Emergency medicine
Encyclopedia
Emergency medicine is a medical specialty in which physician
Physician
A physician is a health care provider who practices the profession of medicine, which is concerned with promoting, maintaining or restoring human health through the study, diagnosis, and treatment of disease, injury and other physical and mental impairments...

s care for patients with acute illnesses or injuries which require immediate medical attention. While not usually providing long-term or continuing care, emergency medicine physicians diagnose a variety of illnesses and undertake acute interventions to stabilize the patient. Emergency medicine physicians practice in hospital
Hospital
A hospital is a health care institution providing patient treatment by specialized staff and equipment. Hospitals often, but not always, provide for inpatient care or longer-term patient stays....

 emergency departments, in pre-hospital settings via emergency medical services
Emergency medical services
Emergency medical services are a type of emergency service dedicated to providing out-of-hospital acute medical care and/or transport to definitive care, to patients with illnesses and injuries which the patient, or the medical practitioner, believes constitutes a medical emergency...

, other locations where initial medical treatment of illness takes place, and recently the intensive-care unit. Just as clinicians operate by immediacy rules under large emergency systems, emergency practitioners aim to diagnose emergent conditions and stabilize the patient for definitive care.

Physicians specializing in emergency medicine in the US and Canada can enter fellowships to receive credentials in subspecialties. These are palliative medicine, medical toxicology
Medical toxicology
Medical toxicology, or clinical toxicology, is a subspecialty of medicine. It is practiced by toxicologists, but toxicologic knowledge is often used in emergency medicine, occupational medicine and pediatrics...

, wilderness medicine
Wilderness medicine
Wilderness medicine is defined by difficult patient access, limited equipment, and environmental extremes. Today, wilderness or expedition medicine is practiced by Wilderness First Responders, Wilderness EMTs, Remote/Offshore/Wilderness Paramedics and Physicians on expeditions, in outdoor...

, pediatric
Pediatrics
Pediatrics or paediatrics is the branch of medicine that deals with the medical care of infants, children, and adolescents. A medical practitioner who specializes in this area is known as a pediatrician or paediatrician...

 emergency medicine, sports medicine
Sports medicine
Sports medicine is a branch of medicine that deals with physical fitness, treatment and prevention of injuries related to sports and exercise...

, and undersea and hyperbaric medicine.

Scope

Emergency medicine has evolved to treat conditions that pose a threat to life, limb, or have a significant risk of morbidity. In the words of the International Federation for Emergency Medicine:


"Emergency medicine is a medical specialty—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 behavioral 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."


Emergency Medicine encompasses a large amount of general 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 must have the skills of many specialists—the ability to resuscitate a patient (Critical Care Medicine
Critical Care Medicine
Critical Care Medicine is a peer-reviewed medical journal in the field of intensive care medicine. It is the official publication of the Society of Critical Care Medicine, and is published by Lippincott Williams & Wilkins. The editor-in-chief is Joseph E. Parrillo....

), manage a difficult airway (Anesthesia
Anesthesia
Anesthesia, or anaesthesia , traditionally meant the condition of having sensation blocked or temporarily taken away...

), suture a complex laceration (Plastic Surgery
Plastic surgery
Plastic surgery is a medical specialty concerned with the correction or restoration of form and function. Though cosmetic or aesthetic surgery is the best-known kind of plastic surgery, most plastic surgery is not cosmetic: plastic surgery includes many types of reconstructive surgery, hand...

), reduce (set) a fractured bone or dislocated joint (Orthopedic surgery
Orthopedic surgery
Orthopedic surgery or orthopedics is the branch of surgery concerned with conditions involving the musculoskeletal system...

), treat a heart attack (Cardiology
Cardiology
Cardiology is a medical specialty dealing with disorders of the heart . The field includes diagnosis and treatment of congenital heart defects, coronary artery disease, heart failure, valvular heart disease and electrophysiology...

