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14-September-2008 12:50:31 - medicine September 2006 Emergency Medicine is a speciality of medicine that focuses on the diagnosis and treatment of acute illnesses and injuries that require immediate medical attention. While not usually providing long-term or continuing care, emergency medicine physicians diagnose a wide array of pathology and undertake acute interventions to stabilize the patient. These professionals practice in hospital emergency departments, in the prehospital setting via emergency medical service and other locations where initial medical treatment of illness takes place. Just as clinicians operate by immediacy rules under large emergency systems, emergency practioniers aim to diagnose emergent conditions and stabilize the patient for definitive care. Urgent Care Centers are often staffed by physicians, physician assistants, nurses and nurse practitioners who may or may not be formally trained in emergency medicine. They offer primary care treatment to patients who desire or require immediate care, but who do not reach the acuity that requires care in an emergency department or admission to a hospital. Emergency Medicine encompasses a large amount of general medicine but involves 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 ideally have the skills of many specialists - the ability to manage a difficult airway anesthesia, suture a complex laceration plastic surgery, reduce set a fractured bone or dislocated joint orthopedic surgery, treat a heart attack internist, work-up a pregnant patient with vaginal bleeding Obstetrics and Gynecology, and stop a bad nosebleed ENT. Contents 1 Definition 2 History 3 Organizations around the world 4 Education 5 Working 6 References 7 See also 8 External links Definition 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. International Federation for Emergency Medicine 1991 History During the French Revolution, after seeing the speed with which the carriages of the French flying artillery maneuvered across the battlefields, French military surgeon Dominique Jean Larrey 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 units. Dominique Jean Larrey 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 70's, hospital emergency rooms 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 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 at Alexandria Hospital, VA established 24/7 year round emergency care which became known as the Alexandria Plan. Soon, the problem of the ER, propagated by published reports and media coverage of the poor state of affairs for emergency medical care had culminated with the establishment of the first emergency medicine training program at Cincinnati General Hospital, with Bruce Janiak, M.D. being the first emergency medicine resident in 1970. During the 1970s, several other residency programs developed throughout the country. At this time, EM was not yet a recognized specialty and hence had no primary board certification exam. It was not until the establishment of 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 that EM became a recognized medical specialty. Organizations around the world In the United Kingdom and Ireland, the College of Emergency Medicine sets the examinations that trainees in Emergency Medicine take in order to become consultants fully-trained emergency physicians. The British Association for Emergency Medicine is the member organization in the UK. In 2005 , the two organizations initiated steps, and have applied for a royal seal, to merge as the Royal College of Emergency Medicine. In Australia and New Zealand, advanced training in Emergency Medicine is overseen by the Australasian College for Emergency Medicine ACEM. In Canada, there are two routes to practice emergency medicine. More than two thirds of physicians currently practicing emergency medicine across the Canadian nation have no specific emergency medicine residency training.citation needed Emergency physicians who tend to work in more community-based settings complete a residency specializing in Family Medicine and then proceed to obtain an additional year of training of special competence on Emergency Medicine from the College of Family Physicians of Canada CCFP-EM. Physicians practicing in major urban/tertiary care hospitals will often pursue a 5 year specialist residency in Emergency Medicine, certified by the Royal College of Physicians and Surgeons of Canada. These members typically spend a great deal of time in academic and leadership roles within emergency medicine, EMS, research, and other avenues. There is no significant difference in remuneration or clinical practice type between physicians certified via either route. In the United States, there are many member organizations for emergency physicians: The American College of Emergency Physicians ACEP is presently the largest member organization of emergency physicians, and Active membership is open to all physicians that have completed an emergency medicine residency approved by the Accration Council on Graduate Medical