Emergency medicine in Scandinavia - an outstanding opportunity for research

It was not long ago that emergency medicine (EM) was only something for the rest of the world. Emergency patients in the Scandinavian countries were still being handled by young and poorly trained doctors from many specialties and no doctor tended especially to the undiagnosed patient in the emergency department (ED). The work environment was hostile, and the nurses had to make do with temporary physicians who did nothing to improve it. In Norway doctors from different specialities ran the ED, in Denmark it more or less was managed by the orthopaedic surgeons and in Sweden general surgeons were often in charge, but few doctors really took ownership of the ED. However, in 1999 the Swedish Society for Emergency Medicine (SWESEM) was established and things started to change. The Danish Society for Emergency Medicine (DASEM) was established in 2006 and the work to improve the care of emergency patients began. Finland also has a society but no speciality, whereas in Norway there seem to be no plans to establish EM as a specialty. Sweden is the country that has now come the longest way in implementing emergency medicine and Denmark is following close behind. In Sweden, the EDs are now starting to be populated by designated doctors working only there, and specialists in EM are increasing. In Denmark the National Board of Health has recently proposed major changes in the organisation of the entire emergency care system. This will lead to a completely new way of organising the EDs and admission units at most hospitals in Denmark. As EM is still in its infancy in our region of the world, there is an outstanding opportunity for conducting research. Now, before changes are implemented in all EDs, is the chance to design before versus after studies, and several important fields of research are opening up. First, we believe the implementation of EM as a specialty is a good idea, but we basically don’ tk now if this is true. Evidence-Based Medicine is now the universal credo for all specialties, but no physician speciality in medicine was originally established based on solid evidence. Nor will this be the case for EM, but we now have ar are chance to test whether EM as as peciality and a higher level of competence in the ED makes a difference. There is evidence from previous studies that emergency physicians are at least as competent as their