), work-up a pregnant patient with vaginal bleeding (Obstetrics and Gynecology), stop a bad nosebleed (ENT
Otolaryngology
Otolaryngology or ENT is the branch of medicine and surgery that specializes in the diagnosis and treatment of ear, nose, throat, and head and neck disorders....

), place a chest tube
Chest tube
A chest tube is a flexible plastic tube that is inserted through the side of the chest into the pleural space. It is used to remove air or fluid , or pus from the intrathoracic space...

 (Cardiothoracic Surgery
Cardiothoracic Surgery
Cardiothoracic surgery is the field of medicine involved in surgical treatment of diseases affecting organs inside the thorax —generally treatment of conditions of the heart and lungs .-Cardiac / Thoracic:...

), and to conduct and interpret ultrasounds  (Radiology
Radiology
Radiology is a medical specialty that employs the use of imaging to both diagnose and treat disease visualized within the human body. Radiologists use an array of imaging technologies to diagnose or treat diseases...

).

History

During the French Revolution
French Revolution
The French Revolution , sometimes distinguished as the 'Great French Revolution' , was a period of radical social and political upheaval in France and Europe. The absolute monarchy that had ruled France for centuries collapsed in three years...

, after seeing the speed with which the carriages of the French flying artillery maneuvered across the battlefields, French military surgeon Dominique Jean Larrey
Dominique Jean Larrey
Dominique Jean Larrey was a French surgeon in Napoleon's army and an important innovator in battlefield medicine.-Biography:...

 applied the idea of ambulances, or "flying carriages", for rapid transport of wounded soldiers to a central place where medical care was more accessible and effective. Larrey manned ambulances with trained crews of drivers, corpsmen and litter-bearers and had them bring the wounded to centralized field hospitals, effectively creating a forerunner of the modern MASH
Mobile Army Surgical Hospital
The Mobile Army Surgical Hospital refers to a United States Army medical unit serving as a fully functional hospital in a combat area of operations. The units were first established in August 1945, and were deployed during the Korean War and later conflicts. The U.S...

 units. Dominique Jean Larrey
Dominique Jean Larrey
Dominique Jean Larrey was a French surgeon in Napoleon's army and an important innovator in battlefield medicine.-Biography:...

 is sometimes called the father of emergency medicine for his strategies during the French wars.

Emergency medicine (EM) as a medical specialty is relatively young. Prior to the 1960s and 70s, hospital emergency departments 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 Emergency Department (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; Dr. Chalmers A. Loughridge, Dr. William Weaver, Dr. John McDade, and Dr. Steven Bednar at Alexandria Hospital, VA established 24/7 year round emergency care which became known as the "Alexandria Plan". It was not until the establishment of American College of Emergency Physicians
American College of Emergency Physicians
The American College of Emergency Physicians is the first and largest professional organization of emergency medicine physicians in the United States. It was founded in 1968 and is now headquartered in Irving, Texas. As of 2009 ACEP has over 28,000 physician members.The college exists to support...

 (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
American Board of Medical Specialties
The American Board of Medical Specialties is a non-profit physician-led umbrella organization for 24 of the 26 approved medical specialty boards in the United States...

 that EM became a recognized medical specialty. The first Department of Emergency Medicine at a U.S. medical school was founded in 1971 by Vail V. Anderson at the University of Southern California
University of Southern California
The University of Southern California is a private, not-for-profit, nonsectarian, research university located in Los Angeles, California, United States. USC was founded in 1880, making it California's oldest private research university...

.

