Emergency Medicine - World Championship in Pediatric Emergency Medicine


Emergency medicine

Emergency medicine, also known as accident and emergency medicine, is the medical specialty concerned with caring for undifferentiated, unscheduled patients with illnesses or injuries requiring immediate medicalattention. In their role as first-line providers, emergency physicians are responsible for initiating resuscitation and stabilization, starting investigations and interventions to diagnose and treat illnesses in the acute phase, coordinating care with specialists, and determining disposition regarding patients' need for hospital admission, observation, or discharge. Emergency physicians generally practice in hospital emergency departmentspre-hospital settings via emergency medical services, and intensive care units, but may also work in primary care settings such as urgent care clinics.

Emergency Medicine is a medical specialty—a field of practice based on the knowledge and skills required for the prevention, diagnosis and management of acute and urgent aspects of illness and injury affecting patients of all age groups with a full spectrum of undifferentiated physical and behavioral disorders. It further encompasses an understanding of the development of pre-hospital and in-hospital emergency medical systems and the skills necessary for this development.[3]


How to Apply for World Championship in Pediatrics


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Last Date - 31st of every month

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Winner of World Championship 2018                       

Winner of World Championship 2017                         

Winner of World Championship 2016                              

Winner of World Championship 2015            

Winner of World Championship 2014    

Year                 2013 



World Championship is organized by International Agency for Standards and Ratings


Year 2018

____________________________________________________________________

 

 Dr. Ingo Schmidt from Germany is conferred with World Championship -2018 in Rheumatology (metacarpophalangeal joints) World Cup


 Lucieta Guerreiro Martorano from Brazil is conferred with World Championship - 2018 in Climate Change (Precipitation Rate) World Cup

   Dr. Brij Bhushan Tewari from Guyana is World Champion - 2018 in Applied Science (Adsorption Parameters)


  Professor Ivet B. KOLEVA from Nigeria is World Champion - 2018 in Orthopedic Rehabilitation (Knee Arthroplasty)


 Dr. Miah Muhammad Adel from USA is World Champion- 2018 in Environmental Sciences (Reservoirs) World Cup

   Professor Zhiyong Wang from China is the World Champion-2018 in Biliary Sciences

 Dr. Alexandru Trifu from Romania is World Champion - 2018 in Humanistic Sciences (Transhumance)


 Professor Elzo Alves Aranha from Brazil is World Champion- 2018 in Business Management (Entrepreneurship) World Cup


 Dr. Vincenza Bonfiglio from Italy Wins World Championship-2018 in Drug Designing (Corticosteroids)


 Professor WEI Erhu from China is World Champion-2018 in Educational Research (Courseware)


 Dr. Sujoy Ghosh from India is the World Champion-2018 in Metabolomics (Teneligliptin)


 Dr. Jesy. E.J. from India is the World Champion-2018 in Cytotoxic Activities (Gas Chromatography-Mass Spectrometry Analysis)


 Dr. Kazuhiro Esaki from Japan is World Champion-2018 in Global Quality Assessment


 Professor Santiago Nieto Martin from Spain is World Champion-2018 in Research on Education Systems (Educational Research) World Cup


    Professor Manuela Valentini, Elisa Di Massa, Giovanna Troiano and Professor Ario Federici from Italy are World Champions-2018 in Educational Research (Self-Esteem)


 Dr. Sandra Ricart Casadevall from Spain is World Champion - 2018 in Earth Science (Irrigation)


  Dr. Paulo José Menegasso and Dr. André Luis dos Santos Menezes from Brazil are World Champions - 2018 in Educational Research (Visual Impairment) World Cup


 Dr. Tatyasaheb. R Patil from India is the World Champion-2018 in Neurodegenerative Disorders (Pharmacognosy)


 Professor Maurizio Lanfranchi from Italy is World Champion - 2018 in Applied Sciences (Cumulative Proportional Odds Model)


