Within our respective specialties, we often set our sights to new beginnings and adventures. With the passage of the resolution 44 by the American College of Emergency Physicians this past October and a recent post written by Bryan Hayes (@PharmERToxGuy) on Academic Life in Emergency Medicine describing in detail the training of EM pharmacists, I have been contemplating the general progression of the initiation and establishment of emergency medicine pharmacy, with ideas mainly surrounding the theme of “Where did we come from?”

I often took for granted the fact emergency medicine pharmacy practice was established in the 1970s, but I had never really thought further related to the “how” of the creation of pharmacy services in the emergency department. Being a bit of a history buff, I decided to dig further deeper to find more literature on the topic. After conducting a somewhat in-depth search that took longer than anticipated (and waiting a few days to receive those articles that were not readily available via an easy PDF download), I found much of the literature written by those pioneers who established pharmacy services in the emergency department. 
Reading these articles made me humbled by their groundbreaking ideas related to establishing a practice in the emergency department, and more specifically related to their roles as emergency medicine pharmacists. It is quite amazing to compare practice from “back in the day” to now. Some of the practices described in these articles are very similar (if not exactly the same) as most of us EM pharmacists, and some of the challenges faced by these pioneers related to practice are still relevant today. Some of the practices described are certainly head-scratchers (along the lines of, “They did that back then?!”), but I believe they are worth being aware of for historical reasons; perhaps some of these practices may even make a comeback at some point in the future. 
These articles are must-reads for anyone who practices or is interested in emergency medicine pharmacy, as they do indeed provide a multitude of answers to the aforementioned question related to our origins. The full citations of these historical articles are provided below:

  • Edwards GA, Samuels TM. The role of the hospital pharmacist in emergency situations. Am J Hosp Pharm 1968; 25(3):128-133.
  • Rapp RP, Piecoro JJ, Swintosky JV. The value of emergency care situations in the clinical pharmacy education of a pharmacist. Drug Intell Clin Pharm 1974; 8(6):392-396.
  • Elenbaas RM, Waeckerle JF, McNabney WK. The clinical pharmacist in emergency medicine. Am J Hosp Pharm 1977; 34(8):843-846.
  • Roberts RW, Russell WL. A pharmacist-based toxicology service. Drug Intell Clin Pharm 1978; 12(11):665-670.
  • Majerus TC. Shock-trauma: Clinical pharmacy in emergency medicine. Top Hosp Pharm Manage 1982; 2(1):87-93.
  • Kasuya A, Bauman JL, Curtis RA, Duarte B, Hutchinson RA. Clinical pharmacy on-call program in the emergency department. Am J Emerg Med 1986; 4(5):464-467.

Some bonus interesting articles that I came across in my search include:

  • Baars R, Amerson AB, Rapp RP. Rapid calculations for emergency practice–a self instructional learning package for students and practitioners of nursing, medicine and pharmacy. Drug Intell Clin Pharm 1977;11(10):610-613.
  • Pelter M, McGhan W. Drug emergencies and the pharmacist. Lancet 1980;1(8177):1086.
As important as it is determine new directions for the specialty of emergency medicine pharmacy, it is also essential to become cognizant of the paths that have been built that will lead us there.

“If you do not know where you come from, then you don’t know where you are, and if you don’t know where you are, then you don’t know where you’re going.” 
— Terry Pratchett