I think the first thing we should try and get to the bottom of is ‘What is an Emergency Physician’? We used to be Casualty and that is still the name of a popular BBC TV program. That name stems from the following definitions:
Definitions from the Shorter Oxford Dictionary
Casual “Occurring unpredictably; irregular”
Casualty “A chance occurrence; an accident; a mishap; a disaster. A person killed or injured in war or accident”
Accident “An event that is without apparent cause, or unexpected; an unfortunate event”
Emergency “A situation, especially of danger or conflict, which arises unexpectedly and requires urgent action”
The formation of Casualty doctors stemmed from the desire of pioneers to deliver better care to those unpredictable patients who turned up at Hospitals.
In 1972, 30 Consultant posts were established as an experimental pilot, creating a new specialty in the UK - Accident and Emergency Medicine.
In 2004, a UK Statutory Instrument formally changed the name of the specialty from A&E Medicine to Emergency Medicine (also known as Accident & Emergency Medicine), in order to keep in line with International nomenclature.
In 2008, the College of Emergency Medicine was formed with the Royal appellation coming in 2015.
That is how we moved from Casualty Surgeons to Emergency Physicians, a lot of change in a relatively short time period. That pace of change continues now.
The Royal College of Emergency Medicine has used the definition from the International Federation for Emergency Medicine, 1991 to state that
“Emergency Medicine is a field of practice based on the knowledge and skills required for the prevention, diagnosis and management of acute and urgent aspects of illness and injury affecting patients of all age groups with a full spectrum of undifferentiated physical and behavioural disorders. It further encompasses an understanding of the development of pre-hospital and in-hospital emergency medical systems and the skills necessary for this development.”
So if you’ve read that, then you know that we see patients whose complaints range across the entire spectrum of Medicine and, more than that, some of what we do is work to ensure that we don’t see patients by creating safer systems.
It allows us to see what we believe to be the best bits of each specialty - the Emergencies.
The current training programme is a run-through training program so that you enter through a competitive Interview process at ST1 and then spend 6 years to gain a CCT in Emergency Medicine.
The interview process in Northern Ireland is run locally and focuses on clinical questions and communication skills. It is competitive as there are only 12 ST1 posts in the Emergency Medicine training program in Northern Ireland.
The first three years are part of the ACCS programme and rotate the trainee through Acute Medicine, Emergency Medicine, Anaesthetics, ICU and Paediatric Emergency Medicine thus creating a broad skill base in managing acutely unwell patients of all ages and presentation.
The last three years are spent in Emergency Medicine, utilising those skills and developing new ones to help recognise and then treat a broad spectrum of injury and illness.
Whilst working in the Emergency Department on a daily basis there is the opportunity to work in different areas. This allows you to see and assess minor injuries, children, elderly, Trauma and Resuscitation cases, patients suitable for Medical or Surgical admission, and in some departments the ability to look after patients for a short period of time using an Observation Ward model.
In the Emergency Department you work with a large and varied team with all grades of medical and nursing staff on the shop floor and allied health professionals such as Physiotherapists, Occupational Therapists, Social Workers, Psychiatric specialist staff and Pharmacists working together to achieve the best outcomes for your patients.
There is the possibility of sub-specialisation also, with recognised sub-specialty interests being Paediatric Emergency Medicine, Intensive Care Medicine and Pre-Hospital Medicine. There are other areas for developing interests and these include Academic EM, Geriatric EM, Ambulatory Care and a number of other allied specialties.
Some Emergency Physicians also work as General Practitioners or have an interest in almost anything you can think of, including Toxicology, Infectious Diseases, Sexual Health, Wilderness Medicine, Retrieval Medicine… the list goes on and on!
But, still, we haven’t answered the Why question. Being an Emergency Physician can be one of the most rewarding jobs in all of Medicine. As a person you will be constantly challenged - personally, intellectually, physically all of which will create the environment for ongoing growth and no chance of boredom.