collaboration with ACEP, has adopted standards for the accreditation of educational programs for the emergency medical technician.

On the state level, the College has as a goal the development of close relations between chapters and state medical societies and the organization of sections of emergency medicine in each state medical society. If achieved, this will improve the effectiveness of chap- ters within each state and increase the interaction of emergency physicians within the state societies.

Physicians can no longer be content to simply practice medicine. Medicine as we know it today is undergoing changes because of government interven- tion, rising health care costs, and the need for access to health care by all segments of our population. We must become concerned and involved with major social issues and attempt to effect changes for the benefit of

our patients. In order to maintain our freedom to prac- tice medicine appropriately in the years to come, it is essential that we involve ourselves in the process of advocacy early in our careers and make our opinions heard.

I urge each of you, through your county society, state society, the AMA, and the College, to become an active member and participant in these organizations which provide us with the opportunity to influence our professional future. Our membership is a formidable force for shaping the destiny of American medicine in such a way that the advancements of our past will con- tinue into the future for the ultimate benefit of our patients.

Leonard M. Riggs, Jr, MD President, A CEP

Phencyclidine Overdose: An Overview

Patients with phencyclidine toxicity present a highly variable initial picture. Some patients will have serious problems, such as coma, respiratory fail- ure, and seizures. Others may present with milder but still disconcerting symptoms, such as nystagmus, ataxia, and paranoid schizophrenia. Coma with eyes open and self-mutilation also have been reported} '2 The majority of patients, however, will present with minimal changes in sensorium, no life-threatening problems, and a t r ans ien t mild paranoia. While attempts have been made by some to relate these prob- lems to blood levels and "stage" the toxicity, the emergency physician rarely is able to obtain rapid blood or urine confirmation of the drug. Treatment, then, must be based on the clinical evaluation of the patient over an observational time. ~Other than those with life-threatening symptoms, the less done for these patients, the better.

The most frequent problems with PCP patients are the toxic consequences of excessive treatment. Somehow physicians seem to have decided that all PCP patients require acid diuresis, haloperidol and propranolol. In fact, 90% or more of these patients will do just fine with no treatment. Recent evidence sug- gests strongly that only 10% to 13% of an ingested dose of PCP can be excreted under the most ideal con- ditions of acid diuresis. Exposure of most of these pa- tients to acid diuresis is an unnecessary hazard and is a procedure which should be reserved for those pa-

tients with serious PCP toxicity, where excretion of a portion may be of some benefit. It is contraindicated in patients with rhabdomyolysis. 3

The article by Patel et al in this issue of Annals reports eight cases of myoglobinuric renal failure. This observation is very important, for acid diuresis of these patients would have been totally inappropriate.

Physicians seeing patients involved with PCP should take measures to avoid unnecessary treatment and should add an appropriate urinalysis to their eval- uation. Measures to prevent further absorption, such as administration of charcoal, should be instituted, and further treatment with diazepam, haloperidol, or forced acid diuresis utilized only when absolutely nec- essary. 1'4 A quiet, supportive environment may be all tha t is needed for the majority of patients.

Barry Rumack, MD Annals Consulting Editor

1. Aronow R, Done AK: Phencyclidine overdose: an emerging concept of management. JACEP 7:56-59, 1978. 2. Grove VE: Painless self-injury after ingestion of ~angel dust." JAMA 242:655-656, 1979. 3. Barton CH, Sterling ML, Vaziri ND: Rhabdomyolysis and acute renal failure associated with phencyclidine intoxica- tion. Arch Intern Med 40:568-569, 1980. 4. Picchioni AL, Consroe PF: Activated charcoal -- a phen- cyclidine antidote, or hog in dogs. N Engl J Med 300:202, 1979.

RRC (Nee LREC)

By any standard, the Liaison Residency Endorse- ment Committee (LREC), formed in January 1975, has been a success. The original dual sponsorship of the American College of Emergency Physicians (ACEP) and the University Association for Emergency Medi- cine (UAEM) was joined by the American Board of Emergency Medicine (ABEM) in May 1976. The Com- mittee has served emergency medicine education well by providing quality control, critique and consultation

to the developing residencies, and useful information for medical students and physicians applying to res- idencies.

It is a unique body that developed clout and re- spect by its contemplated decisions, use of emergency medicine site surveyors and, finally, specific mention in the regulations of Sections 7, 8, and 9 of the Public Health Services Act. Early on, endorsement proce- dures were adopted in accordance with the Liaison

Bo/595 Ann Emerg Med 9:11 (November) 1980