Chief editor’s note: This paper, based on some discussions in the framework of our last Euroanaesthesia, discusses a very important issue, related to anaesthesiologists’ involvement in the field of emergency medicine. Our readers are invited to contribute to the Newsletter by sending us their opinions on this important topic.
Karl Thies on behalf of ESA Scientific Subcommittee 10
Over the past 20 years Emergency Medicine has evolved as a standalone specialty in Europe. This certainly has improved access to urgent care in many countries. However, it is still not yet clear how Emergency Medicine as a standalone specialty would fit into already highly developed Central and Northern European care systems where emergency care has traditionally been driven by the acute care specialties Anaesthesiology, Surgery, Cardiology, and Neurology. In these longitudinal systems the specialties are moving their expertise freely along the care pathway, out of the operating room into the pre-hospital field for instance. This has allowed an unrivalled progress in emergency care of which immediate operating theatre access, massive transfusion management, and early CT scanning are only a few of many examples. There is no evidence suggesting that these high performing systems would benefit from the introduction of Emergency Medicine as a standalone specialty. In fact there is a risk that the most critical patients get deprived of immediate specialist vital function care by introducing new inter-specialty barriers into currently seamless and fast developing pathways. Another risk is the delay of development of emergency care by hampering the transfer of knowledge and expertise along the pathway.
Vital function care is the core expertise of Anaesthesiology and Intensive Care Medicine, and therefore anaesthesiologists should be treating critical patients at all stages of their pathway. To prevent pathway fragmentation it has become essential to accomplish a function differentiation between Anaesthesiology and Emergency Medicine.
In order to achieve this function differentiation the Scandinavian Society of Anaesthesiology and Intensive Care Medicine has introduced the sub-specialty concept of Critical Emergency Medicine,1 which defines the anaesthetic scope of practice as immediate life support and resuscitation of critically ill and injured patients in the pre-hospital as well as hospital settings.
We strongly feel that national anaesthesia training programmes should also put more focus on formal training in emergency care as proposed by De Robertis in the ESA’s ‘Core Curriculum in Emergency Medicine’ published in 2007.2
Due to the ongoing debates in many European countries the Scientific Subcommittee of Emergency Medicine, Trauma and Resuscitation has decided to put this ever hot-topic on their business plan for the oncoming years.