A survey of emergency medicine in 36 countries

Scientific publication trends of emergency department of International Federation for Emergency Medicine members, 2009 to 2018

BACKGROUND

Emergency medicine (EM) is a rapidly developing specialty worldwide. The scientific publications trend is one of the parameters to evaluate national EM developmental milestones. This study was performed to analyze the publication trends from emergency departments (EDs) of International Federation for Emergency Medicine (IFEM) full member countries from 2009 to 2018.

METHODS

All data were retrieved from the SciVerse Scopus database. IFEM full member countries where EM was recognized as a specialty before 2009 and annual publication numbers exceeded 12 in 2018 were included. The EM journals list was adopted from the 2017 Journal Citation Reports. Publications with the first author affiliated with EDs were divided into EM or non-EM journal groups according to the publishing journal. The slope (β) of the linear regression was used to assess the trends of publication numbers. The correlation between the 2009 publication number and the trend of publication between 2009 and 2018 was measured by Pearson's correlation coefficient (r). The correlation between funding numbers and publication numbers was analyzed by Spearman's rank correlation coefficient (r_s).

RESULTS

We identified 30,130 publications with first authors from EDs in 19 countries. The numbers of publications in both EM and non-EM journals showed an increasing trend in 12 countries. Fifteen of the 19 countries had a greater increasing trend in non-EM journals than in EM journals. The 2009 publication numbers were positively correlated with the publication increasing trend between 2009 and 2018 in both EM and non-EM journals (r = 0.854 and 0.947, respectively, both p < 0.001). The funded publication number was positively correlated with the total national publication amount (r_s = 0.748, p < 0.001).

CONCLUSIONS

The research capacity of EDs has been increasingly recognized by other medical specialties. The national publication numbers from EDs may predict the academic publication increasing trends in the subsequent 10 years.

Medical expertise as a critical influencing factor on the length of stay in the ED: A retrospective cohort study

Overcrowding in the emergency departments (ED) is a significant issue associated with increased morbidity and mortality rates as well as decreased patient satisfaction. Length of stay (LOS) is both a cause and a result of overcrowding. In Israel, as there are few emergency medicine (EM) physicians, the ED team is supplemented with doctors from specialties including internal medicine, general surgery, orthopedics etc. Here we compare ED length of stay (ED-LOS), treatment time and decision time between EM physicians, internists and general surgeons.A retrospective cohort study was conducted examining the Emergency Department length of stay (ED-LOS) for all adult patients attending Sheba Medical Center ED, Israel, between January 1st, and December 31st, 2014. Using electronic medical records, data was gathered on patient age, sex, primary ED physician, diagnosis, eventual disposition, treatment time and disposition decision time. The primary outcome variable was ED-LOS relative to case physician specialty and level (ED, internal medicine or surgery; specialist or resident). Secondary analysis was conducted on time to treatment/ decision as well as ED-LOS relative to patient classification variables (internal medicine vs surgical diagnosis). Specialists were compared to specialists and residents to residents for all outcomes.Residents and specialists in either EM, internal medicine or general surgery attended 57,486 (51.50%) of 111,630 visits to Sheba Hospital's general ED. Mean ED-LOS was 4.12 ± 3.18 hours. Mean treatment time and decision time were 1.79 ± 1.82 hours, 2.84 ± 2.17 hours respectively. Amongst specialists, ED-LOS was shorter for EM physicians than for internal medicine physicians (mean difference 0.28 hours, 95% CI 0.14-0.43) and general surgeons (mean difference 0.63 hours, 95% CI 0.43-0.83). There was no statistical significance between residents when comparing outcomes.Increasing the number of EM specialists in the ED may support efforts to decrease ED-LOS, overcrowding and medical errors whilst increasing patient satisfaction and outcomes.

Broadening Our Horizons: Increasing Diversity of Scientific Publications From Taiwan Emergency Physicians, 2012-2017

BACKGROUND

Scientific publications and academic research are objective indicators that provide dynamic views of the evolution of emergency medicine (EM). This study is aimed to evaluate the academic contribution of Taiwan emergency departments (EDs) by analyzing scientific publications.

METHODS

This is an observational study and all publications between 2012 and 2017 were retrieved from the Scopus database. The EM journals were adopted from the 2016 Journal Citation Reports (JCR) category of EM. Three groups of publications were enrolled: (1) publications with first authors affiliated with Taiwan EDs in EM journals; (2) publications with first authors affiliated with Taiwan EDs in non-EM journals; (3) publications with first authors affiliated with Taiwan other than EDs in EM journals. Data regarding the name and category of the publishing journal, the publication year, the publication type, and the number of citations were collected for further analysis. The publication and category numbers were also merged with previous study to obtain a longer trend analysis from 1992.

