आकस्मिक चिकित्सा

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Emergency medicine is a branch of medicine that is practiced in a hospital emergency department, in the field (in a modified form - see EMS), and other locations where initial medical treatment of illness takes place.

Emergency medicine focuses on diagnosis and treatment of acute illnesses and injuries that require immediate care. While not usually providing long-term care, EM physicians and pre-hospital personnel still provide care with the aim of improving long-term patient outcome. In the United States, some people use the emergency department for outpatient care that could be provided at a doctor's office. As a result, much of emergency room care is general practice (coughs, colds, aches, pains).

A variant of an Emergency Department is an Urgent Care Center, often staffed by non-Emergency Medicine trained physicians and/or nurses, which treats patients who desire or require immediate care, but do not reach the acuity that requires care in an emergency department.

Emergency Medicine involves a large amount of general medicine but involves all fields of medicine including the surgical sub-specialties. Emergency Physicians are tasked with seeing a large number of patients, treating their illnesses and admitting them to the hospital as necessary. The field requires a broad field of knowledge and requires advance procedural skills often including surgical procedures, trauma resuscitation, advance cardiac life support and advanced airway management.

1 Definition
2 History
3 Organizations around the world
4 Practice
5 See also
6 External links

[परिवर्तन्] Definition

"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 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."

International Federation for Emergency Medicine 1991

[परिवर्तन्] History

Emergency Medicine as a standalone medical specialty is relatively young. Prior to the 1960's and 70's, hospital emergency rooms were generally staffed by doctors trained in other specialties, such as internal medicine and primary care. However, during this time period, groups of physicians mostly located in the midwestern United States (notably Cincinnati, Ohio, and Denver, Colorado) recognized the need, and the niche, for physicians specifically trained to handle acute medical emergencies.

[परिवर्तन्] Organizations around the world

In the United States, the American College of Emergency Physicians (ACEP) is presently the largest member organization of emergency physicians (EPs), and is open to most physicians who practice in an Emergency Department. Originally founded in 1968, it was the first Emergency Medicine society formed in the United States. Fellows use the designation FACEP.

The American College of Osteopathic Emergency Physicians (ACOEP) was founded seven years later in 1975. Membership is open to both osteopathic (D.O.) and allopathic (M.D.) physicians who practice emergency medicine. Fellows use the designation FACOEP.

The American Academy of Emergency Medicine (AAEM) is another specialty society of Emergency Medicine. It was formed after ACEP and ACOEP and is considered a rival organization although both organizations have cooperated in the past. Members must be board certified in Emergency Medicine. Fellows use the designation FAAEM.

The American College of Veterinary Emergency and Critical Care (ACVECC) is the governing body that offers board-certification to veterinarians who have completed an accredited residency program and passed a rigorous written, practical and oral certification examination. Specialists are known as criticalists, and most are employed in referral practice or academic institutions. It is a rapidly expanding field of veterinary medicine. Specialists are given the desgination of DACVECC after becoming certified for Diplomate of the American College of Veterinary Emergency and Critical Care.

The American Board of Emergency Medicine (ABEM) provides board certification to allopathic (M.D.) emergency physicians who have successfully completed a residency in emergency medicine, completed an additional year of practice, passed a written exam, and then an oral exam.

The American Osteopathic Board of Emergency Medicine (AOBEM) provides board certification to osteopathic (D.O.) emergency physicians who have successfully completed a residency in emergency medicine, completed an additional two years of practice, passed a written exam, and passed an oral exam.

The American Board of Physician Specialties (ABPS) also offers Board Certification in Emergency Medicine (BCEM). This certification is offered to experienced physicians who have completed residency training in related primary care fields, who have more than 5 years of full-time emergency medicine experience, are certified in ACLS/PALS/ATLS courses, provide letters of recommendation, and file 10 case reports - all required prior to passing both written and oral tests. The ABPS certification is more widely recognized in rural and suburban hospitals. The 'grandfathering-in' of other experienced non-residency trained physicians practicing emergency medicine was closed off from ABEM and AOBEM several years ago, likewise from BCEM if the doctor has not completed a residency. Currently (as of 7/06), only the state of Florida has recognized BCEM at the state medical board level, but many hospitals across the country do recognize BCEM.

