Lessons Learnt from

Implementing
EM as a specialty
Personal Views

Gautam G. Bodiwala,

CBE, DL
DSc (Hon), MS, FRCS, FRCP, FCEM, FIFEM

President
International Federation for Emergency Medicine

Confession
Man is nature’s sole mistake
Princess Ida (1884) act 2

First Casualty Department Opened in 1869 at St Bartholomew’s Hospital .

THE PLATT COMMITTEE ESTABLISHED in 1962 ‘TO INVESTIGATE ARRANGEMENTS IN HOSPITALS FOR RECEPTION AND TREATMENT OF ACCIDENT PATIENTS’ Very little went to casualty in those days in the form of Acute Medicine .

THE PLATT REPORT    Standard poor and morale low Accident Surgery can not provide satisfactory career Casualty Departments should be renamed ‘Accident and Emergency Departments’ How wrong was Platt regarding career in ‘Accident Surgery!’ .

Casualty Surgeons Association The Senior Medical Officers working in Casualty Department were so incensed that they established the Casualty Surgeons Association on 12th October 1967. OBJECTS: ‘To promote for the public. high standards in Science and art of Casualty Medicine and Surgery’ .

FROM CAS TO A&E TO EM •1967 Casualty Surgeons Association (CSA) •1972 First ‘experimental’ consultants appointed •1975 SAC in Accident and Emergency Medicine •1977 First Senior Registrar appointed •1983 FRCSEd (A&E) started •1986 First International Conference on Emergency Medicine. London •1990 First Professorial Appointment •1990 CSA became British Association for Accident and Emergency Medicine (BAEM) •1991 International Federation for Emergency Medicine •1993 Faculty of Accident and Emergency Medicine .

FROM CAS TO A&E TO EM (Contd.) •1996 FFAEM (Exit Examination) Started •2003 MFAEM (Entry Examination) started •2005 Name changed to ‘Emergency Medicine’ •2005 British Association for Emergency Medicine •2006 International examinations started •2006 Faculty of Accident and Emergency Medicine became College of Emergency Medicine(CEM) •2006 Merger Board established to create a merged College of CEM and BAEM •2008 The College of Emergency Medicine .

Points to ponder           Name Type of Organisation Training Programme/Curriculum Assessment Relations with other Specialties/Colleges Relation with Government and Politics Lessons from other Nations Lessons from other Specialties International Perspective Creating a profile/Public image .

What’s in a name? That which we call rose by any other name would smell as sweet Shakespeare .

’ to ‘A & E’ to ‘EM’ Tom Hamilton First President ACEM at CSA Annual Conference Maurice Ellis Memorial Lecture 1989 .Maurice Ellis Lecture From ‘Cas.

Name      Casualty Surgeons Association British Association for Accident and Emergency Medicine Faculty of Accident and Emergency Medicine British Association for Emergency Medicine The College of Emergency Medicine .

EMERGENCY MEDICINE The name ‘Emergency Medicine’ gives  Identity  Dignity  Creates right public image  Describes its function .

Academy. interested in EM care Association. Paramedics etc. Nurses. Faculty or College? .Type of Organisation      EM trained Physicians only ED Physicians only EM trained Physicians and Nurses All – Physicians.

Training Programme and Curriculum    Specialist Advisory Committee in Accident and Emergency Medicine (1975) Joint Committee in of Higher Training in Accident and Emergency Medicine (1993) Training Standards Committee (2008) Training Programmes according to your needs .

Entry and Assessment Determine who can enter the training programme and what is the final assessment?       1983 FRCS (A&E) RCSEd 1993 (Exit) FFAEM Pre 2003 (Entry) FRCS (A&E). ‘First Part’ of MRCP. FRCS. FRCA 2003 (Entry) MFAEM 2005 MCEM and FCEM In training Assessment .

Government and Politics Emergency Medicine is recognised and valued as an essential public service ACEP Vision Statement .

Definition POLITICS Science and Art of Public Affairs Oxford Dictionary Politics is a process by which people take decisions on who gets ‘what. how?’ . when. why.

Inter phase of EM and PH In Public Health Issues. how do we influence Government and legislations?   ACEP – Washington DC CEM (BAEM/FAEM) – Clinical advisor to Department of Health Inviting Health Ministers/CMO to conferences .

Relations with other specialties      Acute Medicine Paediatrics Anaesthesia and Intensive care Trauma orthopaedics Public Health etc. .

EM in developed countries performed in two ways   Anglo American Model Skilled EDs Pre hospital EMS with paramedics Franco German Model Highly developed pre hospital EP system But basic hospital based EM in Europe .

International Perspective    Geographical Cultural Disease/ case mix related .

Creating a profile for EM Early Access Medical help Early intervention Resuscitation Govern (manage) Evaluation Networking Cooperation (and Communication) Yes-will do it .

Media and Public perception Casualty ER City Hospital Holby City Chicago Hope Cardiac Arrest .

does not usually make any thing. American Lawyer and Diplomat .Learn from experience One who makes no mistakes. Edward John Phelps (1889).