Dev’t of EM in HK
Development of Emergency Medicine in Hong Kong
Few hospitals in Hong Kong had dedicated emergency rooms prior to the Second World War, and Casualty as a concept received its baptism of fire during the Battle of Hong Kong. The first casualty unit was established at Queen Mary Hospital in 1947 after the Pacific War. The main function of casualty then was to treat accident and police cases. Professor David Todd recalled in the Foreword of the inaugural issue of the Hong Kong Journal of Emergency Medicine that in 1952, house officers (interns) were on duty at the Casualty Department, Queen Mary Hospital from 8:00 p.m. to 8:00 a.m.about once a week.
As more hospitals were built to cater for the need of the growing population, due to the large influx of refugees from China, more casualty units came into existence in the sixties. In the early years, casualty units were staffed mainly by junior doctors, many of them fresh graduates, as a stepping stone before embarking on training to become a specialist in another branch of medicine. There was usually one senior medical officer, who may be only working part time, to oversee the administration of the department. Supervision on the job was minimal and organised teaching for junior staff was lacking. Over the years, ‘Casualty’ became a happy sojourn for junior doctors and haven for doctors who had no aspiration for specialist training. Things were changing in the United Kingdom after the Platt report in 1962 but the changes came to Hong Kong much later.
In 1983, Casualty Departments were renamed “Accident and Emergency Department” which is more reflective of its roles and functions. In the early eighties, Consultants appointed were mainly senior doctors with surgical training. A clear career path in Emergency Medicine was ushered in by the introduction of a Fellowship Examination on Accident and Emergency Medicine by the Royal College of Surgeons of Edinburgh in 1982. In 1984, one local doctor passed the examination and was elected Fellow of the Royal College of Surgeons of Edinburgh in Accident& Emergency Medicine. From then on, doctors who aspired to become a specialist in Emergency Medicine could choose to go through the training requirement and sit for the Fellowship examination in Edinburgh. Meanwhile, more doctors with an internal medicine background were attracted to specialise in this young and growing specialty as more senior posts were created.
The birth of the specialty was signified by the formation of the Hong Kong Society for Emergency Medicine and Surgery in 1985. The Society is pivotal in the promotion of training and education in the field of Emergency Medicine. We all recognise the importance of proper training and education for junior staff. However, the shift nature of work in Accident & Emergency Department and the huge service demand have been obstacles in the organisation of training activities. Despite these difficulties, the Society has established a framework for continuing medical education for doctors in the specialty.
The Society has also contributed to the teaching of junior doctors by publishing training manuals. So far, four manuals and one handbook have been published: Core Manual for Training in Emergency Medicine, Emergency Procedure Manual, Emergency Drug Manual & Handbook,Emergency Diagnostic Test Manual. A CD-ROM version of the manuals was made available in 2000.
The Society started a mini-journal, the Emergi-news, in 1990 and it has matured into the Hong Kong Journal of Emergency Medicine in 1994. It has become the official journal of the College since 1997.