United Kingdom

Emergency medicine traces its development as a specialty in UK to 1952 when Mr Maurice Ellis was appointed as the first consultant in Emergency Medicine in the UK at Leeds General Infirmary. In 1967 the Casualty Surgeons Association was established with Maurice Ellis as its first President. The name of the Association was changed twice, in 1990, to the British Association for Accident and Emergency Medicine, and later on in 2004, to British Association for Emergency Medicine (BAEM). In 1993, Intercollegiate Faculty of Accident and Emergency Medicine (FAEM) was formed at the Royal College of Surgeons of England, London. In 2005, the BAEM and the FAEM were merged to form College of Emergency Medicine
College of Emergency Medicine
The College of Emergency Medicine is an organization of emergency physicians in the United Kingdom which sets standards of training and administers examinations for emergency physicians in the United Kingdom and Ireland.-Entrance criteria:...

. The College of Emergency Medicine is the single authoritative body for emergency medicine in the UK. It conducts its fellowship and membership exams, publishes guidelines and standards for the practise of emergency medicine, and has its own journal, called the Emergency Medicine Journal (EMJ).

Australia and New Zealand

In Australia
Australia
Australia , officially the Commonwealth of Australia, is a country in the Southern Hemisphere comprising the mainland of the Australian continent, the island of Tasmania, and numerous smaller islands in the Indian and Pacific Oceans. It is the world's sixth-largest country by total area...

 and New Zealand
New Zealand
New Zealand is an island country in the south-western Pacific Ocean comprising two main landmasses and numerous smaller islands. The country is situated some east of Australia across the Tasman Sea, and roughly south of the Pacific island nations of New Caledonia, Fiji, and Tonga...

, advanced training in Emergency Medicine is overseen by the Australasian College for Emergency Medicine
Australasian College for Emergency Medicine
The Australasian College for Emergency Medicine with its headquarters in Melbourne, is the primary training body for specialist emergency physicians in Australia and New Zealand...

 (ACEM).Emergency Medicine Board certification in Australia is a five to seven years of training, in some way it considered as a subspecialty of medical or surgical track residency program.

India

In India, many private hospitals and institutes have been providing emergency medicine training for doctors, nurses & paramedics since 1994. The certification programs varied from 6 months to 3 years. Emergency medicine was recognized as a separate specialty by Medical Council of India (MCI) only from July 2009. After this many medical colleges are about to start postgraduate training i.e. MD in Emergency Medicine. It will be at least a few years until the specialty gets streamlined in India. .

Canada

In Canada
Canada
Canada is a North American country consisting of ten provinces and three territories. Located in the northern part of the continent, it extends from the Atlantic Ocean in the east to the Pacific Ocean in the west, and northward into the Arctic Ocean...

, there are two routes to certification in emergency medicine. The vast majority of full-time practicing ED physicians in Canada are certified via one of these routes. Most busy urban, sub-urban and larger rural hospitals are staffed primarily by full time, certified career emergency physicians. Smaller rural and community hospitals may still be staffed by family physicians who work in the emergency department on a part-time rotating basis. Basic experience in emergency medicine is a core component of family medicine training in Canada. The general trend in Canadian emergency departments over the last decade has been the gradual replacement of part-time, non-certified physicians (mostly family physicians) by full-time certified emergency physicians. This trend was first noted in larger academic centers but has gradually evolved to include most busy emergency departments.

The two routes to ED certification can be summarized as follows:

Route 1: A five year residency leading to the designation of FRCP(EM) through the Royal College of Physicians and Surgeons of Canada (Emergency Medicine Board Certification- Emergency Medicine Consultant).

Route 2: A 1 year emergency medicine fellowship after a two year family medicine residency leading to the designation of CCFP(EM) through the College of Family Physicians of Canada (Competency Certification)

CCFP(EM) ED physicians outnumber FRCP(EM) physicians by about 3 to 1, and tend to work primarily as clinicians with a smaller focus on academic activities such as teaching and research mostly run urgent care units. FRCP(EM) ED Emergency Medicine Board specialists tend to congregate in academic centers and tend to have more academically oriented careers, which emphasize administration, research, critical care, disaster medicine, teaching and tend to go for subspecialty in toxicology, Critical Care, pediatrics, and sport medicine . Furthermore the length of the FRCP(EM) residency allows more time for formal training in these areas.

