An urgent care center ( UCC ), also known as an urgent treatment centre (UTC) in the United Kingdom , is a type of walk-in clinic focused on the delivery of urgent ambulatory care in a dedicated medical facility outside of a traditional emergency department located within a hospital . Urgent care centers primarily treat injuries or illnesses requiring immediate care, but not serious enough to require an ED visit. In the United Kingdom , urgent treatment centres are provided by the National Health Service , which decided in 2019 that all areas of England should be served by a network of urgent treatment centres. In the United States , urgent care centers were first used in the 1970s and have since expanded to approximately 10,000 centers across the country.
174-479: Urgent care may be categorized as its own branch of medicine, as in New Zealand . They are intended for the treatment of conditions which require urgent medical attention but are not life-threatening , such as broken bones, minor infections, sprains and strains, cuts, grazes, minor burns or scalds, and bites and stings. Various media reports have examined the relative benefits of using an urgent care center. Some of
348-557: A minority government can be formed if support from other parties during confidence and supply votes is assured. The governor-general appoints ministers under advice from the prime minister, who is by convention the parliamentary leader of the governing party or coalition. Cabinet , formed by ministers and led by the prime minister, is the highest policy-making body in government and responsible for deciding significant government actions. Members of Cabinet make major decisions collectively and are therefore collectively responsible for
522-468: A protectionist and highly regulated economy to a liberalised free-trade economy. Unemployment peaked just above 10% in 1991 and 1992, following the 1987 share market crash , but eventually fell to 3.7% in 2007 (ranking third from twenty-seven comparable OECD nations). However, the global financial crisis that followed had a major effect on New Zealand, with the GDP shrinking for five consecutive quarters,
696-455: A "specialist" model or "a multidisciplinary model". Additionally, in some countries, the emergency medicine specialist rides in the ambulance. For example, in France and Germany, the physician, often an anesthesiologist, rides in the ambulance and provides stabilising care at the scene. The patient is directed to the appropriate hospital department, so emergency care is much more multidisciplinary than
870-466: A 12% increase in salary from 2014 – 2015 (which was not out of line with many other physician specialities that year). While emergency physicians work 8–12 hour shifts and do not tend to work on-call, the high level of stress and need for solid diagnostic and triage capabilities for the undifferentiated, acute patient contributes to arguments justifying higher salaries for these physicians. Emergency care must be available every hour of every day and requires
1044-650: A 2010 study in Health Affairs . The Royal New Zealand College of Urgent Care (RNZCUC), was founded in 1995 originally as the Accident and Medical Practitioners Association (AMPA), and presently provides certification for urgent care physicians in New Zealand. The RNZCUC has branch of medicine recognition with the Medical Council of New Zealand (MCNZ), and is recognised as a separate branch of medicine in New Zealand. It
1218-456: A GP referral, and be equipped with basic diagnostic equipment. They are intended also to relieve the pressure on general practice . The many units with local names and differing levels of service are to be subsumed into them and some will close. The programme is led by the local sustainability and transformation partnerships . The initial urgent care centers opened in the United States during
1392-456: A UCC or physicians office (65% and 64% respectively). Patients who presented to an UCC were significantly more likely to be aged over 85 (27%, compared to 15% of physicians office presentations, and 13% of ED presentations) or Black (11%, compared to 6% of physicians office presentations, and 4% of ED presentations). In 2014, 3.1% of family physicians in the United States worked primarily in UCCs, with
1566-642: A changing culture away from defensive medicine can improve cost-effective use. A transition towards more value-based care in the ED is an avenue by which providers can contain costs. Doctors that work in the EDs of hospitals receiving Medicare funding are subject to the provisions of EMTALA . The US Congress enacted EMTALA in 1986 to curtail "patient dumping", a practice whereby patients were refused medical care for economic or other non-medical reasons. Since its enactment, ED visits have substantially increased, with one study showing
1740-531: A critical part of the healthcare safety net for uninsured patients who cannot afford medical treatment or adequately utilize their coverage. In emergency departments in Australia, the government utilises an "Activity based funding and management", meaning that the amount of funding to emergency departments are allocated money based on the number of patients and the complexity of their cases or illnesses. However, rural emergency departments of Australia are funded under
