Samuel M. Galvagno, Jr, DO, MS, PhD, is a physician at the University of Maryland in Baltimore, Maryland, USA. He joined the Society of Critical Care Medicine (SCCM) in 2005 and is currently involved on several committees and is one of the authors of SCCM's Fundamentals of Critical Care Support: Obstetrics, 2nd edition. He enjoys flying planes, martial arts, and welding in his free time. His professional interests include research, resuscitation, and trauma. Learn more about Dr. Galvagno's journey into critical care and his advice for those just starting their careers.
Why do you love being in critical care?
My primary specialty, anesthesiology, was a means to an end for me. Since first working with Paul L. Marino, MD, PhD, in New York City many years ago, I quickly became fascinated with the ability to understand physiology while also applying pharmacology to the sickest patients in the hospital. I also learned that the sickest patients often recover in the ICU. But there is so much more involved in critical care! The specialty allows us to interact with colleagues from disparate disciplines, ranging from integrative medicine specialists to critical care nurses, respiratory therapists, advanced practitioners, and every physician specialist imaginable.
Most importantly, the social aspect of our work with patients and families in the ICU is the most rewarding. We meet patients and families in the worst imaginable situations and work with them to establish goals of care. Whether it be end-of-life care or a life saved with a fully functional recovery, critical care is the specialty that unites multiple medical disciplines to always do what is best for the patient.
Finally, I am an ardent supporter of providing appropriate critical care as soon as possible, even in the prehospital arena. Much of my research has focused on this area, and hopefully more of my clinical practice in the future.
How did you get into critical care?
I started as an EMT, then a paramedic, ski patroller, and general medical officer in the U.S. Air Force. Along the way, I was fortunate to meet Dr. Marino, the acclaimed author of The ICU Book. He helped me understand that the base specialty for critical care is less important than where a fellowship is completed. He influenced me deeply—during my mandatory Air Force active duty years, I longed to return to the critical care world.
Following tours as an emergency physician and flight surgeon under the tutelage of critical care legends (and former SCCM presidents) such as Pamela A. Lipsett, MD, MHPE, MCCM, and Todd Dorman, MD, MCCM, I was fortunate to obtain outstanding multidisciplinary critical care training at Johns Hopkins University after finishing my anesthesiology residency at Brigham and Women's Hospital.
What are the top advances in critical care since you started your career?
Critical care ultrasound, improved airway devices (e.g., videolaryngoscopy), and the ability to monitor patients with minimally invasive devices have helped intensivists make better decisions and improve care at the bedside. While these technological innovations are important, what is more important is the ongoing recognition of critical care as a multidisciplinary, full-time specialty. As our training programs and acceptance as a specialty (not a part-time secondary subspecialty) continue to evolve, so will patient care.
What is your biggest professional achievement?
My biggest professional achievement is helping to mentor the next generation of critical care professionals! Whether it be anesthesiologist-intensivists, respiratory therapists, advanced practice practitioners, pharmacists, or any other healthcare professional involved with critical care, I derive immense pleasure in helping others learn how to take care of critically ill patients.
What advice do you have for those starting their critical care careers?
For physicians, nurses, pharmacists, or any other healthcare professional, it doesn't matter where you begin. I began as an EMT and paramedic and gradually gained more and more exposure to critically ill patients. Those interested in critical care need to seek out every opportunity to be around the "sickest of the sick." This may mean doing extra rotations in an ECMO unit, working in the operating room or catheter lab, or shadowing a critical care transport team. To become more comfortable with critically ill patients, clinicians need to get the "reps" (repetitions).
What do you see as the most challenging issue facing critical care?
Staffing shortages and burnout are the two most challenging issues facing our specialty. They are interrelated. We need to learn how to work smarter. The days of not taking a lunch break for 13 hours or working 36-hour shifts need to disappear. We need to do a better job of integrating wellness into our ICUs. This doesn't just mean yoga, pet visits, or other strategies (although these are helpful). We must do a better job of leveraging technology to improve our workflows (e.g., data interpretation, predictive analytics, easier documentation) so we can spend more time at the bedside with patients and families and do more teaching with the many learners who rotate into our ICUs.
What industry trends have you excited about the future?
I am excited about new monitoring techniques—some that incorporate predictive analytics—that allow us to make better decisions for our patients. I am also very interested in the work of some of my colleagues who continue to advance the technology involved in telemedicine and telehealth. These technologies can potentially bring critical care knowledge and practices to underserved areas.
What do you love about SCCM membership?
The multiprofessional nature of SCCM makes it a truly unique organization. I have met a wide variety of critical care experts in my specialties (anesthesiology and critical care), as well as many others. SCCM continues to offer world-class educational products that members can deliver at their institutions (e.g., the Fundamentals courses). Additionally, the annual Critical Care Congress is always hosted at great locations!
Connect with @Samuel Galvagno on SCCM Connect or Twitter @GalvagnoSam!