing resources and better conditions for patient and families. You should help be the final arbiter of that transition, because you are the person that is most well positioned to facilitate the patient care goals. You are the person that helps to ease that transition and reassure people on both sides that you are doing the best thing for the patient in both environments.