Development Of Emergency Medicine Research Articles

The role of emergency medicine interest groups in the development of emergency medicine: A case of Mbarara University of Science and Technology-Emergency Medicine Interest Group (MUST-EMIG) in Uganda.

Emergency medicine (EM) is a new specialty in Uganda. There is no current formal EM undergraduate curriculum. The Mbarara University of Science and Technology Emergency Medicine Interest Group (MUST-EMIG) was established to bridge this gap. This survey was done to assess the contributions of MUST-EMIG. Objectives of the study were to: discover students' reasons for joining the MUST-EMIG; assess whether interest in learning emergency medicine was affected by participation in MUST-EMIG; evaluate plans to pursue emergency medicine as a specialty before and after joining MUST-EMIG; determine whether MUST-EMIG affected students' perception of emergency medicine's importance in Uganda's health care system; and elicit feedback from students on their experience as members of MUST-EMIG. The MUST-EMIG executive developed a membership survey which was reviewed by MUST-EMIG's faculty advisor for suitability. Members of MUST-EMIG were voluntarily asked to participate in the online survey. Results of the survey were summarized using descriptive statistics and thematic analysis. 49 responses (46.7% response rate) were collected and analyzed. Participants included 29 (59.2%) male and 20 (40.8%) female medical students. The majority of participants were fourth year students 22 (44.9%). 44 (89.8%) students joined MUST-EMIG to learn how to handle medical emergencies, and expressed a desire of at least 6/10 to learn more about emergency medicine after utilizing opportunities provided by MUST-EMIG. Overall, students had a good experience with MUST-EMIG. They reported that our interest group had provided them networking, unique learning, and leadership opportunities. Having an EMIG significantly affects students' desire to pursue a career in emergency medicine and their perception of the relevance of emergency medicine. An EMIG helps develop interest of medical students in emergency medicine. Students passionate about emergency medicine need to be supported to help them preserve and further develop this passion.

The current status of emergency departments in secondary emergency medical institutions in Japan: a questionnaire survey

BackgroundWhile emergency medicine (ER)-based emergency care is prevalent in many countries, in Japan, the “department-specific emergency care model” and the “emergency center model” are mainstream. We hypothesized that many secondary emergency medical institutions in Japan have inadequate systems. Using a questionnaire, we investigated the status of and problems in the emergency medical services system in secondary emergency medical institutions in Japan. Until date, there has not been an exhaustive survey of emergency facilities on a countrywide scale. The main objective of this study was to investigate problems in the Japanese emergency medical services system and thereby improve optimal care for emergency patients.ResultsA nationwide questionnaire survey involving 4063 facilities (all government-approved emergency medical facilities certified by prefectural governors) in Japan was conducted. Of the facilities that responded, all secondary emergency facilities were included in the analysis. Responses from 1289 facilities without a tertiary emergency medical care center were analyzed. Among them, 61% (792/1289) had ≤ 199 beds, and 8% were emergency department specialty training program core facilities. Moreover, 42% had an annual patient acceptance number of ≤ 500, 19% did not calculate the number of acceptances, 29% had an acceptance rate of ≥ 81%, and 25% had an acceptance rate of 61–80%. Pregnant women (63%) and children (56%) were the major types of patients that affected the acceptance rate. Factors affecting facilities with a response rate of 81% or higher were “hospitals designated for residency training” and “facilities making some efforts to improve the quality of emergency care and the emergency medical system” (logistic analysis, P < .001).ConclusionRelevant authorities and core regional facilities should consider and implement specific measures for regions and hospitals with a shortage of emergency medicine specialists and physicians (e.g., development of ER-based emergency medicine and provision of education). This study may lead to further improvement in the optimal care of emergency patients through the nationwide establishment of the proposed measures as well as through grouping and integrating the structures and systems in emergency and other medical facilities.

Chinese families' knowledge, attitudes, and practices regarding seizure management for children with epilepsy: a mixed-methods study.

