Intensive care medicine
Intensive care medicine, or critical care medicine, is a branch of medicine concerned with the diagnosis and management of life-threatening conditions that may require sophisticated life support and intensive monitoring. Patients requiring intensive care may require support for cardiovascular instability lethal cardiac arrhythmias, airway or respiratory compromise, acute renal failure, or the cumulative effects of multiple organ failure, more referred to now as multiple organ dysfunction syndrome, they may be admitted for intensive/invasive monitoring, such as the crucial hours after major surgery when deemed too unstable to transfer to a less intensively monitored unit. Medical studies suggest a relation between ICU volume and quality of care for mechanically ventilated patients. After adjustment for severity of illness, demographic variables, characteristics of the ICUs, higher ICU volume was associated with lower ICU and hospital mortality rates. For example, adjusted ICU mortality was 21.2% in hospitals with 87 to 150 mechanically ventilated patients annually, 14.5% in hospitals with 401 to 617 mechanically ventilated patients annually.
Hospitals with intermediate numbers of patients had outcomes between these extremes. ICU delirium and inaccurately referred to as ICU psychosis, is a syndrome common in intensive care and cardiac units where patients who are in unfamiliar, monotonous surroundings develop symptoms of delirium; this may include interpreting machine noises as human voices, seeing walls quiver, or hallucinating that someone is tapping them on the shoulder. There exists systematic reviews in which interventions of sleep promotion related outcomes in the ICU have proven impactful in the overall health of patients in the ICU. In general, it is the most expensive, technologically advanced and resource-intensive area of medical care. In the United States, estimates of the 2000 expenditure for critical care medicine ranged from US$15–55 billion. During that year, critical care medicine accounted for 0.56% of GDP, 4.2% of national health expenditure and about 13% of hospital costs. In 2011, hospital stays with ICU services accounted for just over one-quarter of all discharges but nearly one-half of aggregate total hospital charges in the United States.
The mean hospital charge was 2.5 times higher for discharges with ICU services than for those without. Intensive care takes a system-by-system approach to treatment; as such, the nine key systems are each considered on an observation-intervention-impression basis to produce a daily plan. In addition to the key systems, intensive care treatment raises other issues including psychological health, pressure points and physiotherapy, secondary infections. In alphabetical order, the nine key systems considered in the intensive care setting are: cardiovascular system, central nervous system, endocrine system, gastro-intestinal tract, integumentary system, microbiology and respiratory system. Intensive care is provided in a specialized unit of a hospital called the intensive care unit or critical care unit. Many hospitals have designated intensive care areas for certain specialities of medicine, such as the coronary intensive care unit for heart disease, medical intensive care unit, surgical intensive care unit, pediatric intensive care unit, neuroscience critical care unit, overnight intensive-recovery, shock/trauma intensive-care unit, neonatal intensive care unit, other units as dictated by the needs and available resources of each hospital.
The naming is not rigidly standardized. For a time in the early 1960s, it was not clear that specialized intensive care units were needed, so intensive care resources were brought to the room of the patient that needed the additional monitoring and resources, it became evident, that a fixed location where intensive care resources and dedicated personnel were available provided better care than ad hoc provision of intensive care services spread throughout a hospital. Common equipment in an intensive care unit includes mechanical ventilation to assist breathing through an endotracheal tube or a tracheotomy. Critical care medicine is an important medical specialty. Physicians with training in critical care medicine are referred to as intensivists. In the United States, the specialty requires additional fellowship training for physicians having completed their primary residency training in internal medicine, anesthesiology, surgery or emergency medicine. US board certification in critical care medicine is available through all five specialty boards.
Intensivists with a primary training in internal medicine sometimes pursue combined fellowship training in another subspecialty such as pulmonary medicine, infectious disease, or nephrology. The American Society of Critical Care Medicine is a well-established multiprofessional society for practitioners working in the ICU including nurses, respiratory therapists, physicians. Most medical research has demonstrated that ICU care provided by intensivists produces better outcomes and more cost-effective care; this has led the Leapfrog Group
Social work is an academic discipline and profession that concerns itself with individuals, families and communities in an effort to enhance social functioning and overall well-being. Social functioning refers to the way in which people perform their social roles, the structural institutions that are provided to sustain them. Social work applies social sciences, such as sociology, political science, public health, community development and economics, to engage with client systems, conduct assessments, develop interventions to solve social and personal problems. Social work practice is divided into micro-work, which involves working directly with individuals or small groups. Social work developed in the 19th century, with roots in voluntary philanthropy and grassroots organizing. However, the act of responding to social needs have existed long before primarily from private charities, religious organizations; the effects of the Industrial Revolution and the Great Depression placed pressure on social work to become a more defined discipline.
