EMERGENCY MEDICINE An Emerging Clinical Practice Faith Joan C. Mesa-Gaerlan, MD, FPCEM, MS College of Medicine-Philippine General Hospital University of the Philippines

Amang Rodriguez Medical Center

IN TIMES OF EMERGENCIES, WHO ARE YOU GOING TO CALL?

Objectives Define Emergency Medicine Enumerate the scope of the specialty Discuss the fundamental principles of Emergency Medicine Describe the current status of the Emergency Medicine in the Philippines Illustrate the importance of EM in the Philippine context

Definitions Emergency is any situation that requires immediate action. WHO Medical Disaster is an occurrence “when the destructive effects of natural or manmade forces overwhelm the ability of a given area or community to meet the demand for health care”. ACEP

Definitions Emergency Medicine (EM) - A branch of medicine that deals with the appropriate management of all forms of acute illness or injury. Specialization in EM will lessen unwanted morbidity or mortality due to a sudden illness or injury. In the British System this is known as Accident and Emergency (A&E).

Definitions Emergency Department (ED) or Emergency Room (ER) - A unit of the hospital composed of health care workers organized to address management of acute illness or injury.

The Emergency Department The current trend in Emergency Medicine is to establish the ED as a separate and distinct department within the hospital, complete with its own management and staff.

What is the Practice of Emergency Medicine? Takes the most difficult cases from all medical specialties Multidisciplinary Defined by the demands of the Emergency Department Involves both Medical and Non-Medical Problems Includes all Medically-related incidents outside the hospital

Emergency Medicine International Federation for Emergency Medicine, 1991 knowledge and skills required for the prevention, diagnosis and management of acute and urgent aspects of illness and injury all age groups spectrum of episodic undifferentiated physical and behavioral disorders encompasses pre-hospital and in-hospital emergency medical systems

Characteristics of the Specialty Triage, Stabilize, Prioritize, Refer, Observe ABCs Limited resources Time Information Space Technology dependent Cutting-edge medicine

Difference with other Specialties Sequence of Assessment Assess  Action  Reassess  Action Always thinks of worst-case scenario Chest pain is MI! AMPLE history Prioritize patient’s clinical problems Emergent-Urgent-Non-urgent Resuscitate to Stabilize  improve patient’s clinical outcome

Pillars of EM Chain of Survival ABCDs . . . Pain Management EMSS BLS RSI, ACLS PALS / NALS ATLS Pain Management EMSS

Characteristics of the Practice Low overhead No clinic to rent No staff to hire Minimal equipment necessary Flexible Work Hours Choose your hours Maximum 60-hours/week Not necessary to file for leave

Characteristics of the Practice High Stress Kinds of cases seen Kinds of patients seen Limited resources No Follow-ups – no admitting privileges Exposed to legal and ethical dilemnas Group practice

Characteristics of EM Physicians Type A personality Adrenaline junky Multi-tasker Able to make quick decisions Willing to work nights, weekends, holidays Good communicator Team player

Subspecialties Pediatric EM Toxicology Emergency Health Emergency Medical Services Disaster Medicine and Mass Gatherings International EM Emergency Public Health information ED Administration Intensive Care

Areas of Special Interest Emergency Cardiac Care Neurology: “Brain Attack” Sports Medicine / On-site Medical Care Research Child Abuse & Abuse of Women in Intimate Relationship / Medico-Legal (i.e. torture) Environmental & Occupational Health

EMS System Emergency Medical Services System (EMSS) – The total system intended to care for a casualty from the site of incident to definitive care.

