Development of Emergency Medicine in Europe

Totten, Vicken Y.; Bellou, Abdelouahab

doi:10.1111/acem.12126

Cited by 25 publications

(14 citation statements)

References 14 publications

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“…The main reason behind the improper access to health care in rural areas is the distance to health care facilities. The solution found by many countries to eliminate this problem is the establishment of the Helicopter Emergency Medical Rescue Service, which has made it possible to reduce the time of arrival to the event site, that is far from health care facilities, as well as the time of patient arrival at the hospital [11,18]. The issues of accessibility and actions taken to improve the quality of medical services in rural areas prompted the authors of this paper to present the characteristics of missions performed by HEMS crew and the analysis of health problems, which are the most cause of the HEMS interventions in rural areas.…”

Section: Discussionmentioning

confidence: 99%

Helicopter Emergency Medical Service (HEMS) Response in Rural Areas in Poland: Retrospective Study

Rzońca

Świeżewski

Jalali

et al. 2019

IJERPH

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The aim of the study was to identify the characteristics of missions performed by HEMS (Helicopter Emergency Medical Service) crews and the analysis of health problems, which are the most common cause of intervention in rural areas in Poland. The study was conducted using a retrospective analysis based on the medical records of patients provided by the HEMS crew, who were present for the emergencies in rural areas in the period from January 2011 to December 2018. The final analysis included 37,085 cases of intervention by HEMS crews, which accounted for 54.91% of all the missions carried out in the study period. The majority (67.4%) of patients rescued were male, and just under a quarter of those rescued were aged between 50–64 years. Injuries (51.04%) and cardiovascular diseases (36.49%) were the main diagnoses found in the study group. Whereas injuries were significantly higher in the male group and patients below 64 years of age, cardiovascular diseases were higher in women and elderly patients (p < 0.001). Moreover, in the group of women myocardial infarction was significantly more frequent (30.95%) than men, while in the group of men head injuries (27.10%), multiple and multi-organ injuries (25.93%), sudden cardiac arrest (14.52%), stroke (12.19%), and epilepsy (4.95%) was significantly higher. Factors that are associated with the most common health problems of rural patients are: gender and age, as well as the seasons of the year and the values of the Glasgow Coma Scale (GCS), Revised Trauma Score (RTS), and National Advisory Committee for Aeronautics (NACA) used to assess the clinical status of patients.

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Section: Discussionmentioning

confidence: 99%

Helicopter Emergency Medical Service (HEMS) Response in Rural Areas in Poland: Retrospective Study

Rzońca

Świeżewski

Jalali

et al. 2019

IJERPH

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“…As emergency medicine gained momentum in these settings, some examples of diffusion to India appeared in the early 1990s in both public and private sectors. The form of emergency medicine that took root in India was the ‘Anglo-American’ model, where clinical care was provided primarily in hospitals, rather than the ‘Franco-German’ model, which emphasized pre-hospital clinical care [ 79 ].…”

Section: Resultsmentioning

confidence: 99%

Socialization, legitimation and the transfer of biomedical knowledge to low- and middle-income countries: analyzing the case of emergency medicine in India

Sriram

George

Baru

et al. 2018

Int J Equity Health

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BackgroundMedical specialization is a key feature of biomedicine, and is a growing, but weakly understood aspect of health systems in many low- and middle-income countries (LMICs), including India. Emergency medicine is an example of a medical specialty that has been promoted in India by several high-income country stakeholders, including the Indian diaspora, through transnational and institutional partnerships. Despite the rapid evolution of emergency medicine in comparison to other specialties, this specialty has seen fragmentation in the stakeholder network and divergent training and policy objectives. Few empirical studies have examined the influence of stakeholders from high-income countries broadly, or of diasporas specifically, in transferring knowledge of medical specialization to LMICs. Using the concepts of socialization and legitimation, our goal is to examine the transfer of medical knowledge from high-income countries to LMICs through domestic, diasporic and foreign stakeholders, and the perceived impact of this knowledge on shaping health priorities in India.MethodsThis analysis was conducted as part of a broader study on the development of emergency medicine in India. We designed a qualitative case study focused on the early 1990s until 2015, analyzing data from in-depth interviewing (n = 87), document review (n = 248), and non-participant observation of conferences and meetings (n = 6).ResultsFrom the early 1990s, domestic stakeholders with exposure to emergency medicine in high-income countries began to establish Emergency Departments and initiate specialist training in the field. Their efforts were amplified by the active legitimation of emergency medicine by diasporic and foreign stakeholders, who formed transnational partnerships with domestic stakeholders and organized conferences, training programs and other activities to promote the field in India. However, despite a broad commitment to expanding specialist training, the network of domestic, diasporic and foreign stakeholders was highly fragmented, resulting in myriad unstandardized postgraduate training programs and duplicative policy agendas. Further, the focus in this time period was largely on training specialists, resulting in more emphasis on a medicalized, tertiary-level form of care.ConclusionsThis analysis reveals the complexities of the roles and dynamics of domestic, diasporic and foreign stakeholders in the evolution of emergency medicine in India. More research and critical analyses are required to explore the transfer of medical knowledge, such as other medical specialties, models of clinical care, and medical technologies, from high-income countries to India.

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“…Only US costs were identified and these are the ones applied to our analysis. Although the most costly component was IV infusion pumps, which are more commonly used in United States than in Europe, they do represent possible costs in Europe, as EDs become more specialized [ 61 ]. These costs were taken from the poster presented by Abraham et al at the 20th annual meeting of the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) [ 55 ].…”

Section: Discussionmentioning

confidence: 99%

Administration of intravenous morphine for acute pain in the emergency department inflicts an economic burden in Europe

Casamayor¹,

DiDonato²,

Hennebert³

et al. 2018

DIC

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BackgroundAcute pain is among the leading causes of referral to the emergency department (ED) in industrialized countries. Its management mainly depends on intensity. Moderate-to-severe pain is treated with intravenous (IV) administered opioids, of which morphine is the most commonly used in the ED. We have estimated the burden of IV administration of morphine in the five key European countries (EU5) using a micro-costing approach.ScopeA structured literature review was conducted to identify clinical guidelines for acute pain management in EU5 and clinical studies conducted in the ED setting. The data identified in this literature review constituted the source for all model input parameters, which were clustered as analgesic (morphine), material used for IV morphine administration, nurse workforce time and management of morphine-related adverse events and IV-related complications.FindingsThe cost per patient of IV morphine administration in the ED ranges between €18.31 in Spain and €28.38 in Germany. If costs associated with the management of morphine-related adverse events and IV-related complications are also considered, the total costs amount to €121.13–€132.43. The main driver of those total costs is the management of IV-related complications (phlebitis, extravasation and IV prescription errors; 73% of all costs) followed by workforce time (14%).ConclusionsIV morphine provides effective pain relief in the ED, but the costs associated with the IV administration inflict an economic burden on the respective national health services in EU5. An equally rapid-onset and efficacious analgesic that does not require IV administration could reduce this burden.

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Development of Emergency Medicine in Europe

Cited by 25 publications

References 14 publications

Helicopter Emergency Medical Service (HEMS) Response in Rural Areas in Poland: Retrospective Study

Helicopter Emergency Medical Service (HEMS) Response in Rural Areas in Poland: Retrospective Study

Socialization, legitimation and the transfer of biomedical knowledge to low- and middle-income countries: analyzing the case of emergency medicine in India

Administration of intravenous morphine for acute pain in the emergency department inflicts an economic burden in Europe

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