Competence makes the difference in emergency medicine

Competence makes thae difference in emergency medicine
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Dr Roberta Petrino, president of the European Society for Emergency Medicine, shares with Health Europa her hopes for the inaugural Emergency Medicine Day.

The European Society for Emergency Medicine (EUSEM) is a non-profit organisation dedicated to advancing research, education and training, promoting standards, and supporting good practice in emergency medicine throughout Europe. Boasting 32 national society members, EUSEM works to encourage international collaboration in the field; facilitate information exchange through meetings, courses, research and publications; foster the development of uniform information systems and data banks; and support co-operation between – and the formation of – national emergency medicine associations.

As part of its mission to raise the profile of emergency medicine, EUSEM has this year christened 27 May ‘Emergency Medicine Day’ – an annual event dedicated to celebrating professionals in the field and encouraging the public and healthcare policymakers all around the world to think and talk about emergency medicine.

Speaking to Health Europa, EUSEM’s president, Dr Roberta Petrino, outlines her hopes for Emergency Medicine Day, the importance of emergency medicine in the transition to a more sustainable healthcare system, and how policymakers could help to improve competence in the field.

What were the key aims of this year’s Emergency Medicine Day?

Emergency Medicine Day was proposed and launched by EUSEM for the first time this year, with the aim of calling on all citizens, stakeholders, decision makers and healthcare professionals to talk and think about emergency medicine and the value of functioning emergency medical care.

We strongly believe that a well-developed, well-prepared and well-organised emergency medical system is able to increase survival and reduce disability after any kind of urgent or emergent medical situation.

The message and invitation of Emergency Medicine Day is global, but we know that in Europe the journey towards a homogeneous emergency medical system is incomplete and a lot of attention and effort is still needed to make it a reality.

This year we wanted to send a strong message, so we chose a video and an image that explain in a very efficacious way what our job and our identity are (including not only the work of the emergency departments but also the out-of-hospital emergencies and disaster scenarios, as well as clinical work, training, research, humanity and, above all, passion).

The message is not about complaining about the hard work we do and the difficult environment we do it in but is instead a positive one: we want to show that even a sometimes strenuous job like ours – one that requires us to be available no matter the hour, day, environment or circumstances – is the best job possible when approached with enthusiasm and passion, and that greater awareness and understanding among the public and more support from politicians might help us to do it better, increase competence, and lead to a reduction in morbidity and mortality.

The theme of Emergency Medicine Day was ‘competence makes the difference’ – are current training and teaching programmes in emergency medicine sufficient, and what role does EUSEM play in this space?

The role of EUSEM has been and is crucial; together with the UEMS (European Union of Medical Specialists) Section and Board of Emergency Medicine, it provides guidance on achieving ‘competence’. The European Curriculum of Emergency Medicine describes all the competencies expected of an emergency physician – not only the medical knowledge and patient care capabilities required but also the technical, managerial, communication, ethical, legal, organisational and teaching skills that are essential components of our everyday job. These ‘non-clinical’ skills have been fundamental for the justification and accreditation of the discipline and specialty of emergency medicine.

The big difference between emergency medical care based on consultations of specialists from different disciplines and one based on specialists in emergency medicine and in a well-structured system is the capacity to use resources in a wise and proper way, to visualise a situation, and to be prepared for any sudden event; above all, it is the sense of belonging to a community that is driving improvement. This is not to say that emergency medicine doesn’t require help and advice from other specialities. Hospital care is based on a multidisciplinary approach and management, but in an emergency setting the specialist needs to be able to act immediately and should seek other specialists’ expertise only when needed and appropriate.

Many countries in Europe and beyond have adopted the European curriculum to boost their training programmes in emergency medicine, and this is the first step towards uniformity of the system. Other steps include allocating the necessary resources, human and structural, and gaining the attention of policy and decision makers. Teaching and training programmes need to be translated into practice, which also requires investment.

EUSEM, together with the UEMS Section and Board of Emergency Medicine, is also trying to promote competence through the European Board Examination of Emergency Medicine (EBEEM), an exam designed according to the curriculum which certifes that the standard competencies of the European emergency physician have been achieved. The exam evaluates candidates’ knowledge as well as their technical skills and attitude towards an emergency situation through the evaluation of candidates in simulated scenarios. The aim is that the EBEEM will become the standard evaluation exam of certification for all European residents in emergency medicine.