Board certification is maintained through annual testing over required reading lists and a more extensive written exam every 10 years (for ABEM), every 8 years for BCEM.

Many types of physicians may practice in an Emerency Department; however, only those who have successfully passed the board certification process are considered "Emergency Medicine Specialists". Currently the ABEM and AOBEM require a number of years of residency training after medical school, followed by comprehensive written and oral examinations. The BCEM requires (in addition to passing written and oral examinations) completion of an ACGME approved residency in an approved specialty such as Family Medicine or Internal Medicine, 5 years of the practice of emergency medicine, 10 Peer reviewed case reports, current ATLS/PALS/ACLS certification and 3 letters of recommendation from peers.

A sudden surge of interest in the specialty in the late 1990s was due to the popularity of the American TV series ER. Showcasing the function of a Chicago Emergency Department (loosely based on Cook County Hospital) and its many characters, the show introduced a large number of people to the specialty.

In the United Kingdom and Ireland, the College of Emergency Medicine sets the examinations that trainees in Emergency Medicine take in order to become consultants (fully-trained emergency physicians). The British Association for Emergency Medicine is the member organization in the UK. In 2005, the two organisations initiated steps to merge as the College of Emergency Medicine.

In Australia and New Zealand, advanced training in Emergency Medicine is overseen by the Australasian College for Emergency Medicine (ACEM).

In Canada, there are two routes to practice emergency medicine. More than two thirds of physicians currently practicing emergency medicine across the nation have no specific emergency medicine residency training. Emergency physicians who tend to work in more community-based settings complete a residency specializing in Family Medicine and then proceed to obtain an additional year of training of special competence on Emergency Medicine from the College of Family Physicians of Canada (CCFP-EM). Physicians practicing in major urban/tertiary care hospitals will often pursue a 5 year specialist residency in Emergency Medicine, certified by the Royal College of Physicians and Surgeons of Canada. These members typically spend a great deal of time in academic and leadership roles within emergency medicine, EMS, research, and other avenues. There is no significant difference in remuneration or clinical practice type between physicians certified by either route.

See medical emergency for specific lists of medical emergencies and how best to respond.

[परिवर्तन्] Practice

In the US, Emergency Medicine is one of the more competitive specialties to get into, and residency programs generally select physicians from the top of their medical school class. There are usually many physicians competing for each residency spot.

Allopathic (M.D.) emergency medicine residencies can be 3 or 4 years in length, combining both the internship and residency into one program or "1+3," utilizing a separate internship followed by 3 years of Emergency Medicine. Osteopathic (D.O.) residencies are four years in length, requiring a one year traditional rotating internship followed by a three-year emergency medicine residency. In addition to the didactic exposure, much of an emergency medicine residency involves rotating through other specialties with a majority of such rotations through the emergency department itself. By the end of their training, EPs are expected to handle a vast field of medical, surgical, and psychiatric emergencies. EPs are therefore both clinical generalists and well-rounded diagnosticians. EPs are considered specialists in advance cardiac life support protocols ('codes') and airway management.

The employment arrangement of emergency physician practices are either private (a democratic group of EPs staff an ED under contract), institutional (EPs with an independent contractor relationship with the hospital), or corporate (EPs with an independent contractor relationship with a third party staffing company that services multiple emergency departments).

Most emergency physicians staff hospital emergency departments in shifts, a job structure necessitated by the 24/7 nature of the emergency department.

[परिवर्तन्] See also

CPR
Toxicology
Emergency medical service
Traumatology
Physical trauma
Rescue squad
Emergency Medical technician
Wound care
First aid
Paramedic
Golden hour

[परिवर्तन्] External links

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