25th Annual Scientific Assembly

25th Anniversary Story

Submitted by: Joseph R. Lex Jr., MD MAAEM FAAEM

In 1994, I was working at Chestnut Hill Community Hospital in Philadelphia, shortly after leaving another community hospital in Coatesville, PA. I was five years out of residency and still thinking about academia, although my first two jobs were in the community. I had given up on ACEP Scientific Assembly as it offered very little of value to a practicing, residency-trained ER doc, but I did go to the annual SAEM meeting, even though it offered no CME credits at the time. In San Francisco I went to the Gala Dinner and, having no academic affiliation, I looked for a familiar face. Bob McNamara was there with a group from MCP and I joined their table. I knew Bob because he had interviewed me for a residency position at MCP, although I ended up at Jefferson. I had seen him at city and state meetings. He told me about a new group he was joining called the American Academy of Emergency Medicine, an organization that promised to work for the individual practitioner. I was curious about their philosophy, as I had worked five years for a group in which the owners were obviously skimming off the top. I read "The Rape of Emergency Medicine," which I would describe as a badly-written book that I could not put down. So I attended the first Scientific Assembly in the Society Hill section of Philadelphia, which Bob had put together, calling in favors from many top names in Emergency Medicine. I joined AAEM. The next year, the SciAss was back in Philadelphia and I sat in the hotel lobby with Jim Keaney, aka "The Phoenix," organization founder, and proposed putting together a Written Board and an Oral Board Review course. I had been working with Pennsylvania ACEP on their courses and thought I had the knack for writing review material. Within a few months, I had received the go-ahead from the AAEM board and developed the courses, with the help of members Ghazala Sharieff and Sam Kini.

It is impossible to describe only one thing that has changed in 25 years, except to say that most changes evolved from the realization of other specialties that we were there 24/7 to make their jobs easier. In my residency training, more than half of the intubations I did were awake Blind Nasotracheal; the concept of Rapid Sequence (or Drug Assisted) Intubation was unknown, and induction agents had to be ordered from the pharmacy. "Procedural Sedation" consisted of some acetaminophen with codeine or a DTP (Demerol / Thorazine / Phenergan) injection. After hours CT scan required an argument with a radiologist, and after hours ultrasound was unheard of. The first ED ultrasound machine I saw was the size of a small refrigerator on wheels; we self-taught ourselves how to use it by pushing a lot of buttons and twisting a lot of dials.

Cervical spine CT was rarely if ever done and we were very adept at reading c-spine and facial x-rays. We dosed theophylline intravenously for asthma patients based on whether or not the patient smoked. Bretyllium was part of our ACLS protocol. MAST garments were part of our treatment for shock. Gastric lavage with iced saline and levophed was standard for the patient with an upper GI bleed. Every patient with an allergic reaction or asthma got a shot of Sus-phrine before discharge. Every overdose patient got activated charcoal. Pulmonary embolism work-up was avoided because obtaining a V/Q scan was a painful process, and we had to convince the radiologist by assuring him (it was always a him) that there was indeed a massive A-a gradient on the blood gas. Anyone with hypertension got a sublingual dose of nifedipine. The sound of a "Thumper" coming through the door was often the first indication that prehospital personnel were bringing you a patient in cardiac arrest.

Residency-trained Emergency Medicine Specialists were becoming more common and starting their own groups. Many hospital contracts were held by "kitchen table schedulers" who supplied warm bodies to work a shift, frequently surgery residents from the local medical school. While democratic groups existed, they were often dictatorships with excess profits going to the group founders in payment for the 'risk' they had taken in assuming a contract; I worked for 5 years at one location and was never offered partnership.

AAEM changed all that. It gave Emergency Physicians the tools they needed to develop their own democratic groups. It gave us information we had never heard about 'due process' and 'open books.' It gave us education for the present and future of Emergency Medicine, and not just 'refresher courses' straight from the textbooks. It gave us practicing Emergency Physicians teaching other Emergency Physicians. It led to the future of Emergency Medicine, both for members and non-members. It continues to lead the way.