Emergency Medicine: A global specialty

See also pp. 289–95, 296–9, 300–2 While recorded evidence of the practice of Emergency Medicine by an Indian physician, Charak dates back to 300 bc, it is fair to say that the birth of modern Emergency Medicine took place only in 1967. In 1962, the British Medical Association established a committee under the chairmanship of Sir Harry Platt, an eminent orthopaedic surgeon, to look into the management of accidents in casualty departments of British hospitals. In those days, very little went direct to casualty departments in the form of acute medicine. Among many recommendations in his report, he suggested that the name ‘Casualty’ should be changed to ‘Accident and Emergency’.1 It was to become what we now know as Emergency Medicine. The Platt report also said that accident surgery was unlikely to provide a satisfactory career for a consultant. But great leaders do get things wrong sometimes. Even Mrs Margaret Thatcher (now Baroness Thatcher) is reported to have said that in her political life time she did not think there would be a woman prime minister. Some senior medical officers working in British casualty departments were so incensed by Sir Harry Platt's comments related to accident surgery that they established the Casualty Surgeons' Association (CSA) on 12 October 1967 to promote the ‘art and science of casualty medicine and surgery’. Hence was the birth of modern Emergency Medicine globally. When Tom Hamilton was invited by the CSA (UK) in 1989 for the prestigious Maurice Ellis Lecture he was to deliver at the conference, he chose the title, ‘Not Cas., Not A&E, but Emergency Medicine’. Tom was a man of wisdom and vision. Among many other reasons, his talk was inspirational for the CSA to change its name to the British Association for Accident and Emergency Medicine. What is in a name? Lovers of Shakespeare will say ‘What’s in a name? That which we call rose by any other name would smell as sweet'. I think a good name is rather to be chosen than riches. The name ‘Emergency Medicine’ gives identity, dignity and creates the right public image but, above all, in our case describes its function. Emergency Medicine is defined by the International Federation for Emergency Medicine (IFEM) as ‘. . . a field of practice based on the knowledge and skills required for the prevention, diagnosis and management of acute and urgent aspects of illness and injury affecting patients of all age groups with a full spectrum of episodic undifferentiated physical and behavioural disorders; it further encompasses an understanding of the development of prehospital and inhospital emergency medical systems and the skills necessary for this development’. Although a general definition of the specialty exists, the function of the ED needs to be tailored according to the geography of the area and cultural and clinical needs of an individual country. It should be a specialty dealing with acutely ill or injured patients who require immediate treatment. It is here in EDs that the evaluation and treatment of these conditions will take place. This is a branch of medicine that is performed in a hospital department, in the field, and in other locations where initial treatment takes place. Emergency Medicine is practised differently in different parts of the world, as is so aptly shown by the papers by David, Ezaki and Fulde in this issue.2–4 It has a different connotation in different cultures. Each country has its own set of common diseases and it is not always easy to apply the art and science of Emergency Medicine uniformly. The level of Emergency Medicine development in a country depends on many factors like health-care development, variety of diseases, resources available, the availability of trained physicians and of course public demand. After the British organization was established, the Americans followed in 1968 and then the Canadians and Australasians established their own Emergency Medicine organizations. Since then, although international Emergency Medicine has grown rapidly over the last few decades, there is still a lack of high-quality, consolidated and easily accessible evidence-based literature. We need to facilitate academic and research-based Emergency Medicine training, develop and maintain standards of care, coordinate data collection and disseminate information. This will help interested parties where Emergency Medicine is already established, and where it needs to be established. At the Scientific Assembly of the American College of Emergency Physicians (ACEP) in 1984, we (William Rutherford, the then CSA President, and myself) tossed with the idea of an international conference related to Emergency Medicine topics. This saw the birth of the International Conference on Emergency Medicine (ICEM) in 1986 in London. At the second ICEM in Brisbane, Australia in 1988, it was proposed that an international organization in Emergency Medicine should be created and the IFEM was born in 1991. Although the IFEM was established to spread the word for Emergency Medicine and exchange information, it has blossomed into a truly international organization. Its mission is to ‘promote at an international level interchange, understanding and cooperation among physicians practising Emergency Medicine’. One of its goals is to ‘offer advice and guidance to Emergency Medicine practitioners worldwide in the formation of national association and training and certification programmes’. The Emergency Medicine community has the responsibility to encourage the availability of emergency medical services to those who need them, in all countries. We need to help promote the development of emergency medical care, promote prehospital development, help provide care in man-made and natural disasters, work towards accident prevention and recognize and further promote academic Emergency Medicine. Again, this has been well highlighted in the papers on Emergency Medicine in India, Japan and parts of Europe in this issue.2–4 The USA, like the UK, Australasia and Canada, could be regarded in the forefront by creating the Directorate of International Emergency Medicine in institutions such as the New York-Presbyterian University. Steadily the specialty of Emergency Medicine is gaining global acceptance. This is because of the efforts of emergency physicians, local advocates of the specialty, national, regional and international organizations, such as the European Society for Emergency Medicine and the IFEM. There is undoubtedly now more awareness about the specialty, but the stakeholders have the responsibility to promote it further, and politicians have the responsibility to ensure the adequate and proper allocation of resources for the local population. Examples of influencing our political masters, by having a political lobby (ACEP's in Washington DC), or involving national Government's health department and health ministers in discussions (as in the UK) are encouraging. Efforts like these led the Government in the UK to put emergency care on top of the health agenda. Our next march should be in the direction of the WHO. But before that we, the specialists, have obligations both as individuals and collectively, to help develop Emergency Medicine worldwide. There are challenges for all of us. Although there are threats of war and terrorism and atrocities like 9/11, let us not forget that everyday there are patients needing treatment for anything from sprained ankles, to heart attacks all over the world. The moving accident is not my trade; To freeze the blood I have no ready arts; ‘Tis my delight, alone in summer shade, To pipe a simple song for thinking hearts.