Emergency Medicine In Europe Research Articles

Status of the specialty Emergency Medicine in Europe.

Status of the specialty Emergency Medicine in Europe.

Providing care for older adults in the Emergency Department: expert clinical recommendations from the European Task Force on Geriatric Emergency Medicine.

Despite the rapidly expanding knowledge in the field of Geriatric Emergency Medicine in Europe, widespread implementation of change is still lacking. Many opportunities in everyday clinical care are missed to improve care for this susceptible and growing patient group. The aim was to develop expert clinical recommendations on Geriatric Emergency Medicine to be disseminated across Europe. A group of multi-disciplinary experts in the field of Geriatric Emergency Medicine in Europe was assembled. Using a modified Delphi procedure, a prioritized list of topics related to Geriatric Emergency Medicine was created. Next, a multi-disciplinary group of nurses, geriatricians and emergency physicians performed a review of recent guidelines and literature to create recommendations. These recommendations were voted upon by a group of experts and placed on visually attractive posters. The expert group identified the following eight subject areas to develop expert recommendations on: Comprehensive Geriatric Assessment in the Emergency Department (ED), age/frailty adjusted risk stratification, delirium and cognitive impairment, medication reviews in the ED for older adults, family involvement, ED environment, silver trauma, end of life care in the acute setting. Eight posters with expert clinical recommendations on the most important topics in Geriatric Emergency Medicine are now available through https://posters.geriemeurope.eu/ . Expert clinical recommendations for Geriatric Emergency Medicine may help to improve care for older patients in the Emergency Department and are ready for dissemination across Europe.

Feminization of Emergency Medicine in Europe in the 21st century.

Feminization of Emergency Medicine in Europe in the 21st century.

Resuscitative endovascular balloon occlusion of the aorta : Option for incompressible trunk bleeding?

Hemorrhage is the single largest cause of avoidable death in trauma patients, whereby in civil emergency medicine in Europe most life-threatening hemorrhages occur in the abdomen and the pelvis. This is one reason why endovascular balloon occlusion of the aorta (EBOA), aprocedure especially established in vascular surgery, is increasingly propagated for rapid bleeding control in these patients. This review article provides acomprehensive overview of the technique, indications, contraindications and complications of resuscitative endovascular balloon occlusion of the aorta (REBOA). Additionally, outcomes reported in in the currently available literature are summarized and discussed. From this practical and user-oriented consequences for future successful introduction of REBOA in the field of emergency medicine are deduced.

The development of Emergency Medicine in Europe

The United Kingdom and the United States first recognised the need for a hospital-based specialty of Emergency Medicine in the early 1970s and were closely followed by Canada and Australia. However, similar developments were not seen on mainland Europe until 1994, when the European Society for Emergency Medicine (EuSEM) was established. Its main aims were to promote the establishment of Emergency Medicine as a primary specialty in individual countries and to develop common standards of specialty training across Europe by agreeing a core curriculum and a 5-year programme of specialty training. This article traces the development of Emergency Medicine as a hospital-based specialty in Europe over the last 20 years. Emergency Medicine is now established as a primary specialty in 17 of the 28 member countries of the European Union as well as Turkey. Moreover, in October 2014, the EuSEM celebrated its twentieth anniversary during a congress in Amsterdam attended by more than 2400 delegates.

Development of Emergency Medicine in Europe

Emergency medicine (EM) is emerging worldwide. Its development as a recognized specialty is proceeding at difference rates in different countries. Europe is a region with complex political affiliations and is composed of countries both within and outside the European Union (EU). Europe is seeking greater standardization (harmonization) for mutually improved economic development. Medicine in general, and EM in particular, is no exception. In Europe, as in other regions, EM is struggling for acceptance as a valid field of specialization. The European Union of Medical Specialists requires that once two-fifths of countries acknowledge a specialty, all EU countries must address the question. EM had achieved the needed majority by 2011. This article briefly describes the European road to specialty acceptance.

Research in emergency medicine in Europe

Health research is fundamental for clinical excellence, a fact that applies equally to emergency medicine (EM). Although European scientific publication rates in EM have traditionally been lower than those of other medical specialties, from 1995 steady progress has been made. To increase the scientific output in EM it is necessary to resolve issues that hinder this progress, including the fact that EM is a new specialty, or even nonexistent in many European countries. This has resulted in a relative lack of scientific culture and training in research methodology of emergency physicians, of explicit recognition of scientific work, or of emergency physician competitiveness to apply to national and European grants for research projects. In addition, it is necessary to improve representation of European journals indexed in the category of EM and to receive a firm boost to EM research from the European Society for Emergency Medicine as well as from all European national societies. This study reviews these aspects and offers a personal perspective on where European EM research should be going.

