What will emergency care look like 10 years from now?

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The year 2017 is rapidly drawing to a close and it has not been short of drama. Changes in political directions in the USA, continuing sporadic terrorism in Europe and beyond, the latest devastating events being witnessed in Barcelona and again in London, and the realities of Brexit are beginning to be realized by the population of both Britain and Europe. The consequences of all these are far reaching and potentially life changing.
In the last few weeks, tensions between North Korea and the USA have led to several people asking me what my plans are when the missiles start falling in Asia. I was much more concerned about the impact of two recent back-to-back tropical cyclones that hit Hong Kong and devastated Macau. With all of this drama, it is easy to forget the plight of the many thousands of migrants who continue to make perilous journeys towards Europe, and the victims of flooding both in Asia and, more recently, in Texas and the Caribbean.
It has made me think how will our specialty look like in a decade from now 1–7. I think it is much easier to predict what will still be around than to work out what new challenges may affect us then. For sure, there will be more elderly patients, and their multiple comorbidities and evident frailty will be an extreme challenge to us all 8. This will affect developing countries as much as developed nations and Asia more than anywhere else.
We are woefully underprepared. The hopes that hospital planners have had for years that complex procedures can be reduced to short-stay or day-case procedures has led to many efficiencies, but the reality is that the majority of an individual’s use of healthcare resources occurs in the final year of life and, unless you are a miracle worker, every person on Earth will have a final year of life at some point. The need for more hospital beds, not less, is ever more apparent globally. Efficiency can only stretch so far.
I would like to believe that we will encounter less infectious disease (with the occasional outbreak of a novel strain such as SARS), but I suspect we will see much more sepsis, and although the outcomes for sepsis are improving markedly in centres of excellence, the challenge is now to get everyone providing high standards of sepsis care to minimize avoidable deaths. The increasing prevalence of immunocompromised patients will change the face of sepsis again and make it even more difficult to identify these patients in the emergency setting 9.
I hope we will see less major trauma, particularly from intentional violence and vehicular crashes, but I think we will see more before it gets less. Terrorism is not going to vanish overnight, and our preparation for urban conflict and disaster planning in general must be enhanced. The use of information technology has revolutionized emergency care already and I can only see that continuing, with further integration of technology and patient care. Our smartphones will do things that are unimaginable at the moment, just like their current functions were unimaginable a decade ago.
One thing is certain – our training for our future specialists needs to be rigorous and of the highest quality 10. We must commit to achieving the highest standards of training and skill for our future emergency care workforce so that everyone can receive excellent quality emergency care wherever they need it in the future.
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