Social work is a broad profession. Social work organizations offer the following definitions: “Social work is a practice-based profession and an academic discipline that promotes social change and development, social cohesion, the empowerment and liberation of people. Principles of social justice, human rights, collective responsibility and respect for diversities are central to social work. Underpinned by theories of social work, social sciences and indigenous knowledge, social work engages people and structures to address life challenges and enhance wellbeing." International Federation of Social Workers "Social work is a profession concerned with helping individuals, families and communities to enhance their individual and collective well-being. It aims to help people develop their skills and their ability to use their own resources and those of the community to resolve problems. Social work is concerned with individual and personal problems but with broader social issues such as poverty and domestic violence."
- Canadian Association of Social Workers Social work practice consists of the professional application of social work values and techniques to one or more of the following ends: helping people obtain tangible services. The practice of social work requires knowledge of human behavior; this may be helping to protect vulnerable people from harm or abuse or supporting people to live independently. Social workers support people, act as advocates and direct people to the services they may require. Social workers work in multi-disciplinary teams alongside health and education professionals." - British Association of Social Workers The practice and profession of social work has a modern and scientific origin, is considered to have developed out of three strands. The first was individual casework, a strategy pioneered by the Charity Organization Society in the mid-19th century, founded by Helen Bosanquet and Octavia Hill in London, England. Most historians identify COS as the pioneering organization of the social theory that led to the emergence of social work as a professional occupation.
COS had its main focus on individual casework. The second was social administration, which included various forms of poverty relief –'relief of paupers'. Statewide poverty relief could be said to have its roots in the English Poor Laws of the 17th century, but was first systematized through the efforts of the Charity Organization Society; the third consisted of social action – rather than engaging in the resolution of immediate individual requirements, the emphasis was placed on political action working through the community and the group to improve their social conditions and thereby alleviate poverty. This approach was developed by the Settlement House Movement; this was accompanied by a less defined movement. All had their most rapid growth during the nineteenth century, laid the foundation basis for modern social work, both in theory and in practice. Professional social work originated in 19th century England, had its roots in the social and economic upheaval wrought by the Industrial Revolution, in particular the societal struggle to deal with the resultant mass urban-based poverty and its related problems.
Because poverty was the main focus of early social work, it was intricately linked with the idea of charity work. Other important historical figures that shaped the growth of the social work profession are Jane Addams, who founded the Hull House in Chicago and won the Nobel Peace Prize in 1931. Social work is an interdisciplinary profession, meaning it draws from a number of areas, s
A medical laboratory or clinical laboratory is a laboratory where clinical pathology tests are carried out on clinical specimens to obtain information about the health of a patient to aid in diagnosis and prevention of disease. Clinical Medical laboratories are an example of applied science, as opposed to research laboratories that focus on basic science, such as found in some academic institutions. Medical laboratories so offer a variety of testing services. More comprehensive services can be found in acute-care hospitals and medical centers, where 70% of clinical decisions are based on laboratory testing. Doctors offices and clinics, as well as skilled nursing and long-term care facilities, may have laboratories that provide more basic testing services. Commercial medical laboratories operate as independent businesses and provide testing, otherwise not provided in other settings due to low test volume or complexity. In hospitals and other patient-care settings, laboratory medicine is provided by the Department of Pathology, divided into two sections, each of which will be subdivided into multiple specialty areas.
The two sections are: Anatomic pathology: areas included here are histopathology and electron microscopy. Clinical pathology, which includes the following areas:Clinical Microbiology: This encompasses several different sciences, including bacteriology, parasitology and mycology. Clinical Chemistry: This area includes automated analysis of blood specimens, including tests related to enzymology and endocrinology. Hematology: This area includes manual analysis of blood cells, it often includes coagulation. Blood Bank involves the testing of blood specimens in order to provide blood transfusion and related services. Molecular diagnostics DNA testing may be done along with a subspecialty known as cytogenetics. Reproductive biology testing is available in some laboratories, including Semen analysis, Sperm bank and assisted reproductive technology. Layouts of clinical laboratories in health institutions vary from one facility to another. For instance, some health facilities have a single laboratory for the microbiology section, while others have a separate lab for each specialty area.