A curriculum for the specialty of emergency medicine in Europe

S. Andrea Hospital, Vercelli, Italy, On behalf of the Task Force for the Core Curriculum in Emergency Medicine Correspondence to Dr Roberta Petrino, MD, ASO Maggiore della Carità di Novara, C.so Mazzini 18, Novara 28100, Italy Tel: +39 3479689806; e-mail: [email protected] Received 15 February 2009 Accepted 27 February 2009

Core curriculum in Emergency Medicine

Reply EDITOR: The authors of the Working Party on Emergency Medicine of the European Board of Anaesthesiology (European Union of Medical Specialists, EUMS/UEMS) want to thank Dr Raed and colleagues for their correspondence. However, we are afraid that Dr Raed and colleagues have misunderstood the intention of our paper. Our paper, in fact, describes the part of the core curriculum in Anaesthesiology dedicated to Emergency Medicine, as is desirable and as is required for any resident who is trained as an Anaesthesiologist in Europe. In contrast to what Dr Raed and colleagues suggest, our paper does in no way promote exclusivity. Emergency Medicine in Europe is diverse, has different contents and different positions in different countries in association with varying organizations of medical care, varying geography and varying resources. With the exception of nine European Countries, Emergency Medicine is not an independent speciality in most European Member States. The European Directive on recognition of professional qualifications (Directive 2005/36/CE of the European Parliament) does not identify Emergency Medicine as a primary medical speciality. The European Union requires that, to become a speciality it must be recognized in at least two-fifths of the Member States and at the same time, by a particular majority (a weighted vote that is determined by the population of each country and other factors and giving what is called a ‘qualified majority') in a committee on Qualification of the European Commission (not only for medical professions but generally also for all protected professions). Furthermore, to create a Specialist Section for Emergency Medicine within the UEMS, Emergency Medicine has to be recognized as an independent speciality by more than one-third of the EU Member States and must be registered in the official Journal of the European Commission (Medical Directives). All these requirements for a primary medical speciality are not fulfilled for Emergency Medicine. The European Board of Anaesthesiology (and not the European Society of Anaesthesiology, which unfortunately was misquoted in the correspondence) has no ambition to be involved in the crusade of the European Society of Emergency Medicine to have Emergency Medicine recognized as a separate medical specialty. Emergency Medicine has many definitions in many regions and countries in Europe. In our opinion it would definitely be preferable first to agree on the definitions of Emergency Medicine in Europe and then to agree on the competencies that are required to achieve high-quality care in Emergency Medicine throughout Europe. It is also important to identify general quality indicators for Emergency Medicine, applicable to all countries and health care systems. It then remains to be seen whether the institution of Emergency Medicine as a separate medical specialty is the way to go to achieve the aforementioned goals. This may be the case for some countries in Europe, but not for others, depending on many factors. Like for Intensive Care Medicine, the multidisciplinary input from various specialties is considered essential to achieve high-quality care in Emergency Medicine. This multidisciplinary input threatens to be lost by the institution of a separate specialty. We do agree with the authors of the correspondence: let us not forget the history of medicine. Too widespread a specialization in medicine has created barriers in the past, which have not served well for the quality of care for our patients. However, mutual stimulation, mutual respect, communication and cooperation are characteristics which we do have!

