General practitioners (GPs) will be involved in acute, emergency type presentations, especially in rural and regional areas. Acute life-threatening emergency and trauma presentations are likely to be rare but will require time-critical and effective responses.1-2 A GP will be exposed to these life-threatening presentations in a variety of settings, including consulting clinics, hospitals, nursing homes, disability facilities, correctional institutions and pre-hospital in the community. GPs need to be able to provide independent and team-based care in these settings.
Australia is geographically vast and response times for emergency services can vary. The ability to appropriately respond to time-critical emergencies is associated with improved patient outcomes.3 GPs also provide significant input into the compassionate management of death during resuscitation attempts or in futile care.4 In many rural communities, GPs with advanced training will be part of the retrieval and first responders emergency service.3,5,6
The role of the GP in the management of emergency and trauma presentations will be varied. It will often include significant input into leadership/coordination, assessment/management and debrief/education. As a significant member of any community, the GP will be expected to advocate for the appropriate provision of emergency medical response services. Advocacy in Aboriginal and Torres Strait Islander communities is especially vital with higher rates of emergency presentations and poorer outcomes with delayed presentations. Historical context and cultural safety for Aboriginal and Torres Strait Islander peoples may contribute to a reluctance to engage with healthcare services. GPs need to consider how social determinants of health, health literacy, population characteristics and rural and remote location impact on the escalation to emergency care and the appropriateness of inpatient care.
It is important to have a firm foundational understanding of the algorithmic approach to emergency, life threatening and trauma presentations. Understanding and identifying appropriate resuscitation resources, including staffing, equipment and retrieval services is critical in effectively responding to these presentations.3 GPs need to understand the red flags for common acute presentations and know how to triage these presentations, identifying which need to be immediately escalated and which can wait until the next day.
It is important that GPs undertake regular self-reflective practice to understand personal capabilities and limitations. Fellowship training places GPs in an ideal situation to undertake further continuing professional education in pre-hospital and hospital-based emergency medicine, with a variety of courses available for additional training.7-11
Being involved in emergency life-threatening care and trauma exposes the practitioner to mental and physical health risks, in addition to specific medico-legal risks.12 These risks need to be understood and managed appropriately. The GP will often be looked to for leadership and debrief, both during and following these events, which entails its own set of challenges.
GPs are unique amongst medical professionals in having to respond to emergency presentations in a variety of different contexts and environments. Unlike emergency and critical care professionals, the general practice environment is rarely structured to facilitate the management of these situations. Exposure to emergency and trauma is often rare and intermittent. The ability to be flexible, and respond effectively, in unfamiliar environments and unpredictable circumstances, is a defining feature of a GP.