Education ACGME or the American Osteopathic Association AOA, or are certified by any emergency medicine certifying body recognized by ACEP. Physicians engaged in the practice of emergency medicine prior to 2000 also qualify for membership under a grandfather clause. Originally founded in 1968, ACEP was the first Emergency Medicine society formed in the United States. Fellows use the designation FACEP. As of 2006, ACEP had about 25,000 members.12 The American Academy of Emergency Medicine AAEM was formed in 1993 and has been the subject of some controversy due to its traditional position statements concerning board certification, resident moonlighting, and the practice of corporate medicine. Nevertheless, AAEM has worked cooperatively alongside the ACEP and the ACOEP when the interests of emergency medicine have called for a united front. Active membership is open to all physicians who have completed an emergency medicine residency approved by either ACGME or the AOA. Fellows use the designation FAAEM. As of 2007, the AAEM had about 5,000 members. The American College of Osteopathic Emergency Physicians ACOEP was founded seven years later in 1975.3 Active membership is open only to osteopathic D.O. medical physicians who have practiced emergency medicine for the past three years and/or have completed an emergency medicine residency approved by the AOA or ACGME. Fellows use the designation FACOEP. As of 2006, ACOEP enrolled about 2,300 members The Association of Emergency Physicians AEP, which was founded in 1991, distinguishes itself by offering membership to any practicing emergency physician regardless of training.4 By so doing, the AEP acknowledges that more than half of practicing emergency physicians in the United States, much like their colleagues in other countries, completed residencies in other related specialties that included training in the practice of emergency medicine. Currently, this organization is the only US organization that admits non-specialty trained physicians. AEP has members in 45 states.4 The American Board of Emergency Medicine ABEM provides board certification to emergency physicians. Although ABEM now requires successful completion of an ACGME-approved residency in emergency medicine followed by completion of an additional year of practice before taking the exam, currently half of the emergency physicians currently holding ABEM certification were grandfathered in to certification eligibility via the practice track by training in another specialty, practicing emergency medicine, and then passing the ABEM certification exam. The American Osteopathic Board of Emergency Medicine AOBEM provides board certification to osteopathic D.O. emergency physicians who have successfully completed an AOA-approved residency in emergency medicine, completed two years of practice, passed a written exam, and passed an oral exam. Like ABEM, the AOBEM at one time offered certification eligibility via a practice track, allowing training in another specialty, practicing emergency medicine, and then passing the AOBEM certification exam. The Board of Certification in Emergency Medicine BCEM provides board certification to both physicians who have completed an emergency medicine or primary care residency and performed five years of emergency medicine practice, followed by a written and oral examination process. Many of the above-mentioned legacy, or grandfathered, physicians are certified via this pathway. Also, EM doctors who do not qualify for ABEM or AOBEM under the grandfather clause can apply and get boarded via AAPS. The board is being accepted more by hospitals, although it does not carry nearly the weight of ABEM. Furthermore, many emergency departments in the US insist on residency-trained ABEM emergency medicine physicians only. Education June 2007 In the US, Emergency Medicine is a moderately competitive specialty for medical graduates to enter, ranking 7 of 16 specialties in terms of percentage of U.S. graduates whose applications are successful. However, over 90% of applicants from US medical schools to US Emergency Medicine residencies are successful. 5 Emergency medicine residencies MD,MBBS,MBChB can be three or four years in length, depending on the training institution, while all osteopathic DO residencies are four years in length, the first being a one-year traditional rotating internship. In addition to the didactic exposure, much of an emergency medicine residency involves rotating through other specialties with a majority of such rotations through the emergency department itself. 