Defining Critical Emergency Medicine (CrEM): A Delphi Study From Scandinavia

Area of Science:

• Anesthesiology and Intensive Care Medicine
• Emergency Medicine
• Medical Subspecialties

Background:

• Critical emergency medicine (CrEM) is a recognized subspecialty within anesthesiology and intensive care medicine.
• A comprehensive definition and framework for CrEM were previously lacking.
• This study aimed to establish a consensus-based definition and delineate CrEM's core components.

Purpose of the Study:

• To establish a consensus-based definition of Critical Emergency Medicine (CrEM).
• To delineate the core components, competencies, and operational domains of CrEM.
• To provide a framework supporting CrEM curriculum development and clinical governance.

Main Methods:

• A modified Delphi study involving experts from the SSAI-CrEM education program.
• Two iterative rounds of evaluation followed by external validation with program alumni.
• Consensus defined as ≥90% agreement on statements refined by a steering committee.

Main Results:

• 37 out of 44 statements reached consensus, organized into six thematic domains.
• CrEM defined as a physician-led, context-adapted subspecialty for rapid stabilization and high-acuity care.
• Emphasis on structured training, ethical competence, leadership, and scientific development.

Conclusions:

• CrEM is a distinct and essential subspecialty bridging advanced emergency care across settings.
• The defined framework supports curriculum development, clinical governance, and research in CrEM.
• Further validation and evolution of CrEM in clinical and academic contexts are recommended.