Chapter One

James M. Madsen United States Army Medical Research Institute of Chemical Defense, Aberdeen Proving Ground, MD and Uniformed Services University of the Health Sciences, Bethesda, MD

Introduction

This book is designed primarily for the busy emergency physician in search of a practical guide to occupational medicine in the emergency department. Occupational physicians should also find in it a useful perspective on the approach to occupational medicine in a venue not traditionally considered an occupational-medicine setting. Hopefully, this text will also throw light onto the heretofore-little-illuminated interface between two crucial specialties.

Emergency medicine, occupational medicine, and their intersection

In the 1970s and 1980s, emergency physicians proposed several definitions of their unique role in clinical medicine. A special document prepared by the American College of Emergency Physicians(ACEP) Practice Management Committee and approved by the ACEP Board of Directors defined emergency medicine as encompassing "the immediate decision making and action necessary to prevent death or any further disability for patients in health crises," described the specialty as "patient-demanded, broadly available, and continuously accessible care by physicians trained to engage in the recognition, stabilization, evaluation, treatment, and disposition of patients in response to acute illness and injury," and characterized the relevant patient population as unrestricted and presenting "with a full spectrum of episodic, undifferentiated physical and behavioral conditions."