The following is an example of a typical breakdown of the responsibilities of each area: Microbiology includes culturing of clinical specimens, including feces, blood, cerebrospinal fluid, synovial fluid, as well as possible infected tissue. The work here is concerned with cultures, to look for suspected pathogens which, if found, are further identified based on biochemical tests. Sensitivity testing is carried out to determine whether the pathogen is sensitive or resistant to a suggested medicine. Results are reported with the identified organism and the type and amount of drug that should be prescribed for the patient. Parasitology is. For example, fecal samples may be examined for evidence of intestinal parasites such as tapeworms or hookworms. Virology is concerned with identification of viruses in specimens such as blood and cerebrospinal fluid. Hematology analyzes whole blood specimens to perform full blood counts, includes the examination of Blood films. Other specialized tests include cell counts on various bodily fluids.
Coagulation testing determines various blood clotting times, coagulation factors, platelet function. Clinical Biochemistry performs dozens of different tests on serum or plasma; these tests automated, includes quantitative testing for a wide array of substances, such as lipids, blood sugar and hormones. Toxicology is focused on testing for pharmaceutical and recreational drugs. Urine and blood samples are the common specimens. Immunology/Serology uses the process of antigen-antibody interaction as a diagnostic tool. Compatibility of transplanted organs may be determined with these methods. Immunohaematology, or Blood bank determines blood groups, performs compatibility testing on donor blood and recipients, it prepares blood components and products for transfusion. This area determines a patient's blood type and Rh status, checks for antibodies to common antigens found on red blood cells, cross matches units that are negative for the antigen. Urinalysis tests urine including microscopically. If more precise quantification of urine chemicals is required, the specimen is processed in the clinical biochemistry lab.
Histopathology processes solid tissue removed from the body for evaluation at the microscopic level. Cytopathology examines smears of cells from all over the body for evidence of inflammation and other conditions. Molecular diagnostics includes specialized tests involving DNA analysis. Cytogenetics involves using blood and other cells to produce a DNA karyotype; this can be helpful in cases of prenatal diagnosis as well as in some cancers which can be identified by the presence of abnormal chromosomes. Surgical pathology examines organs, tumors and other tissues biopsied in surgery such as breast mastectomies; the staff of clinical laboratories may include: Pathologist Clinical Biochemist Pathologists' Assistant Biomedical Scientist in the UK, Medical Laboratory Scientist in the US or Medical Laboratory Technologist in Canada Medical Laboratory Technician/Clinical Laboratory Technician Medical Laboratory Assistant Phlebotomist Histotechnologist/Histology Technician In the United States, there is a documented shortage of working laboratory professionals.
For example, in 2016 vacan
Blood is a body fluid in humans and other animals that delivers necessary substances such as nutrients and oxygen to the cells and transports metabolic waste products away from those same cells. In vertebrates, it is composed of blood cells suspended in blood plasma. Plasma, which constitutes 55% of blood fluid, is water, contains proteins, mineral ions, carbon dioxide, blood cells themselves. Albumin is the main protein in plasma, it functions to regulate the colloidal osmotic pressure of blood; the blood cells are red blood cells, white blood cells and platelets. The most abundant cells in vertebrate blood are red blood cells; these contain hemoglobin, an iron-containing protein, which facilitates oxygen transport by reversibly binding to this respiratory gas and increasing its solubility in blood. In contrast, carbon dioxide is transported extracellularly as bicarbonate ion transported in plasma. Vertebrate blood is bright red when its hemoglobin is oxygenated and dark red when it is deoxygenated.
Some animals, such as crustaceans and mollusks, use hemocyanin to carry oxygen, instead of hemoglobin. Insects and some mollusks use a fluid called hemolymph instead of blood, the difference being that hemolymph is not contained in a closed circulatory system. In most insects, this "blood" does not contain oxygen-carrying molecules such as hemoglobin because their bodies are small enough for their tracheal system to suffice for supplying oxygen. Jawed vertebrates have an adaptive immune system, based on white blood cells. White blood cells help to resist parasites. Platelets are important in the clotting of blood. Arthropods, using hemolymph, have hemocytes as part of their immune system. Blood is circulated around the body through blood vessels by the pumping action of the heart. In animals with lungs, arterial blood carries oxygen from inhaled air to the tissues of the body, venous blood carries carbon dioxide, a waste product of metabolism produced by cells, from the tissues to the lungs to be exhaled.
