A Public Health Approach to Emergency Medicine: Preparing for the Twenty‐first Century

Abstract

This paper focuses on the implications of an inadequate public health/preventive health care system for emergency medicine (EM), the role that EM providers can play in remedying critical health problems, and the benefits gained from a public health approach to EM. A broad definition of public health is adopted, suggesting shared goals of public health and EM. Critical problems posed for EM include alcohol, tobacco, and other drug abuse; injury; violence; sexually transmitted diseases and human immunodeficiency virus (HIV) infection occupational and environmental exposures; and the unmet health needs of minorities and women. A blueprint for future merging of public health issues with EM is presented that includes the application of public health principles to 1) clinical practice; 2) public education, community involvement, and public policy advocacy; 3) development of medical school and residency public health/prevention curricula and teaching methods; and 4) research opportunities and surveillance. Finally, recommendations are proposed that require restructuring the present health care system to provide resources, incentives, and organizational changes that promote an integration of public health and preventive services in the practice of EM.

Public Health Considerations in Knowledge Translation in the Emergency Department

“…Numerous investigators have published ''calls to action'' for ED-based screening, counseling, and intervention. 1,6,7 Yet, prevention and health behavior are relatively underrepresented in the amount of time they receive in the core curriculum of EM. 11 Smoking, for example, the leading cause of preventable death and illness, is not formally represented in the core curriculum, and only 7% of all U.S. EM residencies cover the topic.…”

“…''Public health'' is a broad term that encompasses a diverse array of activities. Emergency care personnel, who have been interested in public health-related initiatives for years, 1 have four domains with which to interact with public health officers: ''surveillance of diseases, injuries, and health risks; monitoring health care access; delivering clinical preventive services; and developing policies to protect and improve the public's health.'' 2 Because the first, second, and fourth domains are generally the province of public sector agencies, we will focus on the knowledge translation (KT) activities needed to enhance the delivery of clinical preventive and screening services in the ED.…”

Climate Change and Emergency Medicine: Impacts and Opportunities

“…127,128 Many leaders at the CDC and other agencies that coordinate disaster response are EM trained, and although the entire specialty is called upon to serve in times of disasters and severe resource constraints, these leaders help bridge the gap between clinical and public health concerns. EM clinicians also play a role in public health activities in EDs, including surveillance and outreach.…”

Public Health Education for Emergency Medicine Residents

“…1,2 Emergency departments have proved to be effective settings for disease surveillance and for a variety of screening and intervention programs for conditions such as HIV, falls, suicide, intimate partner violence, tobacco addiction, alcohol and drug abuse, chronic disease and injury [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] . These public health-relevant activities, surveillance, screening, and intervention, were the subject of a 2009 conference convened by emergency physicians for emergency physicians, policymakers, and educators.…”