What is Emergency Medicine?

Emergency Medicine was defined by the International Federation for Emergency Medicine in 1991 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 undifferentiated physical and behavioural disorders. It further encompasses an understanding of the development of pre-hospital and in-hospital emergency medical systems and the skills necessary for this development."

The specialty of Emergency Medicine has embraced the challenge of providing around the clock care to patients who present with symptoms of acute illness and injury, across the whole age spectrum. In the UK , Emergency Medicine as a specialty is constantly adapting and developing. This has been in response to external pressures, for example the multiplicity of changes in the provision of out of hours and acute care, changes in the expectations of patients, changes in medical practice, government targets such as the “4 hour target,” as well as discussion and internal debate around the future direction of emergency and urgent care.

The specialty is quite different now compared to the first "casualty surgeons" in the 60's and 70's.  The emphasis has developed beyond simply treating traumatic injury, to encompass critical and acute care for a much wider range of problems. Departments of Emergency Medicine may be known by several names: Casualty, Accident and Emergency, or Emergency Department (the latter may best reflect the nature of the work, and is also the name used in other countries such as the USA and Australia ).

Patients with acute illness or injury can present at any time, with a wide range of problems. Patients often have “undifferentiated” presentations (i.e. they don’t come in with a known diagnosis), with little initial information available apart from that obtained by talking to the patient; the history, examination and bedside investigations. There is a great challenge in providing rapid and appropriate treatment in the first hours, but effective early diagnosis and treatment has been shown to make big differences for short and longer term outcome in many conditions.

It is not possible or practical to have an experienced representative from every hospital sub-specialty standing by in the Emergency Department at all times. Emergency Medicine evolved because emergencies can occur in any age group, at any time, in one or many body systems, and emergency physicians developed expertise as specialised generalists.  This enables them to make working diagnoses, start appropriate treatment, and if the problem can’t be completely fixed at the time refer on to other appropriate specialists.

Many emergency physicians sub-specialise to bring particular expertise to the practice of Emergency Medicine. For example, they may become experts in the fields of children’s emergencies, acute medical emergencies, poisoning, life-threatening emergencies needing critical care skills, and emergencies in the pre-hospital setting. Other experts spend time focusing on sports medicine.

Many departments are increasing their capacity for practising observation medicine where patients remain in a ward style environment for up to 48 hours under the care of the emergency physician. This allows time for more detailed investigation and treatment, or support for those who have a temporary condition that prevents them being safe at home after discharge.

As far as training is concerned the specialty has a well developed curriculum and specific examinations. Junior doctors in the emergency department receive high quality training and experience under direct supervision of senior doctors who are dedicated to medical education and to the development of Emergency Medicine as a specialty in its own right.

Research into Emergency Medicine has to some extent lagged behind research in other areas. This situation is now changing, and high quality research has been emerging.Emergency Medicine in the UK is making an increasingly important contribution to clinical care with centres of excellence in research developing around the country and academic training programmes being developed.

Emergency Medicine has been pioneered in the UK , along with North America and Australasia. Many European countries are now developing services based on the UK model. Australasia and North America have long championed the specialty and advanced the levels of care offered by incorporating techniques from the fields of radiology (ultrasound) and intensive care medicine (advanced airway skills), and the UK is embracing these developments.

These pages will, we hope, explain what is involved in the work of the Emergency Department and reflect the perspectives of senior doctors, trainee doctors, and the public. We welcome any feedback or contributions to the website - contact the administrator.