Swedish emergency care was organized according to hospital departments as a multi-disciplinary system, often with junior doctors on call in the ED, with senior back up in the wards or at home until the late 1990s.
Swedish emergency care was organized according to hospital departments as a multi-disciplinary system, often with junior doctors on call in the ED, with senior back up in the wards or at home until the late 1990s. In 2000 two programmes for EM were launched at two major inner-city hospitals in Stockholm. A task force of dedicated doctors drafted a core curriculum based on the EUSEM and SAEM curricula, which from start postulated a common specialty for EM of all ages. A national society SWESEM was founded in 2002. As in many other countries endeavouring a paradigm shift consumes patience and a large number of people involved in formalizing and practicing EM as living examples. The process was questioned and critisized for many years mainly by the internists but also by a group of paediatricians in 2012. In 2015 however, the National Board of Health and Welfare granted EM specialist status.
The origins of paediatric emergency medicine in Sweden go back to 2005 when APLS was introduced and a few pediatric EM doctors became instructors. Developing a subspecialist for PEM in its own right has benefitted from the general acknowledgment of EM but still needs formal recognition and spreading formalized training to all parts of the country. Pioneer programs have been developed in Stockholm, Gothenburg, Linköping, Malmö and Lund, while in smaller hospitals the PED is usually attached to the Department of Paediatrics and for medical (non surgical and orthopedic) cases.
Linköping University Hospital ED is the first Swedish ED run by its own EM specialists and also sees children with surgical and trauma presentations. Collaboration with the paediatricians is well under way to incorporate also the medical cases.
Gothenburg has a PED for all patients up to 16 years of age, while Stockholm has three PED, with different profiles. Astrid Lindgrens Children’s Hospital (ALB) in Solna (Stockholm county) has annual visits mounting to around 60000 this year. From 2011 ALB has had the goal of creating a specialist group of pediatricians and EM specialists collaborating in setting standards of care equivalent to international PEM. The department has had the privilege of attracting a number of internationally trained PEM specialists from the UK, USA, Spain, Israel, Finland, Australia. The PED is part of the university hospital Karolinska and collaborates with the regional trauma centre.
ALB Solna has a POCUS course run by PEM specialists and after years of debating with anesthetic colleagues now works with the paediatric pain management team to establish and promote basic competency in procedural sedation. A 3 year fellowship for specialists in either pediatrics or emergency medicine is under way.
As for many of our international colleagues the health care system is under huge strain because of shortage of nurses in 24/7 care and crowding. Emergency medicine in Sweden has yet to gain total acceptance as a special competence, but looking back on 25 years of promoting EM and PEM a number of important and crucial steps have been taken already. The first generation of pioneers are starting to hand over to the next. As in other countries we are still building bridges while we walk on them.