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INTRODUCTION

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Illustration by George Folz, © 2020 McGraw-Hill Education

BACKGROUND

Emergency departments have been featured prominently on American television sets for decades, with drama and intrigue set against a backdrop of trauma and health crises. These shows highlight two trends that are noteworthy insofar as they ring true, at least from the perspective of pharmacy. First, interprofessional teamwork is the lifeblood of emergency departments (EDs). Good outcomes abound when first responders, nurses, physicians, and other health professionals effectively communicate and coordinate their efforts. Second, pharmacists very rarely make it on screen.

Historical comparisons provide a good explanation for these trends. As a distinct specialty practice area for physicians, emergency medicine (EM) was first recognized by the American Board of Medical Specialties in 1979.1 As of 2020, there were over 2500 available positions for graduates of medical schools seeking the additional training required for this career path.2

EM pharmacy practice, by comparison, is relatively new. In 2006, there were only four EM pharmacy residency programs for graduates of pharmacy schools seeking specialty training in this area.3 By 2020, this number had grown to 50, representing an increase of over 1100%. In recognition of this rapid growth, which underscores the value health systems and other health professionals place in pharmacists as members of EM teams, the Board of Pharmacy Specialties formally recognized EM pharmacy as its fourteenth official specialty practice area in 2020.4 The American College of Clinical Pharmacy and the American Society of Health-System Pharmacists (ASHP) jointly submitted the petition to recognize EM pharmacy as a specialty. Importantly, during the public comment period, over 200 physicians and 70 nurses voiced their support. The petition included the following description:

“Emergency medicine pharmacy practice focuses on rapid assessment of available patient data to optimize pharmacotherapy, improve patient safety, increase efficiency and cost‐effectiveness of care, facilitate medication stewardship, educate patients and health care clinicians, and contribute to research and scholarly efforts.”

Broadly speaking, EM pharmacists maximize the safe and effective use of medications within EDs. To fully appreciate this, a review of EM as a distinct branch within healthcare is warranted. EM involves the triage, stabilization, diagnosis, management, and disposition of patients who present to the ED.5 The word “triage” has roots meaning “to sort,” and the history of this process stems from mass casualty and battlefield situations.6 When resources are limited, those who are most critical must be tended to sooner. This is why EDs do not operate on a “first come, first served” basis; instead, “sickest first” is more appropriate. Stabilization refers to care that is provided to ensure that the patient will not deteriorate if moved from one health facility to another.7

Diagnosis is typically led by an EM physician and is usually based on laboratory values taken from the patient’s ...

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