International Emergency Medicine

The rapid global development of emergency medicine (EM) is here and now. One can hardly pick up an EM journal without seeing some article discussing development, research, or practice in varied countries. Our experiences at the special interest sections of EM professional societies in the United States clearly indicate that a growing number of United States–based emergency physicians have a keen interest in the global arena. We marvel at the exponential growth of the specialty globally and ponder how our specialty will best serve different populations in different environments facing many difficult socioeconomic challenges. Our challenge as Guest Editors of this issue of the Emergency Medicine Clinics of North America has been to present a detailed, albeit not comprehensive, review of the topic of global development of EM touching on the key components of this phenomenon. Articles treating various aspects of emergency health care around the world are scattered throughout the medical literature; hopefully this issue will serve to pull together this diverse body of literature and expand on key concepts.

The domain of EM as we understand it in its broadest sense is rapidly developing around the world. In the mid-1990s one could quickly list the countries with any organized medical specialty group in EM. Global changes during the past decade have resulted in an “explosion” of interest in EM as a distinct medical specialty. Increasing awareness of the specialty, international and transnational professional collaboration, epidemiologic shifting of the burden of disease, disasters, bioterrorism, and complex humanitarian crises have all helped create global interest in acute care medicine as a vital component of the World Health Organization primary health care agenda. In concert with this growing awareness is the recognition that optimally managing acute illnesses requires a specialized set of knowledge and expertise.

Depending on each author's preference and the topic under discussion, the terms “global” and “international” are both used throughout this issue. The term “international” is seen by some as limiting conceptually, with the term “global” seeming more helpful. “Global” health carries with it the implications that health factors do not respect the artificial constructs of national boundaries [1]. Although we all strive for truly global recognition and development of organized, high-quality emergency services manifest as the medical specialty of EM, this remains our challenge and our advocacy and not our reality as long as open access to such services eludes poorer populations.

This issue of the Emergency Medicine Clinics of North America is directed to United States physicians with an interest in global emergency health care and the development of our specialty well beyond United States borders. We intentionally did this not to appear United States–centric or to assert that our emergency system is best but to create a document that will be useful for United States–based emergency health care workers with a budding interest in EM development who might be wondering, as many of the authors once were: “What's out there?” “Who are the known players?” “How do I get involved?” “Where is the door of entry?”

We have chosen a set of article topics and authors to ensure that key areas would be covered and that we could capitalize on the collective experiences of many of the United States EM physicians who have spent significant amounts of their time involved with EM development around the world. The personal experiences they have lived served to enrich their reviews of these topics.

We hope this issue will function as a useful document summarizing key concepts and components of global EM development. More importantly, we hope this issue motivates the novice and serves as both a “primer” and springboard for the many health care personnel interested in becoming involved in global emergency health services and EM development. We hope we will have the honor of meeting you on this very worthwhile journey.

We have been excited by the enthusiastic response of our many colleagues and students who are interested in this timely topic. We want to thank all of our contributors who shared their experiences and thoughts on key topics in global EM development. We collectively hope that we have met the challenge of maintaining and increasing the excitement expressed to us. We also want to thank the staff at Elsevier for their enthusiastic support of this publication. A special thanks to Karen Sorensen, our Editor, who not only provided ongoing support but who truly believes in the importance of these issues. We encourage the reader to remember that all of us, even those with limited time and resources, can advance the global development of emergency medicine.