As a consequence of the above, most Canadian medical students who wish to pursue an academic emergency medicine career, and/or work primarily in a major academic center, choose the FRCP route of certification. Conversely, those who wish to function primarily as clinical ED physicians choose the CCFP route of certification.

Although many in the Emergency Medicine community in Canada feel that a unified training process would be beneficial to the current 2 stream schism, this has yet to happen for a variety of complex reasons.

China

There are only two academic societies in EM in China, Chinese Association of EM (CAEM) and Chinese College of Emergency Physicians (CCEP, equivalent to ACEP in US). CAEM was established in 1986, under the management of the China Medical Society (CMS). However, CCEP was organized by the Ministry of Public Health in 2009. Their primary missions and tasks are not yet clearly defined. As a matter of fact, there are some overlaps in terms of organization administrators and academic activities.

United Kingdom and Ireland

In the United Kingdom
United Kingdom
The United Kingdom of Great Britain and Northern IrelandIn the United Kingdom and Dependencies, other languages have been officially recognised as legitimate autochthonous languages under the European Charter for Regional or Minority Languages...

 and Ireland
Ireland
Ireland is an island to the northwest of continental Europe. It is the third-largest island in Europe and the twentieth-largest island on Earth...

, the College of Emergency Medicine
College of Emergency Medicine
The College of Emergency Medicine is an organization of emergency physicians in the United Kingdom which sets standards of training and administers examinations for emergency physicians in the United Kingdom and Ireland.-Entrance criteria:...

 sets the examinations that trainees in Emergency Medicine take in order to become consultants (fully trained emergency physician
Emergency physician
An emergency physician is a physician who works at an emergency department to care for acutely ill patients. The emergency physician is a specialist in advanced cardiac life support , trauma care such as fractures and soft tissue injuries, and management of other life-threatening situations.In...

s). Physicians that have passed the fellowship examination of the college of emergency medicine are awarded the post nominals 'FCEM'.

United States

In the United States
United States
The United States of America is a federal constitutional republic comprising fifty states and a federal district...

, there are many member organizations for emergency clinicians:
  • The American Academy of Emergency Medicine
    American Academy of Emergency Medicine
    The American Academy of Emergency Medicine is a professional medical association of emergency medicine physicians concerned with the "corporate practice of medicine" and the negative consequences related to patient care. It was formed in 1993...

     (AAEM) restricts its membership to board certified specialists in emergency medicine, and as of 2009 has over 6000 members. It promotes the independence of emergency physicians and seeks to limit the interference of corporations and other outside groups in the doctor-patient relationship.
  • The American College of Emergency Physicians
    American College of Emergency Physicians
    The American College of Emergency Physicians is the first and largest professional organization of emergency medicine physicians in the United States. It was founded in 1968 and is now headquartered in Irving, Texas. As of 2009 ACEP has over 28,000 physician members.The college exists to support...

     (ACEP) is the oldest and largest professional organization. Originally founded in 1968, it now has over 25,000 members, although some became members before board certification in Emergency Medicine was required.
  • The American College of Osteopathic Emergency Physicians
    American College of Osteopathic Emergency Physicians
    The American College of Osteopathic Emergency Physicians is a professional organization of emergency medicine physicians. It was founded in 1975, seven years after the oldest and largest organization, ACEP...

     (ACOEP) was founded in 1975 and is open only to D.O. emergency physicians.
  • The Association of Emergency Physicians
    Association of Emergency Physicians
    The Association of Emergency Physicians is a professional organization of emergency medicine physicians. It was founded in 1991 and offers membership to any practicing emergency physician regardless of training. Therefore, it is more inclusive than its counterparts ACEP and ACOEP...

     (AEP) offers membership to any practicing emergency physician regardless of training.
  • The Emergency Department Practice Management Association (EDPMA) is a trade association that offers membership to emergency medicine physician groups and their practice business partners, including billing companies and emergency department supporting organizations like EMR firms, consultants, and scribe companies. Founded in 1997, EDPMA's members make it their business to deliver quality care in the emergency department.