1914-774: A day, 70% of centers in the United States open by 8:00 a.m. or earlier and 95% close after 7:00 p.m. As of 2014, the urgent care industry is worth an estimated $ 14.5 billion. In 2014, US communities with non-hospital-based UCCs were mainly urban, located in areas with higher income levels and higher levels of private insurance. Kaissi et al., considered local multi-hospital systems in Florida, Maryland, Nevada, Texas, Virginia and Washington. In 2012, 50% of 117 hospital-based "clusters" included either UCCs, retail clinics, or both. 57% of systems in Washington operated an UCC, compared to 36% of systems in Washington, while systems in Florida had
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#17328582560402088-403: A definitive diagnosis in the ED, making it challenging to allocate payments through coding . Additionally, adjustments based on patient risk-level and multiple co-morbidities for complex patients further complicate attribution of positive or negative health outcomes. It is not easy to assess whether much of the costs directly result from the emergent condition treated in acutely care settings. It
2262-696: A difficult airway ( anesthesiology ), suture a complex laceration ( plastic surgery ), set a fractured bone or dislocated joint ( orthopaedic surgery ), treat a heart attack ( cardiology ), manage strokes ( neurology ), work-up a pregnant patient with vaginal bleeding ( obstetrics and gynaecology ), control a patient with mania ( psychiatry ), stop a severe nosebleed ( otolaryngology ), place a chest tube ( cardiothoracic surgery ), and conduct and interpret x-rays and ultrasounds ( radiology ). This generalist approach can obviate barrier-to-care issues seen in systems without specialists in emergency medicine, where patients requiring immediate attention are instead managed from
2436-627: A doctor to be available on-site 24/7, unlike an outpatient clinic or other hospital departments with more limited hours and may only call a physician in when needed. The necessity to have a physician on staff and all other diagnostic services available every hour of every day is thus a costly arrangement for hospitals. American health payment systems are undergoing significant reform efforts, Which include compensating emergency physicians through " pay for performance " incentives and penalty measures under commercial and public health programs, including Medicare and Medicaid. This payment reform aims to improve
2610-446: A high level of innovation . Poverty in New Zealand is characterised by growing income inequality; wealth in New Zealand is highly concentrated , with the top 1% of the population owning 16% of the country's wealth, and the richest 5% owning 38%, leaving a stark contrast where half the population, including state beneficiaries and pensioners, receive less than $ 24,000. Moreover, child poverty in New Zealand has been identified by
2784-460: A hospital ED with patient capacity. EMTALA holds both the hospital and the responsible ED physician liable for civil penalties of up to $ 50,000 if there is no help for those in need. . While both the Office of Inspector General, U.S. Department of Health and Human Services (OIG) and private citizens can bring an action under EMTALA, courts have uniformly held that ED physicians can only be held liable if
2958-429: A lack of disclosure of medical error and near misses to patients and other caregivers. While concerns about malpractice liability are one reason why disclosure of medical errors is not made, some have noted that disclosing the error and providing an apology can mitigate malpractice risk. Ethicists uniformly agree that the disclosure of a medical error that causes harm is a care provider's duty. The critical components of
3132-528: A lack of teamwork (i.e. poor communication, lack of team structure, lack of cross-monitoring) was implicated in a particular incident of ED medical error, "an average of 8.8 teamwork failures occurred per case [and] more than half of the deaths and permanent disabilities that occurred were judged avoidable." Particular cultural (i.e. "a focus on the errors of others and a 'blame-and-shame' culture") and structural (i.e. lack of standardisation and equipment incompatibilities) aspects of emergency medicine often result in
3306-520: A male:female ratio of workforce is 6:7, and an urban:rural ratio of 2:1. This compares to 3.6% of family physicians working primarily in emergency care, with a male:female ratio of 5:3 and urban:rural ratio approaching 1:2. The Urgent Care Association (UCA) is an organization founded in 2004 to provide resources and training for the industry. The UCA also publishes the Journal of Urgent Care Medicine (JUCM). The American Board of Urgent Care Medicine (ABUCM)
3480-766: A party must win at least one electorate or 5% of the total party vote before it is eligible for a seat. Elections since the 1930s have been dominated by two political parties , National and Labour . More parties have been represented in Parliament since the introduction of MMP. New Zealand's judiciary , headed by the chief justice , includes the Supreme Court , Court of Appeal , the High Court , and subordinate courts. Judges and judicial officers are appointed non-politically and under strict rules regarding tenure to help maintain judicial independence . This theoretically allows
