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Features of
Emergency Medicine
Emergency medical
care of a high standard should be available to every person in need in all
situations and at all times. This requires a dedicated system which
provides care for all acutely ill or injured people in an appropriate form.
The specialty of Emergency Medicine meets the scientific, clinical and
organisational need for a medical discipline that has a primary concern
with emergencies. It requires a physical and/or conceptual presence in the
pre-hospital, in-hospital and inter-hospital care of emergency patients.
The province of Emergency Medicine is early diagnosis and treatment of all
life, organ or limb-threatening conditions. Timely and well-coordinated
care limits both immediate and late mortality and reduces the duration and
severity of morbidity from sudden illness and injury. The relief of
suffering is also of paramount importance.
The emergency health care system must be clinically, organisationally and
financially independent. Certain features such as triage, resuscitation
and facilities for short-term observation and therapy should be
incorporated into the system. The amount and type of emergency work is
difficult to predict with certainty and so staffing and resources must be
adequate for all likely situations. Training must be extensive so as to
prepare specialists for the management of a wide range of conditions.
Good practice in Emergency Medicine will maximise the likelihood of a
favourable outcome for the patient. Therapy should be consistent with
current knowledge and care must be provided in a humane and respectful
manner with psycho-social support available as required. There is no
defined time limit to the duration of emergency care.
Emergency Medicine encourages collaboration between all members of the
health care team. An efficient chain of care requires liaison with
pre-hospital care providers, hospital specialists and other staff and also
with community medical and nursing staff and social workers. Team work is
essential and must involve close cooperation and integrated facilities for
protocol development and implementation, teaching and research.
However, the specialty of Emergency Medicine will only realise its full
potential when qualified emergency physicians possess the authority to
direct the emergency care that patients receive and accept responsibility
for the outcome of that care. These physicians must have a similar
responsibility for the management of the environment in which emergency
care occurs.
In the case of a major incident, a natural disaster or other special
circumstances, specialists in Emergency Medicine would normally lead the
organisation of medical care. It is thus essential that members of the
specialty participate in disaster planning at local, regional, national
and international levels. However, the difference between Emergency
Medicine in normal circumstances and emergency medicine in special
circumstances (disaster medicine) is more than just a matter of degree. A
disaster is a situation with an imbalance between the immediate need for
medical care and the resources available which is not the case in normal
emergency medicine. Specific training in preparedness for disasters is
thus required for all Emergency Physicians.
Objectives of Emergency Medicine
=> to provide an
integrated system of pre-hospital, in-hospital and inter-hospital
emergency care
=> to standardise and to improve the quality of emergency medical care
=> to reduce the mortality, morbidity, disability and suffering associated
with injury and sudden illness
=> to research into the nature and treatment of medical emergencies
=> to collect epidemiological data which relate to the prevention of
accidents and to health promotion
=> to study the epidemiology and the management of major incidents and
disasters and to participate in the planning for such circumstances.
=> to study the ethical problems involved in emergency medical care and to
provide guidelines for decision making.
Training for and eligibility to practise Emergency Medicine
The provision of
high quality emergency care requires physicians with specialised training.
Other doctors who are not specialists in Emergency Medicine will still be
involved in the care of patients with emergency conditions. However, the
head of a department of Emergency Medicine and the senior medical staff of
the department must be recognised specialists in that field.
Emergency Medicine is a specialty in its own right. Physicians may enter a
training programme from a background in surgery, internal medicine,
anaesthesia, paediatrics, intensive care or a mixture of these subjects.
Training in the specialty of Emergency Medicine will require a minimum of
two years full-time experience in a department providing emergency medical
care for a broad range of cases. Up to one year of this may be included as
part of basic specialist training. However, supervised practice at a
higher level is essential. The right to practise as a specialist in
Emergency Medicine should be granted by a specific board of accreditation.
European certification in Emergency Medicine is desirable. It should be
based on comparable standards throughout all European countries. A
pan-European examination should also be developed which evaluates
knowledge, skills and management capabilities. The implementation of
similar standards of training in Emergency Medicine throughout Europe is a
priority.
Council of the
European Society for Emergency Medicine (EuSEM)
July 1998
Published: European Journal of Emergency Medicine (EJEM) 1998, 5(1): 7-8;
revised: EJEM 1998, 5(4): 1-2
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