Emergency medicine

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Emergency medicine , also known as accident and emergency medicine , is a medical specialty related to undiagnosed and unscheduled patient care with illness or injury requiring immediate medical attention. In their role as first-line providers, emergency physicians are responsible for initiating resuscitation and stabilization, initiating investigations and interventions to diagnose and treat acute-phase illness, coordinate care with specialists, and determine disposition of the patient's need for admission, observation, or debit. Emergency physicians generally practice in hospital emergency departments, pre-hospital settings through emergency medical services, and intensive care units, but can also work in primary care settings such as urgent care clinics.

Different models for emergency medicine exist in the international world. In countries that follow the Anglo-American model, emergency medicine was originally a domain of surgeons, general practitioners, and other general practitioners, but in recent decades has been recognized as a specialization in itself with its own academic training and post programs, and specialization is now a popular choice among medical students and newly qualified medical practitioners. In contrast, in countries following the Franco-German model, no specialization is available and emergency medical care is provided directly by an anesthesiologist (for early resuscitation), surgeon, specialist in internal medicine, or other appropriate specialization. In developing countries, emergency medicine is still developing and international emergency treatment programs offer hope for improving basic emergency care where resources are limited.

Video Emergency medicine

Coverage

Emergency Medicine is a medical specialty - a field of practice based on the knowledge and skills necessary for the prevention, diagnosis and management of acute and urgent aspects of illness and injury that affect patients of all age groups with full spectrum of physical and undifferentiated behavior disorders. This further includes an understanding of the development of pre-hospital emergency medical systems and in hospitals and the skills necessary for these developments.

The emergency treatment field includes treatments that involve acute care of medical conditions and internal surgery. In many modern emergency departments, emergency physicians are tasked with seeing a large number of patients, treating their illness and regulating dispositions - either admitting it to the hospital or releasing them after treatment as necessary. Emergency doctors require a broad field of knowledge and advanced procedural skills often including surgical procedures, trauma resuscitation, sophisticated heart life support and advanced airway management. They must have the expertise of many specialists - the ability to awaken the patient (critical care medicine), manage difficult airway (anesthesia), tailor complex laceration (plastic surgery), reduce cracked or sprained bones (orthopedic surgery) , treating a heart attack (cardiology), managing a stroke (neurology), working-up a pregnant patient with vaginal bleeding (obstetrics and gynecology), stopping severe nosebleed (ENT), placing a chest tube (cardiothoracic surgery), and for performing and interpreting x -rays and ultrasound (radiology). Emergency physicians are thus trained in a variety of skills, and this joint approach can eliminate the barrier-to-care problems generated under less efficient service providers. Emergency doctors also provide episodic primary care to patients during working hours and for those who do not have primary care providers.

Emergency treatment differs from urgent care, which refers to immediate health care for less medical problems. However, many emergency physicians work in urgent care settings, because there is a clear overlap. Emergency treatment also includes many aspects of acute primary care, and sharing with family medicine, the uniqueness of seeing all patients regardless of age, sex or organ system. Emergency physicians also include many competent doctors trained in other specialties.

Doctors specializing in emergency medicine may include scholarships to receive subspecialty credentials such as palliative care, critical care, medical toxicology, desert medicine, pediatric emergency medicine, sports medicine, disaster medicine, tactical medicine, ultrasound, pain medications, pre-homes illness of emergency medicine, or underwater and hyperbaric drugs.

Emergency treatment practices are often very different in rural areas where there are far fewer consultants and health care resources. In these areas, family doctors with additional skills in emergency medicine are often emergency department staff. Rural emergency physicians may be the only healthcare provider in the community, and require skills that include primary and midwifery care.

Work patterns

Patterns vary by country and region. In the United States, personal medical practice arrangements for emergency physicians (with groups of emergency department of emergency department staff co-workers), institutional (physicians with independent contractor relationships with hospitals), firms (physicians with independent contractor relationships with third-party employment firms serving some emergency departments), or the government (for example, when working in a military service of personal services, public health services, veteran perks systems or other government agencies).