In the United States and Canada, there are four ways to become board certified
Board certification
Board certification is the process by which a physician , dentist , or podiatrist in the United States demonstrates through either written, practical, and/or simulator based testing, a mastery of the basic knowledge and skills that define an area of medical specialization...

 in emergency medicine:
  • The American Board of Emergency Medicine
    American Board of Emergency Medicine
    The American Board of Emergency Medicine is an organization that provides board certification in the medical specialty of emergency medicine to qualified physicians....

     (ABEM) is primarily for MD
    Doctor of Medicine
    Doctor of Medicine is a doctoral degree for physicians. The degree is granted by medical schools...

    's, and is under the authority of the American Board of Medical Specialties
    American Board of Medical Specialties
    The American Board of Medical Specialties is a non-profit physician-led umbrella organization for 24 of the 26 approved medical specialty boards in the United States...

    .
  • The American Osteopathic Board of Emergency Medicine
    American Osteopathic Board of Emergency Medicine
    The American Osteopathic Board of Emergency Medicine is the smallest of three organizations that provide board certification in the medical specialty of emergency medicine...

     (AOBEM) certifies only emergency physicians with a D.O.
    Doctor of Osteopathic Medicine
    Doctor of Osteopathic Medicine is a professional doctoral degree for physicians in the United States. Holders of the MD degree, Doctor of Medicine, have the same rights, privileges and responsibilities as osteopathic physicians in the United States.The American Osteopathic Association’s Commission...

     degree. It is under the authority of the American Osteopathic Association
    American Osteopathic Association
    The American Osteopathic Association is the representative member organization for the over 78,000 osteopathic medical physicians in the United States...

    .
  • The Royal College of Physicians and Surgeons of Canada
    Royal College of Physicians and Surgeons of Canada
    The Royal College of Physicians and Surgeons of Canada ' , French: Collège royal des médecins et chirurgiens du Canada, is a national, private, nonprofit organization established in 1929 by a special Act of Parliament to oversee the medical education of specialists in Canada...

    .
  • The Board of Certification in Emergency Medicine (BCEM) is the fourth route to emergency medicine board certification - outside of the ABEM, AOBEM, or RCPSC exams. The BCEM is the newest certifying body in emergency medicine, and since 1988 the only organization in the United States that will grant board certification in emergency medicine to a physician who has not completed an emergency medicine residency (but did complete another residency, such as one of the primary care residencies). It is under the authority of the American Board of Physician Specialists/American Association of Physician Specialists.

Turkey

In Turkey
Turkey
Turkey , known officially as the Republic of Turkey , is a Eurasian country located in Western Asia and in East Thrace in Southeastern Europe...

 there are two associations for Emergency Physicians:
  • Emergency Medicine Association of Turkey (EMAT) is the oldest professional organization.
  • Emergency Physicians' Association of Turkey (EPAT) is the second organization and refers to Emergency Medicine Specialists.

Canada

In Canada there are a few different ways to become certified as an emergency physician. For all methods one has to first complete a medical degree. The next most common step is to complete two years of family medicine residency offered by the College of Family Physicians Canada
College of Family Physicians Canada
The College of Family Physicians of Canada is a professional association and the legal certifying body for family medicine in Canada. This national organization of family physicians was founded in 1954 and currently numbers over 25,000 members....

 (CFPC) followed by a further one year residency in emergency medicine. There is also a 5 year residency offer by the Royal College of Physicians and Surgeons of Canada
Royal College of Physicians and Surgeons of Canada
The Royal College of Physicians and Surgeons of Canada ' , French: Collège royal des médecins et chirurgiens du Canada, is a national, private, nonprofit organization established in 1929 by a special Act of Parliament to oversee the medical education of specialists in Canada...

 that may be completed instead of the above. The CFPC also allows those who have worked a minimum of 4 years at a minimum of 400 hours per year in emergency medicine to challenge the examination of special competence in emergency medicine and thus become specialized.

