XXXV Congreso de la semFYC - Gijón
del 11 al 13 de junio 2015
Actividades para Residentes / Jóvenes Médicos de Familia
Residentes y JMF: situación actual de la Medicina de Familia en urgencias en Europa. Análisis de una futura especialidad
Moderadora
Verónica Parent Mathías.
Verónica Parent Mathias
Especialista en Medicina Familiar y Comunitaria. Médica adjunta del Servicio de Cuidados Críticos y Urgencias del Hospital Regional Universitario de Málaga. Miembro VdGM. Miembro del GdT Urgencias y Atención Continuada (GUAC) de la semFYC. Vocal de Investigación de semFYC Cantabria.
Rafael Fernando Beijinho do Rosário
Residente de 4.º año de Medicina Familiar y Comunitaria. CS Las Calesas. Madrid. Miembro del GdT Urgencias y Atención Continuada (GUAC) de la semFYC y del GdT Nuevas Tecnologías de la SoMaMFyC.
Resumen
El objetivo principal de esta mesa es conocer el mapa de especialidades que trabajan en los servicios de urgencias en los países europeos (tanto los que forman parte de la Unión Europea como los que no).
Durante la mesa se pretende: desarrollar un debate de la especialidad de urgencias; conocer la formación en urgencias de la especialidad de Medicina de Familia y Comunitaria en el resto de Europa, y exponer las salidas laborales de los jóvenes médicos de familia a nivel Europeo.
Residents and YFD’s Symposium: Current situation of Family Medicine in European Emergency Medicine. Prospects for a future specialty.
1. Current situation of emergency medicine in Europe. Emergency medicine specialty in Europe. (Situación actual de las urgencias en Europa. Especialidades de urgencias en países europeos)
Concept and History
Ever since French military surgeon Dominique Jean Larrey, during the French Revolution, applied the idea of ambulances, or "flying carriages", for rapid transport of wounded soldiers to a central place where medical care was more accessible and effective, Emergency Medicine has been evolving up to a point where it is now a primary specialty in as many as 12 countries in the European continent as well as in the US, Canada, Australia and New Zealand.
Emergency Medicine as a specialty is relatively new although it has been practiced for as long as there have been people with medical knowledge who could respond to emergencies.
It’s foundation dates back to the late 60’s when Mr. William Rutherford was appointed as the “surgeon in charge of the Accident & Emergency Department” of the Royal Victoria Hospital in Belfast, effectively becoming the first A&E consultant in Ireland and when the College of Emergency Medicine first met.
Emergency Medicine is defined as a specialty based on the knowledge and skills required for the prevention, diagnosis and management of urgent and emergency aspects of illness and injury affecting patients of all age groups with a full spectrum of undifferentiated physical and behavioural disorders. It is a specialty in which time is critical.
According to the European Society of Emergency Medicine (EuSEM), the practice of Emergency Medicine encompasses the prehospital and inhospital triage, resuscitation, initial assessment and management of undifferentiated urgent and emergency cases until discharge or transfer to the care of another physician or health care professional. It also includes involvement in the development of prehospital and inhospital emergency medical systems.
Models of Emergency Medicine
The growth of emergency medicine (EM) has occurred rapidly throughout the world in the last decade. This development has occurred through the formation of national specialty societies and residency training programs; international societies; national, transnational, and international meetings; and international collaboration through less formal initiatives such as continuing education courses and modular trainthetrainer programs.
Although Emergency Departments (ED) are a legal requirement for the majority of European hospital, the way they are organized (concerning triage system, staff and it’s qualification, as well as financing) differs as much as the number of different health systems there are across Europe.
There are two major models for the delivery of EM care: the AngloAmerican and the FrancoGerman.
The former is almost entirely prehospitalbased, performing triage (sorting) functions, care, and if needed, resuscitation in the field, and then making a disposition. The disposition could range from leaving the patient in his or her home if the reason for the call had been solved, or delivering the patient directly to an operating room, a medical ward, or even a catheterization suite.
The latter, which is also the predominant model in Russia, has the Emergency Physician colocated with the hospital, with access to the hospital’s resources, and after evaluation, resuscitation if needed, and treatment, the patient may be discharged to go home or admitted to an appropriate hospital location.
Harmonization of EM Education
Failing to achieve the required twofifths of european countries recognizing EM as a primary medical specialty, the European Union has been addressing the needs for the harmonization of EM across Europe through a Multidisciplinary Joint Committee under the auspices of the European Union of Medical Specialties (UEMS).