In the UK, all consultants are in emergency treatment jobs at the National Health Service and there is little room for private emergency practice. In other countries such as Australia, New Zealand or Turkey, emergency medicine specialists are almost always paid employees from government health departments and work in public hospitals, with work bags in rescue or private or non-governmental transport services, as well as some private hospitals with the emergency department; they can be equipped or supported by a non-specialist medical officer, and visit a GP. The rural emergency department may be headed by a GP only, sometimes with a non-specialist qualification in emergency medicine.

Maps Emergency medicine

History

During the French Revolution, after seeing the speed of French flying artillery wagons maneuvering across the battlefield, French military surgeon Dominique Jean Larrey applied the idea of ​​an ambulance, or "flying carriage", to the rapid transport of wounded soldiers to the center of the place where medical care was more accessible and effective. Larrey manned an ambulance with trained crew of drivers, corps and garbage carriers and brought those wounded to a centralized field hospital, effectively creating a pioneer of modern MASH units. Dominique Jean Larrey is sometimes called the father of emergency medicine for his strategy during the French war.

Emergency treatment as an independent medical specialist is relatively young. Prior to the 1960s and 1970s, the hospital emergency department (ER) was generally managed by physicians on rotating hospital staff, including family doctors, general surgeons, internists, and other specialists. In many smaller emergency departments, nurses will sort patients out and doctors will be called on by type of injury or illness. Family physicians are often called on for emergency departments, and recognize the need for special emergency department coverage. Many pioneers of emergency medicine are family doctors and other specialists who see the need for additional training in emergency care.

During this period, a group of doctors began emerging who had abandoned their respective practices to devote fully their work to the ED. In England in 1952, Maurice Ellis was named the first "victim consultant" at Leeds General Infirmary. In 1967, the Surgeon Surgeon Association was founded with Maurice Ellis as its first President. In the US, the first group led by Dr. James DeWitt Mills in 1961 who, along with four physician associations; Dr. Chalmers A. Loughridge, Dr. William Weaver, Dr. John McDade, and Dr. Steven Bednar at Alexandria Hospital in Alexandria, Virginia, established 24/7 emergency care throughout the year, which came to be known as the "Alexandria Plan".

It was not until the establishment of the American College of Emergency Physicians (ACEP), the recognition of the emergency treatment training program by AMA and AOA, and in 1979 the voice of history by the American Board of Medical Specialties that emergency medicine became a recognized medical specialty in the US. The world's first emergency drug resident program started in 1970 at the University of Cincinnati and the first Department of Emergency Medicine in US medical school was founded in 1971 at the University of Southern California.

In 1990, the British Surgeons Surgeon changed its name to the British Association for Accident and Emergency Medicine, and later became the British Association of Emergency Medicine (BAEM) in 2004. In 1993, the Faculty of Obesity and Emergency Medicine between universities (FAEM) as a "female college" of six medical royal colleges in England and Scotland to organize professional examinations and training. In 2005, BAEM and FAEM joined forces to form the College of Emergency Medicine, now the Royal College of Emergency Medicine, which conducts membership and fellowship checks and publishes guidelines and standards for emergency treatment practices.

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Organization financing and practices

Returns

Many hospitals and care centers have emergency medicine departments, where patients can receive acute care without an appointment. While many patients are treated for life-threatening injuries, others use emergency departments (ED) for non-urgent reasons such as headaches or colds. (defined as "visits for conditions that delay several hours will not increase the likelihood of adverse outcomes"). Thus, EDs can adjust staff ratios and designate department areas for faster patient turnover to accommodate patient needs and volumes. Policies have been developed to assist ED staff (such as Emergency Medical Technicians, paramedics, and mid-level providers such as nurse practitioners and physician assistants) directing patients toward more precise medical settings, such as primary care physicians, urgent care clinics, or detoxification. amenities. The emergency department, together with welfare programs and health clinics, serve as an important part of the health safety net for uninsured patients, unable to afford medical care or not understanding how to properly utilize the scope.