China

The current post-graduate emergency medicine training process is highly complex in China. The first EM post-graduate training took place in 1984 at the Peking Union Medical College Hospital. Because specialty certification in EM has not been established, formal training is not required to practice emergency medicine in China. For those physicians that do choose to obtain training in EM, several options are available. Graduates from medical school can apply directly to hospitals for staff physician-in-training positions which eventually lead to a staff position at that same hospital. In addition, physicians from smaller hospitals can go to those larger academic centers for a 6 to 12 month post-graduate re-education. While these physicians may undergo the same training as the staff physicians, they will return to their own hospital once their training is completed. Finally, physicians who have completed previous post-graduate training may choose to apply for fellowship positions for further training in emergency medicine.

About one decade ago, emergency medicine residency training was centralized at the municipal levels, following the guidelines issued by The Ministry of Public Health. Residency programs in all hospitals are called residency training bases, which have to be approved by local health governments. These bases are hospital-based, but the residents are selected and managed by the municipal associations of medical education. These associations are also the authoritative body of setting up their residents' training curriculum. All medical school graduates who want to practice medicine have to go through 5 years of residency training at designated training bases, first 3 years of general rotation followed by 2 more years of specialty-centered training.

United States

Emergency medicine is a highly competitive specialty for medical graduates to enter, and has been increasing in selectiveness over the last few years. In addition to the didactic exposure, much of an emergency medicine residency involves rotating through emergency departments, intensive care units, pediatric and obstetric units, and other specialties. By the end of their training, emergency physicians are expected to handle a vast field of medical, surgical, and psychiatric emergencies, and are considered specialists in the stabilization and treatment of emergent conditions.

A number of fellowships are available for emergency medicine graduates including prehospital medicine (emergency medical services
Emergency medical services
Emergency medical services are a type of emergency service dedicated to providing out-of-hospital acute medical care and/or transport to definitive care, to patients with illnesses and injuries which the patient, or the medical practitioner, believes constitutes a medical emergency...

), hospice and palliative care, research, undersea and hyperbaric medicine, sports medicine, ultrasound, pediatric emergency medicine, disaster medicine, wilderness medicine, toxicology, and Critical Care Medicine.

United Kingdom

Emergency medical trainees enter specialty training after five years of medical school and two years of foundation training
Foundation Programme
The Foundation Programme is a two-year structured programme of workplace-based learning for junior doctors that forms a bridge between medical school and specialty/GP training. The programme aims to provide a safe, well-supervised environment for doctors to put into practice what they learned in...

.

During the two year core training programme (Acute Care Common Stem), doctors complete training in anaesthesia, acute medicine, intensive care, and emergency medicine. In the third year the trainee learns about emergency medicine (paediatric focus) and musculo-skeletal emergency medicine. They must also pass the Membership of the College of Emergency Medicine
Membership of the College of Emergency Medicine
Membership of the College of Emergency Medicine or MCEM is a qualification awarded by examination by the College of Emergency Medicine, the organisation which has the responsibility of guiding the training and examinations of specialists in emergency medicine in the United Kingdom. The examination...

 (MCEM) examination. Trainees will then go onto Higher Training, lasting a further 3 years. Before the end of higher training, the final examination—the Fellowship of the College of Emergency Medicine
Fellowship of the College of Emergency Medicine
The Fellowship of the College of Emergency Medicine is the exit examination taken by specialists in Emergency Medicine in the United Kingdom and Ireland. The examination was previously known as the Fellowship of the Faculty of Accident and Emergency Medicine...

 (FCEM) must be passed. Upon completion of training the doctor will be eligible for entry on the GMC
General Medical Council
The General Medical Council registers and regulates doctors practising in the United Kingdom. It has the power to revoke or restrict a doctor's registration if it deems them unfit to practise...

