United States Physician Assistance in Development of Emergency Medicine in Hangzhou, China,☆☆,

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Abstract

Emergency medicine is growing rapidly as a specialty and is beginning to be recognized as an essential component of medicine in China. Traditional Chinese medicine and modern technology exist together. A description of the US authors’ experience as consultants at a new emergency department and in establishing an emergency medicine residency program in Hangzhou, China is provided. A total of 7 months were spent in the observation, identification, and development of a basic framework of emergency care at a new hospital. The practice of emergency medicine in China was researched by direct observation at several Chinese cities and by literature review. China is taking the parts of the Western system it can use and implementing its own methods in the overall practice of emergency medicine.

[Clem KJ, Thomas TL, Wang Y-T, Bradley D: United States physician assistance in development of emergency medicine in Hangzhou, China. Ann Emerg Med July 1998;32:86-92.]

Section snippets

INTRODUCTION

Emergency medicine as a specialty is relatively new in the People’s Republic of China. This article provides an overview of emergency medicine development as well as a report on a new emergency department and emergency medicine residency in Hangzhou, China.

Three US emergency physicians and two nurse managers were present intermittently as consultants at Sir Run Run Shaw Hospital (SRRSH) located in the Zhejiang Province, for a total of 7 months (1994–1996). Their role in providing teaching and

THE DEVELOPMENT OF MODERN MEDICINE IN CHINA

The origins of Chinese medicine may be traced more than 3,000 years.1 Western medicine was introduced to China in the early 19th century and has developed concurrently but has not replaced traditional medicine.1 Traditional Chinese medicine is highly appreciated by Chinese people because it is viewed as safe and without side effects.2 Recently China has combined modern technology and traditional medicine, which is not folk medicine, but a discipline with observations and experimental trials.3

In

MEDICAL INSURANCE AND HEALTH CARE SPENDING

Medical insurance coverage and benefits vary considerably by individual (age, gender, education, occupation, employment sector) and regional characteristics (urbanization, level of industry, commercial development, province). The rural and poor are less likely to have medical insurance.8, 9

Funded private hospitals (such as SRRSH) are uncommon. Hospitals and township health centers obtain revenue directly from patients, although only 25% of the population has health insurance.8

In 1989 China

EMERGENCY MEDICINE DEVELOPMENT IN CHINA

In China, emergency medicine is a new specialty undergoing tremendous growth. Chinese emergency care development began in the 1950s with influence from the Soviet system. China established 75 first-aid stations attached to hospital EDs for emergency medical care.10 The Chinese Ministry of Public Health addressed emergency medical system development in 1980 by issuing Directives to Further Strengthen the Emergency Care in Urban Areas and in 1983 by establishing standards for EDs to replace

PUBLIC PERCEPTIONS OF EMERGENCY MEDICINE IN CHINA

The general public sees the ED as an emergency clinic with the additional function of caring for serious emergencies. Chinese rarely make outpatient appointments and tend to access care through self-triage, often choosing a specialist on the basis of complaint. The hospital’s cost reputation may be a factor in determining which clinic or ED is chosen.

MEDICAL EDUCATION

After completion of high school at age 19, students who pass a strenuous competency examination enter the university. Those chosen for medical training complete their intern year by graduation (at age 24), and then study and operate under practiced physicians’ guidance.

There are no prior documented Chinese emergency medicine residencies, although through CAEM’s influence there are now 30 to 50 hours of emergency medicine courses in most medical schools; and more than 20 medical schools have

EMERGENCY MEDICAL SERVICES

EMSS development in China consists of prehospital EMS, hospital EMS (or ED), and ICU. In the early 1980s the Chinese Ministry of Health approved standards for ED development.10, 11 Prehospital EMS is in an early development phase compared with ED advancement. Most rural areas do not have a prehospital system. In contrast, prehospital development is taking place in large urban areas (Beijing, Shanghai, Chongqing, and Guanzhou).13, 14 Attempts at modeling a system through China’s top-down

SIR RUN RUN SHAW HOSPITAL

SRRSH is located in the city of Hangzhou (with a surrounding population of 5.5 million) about 180 km south of Shanghai. Hangzhou, the capital of Zhejiang Province, is a political, economic, cultural, and transport center. It has an extensive medical community with 35 provincial and municipal hospitals, 51 community hospitals, and 20 community clinics. Academic affiliations include with Traditional Chinese Medicine College and Zhejiang Medical University.16 Specialty hospitals include two

ROLE AS CONSULTANTS TO SRRSH

Modern technology and Chinese traditions are combined throughout China.6, 7 Many basic medical principles are similar to those of Western medicine. The primary goal was to contribute to SRRSH’s ability to provide independent care in practical ways. As consultants, our recommendations were offered as suggestions within existing frameworks, not as policy changes.

Other EDs were visited to help identify the emergency medicine framework in Hangzhou. Daily ED operations at SRRSH were observed and

Social Implications

The Chinese culture is one of the oldest in the world and is known for graciousness and politeness. As China has a functioning medical system, caution was exercised to avoid the assumption that the Western health care model is the standard. The LLU team made every effort to respect Chinese culture and to implement those concepts that would have long-term benefit. Consultant working strategy was to suggest ideas, wait, and observe in order to assist only with ideas that the Chinese embraced as

FUTURE PROGRAM EXPANSION

It is a unique privilege to work internationally teaching emergency medicine. The LLU team appreciated the enthusiasm and openness of the Chinese staff who consistently showed a willingness to try new concepts.

Progress can be made in teaching emergency medicine concepts outside the United States, but American ethnocentricity must be constrained. Visiting health care workers should ensure that their efforts contribute to rather than detract from the ability of their hosts to independently

References (21)

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From the Department of Emergency Medicine, Loma Linda University Medical Center,* Loma Linda, CA, Chinese Association of Emergency Medicine and Nanjing Medical University, People’s Republic of China.

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Reprint no. 47/1/90883

Address for reprints: Kathleen J Clem, MD, Department of Emergency Medicine, Loma Linda University Medical Center, Loma Linda, CA 92354, 909-824-4344, Fax 909-478-4121, E-mail [email protected]

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