Rehmani, Rifat

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eCommons@AKUDepartment of Emergency Medicine Medical College, PakistanMay 2004Emergency medicine: a relatively new specialtyRifat RehmaniAga Khan University, rifat.rehmani@aku.eduFollow this and additional works at: https://ecommons.aku.edu/pakistan_fhs_mc_emerg_medPart of the Emergency Medicine CommonsRecommended CitationRehmani, R. (2004). Emergency medicine: a relatively new specialty. Journal of Pakistan Medical Association, 54(5), 232-233.Available at: https://ecommons.aku.edu/pakistan_fhs_mc_emerg_med/211The specialty of Emergency Medicine (EM) embod-ies the belief by those who have chosen it as a career that"quality emergency care is a fundamental right and shouldbe available to all who seek it."1EM is a relatively new specialty, which has evolvedjust over the last quarter of a century. The American Collegeof Surgeons was among the first groups of physicians to rec-ognize the need for organized emergency services. In 1970,the first EM residency was started and in 1979 the AmericanBoard of Medical Specialties recognized EM as medicine'snewest specialty.2 In the United Kingdom, the equivalentspecialty of accident and emergency (A&E) medicine iscurrently in a phase of rapid development. Following theinception of Faculty of A&E Medicine in 1993 and theintroduction of Calman proposals, specialist registrar train-ing in A&E is also developing rapidly.3EM is the medical specialty with the principal mis-sion of evaluating, managing, treating, and preventing unex-pected illness and injury. Anyone may unexpectedly requiremedical care at any time. Emergency medical care musttherefore be available 24 hours a day as an essential compo-nent of a health care delivery system. The specialty of EM is practiced in a variety of hos-pital and non-hospital settings. Emergency physicians arefirst contact providers. They care for a patient populationundifferentiated by age or disease process. They providerapid treatment and stabilization of true emergencies, aswell as rapid differentiation between emergent and non-emergent conditions over the spectrum of disease processes.Their care extends to out-of-hospital assessment, treatment,and transport of patients into emergency facilities by virtueof their management and supervision of emergency medicalservices. EM is a specialty of depth and breadth. It addressesa spectrum of clinical and social problems in a fashion andenvironment quite apart from that of any other medical dis-cipline. EM encompasses many domains, each of whichcontribute to the body of knowledge and skills, which iden-tify the specialty. They include: provision of clinical emer-gency care, teaching, research, pre-hospital and disastermedicine, resuscitative medicine, toxicology, environmen-tal medicine, trauma, and administration. There is a rapidly growing interest in EM throughoutthe world. This interest in the specialty has many sources.There has been increasing economic development in manycountries, which has led to rapid urbanization, increases indeaths from injuries, and increasing outpatient visits to thehospitals. In addition, there is a desire by physicians all overthe world to provide the highest quality, or at least mosttechnically advanced level of care.4Why do countries such as Pakistan need the special-ty of EM? In the author's opinion, EM is an extremelyimportant component of any health care system and pro-vides a vital service to the public. In fact, EM is the firstspecialty to develop directly due to demand by the public.Other specialties are defined by anatomic region, a particu-lar type of disease or by a particular age group of patients.In contrast, EM encompasses all types of medical and sur-gical problems of all age groups. EM also provides a "safe-ty net" for any national health care system to ensure patientaccess to needed unscheduled care. Major clinical problems(all of which are common in Pakistan) that are very wellmanaged by EM include the following: trauma, cardio-res-piratory illnesses, toxicology,  environmental disorders, andmass casualties from disasters. EM has a number of beneficial effects that increasethe efficiency of any national health care system. Theseinclude the prompt evaluation of emergencies and the abili-ty to complete diagnostic work-up for patients in a singlevisit. EM also provides significant benefits to the generalpublic. These include reassurance and confidence, conven-ience, and ensured access to care. EM also is important forpublic education in illness and injury prevention, teachingthe public how to correctly utilize the health care system.There are significant benefits in developing physi-cian residency training programs in EM.2,5 These programsprovide a core of specialists to staff the nation's emergencydepartments. In general, these programs also ensure thequality, depth, and uniformity of training for emergencycare. EM also provides significant benefits in trainingphysician residents from other specialties about emergencycare. This training gives these other physicians' ability andconfidence in managing basic emergencies. It also familiar-izes them with emergency department operations and needsand can improve the working relationships they have withEM faculty and residents. This training also allows them tolearn cost-effective use of lab tests and radiographic proce-dures and can facilitate their future appropriate referral ofcases to the emergency department. There are significantEditorialEmergency Medicine: a relatively New SpecialtyR. RehmaniSection of Emergency Medicine, The Aga Khan University, Karachi.Vol.54 No.5 May 2004                                                                                                  232future appropriate referral of cases to the emergencydepartment. There are significant benefits in requiring train-ing of all medical students in EM. This training ensurestheir exposure to proper emergency management of com-mon conditions and meets the public expectation that alldoctors should know basic emergency care. This trainingalso encourages some students to pursue EM residencytraining or EM research projects.2,5EM in Pakistan is a new specialty, and in fact, is notan officially designated specialty.6 The introduction of EMas a specialty in Pakistan will face challenges because pri-mary care takes precedence over critical care. The primarycare health approach is emphasized throughout the trainingof medical students, residents, and by the policy of theMinistry of Health. Furthermore, scarcity of resources is alimiting factor in establishing EM as a legitimate specialtybecause it requires upgrading of basic infrastructures andadequate training of EM personnel. Lack of trained EM fac-ulty and a professional society to teach and represent theinterest of EM among other traditional specialties are otherlimiting factors, as is inadequate public education as to theimportance of EM in Pakistan. The general recommendations for EM developmentat the national level, may not be in this sequence, would beto form a cadre of interested physicians, set model clinicalEmergency Departments, form a national professional soci-ety to coordinate activities at the national level, set trainingstandards and training curricula, organize Residency pro-grams, publish a national specialty journal and other educa-tional communications, establish a specialty examination,and finally declare EM an officially recognized specialty.Despite obstacles, there is a potential for the devel-opment of EM. It is hoped that this relatively new specialtywill meet the challenges and will grow with time.  References1. Definition of emergency medicine:American College of EmergencyPhysicians.Ann Emerg Med 1994;24:553-4. 2. Schneider SM, Hamilton GC, Moyer P, et al. Definition of emergency medi-cine. Acad Emerg Med 1998;5:348-51.3. Wyatt JP, Weber JE. A transatlantic comparison of training in emergency med-icine. J Accid Emerg Med 1998;15:175- 80.4. Kirsch TD. Emergency medicine around the world. Ann Emerg Med1998;32:237-8.5. Kellermann AL. Clinical emergency medicine, today and tomorrow. AnnEmerg Med 1995;25:235- 8.6. Raftery KA. Emergency medicine in Southern Pakistan. Ann Emerg Med1996;27:79-83.233                                                                                                       J Pak Med Assoc

Emergency medicine: a relatively new specialty

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Emergency medicine: a relatively new specialty

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