 Specialist Register and allowed to apply for a post as a Consultant in Emergency Medicine.

Emergency Medicine
Emergency medicine
Emergency medicine is a medical specialty in which physicians care for patients with acute illnesses or injuries which require immediate medical attention. While not usually providing long-term or continuing care, emergency medicine physicians diagnose a variety of illnesses and undertake acute...

 training in the UK is emerging. Historically emergency specialists were drawn from anaesthesia, medicine and surgery. Many established EM consultants were surgically trained; some hold the Fellowship of Royal College of Surgeons of Edinburgh
Royal College of Surgeons of Edinburgh
The Royal College of Surgeons of Edinburgh is an organisation dedicated to the pursuit of excellence and advancement in surgical practice, through its interest in education, training and examinations, its liaison with external medical bodies and representation of the modern surgical workforce...

 in Accident and Emergency—FRCSEd(A&E). Some of these consultants will be referred to as 'Mister' whilst others choose either not to change from 'Doctor' or to change back to 'Doctor' after passing the FCEM exam. Others used the MRCP or the FRCA as their primary examination (now replaced by MCEM). Trainees in emergency medicine may dual accredit in Intensive Care Medicine or seek sub-specialisation in Paediatric emergency medicine.

Turkey

The only way to become a certified Emergency Medicine
Emergency medicine
Emergency medicine is a medical specialty in which physicians care for patients with acute illnesses or injuries which require immediate medical attention. While not usually providing long-term or continuing care, emergency medicine physicians diagnose a variety of illnesses and undertake acute...

 Physician is via attending Medical Board Examination (TUS) to become a resident. After TUS, candidates are allocated to different residencies according to their score and choice.

Emergency Medicine
Emergency medicine
Emergency medicine is a medical specialty in which physicians care for patients with acute illnesses or injuries which require immediate medical attention. While not usually providing long-term or continuing care, emergency medicine physicians diagnose a variety of illnesses and undertake acute...

 residency lasts for 4 years in Turkey. During the programme doctors complete 13 months of rotation on different specialties, including anesthesia, orthopedics, pulmonary medicine, internal medicine, pediatrics, general surgery, radiology, neurosurgery, neurology, and cardiology. Last year, they design and manage a clinical or animal research, and write their dissertations. At the end of their residency they attend two different exams three months apart: Dissertation Exam, Emergency Medicine Specialty Exam. Both exams are oral, and doctor is expected to answer all questions asked by the Exam Board. Exam Board consists of 5 members: 2-3 from Emergency Medicine, others from Internal Medicine, Surgery or Anesthesia faculty members. After the exam, doctor starts to hold the title of Emergency Medicine Specialist. However, all the doctors should attend a 2 year Obligatory Service in Turkey to be qualified to have their diploma. After this period, EM specialist can choose to work in private or governmental ED's.

Work

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, the Veteran's Administration 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. In the United States, emergency medicine practitioners are expected to be competent in treating, diagnosing and managing a wide array of illnesses and conditions, both chronic and acute. Contrary to popular belief, emergency physicians do not treat a disproportionate number of, nor do they provide primary care to, the uninsured. In Massachusetts, when health insurance became mandatory, emergency department usage actually rose.
Overall, more than half of emergency physicians report high levels of career satisfaction. Although career satisfaction has remained high among emergency physicians, concern about burnout is substantial.

In the United Kingdom all Consultants in Emergency Medicine work in the NHS
National Health Service
The National Health Service is the shared name of three of the four publicly funded healthcare systems in the United Kingdom. They provide a comprehensive range of health services, the vast majority of which are free at the point of use to residents of the United Kingdom...

. There is little scope for private emergency practice.

In Turkey, EM specialist may choose to work in private (corporate hospitals), governmental (all the hospitals under Ministry of Health) or institutional (University Hospitals) EDs. However most of the EPs work in governmental or university hospitals.

