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The Tower of Babble

Totten, Vicken MD

doi: 10.1097/01.EEM.0000412292.42561.64

    Definitions are the antidotes to babble. The babble problem became clear to me when I attended the Eighth New York Symposium for Emergency Medicine. It was an excellent conference, but it was clear that not all participants understood the same things when they used certain words or phrases. I was very happy to learn that the International Federation of Emergency Medicine was hosting a meeting at ACEP's Scientific Assembly to define their terms.

    In the spirit of cooperation, I would like to submit some definitions to you, members of the international emergency medicine community. I have pulled some of these definitions from recent publications. Others I have tried to define myself. I invite each of you to correspond with me to change, amend, or comment on any or all of my proposed definitions. Feel free to send me your terms and definitions. If someone out there wants to set up a Wiki, that might be a good method to increase collaboration. Set up a Wiki, send me the URL, and EMN will publish it.

    If we have a Wikipage, each member of that Wiki community can comment on, amend, or change any word. It is the modern, web-based Delphi method. This way, we can all agree on a set of definitions, and spend less time debating terms and more focused on solutions. Together we can build and reach the sky.

    Medical Adventurism: Providing direct clinical care to patients, rather than helping to educate local practitioners and improving the health care system, could be termed medical adventurism. While often enjoyable and within a clinician's comfort zone, this behavior may undermine local clinicians' confidence, making them dependent on outside aid as well as undermining local health systems or healers.

    International Medicine: International medicine is a field of study that focuses on the similarities and differences between medical care, medical systems, and medical education in different parts of the world. It also encompasses medical adventurism, disaster relief, and much more. This term is commonly used to mean physicians from a more developed country providing care, education, or systems development in less developed countries.

    International Emergency Medicine: Understanding its limitations, IEM is arbitrarily defined, for the purposes of this paper as emergency physicians from developed countries providing emergency health care, system development, education, or research in developing countries.

    Emergency Medicine Systems Development: Emergency medicine systems development covers the creation of integrated prehospital and hospital-based systems that address the acute health needs of a community.

    Disaster Medical Response: This term describes the efforts of medical personnel to respond to the acute medical needs of a community that has just been struck by a disaster, either natural or manmade. Much of disaster medical response is carried out by non-government organizations and by governmental organizations, sometimes by individuals.

    Disaster Medical Assistance Teams: These teams, called DMATs for short, are a U.S. organizational structure under the control of NDMS. DMATs respond to disasters, primarily within the United States, although I believe some may have responded out of country.

    International Emergency Medicine Specialty Development: This concerns itself with coordination of emergency medicine in various countries so that the scope of practice is mutually understandable. It may also include efforts to legitimize the specialty itself.

    Host Country: This is the country to which the medical person goes.

    Home Country: This is the country where the medical person usually lives and works.

    Medical Tourism: This is the practice of going to a country while on vacation, and receiving elective medical care that is less expensive (or more sophisticated) than is available in one's home country. This is a fairly new big business.

    Medical Voyeurism: Akin to medical adventurism, this means to go to another country and look at hospitals, wards, prehospital care, or ED care briefly and superficially. Unlike medical adventurism, medical voyeurism does not include the practice of medicine.

    Clinical Observership: An educational experience by a medical person who goes to another institution, often in another country, to watch how “they” practice medicine. Observerships usually last a week to a month, but can be longer. The observer usually is not licensed to practice in the host institution, and can only watch, not make medical decisions.

    Administrative Observership: This is an educational experience that may include clinical observing but primarily focuses on learning about how the host institution performs its administrative tasks. It doesn't require a medical license in the host country. It may include learning about how training programs are set up.

    Training Program: This includes a defined curriculum, and usually confers some kind of degree or certificate. A training program may be as little as one or two days, and result in a merit badge certificate such as ATLS, or may last for several years and result in a medical specialization.

    Merit Badge Program: This training is a somewhat negative term for freestanding, short-course education focusing on establishing pre-determined responses to limited clinical situations. Merit badge courses usually last no more than a few days, are not conducted on live patients, and may include simulation and animal models designed to teach specific responses to circumscribed situations. These courses provide a common background and response set for persons from widely different systems. They are not meant to replace specialty training. Examples of merit badge courses include ATLS and PALS. They are sometimes required by hospitals for certain privileges.

    Those are my suggested terms and definitions. Please send me yours by writing to

    Comments about this article? Write to EMN at

    Dr. Tottenis the director of research in emergency medicine at University Hospitals Case Medical Center and an assistant professor at Case Western Reserve University in Cleveland.

    © 2012 Lippincott Williams & Wilkins, Inc.