This study aimed to examine Chinese families' knowledge, attitudes, and practices regarding the management of acute seizures (AS) that occur outside the hospital in children with epilepsy (CWE) and factors that influence AS. A mixed-methods sequential explanatory study was conducted, which was integrated at the design and methods levels. In phase 1, a questionnaire was developed for this study, and a family functioning assessment was administered from Nov 2021 to Apr 2022. Multivariate logistic regression was used to analyze the knowledge, attitudes, and practices (KAP) and factors that influence AS. In phase 2, family caregivers (FCGs) were recruited from Jul to Aug 2022 to participate in a qualitative exploration, using semi-structured interviews and a combination of inductive and deductive methods. The setting was five children's specialty hospitals in different regions of China. The participants were FCGs of CWE. A total of 645 participants were included in the quantitative phase, and 15 FCGs (eight parents, five grandparents, and two others) were recruited for the qualitative phase. The FCGs' average total KAP score for AS management was 66.23 ± 15.12, with 45.42% of FCGs having a low level. Univariate and multivariate regression analyses showed that demographic factors, disease characteristics, and family function significantly predicted family management of AS. The three most salient themes and eight sub-themes from phase 2 were explored. The quantitative and qualitative databases were analyzed separately and combined through integration, and a conceptual model was constructed based on the individual and family self-management theory (IFSMT); the model consisted of context, knowledge, self-regulation, and promotion factors. Chinese families have a positive attitude toward the management of out-of-hospital AS in CWE, but lack practice and related knowledge. AS management for CWE families was associated with the demographic characteristics of FCGs, epilepsy, and family characteristics. The research findings expand the existing application requirements of an Acute Seizure Action Plan and patient safety. Our results also indicate a pressing need for localized development of AS emergency medicine in family medicine, the establishment of auxiliary information systems, the utilization of caregivers' positive psychological resources, and improvements in family function for intergenerational care.

Deferiprone and Iron-Maltol: Forty Years since Their Discovery and Insights into Their Drug Design, Development, Clinical Use and Future Prospects.

The historical insights and background of the discovery, development and clinical use of deferiprone (L1) and the maltol-iron complex, which were discovered over 40 years ago, highlight the difficulties, complexities and efforts in general orphan drug development programs originating from academic centers. Deferiprone is widely used for the removal of excess iron in the treatment of iron overload diseases, but also in many other diseases associated with iron toxicity, as well as the modulation of iron metabolism pathways. The maltol-iron complex is a recently approved drug used for increasing iron intake in the treatment of iron deficiency anemia, a condition affecting one-third to one-quarter of the world's population. Detailed insights into different aspects of drug development associated with L1 and the maltol-iron complex are revealed, including theoretical concepts of invention; drug discovery; new chemical synthesis; in vitro, in vivo and clinical screening; toxicology; pharmacology; and the optimization of dose protocols. The prospects of the application of these two drugs in many other diseases are discussed under the light of competing drugs from other academic and commercial centers and also different regulatory authorities. The underlying scientific and other strategies, as well as the many limitations in the present global scene of pharmaceuticals, are also highlighted, with an emphasis on the priorities for orphan drug and emergency medicine development, including the roles of the academic scientific community, pharmaceutical companies and patient organizations.

Global emergency medicine: A scoping review of the literature from 2021.