RESULTS

A total of 291 publications affiliated with Taiwan EDs were published in EM journals and 697 publications in 275 non-EM journals. A total of 286 publications in EM journals affiliated with Taiwan but other than ED. The trend of publication numbers in all three groups and category numbers since 1992 were increasing (all p < 0.001). Publication numbers in non-EM journals increased the most and obtained the highest cited times. The 275 non-EM journals were classified into 69 categories. The leading five categories were Medicine, General & Internal, Multidisciplinary Sciences, Surgery, Infectious Diseases, Geriatrics & Gerontology.

CONCLUSIONS

The importance of researches originating from Taiwan EDs has been increasingly recognized by both the global EM community and by other medical specialties during the past 25 years. The advancement of academic contribution by Taiwan EDs is evident from the perspectives of quantity and breadth.

Ambulance traffic accidents in Taiwan

BACKGROUND/PURPOSE

Ambulance traffic accidents (ATAs) are the leading cause of occupation-related fatalities among emergency medical service (EMS) personnel. We aim to use the Taiwan national surveillance system to analyze the characteristics of ATAs and to assist EMS directors in developing policies governing ambulance operations.

METHODS

A retrospective, cross-sectional and largely descriptive study was conducted using Taiwan national traffic accidents surveillance data from January 1, 2011 to October 31, 2016.

RESULTS

Among the 1,627,217 traffic accidents during the study period, 715 ATAs caused 8 deaths within 24 h and 1844 injured patients. On average, there was one ATA for every 8598 ambulance runs. Compared to overall traffic accidents, ATAs were 1.7 times more likely to result in death and 1.9 times more likely to have injured patients. Among the 715 ATAs, 8 (1.1%) ATAs were fatal and 707 (98.9%) were nonfatal. All 8 fatalities were associated with motorcycles. The urban areas were significantly higher than the rural areas in the annual number of ATAs (14.2 ± 7.3 [7.0-26.7] versus 3.1 ± 1.9 [0.5-8.4], p = 0.013), the number of ATA-associated fatalities per year (0.2 ± 0.2 [0.0-0.7] versus 0.1 ± 0.1 [0.0-0.2], p = 0.022), and the annual number of injured patients (who needed urgent hospital visits) in ATAs (19.4 ± 7.3 [10.5-30.9] versus 5.2 ± 3.8 [0.9-15.3], p < 0.001).

CONCLUSION

The ATA-associated fatality rate in Taiwan was high, and all fatalities were associated with motorcycles. ATAs in a highly motorcycle-populated area may require further investigation. An ambulance traffic accident reporting system should be built to provide EMS policy guidance for ATA reduction and outcome improvements.

The Academic Contribution of Emergency Departments in Taiwan: Data on Scientific Publications, 1992-2011

Introduction

This study aimed to evaluate the academic contribution of emergency departments (EDs) in Taiwan by analysing scientific publications during the past 20 years.

Methods

This was an observational study. All data were collected from the 2010 Journal Citation Reports (JCR) and the SciVerse Scopus database. Three groups of publications were enrolled: (1) publications from Taiwan EDs in emergency medicine (EM) journals; (2) publications from Taiwan EDs in non-EM journals; (3) publications from Taiwan who were not affiliated with EDs in EM journals. We collected data regarding the name and category of the journal, the publication year, the publication type, and the number of citations for further analysis.

Results

A total of 475 publications affiliated with Taiwan EDs appeared in EM journals and 735 appeared in non-EM journals. A total of 389 publications in EM journals affiliated with departments other than EM. The number of publications showed an increasing trend (all p-value <0.001). The number of publications from Taiwan EDs in EM and non-EM journals changed in opposite directions since 2008. Researches from Taiwan EDs were published in 68 categories of journals in addition to EM. Publications in non-EM journals were more frequently cited than were the publications in EM journals.

conclusions

During the past 20 years, the academic contribution of EDs in Taiwan has increased substantially. The bidirectional change in publication numbers since 2008 constitutes a milestone in the development of EM in Taiwan, and improvements are evident in the quality, quantity, and breadth of research. (Hong Kong j.emerg.med. 2016;23:28-34)

Spontaneous non-traumatic massive intraabdominal spleen bleeding in young females: Importance of ATLS principles and trauma alarm

Patient: Female, 28

Final Diagnosis: Rupture of the splenic artery aneurysm

Symptoms: Hypovolemic shock

Medication: —

Clinical Procedure: —

Specialty: Surgery

Dermatological conditions presenting at the Emergency Department in Siena University Hospital from 2006 to 2011

BACKGROUND

Published studies on emergency dermatology consultations are few because there are few dermatology emergency units in the world. No study has yet described the Italian situation.