3654-454: A patient, EMS providers are responsible for diagnosing and stabilising a patient's condition without regard for the ability to pay. In the pre-hospital setting, providers must exercise appropriate judgement in choosing a suitable hospital for transport. Hospitals can only turn away incoming ambulances if they are on diversion and incapable of providing adequate care. However, once a patient has arrived on hospital property, care must be provided. At
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#17328582560403828-571: A primary care physician (PCP) in the ED with general knowledge is likely to be the only source of health care for a population, as specialists and other health resources are generally unavailable due to lack of funding and desire to serve in these areas. As a result, the incidence of complex co-morbidities not managed by the appropriate provider results in worse health outcomes and eventually costlier care that extends beyond rural communities. Though typically quite separated, PCPs in rural areas must partner with larger health systems to comprehensively address
4002-461: A range of cases requiring vast knowledge. They deal with patients from mental illnesses to physical and anything in-between. An average treatment process would likely involve, investigation then diagnosis then either treatment or the patient being admitted. In terms of procedure's they cover a wide and broad range, including treatment to GSW's (Gun Shot Wounds), Head and body traumas, stomach bugs, mental episodes, seizures and much more. They are some of
4176-490: A ratio of about 3 to 1, and they tend to work primarily as clinicians with a minor focus on academic activities such as teaching and research. FRCP(EM) Emergency Medicine Board specialists tend to congregate in academic centres and have more academically oriented careers, which emphasize administration, research, critical care, disaster medicine, and teaching. They also tend to sub-specialize in toxicology, critical care, pediatric emergency medicine, and sports medicine. Furthermore,
4350-406: A rise in visits of 26% (which is more than double the increase in population over the same period). While more individuals are receiving care, a lack of funding and ED overcrowding may be affecting quality. To comply with the provisions of EMTALA, hospitals, through their ED physicians, must provide medical screening and stabilize the emergency medical conditions of anyone that presents themselves at
4524-662: A similar or higher level of care. Hospitals and physicians must also ensure that the patient's condition will not be further aggravated by the transfer process. The setting of emergency medicine presents a challenge for delivering high quality, patient-centered care. Clear, effective communication can be particularly difficult due to noise, frequent interruptions, and high patient turnover. The Society for Academic Emergency Medicine has identified five essential tasks for patient-physician communication: establishing rapport, gathering information, giving information, providing comfort, and collaboration. The miscommunication of patient information
4698-702: A similar trend to dairy, the number of vineyards doubling over the same period, overtaking wool exports for the first time in 2007. Emergency medicine Emergency medicine is the medical specialty concerned with the care of illnesses or injuries requiring immediate medical attention. Emergency medicine physicians (often called "ER doctors" in the United States) specialize in providing care for unscheduled and undifferentiated patients of all ages. As first-line providers, in coordination with emergency medical services , they are primarily responsible for initiating resuscitation and stabilization and performing
4872-499: A small portion of those contributing to overutilization and are often insured. Injury and illness are often unforeseen, and patients of lower socioeconomic status are especially susceptible to being suddenly burdened with the cost of a necessary ED visit. For example, in the event that a patient is unable to pay for medical care received, the hospital, under the Emergency Medical Treatment and Active Labor Act ( EMTALA ),
5046-403: A small proportion will be critically ill or injured. Therefore, the emergency physician requires broad knowledge and procedural skills, often including surgical procedures, trauma resuscitation, advanced cardiac life support and advanced airway management. They must have some of the core skills from many medical specialities—the ability to resuscitate a patient ( intensive care medicine ), manage
5220-521: A supra-specialty program of two years to become an emergency medicine specialist. In Brazil, the first emergency medicine residency program was created at Hospital Pronto Socorro de Porto Alegre in 1996. In 2002, the emergency medical services were standardized nationally with the creation of SAMU (Serviço de atendimento móvel de urgência), inspired by French EMS, which also provides training to its employees. The nacional emergency medicina association (ABRAMEDE – Associação Brasileira de Medicina de Emergência)
5394-518: A three-year program with training in all emergency department specialties (i.e. internal medicine, surgery, pediatrics, orthopedics, OB/GYN), EMS and intensive care. In Chile, emergency medicine begins its journey in Chile with the first specialty program at the beginning of the 1990s, at the University of Chile and the University of Santiago of Chile. Currently, it is a primary specialty legally recognised by