The objective was to identify the most important and impactful peer-reviewed global emergency medicine (GEM) articles published in 2021. The top articles are summarized in brief narratives and accompanied by a comprehensive list of all identified articles that address the topic during the year to serve as a reference for clinicians, researchers, and policy makers. A systematic PubMed search was carried out to identify all GEM articles published in 2021. Title and abstract screening was performed by trained reviewers and editors to identify articles in one of three categories based on predefined criteria: disaster and humanitarian response (DHR), emergency care in resource-limited settings (ECRLS), and emergency medicine development (EMD). Included articles were each scored by two reviewers using established rubrics for original (OR) and review (RE) articles. The top 5% of articles overall and the top 5% of articles from each category (DHR, ECRLS, EMD, OR, and RE) were included for narrative summary. The 2021 search identified 44,839 articles, of which 444 articles screened in for scoring, 25% and 22% increases from 2020, respectively. After removal of duplicates, 23 articles were included for narrative summary. ECRLS constituted the largest category (n= 16, 70%), followed by EMD (n= 4, 17%) and DHR (n= 3, 13%). The majority of top articles were OR (n= 14, 61%) compared to RE (n= 9, 39%). The GEM peer-reviewed literature continued to grow at a fast rate in 2021, reflecting the continued expansion and maturation of this subspecialty of emergency medicine. Few high-quality articles focused on DHR and EMD, suggesting a need for further efforts in those fields. Future efforts should focus on improving the diversity of GEM research and equitable representation.

Diagnostic ultrasound examinations during evacuation of urgent patients by ambulance helicopters: literature review

Relevance. The use of ultrasound diagnostics at the place of providing medical care to an urgent patient is one of the promising directions in the development of emergency medicine. At the same time, of particular interest is the possibility of using diagnostic ultrasound in an ambulance helicopter, given the lack of clear algorithms and standards for its application, as well as the limited number of publications on this problem.Intention. Analysis of publications on the use of urgent ultrasound examination in an ambulance helicopter.Methodology. A search was made for scientific publications on the topic on the electronic resource PubMed, in the Google Scholar search system for the period from 2000 to 2021.Results and discussion. The main algorithms used for ultrasound diagnostics of an urgent patient in an ambulance helicopter are Focused Assessment with Sonography for Trauma (FAST), point-of-care ultrasound (POCUS), Rapid Ultrasound in SHock (RUSH), Bedside Lung Ultrasound in Emergency (BLUЕ), prehospital ultrasonography (PHUS), etc. They help exclude damage to vital organs and emergency pathology – pneumo- and hemothorax, hemoperitoneum, hemopericardium, large fractures and others that affect the tactics of treatment and patient routing; there is also the possibility of ultrasound navigation for a number of medical and diagnostic procedures. According to the results of published studies and clinical observations, prehospital ultrasound examination of urgent patients is successfully used during medical evacuation by an ambulance helicopter in emergency medical services in many countries of the world (both by doctors and other medical personnel), making it possible to diagnose a number of lifethreatening conditions with a fairly high accuracy, without loss of time and without damage to patient’s health. An important aspect of the successful application of the method during flight is the training of qualified personnel. The prospects for the development of the method are the development of more advanced ultrasound scanners and sensors adapted to flight conditions, as well as the use of telemedicine technologies for remote analysis of ultrasound images.Conclusion. The experience of using prehospital diagnostic ultrasound in an ambulance helicopter requires further data accumulation and systematic analysis, but the method is already undoubtedly useful in determining the tactics of treatment and the route of hospitalization of urgent patients with acute trauma and a number of other pathological conditions.

Position of trauma surgery in emergency medicine

The decision of the Federal Joint Committee has resulted in the further development of in-hospital emergency medicine through the establishment of central emergency departments and staged emergency care. In addition, the additional training in clinical acute and emergency medicine was established. The aim of this work is on the one hand to make trauma surgeons aware of these structural changes. On the other hand, we would like to evaluate an opinion and discuss the position of trauma surgery in emergency medicine. Aweb-based online survey was conducted at the Trauma Network and Trauma Registry Congress to collect participants' opinions on the position of trauma surgery in emergency medicine. Of 143 congress participants, 98 (67%) responded to the survey. The majority of participants were male (n = 78, 80%), over 40years of age (n = 62, 63%), and in aprofessional position with staff responsibility (n = 73, 75%). Emergency medicine (mean: 84.8; SD: 18.7) and intensive care medicine (mean: 78.3; SD: 20.4) training appears important. On the other hand, subsequent work in these areas appears less important (prehospital emergency medicine: mean: 65.1; SD: 28.0; ICU: mean: 53.7, SD: 30.3); however, activity in an emergency department is rated higher (MW: 87.0; SD: 18.7). There is high agreement that the trauma leader should be atrauma surgeon (mean 87.9; SD: 19.7). Ahigh volume of emergency trauma surgery patients and the care of severely injured patients in designated trauma centers show that trauma surgery expertise is mandatory in acentral emergency department. Senior positions should also be sought to ensure high quality standards.

