History of Resuscitation and Emergency Critical Care
Emergency physicians are well trained in the management of the undifferentiated patient presenting to the emergency department (ED). However, it is difficult to gain sufficient exposure to the breadth of critical illness and their associated management strategies seen in the ED setting during a 3- or 4-year emergency medicine (EM) residency. Furthermore, there is little emphasis placed on the care of critically ill patients beyond the initial steps in resuscitation. As presentations of critically ill patients have increased in recent years, intensive care unit (ICU) beds have not kept up, resulting in increased boarding in the ED, with worsened morbidity and mortality among this vulnerable population. Resuscitation and Emergency Critical Care (RECC) is a subspecialty of EM which serves to refine and further develop the skills needed to care for the critically ill undifferentiated patient in the initial phase of resuscitation and to provide the skills necessary to the ongoing management of critically ill patients boarding in ED management.
The RECC fellowship is distinct from traditional critical care. The RECC fellowship is a one-year fellowship focused on developing leaders in high-quality ED-based critical care. It is overseen by the ED and, at the time of writing, is not currently accredited by the Accreditation Council of Graduate Medical Education (ACGME). Traditional critical care fellowships are two-year ACGME-accredited fellowships, which may be pursued via various pathways like Critical Care Medicine, Anesthesia Critical Care Medicine, Surgical Critical Care, and Neuro-Critical Care, which are all ACGME-accredited options for EM graduates. Other major differences are that RECC-trained physicians practice exclusively in the ED while critical care medicine physicians may work in the ED, ICU, or both.
Why Pursue RECC?
Pursuit of an RECC fellowship facilitates not only further development of cognitive and procedural skills and critical thinking; it also provides EM physicians a niche within education, administration, and/or research. From a patient care perspective, as boarding in the ED continues to be a challenge worldwide, more critically ill patients are remaining in the ED for longer periods of time under the direct supervision of the EM physician. RECC and Critical Care physicians are trained to be able to provide high quality care to these patients both on their initial presentation and until they are transferred to their respective ICUs. While those with traditional critical care training are also well suited to the care of these patients, they often split their practice or prefer to work exclusively in the ICU. RECC physicians, however, practice exclusively in the ED setting and are therefore uniquely positioned to the ED-based management, development of local practice or pathways, and resident education of critically ill patients.