EM Gains Steam in Europe

Emergency medicine was in various phases of development throughout Europe at this time. While the United Kingdom had recognized the specialty for almost half a century, most other European countries were in their infancy with regard to emergency medicine. In 2013, the European Society for Emergency Medicine administered its first written board exam in emergency medicine. I was among the first 100 physicians who sat for this exam. It was administered in five locations throughout Europe. I flew to London for my exam, knowing that I was helping to create history. The 36 of us who passed this exam were invited to take the oral exam in Italy the following May. It was similar to an objective structured clinical examination. While it was not in a hotel room with an examiner behind a binder, I felt like my residency training and American Board of Emergency Medicine certification and recertification had prepared me well for the European exam. At the 2014 European Society for Emergency Medicine (EUSEM) conference in Amsterdam, I was recognized as one of the first 12 physicians to have passed the first written and oral emergency medicine exam in Europe.

Back at AHUS, patient care was improving. Since starting our pilot project, there had been no unexpected deaths in the emergency room. I can think of several of my patients who certainly would have died without the attending-level emergency medicine supervision I was able to provide. I remember a type A dissection that I diagnosed with bedside ultrasound, an unrecognized acetaminophen overdose, a patient sent in for presumed urosepsis that I correctly identified as Fournier’s gangrene, and a patient with pericardial tamponade (also diagnosed with bedside ultrasound), just to name a few.

At the same time, patient complaints to the ombudsman drastically decreased from 92 in the two-year, eight-month period before emergency medicine staffing to just two in the six-month period after staffing the emergency department with attending physicians around the clock. Lifesaving treatments such as cardioversion for unstable atrial fibrillation were now being performed immediately in the emergency room rather than after the delays around admitting these patients to hallway beds on the cardiology floor for management. We also discharged patients faster from our observation unit. The nurses and EMS felt safer having a small, dedicated group of attending physicians in the emergency room rather than relying on inexperienced interns rotating from the various services.