The U.S. vs. European Emergency Medicine system? 1

Leading Emergency Medicine expert compares the U.S. emergency medicine system with European emergency medicine system. “Load and go” and “scoop and run” or “stay and play”? Does U.S. Emergency Medicine system has advantage over European Emergency Medicine system? Is it better to transport patient to big hospital as soon as possible? Is it better to provide medical treatment at the place of accident or emergency?

Leading Emergency Medicine expert compares the U.S. emergency medicine system with European emergency medicine system. “Load and go” and “scoop and run” or “stay and play”? Does U.S. Emergency Medicine system has advantage over European Emergency Medicine system? Is it better to transport patient to big hospital as soon as possible? Is it better to provide medical treatment at the place of accident or emergency? The U.S. vs. European Emergency Medicine system. Anglo-American vs. Franco-German emergency medical services system. Video interview with top expert in Emergency Medicine. US Emergency medical system is defined by “load and go” or “scoop and run” strategy. Patients are stabilized at the scene of accident or emergency. Then goal is to get the patient as fast as possible to the Emergency Department of hospital. This works best in trauma, heart attacks and strokes. European emergency medicine system is “stay and play”. Significant medical care is provided to the patient at the place of accident or emergency. Medical second opinion helps to make sure preliminary diagnosis is correct and complete. Medical second opinion also helps to choose the best treatment for health problems that can become emergencies at any time. Obtain medical second opinion to avoid emergency room visit. Emergency Medical treatment system in the US. Anglo-American vs. Franco-German emergency medical services system. Dr. Anton Titov, MD. How does emergency medical system work in the United States? What happens after a person dials an emergency telephone number? (911 in the United States) Dr. Sam Shen, MD. Sometimes the patient calls 911, the phone call is received by a dispatcher. The dispatcher transfers the call to an outside contracted ambulance service. Then ambulance service will bring the patient from home to the Emergency Department of a hospital. Ambulance services, Emergency medical services, can be private or government-run or volunteer-based. These are the most common models of organization of ambulance services in the US. The goal of ambulance service is to stabilize a patient. Then get a patient to a higher level of medical care as quickly as possible. This higher level of care is Emergency Medicine department of the hospital. Dr. Anton Titov, MD. in the United States when a person complains of chest pain, this person phones 911 number. Ambulance arrives and Emergency Medical Technicians (EMTs) come and bring this person to the Emergency Medicine department of the hospital. In this dedicated Emergency Department physicians are specially trained in Emergency Medicine. They evaluate and treat the patient. What are the advantages of such system of emergency medical care? What are the challenges that such system faces? Dr. Sam Shen, MD. There are advantages to have a specialty of medicine. It is focused and dedicated to evaluating this particular type of patients. 40 years ago Emergency Medicine did not exist as a dedicated specialty of medicine. Physicians who would take care of patients in Emergency Room section of the hospital had different backgrounds. They could be generalist doctors or specialist doctors. The creation of dedicated Emergency Medicine specialty made sense. Because when patient comes to the hospital, the medical problem is not differentiated. It is not known what is wrong with the patient. Physicians who take care of such patient must have special skills and very broad experience to evaluate and treat acute emergency medical problems. Such physician must be comfortable to diagnose and treat a large number of medical problems when they initially appear in acutely ill patients. This approach warranted the creation of dedicated specialty of emergency medicine. In our opinion Emergency Medicine field has benefited patients. To have dedicated Emergency Medicine specialty helped to provide faster and more comprehensive medical care to patients. It also helps to improve quality of care for acutely ill patient. Dr. Anton Titov, MD. Let’s continue to use example of a patient with chest pain. Chest pain is not necessarily caused by heart problem. if physician evaluates a patient with chest pain at home, there are no sophisticated tools to identify all possible reasons for chest pain. In the absence of Emergency Medicine department in the hospital, the physician who evaluates a patient at home has to decide this department of the hospital this patients needs to go to. cardiology department might not be the best place for this patient if chest pain has a cause other than heart problem. In the US this patient is admitted to Emergency Department, where specially trained physicians determine the cause of chest pain of such patient. Dr. Sam Shen, MD. Yes and that is a good example. Sometimes someone presents with pain in the chest area, it doesn’t necessarily mean a heart attack. A lot different causes can case chest pain. A dedicated Emergency Department is a place that allows you to manage all the different possibilities for diagnosis. It gives that patient the best chance to have correct diagnosis and appropriate treatment. Sometimes chest pain is cased by heart attack, this is a very urgent situation. Emergency Department has all resources and structure to manage heart attack. But if it is not a heart attack. If something else causes this patient’s chest pain. Then Emergency medicine physician has breadth of knowledge and resources of Emergency Department to make correct diagnosis. For example, if the chest pain is cause by gastrointestinal problem, then in the absence of Emergency Department the person who is admitted to Cardiology department is at the wrong place to receive the best care for gastrointestinal problem. Emergency Medicine Department system in the United States allows appropriate triage and assessment of patients with problems that are not yet diagnosed with certainty. Dr. Anton Titov, MD. Should a person be treated for more extended period of time at home or outside of a hospital? Or should a person with medical problem be brought to the hospital as soon as possible? This is an important strategic choice between different models of emergency care. One system of emergency medical care is known as Anglo-American emergency medical care system. It is defined by strategy to bring a patient as soon as possible to dedicated Emergency Medicine department within a hospital. This model of emergency medical care is known as “load and go” or “scoop and run”. Another approach to emergency medical situation is known as Franco-German emergency medical care model. It is often called “stay and play”. Under Franco-German model of emergency medical services, physicians provide extended care at the place of accident or at a patient’s home. How can you compare Anglo-American and Franco-German models of emergency medical care? Which system is more effective for patients? Dr. Sam Shen, MD. Yes, I can certainly speak to the US system of emergency medical care. This is the first model that you described (Anglo-American model of emergency medical care). The goal of US Emergency medical care is to quickly get the patient to the Emergency Department. But emergency paramedics receive extensive training. They have skills and can do a wide variety of life saving maneuvers. For example, CPR and Advance Cardiac Life Support (ACLS), or intubation. Although their goal is to get the patients quickly to the hospital, emergency technicians perform life-saving procedures at the scene of accident or at patient’s home. However, the principle of the US Emergency medical system is to do what is the the most minimally necessary to allow safe transport of that patient to the Emergency Department of a hospital. There are some controversies of what interventions and how much care emergency medical personnel should do at the scene. But many emergency medical conditions are very time-sensitive by nature. the goal of emergency medical services is to get the patient to the hospital as fast as possible. Hospital is the place with the most controlled environment with the maximum amount of resources and specialists. this is especially important for heart attacks, strokes and trauma. The U.S. vs. European Emergency Medicine system. Video interview with top emergency medicine expert. Scoop and run or stay and play? US emergency medicine.