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5568-558: A trade which provided the basis for strong economic growth in New Zealand. High demand for agricultural products from the United Kingdom and the United States helped New Zealanders achieve higher living standards than both Australia and Western Europe in the 1950s and 1960s. In 1973, New Zealand's export market was reduced when the United Kingdom joined the European Economic Community and other compounding factors, such as
5742-484: A yearly average of more than 2,000 hours of sunshine. The southern and southwestern parts of the South Island have a cooler and cloudier climate, with around 1,400–1,600 hours; the northern and northeastern parts of the South Island are the sunniest areas of the country and receive about 2,400–2,500 hours. The general snow season is early June until early October, though cold snaps can occur outside this season. Snowfall
5916-609: Is a constitutional monarchy with a parliamentary democracy , although its constitution is not codified . Charles III is the King of New Zealand and thus the head of state . The king is represented by the governor-general , whom he appoints on the advice of the prime minister . The governor-general can exercise the Crown 's prerogative powers , such as reviewing cases of injustice and making appointments of ministers , ambassadors, and other key public officials, and in rare situations,
6090-481: Is a crucial source of medical error; minimising shortcoming in communication remains a topic of current and future research. Many circumstances, including the regular transfer of patients in emergency treatment and crowded, noisy and chaotic ED environments, make emergency medicine particularly susceptible to medical error and near misses. One study identified an error rate of 18 per 100 registered patients in one particular academic ED. Another study found that where
6264-400: Is a medical specialty—a field of practice based on the knowledge and skills required to prevent, diagnose, and manage acute and urgent aspects of illness and injury affecting patients of all age groups with a full spectrum of undifferentiated physical and behavioural disorders. It further encompasses an understanding of the development of pre-hospital and in-hospital emergency medical systems and
6438-704: Is a member of the United Nations , the Commonwealth of Nations and the Organisation for Economic Co-operation and Development (OECD), and participates in the Five Power Defence Arrangements . Today, New Zealand enjoys particularly close relations with the United States and is one of its major non-NATO allies , as well as with Australia , with a " Trans-Tasman " identity between citizens of
6612-462: Is a primary or first-contact point of care for patients requiring the use of the health care system. Specialists in emergency medicine are required to possess specialist skills in acute illness diagnosis and resuscitation. Emergency physicians are responsible for providing immediate recognition, evaluation, care, and stabilisation to adult and pediatric patients in response to acute illness and injury. Emergency medical physicians provide treatments to
6786-473: Is also consistent with a much debated questionable third line of oral evidence, traditional genealogies ( whakapapa ) which point to around 1350 as a probable arrival date for many of the founding canoes ( waka ) from which many Māori trace their descent. Some Māori later migrated to the Chatham Islands where they developed their distinct Moriori culture. A later 1835 invasion by Māori resulted in
6960-851: Is also difficult to quantify the savings due to preventive care during emergency treatment (i.e. workup, stabilizing treatments, coordination of care and discharge, rather than a hospital admission). Thus, ED providers tend to support a modified fee-for-service model over other payment systems. Some patients without health insurance utilize EDs as their primary form of medical care. Because these patients do not utilize insurance or primary care, emergency medical providers often face overutilization and financial loss, especially since many patients cannot pay for their care (see below). ED overuse produces $ 38 billion in wasteful spending each year (i.e. care delivery and coordination failures, over-treatment, administrative complexity, pricing failures, and fraud), Moreover, it unnecessarily drains departmental resources, reducing
7134-564: Is classified as a non-self-governing territory , but is administered by a council of three elders (one from each Tokelauan atoll ). The Ross Dependency is New Zealand's territorial claim in Antarctica , where it operates the Scott Base research facility. New Zealand nationality law treats all parts of the realm equally, so most people born in New Zealand, the Cook Islands, Niue, Tokelau, and
