Emergency Medicine is a speciality of medicine that focuses on the diagnosis and treatment of acute illnesses and injuries that require immediate medical attention. While not usually providing long-term or continuing care, emergency medicine physicians diagnose a wide array of pathology and undertake acute interventions to stabilize the patient. These professionals practice in hospital emergency departments, in the prehospital setting via emergency medical service and other locations where initial medical treatment of illness takes place. Just as clinicians operate by immediacy rules under large emergency systems, emergency practioniers aim to diagnose emergent conditions and stabilize the patient for definitive care.
Urgent Care Centers are often staffed by physicians, physician assistants, nurses and nurse practitioners who may or may not be formally trained in emergency medicine. They offer primary care treatment to patients who desire or require immediate care, but who do not reach the acuity that requires care in an emergency department or admission to a hospital.
Emergency Medicine encompasses a large amount of general medicine but involves virtually all fields of medicine and surgery including the surgical sub-specialties. Emergency physicians are tasked with seeing a large number of patients, treating their illnesses and arranging for disposition - either admitting them to the hospital or releasing them after treatment as necessary. The emergency physician requires a broad field of knowledge and advanced procedural skills often including surgical procedures, trauma resuscitation, advanced cardiac life support and advanced airway management. Emergency physicians ideally have the skills of many specialists - the ability to manage a difficult airway (anesthesia), suture a complex laceration (plastic surgery), reduce (set) a fractured bone or dislocated joint (orthopedic surgery), treat a heart attack (internist), work-up a pregnant patient with vaginal bleeding (Obstetrics and Gynecology), and stop a bad nosebleed (ENT).
International Federation for Emergency Medicine 1991
Emergency Medicine (EM) as a medical specialty is relatively young. Prior to the 1960s and 70's, hospital "emergency rooms" were generally staffed by physicians on staff at the hospital on a rotating basis, among them general surgeons, internists, psychiatrists, and dermatologists. Physicians in training (interns and residents), foreign medical graduates and sometimes nurses also staffed the ED. EM was born as a specialty in order to fill the time commitment required by physicians on staff to work in the increasingly chaotic emergency departments (EDs) of the time. During this period, groups of physicians began to emerge who had left their respective practices in order to devote their work completely to the ED. The first of such groups was headed by Dr. James DeWitt Mills who, along with four associate physicians at Alexandria Hospital, VA established 24/7 year round emergency care which became known as the "Alexandria Plan". Soon, the problem of the "ER", propagated by published reports and media coverage of the poor state of affairs for emergency medical care had culminated with the establishment of the first emergency medicine training program at Cincinnati General Hospital, with Bruce Janiak, M.D. being the first emergency medicine resident in 1970. During the 1970s, several other residency programs developed throughout the country. At this time, EM was not yet a recognized specialty and hence had no primary board certification exam. It was not until the establishment of ACEP, the recognition of emergency medicine training programs by the AMA and the AOA, and in 1979 a historical vote by the American Board of Medical Specialties that EM became a recognized medical specialty.
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.
In the United States, there are many member organizations for emergency physicians:
A number of fellowships are available for emergency medicine graduates including prehospital medicine (emergency medical services), toxicology, sports medicine, ultrasound, and pediatric emergency medicine.
In the United Kingdom, emergency medical trainees enter training after five years of medical school and two-years of the Foundation Programme. During the three year core training programme (Acute Care Common Stem), doctors will complete training in anaesthesia, actue medicine, intensive care and emergency medicine and also sit the Membership of the College of Emergency Medicine (MCEM) examination. Trainees will then go onto Higher Training, lasting a further 4 years. Before the end of higher training, the final examination of MCEM must be taken. Upon completion of training the doctor will become a Consultant in Emergency Medicine and will be eligible for entry on the GMC Specialist Register. Emergency Medicine training in the UK is emerging. Traditionally emergency medics have been drawn from anaesthesia, medicine and surgery. The majority of A&E consultants are surgically trained and hold the Fellowship of Royal College of Surgeons of Edinburgh in Accident and Emergency - FRCSEd(A&E). Many of these consultants will be referred to as 'Mister'. Medical consultants will be holders of the MRCP and anaesthetic trained consultants will hold the FRCA and some may hold both FRCA and MRCP. A&E Consultants may dual accredit in Intensive Care Medicine.
Most emergency physicians staff hospital emergency departments in shifts, a job structure necessitated by the 24/7 nature of the emergency department.
In the United Kingdom all Consultants in Emergency Medicine work in the NHS. There is little scope for private emergency practice.
Research on emergency medicine detailed by scientists at University of North Carolina, Department of Emergency Medicine.
Nov 04, 2009; A report, 'International Federation for Emergency Medicine model curriculum for medical student education in emergency medicine,'...
Antitrust: Emergency Medicine Physicians Lack Standing to Bring Antitrust Action against Physician-Certification Organization-Daniel V. American Board of Emergency Medicine1
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American College of Emergency Medicine Recognizes Excellence in Emergency Medicine Prestigious Awards Given at Annual Scientific Assembly in Denver
Oct 18, 2012; DALLAS, TX -- The following information was released by the American College of Emergency Physicians: The American College of...
International Federation for Emergency Medicine model curriculum for medical student education in emergency medicine
Jul 01, 2009; ABSTRACT There is a critical and growing need for emergency physicians and emergency medicine resources worldwide. To meet this...