Emergency Physicians Monthly (EPM): What is the ECCC?
Michael Handrigan: There’s never been a federal focus for activities around emergency care. This challenges institutions like the NIH and CDC because emergency care transcends all of the institutes at the NIH and many of the activities at CDC. It’s difficult to find any one place in government that emergency care should live. The 2006 Institute of Medicine report on the State of Emergency Medicine report recommended the creation of an office that could help coordinate emergency care activities across the various departments and agencies and find opportunities for collaboration. The Emergency Care Coordination Center is that organization.
EPM: How were you chosen to be the first director of the ECCC? What in your background prepared you for this?
MH: This job needs to have folks who can understand the full spectrum of activities in federal government related to emergency care. I spent a good portion of my career as a US Army officer. My positions ranged from strict clinical practice and practice management to academics. I was a research faculty member at the Brooke Army Medical Center residency program. I spent half of my military time doing basic science and clinical research for the Army.
EPM: That sounds great in theory. What does it mean for the practicing emergency physician?
MH: The ECCC provides a central coordinating hub in the federal government for activities around emergency care.
EPM: What’s currently working its way through the ECCC that the practicing emergency physician should know about?
MH: Activities in the office are pretty varied. Work on H1N1 flu, including a productive partnership with ACEP, has taken a fair amount of our effort recently. The office is intended to look specifically at routine care delivery. We’ll be helping to examine things like quality of care measures and the concepts around regionalization of emergency care. We’ll be bringing our federal partners together and partnering with our academic communities. The opportunity to provide a central federal home for coordination of activities is really quite valuable.
EPM: Do you still practice?
MH: I practice at Suburban Hospital in Bethesda, Maryland.
EPM: Has it been difficult balancing a big-picture policy position with clinical practice?
MH: It’s important to be able to bring a clinical perspective. I see it as a critical element of value that I bring to the job.
While the ECCC has the potential to be emergency care’s new voice in the federal government, it is still early to gauge progress. The ECCC is so new, in fact, that a Google search fails to produce the desired link on the first page. Perhaps we’ll know best of its progress and success when it appears among the top ten.
In the meantime, the ECCC represents the first time that emergency care has had a unified, coordinated, and focused office in federal government. It took an Institute of Medicine Report to get us here. Here’s what the IOM Report, Hospital-Based Emergency Care: At the Breaking Point, proposed:
“The committee therefore recommends that Congress establish a lead agency for emergency and trauma care within 2 years of this report. The lead agency should be housed in the Department of Health and Human Services, and should have primary programmatic responsibility for the full continuum of emergency medical services and emergency and trauma care for adults and children, including medical 9-1-1 and emergency medical dispatch, pre-hospital emergency medical services (both ground and air), hospital-based emergency and trauma care, and medical-related disaster preparedness. Congress should establish a working group to make recommendations regarding the structure, funding, and responsibilities of the new agency, and develop and monitor the transition. The working group should have representation from federal and state agencies and professional disciplines involved in emergency and trauma care.”
Formally established through a Homeland Security Presidential Directive under then President Bush, and opened in January of this year, the ECCC has a grand vision: “To enhance the provision of exceptional emergency medical care for all people in the United States.”
With 115 million visits annually and growing, the opportunities are significant. This is “our” new federal agency. EPM will be following along and keeping in touch with Dr. Handrigan. We’ll also be looking for how the practicing emergency physician can influence federal coordination of emergency care for the benefit of our patients every day.