 Dr. János Ladvánszky from Hungary wins World Championship - 2018 in Intermodulation Power (Electrical Engineering) out of 56 countries World Cup


 Dr. Udochukwu Martins Okechukwu from Nigeria is World Champion - 2018 in Climate Change (Floodplains)


 Dr. Mohanraj N Pattar from India is the World Champion-2018 in Medicinal Plants (Minerals and Trace Elements)


 Dr. Osayande Osaretin Julie from Belgium is World Champion - 2018 in Clinical Studies (Genetic Engineering ) World Cup 


World Championship is Biggest World Science Fair  



 Dr. Yasin Idweini from Jordan is conferred with World Championship -2018 in Endoscopic Treatment World Cup


 Dr. Afonin Sergey Mikhailovich from Russia is the World Champion-2018 in Physics (Electromagnetoelastic Actuators) World Cup 


 Dr. Miah Muhammad Adel from USA is World Champion - 2018 in Environmental Sciences (Water Politics) World Cup 


 Dr. Aroloye O. Numbere from Nigeria is World Champion - 2018 in Environmental Sciences (Precipitation)


 Dr. Mikhailenko Ilya Mikhailovitch from Russia is World Champion-2018 in Genetics (Genotypes and Phenotypes)


  Dr. Chinyere Ogochukwu Dike from Nigeria is World Champion - 2018 in Applied Mathematics (Ebola Virus Disease)


 Dr. Hyun Woo Kang from Korea wins World Championship - 2018 in Nutrition Research (Functional Food) World Cup

 Dr. ThukaaZuhair Abdul-Jalil from Iraq is World Champion - 2018 in Pharmacognosy (GC/MS Phytochemical Analysis)


  Dr. Bosede Oyegbile from Nigeria is World Champion - 2018 in Educational Administration


 Dr. Saiden Thondhlana from Zimbabwe is World Champion-2018 in Educational Research (Teacher and Pupil Related Conflicts)


 Dr. Karkaz Mohammed Thalij from Iraq is World Champion - 2018 in Biotechnology (Antibacterial Activity)

 Dr. Nwachukwu Williams from Nigeria is World Champion - 2018 in Soil Science (Rural Sociology)


 Dr. Sanjeev Kumar from India is the World Champion-2018 in Environmental Science (Global Warming)


 Dr. Akalonu George I. from Nigeria is World Champion - 2018 in Occupational Health (Construction)


  Dr. Tukumbi Lumumba-Kasongo from USA is World Champion-2018 in African Development (Public Administration)


 Dr. Okuyade Ighoroje Wilson Ata from Nigeria is World Champion - 2018 in Advances in Research (Bifurcating Rectangular Porous Channel)



  Dr. Jubilee Purkayastha from India is conferred with World Championship -2018 in Molecular Biology and Biotechnology World Cup



    Dr. Eke Onyebuchukwu Desmond, Dr. Chukwumobi Nkechinyere Anulika, Dr Ernest Ndukaife Anyabolu and Dr Innocent Chukwuemeka Okoye from Nigeria are World Champions - 2018 in Medical Sciences (Social Medicine) World Cup


 Dr. Gopa Saha Roy from India is World Champion - 2018 in Sports Science (Anaerobic Thresholds) World Cup



 Dr. Abosede Adebola Otemuyiwa from Nigeria is conferred with World Championship - 2018 in Semiotics World Cup


  Mrs. P. Selvavathi and Dr. R.Sophia Porchelvi from India are World Champions-2018 in Mathematical Analysis (Fuzzy Comprehensive Evaluation)

 Dr. Claudine NTSAMA MBALA spouse ESSOMBA from Cameroon is World Champion - 2018 in Parasitology (Surgical Site Infections) World Cup


 Dr. Alok Kumar Pramanik from India is World Champion - 2018 in Environment Sciences (Allopreening)


