Learn about Emergency Care
What is Emergency Care?
Emergency Medicine is a medical specialty (like dermatology, paediatrics, or internal medicine), that is concerned with delivering time-sensitive care to individuals with any type of acute (emergency) illness or injury. Acute care may be defined as the comprehensive, system-based approach to time-sensitive disease. It encompasses all health system components and care delivery platforms used to diagnose, manage, and treat injury and illness that may lead to death or disability without timely intervention. This includes acute care surgery, trauma care, emergency obstetrics, and primary urgent care.
Emergency care is a subset of acute care concerned with providing effective health action in response to extreme risk under intense time pressure to address emergent health conditions that present sudden or unexpected threats to life or limb. The value added by acute care and integrated acute care systems can be appreciated from the clinical perspective, the patient perspective, and the system level.
As a first step towards defining the scope of the emergency care system (i.e. who should be able to access it, and under what circumstances), AFEM and its collaborators required a definition of a medical emergency. This definition was the result of a core working group (3 people) and a 138-person consensus input process. Everyone had the opportunity for verbal input; around 35% of participants chose to make written inputs in addition.
The agreed definition of a medical emergency (agreed on 22 April, 2016):
Emergency health conditions are those requiring rapid intervention to avert death or disability, and those for which treatment delays of hours or less make interventions less effective. Concern that such a condition exists requires urgent assessment.
Here are two other broad definitions of Emergency Medicine:
The International Federation for Emergency Medicine:
Emergency medicine is 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. (from www.ifem.cc)
American College of Emergency Physicians:
Emergency medicine is the medical specialty dedicated to the diagnosis and treatment of unforeseen illness or injury. It encompasses a unique body of knowledge as set forth in the "Model of the Clinical Practice of Emergency Medicine." The practice of emergency medicine includes the initial evaluation, diagnosis, treatment, and disposition of any patient requiring expeditious medical, surgical, or psychiatric care. Emergency medicine may be practiced in a hospital-based or freestanding emergency department (ED), in an urgent care clinic, in an emergency medical response vehicle or at a disaster site. (from www.acep.org)
What do Emergency Care providers do?
Emergency care is practiced in many environments, across a continuum of healthcare professionals. Community first responders; basic and advanced EMS personnel; paramedics; nurses, clinical associates, and physicians are all important players in the delivery of successful emergency care. They require a broad knowledge base and possess the skills of many specialists. Emergency physicians, for example, have the ability to manage a difficult airway (anesthesia), suture a complex laceration (plastic surgery), reduce a fractured bone or dislocated joint (orthopedic surgery), treat a heart attack (internist), deliver a baby (Obstetrics and Gynecology), stop a bad nosebleed (ENT), manage suicide attempts and complex overdoses (Psychiatry & Toxicology), tap a septic joint (Rheumatology), protect an abused child (Paediatrics), and place a chest tube (Cardiothoracic Surgery).
Emergency medicine professionals also provide valuable clinical and administrative services to the emergency department and other sectors of the health care delivery system. These may include and are not limited to:
- The coordination of out-of-hospital emergency medical response
- Participating in community disaster preparedness
- Emergency department leadership and medical direction
- Active participation in the direction of the emergency department patient intake process
- Active participation in the planning of emergency department staffing levels
- Active participation in approval of emergency department policies and procedures
- Active participation in the emergency department budgetary process
- Participation in emergency department staff continuing education
- Oversight and direction of emergency department patient disposition
- The coordination of emergency department patient care among multiple providers and healthcare facilities
Why is Emergency Care important?
Emergency care is a horizontal intervention, needed by everyone regardless of age, gender, or history, whose successful implementation forms the base of a functioning healthcare system and eases pressure on every other branch of that system. Emergencies will cost the system in both human and financial terms, no matter what. Creating a dedicated emergency care system can increase the effectiveness and efficiency with which they are treated, saving more lives per amount spent.
Emergency care focuses on the immediate decision making and action necessary to prevent death or any further disability both in the pre-hospital setting by directing emergency medical technicians and in the emergency department. It is both high-impact and cost-effective, as early resuscitation and stabilisation of acutely ill patients greatly reduces morbidity and mortality.
In fact, many major international organisations recognise the critical need for emergency care: WHO data shows that HIV/AIDs, TB, and malaria combined kill 4.4 million people per year, yet injury alone kills 5.8 million. The World Bank estimates that 45% of deaths and 36% of disability-adjusted life years (DALYs) in low- and middle-income countries could be addressed by the implementation of emergency care systems.
What is Emergency Care like in Africa?
African countries suffer the highest rates of every category of injury; the highest rates of maternal death from acute complications of pregnancy; and the highest rates of acute complications of communicable diseases including tuberculosis, malaria, and HIV. Yet despite this, acute care is virtually non-existent in much of sub-Saharan Africa.
Emergency Care is very much in flux across the continent, and the state of development differs widely for different countries. In general, however, there are still many countries where EM is not yet recognized as a medical specialty, or has very recently been recognized. In either case, emergency centres are often staffed by rotating or junior personnel, who are poorly trained to handle the wide variety of presentations with the limited resources available to them. Educational and training opportunities are limited. However, residency programs in Emergency Medicine are beginning to appear in several areas, as well as advanced educational opportunities in EC for nurses, EMS, and other practitioners. For more detailed descriptions of the state of Emergency Care in a few specific areas, have a look at these reports, published in the African Journal of Emergency Medicine:
Setting the EM Agenda: http://www.sciencedirect.com/science/article/pii/S2211419X14000731
Emergency Care in Sudan: http://www.sciencedirect.com/science/article/pii/S2211419X1400007X
Emergency Care in Ghana: http://www.sciencedirect.com/science/article/pii/S2211419X1200122X
Emergency Care in Tanzania: http://www.sciencedirect.com/science/article/pii/S2211419X12000663
What is the African Federation of Emergency Medicine doing to address Emergency Care needs across Africa?