These training and educational activities include:
- Quarterly Scientific Meeting
- Bimonthly Inter-hospital Clinical Conference
- Bimonthly Recent Advances Seminar
- Induction Course for new A&E doctors in July
- Certificate Course in A&E Nursing in collaboration with Government Nursing Officer
Association since 1988
- Basic & Advanced Cardiac Life Support Course since 1991 in collaboration with the Justice Institute of British Columbia, Canada
- Cardiac Arrest Management Course since 1993
- CPR-AED(Automated External Defibrillation) Course since 1993
- Certificate Course in Wound Management and Suturing since 1992
- Workshops for emergency procedures since 1994
- Basic Trauma Life Support Courses for Nurses and Prehospital Care Providers since 1994 in collaboration with the Justice Institute of British Columbia, Canada
- Intravenous Access Course for Nurses since 1995
- Paediatric Advanced Life Support Course since 1996
- Advanced Paediatric Life Support Course since 1997
- Trauma Nursing Core Course since 1997 in collaboration with St. Paul’s Ramsey Medical Centre, Minnesota, USA
Prehospital care is a relatively neglected area in the chain of service provided to the citizens of Hong Kong. Colleagues in the field of Emergency Medicine has been involved in protocol setting and teaching in the Emergency Medical Assistant II Courses of the Fire Service Department in collaboration with the Paramedic Academy of the Justice Institute of British Columbia, Canada since 1993. This new batch of ambulance staff is capable of providing more care e.g. IV fluid replacement, to patients at the prehospital phase. We have also organised CPR-AED courses to help prehospital providers to master the technique of defibrillation using a semi-automatic machine in patients suffering from ventricular fibrillation. In 1997, Dr. CB Lo, a Consultant emergency physician from Fanling Hospital, was appointed Medical Director of the Ambulance Service of the Fire Service Department.With the establishment of the A&E Training Centre in Tang Shiu Kin Hospital in 1994, training for doctors and nurses are much facilitated. The centre is equipped with many state-of-the-art teaching models and training manikins to provide the necessary hands on experience. Since the establishment of the College, most of the training activities of the HKSEMS for doctors have been taken over by the College.
Disaster and radiation contamination accident management are two important areas with inemergency medicine where collaboration with prehospital care provider is essential. Local Accident & Emergency Departments have already gained some experience in these areas and we are in an unenviable position to become experts in these areas.
In 1995, the first Academic Unit in Accident & Emergency Medicine was established in the Chinese University of Hong Kong. The unit was initially headed by Prof. RA Cocks and is responsible for undergraduate teaching at the University. Many colleagues are also involved in the undergraduate teaching of Emergency Medicine at both the University of Hong Kong and the Chinese University as honorary professors to the medical faculties.
Research in the practice of emergency medicine was relatively under-developed. We fully appreciate the importance of research in the building of a knowledge base for the specialty.We started our own mini-journal, the Emergi-news, in 1990 and it matured into the Hong Kong Journal of Emergency Medicine in 1994. We are expecting more and better research originating from local Accident & Emergency Departments.
The inauguration of the Hong Kong Academy of Medicine in 1993 marked a new era in specialist training in Hong Kong. The Hong Kong Society for Emergency Medicine & Surgery formed an adhoc group in early 1994 to look into the ways to establish a Faculty or College of Emergency Medicine under the Academy. With help from Prof. Sir David Todd, Prof. HK Ma, Dr CH Leong,Dr. PC Leung, Dr. Ronald Lo, Dr. Allan Chang and Dr. David Fang, the Hong Kong College of Emergency Medicine was finally incorporated in 1996 and subsequently admitted as a constituent College of the HK Academy of Medicine in January 1997. This marks the beginning of structured specialist training in Emergency Medicine in Hong Kong. The first conjoint fellowship examination in Accident & Emergency Medicine with the Royal College of Surgeons of Edinburgh was conducted for the first time locally in March 1997. The first College exit examination took place in 1999. Some examples of educational activities now organized by the HKCEM are listed below:
- Quarterly Scientific Meeting
- Monthly Joint Clinical Meeting
- Inter-hospital Toxicology Meeting
- Workshops for surgical and orthopaedic skills
- Airway Management Workshop
- Research Seminars
- Management Seminars
- Courses in collaboration with other organisations
- Advanced Cardiac Life Support Course (Justice Institute of British Columbia)
- Paediatric Advanced Life Support Course (Justice Institute of British Columbia)
- Advanced Paediatric Life Support Course (Justice Institute of British Columbia)
- Advanced Life Support in Obstetric Course (American Academy of Family Physicians)
- Clinical Toxicology Course (New York City Poison Control Center)
Emergency Medicine as a specialty in Hong Kong is at an early stage of development but we are optimistic that the specialty will continue to grow and achieve maturity in the next century.