Non-specialist emergency medicine qualifications in Africa: Lessons from the South African Diploma in Primary Emergency Care.

Non-specialist emergency medicine qualifications are an important step in developing the specialty of emergency medicine. The Diploma in Primary Emergency Care (Dip PEC) of the Colleges of Medicine of South Africa is one of the oldest registrable qualifications. Reviewing its changing role over time has lessons for academics developing Emergency Medicine training in Africa. Through a series of meetings and stakeholder engagements, the Council of the College of Emergency Medicine conducted a three year review of the qualification focusing on the curriculum, assessment processes, success rate and role of the qualification in the South African medical context. A survey of the perceptions of graduates over the last six years was also conducted. The survey showed candidate numbers increased dramatically from 2011 to 2017, resulting in an entry cap. Lessons identified included ensuring that the qualification is responsive to the state of development of emergency medicine in the country, needing aligned and valid assessment processes and maintaining the value of the qualification in context. Emergency medicine qualifications are dynamic in and of themselves and how they relate to their context. Program designers must prioritize ongoing evaluation from the start.

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

ObjectiveThe specialty of emergency medicine and recognition of the need for emergency care continue to grow globally. The specialty and emergency care systems vary according to context. This study characterizes the specialty of emergency medicine around the world, trends according to region and income level, and challenges for the specialty.MethodsWe distributed a 56‐question electronic survey to all members of the American College of Emergency Physicians International Ambassador Program between March 2019 and January 2020. The Ambassador Program leadership designed the survey covering specialty recognition, workforce, system components, and emergency medicine training. We analyzed results by country and in aggregate using SAS software (SAS Institute Inc). We tested the associations between World Bank income group and number of emergency medicine residency‐trained physicians (RTPs) and emergency medicine specialty recognition using non‐parametric Fisher's exact testing. We performed inductive coding of qualitative data for themes.ResultsSixty‐three out of 78 countries’ teams (80%) responded to the survey. Response countries represented roughly 67% of the world's population and included countries in all World Bank income groups. Fifty‐four countries (86%) recognized emergency medicine as a specialty. Ten (16%) had no emergency medicine residency programs, and 19 (30%) had only one. Eight (11%) reported having no emergency medicine RTPs and 30 (48%) had <100. Fifty‐seven (90%) had an emergency medical services (EMS) system, and 52 (83%) had an emergency access number. Higher country income was associated with a higher number of emergency medicine RTPs per capita (P = 0.02). Only 6 countries (8%) had >5 emergency medicine RTPs per 100,000 population, all high income. All 5 low‐income countries in the sample had <2 emergency medicine RTPs per 100,000 population. Challenges in emergency medicine development included lack of resources (38%), burnout and poor working conditions (31%), and low salaries (23%).ConclusionsMost surveyed countries recognized emergency medicine as a specialty. However, numbers of emergency medicine RTPs were small, particularly in lower income countries. Most surveyed countries reported an EMS system and emergency access number. Lack of resources, burnout, and poor pay were major threats to emergency medicine growth.