OBJECTIVES

To quantify and characterize patients evaluated in our dermatology emergency unit from 2006 to 2011.

METHODS

We studied personal details, diagnosis, annual trend of cases, emergency level and hospitalization of dermatology cases over the 6-year period.

RESULTS

A total of 12,226 patients were evaluated. The most numerous diagnostic group was infections (27.1%), followed by non-specific and descriptive diagnosis (22.5%), skin conditions caused by mechanical or physical agents (13.1%), eczematous diseases (10.5%), insect bites (9.5%) and urticaria/angio-oedema (8.8%). The most common indications for admission to hospital were skin conditions caused by mechanical or physical agents (33.3%), infections (27.5%), drug eruption (15.9%) and autoimmune or inflammatory disorders (7.4%). Emergency dermatology cases followed a variable annual trend, with more consultations in the summer months.

CONCLUSION

This is the first long-term retrospective analysis of a large series of dermatology emergency patients. It provides useful quantitative and qualitative information on cases for physicians and the national health system for the purposes of improving patient care and cost-effectiveness.

Factors influencing medical students' choice of future specialization in medical sciences: a cross-sectional questionnaire survey from medical schools in china, malaysia and regions of South asian association for regional cooperation

Background:

In future, increase in the number of healthcare professionals is dependent on the career interest among present undergraduate medical students. Based on their interest to pursue their specialty, the availability of medical doctors in each specialty could be done.

Aims:

This study was to find out future career interest and factors that influence undergraduate medical students to choose their future specialization.

Materials and Methods:

The study was carried out among first-year medical students from five countries. The students were asked to complete an 8-item questionnaire. Two thousand one hundred fifty three participants were enrolled in the study. Data were analyzed in Microsoft-Excel and Statistical Package for the Social Sciences.

Results:

Of the 2153 participants, only 1470 responded. Among the 1470 participants, 169 participants were excluded due to the ambiguity in responses, finally making it to 1301participants. Among them, Anatomy (49.3%) followed by Biochemistry (26.7%) and Physiology (24%) were the most preferred subjects.

Conclusions:

Anatomy was the most preferred basic science subject among the other subjects and the students were interested to pursuing surgery in future. Furthermore, the most preferred future specialties were surgery, internal medicine and pediatrics with gender variations; males preferring surgery and females in obstetrics and gynecology.

Registries to measure and improve outcomes after cardiac arrest

PURPOSE OF REVIEW

Cardiac arrest registries are used to measure and improve the process and outcome of resuscitation care, and can give insight into risk factors, prognosis, and the effectiveness of interventions to mitigate its impact. This review provides an overview of current out-of-hospital (OHCA) and in-hospital cardiac arrest (IHCA) registries, with attention to key recent findings and future directions.

RECENT FINDINGS

Major OHCA registries include the Resuscitation Outcomes Consortium Cardiac Arrest Epistry and Cardiac Arrest Registry to Enhance Survival. Registry data from IHCA largely stem from the US and Canada with Get with the Guidelines-Resuscitation, and the UK with the National Cardiac Arrest Audit. Each registry has strengths and limitations. Important findings include trends in survival, racial disparities in care, and hospital and community-level variations in performance, as well as estimates of the effectiveness of individual interventions. Utstein definitions facilitate uniform reporting of the process and outcome of care, and are currently being updated. Standardization of registry data is an ongoing challenge.

SUMMARY

OHCA and IHCA registries are invaluable in advancing our understanding of resuscitation care, as well as variations in international practice. Investigations that compare and contrast outcomes from established and evolving registries will help advance resuscitation science further.