Compensation

Emergency doctors are compensated at a higher rate than some other specialties, ranked 10th out of 26 physician specialties by 2015, with an average salary of $ 306,000 per year. They are compensated in the middle range (average $ 13,000 per year) for non-patient activities, such as lectures or acting as expert witnesses; they also see a 12% wage increase from 2014 - 2015 (which is not in line with many other doctor specialties that year). While emergency physicians work 8-12 hours of shift and do not tend to work on-call, high stress levels and the need for robust diagnostic and triage capability for undifferentiated and acute patients contribute to arguments justifying higher salaries for this doctor. Emergency care should be available every hour of the day, and requires doctors to be available on site 24/7, unlike outpatient clinics or some other hospital departments that have more limited hours, and can only call a doctor if necessary. The need to have a staff physician along with all the other diagnostic services available every hour of every day is an expensive arrangement for the hospital.

Payment System

The US healthcare payment system is undergoing significant reform efforts, which include emergency doctor compensation through "Performance Pay" incentives and penalties imposed under public and commercial health programs, including Medicare and Medicaid. This payment reform is aimed at improving the quality of care and control costs, despite disagreements about existing evidence to show that this payment approach is effective in emergency medicine. Initially, this incentive is only targeted for primary care providers (PCP), but some would argue that emergency medicine is primary care, since no one is referring patients to the ER. In one such program, two speci fi cally listed conditions are directly related to patients often seen by emergency medical providers: acute myocardial infarction and pneumonia. (See: Hospital Quality Incentive Demonstration.)

There are some challenges with implementing these quality-based incentives in emergency medicine in patients who are often not given a definitive diagnosis in the ED, making it difficult to allocate payment through coding. Additionally, adjustments based on patient risk levels and some comorbidities for complex patients further complicate the association of positive or negative health outcomes, and it is difficult to assess whether many costs are a direct result of emerging conditions treated in acute care settings. It is also difficult to measure savings due to preventive care during emergency care (ie checks, stabilization treatments, coordination of care and disposal, rather than admission to the hospital). Thus, ED service providers tend to favor a modified cost-for-service model over other payment systems.

Overutilization

Some patients without health insurance use ED as the primary form of their medical care. Because these patients do not use insurance or primary care, emergency medical providers often face problems of overutilization and financial loss, especially since many patients can not afford to pay for their care (see below). Frequently used ED generates $ 38 billion in wasteful spending every year (ie delivery of care and coordination failures, over-treatment, administrative complexity, pricing failures, and fraud), and unnecessary departmental resources, thus reducing the quality of care at all patients. While excessive use is not limited to the uninsured, the uninsured consists of non-urgent non-urgent visit proportions - insurance coverage can help reduce excessive use by increasing access to alternative forms of care and decreasing the need for emergency visits. A common misconception breaks ED visitors as a major factor in spending wastage. However, ED users often make a fraction of them contribute too much usage and are often insured.

Uncompensated Treatment

Injuries and illnesses are often unpredictable, and patients with low socioeconomic status are particularly vulnerable to being suddenly burdened with the cost of necessary ED visits. If they can not afford the care they receive, then hospitals (under Emergency Medical Care and Active Labor Act (EMTALA), as discussed below, are obliged to treat emergencies regardless of paying ability) face economic losses for care without this compensation. Fifty-five percent of emergency care is not compensated, and inadequate replacement has led to the closure of many EDs. Policy changes (such as the Affordable Care Act) designed to reduce the number of uninsured people have been projected to drastically lower the amount of uncompensated care.

In addition to reducing uninsured rates, ED overutilization can be reduced by increasing patient access to primary care and increasing patient flow to alternative care centers for non-life-threatening injuries. Financial disincentives, patient education, and improved management for patients with chronic diseases can also reduce overuse and help manage maintenance costs. In addition, doctors' knowledge of pricing for care and analysis, discussions about costs with their patients, as well as the changing culture of defensive drugs can increase cost-effective use. The transition to more value-based care in ED is a way in which providers can contain costs.

