EMERGENCY MEDICINE

An Emerging Clinical Practice

Faith Joan C. Mesa-Gaerlan, MD, FPCEM, MS

College of Medicine-Philippine General Hospital
University of the Philippines
 UPCM

Department of Emergency Medicine

 UPCM

Amang Rodriguez Medical Center

Department of Emergency Medicine

 UPCM

Department of Emergency Medicine

 UPCM

Department of Emergency Medicine

 UPCM

Department of Emergency Medicine

 UPCM

Department of Emergency Medicine

 UPCM

Department of Emergency Medicine

 UPCM

IN TIMES OF
EMERGENCIES,
WHO ARE YOU
GOING TO CALL?
Department of Emergency Medicine
 UPCM

Objectives
 Define Emergency Medicine
 Enumerate the scope of the specialty
 Discuss the fundamental principles of Emergency
Medicine
 Describe the current status of the Emergency
Medicine in the Philippines
 Illustrate the importance of EM in the
Philippine context

Department of Emergency Medicine

 UPCM

Definitions
Emergency
is any situation that requires immediate action.
WHO
Medical Disaster
is an occurrence “when the destructive effects of
natural or manmade forces overwhelm the ability
of a given area or community to meet the demand
for health care”.
ACEP

Department of Emergency Medicine

 UPCM

Definitions
 Emergency Medicine (EM) - A branch of
medicine that deals with the appropriate
management of all forms of acute illness
or injury.
 Specialization in EM will lessen unwanted

morbidity or mortality due to a sudden

illness or injury.
 In the British System this is known as

Accident and Emergency (A&E).

Department of Emergency Medicine

 UPCM

Definitions
 Emergency Department (ED) or Emergency
Room (ER) - A unit of the hospital composed of
health care workers organized to address
management of acute illness or injury.

Department of Emergency Medicine

 UPCM

The Emergency Department

The current trend in Emergency
Medicine is to establish the ED as a
separate and distinct department
within the hospital, complete with its
own management and staff.

Department of Emergency Medicine

 UPCM

What is the Practice of

Emergency Medicine?
 Takes the most difficult cases from all
medical specialties
 Multidisciplinary
 Defined by the demands of the Emergency
Department
 Involves both Medical and Non-Medical
Problems
 Includes all Medically-related incidents
outside
the hospital
Department of Emergency Medicine
 UPCM

Emergency Medicine
International Federation for Emergency Medicine, 1991
 knowledge and skills required for the prevention,
diagnosis and management of acute and urgent
aspects of illness and injury
 all age groups
 spectrum of episodic undifferentiated physical
and
behavioral disorders
 encompasses pre-hospital and in-hospital
emergency medical systems

Department of Emergency Medicine

 UPCM
Characteristics of the

Specialty
Triage, Stabilize, Prioritize, Refer,
Observe
 ABCs
 Limited resources
– Time
– Information
– Space
 Technology dependent
 Cutting-edge medicine

Department of Emergency Medicine

 UPCM

Difference with other

Specialties
 Sequence of Assessment
– Assess  Action  Reassess  Action
 Always thinks of worst-case scenario
– Chest pain is MI!
 AMPLE history
 Prioritize patient’s clinical problems

Emergent-Urgent-Non-urgent
 Resuscitate to Stabilize 

improve patient’s clinical outcome

Department of Emergency Medicine
 UPCM

Pillars of EM
 Chain of Survival
 ABCDs . . .
– BLS
– RSI, ACLS
– PALS / NALS
– ATLS
 Pain Management
 EMSS

Department of Emergency Medicine

 UPCM

Characteristics of the Practice

 Low overhead
– No clinic to rent
– No staff to hire
– Minimal equipment necessary
 Flexible Work Hours
– Choose your hours
– Maximum 60-hours/week
– Not necessary to file for leave

Department of Emergency Medicine

 UPCM

Characteristics of the Practice

 High Stress
– Kinds of cases seen
– Kinds of patients seen
– Limited resources
 No Follow-ups – no admitting
privileges
 Exposed to legal and ethical dilemnas
 Group practice

Department of Emergency Medicine

 UPCM

Characteristics of EM Physicians

 Type A personality
 Adrenaline junky
 Multi-tasker
 Able to make quick decisions
 Willing to work nights, weekends, holidays
 Good communicator
 Team player

Department of Emergency Medicine

 UPCM

Subspecialties
 Pediatric EM
 Toxicology
 Emergency Health
– Emergency Medical Services
– Disaster Medicine and Mass Gatherings
– International EM
– Emergency Public Health information
 ED Administration
 Intensive Care

Department of Emergency Medicine

 UPCM

Areas of Special Interest

 Emergency Cardiac Care
 Neurology: “Brain Attack”
 Sports Medicine / On-site Medical Care
 Research
 Child Abuse & Abuse of Women in Intimate
Relationship / Medico-Legal (i.e. torture)
 Environmental & Occupational Health

Department of Emergency Medicine

 UPCM

EMS System
Emergency Medical Services
System (EMSS) – The total
system intended to care for a
casualty from the site of incident
to definitive care.