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7308-869: Is common in the eastern and southern parts of the South Island and mountain areas across the country. New Zealand's geographic isolation for 80 million years and island biogeography has influenced evolution of the country's species of animals , fungi and plants . Physical isolation has caused biological isolation, resulting in a dynamic evolutionary ecology with examples of distinctive plants and animals as well as populations of widespread species. The flora and fauna of New Zealand were originally thought to have originated from New Zealand's fragmentation off from Gondwana, however more recent evidence postulates species resulted from dispersal. About 82% of New Zealand's indigenous vascular plants are endemic , covering 1,944 species across 65 genera . The number of fungi recorded from New Zealand, including lichen-forming species,
7482-459: Is equivalent to 15% of the population of New Zealand. New Zealand has a strong presence among the Pacific Island countries, and enjoys strong diplomatic relations with Samoa , Fiji , and Tonga , and among smaller nations. A large proportion of New Zealand's aid goes to these countries, and many Pacific people migrate to New Zealand for employment. The increase of this since the 1960s led to
7656-453: Is exercised by the Government , led by the prime minister , currently Christopher Luxon . Charles III is the country's king and is represented by the governor-general , Cindy Kiro . In addition, New Zealand is organised into 11 regional councils and 67 territorial authorities for local government purposes. The Realm of New Zealand also includes Tokelau (a dependent territory );
7830-440: Is heavily dependent on international trade, particularly in agricultural products. Exports account for 24% of its output, making New Zealand vulnerable to international commodity prices and global economic slowdowns . Food products made up 55% of the value of all the country's exports in 2014; wood was the second largest earner (7%). New Zealand's main trading partners, as at June 2018 , are China ( NZ$ 27.8b), Australia ($ 26.2b),
8004-650: Is made up of two main islands and more than 700 smaller islands . The two main islands (the North Island , or Te Ika-a-Māui , and the South Island , or Te Waipounamu ) are separated by Cook Strait , 22 kilometres (14 mi) wide at its narrowest point. Besides the North and South Islands, the five largest inhabited islands are Stewart Island (across the Foveaux Strait ), Chatham Island , Great Barrier Island (in
8178-537: Is nominally seven years in duration, after which the trainee is awarded a Fellowship of ACEM, conditional upon passing all necessary assessments. Dual fellowship programs also exist for paediatric medicine (in conjunction with the Royal Australasian College of Physicians ) and intensive care medicine (in conjunction with the College of Intensive Care Medicine ). These programs nominally add one or more years to
8352-436: Is not known, nor is the proportion of those fungi which are endemic, but one estimate suggests there are about 2,300 species of lichen-forming fungi in New Zealand and 40% of these are endemic. The two main types of forest are those dominated by broadleaf trees with emergent podocarps , or by southern beech in cooler climates. The remaining vegetation types consist of grasslands, the majority of which are tussock . Before
8526-460: Is obligated to treat emergency conditions regardless of a patient's ability to pay and therefore faces an economic loss for this uncompensated care. Estimates suggest that over half (approximately 55%) of all quantifiable emergency care is uncompensated and inadequate reimbursement has led to the closure of many EDs. Policy changes (such as the Affordable Care Act ) are expected to decrease
8700-454: Is of European descent ; the indigenous Māori are the largest minority, followed by Asians and Pasifika . Reflecting this, New Zealand's culture is mainly derived from Māori and early British settlers, with recent broadening of culture arising from increased immigration to the country . The official languages are English, Māori , and New Zealand Sign Language , with the local dialect of English being dominant. A developed country , it
8874-412: Is often quite different in rural areas where there are far fewer other specialities and healthcare resources. In these areas, family physicians with additional skills in emergency medicine often staff emergency departments. Rural emergency physicians may be the only health care providers in the community and require skills that include primary care and obstetrics. Patterns vary by country and region. In
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#17328582560409048-452: Is that, whether or not some settlers arrived before 1314, the main settlement period was in the subsequent decades, possibly involving a coordinated mass migration. It is also the broad consensus of historians that the Polynesian settlement of New Zealand was planned and deliberate. Over the centuries that followed, the settlers developed a distinct culture now known as Māori. This scenario
9222-477: Is the 13th largest college in New Zealand by membership (of the 34 recognised by the MCNZ). New Zealand New Zealand is an island country in the southwestern Pacific Ocean . It consists of two main landmasses—the North Island ( Te Ika-a-Māui ) and the South Island ( Te Waipounamu )—and over 700 smaller islands . It is the sixth-largest island country by area and lies east of Australia across
9396-509: Is to regulate "the natural environment with particular emphasis on resource management ", while territorial authorities are responsible for sewage, water, local roads, building consents, and other local matters. Five of the territorial councils are unitary authorities and also act as regional councils. The territorial authorities consist of 13 city councils, 53 district councils, and the Chatham Islands Council. While officially
