197 Emergency Medicine Development Around the World: An Analysis of 2019 American College of Emergency Physicians International Ambassador Country Reports

Abstract

Emergency medicine (EM) is in different stages of development around the world, with many countries not yet formally recognizing the specialty. The American College of Emergency Physicians (ACEP) International Ambassador Program is composed of emergency physicians who represent ACEP and connect with local EM societies and EM pioneers, practitioners, and educators in 78 countries to promote emergency medicine development. Our objective was to describe the current state of EM around the world by analyzing 63 Country Report survey responses submitted by the ACEP Ambassadors in 2019. The 2019 Country Report survey was developed by ACEP Ambassador Program leadership with input from the ACEP Ambassadors. The survey consisted of 40 questions about EM as a specialty, the history of EM, EM residencies, out-of-hospital care, EM academic activities, and challenges and opportunities for growth in EM. ACEP Ambassadors answered questions based on their experience working in their respective countries with assistance from local partners. Maps of the world were created to display categorical variables. Qualitative data was analyzed for themes. Percentages were calculated and variables were categorized by World Bank regions and income categories. Chi-square was used to look for association between country income and recognition of EM as a specialty. The populations of the 63 countries in this study totaled 5.19 billion or about 67% of the world’s population. The sample included countries in each of the World Health Organization Regions. Of the countries represented, 7.9% are low income, 24% lower middle income, 33.3% upper middle income and 35% high income. Country income was not associated with recognition of EM as a specialty (p = 0.29). The number of residency-trained emergency physicians per 100,000 people was >5 in 6 countries (9.5%), 2 to 5 in 12 countries (19%), and <2 in 37 countries (59%). Nine countries (14.5%) do not recognize EM as a specialty (3 high, 1 high middle and 5 low middle-income). Six countries (9.5%) do not have a out-of-hospital system. Eleven countries (17.5%) do not have an emergency phone number (eg, 911). A majority of countries had fewer than 10 EM residency programs (55%), and 16% had none. Thirty countries (48%) have EM board exams. Eighteen countries (29%) have an EM-specific peer-reviewed journal. Common challenges reported in EM development included: lack of resources and/or funding (53%), lack of EM recognition or resistance to the specialty (47%), the need for more educational and faculty organization (29%), and physician shortages (23% ). Within the constraints of a survey study, the ACEP Ambassador Country Report survey provides unique information about the state of EM development around the world. Most countries in the sample have recognized EM or have EM residencies. However, EM is still in the early stages of development in many countries, with few emergency physicians per 100,000 population and few having board exams or EM peer-reviewed journals. Future research can track the growth of EM over time and help promote collaborations across countries.