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Consensus Definition for Global Emergency Medicine
Nomenclature: With regard to nomenclature, there was a strong consensus that “global” is a better descriptor than “international.” Accordingly, two overall names were suggested and subject to repeated discussion by the group: “Global Emergency Medicine” (GEM) and “Global Emergency Care” (GEC). There was a moderate consensus for GEM over GEC, though the latter was recommended as an alternative as it aligns closely with the terminology used by the World Health Organization (WHO) and may be considered a more inclusive title in localities without a formal specialty of EM. Ultimately, the consensus was that GEM provided a stronger base for the development of emergency medicine as a global specialty, and provides strength and credence where the physician specialty is not established.
Location: There was a consensus that there is no specific geographic location in which GEM is practiced. GEM cannot be defined by the income or resource availability of the place in which it is practiced, nor by any region or established international classification scheme. Rather, GEM should be defined with respect to the individual practitioner, with GEM including practice outside one’s home practice environment. The majority felt that GEM should not encompass work done in high income and well-developed EM systems, regardless of practitioner origin.
Providers: There is a strong consensus that GEM is practiced by physicians, nurses and mid-level clinicians who have emergency care training, as well as trained prehospital responders. There was a moderate consensus that nurses, physicians, and mid-level providers without formal emergency medicine specialization and public health workers may still be engaging in the practice of GEM if in acute or emergency settings.
Content: The content subsumed within GEM is broad. There is a strong consensus that GEM encompasses the provision of clinical emergency care, the education, and assessment of this practice, and development of the systems and infrastructure necessary for practice. There is a moderate consensus that it also includes policy work explicitly relevant to the creation and improvement of emergency health systems and care delivery; the provision of disaster and humanitarian response services; and public health activities targeting the reduction of disease faced by emergency providers.
Emergency health systems themselves are inclusive of prehospital care systems and emergency care systems (eg, emergency departments). Dependent on the context, they may also include in-hospital observation systems and affiliated, essential ancillary services (such as radiology, laboratory and blood banks). Within natural disasters and complex humanitarian emergencies, there is consensus that all locations (even if high-income) are included within GEM, and that in these settings, the scope of GEM covers the acute medical and traumatic care of patients, both related to the emergency and not related to the emergency (eg, chronic disease). There was no consensus whether the care of non-acute patients in humanitarian and disaster response settings (eg, antenatal care) is included within GEM.