Critical emergency medicine

The scope of CREM is broad, ranging from providing high-level clinical skills and decision making in the pre-hospital setting, through assisting in rescue work, managing life-threatening medical and surgical emergencies and participating in multidisciplinary in-hospital medical emergency teams and resuscitation teams, through to declaration of death at the site of an incident.[3] Anaesthesiologists specialised in CREM may have additional experience in organising healthcare responses to mass-casualty incidents and disasters, as well as training in management of CBRN defence, hyperbaric medicine, or organisation and coordination of emergency departments, burn centres, poison control centres, or emergency medical services.[3]

Internationally, there are two primary models of emergency medicine: the Anglo-American model, which relies on "bringing the patient to the hospital", and the Franco-German model, which operates through "bringing the hospital to the patient".[4] In the Anglo-American model, the patient is rapidly transported by non-physician providers to definitive care, typically an emergency department in a hospital. Conversely, the Franco-German approach has a physician, often an anesthesiologist, come to the patient and provide stabilizing care in the field. The patient is then triaged directly to the appropriate specialist department of a hospital.[4] As such, CREM specialists must be expert in the principles of patient transfer, often by helicopter or aeroplane as well as by land ambulance, and should exhibit appropriate knowledge, skills and attitudes for working safely in the pre-hospital setting and managing the attendant risks, and communicating with firefighters, police and rescue workers.[3]