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 condition. Emergency physicians are therefore both clinical generalists and well-rounded diagnosticians. A number of fellowships are available for emergency medicine graduates including prehospital medicine emergency medical services, toxicology, sports medicine, ultrasound, and pediatric emergency medicine. Working 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. Patients being served by the emergency medicine unit often proceed to intensive care medicine, which often is closely related to emergency medicine. References ^ About ACEP ^ ACEP Membership ^ ACOEP American College of Osteopathic Emergency Physicians: About. Retrieved on 2008-05-08. ^ a b AEP.org. Retrieved on 2008-05-08. ^ Crystal Reports - Charting_Outcomes_2007.rpt See also Medical emergency, conditions that require immediate or very prompt medical attention First aid, a style of initial medical care Emergency medical service EMS, which provides first aid and transport to a hospital Rescue squad, a specialized part of the EMS Emergency medical technician, a healthcare worker who specializes in emergency care Paramedic, a healthcare worker who specializes in emergency care CPR, a lifesaving treatment for heart attacks Golden hour, about the importance of rapid care in medical emergencies Toxicology, the study of toxins and their treatment Traumatology, the study of physical trauma and its treatment Physical trauma, damage to the body such as due to a car wreck or falling down External links The external links in this article may not follow 's content policies or guidelines. Please improve this article by removing excessive or inappropriate external links. Association of Emergency Physicians American Academy of Emergency Medicine American Board of Emergency Medicine American Board of Medical Specialties The American Board of Physician Specialties American College of Emergency Physicians Emergency Medicine Residents' Association Canadian Association of Emergency Physicians College of Emergency Medicine United Kingdom Emergency Medicine European Resuscitation Council European Society for Emergency Medicine National Centre for Emergency Medicine Informatics Society for Academic Emergency Medicine Hong Kong College of Emergency Medicine Emergency Medicine India v d e Health science Medicine Specialties and subspecialties Surgery Anesthesiology · Cardiac surgery · Cardiothoracic surgery · General surgery · Neurosurgery · Oral and maxillofacial surgery · Orthopedic surgery Hand surgery · Otolaryngology ENT · Pediatric surgery · Plastic surgery · Surgical oncology · Thoracic surgery · Transplant surgery · Trauma surgery · Urology · Vascular surgery Internal medicine Cardiology · Endocrinology · Gastroenterology · Geriatrics · Hematology · Hepatology · Infectious diseases · Intensive care medicine · Nephrology · Oncology · Proctology · Pulmonology · Rheumatology Diagnostic Clinical laboratory sciences Cellular pathology, Clinical chemistry, Hematology, Clinical microbiology, Clinical immunology, Transfusion medicine · Radiology Interventional radiology, Nuclear Medicine · Pathology Anatomical, Clinical · Clinical neurophysiology Other specialties Allergy and immunology · Dermatology · Disaster medicine · Emergency medicine · General practice · Neurology · Obstetrics and gynaecology Fertility medicine · Andrology · Reproductive medicine · Occupational medicine · Ophthalmology · Palliative care · Pediatrics · Physical medicine and rehabilitation Physiatry · Preventive medicine Public health · Psychiatry · Sleep medicine Other Epidemiology · History of medicine · Hospital medicine · Medical education · Medical genetics · Medical school · Osteopathic medicine · Pharmacy · Physician MD and DO · Physician Assistant · Sports medicine · Medical fiction v d e Health Science Medicine Emergency medicine Procedures Advanced cardiac life support ACLS · Advanced life support ALS · Advanced Trauma Life Support ATLS · Basic life support BLS · Cardiopulmonary resuscitation CPR · First aid · Pediatric Advanced Life Support PALS Equipment Ambulance · Bag valve mask BVM · Chest tube · Defibrillation AED, ICD · Electrocardiogram ECG/EKG · Intraosseous infusion IO · Intravenous therapy IV · Intubation · Nasopharyngeal airway NPA · Oropharyngeal airway OPA · Pocket mask People Certified first responder CFR · Emergency medical responder EMR · Emergency medical technician EMT · Paramedic · Emergency physician Drugs Atropine · Amiodarone · Epinephrine/Adrenaline · Magnesium · Bicarbonate Other Golden hour · Emergency department · Emergency medical services · Emergency psychiatry · Medical emergency · Trauma center · Triage Retrieved from http://en..org/wiki/Emergency_medicine Categories: Emergency medicine | Subjects taught in medical schoolHidden categories: Articles needing additional references from September 2006 | All articles with statements | Articles with statements since July 2008 | Articles needing additional references from June 2007 | external links cleanup Views Article Discussion this page History Personal tools Log in / create account Navigation Main page Contents Featured content Current events Random article Search Go Search Interaction Community portal Recent changes Contact Donate to Help Toolbox What links here Related changes Upload file Special pages Printable version Permanent link Cite this page Languages Deutsch Español Français 한국어 Bahasa Indonesia Interlingua עברית Magyar Nederlands 日本語 Português Simple English This page was last modified on 11 September 2008, at 19:3
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