The Progress of Emergency Medicine in Taiwan, China, and Hong Kong: Perspective from Publications in Emergency Medicine Journals, 1992–2011

Study Objective. The progress of emergency medicine (EM) in Taiwan, China, and Hong Kong was evaluated from the perspective of publications in EM journals. Methods. This was a retrospective study. All articles published from 1992 to 2011 in all journals in the EM category in the 2010 Journal Citation Reports (JCR) were included. A computerized literature search was conducted using the SciVerse Scopus database. The slope (β) of the linear regression was used to evaluate the trends in the numbers of articles as well as the ratios to the total number of EM journal articles. Results. The trends in the numbers of articles from Taiwan, China, and Hong Kong were 6.170, 1.908, and 2.835 and the trends in the ratios of their publication numbers to the total number of EM journal articles were 15.0 × 10⁻⁴, 4.60 × 10⁻⁴, and 6.80 × 10⁻⁴, respectively. All P-values were <0.01. The mean, median, and 75th percentiles of the number of citations in all EM journals were greater than those of these three areas. Conclusions. The publications from Taiwan, China, and Hong Kong have increased at a higher rate than those of the overall EM field in the past 20 years and indicated the rapid progress in these three areas.

Comparison of emergency medical services systems across Pan-Asian countries: a Web-based survey

BACKGROUND

There are great variations in out-of-hospital cardiac arrest (OHCA) survival outcomes among different countries and different emergency medical services (EMS) systems. The impact of different systems and their contribution to enhanced survival are poorly understood. This paper compares the EMS systems of several Asian sites making up the Pan-Asian Resuscitation Outcomes Study (PAROS) network. Some preliminary cardiac arrest outcomes are also reported.

METHODS

This is a cross-sectional descriptive survey study addressing population demographics, service levels, provider characteristics, system operations, budget and finance, medical direction (leadership), and oversight.

RESULTS

Most of the systems are single-tiered. Fire-based EMS systems are predominant. Bangkok and Kuala Lumpur have hospital-based systems. Service level is relatively low, from basic to intermediate in most of the communities. Korea, Japan, Singapore, and Bangkok have intermediate emergency medical technician (EMT) service levels, while Taiwan and Dubai have paramedic service levels. Medical direction and oversight have not been systemically established, except in some communities. Systems are mostly dependent on public funding. We found variations in available resources in terms of ambulances and providers. The number of ambulances is 0.3 to 3.2 per 100,000 population, and most ambulances are basic life support (BLS) vehicles. The number of human resources ranges from 4.0 per 100,000 population in Singapore to 55.7 per 100,000 population in Taipei. Average response times vary between 5.1 minutes (Tainan) and 22.5 minutes (Kuala Lumpur).

CONCLUSION

We found substantial variation in 11 communities across the PAROS EMS systems. This study will provide the foundation for understanding subsequent studies arising from the PAROS effort.

Characterizing emergency departments to improve understanding of emergency care systems

International emergency medicine aims to understand different systems of emergency care across the globe. To date, however, international emergency medicine lacks common descriptors that can encompass the wide variety of emergency care systems in different countries. The frequent use of general, system-wide indicators (e.g. the status of emergency medicine as a medical specialty or the presence of emergency medicine training programs) does not account for the diverse methods that contribute to the delivery of emergency care both within and between countries. Such indicators suggest that a uniform approach to the development and structure of emergency care is both feasible and desirable. One solution to this complex problem is to shift the focus of international studies away from system-wide characteristics of emergency care. We propose such an alternative methodology, in which studies would examine emergency department-specific characteristics to inventory the various methods by which emergency care is delivered. Such characteristics include: emergency department location, layout, time period open to patients, and patient type served. There are many more ways to describe emergency departments, but these characteristics are particularly suited to describe with common terms a wide range of sites. When combined, these four characteristics give a concise but detailed picture of how emergency care is delivered at a specific emergency department. This approach embraces the diversity of emergency care as well as the variety of individual emergency departments that deliver it, while still allowing for the aggregation of broad similarities that might help characterize a system of emergency care.

Demographic analysis of emergency department patients at the ruijin hospital, shanghai

Emergency medicine is an upcoming discipline that is still under development in many countries. Therefore, it is important to gain insight into the organization and patients presenting to the Emergency Department (ED). The aim of this cross-sectional study was to provide an epidemiological description of complaints and referrals of the patients visiting the ED of the Ruijin Hospital in Shanghai, China. A questionnaire was developed and completed for a convenience sample of all patients presenting to the Triage Desk of the ED. The study was performed in June 2008. A total of 2183 questionnaires were completed. The most common complaints were fever (15%), stomach/abdominal pain (15%), vertigo/dizziness (11%), and cough (10%). Following triage, patients were predominantly referred to an internist (41%), neurologist (14%), pulmonologist (11%), or general surgeon (9%). This study provides a better understanding of the reason for the ED visit and the triage system at the ED of the Ruijin Hospital. The results can be used in order to improve facilities appropriate for the specific population in the ED.