  Dr Ernest Ndukaife Anyabolu from Nigeria is World Champion - 2018 in Hypertension Research (Nephrotic Syndrome) World Cup



Dr. Vishal Saini from India is World Champion-2018 in Applied Chemistry (Thiourea)


 Dr. Belghmaidi Sarah from Morocco is the World Champion -2018 in Medical Science (Corneal Tuberculosis) World Cup


 Dr. Nanda . N from India is the World Champion-2018 in Applied Chemistry (Diazepam)

 Mr. Daniel Anini Baah from Ghana is World Champion - 2018 in Bioremediation


 Dr. T. Govindan from India is the World Champion-2018 in Mangrove Conservation (Mass Propagation)


 Dr. Yasin Idweini from Jordan is conferred with World Championship -2018 in Urology (Electrocoagulation) World Cup



World Championship is popularly known as World Science Festival in Europe and Asia


 Professor Gerelmaa Damba from Mongolia is World Champion - 2018 in Business Management (Labor Market Flexibility) World Cup


 Dr. Komi Apélété AMOU from Togo is World Champion -2018 in Sustainable Energy (Solar Radiation Maps) World Cup


Dr. Venkatesh Dore from India is world Champion-2018 in Crop Physiology (Rice Genotypes)


 Dr. Félix Fofana N'ZUÉ from Côte d’Ivoire is conferred with World Championship - 2018 in International Finance (Gross Domestic Product Ratio) World Cup


 Dr. AMEY Kossi Bollanigni from Togo is World Champion -2018 in Civil Engineering (Silty Sands)


 Dr. Zheng-Chuan Wang from China Wins World Championship -2018 in Physics (Spintronics) World Cup


  Professor Souaïbou FAROUGOU and Dr. SESSOU Philippe are winner of World Championship-2018 in Food Preservation World Cup


 Dr. Ballagere Puttaraju Harini from India is conferred with World Championship - 2018 in Biodiversity (Molecular Genetics) World Cup


 Dr. Nilfer Sahin from Turkey is World Champion-2018 in Biomedicine World Cup 


 Dr. Kavit S. Mehta from India is World Champion - 2018 in Microbiological Research (Ethnomedicine) World Cup


 Tri Aru Wiratno from Indonesia is World Champion-2018 in Educational Research (Social Culture Reality) World Cup


Sek. Men. Keb. Pendeta Zaaba, Negeri Sembilan Sek. Men. Keb. Tunku Ampuan Durah, Negeri Sembilan IIUM, Kuantan Campus UNITAR, Kelana Jaya IIUM, Kuantan Campus ICCE, IIUM, Gombak Campus Dr. Saadi bin Ahmad Kamaruddin from Malaysia is conferred with National Championship-2018 in Electrical Engineering (Evolutionary Algorithms) World Cup


 Dr. Bernard Omwoyo Moenga from Kenya is conferred with World Championship - 2018 in Participatory Epidemiology World Cup


 Dr. N.D. Zargar from India wins World Championship - 2018 in Organic Chemistry (Organic Synthesis) World Cup



 Dr. Fayaz Ahmad Sofi from India is conferred with World Championship-2018 in Rheumatology (Molecular Biology) World Cup


Dr. Dickson Adom from Ghana is conferred with World Championship-2018 in Agricultural Research (Ecosystem Conservation) World Cup




 Dr. Kenichi Meguro from Japan is conferred with World Championship-2018 in Geriatric Behavioral Neurology World Cup



  Dr. Jack Uzezi Gladys from Nigeria is conferred with World Championship - 2018 in Educational Research (Peer Group Activities) World Cup


  Dr. Mitra Akbari and Ramin Elmi from Iran are conferred with World Championship -2018 in Medical Science (Immunology) World Cup


Dr. Aaron TetteyAsare from Ghana is conferred with World Championship-2018 in Plant Breeding World Cup