EMS System includes Triage On-site care Initial resuscitation and treatment Medical transport Definitive care

EMS System Components Transport Personnel Communications System Medical Control Equipment and Supplies Legislation and advocacy

where are we now? where are we going? Picture of an earthquake (audience will identify 7 concepts)

HISTORY OF EMERGENCY MEDICINE Before Emergency Medicine War 18th Century Field Hospitals Medics during Korean & Vietnam Wars Emergency Rooms (in the 1960’s) Staffed by nurses and interns On-call physicians from other specialties

History of Emergency Care Development of EM 1960s – Creation of “Casualty Department” in UK & Australia 1968 – American College of Emergency Physicians founded 1969 – 1st ACEP scientific assembly held 1970 – 1st EM residency established in Univ. of Cincinnati

1972 – Casualty Surgeons Association Development of EM 1972 – Casualty Surgeons Association restructured as British Association for Accident & Emergency Medicine 1972 – Journal of ACEP published 1973 – Emergency Medical Services Systems Act signed into law 1973 – AMA establishes section on EM 1974 – EMRA established 1976 – American Board of EM established

1981 --Australasian College for Emergency Medicine established Development of EM 1979 – EM established as 23rd medical specialty 1981 --Australasian College for Emergency Medicine established 1986 – 1st International Conference on EM 1989 – ABEM given primary board status

1990 – International Federation for EM founded Development of EM 1990 – International Federation for EM founded 1992 – ABEM and American Pediatric Society establish Subspecialty Board for Pediatric EM 1994 – 1st Subspecialty Board for Toxicology 1998 – 1st Asian Congress of EM held in Singapore.

EM IN THE PHILIPPINES 1988 –Emergency department created at Makati Medical Center / Philippine College Emergency Medicine and Acute Care formed 1989 -- Philippine Society of Emergency Care Physicians formed 1996 – Setting up of PGH Emergency Medical Services System 1997 – Establishment of Residency Program at DEMS, PGH

Emergency Medicine in the Philippines 2001 – Department of EM established as Academic unit of UP College of Medicine 2011 – Philippine College of Emergency Medicine (PCEM) formed & recognized as specialty society of specialty division of the Philippine Academy of Family Physicians under the Philippine Medical Association

Emergency Medicine in the Philippines VISION: The national academic body composed of dedicated professional emergency medicine physicians oriented towards quality service, research and training in emergency care, working together towards global recognition.

EMERGENCY MEDICINE IN THE PHILIPPINES MISSION: To achieve national recognition as a distinct specialty in medicine. To promote emergency care nationwide to its highest standards. To regulate the practice and training of emergency medicine. To participate in disaster planning and pre-hospital care. To innovate emergency medicine practice through research and continuing medical education

Access to professional emergency health care services

Emergency Medicine in the Philippines “Ideally, the emergency department is headed by a specialist trained in Emergency Medicine.” (DOH, ER Management Manual, 2009)

COMPARATIVE DESIGNS OF EMERGENCY RESPONSE SERVICES USA Asian Nations Funding Well Funded Scarce Funding Infrastructure Uniform federal Not Uniform Support National Safety stats. Vehicles, Exists Does not Exist equipment's Minimum standard Recognition Requires care provided present recognition Minimum guidelines Existing Not existing for education & training

COMPARATIVE DESIGNS OF EMERGENCY RESPONSE SERVICES USA Asian Nations Support Professional Minimal Voluntary Improvements in Organizations Organizations System Design Cost of Med. & Heightened Lack of Trauma Care awareness awareness Public Health Continued Non existent Prevention Prog. Awareness Network for Disaster Structured Partially Response structured System Flexibility Existent No System

PGH EMS 42

Directions in EM Establish and improve EM training programs Training programs – 4 government, 6 private Highest standards in emergency care Take the lead in medical control for disaster planning and preparedness Improve pre-hospital emergency care

Directions in EM Curricular changes for Undergraduate Medical Education Research and Documentation Training BLS, ACLS, ATLS Emergency Nursing Emergency Medical Technicians

Pre-Hospital & ED reimbursement Emergency Public Health Information Directions in EM Pre-Hospital & ED reimbursement Emergency Public Health Information Dissemination ED Design Continuous Quality Improvement

Emergency Doctrine Implied Consent for patients in the ED who cannot give consent for actions to save or preserve life Serves to protect emergency personnel who act in good faith Encourages personnel to act decisively in the patient’s best interest

In the business of saving lives, our COMMITMENT to SERVE, makes all the DIFFERENCE

QUESTIONS?