Redrawing medical professional domains: new doctors, shifting boundaries, and traditional force fields

PURPOSE

This paper aims to investigate the forces that influence the shifting of professional boundaries on the entry of a new medical occupation in Dutch hospitals - non-specialist emergency physicians.

DESIGN/METHODOLOGY/APPROACH

Five case studies of Dutch hospitals were conducted and the emergency physicians' implementation process was analyzed by means of force field analysis.

FINDINGS

Emergency physicians were conceptualized as being the answer to unequivocal contextual changes. However, their contribution to better performance varies due to problems in the implementation process. Strong socio-political forces between traditional specialties and these new doctors mediate the intended improvement. The emergency physicians aim to establish their own organizational-, patient- and knowledge-domain by redrawing professional boundaries but they are not on a par with the specialists who set these boundaries. Consequently, emergency physicians only gradually redraw the existing boundaries, resulting in limited added value. Their reaction is to obtain power by striving to develop into a recognized specialty; ironically, by becoming an additional layer in the traditional medical hierarchy they might lose their envisaged added value.

RESEARCH LIMITATIONS/IMPLICATIONS

This paper is based on the first Dutch hospitals that implemented emergency physicians. The number of cases is therefore limited. Moreover, the study took place at an early stage of emergency physician implementation.

PRACTICAL IMPLICATIONS

The extent of successful redrawing depends on the implementation's transition logic, the existing degree of differentiation and boundary permeability and on the ideological power developed by the leaders.

ORIGINALITY/VALUE

The introduction of emergency physicians is currently being discussed in many countries worldwide, and some countries consider following the Dutch example of non-specialist doctors. This paper supports health professionals and hospital managers in not falling prey to the same pitfalls as some Dutch hospitals.

Transfusion medicine in trauma patients

Injured patients stress the transfusion service with frequent demands for uncrossmatched red cells and plasma, occasional requirements for large amounts of blood products and the need for new and better blood products. Transfusion services stress trauma centers with demands for strict accountability for individual blood component units and adherence to indications in a clinical field where research has been difficult, and guidance opinion-based. New data suggest that the most severely injured patients arrive at the trauma center already coagulopathic and that these patients benefit from prompt, specific, corrective treatment. This research is clarifying trauma system requirements for new blood products and blood-product usage patterns, but the inability to obtain informed consent from severely injured patients remains an obstacle to further research.

Injury deaths of US citizens abroad: new data source, old travel problem

BACKGROUND

Global travel continues to increase, including among US citizens. The global burden of injuries and violence, accounting for approximately 5 million deaths worldwide in 2000, is also growing. Travelers often experience heightened risk for this biosocial disease burden. This study seeks to further describe and improve our understanding of the variable risk of travel-related injury and death.

METHODS

Information on US civilian citizen deaths from injury while abroad was obtained from the US Department of State Web site. This information was categorized into regional and causal groupings. The groupings were compared to each other and to injury deaths among citizens in their native countries.

RESULTS

From 2004 to 2006, there were 2,361 deaths of US citizens overseas due to injury. Of these US citizen injury deaths, 50.4% occurred in the Americas region. Almost 40% (37.8%) of US citizen injury deaths in the low- to middle-income Americas were due to vehicle crashes compared to about half that (18.9%) (proportional mortality ratio [PMR] = 1.72, 95% confidence interval [CI] 1.59-1.62) for low- to middle-income Americas citizen injury deaths. Similar differences between US citizen injury death abroad and the in-country distributions were also found for vehicle crashes in Europe (35.9% vs 16.5%, PMR = 2.17, 95% CI 1.78-2.64; p < 0.0005), for drowning deaths in the Americas (13.1% vs 4.6%, PMR = 2.67, 95% CI 2.29-3.11) and many island nations (63.5% vs 3.5%, PMR = 11.38, 95% CI 8.17-15.84), and for homicides in the low- to middle-income European countries (16.9% vs 10.5%, PMR = 1.52, 95% CI .90-2.57).

CONCLUSIONS

US citizens should be aware of regional variation of injury deaths in foreign countries, especially for motor vehicle crashes, drowning, and violence. Improved knowledge of regional variations of injury death and risk for travelers can further inform travelers and the development of evidence-based prevention programs and policies. The State Department Web site is a new data source that furthers our understanding of this challenging travel-related health issue.

An attempt to measure the spread of emergency medicine internationally

OBJECTIVE

To determine the feasibility of using the internet to track the spread of emergency medicine internationally.