 Kraleti Lakshmi Yaso Tejaswini from India is World Champion-2018 in Agriculture Sciences (Correlation) World Cup


  Dr Badade Zunjarrao Ganpat from India is conferred with World Championship-2018 in Biochemistry (Oxidative Stress) World Cup


 Shah Imran Ahmed from Bangladesh is conferred with World Championship - 2018 in Sociology and Anthropology (Parenthood) World Cup


 Dr. Eng. Satoshi TAKEI from Japan is conferred with World Championship-2018 in Nanotechnology World Cup


  Dr. Nayareen Akhtar, Dr. Rezwanur Rahman from Bangladesh are World Champion-2018 in Urinary Tract Infections (Microbiological Research)


 Dr. F.Özge MAVİŞ SEVİM from Turkey is World Champion- 2018 in Education (Corrective Feedback) World Cup


 Dr. Maryam Hassana Ati from Nigeria is conferred with World Championship-2018 in Morphology (Crop Production) World Cup


 Dr. Melike Elif Teker from Turkey is World Champion - 2018 in Aortic Coarctation World Cup


  Dr G. Sreenivasan from India is conferred with World Championship-2018 in Electrical Engineering (Power Quality) World Cup


 Dr. Ekaette Emenike Iroegbu is World Champion - 2018 in Teleconferencing (Educational Research) World Cup


 Dr. Rustam Effendi-YS from Indonesia is conferred with World Championship-2018 in Colorectal Cancer (Molecular Biology) World Cup


Dr. Shashi Khare from India is conferred with World Championship-2018 in Microbiology (Drug Resistance) World Cup 


 Dr. Justin R. Nayagam from India is conferred with World Championship-2018 in Agricultural Science (Plant Biotechnology) World Cup  


  Dr. Daferighe Emmanuel Emeakponuzo from Nigeria is World Champion - 2018 in Corporate Governance (Environmental Accounting)


 Dr. Manoj Gupta from Singapore is conferred with World Championship-2018 in Biomedical Science World 

Cup


 Dr. Peter SIYAN from Nigeria is the World Champion-2018 in Business Management (Infrastructure Development) World Cup 


Dr. Bakulranjan Jana from India is conferred with World Championship-2018 in Agricultural Science (Physico –chemical Characters) World Cup


 Dr. Sanit Srikoon from Thailand is conferred with World Championship-2018 in Learning World Cup 


 Ramadhani Amri Mpasiwakomu from Tanzania is World Champion-2018 in Wild Medicinal Plants World Cup 


 Dr. Jonathan Edward Tetteh Kuwornu-Adjaottor from Ghana is the World Champion -2018 in Social Sciences (Employability Skills) World Cup 


 Mandava Hemalatha from India is the World Champion-2018 in Social Science (Alzheimer’s Patients)


 Dr. Ogugua N. Okonkwo from Nigeria is World Champion - 2018 in Ophthalmology (Macular Hole)


 Prof Swapna Chaudhuri from India is conferred with World Championship -2018 in Oncology (Molecular Immunology) World Cup 


 Dr. Justina Ifeoma Ofuebe from Nigeria is World Champion-2018 in Yoga (Educational Research) World Cup 

Mr. Mohammedsaeed Ganjoor from Iran is conferred with World Championship-2018 in Genetics (Aquaculture) World Cup


 Dr. Abdulrahman Yusuf Maigida from Nigeria is World Champion - 2018 in Educational Research (Contemporary Islamic Education)


 Dr. Yasuko Fukaya from Japan is conferred with World Championship -2018 in Nursing (Clinical Communication) World Cup 


 Dr. NAMO Otsanjugu Timothy Aku from Nigeria is World Champion - 2018 in Crop Science (Zea mays Flowering)


 Prof. Dr. B.M. Patil from India is conferred with World Championship -2018 in Proteomics (Mutation) World Cup 


