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It’s the end of the world as we know it

Graham, Colin A.

European Journal of Emergency Medicine: August 2019 - Volume 26 - Issue 4 - p 231
doi: 10.1097/MEJ.0000000000000615

Department of Emergency Medicine, Chinese University of Hong Kong, Shatin, Hong Kong

Correspondence to Colin A. Graham, Department of Emergency Medicine, Chinese University of Hong Kong, Shatin, Hong Kong, e-mail:

So said REM… and yes, I do feel fine. Well, it has finally arrived—the time for me to write my (probably) last editorial for the European Journal of Emergency Medicine. After more than 10 years, I have come to my senses and decided that it is time for a new Editor-in-Chief to guide the journal to new highs. So we enter a brave new world — one where emergency medicine in Europe and globally is ever increasingly important but under pressure [1] — and I would argue is an essential component of any modern effective healthcare service.

A lot has changed in 10 years — goal directed therapy for sepsis is no longer considered useful, but we still don’t really know what to do for sepsis in its early stages [2]. Trauma care has changed — we no longer advocate large volume crystalloid infusions, but instead we use tranexamic acid, massive transfusion protocols, minimum volume replacement, and early surgery. So where do we go next in emergency care?

The research must continue, and it must improve [3,4]. We are no longer a young specialty, we are decidedly middle aged. With wisdom comes the need to do the right thing [5], in our case, to do our best for the increasingly frail and elderly patients we serve [6]. We must also maintain the highest of ethical standards [7–9] — there are no excuses.

Education is at the core of what we do [10]. We will see more changes with our need for asynchronous learning and the digital revolution in education. Examinations and other assessment methods [11] will continue to evolve for the modern learner so our patients receive the best emergency care possible. Prehospital education and assessment are particularly challenging; and disaster medicine remains integral to our discipline [12].

None of what has been achieved over the last decade could have been done without a very large number of people, all of whom have played pivotal roles to allow me to spend (a lot of) time on this task. My most sincere thanks go to Phil Daly and his entire team of editorial assistants, production editors, and publishing staff, who have been encouraging and enthusiastic partners in taking the journal forward. I thank the Executive and Board of the European Society for Emergency Medicine for your support and your faith in me, however misguided, and for the opportunity to serve no less than five Presidents.

I thank my Deputy Editors, Mikkel Brabrand and Yonathan Freund, for your dedication and hard work. I thank everyone on the Editorial Board, past and present, for your commitment and support, and I thank them and all our authors and reviewers for your enormous contributions. I would particularly like to thank all of my colleagues at the Chinese University of Hong Kong, and the Prince of Wales Hospital in Hong Kong, for their enormous support during my time as editor.

None of what I do would be possible without the encouragement, support and sacrifice of my family, and I send grateful thanks to my wife Jackie and my sons Clive and David for putting up with all the times when I had to work on the journal to their personal detriment.

Finally, I would like to wish our new Editor-in-Chief, Professor Yonathan Freund, and his team every success with the European Journal of Emergency Medicine as it goes forward — if you enjoy the experience even a tenth as much as I have, then you will have a wonderful time indeed. Bonne chance!

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Conflicts of interest

There are no conflicts of interest.

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1. Graham CA. Emergency care systems: increasing pressures but little sustainability.. Eur J Emerg Med. 2017; 24:157.
2. Freund Y, Khoury A, Möckel M, Karamercan M, Dodt C, Leach R, Bloom B, Garcio-Castrillo L. European Society of Emergency Medicine position paper on the 1-hour sepsis bundle of the Surviving Sepsis Campaign: expression of concern.. Eur J Emerg Med. 2019; 26:232–233.
3. Brabrand M, Graham CA. Emergency medicine research and the European Journal of Emergency Medicine.. Eur J Emerg Med. 2018; 25:303.
4. Hung KK, Lo RS, Graham CA. Outcomes in emergency care research.. Eur J Emerg Med. 2017; 24:1.
5. Graham CA. Reviewing papers for publication: privilege, pain, or perhaps a responsibility.. Eur J Emerg Med. 2017; 24:79.
6. Bellou A, Conroy SP, Graham CA. The european curriculum for geriatric emergency medicine.. Eur J Emerg Med. 2016; 23:239.
7. Freund Y. Ethical and scientific misconduct: the beginner’s experience.. Eur J Emerg Med. 2018; 25:77.
8. Graham CA. Progress and publication ethics.. Eur J Emerg Med. 2011; 18:243.
9. Graham CA. Ethics in emergency medicine conferences.. Eur J Emerg Med. 2011; 18:313.
10. Graham CA. The future of emergency medicine is education.. Eur J Emerg Med. 2014; 21:1.
11. Petrino R, Brown R, Härtel C, Lemoyne S, Pini R, Spiteri A, et al. european Board Examination in Emergency Medicine (EBEEM): assessment of excellence.. Eur J Emerg Med. 2014; 21:79–80.
12. Graham CA. Disaster medicine is an integral component of emergency medicine.. Eur J Emerg Med. 2011; 18:63.
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