A 2008 report from WHO concludes that above all there is “a lack of uniformity, as far as training in and accreditation of specialists in EM is concerned. The adoption by
all EU countries of a common core curriculum, as the basis for the specialty, is the most suitable way to fulfil the EU Doctor’s Directive and assure free exchange of EM physicians between EU countries.
It is comprehensible that the relatively young age of this medical discipline requires a longer period to achieve full maturity. Nevertheless, universities and medical schools in many Member States underestimate the importance of inserting formal courses in EM at the undergraduate level. Any medical doctor, whatever specialty he/she will choose to follow, could conceivably encounter a major accident or an individual medical emergency at any time: basic and simple knowledge can make a difference to the life of a patient, as demonstrated by the huge number of lay volunteers attending “firstaid” courses.”
2. The role of Family Medicine doctors in Emergency Medicine across Europe. (Médico de familia en Urgencias. Mapa laboral de urgencias y medicina de familia en Europa)
Current situation in some European Countries
Certification in Emergency Medicine in most countries where it is a primary specialty is overseen by one or various national Boards.
Emergency Medicine in Europe saw his first steps in the British Islands when the British Association for Emergency Medicine first held a meeting. After that the specialty has been approved in different european countries. Most require a minimum of 5 years to receive qualification.
Currently there are 13 countries recognizing EM as a primary specialty, plus another six considering it as a supraspecialty. Primary specialty countries need a minimum of five years for qualification. Still, EuSEM provides a certification exam to those doctors wishing to get EuSEM accreditation.
Path to Emergency Medicine in Spain
Spain has had a long history of emergency medicine, being one of the most expert countries in the management of catastrophes.
Although not a primary specialty, Spanish EDs have long been staffed with dedicated emergency medicine doctors, the majority of them coming from family medicine and internal medicine.
Another large portion of Spain’s emergency medicine system comes from it’s OutofHospital system which comprises both the prehospital care (ambulance) and primary care emergency medicine (which in turn is comprised of rural ED’s and outofhours primary care clinics). Of note, to work in a mobile ICU in Spain, applying doctors are required to have a MSc in Emergency Medicine.
Role of Family Medicine in Spanish Emergency Medicine
As previously seen, Family Medicine (FM) in Spain comprises a very important part of Emergency Medicine. Firstly, a substantial part of EM care takes part in a primary care setting and secondly, a greater part of EM doctors (hospital and outofhospital) are FM specialists in the first place.
Emergency Medicine in Spain is currently a hot topic in debate with its national society (SEMES) pushing for the formal creation of EM as a primary specialty but both semFYC and SEMI (family medicine and internal medicine national societies) preferring to have EM as a supraspecialty being accessed through primary specialization on a series of medical specialties.
Bibliografía
- Anderson, P. D., Suter, R. E., Mulligan, T., Bodiwala, G., Razzak, J. a., & Mock, C. (2012). World Health Assembly Resolution 60.22 and its importance as a health care policy tool for improving emergency care access and availability globally. Annals of Emergency Medicine, doi:10.1016/j.annemergmed.2011.10.01860(1), 35–44.
- Doney, M. K., Smith, J., & Kapur, G. B. (2005). Funding emergency medicine development in low and middleincome countries. Emergency Medicine Clinics of North America, 23, 45–56. doi:10.1016/j.emc.2004.09.010 in the European Union Report of an assessment project coordinated by the. (n.d.).
- Rapp, M. T., & Podgorny, G. (2005). Reflections on becoming a specialty and its impact on global emergency medical care: Our challenge for the future. Emergency Medicine Clinics of North America, 23, 259–269. doi:10.1016/j.emc.2004.09.001 4. Totten, V., & Bellou, A. (2013). Development of emergency medicine in Europe Academic Emergency Medicine, 20, 514–521. doi:10.1111/acem.12126
- Union, E., Programme, E. U. H., Programme, E. U. H., Agency, E., Commission, E., Com, E., … Commission, T. E. (2013). professional development and lifelong learning for health.
- Zink, B. J. (2011). The biology of emergency medicine: What have 30 years meant for Rosen’s original concepts? Academic Emergency Medicine, 18, 301–304. doi:10.1111/j.15532712.2011.01011.x
- http://www.eusem.org/whatisem/
- https://ec.europa.eu/digitalagenda/sites/digitalagenda/files/WHO.pdf
Comunicaciones y ponencias semFYC: 2024; Actividades para Residentes / Jóvenes Médicos de Familia. ISSN: 2339-9333