Medical terms related to blood begin with hemo- or hemato- from the Greek word αἷμα for "blood". In terms of anatomy and histology, blood is considered a specialized form of connective tissue, given its origin in the bones and the presence of potential molecular fibers in the form of fibrinogen. Blood performs many important functions within the body, including: Supply of oxygen to tissues Supply of nutrients such as glucose, amino acids, fatty acids Removal of waste such as carbon dioxide and lactic acid Immunological functions, including circulation of white blood cells, detection of foreign material by antibodies Coagulation, the response to a broken blood vessel, the conversion of blood from a liquid to a semisolid gel to stop bleeding Messenger functions, including the transport of hormones and the signaling of tissue damage Regulation of core body temperature Hydraulic functions Blood accounts for 7% of the human body weight, with an average density around 1060 kg/m3 close to pure water's density of 1000 kg/m3.
The average adult has a blood volume of 5 litres, composed of plasma and several kinds of cells. These blood cells consist of erythrocytes and thrombocytes. By volume, the red blood cells constitute about 45% of whole blood, the plasma about 54.3%, white cells about 0.7%. Whole blood exhibits non-Newtonian fluid dynamics. If all human hemoglobin were free in the plasma rather than being contained in RBCs, the circulatory fluid would be too viscous for the cardiovascular system to function effectively. One microliter of blood contains: 4.7 to 6.1 million, 4.2 to 5.4 million erythrocytes: Red blood cells contain the blood's hemoglobin and distribute oxygen. Mature red blood cells lack a nucleus and organelles in mammals; the red blood cells are marked by glycoproteins that define the different blood types. The proportion of blood occupied by red blood cells is referred to as the hematocrit, is about 45%; the combined surface area of all red blood cells of the human body would be 2,000 times as great as the body's exterior surface.
4,000–11,000 leukocytes: White blood cells are part of the body's immune system. The cancer of leukocytes is called leukemia. 200,000 -- 500,000 thrombocytes: Also called platelets. Fibrin from the coagulation cascade creates a mesh over the platelet plug. About 55% of blood is blood plasma, a fluid, the blood's liquid medium, which by itself is straw-yellow in color; the blood plasma volume totals of 2.7–3.0 liters in an average human. It is an aqueous solution containing 92% water, 8% blood plasma proteins, trace amounts of other materials. Plasma circulates dissolved nutrients, such as glucose, amino acids, fatty acids, removes waste products, such as carbon dioxide and lactic acid. Other important components include: Serum albumin Blood-clotting factors Immunoglobulins lipoprotein particles Various
Science, technology, engineering, and mathematics
Science, Technology and Mathematics Science, Math and Technology, is a term used to group together these academic disciplines. This term is used when addressing education policy and curriculum choices in schools to improve competitiveness in science and technology development, it has implications for national security concerns and immigration policy. The acronym came into common use shortly after an interagency meeting on science education held at the US National Science Foundation chaired by the NSF director Rita Colwell. A director from the Office of Science division of Workforce Development for Teachers and Scientists, Peter Faletra, suggested the change from the older acronym SMET to STEM. Colwell, expressing some dislike for the older acronym, responded by suggesting NSF institute the change. However, the acronym STEM predates NSF and traces its origin to Charles Vela, the founder and director of the Center for the Advancement of Hispanics in Science and Engineering Education. In the early 1990's CAHSEE started a summer program for talented under-represented students in the Washington, DC area called the STEM Institute.
Based on the program's recognized success and his expertise in STEM education, Charles Vela was asked to serve on numerous NSF and Congressional panels in science and engineering education. One of the first NSF projects to use the acronym was STEMTEC, the Science, Technology and Math Teacher Education Collaborative at the University of Massachusetts Amherst, founded in 1998. STM eSTEM STEMIE. ISTEM. STEMLE. STEMS^2. METALS, introduced by Su Su at Teachers College, Columbia University. STREM. STREM. STREAM. STEAM STEAM. STEMM AMSEE THAMES MINT In the United States, the acronym began to be used in education and immigration debates in initiatives to begin to address the perceived lack of qualified candidates for high-tech jobs, it addresses concern that the subjects are taught in isolation, instead of as an integrated curriculum. Maintaining a citizenry, well versed in the STEM fields is a key portion of the public education agenda of the United States; the acronym has been used in the immigration debate regarding access to United States work visas for immigrants who are skilled in these fields.
