Emergency medicine: past, present, and future challenges

摘要

Origin and history of emergency medicine The term “emergency,” first used in the 1630s, is derived from the Latin word emergere, meaning unforeseen events that require immediate attention. The term “emergency medicine” can be traced to the French Revolution (1789–1799). In 1792, Dominique Jean Larrey, a military medical surgeon, gained a position in the Army of the Rhine and left for Strasbourg, where he witnessed great mobility of the horse artillery and then suggested that General Adam Philippe de Custine have the medical staff use this method to speed up transport of the wounded. The general approved Larrey's proposal. Larrey's “ambulance” was a simple carriage, despite the exposure to enemy fire. In 1797, during the first Italian campaign, Larrey created a complete rescue system with an active medical team in the battlefield. In contrast to previous rescue methods, Larrey transported critically wounded patients to the rescue station and operated on them as soon as possible, instead of delaying the operation after the battle. The timely rescue system created by him enabled every wounded soldier to be treated within 24 hours, which significantly reduced the mortality rate. Therefore, Larrey has often been referred to as “the father of emergency medical services.”[1] Medicine, as a professional field, dates back to the early 19th century, while emergency medicine can only be traced back to 50 years ago, making it the most recently developed major field in medicine. Before the 1960s, staff in hospital emergency departments usually worked in rotation with family doctors, general surgeons, physicians, and other specialists. In many small emergency departments, nurses conducted the triage of patients, and specialty doctors were called in based on the type of injury or disease. Many pioneers of emergency medicine were family doctors and other specialists, who believed that extra training in first aid was necessary. A group of doctors left their professional positions and devoted themselves to education. In 1952, Maurice Ellis was appointed as the first “first aid consultant” at Leeds General Infirmary in England. In 1967, the Casualty Surgeons Association was founded, with Maurice Ellis as its president.[2,3] In 1961, in the United States, Dr James DeWitt Mills, along with 4 assistant physicians, established 24/7 emergency care at Alexandria Hospital in Alexandria, Virginia; it was later known as the Alexandria Plan.[4] In 1970, the University of Cincinnati launched the first emergency resident physician program in the world. In 1971, the University of Southern California became the first American medical school to establish a department of emergency medicine.[5] History was made in 1979, when the American Board of Medical Specialties voted to make emergency medicine a recognized medical specialty in the United States.[5] In China, emergency medicine started relatively late. The Ministry of Health issued “Suggestions on Strengthening First Aid Work in the City” and “On the Release of the Construction Plan of Hospital Emergency Departments (Trial)” on October 30, 1980 and June 11, 1984, respectively. These 2 documents stipulated the work direction, scope, and tasks of the emergency department; thereby, laying the foundation for the construction of emergency departments in China. In 1985, Peking Union Medical College Hospital established the first postgraduate program in emergency medicine.[6–8] Current state of emergency medicine Emergency medicine mainly involves the rapid assessment, treatment, and triage of critically ill patients, and has transformed from the emergency room to the emergency department or emergency center. Hospitals typically set up a relatively complete emergency medical system of “out-of-hospital emergency medical services, in-hospital emergency medical services, and critical care.” Numerous emergency diagnostic and treatment technologies, such as cardiopulmonary resuscitation, emergency percutaneous coronary