Department of Emergency Medicine

 UPCM

EMS System includes

 Triage
 On-site care
 Initial resuscitation and treatment
 Medical transport
 Definitive care

Department of Emergency Medicine

 UPCM

EMS System Components

 Transport
 Personnel
 Communications System
 Medical Control
 Equipment and Supplies
 Legislation and advocacy

Department of Emergency Medicine

 UPCM

Department of Emergency Medicine

 UPCM

HISTORY OF EMERGENCY MEDICINE

 Before Emergency Medicine

 War
– 18th Century
– Field Hospitals
– Medics during Korean & Vietnam Wars
 Emergency Rooms (in the 1960’s)
– Staffed by nurses and interns
– On-call physicians from other specialties

Department of Emergency Medicine

 UPCM
History of Emergency Care
Development of EM
 1960s – Creation of “Casualty Department” in
UK & Australia
 1968 – American College of Emergency
Physicians founded
 1969 – 1st ACEP scientific assembly held
 1970 – 1st EM residency established in
Univ. of Cincinnati

Department of Emergency Medicine

 UPCM

Development of EM

 1972 – Casualty Surgeons Association

restructured as British Association for
Accident & Emergency Medicine
 1972 – Journal of ACEP published
 1973 – Emergency Medical Services
Systems
Act signed into law
 1973 – AMA establishes section on EM
 1974 – EMRA established
 1976 – American Board of EM established
Department of Emergency Medicine
 UPCM

Development of EM

 1979 – EM established as 23rd

medical specialty
 1981 --Australasian College for
Emergency Medicine established
 1986 – 1st International Conference on
EM
 1989 – ABEM given primary board status

Department of Emergency Medicine

 UPCM

Development of EM

 1990 – International Federation for EM

founded
 1992 – ABEM and American Pediatric Society
establish Subspecialty Board for Pediatric EM
 1994 – 1st Subspecialty Board for Toxicology
 1998 – 1st Asian Congress of EM held in
Singapore.

Department of Emergency Medicine

 UPCM

EM IN THE PHILIPPINES

 1988 –Emergency department created at

Makati Medical Center / Philippine College
Emergency Medicine and Acute Care formed
 1989 -- Philippine Society of Emergency
Care Physicians formed
 1996 – Setting up of PGH
Emergency Medical Services System
 1997 – Establishment of Residency Program
at DEMS, PGH

Department of Emergency Medicine

 UPCM

Emergency Medicine in the Philippines

 2001 – Department of EM established as

Academic unit of UP College of Medicine
 2011 – Philippine College of Emergency

Medicine (PCEM) formed & recognized as

specialty society of specialty
division of the Philippine
Academy of Family
Physicians under the
Philippine
Medical Association

Department of Emergency Medicine

 UPCM

Emergency Medicine in the Philippines

 VISION:
 The national academic body composed of
dedicated professional emergency medicine
physicians oriented towards quality service,
research and training in emergency care,
working together towards global
recognition.

Department of Emergency Medicine

 UPCM

EMERGENCY MEDICINE IN THE PHILIPPINES

 MISSION:
 To achieve national recognition as a distinct
specialty in medicine.
 To promote emergency care nationwide to its highest
standards.
 To regulate the practice and training of emergency
medicine.
 To participate in disaster planning and pre-hospital care.
 To innovate emergency medicine practice through
research and continuing medical education

Department of Emergency Medicine

 UPCM

Department of Emergency Medicine

 UPCM

Emergency Medicine in the Philippines

 “Ideally, the emergency department is

headed by a specialist trained in
Emergency Medicine.” (DOH, ER Management Manual, 2009)

Department of Emergency Medicine

 UPCM
COMPARATIVE DESIGNS OF
EMERGENCY RESPONSE
SERVICES
USA Asian Nations
Funding Well Funded Scarce Funding
Infrastructure Uniform federal Not Uniform
Support
National Safety
stats. Vehicles, Exists Does not Exist
equipment's
Minimum standard Recognition Requires
care provided present recognition
Minimum guidelines Existing Not existing
for education &
training
Department of Emergency Medicine
 UPCM
COMPARATIVE DESIGNS OF
EMERGENCY RESPONSE SERVICES

USA Asian Nations

Support Professional Minimal Voluntary
Improvements in Organizations Organizations
System Design
Cost of Med. & Heightened Lack of
Trauma Care awareness awareness
Public Health Continued Non existent
Prevention Prog. Awareness
Network for Disaster Structured Partially
Response structured
System Flexibility Existent No System
Department of Emergency Medicine
 UPCM

PGH EMS

Department of Emergency Medicine

 UPCM

Directions in EM
 Establish and improve EM training
programs
– Training programs – 4 government, 6 private
– Highest standards in emergency care
 Take the lead in medical control for disaster
planning and preparedness
 Improve pre-hospital emergency care

Department of Emergency Medicine

 UPCM

Directions in EM

 Curricular changes for

Undergraduate Medical Education
 Research and Documentation
 Training
– BLS, ACLS, ATLS
– Emergency Nursing
– Emergency Medical Technicians

Department of Emergency Medicine

 UPCM

Directions in EM

 Pre-Hospital & ED reimbursement

 Emergency Public Health Information

Dissemination
 ED Design
 Continuous Quality Improvement

Department of Emergency Medicine

 UPCM

Emergency Doctrine

 Implied Consent for patients in the ED who

cannot give consent for actions to save or
preserve life
 Serves to protect emergency personnel
who
act in good faith
 Encourages personnel to act decisively in

the patient’s best interest

Department of Emergency Medicine

 UPCM

Department of Emergency Medicine

 UPCM

QUESTIONS?

Department of Emergency Medicine

 UPCM

Department of Emergency Medicine