A qualitative study of an undergraduate online emergency medicine education program at a teaching Hospital in Kampala, Uganda

BackgroundGlobally, half of all years of life lost is due to emergency medical conditions, with low- and middle-income countries (LMICs) facing a disproportionate burden of these conditions. There is an urgent need to train the future physicians in LMICs in the identification and stabilization of patients with emergency medical conditions. Little research focuses on the development of effective emergency medicine (EM) medical education resources in LMICs and the perspectives of the students themselves. One emerging tool is the use of electronic learning (e-learning) and blended learning courses. We aimed to understand Uganda medical trainees’ use of learning materials, perception of current e-learning resources, and perceived needs regarding EM skills acquisition during participation in an app-based EM course.MethodsWe conducted semi-structured interviews and focus groups of medical students and EM residents. Participants were recruited using convenience sampling. All sessions were audio recorded and transcribed verbatim. The final codebook was approved by three separate investigators, transcripts were coded after reaching consensus by all members of the coding team, and coded data were thematically analyzed.ResultsTwenty-six medical trainees were included in the study. Analysis of the transcripts revealed three major themes: [1] medical trainees want education in EM and actively seek EM training opportunities; [2] although the e-learning course supplements knowledge acquisition, medical students are most interested in hands-on EM-related training experiences; and [3] medical students want increased time with local physician educators that blended courses provide.ConclusionsOur findings show that while students lack access to structured EM education, they actively seek EM knowledge and practice experiences through self-identified, unstructured learning opportunities. Students value high quality, easily accessible EM education resources and employ e-learning resources to bridge gaps in their learning opportunities. However, students desire that these resources be complemented by in-person educational sessions and executed in collaboration with local EM experts who are able to contextualize materials, offer mentorship, and help students develop their interest in EM to continue the growth of the EM specialty.

Profile of Geriatric Patients Attending the Emergency Department of a Tertiary Care Hospital in Karachi: A Cross-Sectional Study.

Background and ObjectivesThe emergency department (ED) is the most important unit of a hospital and is often visited by an ever-increasing proportion of geriatric patients. However, in Pakistan, there is an inadequacy of geriatrics specialists. The objective of this study was to assess the profile of geriatric patients in the ED. We considered main diagnoses, frailty, and other factors that help to come up with certain findings that may assist with policymaking and initiatives for better geriatric care in Pakistan.MethodsA cross-sectional study was conducted at a hospital in Karachi, Pakistan. The study population comprised 101 patients aged 65 years and older who attended the hospital’s ED from July to September 2021. Data were collected by taking the patients’ histories.ResultsThe majority of patients were aged between 65 and 70 years. The most common diagnoses were: gastrointestinal disorders, cerebrovascular accidents, and neurologic disorders. More than half of the patients were found to be frail by the five-item FRAIL questionnaire. The mean Charlson Comorbidity Index score was 5.37 ± 1.88.ConclusionIt was concluded that the need for geriatric care is worth mentioning since it imposes a significant burden on the ED. The geriatric patients had a higher risk of being on the critical list as most of them were frail and suffered from multiple severe comorbidities. Our results can assist in the development of geriatric emergency medicine and acute care systems in Pakistan.

Emergency medicine: past, present, and future challenges

Emergency medicine: past, present, and future challenges

Smart hospitals and A&amp;E departments in Hong Kong: Advantages, considerations and way forward

The concept of smart hospital is not new, but its development has unprecedentedly been accelerated by the COVID-19 pandemic. Throughput and performance dashboard on ED operation running in real-time manner would facilitate ED managers to maintain smooth ED operation or even predict and anticipate the service surge. The ED health big data would also have potential impact on the development of geriatric and ambulatory emergency medicine to accurately identify high-acuity patients and stratify low-risk patients for ambulatory care. [Extracted from the article] Copyright of Hong Kong Journal of Emergency Medicine is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

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

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.

A National US Survey of Pediatric Emergency Department Coronavirus Pandemic Preparedness.