EMTALA

Doctors working in hospitals from hospitals receiving Medicare funding are subject to EMTALA provisions. EMTALA was enacted by the US Congress in 1986 to limit "patient dumping," a practice whereby patients are denied medical treatment for other economic or non-medical reasons. Since enactment, ED visits have increased substantially, with one study showing a 26% increase in visits (more than double the population increase over the same time period). While more people receive care, lack of funding and ED density may have an impact on quality. To comply with the provisions of EMTALA, hospitals, through their ER doctors, must provide medical examinations and stabilize emergency medical conditions from anyone coming to the hospital with patient capacity. If this service is not provided, EMTALA has a responsible hospital and ED doctor responsible for civil penalties up to $ 50,000 each. Although the Office of the Inspector General, the Department of Health and Human Services (OIG) and private citizens may take action under EMTALA, the courts uniformly state that ED doctors can only be held responsible if the case is prosecuted by OIG (whereas hospitals are subject to penalties regardless of who brought the lawsuit). In addition, the Medicare and Medicaid Service Centers (CMS) may discontinue the status of providers under Medicare for physicians who do not comply with EMTALA. Responsibility also extends to call doctors who fail to respond to ED requests to come to the hospital to provide services. While EMTALA's purpose is commendable, commentators have noted that it appears to have created substantial substantial burdens on hospital and emergency department resources. As a result of financial difficulties, between the period 1991-2011, 12.6% of EDs in the US were closed.

Shipping Treatments in Multiple Settings ED

Rural

Despite emerging practices over the last few decades, emergency drug delivery has increased significantly and evolved in various settings relating to cost, provider availability and overall use. Prior to the Affordable Care Act (ACA), emergency medicine is used primarily by "uninsured or uninsured, women, children, and minorities, all of whom often face barriers to accessing primary care". While this still exists today as mentioned above, it is important to consider the location where care is given to understand the population and system challenges associated with excessive use and high costs. In rural communities where providers and lack of outpatient facilities exist, primary care physicians (PCP) in the ER with general knowledge tend to be the only source of health care for a population, as specialists and other health resources are generally unavailable due to lack of funding and desire to serve in these areas. Unfortunately as a result, the incidence of complex comorbidities that are not managed by the right provider leads to worse health outcomes and ultimately more costly treatments that go beyond rural communities. Although usually quite separate, it is vital that rural PCPs partner with larger health systems to comprehensively address the complex needs of their communities, improve population health, and implement strategies such as telemedicine for positive health outcomes and reduce the use of ED for preventive diseases. (See: Rural health.)

Urban

Alternatively, urban emergency treatment consists of a diverse group of providers including PCP, nurse practitioners, doctors and registered nurses coordinating with specialists at inpatient and outpatient facilities to address patient needs, more specifically in the ER. For all systems regardless of source of funding, EMTALA mandates ED to conduct medical checks for anyone present in the department, regardless of ability to pay. Fortunately, non-profit hospitals and health systems - as required by the ACA - must provide certain charity care thresholds "by actively ensuring that those eligible for financial assistance get it, by imposing a reasonable tariff for uninsured patients and with avoid the tremendous collection of practices ". Despite these limitations, this mandate provides support to many people in need. Although, policy efforts and increased federal funding and reimbursement in urban areas, triple objectives (improving patient experience, improving population health, and reducing per capita care costs) remain a challenge without provider and payer collaboration to improve access to preventive care and reduced use of ED. As a result, many experts support the notion that emergency medical services can only serve immediate risks in urban and rural areas.

