Emergency Medicine Australasia最新文献

Emergency Medicine is a cognitive specialty because its core deliverable is accurate choice under uncertainty. Pauker and Kassirer's threshold model describes how rational decisions are made when information is incomplete, yet contemporary practice has drifted away from this framework. Rapid assessment protocols and the routine use of non-specific investigations create the appearance of efficiency but displace the cognitive work that produces clinical judgement. These practices reinforce relief-seeking decision making—behaviour that reduces internal discomfort rather than diagnostic uncertainty. CRP exemplifies this pattern: it generates data that feels objective but rarely changes management and instead reinforces dependence on testing. If Emergency Medicine wants to produce threshold-based decision makers, then training environments must deliberately restore conditions that require probabilistic reasoning, articulate pre-test probabilities and withhold low-utility investigations. Otherwise, the specialty will continue to select for and reproduce relief-seeking behaviour.

As doctors, you may be called to give evidence in court either as a treating practitioner providing factual observations or as an expert witness offering a specialised opinion. Regardless of your role, your primary duty is to assist the court impartially, with objective, unbiased information. As treating doctors, you present what you saw, heard, or observed during patient care, while as an expert witness, you offer analysis based on your clinical knowledge and must comply with the court requirements. Understanding courtroom procedures—examination-in-chief, cross-examination, and re-examination—is important, as is preparation and consistency in clinical documentation. Accuracy in patient history, timing, and note-taking can significantly impact the reliability of medical evidence. Ultimately, your evidence can play a vital role in a court's understanding of medical issues, and your contribution supports the fair and informed administration of justice.

Forensic medicine is the application of medical expertise to legal contexts and holds particular significance in the ED, where clinicians frequently encounter cases with medico-legal implications. In Australia, Clinical Forensic Medicine is a stand-alone specialty with an established fellowship pathway: the Fellowship of the Faculty of Clinical Forensic Medicine, Royal College of Pathologists Clinical Forensic Medicine. It is a unique medical discipline concerned with the provision of forensic medical services, primarily to the living. This article outlines the scope of clinical forensic medicine, with a focus on sexual assault assessment, forensic specimen collection and injury interpretation. It must be acknowledged, however, that the full scope of the discipline is much broader. This commentary briefly considers other forensically based medico-legal obligations, and the importance of balancing patient care with evidentiary integrity. Emergency clinicians require not only clinical acumen but also familiarity with legal frameworks to ensure their practice supports both medical and judicial outcomes.

Dental trauma represents a prevalent yet often overlooked concern within the emergency departments (ED) in Australasia. A range of traumatic dental injuries (TDI), particularly avulsion and dental fractures, requires timely intervention to preserve tooth vitality. However, studies show many emergency physicians in Australia and globally, highlight a lack of adequate training, confidence and limited guidelines in managing these conditions. Delays or inadequate management of these acute TDI can adversely affect patient outcomes. Despite the importance of this issue, there is a lack of prospective studies examining the management of TDI in Australasian EDs where triage systems prioritise life-threatening emergencies, and access to oral and maxillofacial surgery (OMFS) or dental specialist services varies between metropolitan and regional hospitals. This article advocates for a reformation in emergency medicine practices in Australia, emphasising the need for structured educational programs, practical decision-making tools, and integrated referral systems that include on-call dental or OMFS teams.