 Dr. Kaywood E. Leizou from Nigeria is World Champion - 2018 in Chemical Science (Metal Speciation in Sediment)


  Prof., MD Tarık Kıvrak from Turkey is conferred with World Championship -2018 in Cardiology (Pulmonary Atherosclerosis) World Cup


 Dr. K. Suseela from India is World Champion-2018 in Agriculture (Dryland): World Cup


 Dr. Udoaka Otobong Gabriel from Nigeria is World Champion - 2018 in Translational Hull (Mathematics) 


   Dr. Kasturi Ghosh from India is the World Champion-2018 in Agronomy (Date of sowing)


 Dr. Olubanjo Olutola Obafemi from Nigeria is World Champion - 2018 in Environmental Engineering (Yield of Crops)


Dr. Diouf cheikh from Senegal is conferred with World Championship-2018 in Surgery (Laparoscopy) World Cup  


 Dr. Charles E. Anyanechi from Nigeria is World Champion-2018 in Health Sciences (Chronic Periodontitis)


 Dr. Seghosime, Animetuo from Nigeria is World Champion - 2018 in Environmental Science (Phytochemical Screening)


Dr. (Ms) Swapnali Hazarika from India is conferred with World Championship-2018 in Membrane Science World Cup 


  Dr. Daniel Enyinnaya Azunna from Nigeria is World Champion - 2018 in Earth Science (Mineral prospecting)


 Dr. Ram Lakhan Ram from India is the World Champion-2018 in Applied Science (Sericulture)


Dr. Ubogu Monday from Nigeria is conferred with World Championship-2018 in Biological Science World Cup 


 Dr. Iquo Bassey Otu-Bassey from Nigeria is World Champion - 2018 in Hematology (Hemoglobin)



 Dr. Halima Zugher Hussein from Iraq is conferred with World Championship -2018 in Agriculture (Detoxification) World Cup 


  Dr. Ekwumemgbo, Patricia Adamma from Nigeria is World Champion - 2018 in Chemical Science (Fractionation)



 Dr. Kendre Govind Manikrao from India is conferred with World Championship-2018 in Pediatrics (Antiretroviral Therapy) World Cup


_______________________________


Work patterns

Patterns vary by country and region. In the United States, the employment arrangement of emergency physician practices are either private (with a co-operative group of doctors staffing an emergency department under contract), institutional (physicians with an independent contractor relationship with the hospital), corporate (physicians with an independent contractor relationship with a third-party staffing company that services multiple emergency departments), or governmental (for example, when working within personal service military services, public health services, veterans' benefit systems or other government agencies).

In the United Kingdom, all consultants in emergency medicine work in the National Health Service and there is little scope for private emergency practice. In other countries like Australia, New Zealand or Turkey, emergency medicine specialists are almost always salaried employees of government health departments and work in public hospitals, with pockets of employment in private or non-government aeromedical rescue or transport services, as well as some private hospitals with emergency departments; they may be supplemented or backed by non-specialist medical officers, and visiting general practitioners. Rural emergency departments may be headed by general practitioners alone, sometimes with non-specialist qualifications in emergency medicine.


Financing and practice organization

Reimbursement

Many hospitals and care centers feature departments of emergency medicine, where patients can receive acute care without an appointment.[16] While many patients are treated for life-threatening injuries, others utilize the emergency department (ED) for non-urgent reasons such as headaches or a cold. (defined as “visits for conditions for which a delay of several hours would not increase the likelihood of an adverse outcome”).[17] As such, EDs can adjust staffing ratios and designate an area of the department for faster patient turnover to accommodate a variety of patient needs and volumes. Policies have been developed to better assist ED staff(such as Emergency Medical Techniciansparamedics, and mid level providers such as nurse practitioners and physicians assistants) direct patients towards more appropriate medical settings, such as their primary care physician, urgent care clinics or detoxification facilities.[18] The emergency department, along with welfare programs and healthcare clinics, serves as a critical part of the healthcare safety net for patients who are uninsured, cannot afford medical treatment or do not understand how to properly utilize their coverage.[19]