Is emergency medicine sufficiently prioritised on the European public health agenda?

Emergency medicine in Europe is not yet known and promoted enough. In many countries, even in those where the speciality has been recognised, there are still roadblocks to its development and opposition to its independency.

In counties such as the USA, Canada, Australia, the UK and Ireland, where emergency medicine has developed over time, it has been demonstrated to be effective and efficient, appropriate and necessary. Having a dedicated emergency workforce is a far better way of achieving a high standard of competence and behaviour and increasing the appropriateness of actions, leading to less mortality on the field, safer discharges, and fewer unnecessary hospital admissions.

It is clear that providing data on these achievements should be of maximum interest to the European public health agenda. At EUSEM, we hope to attract the interest of policymakers and to be given the opportunity to participate in discussions about the resources and efforts being allocated to emergency medicine in Europe.

How is the shift to a more sustainable healthcare system coming to impact on emergency medicine, and how is the discipline adapting?

As I explained before, emergency medicine is central to a more sustainable healthcare system. Some observations have shown that the healthcare provided to the patient in the emergency department and observation unit is some of the most cost-effective. In a short period of time (4-6 hours in the emergency department, up to 14-30 hours in the observation units), the doctor is carrying out many different evaluations and tests with the objective of making a diagnosis or ruling out a severe diagnosis, treating an urgent and emergency situation, avoiding a death or permanent disability, establishing the basis for a long-term care pathway, dealing with violence and abuse, and acting as an interlocutor or safe harbour in times of social crisis.

The major success of observation units has been to substantially decrease hospital admissions. Observation units enable many acute situations to be resolved in a short period of time, as well as allowing conditions with an intrinsic risk like chest pain or syncope to be observed so that life-threatening pathologies can be ruled out and patients safely discharged.

For this reason, well-organised emergency medical systems in many countries have been able to cope when the number of hospital beds has been significantly reduced. However, at particular moments of the year, for instance during epidemics or occasions of extreme temperatures, the risk of overcrowding in the emergency department is very real and may be dramatic. Policymakers need to be aware of this because these crises are predictable and should be prevented systematically.

More widely, what are the priorities of EUSEM looking ahead to the remainder of the year?

EUSEM is a scientific society, so our priorities lie in education and research. We also provide guidance to national emergency medicine societies about the speciality and discipline, develop policy statements and guidelines, and organise congresses and events.

In particular, EUSEM supports the activity and growth of the young generation of emergency physicians, the new specialists on whom the future of emergency medicine depends. EUSEM’s Young Emergency Medicine Doctors (YEMD) Section is actively engaged in promoting standards of competence and care, is working on education, and is promoting fellowships around Europe for doctors in training.

This September EUSEM will host the 12th European Congress of Emergency Medicine in Glasgow, Scotland, alongside the Royal College of Emergency Medicine, and we are expecting several thousand doctors, nurses and professionals to gather for a great scientific, educational and social programme.

In Glasgow we will dedicate time to explaining the value of Emergency Medicine Day, an event which, without any particular preparation, has this year reached many thousands of people and organisations. We want to create a working group for this initiative in preparation for next year’s celebration, our aim being that all stakeholders, at all levels, will be involved in the day and will lend their voices and efforts to the calls for a universally recognised and well-developed emergency medical care system.

What is emergency medicine?

EUSEM defines emergency medicine as a ‘primary specialty established using the knowledge and skills required for the prevention, diagnosis and management of urgent and emergency aspects of illness and injury, affecting patients of all age groups with a full spectrum of undifferentiated physical and behavioural disorders.
‘[It] encompasses the in-hospital as well as out-of-hospital triage, resuscitation, initial assessment, telemedicine and the management of undifferentiated urgent and emergency patients until discharge or transfer to the care of another healthcare professional.’

Dr Roberta Petrino
European Society for Emergency Medicine (EUSEM)

This article will appear in issue 6 of Health Europa Quarterly, which will be published in August.

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