The state of emergency medicine in Iceland in 2013

This article originally appeared in issue 11 of Emergency Physicians International, as the original text was slightly modified it is published here in it's original state.

Emergency medicine (EM) in Iceland has has grown beyond all expectations in recent years. Currently nearly 20 consultants are working in the Emergency Department (ED) at the University Hospital in the capital, Reykjavik. With approximately 90.000 visits per year it is by far the busiest ED in Iceland. The hospital has all major specialties and most subspecialties represented and is thus able to provide a good back-up for it’s ED.

Some resistance was met when the specialty was established about 20 years ago. The need was obvious and other specialties had minimal interest in working on the floor additionally to working daytime but some specialties had vested interests to keep a presumed position of power at the front line.

Jón Baldursson (board certified 1992) came back from US in 1991, having himself experienced the practice of modern emergency medicine in Cincinnati, where the first EM training program in USA was established in 1970. With patience and excellent personal skills and formal training in emergency medicine he was able to convince the hospital management and political bodies that EM was the only right way to go and of paramount importance as the speciality was unheard of in Iceland at the time.

A formal 2-year training program in EM was launched in 2002. It’s scope was and still is to provide physicians with the first half of the required training in the field. With an increasing interest worldwide and excellent conditions to practise emergency medicine in an academic hospital, a large group of ambitious and eager residents was recruited,  many of whom are now returning having completed specialty training in the USA, UK, Australia, New Zealand and Sweden.

Now that more consultants have returned with expertise from abroad the group has taken over nearly all lines of acutely sick patients but not wholly psychiatry, pediatrics (we do ped. trauma) and gynaecology. Airway management and procedural sedation is mostly in our hands by now. Being located far up in the Atlantic we are far away from bigger and more specialised centers and thus are mostly on our own - a utopia for the emergency physician!

Our island is nearly half the size of the UK (103.000km2) but only populated with 320.000 inhabitants in a wild landscape of mountains and fjords. Thus, backup and medical consulting to rural clinics, EMS and HEMS (also serving surrounding Atlantic ocean for up to 250 miles off shore) is closely tied to our ED activity. Many rotating residents have thus had their first knowledge of emergency medicine through prehospital work which has helped to attract them to our program.

Being a nation of few inhabitants creates short communicative distances and working in the ED you are most likely to somehow know your colleagues working in other departments of the hospital. There is only one medical school in Iceland. Thus, collegiality is respected, interhospital communications are softer and problems are usually solved without conflicts. This friendly climate made the introduction of emergency medicine easier.

The relative isolation of the country increases need for communications with colleagues abroad and thus social media is greatly welcomed for emergency medicine in Iceland. We have 10 days per year set off for CME and strive to attend conferences overseas to stay up-to-date and establish relations with colleagues in the field.

We see a bright future for emergency medicine in Iceland. We are a large group of young and enthusiastic physicians building up an academic emergency department with ever growing number of patients in a country having just ducked a financial crisis. With a tight budget and a growing need of resources, management welcomes new ideas and solutions to old problems creating a flourishing environment for young and creative physicians whether they want to do academic research or improve flow and statistics.

It is worth noticing that all Icelanders learn English at school and speak the language fluently. Thus we have been able to invite colleagues from abroad who are interested in working in our department and thus become acquainted with the way we practice EM in our country and even see our country, from outside the ED.