Emergency medicine

From Wikipedia, the free encyclopedia

Emergency medicine is a branch of medicine that is practiced in a hospital emergency department, in the field (in a modified form - see EMS), and other locations where initial medical treatment of illness takes place.

Emergency medicine focuses on diagnosis and treatment of acute illnesses and injuries that require immediate care. While not usually providing long-term care, EM physicians and pre-hospital personnel still provide care with the aim of improving long-term patient outcome. In the United States, some people use the emergency department for outpatient care that could be provided at a doctor's office. As a result, much of emergency room care is general practice (coughs, colds, aches, pains).

A variant of an Emergency Department is an Urgent Care Center, often staffed by non-Emergency Medicine trained physicians and/or nurses, which treats patients who desire or require immediate care, but do not reach the acuity that requires care in an emergency department.

Emergency Medicine involves a large amount of general medicine but involves all fields of medicine including the surgical sub-specialties. Emergency Physicians are tasked with seeing a large number of patients, treating their illnesses and admitting them to the hospital as necessary. The field requires a broad field of knowledge and requires advance procedural skills often including surgical procedures, trauma resuscitation, advance cardiac life support and advanced airway management.

Definition

"Emergency medicine is a field of practice based on the knowledge and skills required for the prevention, diagnosis and management of acute and urgent aspects of illness and injury affecting patients of all age groups with a full spectrum of undifferentiated physical and behavioural disorders. It further encompasses an understanding of the development of pre-hospital and in-hospital emergency medical systems and the skills necessary for this development."

International Federation for Emergency Medicine 1991

History

Emergency Medicine as a standalone medical specialty is relatively young. Prior to the 1960's and 70's, hospital emergency rooms were generally staffed by doctors trained in other specialties, such as internal medicine and primary care. However, during this time period, groups of physicians mostly located in the midwestern United States (notably Minneapolis, Cincinnati, Ohio, Albuquerque, New Mexico, and Denver, Colorado) recognized the need, and the niche, for physicians specifically trained to handle acute medical emergencies.

Organizations around the world

In the United States, the American College of Emergency Physicians (ACEP) is presently the largest member organization of emergency physicians (EPs), and Active membership is open to both allopathic (M.D.) and osteopathic (D.O.) legacy physicians (physicians engaged in the practice of emergency medicine prior to 2000) and those physicians who have completed an emergency medicine residency approved by the Accreditation Council on Graduate Medical Education (ACGME), the American Osteopathic Association (AOA) or are certified by an emergency medicine certifying body recognized by by ACEP. Originally founded in 1968, it was the first Emergency Medicine society formed in the United States. Fellows use the designation FACEP. Membership census: unknown (2006)

The American College of Osteopathic Emergency Physicians (ACOEP) was founded seven years later in 1975. Active membership is open to osteopathic (D.O.) physicians who have practiced emergency medicine for the past three years and/or have completed an emergency medicine residency approved by the AOA or ACGME. Associate membership is available to any person who does not meet the criteria for Active membership but who has a demonstrated interest in emergency medicine and the college. Fellows use the designation FACOEP. Membership census: 2,300 (2006)

The American Academy of Emergency Medicine (AAEM) was formed in 1993 and has been the subject of some controversy due to its traditional position statements concerning board certification, resident "moonlighting", and the practice of "corporate medicine". Nevertheless, AAEM has worked cooperatively alongside the ACEP and the ACOEP when the interests of emergency medicine have called for a united front. Active membership is open to both allopathic (M.D.) and osteopathic (D.O.) physicians who have completed an emergency medicine residency approved by ACGME or the AOA. Fellows use the designation FAAEM. Membership census: 4,200 members (2006)

The American Board of Emergency Medicine (ABEM) provides board certification to allopathic (M.D.) or osteopathic (D.O.) emergency physicians who have successfully completed an ACGME-approved residency in emergency medicine, completed an additional year of practice, passed a written exam, and an oral exam.

The American Osteopathic Board of Emergency Medicine (AOBEM) provides board certification to osteopathic (D.O.) emergency physicians who have successfully completed an AOA-approved residency in emergency medicine, completed an additional two years of practice, passed a written exam, and passed an oral exam.

In the United Kingdom and Ireland, the College of Emergency Medicine sets the examinations that trainees in Emergency Medicine take in order to become consultants (fully-trained emergency physicians). The British Association for Emergency Medicine is the member organization in the UK. In 2005, the two organizations initiated steps to merge as the College of Emergency Medicine.

In Australia and New Zealand, advanced training in Emergency Medicine is overseen by the Australasian College for Emergency Medicine (ACEM).

In Canada, there are two routes to practice emergency medicine. More than two thirds of physicians currently practicing emergency medicine across the Canadian nation have no specific emergency medicine residency training. Emergency physicians who tend to work in more community-based settings complete a residency specializing in Family Medicine and then proceed to obtain an additional year of training of special competence on Emergency Medicine from the College of Family Physicians of Canada (CCFP-EM). Physicians practicing in major urban/tertiary care hospitals will often pursue a 5 year specialist residency in Emergency Medicine, certified by the Royal College of Physicians and Surgeons of Canada. These members typically spend a great deal of time in academic and leadership roles within emergency medicine, EMS, research, and other avenues. There is no significant difference in remuneration or clinical practice type between physicians certified via either route.

See medical emergency for specific lists of medical emergencies and how best to respond.

Practice

In the US, Emergency Medicine is one of the more competitive specialties to get into, and residency programs generally select physicians from the top of their medical school class. There are usually many physicians competing for each residency spot.

Allopathic (M.D.) emergency medicine residencies can be 3 or 4 years in length, combining both the internship and residency into one program or "1+3," utilizing a separate internship followed by 3 years of Emergency Medicine. Osteopathic (D.O.) residencies are four years in length, requiring a one year traditional rotating internship followed by a three-year emergency medicine residency. In addition to the didactic exposure, much of an emergency medicine residency involves rotating through other specialties with a majority of such rotations through the emergency department itself. By the end of their training, EPs are expected to handle a vast field of medical, surgical, and psychiatric emergencies. EPs are therefore both clinical generalists and well-rounded diagnosticians. EPs are considered specialists in advance cardiac life support protocols ('codes') and airway management.

The employment arrangement of emergency physician practices are either private (a democratic group of EPs staff an ED under contract), institutional (EPs with an independent contractor relationship with the hospital), corporate (EPs with an independent contractor relationship with a third party staffing company that services multiple emergency departments) or governmental (employed by the US armed forces, the US public health service or other government agency).

Most emergency physicians staff hospital emergency departments in shifts, a job structure necessitated by the 24/7 nature of the emergency department.

See also

• CPR
• Toxicology
• Emergency medical service
• Traumatology
• Physical trauma
• Rescue squad
• Emergency medical technician
• First aid
• Paramedic
• Golden hour

External links

• American Academy of Emergency Medicine
• American Board of Emergency Medicine
• American Board of Medical Specialties
• American College of Emergency Physicians
• Canadian Association of Emergency Physicians
• Emergency Medicine
• European Resuscitation Council
• European Society for Emergency Medicine
• National Centre for Emergency Medicine Informatics
• On-Line Emergency Medicine Journal Club (via JournalReview.org
• Society for Academic Emergency Medicine