Emergency Medicine in Ireland
The representative body for Emergency Medicine (EM) in the Republic of Ireland (RoI) is the Irish Association for Emergency Medicine. There have always been very close ties between EM in the RoI and the UK in spite of there inevitably being different administrative arrangements in the two jurisdictions. The Irish Higher Training scheme in EM, administered by the Advisory Committee on Emergency Medicine Training (ACEMT), uses the CEM curriculum for training and the FCEM as its exit examination. From 2011, the only acceptable qualification to enter specialist training will be the MCEM examination.
Emergency Departments fulfil the same functions in the RoI as they do in the UK. Public healthcare, including EM, in the RoI is provided by the Health Service Executive (HSE). Heretofore, interaction between EM and either the HSE or the Department of Health and Children has been conducted exclusively by IAEM. The welcome advent of an Irish National Board of CEM will allow the benefits of a much larger College structure to be brought to bear, in addition to the local expertise IAEM provides.
There are formal links between IAEM, ACEMT and CEM, with the President of IAEM and the chair of ACEMT both being members of the Irish National Board of CEM. Further information is available on the Irish Association for Emergency Medicine's website.
Advice for patients
Emergency Medicine is a medical 'specialty'. That means that the senior doctors (consultants) who work in Emergency Departments (EDs or A&Es) have undertaken specific training to learn how to look after emergencies. The specialty of Emergency Medicine has been developing rapidly in the UK for a number of years. It started off being practised in “Casualty” departments by doctors from a number of different medical backgrounds, but now has its own training programme, examinations, and professional college to ensure that standards are high.
Because patient healthcare provision in the UK has been changing there are still a number of different terms used by different people. Casualty departments are now known as “Accident and Emergency” Departments, or as “Emergency Departments.” Specialists in Emergency Medicine may be known as “Consultants in Accident and Emergency Medicine,” or as “Emergency Physicians.” It doesn’t matter so much what they are called, they all do the same thing. Doctors, nurses and other professionals working in Emergency Departments are dedicated to the care of acutely ill and injured patients of all ages, and with all the different problems that can present as emergencies.
Not all acute problems need to be dealt with in Emergency Departments, and there are now a number of different ways in which patients can access help. You can find your nearest service at nhs.uk/service-search.
NHS services providing out of hours and urgent care
is a 24-hour telephone advice service which can give advice about health problems, and how to access NHS services.
It is possible to access GP services out of hours. If you don’t know what arrangements are in place for your area, NHS 111 should be able to help, or GPs should leave details on their answer phone services / practice information.
NHS Urgent Care Centres, Walk-In Centres and Minor Injuries Units are designed to deal with minor illnesses and injuries. They are usually staffed by nurse practitioners (specially trained nurses), and sometimes by other practitioners, with a lot of experience and expertise in treating minor illness and injuries. Some of these units have doctors working alongside the nurses or nearby, and some units have X-ray facilities. Many have links with local Emergency Departments.
If your injury or illness is not serious you can get help from a Minor Injuries Unit (MIU) rather than an emergency department. By doing so you allow ED (A&E) staff to concentrate on people with serious and life-threatening conditions and save yourself a potentially long wait.
Minor injuries units may not be equipped to deal with very young children, or with more serious conditions such as:
- Chest pain
- Breathing problems
- Abdominal pain
- Serious infections or temperatures which do not respond to cooling and paracetamol
- Gynaecological problems (problems affecting only women such as vaginal bleeding)
- Pregnancy problems
- Drug overdose
- Significant lacerations (cuts), possible major bone fractures and other injuries
- Alcohol related problems
- Mental health problems
- Health conditions that would normally be treated by your GP or hospital
These are the sort of conditions that may be best treated in the Emergency Department or by your own GP.
Emergency Departments are departments based at the 'front door' of a hospital that specialise in the care of acutely ill and injured patients. Most departments deal with patients of all ages and with all conditions, although there are some departments that see only children, or only adults, or only patients with eye problems.
Various healthcare practitioners may work in Emergency Departments, including nurses, physiotherapists, psychiatric nurses, and doctors. The care in Emergency Departments is supervised by specialists in Emergency Medicine (Emergency Physicians), whose job is to ensure that the patients passing through these departments receive care of the highest possible standard.
Most Emergency Departments are open 24 hours a day, 7 days a week. All will have resuscitation facilities for the critically ill, cubicles to see other sorts of patients, and access to investigations (such as blood tests and X-rays) to help make diagnoses.
If you have to visit an Emergency Department you can expect to be asked for your personal details, name, address etc and to be registered onto the computer system. You may be seen by a nurse briefly before seeing the doctor or nurse practitioner. This process is sometimes called 'triage', or sometimes called 'assessment'. The idea is to find out who can best deal with your problem and in which part of the department, whether any treatment or investigations can be started, and whether you need to be seen very urgently. Sometimes you can be treated on the spot, or directed to a more appropriate service. Most Emergency Departments will allocate each patient a 'triage category', which indicates in which order patients should be seen, not necessarily how serious the problem is. This process also allows you to be given pain killers as soon as possible.
When you are seen by a doctor or nurse practitioner they will assess your condition, and decide on what the best treatment for your condition is including whether you need to be seen by a specialist or by your own GP after discharge. Sometimes patients can be treated and discharged, and some will need to be admitted to hospital. Many Emergency Departments have their own wards to which patients can be admitted for short periods of observation or treatment. You may also be referred to other hospital specialists for advice or treatment. This doesn’t mean that the Emergency Department doctors don’t know what they are doing, but that other specialists may be able to provide exactly the right care for your particular problem as well as providing follow up care to ensure your condition responds to the treatment.
Just because Emergency Departments have to see lots of patients doesn’t mean you should ever feel that things have not been properly dealt with, or that you don’t understand what is going on. If you visit an Emergency Department and feel like this, talk to the staff and ask them to explain things for you.
Until recently in England, the government specified that 98% of patients should be seen, treated and either admitted or discharged within 4 hours of arriving in the Emergency Department. In general we believe this has been a good thing and it has enabled us to improve care in many ways in our Emergency Departments. From April 2011, this ‘4 hour standard’ has been replaced by a range of quality indicators designed to further improve patient care. The Royal College of Emergency Medicine meets regularly with the Department of Health (DOH) and has always been clear that quality of care for patients must be the priority.