I recently have been working on a few different projects that have caused me to stop and reflect, “what is emergency medicine”. This specialty is very young within the house of medicine, compared to most other medical specialties. And while other specialties developed out of an attention to anatomical region or approach to diagnosis and treatment, emergency medicine has developed in large part to fill a gap in the healthcare workforce and address a specific needed skillset within healthcare systems.
Different health systems around the world have different structures and models of care. Some countries have developed robust primary health care systems with universal coverage for all citizens, while others have adopted alternative models of preventative and acute care. There is even greater diversity in how individuals seek and receive care for urgent and emergent health needs. The spectrum of the quality and availability of emergency care often varies within countries as well, contrasting highly populated urban centers against rural communities, or between different counties/provinces.
As a frame of reference, emergency medical care is any unscheduled episode of care for an acute health problem. It should be available 24 hours a day and systems should aim for patients to be dispositioned to inpatient units, taken to the operating room/theater, or discharged for outpatient care. Ideally, patients should spend less than 24 hours in the emergency ward, it is meant to be a short-term waypoint for diagnosis, treatment, and disposition. The skills and approach to emergency care are focused on the initial management, stabilization, and resuscitation of ill patients, as well as making targeted diagnostic and treatment decisions. Emergency care units shouldn’t be built to do any and all testing and treatment, but should complement other care pathways within the health system.
In much of the world the emergency ward is the most common entry point to hospitals and inpatient care. And specialized training in emergency medicine improves the quality of patient care with associated reductions in morbidity and mortality. Emergency medicine providers must be capable of treating all age groups, across undifferentiated and potentially routine or life-threatening patient presentations. And yet, there are days when an emergency medicine provider may not encounter any patients with a true life-threatening emergency, but rather may only see patients with a variety of complaints that exist here and now, and require attention to limit longer-term morbidity or mortality. Conversely, other days may have multiple critically-ill patients all at once. Usually, those attracted to emergency medicine enjoy the diversity of presentations, and it would seem almost no two days at work are the same.
As alluded to above, the emergency departments existed as a triage ward quite some time before the development of a specialized education and training in emergency medicine. And in many emergency care wards around the world today, patients are seen by students or junior doctors with little interest or training in emergent medical conditions. It is also important to remember that most emergency department patients are undifferentiated and evaluating a patient for causes of a single complaint requires a thorough history, exam, and targeted diagnostic testing. This skill set is how an emergency medicine provider can assess a patient who presents with chest pain and distinguish a myocardial infarction from a pulmonary embolism from musculoskeletal pain. To me, this is the real benefit of emergency medical education and specialized care: there are so many treatments and disposition pathways any singular chief complaint can lead to.
But, most anyone reading this post is likely familiar with the need for improved emergency care around the world. And as more countries recognize emergency medicine as a specialty and as more individuals decide to dedicate their career to providing high-quality emergency medical care, the global (and local) standards will continue to improve. An ever-growing body of evidence-based care continues to refine when and how we care for different conditions. And it’s so important that we continue to address the multitude of “unscheduled” health needs for our patients. Continue to adapt emergency medicine to your context and improve the care for your patients; as one of the most well-known EM-education podcasters often says: “what you do matters”.