OVERVIEW

This was an attempt to perform a descriptive cross-sectional study employing a web-based survey.

SUBJECTS

Potential respondents were identified from multiple sources.

OBSERVATIONS

The primary outcome was the response to 16 questions about EM care and the setting in which it was delivered for acute cardiac, paediatric, obstetrical illnesses and trauma. The questions were divided into six general areas and elicited for urban, semi-urban and rural settings. A series of four e-mails soliciting completion of the survey were sent to potential respondents.

ANALYSIS

Simple descriptive statistics.

RESULTS

We identified 358 potential respondents with valid e-mail addresses over a period of three years. Overall, 145 (41%) responded and 117 (33% 95% CI 28-38%) of them were complete and interpretable. There was one response from 54 and two responses from 29 countries, representing an overall response rate by country surveyed of 65% (95% CI 57-73%), but of all existing countries of only 43% (95% CI 36-50%). Based on sparse data, it appears that in urban areas, 47% (obstetrics) to 65% (paediatric) of acutely sick or injured patients are taken to an ED-equivalent. For rural areas, this range was 19% (obstetrical) to 40% (trauma). CT scans are available in 78% of urban ED-equivalents but 12% of rural ones. Haematocrits are available in 72% of rural settings. In 60% of responding nations, some type of EM training was available, and in 42% physicians went abroad to study EM.

CONCLUSIONS

A survey of international EM is challenging to achieve because of difficulty in both identifying and in contacting potential respondents. Based on sparse data, population density (urban, rural) appears to be related to both the location to which acutely ill patients are taken for their care and to the level of technology available. The specialty of EM is now recognised internationally and education in EM is common.

Lessons learned from international emergency medicine development

The lessons learned from development of EM around the world span several key areas including general development, systems comparisons, models of EM practice, and education and training. Neither definitive nor exhaustive, these lessons learned are intended to be viewed as sign posts along the road traveled at this point in international EM development. It is hoped that future participants in international EM development can assimilate these lessons learned, adopt the most relevant ones, and add their own insight and wisdom to this growing list. Most importantly, it is hoped that by whichever path future development takes, we all reach the same destination of providing the best possible emergency medical care for the people of the world.

Development of the specialty of emergency medicine in Israel: comparison with the UK and US models

OBJECTIVES

To describe the development of emergency medicine (EM) in Israel and review the specific problems faced by the discipline and describe the solutions that were found.

METHODS

A comprehensive literature search was conducted for data on development of EM in the UK and in North America, and the personal knowledge of two of the authors (PH and YW) was used in preparing the article.

RESULTS

There are differences in development of EM between Israel and the UK/US models. In Israel the specialty developed within the context of established high quality clinical practice and consequently it met resistance from the system, which did not wish to invest in what it felt might be marginal improvements in patient care. The economics of Israeli medicine also dictated that EM be made into a super-specialty rather than a primary specialty. Certified specialists from family medicine, paediatrics, internal medicine, general surgery, anaesthesia, and orthopaedic surgery can access training positions in EM. Currently there are seven active EM programmes of 2.5 years duration and 16 residents. The curriculum is flexible and a national certification examination is being developed.

CONCLUSIONS

Development of EM can and should take different paths according to the specific local needs and realities. There is no single ideal model suitable for all circumstances. The practice of clinical EM in Israel is comparable with that of any developed country and daily progress is being made in the academic areas of teaching and research. There are worldwide similarities in the process of developing EM as a distinct discipline.

International emergency medicine: recent trends and future challenges

In the past two decades, emergency physicians have increasingly looked beyond their national borders to examine how emergency medicine is practised elsewhere in the world. A major result of their efforts is international emergency medicine, which can be defined as the area of emergency medicine concerned with the development and delivery of emergency medical care in the world. Several international trends are currently occurring in emergency medicine, including an increasing number of venues for information exchange, the spread of emergency medicine practice guidelines, an increasing number of international collaborations, and an increasing number of transnational special interest groups in emergency medicine. A closely related trend is the spread of the specialty model of emergency medicine, a key organizational system in which emergency medicine is viewed as a uniquely integrated horizontal body of medical knowledge and skills concerning the acute phases of all types of disease and injury. Multiple challenges await those involved in international emergency medicine, including the need for internationally accepted definitions, a 'systems approach' to analysing emergency medicine systems, and more useful and affordable information. A related challenge is the need for effective consensus-based processes, including international standardization processes. Many of these challenges may be met through the effective leadership of international emergency medicine organizations.