What distinguishes emergency medicine as a speciality in its own right?

Humzah Khan - Mar. 10, 2024 - 5 min read - #Medicine

A ‘medical speciality’ means a branch of medical practice that is focussed on a defined group of patients, in emergency medicine it is ‘emergency patients’. Some may perceive this as a broad term for patients yet I find it rightly justified, not only because of the unique skill set required to navigate uncertainty, but also amidst the relentless battle against time and yearning to stay within the golden hour for maximised efficacy against a patient's mortality. All whilst having an international impact regardless of geographical borders, simultaneously embodying the 4 pillars of medicine. Emergency medicine is deserving of its speciality in its own right - and here’s why.


Emergency medicine is distinguished by the relentless ticking of the clock - each tick being more valuable than any other speciality. The golden hour refers to the first 60 minutes following a traumatic injury, during which immediate intervention significantly enhances the likelihood of survival. Therefore one could infer that ambulances striving to attain a 540 second ALS (arrival of Advanced Life Support) is to savour and preserve the golden hour. This then carries over to emergency physicians and medical professionals who work against the ticks of time maximising the efforts made within the initial hours of a traumatic injury. Other specialties are usually less time strained to the extent emergency medicine is, due to the less likelihood of damage to a patient's health with effect after a short duration of time. According to a comprehensive analysis published in the Journal of Trauma and Acute Care Surgery, adherence to the golden hour principle is associated with a substantial reduction in mortality rates and improved patient prognosis across various emergency scenarios. This implies how actions taken outside of the initial hours of trauma have less immediate significance on the patient, in regards to a patient's mortality, in comparison to effective actions taken within the golden hour(s). Highlighting the crucial role emergency health professionals play signifies the distinguishable difference between health workers within emergency medicine and other specialities.


Emergency physicians excel in the field of navigating uncertainty - unlike other specialities who thrive in structured environments, emergency medicine flourishes due to its unpredictability. Patients are rushed in with symptoms draped in ambiguity, yet emergency physicians are required to make appropriate life saving decisions with potentially limited information. The ability to make calculated decisions amidst incomplete information parts emergency professionals from other specialties. Emergency physicians frequently encounter situations characterised by diagnostic ambiguity, along with decision fatigue after strenuous shifts. Error rates and patient safety is hence a paramount concern, yet despite that, a staggering 17.4 million people are still seen annually by the A&E, and yet only 238 of 23.5 million of those patients received diagnostic errors by emergency physicians. The historically long waiting queue, where the A&E only sees 53% of patients within the first 4 hours, missing their target by 42%, implies the strenuous nature of emergency medicine, and yet the staggering statistic of errors made exemplifies how emergency medicine undoubtedly has a right to stand as its own speciality, due to its physicians navigating the labyrinth of life changing decision making. 


A defining characteristic of emergency medicine which differentiates it from other specialities is the dynamic weaving of various medical specialities, upholding beneficence. Unlike other fields who are characterised by specialisations, emergency medicine demands an intricate dance of collaboration where emergency physicians, surgeons, nurses, paramedics, and specialists from various disciplines converge to address urgent medical crises. The reality that energies often present multifaceted challenges requiring a comprehensive skill set is where emergency medicine thrives, where an interdisciplinary approach is seen. For example, a trauma case may involve the collaboration of physicians for immediate assessment, followed by trauma surgeons for surgical interventions, radiologists for diagnostic imaging, and nurses for ongoing patient care. This intricate teamwork is what distinguishes emergency medicine as its own niche, as immediate medical needs are met, intermediate as well as long term needs, all whilst following autonomy. It is this synchronised interdisciplinary collaboration which is both responsive and adaptive which creates lifelines and counters intricate challenges along the way, all needing an extensive skill set not found elsewhere.


The impact of emergency medicine reaches far beyond national borders, separating it from other specialities. Emergency health professionals emerge as lifelines, transcending borders contributing their expertise during pandemics, natural disasters, and international emergencies. Emergency medicine has now attained a global link, acting as a lifeline for countries and ultimately the world. Organisations such as the World Health Organisation and Médecins Sans Frontières, facilitate a crucial role in providing emergency medical aid when urgently needed. A prime example of this was during the devastating earthquake in Haiti in 2010. Emergency physicians played a pivotal role in global humanitarian efforts by setting up field hospitals, triage centres and mobile medical units. The emergency physicians encountered numerous challenges including a lack of facilities, limited resources, and an overwhelming number of patients. Emergency medical professionals became a lifeline for the devastating effects of the earthquake. The response to Haiti exemplifies how emergency physicians offered immediate assistance in the face of challenge, and reiterates the role emergency medicine plays on a global scale, throwing a rope of lifeline to those trapped regardless of geographical boundaries. The international footprint emergency medicine leaves behind serves as a reminder as to why it is deserving as its own speciality, embracing all 4 pillars of medicine and humanitarian service.


In closing, emergency medicine has proven its worth to be its own specialisation due to the complex skills attained and utilised within emergency, such as the ability to traverse the crucial decision making and hence maximising the golden hour, potentially under diagnostic fatigue, whilst also embodying what it means to be a doctor and portraying the values and pillars all doctors should portray by leaving an international footprint which other established specialities are yet to be seen following.