Ban, K. M.

Gensini, Gian Franco

Pini, Riccardo

Rosen, P.

English

Florence Research

52(Intern Emerg Med 2006; 1 (1): 52-53)It is with great pleasure that this issue marks thecommencement of the first issue of Internal and EmergencyMedicine.It is especially appropriate that this issue also marks theFebruary passage of the Italian federal law enabling thetraining of residents in the specialty of emergencymedicine.The specialty of emergency medicine has emerged inmany different countries in the world, and it is clear thatwith the recognition for the time constrained managementof acute traumatic and non-traumatic emergencies, therehas become an ever increasing need to respond withmedical personnel who possess special training andexperience in the appropriate management of theseproblems.There is a biology of emergency medicine1. That this isincreasingly recognized is signified by the literature ofemergency medicine, and the need for a journal such asthis.It is not enough to simply care for the clinical problems ofemergency medicine. We must collect the evidence uponwhich to base an intelligent and safe practice, and wemust attempt to answer the questions that are stimulatedin the course of such practice.There are innumerable issues that start with the correctmanagement of the life and limb threateningemergencies, but continue on to involve the locus ofcare, the appropriate use of diagnostic and technologicprocedures; the safest and best therapeutics, and theoptimal utilization of the inpatient facilities.There are many problems that represent acuteemergencies that will fall outside the domain ofemergency medicine, such as a cardiac arrest that occursin a surgical theater, but even if there is overlap withcaring for a similar emergency in the prehospital careunit as well as the emergency department, it would beimpractical as well as logistically impossible for theEditorialAddress for correspondence: Kevin M. Ban, MD, Department ofEmergency Medicine, Beth Israel Deaconess Medical Center,Harvard Medical School, One Deaconess Road, West CC2, Boston,MA 02215, USA. E-mail: kban@bidmc.harvard.edu© 2006 CEPI Srlemergency physician to attempt to respond to anyemergency that would occur in such a location.We have a mission to satisfy with this journal: that is toattempt to provide a resource for the practicingemergency physician, whether this is someone providingcare in an emergency department, or prior to that in thefield.That does not mean there is no space for original clinicalor basic research, which as the specialty of emergencymedicine evolves will also become the means by which weanswer the questions of clinical medicine. Nevertheless, inaddition to such basic science research, we need andhope to supply a forum for clinical discussions thatinterest the clinician, as well as assist in the performanceof a safer and more scientific practice.It is simply not enough to practice in a busy emergencydepartment with many complex emergency problems.That practice must be examined, questioned, varied andimproved as we develop new answers to complexquestions, and as we garner the evidence upon which tomake our decisions.There is a special logic that must be applied in emergencymedicine, and only the practicing clinician familiar withthis logic can pose and answer the correct questions.These do change over time, and that is why we need ajournal to stay educated, and current. For example, 20years ago the correct question in response to chest painwas: “Is this patient having a heart attack?” It is now clearthat this question while important is rarely the correctquestion. That question is: “Is this patient having an acuteischemic coronary syndrome?” It is readily seen that thecomplexity of this question requires a much differentstrategy, plan of attack, and therapeutic management.We must always remember that we see the unclassifiedpatient, and that we see the patient at many varied stagesof the course of a disease, and that “classic” presentationsrarely are seen or identifiable during the early course of adisease. For example, if asked “what is a mandatoryindication for endotracheal intubation?”, most physicianswould start with respiratory arrest. While this is a correctindication, how is it recognized? If you come upon apatient in the street, or in an emergency department whois not breathing, how do you know that patient is apneic?You cannot watch the absence of breathing for asufficiently long period to be convinced the patient is inEmergency medicine: welcome addressRiccardo Pini1, Kevin M. Ban2, Peter Rosen2, Gian Franco Gensini11Department of Critical Care Medicine and Surgery, University of Florence and Azienda Ospedaliero-Universitaria Careggi, Florence, Italy,2Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USAEM53Riccardo Pini et al.respiratory arrest without allowing brain death. It ismore likely that we recognize this entity by the presenceof unconsciousness and the absence of a heart beat. Thathowever means that the indications for undertakingendotracheal intubation are completely different.With this journal, we will try to present the things thatcan be recognized by an emergency physician, as well asto recommend the correct strategy for appraisal, and theappropriate management.Our goal is to provide a forum for the recognition of thebiology of emergency medicine, and to provide the meansfor our specialty of emergency medicine to grow and toflourish. We must pose our own questions, and obtain ourown answers because only we, the practitioners of thespecialty of emergency medicine, will be able to identifywhat we need, and not what some other specialty, withcompletely different experience and agendas thinks weneed.We invite you to join us in our quest for the descriptionsof the practice of emergency medicine, and that you willincrease, refresh and solidify your learning of ourimportant and fascinating specialty.Reference1. Rosen P. The biology of emergency medicine. JACEP 1979; 8:280-3.

Emergency medicine: welcome address

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Emergency medicine: welcome address

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