Toxicology in the 1990s The 1990s will undoubtedly be an exciting decade for medical toxicology, and this issue of Annals indicates that emergency medicine will play an important role in its evolution. In this issue several articles relevant to the academics, science, and political future of toxicology are published. Included is a current list of all toxicology fellowships, American Board of Medical Toxicology/American College of Emergency Physicians recommended academic guidelines for toxicology fellowships, 30 abstracts from last year's toxicology meeting, and 13 new scientific articles and case reports. The accompanying editorial by Michael V Vance, MD, FACEP, also describes the possible routes of achieving academic recognition for toxicology by the American Board of Medical Specialties. Whichever route is taken, emergency medicine and medical toxicol0gy seem inexorably linked. In addition to the information found in this edition, there is further evidence of this link. For the first time, the Emergency Medicine Foundation has honored not just one but two toxicology fellowship programs by granting them 1990-91 EMF Fellowship awards. Toxicology has now officially become a section within ACEP, with an ACEP Council m e m b e r and a political voice within the College. It is anticipated that the section will be involved in the following areas: Working with the ACEP Standards Committee in developing recommendations for the treatment of acutely poisoned patients in the emergency department; assisting the ACEP Academic Affairs Committee in developing a new core curriculum in toxicology; revising previously published guidelines on poisoning treatment centers outlining which components
(ie, equipment, antidotes, personnel) the ideal center should have; and developing a strategy for improving toxicology awareness and education at both the residency and medical school levels. As mentioned, in this issue of Annals abstracts from a toxicology meeting are published for the first time. Each year four toxicology organizations, the American Association of Poison Control Centers, the American Academy of Clinical Toxicology, the American Board of Medical Toxicology, and the Canadian Association of Poison Control Centers, pool their resources and hold their annual scientific meeting - toxicology's equivalent of ACEP's Scientific Assembly. Last year's meeting was held in Atlanta, October 11-14, and 202 scientific abstracts were presented. The 30 abstracts published in this issue were selected from among those as being particularly relevant to emergency medicine. The 1990s, through the mechanisms outlined in this issue, should see a real change in medical toxicology as a subspecialty and in its importance to a number of federal agencies including the FDA, EPA, OSHA, NIOSH, and ATSDR. Toxicology fellowship training of emergency physicians will of necessity include emergency/disaster preparedness, management of hazardous materials spills, occupational toxicology, and the chronic effects of toxic chemicals on consumers. Emergency medicine should not only welcome but also generate many of these changes. Kenneth W Kulig, MD, FACEP Chairman, ACEP Toxicology Committee
Medical Toxicology and Emergency Medicine This issue of Annals represents a significant step in the evolution of the relationship between emergency medicine and medical toxicology. Virtually every issue of Annals in recent years has included t o x i c o l o g y - r e l a t e d studies and reports. In January 1989, Annals established a toxicology section, emphasizing the importance of medical toxicology in the emergency medicine literature. The accompanying editorial by Ken Kulig, MD, highlights the importance of medical toxicology in the academic and clinical practices of emergency medicine. The next logical step is the consideration of medical toxicology as a subspecialty of emergency medicine. As the experience of the American Board of Emergency Medicine (ABEM) has shown, the road to recognition within the American Board of Medical Specialties [ABMS) requires thoughtful planning, a patient educational process, and open and active participation of all interested medical specialties. Recognition within ABMS also requires that a medical specialty or subspecialty have an identifiable core content or body of medical knowledge in19:6 June 1990
corporated in formalized training programs, and medical toxicology appears to meet these criteria. In fact, medical toxicology has taken the next step: the development and administration of a certification examination through the American Board of Medical Toxicology (ABMT). The ABMT, while not recognized by ABMS, functions within medical toxicology m u c h as ABEM functions within emergency medicine. Its primary purpose is to certiff/ physicians in a particular area of medicine through the administration of a fair, objective, and clinically relevant e x a m i n a t i o n using written and oral e x a m i n a t i o n techniques. As the ABMT represents and certifies only physicians, it is the logical organization to initiate the process of recognition of medical toxicology as a medical specialty within the house of medicine. The first formal steps have been taken as a result of a meeting convened by ABMT with representatives from the boards of emergency medicine, internal medicine, pediatrics, and preventive medicine. At present, there are no preconceived notions as to how
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medical toxicology should best be recognized and/or represented within ABMS. The possibilities range from certificates of added qualifications being issued independently through individual primary boards to a separate board structure that includes representation from the primary boards interested in sponsoring this area of subspecialization. The educational process and open discussions among all interested parties will no doubt lead to the most appropriate route for recognition of medical toxicology, ensuring the optimal combination of focused attention on the particular needs of the subspecialty within the broader issues of the sponsoring boards and ABMS. It is appropriate that the wheels are in motion for medi-
