The 22nd International Conference on Emergency Medicine (ICEM) was held lately in Jun 2023 at Amsterdam of Netherlands. Yet it happens that emergency medicine (EM) physicians there are still fighting for EM being recognised a specialty, though they are almost at the final stage of receiving official recognition under the support of international EM bodies. While some well-developed localities such as the US, the UK, Canada and Australia are pioneers in establishing EM specialities, some developed areas such as Germany are still without formal EM specialty recognition. Currently there are 23 countries in Europe without formal EM speciality recognition.

The development of EM across the world is not only at different pace, it also goes in different directions with different models at different areas.

There are two systems of EM service: The Anglo-American model and the Franco-German model. In Anglo-American model, the practice also called ‘scoop and run’, the EM physicians are mostly stationed at the emergency department hospitals with access to resources in the hospitals, critical patients are picked up and transported to hospital by paramedics, with minimal interventions performed at the scene. This is a concept of bringing the patients to the doctors so that the patient can be safely managed at an area with adequate resources. This model is adopted by ~30% of countries in Europe and most other countries such as the US, UK and Canada. Hong Kong is also currently using this system, though with time paramedics are given more autonomy to perform resuscitative procedures and administer lifesaving drug in critical conditions.

In Franco-German model, also called ‘stay and play’, EM physicians will be on board of ambulance and travel to the scene of the patients. The patient will be seen and managed by the EM physician and then left at home, if the medical complaint has been solved, or delivered to the ward or even the operating room/cardiac catheterisation room in hospital if needed. This concept works on the basis of bringing the doctor to the patient, so that patient can receive earliest ultimate care by EM physician. This model is adopted by ~60% of countries in Europe.

There are no trials comparing the efficiencies and outcome of the two models. Actually, both models have their own strengths and weaknesses. In situation such as severe trauma or ST elevation myocardial infarction, transporting patients to the hospital as soon as possible for care by the speciality in concern will surely be the best option. However, for patients that require cardiopulmonary resuscitation, having an EM physician at the scene for carrying out lifesaving treatment will certainly mean better option. Having said that, the two models are not mutually exclusive and some may have a mix of the two. ‘Scoop and run’ does not mean no treatment for the patients. Many paramedics nowadays are well equipped with skills to carry out more sophisticated treatment to patients. ‘Stay and play’ also does not imply the emergency medicine physician will always stay at the scene for managing patients. Patients, such as in road traffic accident, will need be transported to hospital to receive definitive operative care. Regardless of the model used, the best outcome will be achieved when the care is delivered by a team who are motivated, well trained and demonstrate excellent team work spirit.

Reference:

1. Totten, V., & Bellou, A. (2013). Development of emergency medicine in Europe. Academic Emergency Medicine, 20(5), 514-521.

2. Revue, E. (2022). Emergency Medicine in the World. Brazilian Journal of Emergency Medicine, 2, 34–47.

3. Rainer, T. H. (2000). Emergency medicine-the specialty. Hong Kong Medical Journal.

4. User, S. (n.d.). Eusem - European Curriculum of Emergency Medicine. Eusem.org. Retrieved June 19, 2023, from https://eusem.org/education/curriculum/european-curriculum-of-emergency-medicine