ObjectiveWe aim to describe the current coronavirus disease 2019 (COVID-19) preparedness efforts among a diverse set of pediatric emergency departments (PEDs) within the United States.MethodsWe conducted a prospective multicenter survey of PED medical director(s) from selected children’s hospitals recruited through a long established national research network. The questionnaire was developed by physicians with expertise in pediatric emergency medicine, disaster readiness, human factors, and survey development. Thirty-five children’s hospitals were identified for recruitment through an established national research network.ResultsWe report on survey responses from 25 (71%) of 35 PEDs, of which 64% were located within academic children's hospitals. All PEDs witnessed decreases in non–COVID-19 patients, 60% had COVID-19–dedicated units, and 32% changed their unit pediatric patient age to include adult patients. All PEDs implemented changes to their staffing model, with the most common change impacting their physician staffing (80%) and triaging model (76%). All PEDs conducted training for appropriate donning and doffing of personal protective equipment (PPE), and 62% reported shortages in PPE. The majority implemented changes in the airway management protocols (84%) and cardiac arrest management in COVID patients (76%). The most common training modalities were video/teleconference (84%) and simulation-based training (72%). The most common learning objectives were team dynamics (60%), and PPE and individual procedural skills (56%).ConclusionsThis national survey provides insight into PED preparedness efforts, training innovations, and practice changes implemented during the start of COVID-19 pandemic. Pediatric emergency departments implemented broad strategies including modifications to staffing, workflow, and clinical practice while using video/teleconference and simulation as preferred training modalities. Further research is needed to advance the level of preparedness and support deep learning about which preparedness actions were effective for future pandemics.

Current trends and prospects for the development of emergency medicine in Ukraine

Current trends and prospects for the development of emergency medicine in Ukraine

A mixed methods needs assessment of pediatric emergency and critical care in Tanzanian providers: a model for curriculum development

Background There are several curricula developed to train providers in low-resource settings on how to care for critically ill and injured children, however few incorporate the unique needs, insights, and challenges faced by the providers. Using a mixed methods approach, we conducted a needs assessment to determine the most important learning issues, attitudes, and beliefs of emergency department (ED) providers at Muhimbili National Hospital (MNH) about the development of a novel pediatric emergency medicine (PEM) curriculum for their setting. Methods A retrospective, observational, analysis of a database of pediatric (&lt;18 years old) ED visits from April 2016 to April 2017 identified the most common presenting diagnoses. Qualitative focus groups and semi-structured interviews were conducted using purposive sampling of providers. Content analysis identified emerging themes and member-checking was performed approximately 5 months later. Results Analysis of 16005 visits showed that 8 of the top 15 most common diagnoses were shared with the 15 most important topics identified by healthcare providers from the qualitative analysis; sepsis, anemia, malnutrition, congenital heart disease, pneumonia, burns, malaria, and seizures. Twenty-one healthcare providers (2 ED attending physicians, 1 pediatric attending, 5 ED residents, 9 nurses, and 4 registrars) participated and thematic saturation was achieved. Fifty-seven percent of respondents (n=13) preferred a course taught in-person, and 58% (n=15) preferred a course length of less than six months. Respondents preferred a mixed instruction approach of lectures and didactics with simulation and skills stations. Three principal perspectives on poor patient outcomes were identified; i) delayed presentation to care from a lack of recognition of disease severity and/or inappropriate or inadequate treatment; ii) poor communication and a lack of knowledge of pediatric resuscitation and critical care, and limited pediatric supplies and equipment; and iii) inadequate inpatient care despite ED stabilization. Conclusions Emergency care providers reported interest in participating in a short PEM curriculum with both live training and self-administered learning. The topics identified were concordant between participants and a database analysis, as well as previously published studies. Themes on poor patient outcomes have provided a deeper context into which the curriculum will be taught. These findings can inform future curriculum development efforts.

Emergency Medicine in Egypt.

