Emergency Medicine Australasia最新文献

In 2023, the Australasian College for Emergency Medicine (ACEM) turned 40. For many, midlife is an important time to reflect on the past, take stock of identity, examine values and set priorities for the next season – and ACEM is not exempt from this period of soul-searching.

The practice of emergency medicine today is significantly different from when ACEM was founded in 1983, and there are vital questions to be answered. How is the scope of the specialty, and the role of emergency physicians, changing? What are the skills and training necessary to deliver effective and compassionate emergency care in increasingly complex healthcare contexts? What is needed to create sustainable and satisfying careers in emergency medicine?

On 30 August 2023, ACEM hosted the Emergency Medicine – Building our Future Summit to begin this conversation. The summit was attended in-person by leaders from ACEM's Councils, Committees and Networks, and ACEM members and trainees were invited to participate online. Rapid-fire presentations about key topics, representing the specialty's ‘growing pains’, were delivered, generating rich discussion. Afterwards, a survey was circulated to seek feedback on the issues raised, and information from the summit and survey was collated and examined.

Reflecting the wide participation of contributors, and the broad church of the ACEM community, input was varied, but key themes, experiences and observations emerged.

Although the practice of emergency medicine has adapted and diversified over time, the majority of emergency physicians share commitment to the acute, generalist, clinical core of the specialty.

Participants indicated a strong dedication to community, and a willingness to adapt to changing pressures over time, to learn new skills, and to adopt expanded clinical and professional scopes to meet the increasingly complex needs of people who seek emergency care.

Emergency medicine is now practised well beyond emergency departments, and the breadth of career options is vast. Many emergency physicians augment clinical work with activities such as research, policy, international development and medical administration, or develop clinical expertise in areas of special interest – such as toxicology, paediatrics, retrieval or aged care.

Increasing diversification, as well as the growing trend for emergency physicians to assume clinical or system-wide leadership positions, demonstrates the maturity of emergency medicine as a specialty, and reflects confidence in our critical position within health systems.

Versatility also brings new tensions and challenges. Emergency medicine sits at the intersection between primary and hospital-based care and occupies a special position in healthcare systems. Emergency departments become a safety net when other services fail.

The scope of emergency medicine practice is heavily shaped by external forces, including political. This has create

In 2023, the Australasian College for Emergency Medicine (ACEM) reached the ripe old age of forty. The practice of emergency medicine today is significantly different from 1983. Questions to consider about current clinical practice include how is the scope of the specialty and the role of emergency physicians changing, what are the skills and training necessary to deliver effective and compassionate emergency care in increasingly complex healthcare contexts and what is needed to create sustainable and satisfying careers in emergency medicine? In August 2023, ACEM hosted the Emergency Medicine – Building our Future Summit in Melbourne to begin this conversation. Clare Skinner, Immediate Past President of the College, summarises the outcomes from the summit and indicates how the College will absorb them into planning for the next forty years.

Centralisation of trauma services in western countries has led to improved patient outcomes. In a first-rate review, clinical guidelines from all ten Emergency Medical Services (EMS) in Australia and Aotearoa New Zealand were compared. There were several inconsistencies between them. The lack of consensus, especially in trauma triage, makes benchmarking and comparison of trauma systems difficult. The conclusions are important and are probably of no surprise to most readers. They can almost certainly be applied to clinical guidelines in other areas of practice, both prehospital and hospital.

Emergency clinicians appear to be generally optimistic about the use of AI in emergency medicine, so long as it is used as a decision support tool and they maintain the ability to override its recommendations.

An advance care directive is a legal document outlining the wishes made by a person about treatment options. A study from South Australia concludes that directives are beneficial when patients, families, and emergency department staff agree with the decisions made. Advance care directives are useful to start conversations around goals of care and end of life care relevant to patient's current situation as well as when the directives were first written. Please also read the papers published under the Trainee Focus section.

Emergency medicine is a discipline with complex leadership demands, which are experienced by junior and senior emergency physicians alike. In this environment, emergency physicians can struggle to work out what it means to be a leader and develop professional identities as leaders, necessitating a leader identity workspace. A team from Swinburne University of Technology conclude that neither emergency departments nor hospitals more generally exhibit the properties of, or are experienced by emergency physicians, as leader identity workspaces.

Patients with severe traumatic brain injuries need urgent medical attention at a hospital. A review from Auckland evaluates whether transporting adult patients with a severe traumatic brain injury directly to a neuroscience