Relations Provider-Provider

As stated above, EMTALA includes provisions that protect patients from being turned away or transferred before adequate stabilization. After making contact with the patient, the EMS provider has the responsibility to diagnose and stabilize the patient's condition regardless of ability to pay. In a pre-hospital setting, the provider should make an appropriate assessment in choosing the appropriate hospital for transportation. Hospitals can only turn incoming ambulances if they are in transit and are unable to provide adequate care. However, once a patient arrives at the hospital, care should be provided. At the hospital, contact with patients is first performed by a triage nurse who determines the appropriate level of care required.

According to Mead v. Legacy Health System, a patient-physician relationship established when "the physician takes affirmative action with regard to patient care". Starting such a relationship creates a legal contract in which the physician must continue to provide care or end the relationship properly. This legal liability can be extended to doctor and physician consultation calls without even direct contact with patients. In emergency medicine, discontinuance of patient-provider relationships before stabilization or without handoff to other eligible providers is considered to be abandoned. To initiate the transfer from the outside, a doctor must verify that the next hospital can provide the same or higher treatment. Hospitals and doctors should also ensure that the patient's condition will not be further aggravated by the transfer process.

The unique setting of emergency treatment practices presents the challenge of providing high quality, patient-centered care. Clear and effective communication can be very difficult because of frequent noise, interruptions, and high patient turnover. The Society for Academic Emergency Medicine has identified five important tasks for patient-physician communication: building relationships, gathering information, providing information, providing comfort, and collaboration. Miscommunication of patient information is a major source of medical error; minimizing deficiencies in communication remains a topic of current and future research.

Medical error

Many circumstances, including regular transfer of patients in the course of emergency care, and a crowded, noisy and chaotic ED environment, make emergency medicines highly susceptible to medical errors and almost die. One study identified an error rate of 18 per 100 patients enrolled in one particular academic ED. Another study found that where the lack of teamwork (eg poor communication, lack of team structure, lack of cross-monitoring) was involved in special incidents of ED medical errors, "an average of 8.8 teamwork failures occurred per case [and] more of the half of deaths and permanent disabilities are deemed unavoidable. "Unfortunately, certain cultures (ie" focus on other people's mistakes and 'blame-shame' culture) and structural (ie lack of standardization and incompatible equipment) aspects of emergency medicine often resulting in a lack of medical disclosure of errors and barely occurring in patients and other caregivers. While concerns about malpractice liability are one of the reasons why medical disclosure is not made, some have noted that disclosure of errors and giving apologies can reduce the risk of malpractice. Ethicists uniformly agree that disclosure of medical mistakes that cause harm is the duty of the service provider. Key components of disclosure include "honesty, explanation, empathy, apology, and opportunities to reduce the likelihood of future mistakes" (represented by the mnemonic HEEAL). The nature of emergency medicine is such that mistakes will always be a major risk of emergency care. Maintaining public trust through open communication about dangerous errors, however, can help patients and doctors constructively address problems when they occur.

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Treatment

Emergency Treatment is the primary care point or first contact for patients requiring the use of a health care system. Specialists in Emergency Medicine are required to have specific skills in the diagnosis of acute illness and resuscitation. Emergency doctors are responsible for providing immediate recognition, evaluation, care, stabilization, for adult and child patients in response to acute illness and injury.

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Training

There are various international models for emergency medicine training. Among those with well-developed training programs there are two different models: the "specialist" model or the "multidisciplinary model". In addition, in some countries emergency medicine specialists are riding in ambulances. For example, in France and Germany doctors, often an anesthesiologist, ride in an ambulance and provide stable care at the scene. Patients are then prioritized to appropriate hospital departments, so emergency care is much more multidisciplinary than in Anglo-American models.

In countries such as the United States, Britain, Canada and Australia, ambulances headed by paramedics and emergency medical technicians respond to emergency situations outside the hospital and transport patients to emergency departments, which means there is more dependence on these healthcare providers and there more dependence on paramedics and EMT for on-site treatment. Therefore, emergency physicians are more "specialists", as all patients are taken to the emergency department. Most developing countries follow the Anglo-American model: 3 or 4 years of independent residency training programs in emergency medicine are the gold standard. Some countries develop training programs based on primary care foundations with additional emergency medical training. In developing countries, there is an awareness that the Western model may not apply and may not be the best use of limited health care resources. For example, specialized training and such pre-hospital care in developed countries is too costly and impractical for use in many developing countries with limited health care resources. International emergency medicine provides an important global perspective and expectations for improvement in this area.

