Terrence Mulligan

International Federation for Emergency Medicine model curriculum for medical student education in emergency medicine

There is a critical and growing need for emergency physicians and emergency medicine resources worldwide. To meet this need, physicians must be trained to deliver time-sensitive interventions and life-saving emergency care. Currently, there is no internationally recognized, standard curriculum that defines the basic minimum standards for emergency medicine education. To address this lack, the International Federation for Emergency Medicine (IFEM) convened a committee of international physicians, health professionals, and other experts in emergency medicine and international emergency medicine development to outline a curriculum for foundation training of medical students in emergency medicine. This curriculum document represents the consensus of recommendations by this committee. The curriculum is designed with a focus on the basic minimum emergency medicine educational content that any medical school should be delivering to its students during their undergraduate years of training. It is not designed to be prescriptive, but to assist educators and emergency medicine leadership in advancing physician education in basic emergency medicine content. The content would be relevant, not just for communities with mature emergency medicine systems, but also for developing nations or for nations seeking to expand emergency medicine within current educational structures. We anticipate that there will be wide variability in how this curriculum is implemented and taught, reflecting the existing educational milieu, the resources available, and the goals of the institutions’ educational leadership.

Comparison of the serious injury pattern of adult bicyclists, between South-West Netherlands and the State of Victoria, Australia 2001-2009

BACKGROUND Head injury is the leading cause of death and long term disability from bicycle injuries and may be prevented by helmet wearing. We compared the pattern of injury in major trauma victims resulting from bicyclist injury admitted to hospitals in the State of Victoria, Australia and South-West Netherlands, with respective high and low prevalence of helmet use among bicyclists. METHODS A cohort of bicycle injured patients with serious injury (defined as Injury Severity Score>15) in South-West Netherlands, was compared to a cohort of serious injured bicyclists in the State of Victoria, Australia. Additionally, the cohorts of patients with serious injury admitted to a Dutch level 1 trauma centre in Rotterdam, the Netherlands and an Australian level 1 trauma centre in Melbourne, Australia were compared. Both cohorts included patients admitted between July 2001 and June 2009. Primary outcome was in-hospital mortality and secondary outcome was prevalence of severe injury per body region. Outcome was compared using univariate analysis and mortality outcomes were also calculated using multivariable logistic regression models. RESULTS A total of 219 cases in South-West Netherlands and 500 cases in Victoria were analyzed. Further analyses comparing the major trauma centres in each region, showed the percentage of bicycle-related death was higher in the Dutch population than in the Australian (n=45 (24%) vs n=13(7%); P<0.001). After adjusting for age, mechanism of injury, GCS and head injury severity in both hospitals, there was no significant difference in mortality (adjusted odds ratio 1.4; 95% confidence interval=0.6, 3.5). Patients in Netherlands trauma centre suffered from more serious head injuries (Abbreviated Injury Scale≥3) than patients in the Australian trauma centre (n=165 (88.2%) vs n=121 (62.4%); P<0.001). The other body regions demonstrated significant differences in the AIS scores with significantly more serious injuries (AIS≥3) of the chest, abdominal and extremities regions in the Australian group. CONCLUSION Bicycle related major trauma admissions in the Netherlands trauma centre, and in South-West Netherlands had a higher mortality rate associated with a higher percentage of serious head injuries compared with that in the Australian trauma centre and the State of Victoria.

Recognizing the common end-point of different emergency medicine specialty training curricula

Terrence Mulligan, Cherri Hobgood and Peter A Cameron Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland, Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA; Division of Emergency Medicine, Stellenbosch University, Cape Town, South Africa; and Emergency and Trauma Centre, The Alfred Hospital, Monash University, Melbourne, Victoria, Australia

Developments in international emergency medicine

Peter Cameron, Cherri Hobgood and Terrence Mulligan Monash University, Academic Director Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia; UNC School of Medicine, Chapel Hill, North Carolina, USA; ACEP Section for International EM, Emergency Medicine Residency, and Department of Emergency Medicine, Erasmus Medical Center, Rotterdam, The Netherlands; and Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA

Psychoactive substance (drugs and alcohol) use by emergency department patients before injury

Objective The aim of this study was to determine the prevalence and risk factors of alcohol, medication and illicit drug use before accidents in Emergency Department (ED)-treated trauma victims with internationally recommended methods to minimize registration bias. Patients and methods The study design was cross-sectional and was carried out at Erasmus Medical Centre in Rotterdam. Alcohol, psychoactive medication and illicit drug use were assessed in an interview by an independent researcher on the basis of the standardized WHO questionnaire. During 84 shifts, covering 4 weeks 24/7, data on a comprehensive population of ED-treated injury patients were collected prospectively. Results A total of 475 patients were included (response rate 87%). The prevalence of alcohol intoxication (defined as ≥3 U alcohol) before trauma was 19%. Alcohol-intoxicated trauma patients were significantly more often men [odds ratio (OR) 2.88, 95% confidence interval (CI) 1.54–5.40], of Dutch descent (native) (OR 2.26, 95% CI 1.24–4.13), unemployed or students (OR 1.77, 95% CI 1.03–3.04), and alcohol intoxication decreased with age (OR 0.98, 95% CI 0.96–0.99). Psychoactive medication was used by 7% of ED trauma patients; increasing age (OR 1.05, 95% CI 1.03–1.07) and living alone (OR 2.4, 95% CI 1.04–5.52) were risk factors. Illicit drugs were used by 4% of trauma patients. Overall, 27% of patients were under the influence of at least one psychoactive substance. Conclusion Over a quarter of trauma patients visiting the ED had used alcohol, psychoactive medication and/or illicit drugs before their accident. By far, the majority of intoxications before trauma were because of alcohol (19%). We found higher prevalence rates of alcohol intoxication and lower prevalence rates for illicit drug use than others. Because of our comprehensive approach and high response rates, registration bias was minimized.

International Flight Considerations

Combined with the rising number of passengers, and increased capacity of larger airplanes with more long-distance domestic and international flights, with long-haul aircrafts—such as the Airbus A380 and Boeing 777 LR now capable of extending flight times to 18–20 h—it is likely that the incidence of in-flight medical emergencies will continue to increase in the coming years. International air travel in particular combines long-haul, extended flight times with unique exposures and an even more austere, secluded environment for passengers with acute and/or chronic illnesses, and suggests unique medical challenges for recognition, stabilization, treatment, diagnosis, and disposition.