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

3. Amang Rodriguez Medical Center

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

10. 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

11. 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

12. 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).

13. 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.

14. 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.

15. 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

16. 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

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

18. 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

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

20. 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

21. 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

22. 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

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

24. 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

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

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

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

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

29. 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

30. 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

31. 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

32. 1981 --Australasian College for Emergency Medicine established
Development of EM
1979 – EM established as 23rd
medical specialty
Australasian College for
Emergency Medicine established
1986 – 1st International Conference on EM
1989 – ABEM given primary board status

33. 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.

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

35. 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

36. 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.

37. 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

38. Access to professional emergency health care services

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

40. 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

41. 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

42. PGH EMS 42

43. 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

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

45. 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

46. 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

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

48. QUESTIONS?