A brief review of the following programs: Argentina

In Argentina, SAE (Sociedad Argentina de Emergencias) is the main organization of Emergency Medicine. There are many residency programs. It is also possible to achieve certification with a two-year postgraduate university course after several years of ED background.

Australia and New Zealand

The specialist medical faculty responsible for Emergency Medicine in Australia and New Zealand is Australasian College for Emergency Medicine (ACEM). The training program lasted seven years in a row, after which the trainee was given a Fellowship of ACEM, depending on the graduation of all necessary assessments.

A dual fellowship program is also available for Pediatric Medicine (in conjunction with the Royal Australasian College of Physicians) and Intensive Care Medicine (in conjunction with the College of Intensive Care Medicine). These programs nominally add one or more years to the ACEM training program.

For physicians who do not (and do not want) specialists in Emergency Medicine but have significant interest or workload in the emergency department, ACEM provides non-specialist certificates and diplomas.

Chile

In Chile, Emergency and Emergency Medicine began its journey with the first special program in the early 90s, at the University of Chile. Currently, the main specialization is legally recognized by the Ministry of Health since 2013, and has several training programs for specialists, especially from Chile University, Pontifical Catholic University of Chile, San Sebastian University-MUE and Santiago Chile University (USACH). with the aim of strengthening country-level specializations, FOAMed initiatives have emerged (free open access medical education in emergency medicine) and the #ChileEM initiative that brings together Universidad San SebastiÃÆ'¡n/MUE, Universidad CatÃÆ'lica de Chile and Universidad de Chile, held a joint clinical meeting between major training programs, regularly and openly to all health teams working in the field of urgency. Trained specialists are grouped in the Chilean Emergency Medical Society (SOCHIMU).

Canada

Two routes for emergency medicine certification can be summarized as follows:

1. 5-year residency leading to the appointment of FRCP (EM) through the Royal College of Physicians and Surgeons of Canada (Certification of the Council of Emergency Medicine - Emergency Medical Consultants).
2. Emergency treatment program developed for 1 year after undergoing a 2-year family medicine residency that leads to the appointment of CCFP (EM) through the College of Family Physicians of Canada (Advanced Competence Certification). CFPC also allows those who work at least 4 years at least 400 hours per year in emergency medicine to challenge the special competence checks in emergency medicine and thus become a specialist.

CCFP emergency physicians (EM) exceed FRCP (EM) physicians by a ratio of about 3 to 1, and they tend to work primarily as doctors with less focus on academic activities such as teaching and research. Emergency Medical Specialists FRCP (EM) tend to gather in academic centers and tend to have a more academically oriented career, which emphasizes administration, research, critical care, disaster treatment, and teaching. They also tend to be sub-specialties in toxicology, critical care, pediatric emergency medicine, and sports medicine. Furthermore, the residency duration of FRCP (EM) allows more time for formal training in this field.

China

The post-graduate Emergency Medical training process is currently very complex in China. The first EM post-graduate training was held in 1984 at the Peking Union Medical University Hospital. Since special certification in EM has not been established, formal training is not required for the practice of Emergency Medicine in China.

About a decade ago, Emergency Medicine training residency was concentrated at the municipal level, following guidelines issued by the Ministry of Public Health. The residency program at all hospitals is referred to as the residency training base, which must be approved by the local health authorities. This base is hospital-based, but residents are selected and managed by the association of city medical education. These associations are also an authoritative body to prepare their residents' training curriculum. All medical school graduates wishing to practice medicine must go through 5 years of residency training at the designated training base, the first 3 years of general rotation followed by 2 more years of specialist-centered training.