It has become commonplace in education discussions as a reference to the shortage of skilled workers and inadequate education in these areas. The term tends not to refer to the non-professional and less visible sectors of the fields, such as electronics assembly line work. Many organizations in the United States follow the guidelines of the National Science Foundation on what constitutes a STEM field; the NSF uses a broader definition of STEM subjects that includes subjects in the fields of chemistry and information technology science, geosciences, life sciences, mathematical sciences and astronomy, social sciences, STEM education and learning research. Eligibility for scholarship programs such as the CSM STEM Scholars Program use the NSF definition; the NSF is the only American federal agency whose mission includes support for all fields of fundamental science and engineering, except for medical sciences. Its disciplinary program areas include scholarships, fellowships in fields such as biological sciences and information science and engineering and human resources, environmental research and education, international science and engineering and physical sciences, social and economic sciences, cyberinfrastructure, polar programs.
Although many organizations in the United States follow the guidelines of the National Science Foundation on what constitutes a STEM field, the United States Department of Homeland Security has its own functional definition used for immigration policy. In 2012, DHS or ICE announced an expanded list of STEM designated-degree programs that qualify eligible graduates on student visas
Physics is the natural science that studies matter, its motion, behavior through space and time, that studies the related entities of energy and force. Physics is one of the most fundamental scientific disciplines, its main goal is to understand how the universe behaves. Physics is one of the oldest academic disciplines and, through its inclusion of astronomy the oldest. Over much of the past two millennia, chemistry and certain branches of mathematics, were a part of natural philosophy, but during the scientific revolution in the 17th century these natural sciences emerged as unique research endeavors in their own right. Physics intersects with many interdisciplinary areas of research, such as biophysics and quantum chemistry, the boundaries of physics which are not rigidly defined. New ideas in physics explain the fundamental mechanisms studied by other sciences and suggest new avenues of research in academic disciplines such as mathematics and philosophy. Advances in physics enable advances in new technologies.
For example, advances in the understanding of electromagnetism and nuclear physics led directly to the development of new products that have transformed modern-day society, such as television, domestic appliances, nuclear weapons. Astronomy is one of the oldest natural sciences. Early civilizations dating back to beyond 3000 BCE, such as the Sumerians, ancient Egyptians, the Indus Valley Civilization, had a predictive knowledge and a basic understanding of the motions of the Sun and stars; the stars and planets were worshipped, believed to represent gods. While the explanations for the observed positions of the stars were unscientific and lacking in evidence, these early observations laid the foundation for astronomy, as the stars were found to traverse great circles across the sky, which however did not explain the positions of the planets. According to Asger Aaboe, the origins of Western astronomy can be found in Mesopotamia, all Western efforts in the exact sciences are descended from late Babylonian astronomy.
Egyptian astronomers left monuments showing knowledge of the constellations and the motions of the celestial bodies, while Greek poet Homer wrote of various celestial objects in his Iliad and Odyssey. Natural philosophy has its origins in Greece during the Archaic period, when pre-Socratic philosophers like Thales rejected non-naturalistic explanations for natural phenomena and proclaimed that every event had a natural cause, they proposed ideas verified by reason and observation, many of their hypotheses proved successful in experiment. The Western Roman Empire fell in the fifth century, this resulted in a decline in intellectual pursuits in the western part of Europe. By contrast, the Eastern Roman Empire resisted the attacks from the barbarians, continued to advance various fields of learning, including physics. In the sixth century Isidore of Miletus created an important compilation of Archimedes' works that are copied in the Archimedes Palimpsest. In sixth century Europe John Philoponus, a Byzantine scholar, questioned Aristotle's teaching of physics and noting its flaws.
He introduced the theory of impetus. Aristotle's physics was not scrutinized until John Philoponus appeared, unlike Aristotle who based his physics on verbal argument, Philoponus relied on observation. On Aristotle's physics John Philoponus wrote: “But this is erroneous, our view may be corroborated by actual observation more than by any sort of verbal argument. For if you let fall from the same height two weights of which one is many times as heavy as the other, you will see that the ratio of the times required for the motion does not depend on the ratio of the weights, but that the difference in time is a small one, and so, if the difference in the weights is not considerable, that is, of one is, let us say, double the other, there will be no difference, or else an imperceptible difference, in time, though the difference in weight is by no means negligible, with one body weighing twice as much as the other”John Philoponus' criticism of Aristotelian principles of physics served as an inspiration for Galileo Galilei ten centuries during the Scientific Revolution.
