aaem.org
Spotlight On...
J. Marc Liu MD
Dr. Liu was interviewed on November 9, 2007.
J. Marc Liu MD, Assistant Professor of Emergency Medicine, Medical College of Wisconsin, Assistant Director of Medical Services-Milwaukee County Emergency Medical Services, Medical Director, Tactical Emergency Medical Services Program-Milwaukee Fire and Police Departments. For more information on this doctor, CLICK HERE.
J.G.: I know you’ve done an EMS fellowship; why did you choose to do that?
J.M.L.: I became interested in out-of-hospital care as a medical student during my emergency medicine rotation. I noticed that a large percentage of patients arriving at the hospital were transported there by EMS, and I had little understanding of how their system operated. I therefore began to do ride-a-longs with the Chicago Fire Department and enjoyed my time with them very much. It became apparent to me that a good EMS system requires an active and collaborative medical director. I believe emergency room physicians are the best equipped to service the fire and police departments due to the broad-based nature of our training. I therefore sought out an EMS fellowship that would prepare me to become a medical director for an EMS system. I knew I needed training in the principles of EMS management. This included training in the administrative aspects of EMS, such as finance/accounting, organization design and quality assurance. In addition, I was able to improve my academic skills, become a better educator and learn how to apply evidence-based medicine to the field of emergency medical services.
J.G.: What are some of the issues facing the various EMS systems?
J.M.L.: The issues facing EMS are similar to those of emergency medicine, one of which is regarding how we are going to serve the growing population with fewer resources available. This is similar to emergency medicine where emergency departments are faced with an increasing patient volume and constant budget cuts. Currently, our society does not place EMS as a high priority. It is an ongoing effort to make the public aware that EMS is an extension of medicine in the field and that they are the safety net. Emergency medicine and EMS will only become more invaluable as patient volumes increase due to the declining health of our population. Developing creative solutions to meet the increasing demands of EMS is a priority to people in the field of EMS. It is important in the future that we as a society make the condition of our healthcare system, including the EMS, system a priority so that more resources can be made available.
J.G.: What research is currently being undertaken in EMS?
J.M.L.: To start, research in EMS has really taken off in the last 15-20 years, which is reflective of how much emergency medicine has evolved. Early on there was very little research. Once EMS was established as a discipline, there was an effort to start applying the principles of evidence-based medicine to this new field. EMS research has helped us become aware that some of the things we have always been doing may not be beneficial and that some things we are doing may actually be harmful. Currently in EMS research, there is a focus on studying resuscitation efforts in traumatic and cardiac arrests, specifically which techniques are most beneficial. There are studies evaluating endotracheal intubation and the use of alternative rescue airway devices. Studies concerning intubation are evaluating whether or not endotracheal intubation in the field is beneficial. There is also research into the uses of hypertonic saline, impedance threshold devices, how to efficiently and accurately analyze cardiac rhythms and other new equipment and protocols in CPR. There will be continued efforts in the future to employ techniques and treatments currently restricted to the hospital setting to EMS personnel in the field. Instituting these new protocols will require more research to see if they are practical and beneficial.
J.G.: You’ve been involved in mass casualty/disaster management. Can you tell me about some of your experiences?
J.M.L.: I had a personal interest in mass casualty/disaster medicine prior to my interests in EMS. More recently, this area of medicine has received a lot of attention due to the current state of world affairs. There are many challenges facing this field. It is hard to think about something that may never happen while already trying to deal with an overburdened medical system that is constantly facing budget cuts. One of my goals is to increase education and awareness of how to handle mass casualty/disaster events to the entire spectrum of healthcare providers from doctors and nurses to technicians and other ancillary staff members. In addition, location should not keep providers from being prepared for this type of event. It should be a concern of those in rural as well as urban areas. Having a basic knowledge of disaster management is critical to healthcare professionals. People will turn to the doctors as experts when these types of situations present themselves. I specifically enjoy giving presentations regarding disaster management to the public as well as my fellow healthcare providers. I also participate in field work with a number of first responder agencies at the local and federal levels. This opportunity gives me a chance to go out in the field and provide medical support for different types of operations. For instance, serving in this capacity allowed me the chance to be deployed to recovery efforts during Hurricane Katrina. Currently, there is an effort to organize regional response systems that cross state lines that may not include federal assistance. Jurisdiction issues put up barriers to large organized medical/EMS responses that cross state lines. When a mass casualty/disaster hits in areas like this, it will be a challenge to properly distribute those in need of medical care as well as equipment and personnel. I am working with a group of people whose goal it is to coordinate interstate/regional medical/EMS response efforts in southeast Wisconsin and northern Illinois. Currently, we are trying to coordinate hospital response efforts in the event of a large regional disaster in our region.
J.G.: Do you have any advice for students/residents who are considering pursuing an EMS fellowship?
J.M.L.: My advice is get involved early. It is a good idea to spend time in the EMS environment to see if it is something you really want to pursue. Also, it has been my experience throughout my career that it is vital to have good mentors. No matter what your area of interest, find good people you admire and trust who are established in their field and can pass on advice. I am very thankful for those who have mentored me in the past and for those who continue to give me support. Currently, at the Medical College of Wisconsin, I get to work with great people who are a wealth of experience and knowledge. Don’t be afraid to ask for advice and pay attention if people offer it to you. Most of your attendings are in academics because they enjoy teaching and mentoring students. It is important to stay in touch with the people who have helped you along because it’s always good to have help and guidance at any stage of your career.
J.G.: Do you have any other advice or something you would like to say to members/supporters of the AAEM/RSA?
J.M.L.: Stay involved and stay active in your organization. Medicine is constantly changing, and in general, we as physicians are not as involved as we need to be. We must stay active in helping to shape policies that will affect our patients and practices. We need to consistently educate our patients and the public on the current state of the healthcare environment. Organizations like AAEM and others are good platforms to help you get involved and work to make effective change in our system. Overall, it is the little things that will help educate your friends, family and neighbors, because everyone has a say in what will become of medicine.