Apart from containing several errors, the report ignores some important facts. Firstly, the Department of Emergency Medicine provides attending staff coverage 24 hours a day, seven days a week. The attending emergency physician is board certified with up to 15 years experience in resuscitation. Since this physician is ultimately responsible for all medical care delivered in the Emergency Department and is the most experienced physician on scene, he has to have the authority to determine the initial treatment of emergency cases. The surgical care is determined by the most senior surgery resident on the scene.
Secondly, the report suggests that “turf battles” have resulted in poor patient outcomes. In the six years I have spent in the medical center, I can honestly say that I have never seen or heard of any patient dying in the Emergency Department because of a “turf battle.”
Additionally, I think it is important to point out that the majority of trauma patients in the U.S. are not initially treated in “trauma centers.” In fact most states do not have specifically designated trauma centers. Patients are stabilized initially by emergency physicians.
Although emergency medicine is a relatively new medical specialty, residency training programs have been in existence for almost 20 years and board certification has existed for 10 years (not one year as stated in the article). To scrap a system which works well on the basis of the ACS surveyor’s report would be unjust.
EDWARD NEWTON, MD
Director of Residency Training
Department of Emergency Medicine
County-USC Medical Center