Compensation

Emergency physicians are compensated at a higher rate in comparison to some other specialities, ranking 10th out of 26 physician specialties in 2015, at an average salary of $306,000 annually.[20] They are compensated in the mid-range (averaging $13,000 annually) for non-patient activities, such as speaking engagements or acting as an expert witness; they also saw a 12% increase in salary from 2014 – 2015 (which was not out of line with many other physician specialties that year).[21] While emergency physicians work 8–12 hour shifts and do not tend to work on-call, the high level of stress and need for strong diagnostic and triage capabilities for the undifferentiated, acute patient contributes to arguments justifying higher salaries for these physicians.[22] Emergency care must be available every hour of every day, and requires a doctor to be available on site 24/7, unlike an outpatient clinic or some other hospital departments that have more limited hours, and may only call a physician in when needed.[23] The necessity to have a physician on staff along with all other diagnostic services available every hour of every day is thus a costly arrangement for hospitals.[24]


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How to publish Books in Pediatrics-

Proposed books can be sent at combinationphoton@gmail.com for publication. Make sure, Books must have UBN (Universal Book Number), when you are publishing them. 

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UBN is a unique identification number for a bookUniversal Book Number is recognized globally and catalyzes the sale of book to bookstores and libraries. UBN allows scientifically management of books and their discoverability at global level. Universal Book Number eliminates the ambiguity in identification of books. While numerous book titles, published by different publishers may have same titles across the world, it creates huge confusion among readers. UBN serves here as a great tool to correctly identify a book. UBN should be printed on cover page of book at any 4 corners. 

 

Innovative medical devices are registered for World Academic Championship for recognition of excellent discoveries in medical science. According to IASR, (STANDARD AGENCY), Manufacturers are encouraged by World Academic Championship if their products, equipment, kits, reagents, or devices have advanced the healthcare system. Recent advancements in public health could be discovered because of World Academic Championship. As a result we see product improvement, innovations and new technologies serving in healthcare industry. Thanks to World Academic Championship, best medical devices can be recognized now easily. It helps medical practitioners and clinicians to purchase best medical devices. WHO estimates there are more than 10 000 types of medical devices available. The selection of appropriate medical equipment always depends on local, regional or national requirements; factors to consider purchase include the type of health facility where the devices are to be used, whether it is approved by IASR: INTERNATIONAL AGENCY FOR STANDARDS AND RATINGS Always ensure the medical device are certified by International Agency for Standards and Ratings, before you purchase them for your hospitals and clinics for best service to patients.

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How to Start a New Journal in Emergency Medicine

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Payment Systems

American health payment systems are undergoing significant reform efforts,[25] which include compensating emergency physicians through “Pay for Performance” incentives and penalty measures under commercial and public health programs, including Medicare and Medicaid. This payment reform aims to improve quality of care and control costs, despite the differing opinions on the existing evidence to show that this payment approach is effective in emergency medicine.[26]Initially, these incentives were only targeted toward primary care providers (PCPs), but some would argue emergency medicine is primary care, as no one refers patients to the ED.[27][26] In one such program, two specific conditions listed were directly tied to patients frequently seen by emergency medical providers: acute myocardial infarction and pneumonia.[28](See: Hospital Quality Incentive Demonstration.)

