Emergency Medicine in The Netherlands

Amongst the best medical care providers in the world, it might come as a surprise to learn emergency medicine in The Netherlands is still very much in evolution

In fact, as a medical speciality, emergency medicine does not exist. But what might strike some as an unusual situation, in no way exempts Dutch emergency staff from facing many of the usual challenges faced by emergency departments.

This situation in The Netherlands does go some way to explain why patient flow is not, to date, an overwhelming issue. Dr Terry Mulligan is employed to build an emergency department (ED) at the University Medical Center, Utrecht. He says that ED overcrowding will come as emergency medicine is established in the country.

"Part of the reason we don’t have ED crowding is they do here what advanced emergency systems used to do decades ago – which was see and admit the patient, and do the work up on the ward. That’s good for emergency staff because the patient is admitted but not for the patient because the attention to acuity, urgency and quick evaluation is somewhat dampened. But, as we build emergency medicine here, ED crowding will follow."

Dr Mulligan believes training usually teaches doctors and nursing staff how to practice emergency medicine but not how to build an emergency department. That requires special training and ED-to-ED staff and hospital-to-hospital information exchanges.

"Results from experiments have shown that focusing on secondary development is important, such as administration, management, finance. But tertiary development should also be involved and that would include participation on a national level – from policy makers. Each of these three areas must be involved for a system to be successful."

Dr Mulligan also believes EDs must be prepared to adapt acute care facilities to meet other changes rapidly occurring in emergency department medicine and because of these changes, emergency medicine must be given greater recognition.

"Emergency medicine will attract greater attention in the coming years. Where once primary care, infectious diseases, public health concerns like immunisation were some of the main reasons for people to attend an ED, these will change. All public health predictors estimate than in the next 15-20 years, non-communicable diseases will overwhelm healthcare systems. Already the top four killers in the world are trauma, cancer, heart disease and stroke."

He points out that in some countries, emergency medicine does not receive deserved recognition, while in others it has emerged as the missing speciality. A speciality well needed to face the challenges of the future.