According to the American College of Emergency Physicians
American College of Emergency Physicians
The American College of Emergency Physicians is the first and largest professional organization of emergency medicine physicians in the United States. It was founded in 1968 and is now headquartered in Irving, Texas. As of 2009 ACEP has over 28,000 physician members.The college exists to support...

, the US will likely face a shortage of physicians in the near future, leading to increased employment opportunities.

Epidemiology

A U.S. government report found there were 119 million emergency department visits in 2006, an increase of 36% from 1996. During this same ten year period of increased usage, the number of emergency departments decreased, from 4,019 to 3,833 and the rate of emergency department visits per 100 people in the U.S. rose from 34.2 to 40.5.

See also

  • Medical emergency
    Medical emergency
    A medical emergency is an injury or illness that is acute and poses an immediate risk to a person's life or long term health. These emergencies may require assistance from another person, who should ideally be suitably qualified to do so, although some of these emergencies can be dealt with by the...

    , conditions that require immediate or very prompt medical attention
  • First aid
    First aid
    First aid is the provision of initial care for an illness or injury. It is usually performed by non-expert, but trained personnel to a sick or injured person until definitive medical treatment can be accessed. Certain self-limiting illnesses or minor injuries may not require further medical care...

    , Initial Medical Care designed to stabilize immediate life threats and prevent further harm.
  • Emergency medical services
    Emergency medical services
    Emergency medical services are a type of emergency service dedicated to providing out-of-hospital acute medical care and/or transport to definitive care, to patients with illnesses and injuries which the patient, or the medical practitioner, believes constitutes a medical emergency...

     (EMS), which provides skills above and beyond that considered First Aid, and transport to a hospital
  • Rescue squad
    Rescue squad
    A rescue company is a public service organization that uses specialized equipment and knowledge to rescue people. There are two typical applications: squads that rescue trapped people, and squads that rescue people who are having medical emergencies....

    , a specialized part of the EMS system charged with gaining access to, and removing patients from special situations.
  • Emergency medical technician
    Emergency medical technician
    Emergency Medical Technician or Ambulance Technician are terms used in some countries to denote a healthcare provider of emergency medical services...

    , a Basic-Level healthcare worker who specializes in emergency and prehospital care
  • Paramedic
    Paramedic
    A paramedic is a healthcare professional that works in emergency medical situations. Paramedics provide advanced levels of care for medical emergencies and trauma. The majority of paramedics are based in the field in ambulances, emergency response vehicles, or in specialist mobile units such as...

    , an Advanced-level healthcare worker who specializes in emergency and prehospital care
  • Golden hour
    Golden hour (medicine)
    In emergency medicine, the golden hour refers to a time period lasting from a few minutes to several hours following traumatic injury being sustained by a casualty, during which there is the highest likelihood that prompt medical treatment will prevent death...

    , about the importance of rapid care in medical emergencies
  • Toxicology
    Toxicology
    Toxicology is a branch of biology, chemistry, and medicine concerned with the study of the adverse effects of chemicals on living organisms...

    , the study of toxins and their treatment
  • Traumatology
    Traumatology
    Traumatology is the study of wounds and injuries caused by accidents or violence to a person, and the surgical therapy and repair of the damage. Traumatology is a branch of medicine. It is often considered a subset of surgery and in countries without the specialty of trauma surgery it is most...

    , the study of physical trauma and its treatment
  • Physical trauma
    Physical trauma
    Trauma refers to "a body wound or shock produced by sudden physical injury, as from violence or accident." It can also be described as "a physical wound or injury, such as a fracture or blow." Major trauma can result in secondary complications such as circulatory shock, respiratory failure and death...

    , damage to the body such as due to a car wreck or falling down
  • International emergency medicine
    International emergency medicine
    International emergency medicine is a discipline that evaluates current standards and development of emergency medicine in various countries throughout the world....


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