Cooperation in emergency medicine in Europe: the bright side of the medal
Resistance to such evolutions in healthcare would have never led to the development of other medical disciplines – for example, anaesthesia, which developed in an environment where surgeons historically tended to take care of all aspects of their operations themselves. Undoubtedly, discussions must have occurred on the advantages and disadvantages of this model among various protagonists. However, now everyone recognizes the benefits and added value of the anaesthesiologist in the setting of a surgical procedure, even when patient care in anaesthesia is often shared with our nursing colleagues, as seems to be the trend in some countries, with nurses often providing practical aspects of anaesthetic care such as intubation.
Just as emergency medicine does not only start by placing a tracheal tube for an unexpected critically ill patient, European Society for Emergency Medicine (EuSEM) has taken into account the modern expectations of society and of our patients who need acute care in a broad spectrum of circumstances, as described in the EuSEM definition of Emergency Medicine, which was updated in February 2017 3. Emergency Medicine addresses the comprehensive medical needs of all our patients in the emergency setting and not just those competencies of value in managing only part of their care.
Consequently, the challenge is to acquire the knowledge, skills and competencies to manage the acute needs required at any moment for any patient anywhere in an emergency. This has led to the development of the European curriculum for emergency medicine and a European board examination in emergency medicine 4. It is a combination of the essential knowledge and skills of all disciplines involved with patients requiring acute care. This is not by a different approach to specific organ diseases but in an integrated model, combined with the organizational insights needed to work efficiently in the environment of the emergency department (ED) and the prehospital setting.
This model is not characterized by a setting where one patient presents with a specific pathology for one specific doctor at a time, but by many undifferentiated patients presenting for several doctors at the same time. There are still countries where the model of providing emergency care is by importing in-hospital specialists to the ED depending on the nature of any individual case. There are doubts about the efficiency of this longitudinal model, where specialists may wait until they can add value to the care of patients with their specific skills and can spend time doing little in between patients. For much of the time in these countries we see no in-hospital specialists at all on the ED floor with junior trainees being sent to the ED instead.
In such circumstances it is not clear who coordinates and manages the ED floor, leading to situations where hospitals pay for basic doctors with insufficient training to call for help at the moment they realize that they are in trouble.
Another positive side effect of the development of emergency medicine as a specialty is the growth of scientific research in all aspects of this important discipline 5,6.