German

In Germany, emergency medicine is not treated as a specialty (Facharztrichtung), but any licensed physician may obtain additional qualifications in emergency medicine through an 80-hour course monitored by each of the "ÃÆ'â € ž rztekammer" (medical associations , responsible for licensing physician). Services as emergency physicians in ambulance services are part of anesthesiology specialization training. Emergency doctors usually work on a volunteer basis and are often anesthesiologists, but may be specialists of any kind. There is especially specialized training in pediatric intensive care.

India

India is an example of how family medicine can be the foundation for emergency medicine training. Many private hospitals and institutes have provided Emergency Medicine training for doctors, nurses & amp; paramedics since 1994, with certification programs varying from 6 months to 3 years. However, emergency treatment was only recognized as a separate specialization by the Indian Medical Board in July 2009.

Malaysia

There are three universities (Universiti Sains Malaysia, Universiti Kebangsaan Malaysia, & Universiti Malaya) offering master's degrees in emergency medicine - a four-year postgraduate training program in duration with clinical rotation, examination and dissertation. The first group of locally trained emergency physicians graduated in 2002.

Saudi Arabia

In Saudi Arabia, Emergency Medical Certification is conducted by taking a 4-year Saudi Board of Emergency Medicine (SBEM) program, which is accredited by the Saudi Council for Health Specialties (SCFHS). This requires passing the two-part exam: the first and the last part (written and oral) to obtain a SBEM certificate, equivalent to a Doctorate Degree.

United States

Most courses are three years old, but some programs are four years long. There are several combined residencies offered with other programs including family medicine, internal medicine and pediatrics. The US is renowned for its excellence in emergency medicine residency training programs. This has led to some controversy about special certification.

There are three ways to become certified board in emergency medicine:

• The American Board of Emergency Medicine (ABEM) is for those who have a Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) degree. ABEM is under the authority of the Council of American Medical Specialties.
• The American Osteopathic Board of Emergency Medicine (AOBEM) states only emergency physicians with DO degrees. It is under the authority of the Osteopathic Association Osteopathic Bureau of America.
• The Board of Certification in Emergency Medicine (BCEM) provides board certification in emergency medicine to doctors who have not completed emergency drug residency but have completed residencies in other fields (internists, family practitioners, pediatricians, general surgeons, and anesthesiologists).

A number of ABMS scholarships are available for Emergency Medical graduates including pre-hospital medicines (emergency medical services), critical care, home care and palliative care, research, underwater and hyperbaric medicine, sports medicine, pain medications, ultrasound, pediatric emergency medicine, disasters drugs, desert drugs, toxicology, and critical care medicine.

In recent years, labor data has led to the recognition of the need for additional training for primary care physicians providing emergency care.

This has led to a number of additional training programs in emergency care at the first hour, and some scholarships for family doctors in emergency medicine.

Funding for Training

"In 2010, there were 157 residency programs for allopathic osteopathy and 37 osteopathic treatment, which collectively receive about 2,000 new residents each year.Research has shown that attending emergency physician surveillance is directly correlated with higher quality and more cost-effective practices , especially when emergency drug residency exists. "Medical education is primarily funded through the Medicare program; payment is given to the hospital for each resident. "Fifty-five percent of ED payments come from Medicare, fifteen percent of Medicaid, five percent of personal payments and twenty-five percent of commercially insured patients." However, the choice of a physician specialization is not mandated by any agent or program, so even though the emergency department sees many Medicare/Medicaid patients, and therefore receives a lot of funding for the training of the program, there is still concerns due to a shortage of specialization - a trained Emergency Medical provider.

United Kingdom

In the UK, the Royal College of Emergency Medicine has a role in setting professional standards and assessments of trainees. Emergency medical trainees enter special training after five or six years of medical school followed by two years of foundation training. Specialized training takes six years to complete and succeed in the assessment and a set of five exam results in the Fellowship award from the Royal College of Emergency Medicine (FRCEM).