Egyptplays a pivotal role in North Africa and the Middle East, and has the largest population of any Arab country and serves as a regional cultural hub. Emergency medicine as a field of study was first initiated at Alexandria University in 1978, but it was only formally recognized as a medical specialty in 2002. Since then, the prehospital system and practice of emergency medicine has evolved and grown. This article will outline the development of emergency medicine in Egypt, including infrastructure, education, specialty certification, and future challenges, including those which are common to other specialties in development, and also those which are unique to Egypt. Opportunities remain with respect to the development of emergency medicine in Egypt, most notably in a continuing 'brain drain' of physicians who leave the country after receiving training, supervision, and oversight of residency programs, and general public and professional awareness of this new specialty. Egypt has made great strides with respect to the delivery of emergency services, physician education and certification within the specialty of emergency medicine. Learning about these developments in Egypt will provide the reader with a compelling example of how an emergency system is developed in an advancing national setting.

Emergency Medicine Training Programs in Low- and Middle-Income Countries: A Systematic Review.

Background:Despite the growing interest in the development of emergency care systems and emergency medicine (EM) as a specialty globally, there still exists a significant gap between the need for and the provision of emergency care by specialty trained providers. Many efforts to date to expand the practice of EM have focused on programs developed through partnerships between higher- and lower-resource settings.Objective:To systematically review the literature to evaluate the composition of EM training programs in low- and middle-income countries (LMICs) developed through partnerships.Methods:An electronic search was conducted using four databases for manuscripts on EM training programs – defined as structured education and/or training in the methods, procedures, and techniques of acute or emergency care – developed through partnerships. The search produced 7702 results. Using a priori inclusion and exclusion criteria, 94 manuscripts were included. After scoring these manuscripts, a more in-depth examination of 26 of the high-scoring manuscripts was conducted.Findings:Fifteen highlight programs with a focus on specific EM content (i.e. ultrasound) and 11 cover EM programs with broader scopes. All outline programs with diverse curricula and varied educational and evaluative methods spanning from short courses to full residency programs, and they target learners from medical students and nurses to mid-level providers and physicians. Challenges of EM program development through partnerships include local adaptation of international materials; addressing the local culture(s) of learning, assessment, and practice; evaluation of impact; sustainability; and funding.Conclusions:Overall, this review describes a diverse group of programs that have been or are currently being implemented through partnerships. Additionally, it highlights several areas for program development, including addressing other topic areas within EM beyond trauma and ultrasound and evaluating outcomes beyond the level of the learner. These steps to develop effective programs will further the advancement of EM as a specialty and enhance the development of effective emergency care systems globally.

Bureaucracies and power: Examining the Medical Council of India and the development of emergency medicine in India.

In many countries, professional councils are mandated to oversee the training and conduct of health professionals, including doctors, nurses, pharmacists and allied health workers. The proper functioning of these councils is critical to overall health system performance. Yet, professional councils are sometimes criticized, particularly in the context of low- and middle-income countries, for their misuse of power and overtly bureaucratic nature. The objective of this paper is to understand how professional councils use their bureaucratic power to shape health policy and systems, drawing upon the recent development of emergency medicine in the context of the former Medical Council of India. We undertook a qualitative case study, conducting 87 interviews, observing 6 meetings and conferences, and reviewing approximately 96 documents, and used the Framework method to analyze our data. The passive exercise of bureaucratic power by the Council resulted in three challenges - 1) Opaque policy processes for recognizing new medical specialties; 2) Insular, non-transparent training policy formulation; 3) Unaccountable enforcement for regulating new courses. The Council did not have the requisite technical expertise to manage certain policy processes, and further, did not adequately utilize external expertise. In this time period, the Council applied its bureaucratic power in a manner that negatively impacted emergency medicine training programs and the development of emergency medicine, with implications for availability and quality of emergency care in India. The successor to the Council, the National Medical Commission, should consider new approaches to exercising bureaucratic power in order to meet its objectives of strengthening medical education in India and ensuring access to high-quality services. Future studies should also explore the utilization of bureaucratic power in the health sectors of low- and middle-income countries in order to provider a deeper understanding of institutional barriers to improvements in health.