Emergency medicine in modern Europe

Emergency medicine in the highly advanced world is traditionally performed in two different ways. The first is the well-known Anglo-American system with skilled EDs, and a pre-hospital emergency medical service utilizing paramedics. The second is the so-called Franco-German system, with a highly developed pre-hospital emergency physician service, but only a basic organization of hospital-based emergency medicine. This gap is now closing fast because of the rapid advancement of hospital-based emergency medicine in Europe. Four criteria might be used to measure this: the recognition as a specialty, the specialist training programme, the professional organization of emergency physicians and the presence of academic centres in Europe. Eleven of the 27 European countries recognize hospital-based emergency medicine as a specialty already. These include Belgium, Czech Republic, Estonia, Hungary, Ireland, Italy, Malta, Poland, Romania, Slovenia and the United Kingdom. Other nations are striving to do so, for example Sweden, France, Germany and Greece. There is no doubt that emergency medicine is gaining momentum and other countries will follow. Training for the specialty of emergency medicine is advanced already. Several curricula presently exist in the respective European countries. A task force, governed by the European Society for Emergency Medicine has been working hard to create a model curriculum for all of Europe, which is expected to be published in 2007. This comprises a 5-year specialty training, with three of them spent in an ED. The curriculum follows a symptom-oriented approach to emergency medicine, and includes a skilled description of the key competencies of the future trained emergency physicians. Given the century-long history of the pre-hospital emergency physician service in some European countries, a number of professional bodies exist representing pre-hospital emergency doctors. Within the last few years, ED physicians followed suit forming organizations of their own. In some countries, the next step of amalgamation has occurred, with the merger of EMS and ED emergency physician organizations, although no country has abolished the pre-hospital emergency physician service. The last milestone, the development of academic emergency centres, has only just started. This process will take some time. The present paper describes the present and future of emergency medicine in some European countries using these criteria.

Emergency Medicine in Europe ??? Time constraints may be universal, but are we seeing the same patients?

Patient satisfaction at emergency departments can be improved by reductions in waiting time. Traditional methods require registration and triage before seeing the doctor with senior emergency physicians mainly engaged in treating serious cases. We examine a radical change in workflow pattern on waiting time by placing a senior emergency physician with the triage nurse and examining the impact of treating simple cases upfront with discharge on the waiting times for stretcher cases. A senior emergency physician was placed with the triage nurse in the Department of Emergency Medicine at Alexandra Hospital during peak busy periods of patient attendance over a period of 2 months. Measures were made of waiting time (registration to doctor consult) of PACS 3 and PACS 2 (Patient Acvity Score) cases accordingly. Ten days were chosen for the changed workflow practice and 10 days for controls in which normal traditional working practice followed. On all days, there was the same number of medical staff. The average waiting time for walk-in patients (PACS 3) was 19 min on experimental days as compared with 35.5 min on control days, with 78% being seen within 30 min in the experimental group compared with 48% on control days (P < 0.05). The PACS 2 waiting time was also significantly decreased on experimental days (P < 0.05). Placing a senior emergency physician with the triage nurse reduced waiting times for walk-in cases. One third of attendances were treated and discharged quickly, allowing the consulting room and PACS 1/PACS 2 doctors to act more efficiently.

The development of emergency medicine in Europe: from childhood to adulthood

The development of emergency medicine in Europe: from childhood to adulthood

Manifesto for emergency medicine in Europe

Manifesto for emergency medicine in Europe

Developments and Aspirations of Emergency Medicine in Europe

Developments and Aspirations of Emergency Medicine in Europe

Developments and Aspirations of Emergency Medicine in Europe

Developments and Aspirations of Emergency Medicine in Europe

Manifesto for emergency medicine in Europe

Manifesto for emergency medicine in Europe

Prehospital emergency medicine services in Europe

In order to get an update on prehospital emergency medicine practice all over Europe we submitted questionnaires with a total of 61 questions concerning prehospital emergency medicine in Europe, to 123 European members of the World Association of Emergency and Disaster Medicine (WAEDM). Sixty (49%) questionnaires were returned. One up to seven questionnaires from 22 European countries were analysed: 37 (62%) from urban and 23 (38%) suburban or rural areas; 12 being from former Eastern European countries. Sixteen of the questions--those concerning rescue systems and equipment--are analysed and presented in this paper. A fleet of ambulance cars staffed with paramedics/nurses based at the emergency organization is the most frequently used system in 59% (10/17) of the countries. The same percentage claims to have a ground-based coverage of its area of 80-100%. Airborne coverage between 80-100% and below 60% of the areas is given in the same percentage of 35% (6/17). Physicians are frequently involved in prehospital emergency care in the Eastern European Countries, France, Germany, Italy, Belgium and Turkey, rarely in Switzerland, Denmark, the United Kingdom, Greece, Ireland and Finland, never in the Netherlands and Sweden. In more than 50%, a combination of national, regional and local organizations provide emergency care, which results in large differences of standards. We discovered remarkable differences which could be overcome by enhanced co-ordination and information exchange provided by the European Society for Emergency Medicine, WAEDM, the European Red Cross or the European Academy of Anaesthesiologists.