Historically, emergency specialists were taken from anesthesia, drugs, and surgery. Many EM consultants are established undergoing surgery; some hold the Royal College of Surgeons of Edinburgh Fellowship in Accident and Emergency - FRCSEd (A & E; Trainees in Emergency Medicine may have double accreditation in Intensive care or seek subspecialty in Pediatric Emergency Medicine.

Turkish

Residency Emergency Treatment lasts for 4 years in Turkey. These doctors have 2 years of Mandatory Services in Turkey to qualify to have their diploma. After this period, EM specialists may choose to work in private ED or government.

Pakistan

Emergency Medical Training in Pakistan lasts for 5 years. The 2-year start involves trainees to be sent to three key areas covering Medicine and Allied, Surgical and Allied and critical care. It is divided into six months each and the remaining six months of the first two years are spent in the emergency department. In the last three years, trainees spend most of their time in the emergency room as senior citizens. Certificate programs include ACLS, PALS, ATLS, and research and dissertation required to complete the training successfully. At the end of 5 years, the candidate is eligible to take part II FCPS exam. After fulfilling the requirements, they became associates of the College of Physicians and Surgeons of Pakistan in Emergency Medicine.

There are currently two institutions where you can get this training namely Shabad International Hospital Islamabad and Aga Khan Karachi Hospital. there are about 30 residents in various years of training, while the College has conducted its first exit test for FCPS in Emergency Medicine during December 2015.

Iran

The first residency program in Iran began in 2002 at Iran University of Medical Sciences, and now there is a standard three-year residency program running in Tehran, Tabriz, Mashhad, Isfahan, and several other universities. All of these programs work under the supervision of the specialist board of Emergency Medicine. There are now more than 200 (and increasing) certified emergency physicians in Iran.

src: phoenixmed.arizona.edu

Ethics and medicolegal issues

Ethical and medical-legal issues are embedded in the nature of Emergency Medicine. The issues of competence, end-of-life care, and the right to refuse treatment are met every day within the Emergency Department. An increasingly important issue is the ethics and legal obligations surrounding the Mental Health Act, as more and more self-suicide and self-harm attempts are seen at the 2007 Wooltorton Case Emergency Department where a patient arrives at the Emergency Department post overdose with a note explaining his request for no intervention, highlighted the frequent dichotomy between the doctors' ethical obligation to 'no harm' and the legality of the patient's right to refuse.

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See also

• Medical emergency
• First aid
• Emergency medical services
• Pre-hospital emergency medicine
• Child emergency medicine
• Rescue team
• Emergency medical technician
• Paramedic
• Golden Clock
• Traumatology
• International emergency medicine
• Royal College of Emergency Medicine

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References

src: www.saem.org

Further reading

• Marx, John (2010). Rosen Emergency Treatment: clinical concepts and practice (7th ed.). Philadelphia, PA: Mosby/Elsevier. ISBN 978-0-323-05472-0.
• Tintinalli, Judith E. (2010). Emergency Medicine: Comprehensive Study Guide (Emergency Medicine (Tintinalli)) . New York: Company McGraw-Hill. ISBN: 0-07-148480-9.
• "WikEM: The Global Emergency Medicine Wiki". Los Angeles, CA: OpenEM Foundation.

src: www.rushu.rush.edu

External links

• MUE emergency treatment
• The International Federation for Emergency Medicine
• Emergency Doctors Association
• Canadian Emergency Doctors Association
• American Emergency Medicine Academy
• American Board of Emergency Medicine
• American College of Emergency Physicians
• College of Emergency Physician, Malaysia
• College of Emergency Medicine (United Kingdom)
• The European Society for Emergency Medicine
• Society for Emergency Medical Treatment
• Hong Kong Emergency Medical College
• Scandinavian Journal of Trauma, Resuscitation and Emergency Treatment
• Turkish Emergency Medical Association (EMAT)
• Turkish Emergency Doctors' Association (EPAT)
• Australasian College of Emergency Medicine (ACEM)
• Council of Europe for Disaster Drugs (ECDM)

Source of the article : Wikipedia