Emergency Medicine is a primary specialty established using the knowledge and skills required for the prevention1 diagnosis and management2 of urgent and emergency aspects of illness and injury, affecting patients of all age groups with a full spectrum of undifferentiated physical and behavioral disorders.
This includes organizing the proper medical response for patients looking for urgent medical care.
Time and timing in this setting may be critical either from a medical or from the patient’s point of view.
The practice of Emergency Medicine3 encompasses the in-hospital as well as out-of-hospital4 triage, resuscitation, initial assessment, telemedicine and the management of undifferentiated urgent and emergency patients until discharge or transfer to the care of another health care professional.
1 Prevention: also includes injury prevention, preparedness for disaster, as well as public health education.
2 Management encompasses the local service organization as well as the development of systems to provide EM care.
3 Primarily hospital-based
4 This applies to out-of-hospital emergency care, disasters and includes other urgent medical care systems outside hospitals.
Status of EM
Europe encompasses not only fifty or more different languages and cultures, but also a similar number of different systems of health care and medical practice. Each country has different medical traditions, different systems of professional registration and differing lists of medical specialties. This latter problem has been addressed in part by the European Union and, in particular, by the Department or Directorate-General which deals with the Internal Market and which includes the mutual recognition of diplomas and other free movement issues. The relevant EU Directive for medical qualifications is known as the ‘Doctors’ Directive’ and was first issued as 1993/16/EC, but most recently updated as 2006/100/EC.
The Directive recognizes 53 different hospital medical specialties within the countries of the European Union and one of the lists is headed ‘Accident and Emergency Medicine’, the name by which the specialty was initially known in the UK and Ireland. Unfortunately this heading still remains, even though the UK and Ireland have officially changed their title to ‘Emergency Medicine’. They have now been joined on the list by seven of the countries which have joined the EU since 2004, namely Bulgaria, Czech Republic, Hungary, Malta, Poland, Romania and Slovakia.
The Directive requires that the period of training for Emergency Medicine should be a minimum of five years and several more EU countries have now recognized Emergency Medicine as a primary specialty with these training requirements (Belgium, Estonia, Croatia, Italy, Latvia, Luxembourg, Slovenia, Norway, Malta, Romania, Lithuania and Czech Republic). Emergency Medicine also exists in several countries as a supra-specialty (Greece, France, Switzerland).
Several of the remaining EU countries are making significant progress towards recognition of the specialty, but it can be a slow and arduous journey! Nonetheless, there has been a very significant increase in the recognition of Emergency Medicine as a primary specialty in Europe during the last decade and this is in line with the rest of the world where there is similar growth in recognition of the specialty.
MJC and European Board
UEMS, the ‘Union Européene des Médecins Spécialistes’, represents hospital medical specialists within the European Union; other European countries are involved as associate members or observers. The main purpose of UEMS is the harmonisation and improvement of medical practice in Europe and it has created specialist Sections for each major discipline which is recognised in more than one third of the EU countries. Emergency Medicine thus just fails to qualify, but it has been accepted in UEMS as a Multidisciplinary Joint Committee, MJC, which includes representatives from other established Sections with an interest in Emergency Medicine.
The MJC first met in Brussels in 2005 and two meetings are held each year. Important agenda items have included the Policy Statement on Emergency Medicine in Europe, the European Curriculum for Emergency Medicine and, most recently, the development of a European Diploma or Fellowship examination. The Committee now includes the Secretary-General of UEMS and ten members nominated by EUSEM as well as representatives from the Sections of Anaesthesiology, Cardiology, Geriatric Medicine, Internal Medicine, Neurology, Orthopaedics and Traumatology, Paediatric Medicine, Plastic and Reconstructive Surgery and General Surgery, from the MJC on Intensive Care Medicine and from the European Junior Doctors.
The Rules of Procedure of UEMS allow each specialist Section to establish its own European Board as a working group with the specific aim to guarantee the highest standards of care in the relevant specialist field, a guarantee to be achieved through recommendations for setting and maintaining standards of training and through recommendations for the content and quality and evaluation of training programmes. The MJC on Emergency Medicine already has this purpose and in October 2010 the Council of UEMS approved the formal establishment of a European Board of Emergency Medicine. It is currently intended that the MJC and the new European Board will meet together on two occasions each year.