There are some challenges with implementing these quality-based incentives in emergency medicine in that patients are often not given a definitive diagnosis in the ED, making it difficult to allocate payments through. Additionally, adjustments based on patient risk-level and multiple co-morbidities for complex patients further complicate attribution of positive or negative health outcomes, and it is difficult to assess whether much of the costs are a direct result of the emergent condition being treated in acute care settings.[29] It is also difficult to quantify the savings due to preventive care during emergency treatment (i.e. workup, stabilizing treatments, coordination of care and discharge, rather than a hospital admission). Thus, ED providers tend to support a modified fee-for-service model over other payment systems.[30]

Overutilization


Some patients without health insurance utilize EDs as their primary form of medical care. Because these patients do not utilize insurance or primary care, emergency medical providers often face problems of overutilization and financial loss, especially since many patients are unable to pay for their care (see below). ED overuse produces $38 billion in wasteful spending each year (i.e. care delivery and coordination failures, over-treatment, administrative complexity, pricing failures, and fraud),[31][32] and unnecessarily drains departmental resources, reducing the quality of care across all patients. While overuse is not limited to the uninsured, the uninsured comprise a growing proportion of non-urgent ED visits[33] – insurance coverage can help mitigate overutilization by improving access to alternative forms of care and lowering the need for emergency visits.[19][34] A common misconception pegs frequent ED visitors as a major factor in wasteful spending. However, frequent ED users make up a small portion of those contributing to overutilization and are often insured.[35]

Uncompensated care

Injury and illness are often unforeseen, and patients of lower socioeconomic status are especially susceptible to being suddenly burdened with the cost of a necessary ED visit. If they are unable to pay for the care they received, then the hospital (which under the Emergency Medical Treatment and Active Labor Act (EMTALA), as discussed below, is obligated to treat emergency conditions regardless of ability to pay) faces an economic loss for this uncompensated care.[36] Fifty-five percent of emergency care is uncompensated,[37][38] and inadequate reimbursement has led to the closure of many EDs.[39]Policy changes (such as the Affordable Care Act) designed to decrease the number of uninsured people have been projected to drastically lower the amount of uncompensated care.[40]

In addition to decreasing the uninsured rate, ED overutilization might be mitigated by improving patient access to primary care and increasing patient flow to alternative care centers for non-life-threatening injuries. Financial disincentives, patient education, as well as improved management for patients with chronic diseases can also reduce overutilization and help to manage costs of care.[31] Moreover, physician knowledge of prices for treatment and analyses, discussions on costs with their patients, as well as a changing culture away from defensive medicine can improve cost-effective use.[41][42] A transition towards more value-based care in the ED is an avenue by which providers can contain costs.

EMTALA

Doctors that work in the EDs of hospitals receiving Medicare funding are subject to the provisions of EMTALA.[43] EMTALA was enacted by the US Congress in 1986 to curtail “patient dumping,” a practice whereby patients were refused medical care for economic or other non-medical reasons.[44] Since its enactment, ED visits have substantially increased, with one study showing a rise in visits of 26% (which is more than double the increase in population over the same period of time).[45]While more individuals are receiving care, a lack of funding and ED overcrowding may be impacting quality.[45] To comply with the provisions of EMTALA, hospitals, through their ED physicians, must provide a medical screening and stabilize the emergency medical conditions of anyone that presents themselves at a hospital ED with patient capacity.[44] If these services are not provided, EMTALA holds both the hospital and the responsible ED physician liable for civil penalties of up to $50,000 each.[43] While both the Office of Inspector General, U.S. Department of Health and Human Services (OIG) and private citizens can bring an action under EMTALA, courts have uniformly held that ED physicians can only be held liable if the case is prosecuted by OIG (whereas hospitals are subject to penalties regardless of who brings the suit).[46][47][48]Additionally, the Center for Medicare and Medicaid Services (CMS) can discontinue provider status under Medicare for physicians that do not comply with EMTALA.[44] Liability also extends to on-call physicians that fail to respond to an ED request to come to the hospital to provide service.[43][49] While the goals of EMTALA are laudable, commentators have noted that it appears to have created a substantial unfunded burden on the resources of hospitals and emergency physicians.[45][50] As a result of financial difficulty, between the period of 1991–2011, 12.6% of EDs in the US closed.[45]

 

To win World Championship in Medical Devices, registration should be done in following format

