International emergency medicine

International emergency medicine is a subspecialty of emergency medicine that focuses not only on the global practice of emergency medicine but also on efforts to promote the growth of emergency care as a branch of medicine throughout the world. The term international emergency medicine generally refers to the transfer of skills and knowledge—including knowledge of ambulance operations and other aspects of prehospital care—from developed emergency medical systems (EMSs) to those systems which are less developed. However, this definition has been criticized as oxymoronic, given the international nature of medicine and the number of physicians working internationally. From this point of view, international emergency medicine is better described as the training required for and the reality of practicing the specialty outside of one's native country.

Emergency medicine has been a recognized medical specialty in the United States and other developed countries for nearly forty years, although these countries' EMSs did not become fully mature until the early 1990s. At that point, some of its practitioners turned their attention from developing the specialty at home to developing it abroad, leading to the birth of international emergency medicine. They began to support the growth of emergency medicine worldwide, doing so through conferences, national and regional emergency medicine organizations, relief and development organizations, international emergency medicine fellowships, physician exchanges, information transfer, and curriculum development.

Most developing countries are taking steps to develop emergency medicine as a specialty, to develop accreditation mechanisms, and to promote the development of emergency medicine training programs. Their interest is a result of improved healthcare, increasing urbanization, aging populations, the rising number of traffic fatalities, and heightened awareness of emergency medicine among their citizens. In addition, emergency medicine is useful in dealing with time-sensitive illnesses, as well as improving public health through vaccinations, interventions, training, and data collection. Countries that lack mature EMSs are developing emergency medicine as a specialty so that they will be able to set up training programs and encourage medical students to pursue residencies in emergency medicine.

Some challenges faced in international emergency medicine include immature or non-existent training programs, a lack of adequate emergency transport, a shortage of resources to fund emergency medicine development, and an absence of research that could inform developing countries how to best spend the resources they devote to emergency medicine. Additionally, the standards and methods used in countries with mature EMSs are not always suited for use in developing countries due to a lack of infrastructure, shortage of funds, or local demographics. Ambulances, the developed country standard, are costly and not practical for the road conditions present in many countries; instead, a variety of modes of transportation are used. Furthermore, in place of expensive medication and equipment, developing countries often opt for cheaper if slightly less effective alternatives. Although it may seem that increasing availability to emergency medicine must improve health, there is little empirical evidence to directly support that claim or to point out which methods are most effective in improving patient health. Evidence-based medicine seeks to address this issue by rigorously studying the effects of different interventions instead of relying on logic or tradition.

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