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cal toxicology to become recognized in the academic and clinical superstructures of medicine. It is equally appropriate that emergency medicine is a supportive sponsor of that effort, and that the academic, professional, and political arms of emergency medicine must demonstrate the desire and willingness to participate cooperatively in the dev e l o p m e n t and recognition of medical toxicology as a medical subspecialty. Michael V Vance, MD, FACEP Toxicology Section Editor Annals of Emergency Medicine
Annals of Emergency Medicine
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(ie, equipment, antidotes, personnel) the ideal center should have; and developing a strategy for improving toxicology awareness and education at both the residency and medical school levels. As mentioned, in this issue of Annals abstracts from a toxicology meeting are published for the first time. Each year four toxicology organizations, the American Association of Poison Control Centers, the American Academy of Clinical Toxicology, the American Board of Medical Toxicology, and the Canadian Association of Poison Control Centers, pool their resources and hold their annual scientific meeting - toxicology's equivalent of ACEP's Scientific Assembly. Last year's meeting was held in Atlanta, October 11-14, and 202 scientific abstracts were presented. The 30 abstracts published in this issue were selected from among those as being particularly relevant to emergency medicine. The 1990s, through the mechanisms outlined in this issue, should see a real change in medical toxicology as a subspecialty and in its importance to a number of federal agencies including the FDA, EPA, OSHA, NIOSH, and ATSDR. Toxicology fellowship training of emergency physicians will of necessity include emergency/disaster preparedness, management of hazardous materials spills, occupational toxicology, and the chronic effects of toxic chemicals on consumers. Emergency medicine should not only welcome but also generate many of these changes. Kenneth W Kulig, MD, FACEP Chairman, ACEP Toxicology Committee
Medical Toxicology and Emergency Medicine This issue of Annals represents a significant step in the evolution of the relationship between emergency medicine and medical toxicology. Virtually every issue of Annals in recent years has included t o x i c o l o g y - r e l a t e d studies and reports. In January 1989, Annals established a toxicology section, emphasizing the importance of medical toxicology in the emergency medicine literature. The accompanying editorial by Ken Kulig, MD, highlights the importance of medical toxicology in the academic and clinical practices of emergency medicine. The next logical step is the consideration of medical toxicology as a subspecialty of emergency medicine. As the experience of the American Board of Emergency Medicine (ABEM) has shown, the road to recognition within the American Board of Medical Specialties [ABMS) requires thoughtful planning, a patient educational process, and open and active participation of all interested medical specialties. Recognition within ABMS also requires that a medical specialty or subspecialty have an identifiable core content or body of medical knowledge in19:6 June 1990
corporated in formalized training programs, and medical toxicology appears to meet these criteria. In fact, medical toxicology has taken the next step: the development and administration of a certification examination through the American Board of Medical Toxicology (ABMT). The ABMT, while not recognized by ABMS, functions within medical toxicology m u c h as ABEM functions within emergency medicine. Its primary purpose is to certiff/ physicians in a particular area of medicine through the administration of a fair, objective, and clinically relevant e x a m i n a t i o n using written and oral e x a m i n a t i o n techniques. As the ABMT represents and certifies only physicians, it is the logical organization to initiate the process of recognition of medical toxicology as a medical specialty within the house of medicine. The first formal steps have been taken as a result of a meeting convened by ABMT with representatives from the boards of emergency medicine, internal medicine, pediatrics, and preventive medicine. At present, there are no preconceived notions as to how
Annals of Emergency Medicine
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medical toxicology should best be recognized and/or represented within ABMS. The possibilities range from certificates of added qualifications being issued independently through individual primary boards to a separate board structure that includes representation from the primary boards interested in sponsoring this area of subspecialization. The educational process and open discussions among all interested parties will no doubt lead to the most appropriate route for recognition of medical toxicology, ensuring the optimal combination of focused attention on the particular needs of the subspecialty within the broader issues of the sponsoring boards and ABMS. It is appropriate that the wheels are in motion for medi-
24/624
cal toxicology to become recognized in the academic and clinical superstructures of medicine. It is equally appropriate that emergency medicine is a supportive sponsor of that effort, and that the academic, professional, and political arms of emergency medicine must demonstrate the desire and willingness to participate cooperatively in the dev e l o p m e n t and recognition of medical toxicology as a medical subspecialty. Michael V Vance, MD, FACEP Toxicology Section Editor Annals of Emergency Medicine
Annals of Emergency Medicine
19:6 June 1990
