Emergency Medicine: A New Paradigm
Dr. Sumidra Laishram
What is Emergency Medicine?
In 1991, International Federation of Emergency Medicine defined Emergency Medicine
(EM) as “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.”
History: EM as a medical
speciality is relatively young. Before the 1970’s, hospital Emergency
Departments(ED) were generally managed 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) 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. In the 1970s, groups of
physicians began to leave their respective practices in order to devote their
work completely to the ED. Alexandria Hospital, VA was among the first to
establish 24/7 year round emergency care headed by Dr.
James DeWitt Mills and his four associate physicians; Dr. Chalmers A.
Loughridge, Dr. William Weaver, Dr. John McDade, and Dr. Steven Bednar .This
emergency care service came to be known
as the "Alexandria
Plan".
The first emergency medicine
residency program in the world was begun in 1970 at the University of Cincinnati and the first
Department of Emergency Medicine at a U.S. medical school was founded in 1971
at the University of Southern California. After the establishment of American
College of Emergency Physicians (ACEP), the recognition
of emergency medicine training programs by the American Medical Association
AMA) and the American Osteopathic Association(AOA), and a historical vote by
the American Board of Medical Specialties in 1979, EM became a recognized medical specialty.
Scope of Emergency Medicine:
Emergency Medicine encompasses a
large amount of general medicine but involves the technical and cognitive
aspects of 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 must have the skills of many specialists—the ability to resuscitate
a patient (critical care medicine), manage a difficult airway (anaesthesia),
suture a complex laceration (plastic surgery), reduce (set) a fractured bone or
dislocated joint (orthopaedic), treat a heart attack (cardiology), work-up a
pregnant patient with vaginal bleeding (Obstetrics and Gynaecology), stop a bad
nosebleed (ENT), place a chest tube (cardiothoracic surgery), and to conduct
and interpret x-rays and ultrasounds (radiology).
The emphasis has developed
beyond simply treating traumatic injury, to encompass critical and acute care
for a much wider range of problems. Patients with acute illness or injury can
present at any time, with a wide range of problems. Patients often have
“undifferentiated” presentations (i.e. they don’t come in with a known
diagnosis), with little initial information available apart from that obtained
by talking to the patient; the history, examination and bedside investigations.
There is a great challenge in providing
rapid and appropriate treatment in the first hours, but effective early diagnosis
and treatment has been shown to make big differences for short and longer term
outcome in many conditions.
Indian Scenario in EM:
Since 1994, many private
hospitals and institutes in India have been providing emergency medicine
training for doctors, nurses & paramedics. The certification programs
varied from 6 months to 3 years.
From July 2009, EM has been
recognised by Medical Council of India (MCI) as a separate medical speciality.
At present, there are six post-graduate seats in EM in India with plans for
increasing in the near future. EM was a division of the department of Medicine
in All India Institute of Medical Sciences (AIIMS). However, since September
2011, Emergency Medicine has been established as full fledged department in
AIIMS with hopes of starting post-graduate courses very soon.
In Manipur, Emergency Medicine is
still a very new concept among the public and even within the medical
fraternity. Shija Hospitals and Research Institute (SHRI), one of the
pioneering institute in health care of the state has taken up the challenge of
providing EM care to the people of the state suffering from acute illness and
injuries. The department of Emergency Medicine is in the process of being
upgraded and expanded to provide optimal care and service.
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The author
is former Senior Resident, Department of Emergency Medicine (AIIMS, New
Delhi) and currently working as Consultant Emergency Medicine, Shija Hospitals and Research Institute, Langol.
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