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Care Delivery in Different ED Settings

Rural

Despite the practice emerging over the past few decades, the delivery of emergency medicine has significantly increased and evolved across diverse settings as it relates to cost, provider availability and overall usage. Prior to the Affordable Care Act (ACA), emergency medicine was leveraged primarily by “uninsured or underinsured patients, women, children, and minorities, all of whom frequently face barriers to accessing primary care”.[51] While this still exists today to an extent as mentioned above, it is critical to consider the location in which care is delivered to understand the population and system challenges related to overutilization and high cost. In rural communities where provider and ambulatory facility shortages exist, a primary care physician (PCP) in the ED with general knowledge is likely to be the only source of health care for a population, as specialists and other health resources are generally unavailable due to lack of funding and desire to serve in these areas.[52] Unfortunately as a result, the incidence of complex co-morbidities not managed by the appropriate provider results in worse health outcomes and eventually costlier care that extends beyond rural communities. Though typically quite separated, it is crucial that PCPs in rural areas partner with larger health systems to comprehensively address the complex needs of their community, improve population health, and implement strategies such as telemedicine to positively impact health outcomes and reduce ED utilization for preventative illnesses.[53][54] (See: Rural health.)


Urban

Alternatively, emergency medicine in urban areas consists of diverse provider groups including PCPs, nurse practitioners, physicians, and registered nurses who coordinate with specialists in both inpatient and outpatient facilities to address patients’ needs, more specifically in the ED. For all systems regardless of funding source, EMTALA mandates EDs to conduct a medical examination for anyone that presents at the department, irrespective of paying ability.[55] Fortunately, non-profit hospitals and health systems – as required by the ACA – must provide a certain threshold of charity care “by actively ensuring that those who qualify for financial assistance get it, by charging reasonable rates to uninsured patients and by avoiding extraordinary collection practices”.[56] While there are limitations, this mandate provides support to many in need. That said, despite policy efforts and increased funding and federal reimbursement in urban areas, the triple aim (of improving patient experience, enhancing population health, and reducing the per-capita cost of care) remains a challenge without providers' and payers' collaboration to increase access to preventive care and decrease in ED usage. As a result, many experts support the notion that emergency medical services should serve only immediate risks in both urban and rural areas.




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Treatments

Emergency Medicine is a primary, or first-contact point of care for patients requiring the use of the health care system.[68]Specialists in Emergency Medicine are required to possess specialist skills in acute illness diagnosis and resuscitation.[69]Emergency physician are responsible for providing immediate recognition, evaluation, care, stabilization, to adult and pediatric patients in response to acute illness and injury.[70]

Training

There are a variety of international models for emergency medicine training. Among those with well developed training programs there are two different models: a "specialist" model or "a multidisciplinary model". Additionally, in some countries the emergency medicine specialist rides in the ambulance. For example, in France and Germany the physician, often an anesthesiologist, rides in the ambulance and provides stabilizing care at the scene. The patient is then triaged to the appropriate department of a hospital, so emergency care is much more multidisciplinary than in the Anglo-American model.

In countries such as the US, the United Kingdom, Canada and Australia, ambulances crewed by paramedics and emergency medical technicians respond to out-of-hospital emergencies and transport patients to emergency departments, meaning there is more dependence on these health-care providers and there is more dependence on paramedics and EMTs for on-scene care. Emergency physicians are therefore more "specialists", since all patients are taken to the emergency department. Most developing countries follow the Anglo-American model: 3 or 4 year independent residency training programs in emergency medicine are the gold standard. Some countries develop training programs based on a primary care foundation with additional emergency medicine training. In developing countries, there is an awareness that Western models may not be applicable and may not be the best use of limited health care resources. For example, specialty training and pre-hospital care like that in developed countries is too expensive and impractical for use in many developing countries with limited health care resources. International emergency medicine provides an important global perspective and hope for improvement in these areas.


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