Galileo cited Philoponus in his works when arguing that Aristotelian physics was flawed. In the 1300s Jean Buridan, a teacher in the faculty of arts at the University of Paris, developed the concept of impetus, it was a step toward the modern ideas of momentum. Islamic scholarship inherited Aristotelian physics from the Greeks and during the Islamic Golden Age developed it further placing emphasis on observation and a priori reasoning, developing early forms of the scientific method; the most notable innovations were in the field of optics and vision, which came from the works of many scientists like Ibn Sahl, Al-Kindi, Ibn al-Haytham, Al-Farisi and Avicenna. The most notable work was The Book of Optics, written by Ibn al-Haytham, in which he conclusively disproved the ancient Greek idea about vision, but came up with a new theory. In the book, he presented a study of the phenomenon of the camera obscura (his thousand-year-old
Emergency medicine known as accident and emergency medicine, is the medical specialty concerned with the care of illnesses or injuries requiring immediate medical attention. Emergency physicians care for undifferentiated patients of all ages; as first-line providers, their primary responsibility is to initiate resuscitation and stabilization and to start investigations and interventions to diagnose and treat illnesses in the acute phase. Emergency physicians practice in hospital emergency departments, pre-hospital settings via emergency medical services, intensive care units, but may work in primary care settings such as urgent care clinics. Sub-specializations of emergency medicine include disaster medicine, medical toxicology, critical care medicine, hyperbaric medicine, sports medicine, palliative care, or aerospace medicine. Different models for emergency medicine exist internationally. In countries following the Anglo-American model, emergency medicine was the domain of surgeons, general practitioners, other generalist physicians, but in recent decades it has become recognised as a speciality in its own right with its own training programmes and academic posts, the specialty is now a popular choice among medical students and newly qualified medical practitioners.
By contrast, in countries following the Franco-German model, the speciality does not exist and emergency medical care is instead provided directly by anesthesiologists, specialists in internal medicine, cardiologists or neurologists as appropriate. In developing countries, emergency medicine is still evolving and international emergency medicine programs offer hope of improving basic emergency care where resources are limited. Emergency Medicine is a medical specialty—a field of practice based on the knowledge and skills required for the prevention 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. The field of emergency medicine encompasses care involving the acute care of internal medical and surgical conditions.
In many modern emergency departments, emergency physicians are tasked with seeing a large number of patients, treating their illnesses and arranging for disposition—either admitting them to the hospital or releasing them after treatment as necessary. They provide episodic primary care to patients during off hours and for those who do not have primary care providers. Most patients present to emergency departments with low-acuity conditions, but a small proportion will be critically ill or injured. Therefore, the emergency physician requires a broad field of knowledge and procedural skills including surgical procedures, trauma resuscitation, advanced cardiac life support and advanced airway management, they must have some of the core skills from many medical specialities—the ability to resuscitate a patient, manage a difficult airway, suture a complex laceration, set a fractured bone or dislocated joint, treat a heart attack, manage strokes, work-up a pregnant patient with vaginal bleeding, control a patient with mania, stop a severe nosebleed, place a chest tube, conduct and interpret x-rays and ultrasounds.
This generalist approach can obviate barrier-to-care issues seen in systems without specialists in emergency medicine, where patients requiring immediate attention are instead managed from the outset by speciality doctors such as surgeons or internal physicians. However, this may lead to barriers through acute and critical care specialties disconnecting from emergency care. Emergency medicine can be distinguished from urgent care, which refers to immediate healthcare for less emergent medical issues, but there is obvious overlap and many emergency physicians work in urgent care settings. Emergency medicine includes many aspects of acute primary care, shares with family medicine the uniqueness of seeing all patients regardless of age, gender or organ system; the emergency physician workforce includes many competent physicians who trained in other specialties. Physicians specializing in emergency medicine can enter fellowships to receive credentials in subspecialties such as palliative care, critical-care medicine, medical toxicology, wilderness medicine, pediatric emergency medicine, sports medicine, disaster medicine, tactical medicine, pain medicine, pre-hospital emergency medicine, or undersea and hyperbaric medicine.
The practice of emergency medicine is quite different in rural areas where there are far fewer other specialties and healthcare resources. In these areas, family physicians with additional skills in emergency medicine staff emergency departments. Rural emergency physicians may be the only health care providers in the community, require skills that include primary care and obstetrics. Patterns vary by region. In the United States, the employment arrangement of emergency physician practices are either private, corporate, or governmental