9570-629: The 1973 oil and 1979 energy crises, led to a severe economic depression . Living standards in New Zealand fell behind those of Australia and Western Europe, and by 1982 New Zealand had the lowest per-capita income of all the developed nations surveyed by the World Bank . In the mid-1980s New Zealand deregulated its agricultural sector by phasing out subsidies over a three-year period. Since 1984, successive governments engaged in major macroeconomic restructuring (known first as Rogernomics and then Ruthanasia ), rapidly transforming New Zealand from
9744-827: The ANZAC tradition it shares with Australia. In addition to Vietnam and the two world wars, New Zealand fought in the Second Boer War , the Korean War , the Malayan Emergency , the Gulf War , and the Afghanistan War . It has contributed forces to several regional and global peacekeeping missions, such as those in Cyprus , Somalia , Bosnia and Herzegovina , the Sinai , Angola , Cambodia ,
9918-472: The Anglo-American model, emergency medicine initially consisted of surgeons , general practitioners , and other generalist physicians. However, in recent decades it has become recognised as a specialty in its own right with its training programmes and academic posts, and the specialty is now a popular choice among medical students and newly qualified medical practitioners. By contrast, in countries following
10092-605: The Cook Islands and Niue (self-governing states in free association with New Zealand); and the Ross Dependency , which is New Zealand's territorial claim in Antarctica . The first European visitor to New Zealand, Dutch explorer Abel Tasman , named the islands Staten Land , believing they were part of the Staten Landt that Jacob Le Maire had sighted off the southern end of South America. Hendrik Brouwer proved that
10266-671: The European Union ($ 22.9b), the United States ($ 17.6b), and Japan ($ 8.4b). On 7 April 2008, New Zealand and China signed the New Zealand–China Free Trade Agreement , the first such agreement China has signed with a developed country. In July 2023, New Zealand and the European Union entered into the EU–New Zealand Free Trade Agreement , which eliminated tariffs on several goods traded between
10440-545: The Franco-German model, the specialty does not exist, and emergency medical care is instead provided directly by anesthesiologists (for critical resuscitation), surgeons, specialists in internal medicine , paediatricians , cardiologists or neurologists as appropriate. Emergency medicine is still evolving in developing countries, and international emergency medicine programs offer hope of improving primary emergency care where resources are limited. Emergency medicine
10614-568: The French Revolution , after seeing the speed with which the carriages of the French flying artillery maneuvered across the battlefields, French military surgeon Dominique Jean Larrey applied the idea of ambulances, or "flying carriages", for rapid transport of wounded soldiers to a central place where medical care was more accessible and practical. Larrey operated ambulances with trained crews of drivers, corpsmen and litter-bearers and had them bring
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#173285825604010788-692: The Gondwanan supercontinent. About 25 million years ago, a shift in plate tectonic movements began to contort and crumple the region. This is now most evident in the Southern Alps, formed by compression of the crust beside the Alpine Fault . Elsewhere, the plate boundary involves the subduction of one plate under the other, producing the Puysegur Trench to the south, the Hikurangi Trough east of
10962-605: The Great Depression . The depression led to the election of the first Labour Government and the establishment of a comprehensive welfare state and a protectionist economy. New Zealand experienced increasing prosperity following the Second World War, and Māori began to leave their traditional rural life and move to the cities in search of work. A Māori protest movement developed, which criticised Eurocentrism and worked for greater recognition of Māori culture and of
11136-614: The Hauraki Gulf ), D'Urville Island (in the Marlborough Sounds ) and Waiheke Island (about 22 km (14 mi) from central Auckland). New Zealand is long and narrow—over 1,600 kilometres (990 mi) along its north-north-east axis with a maximum width of 400 kilometres (250 mi) —with about 15,000 km (9,300 mi) of coastline and a total land area of 268,000 square kilometres (103,500 sq mi). Because of its far-flung outlying islands and long coastline,
11310-515: The Iran–Iraq border, Bougainville , East Timor , and the Solomon Islands . New Zealand has an advanced market economy , ranked 13th in the 2021 Human Development Index , and fourth in the 2022 Index of Economic Freedom . It is a high-income economy with a nominal gross domestic product (GDP) per capita of US$ 36,254. The currency is the New Zealand dollar , informally known as
11484-566: The Legislative Council , until this was abolished in 1950. The supremacy of parliament over the Crown and other government institutions was established in England by the Bill of Rights 1689 and has been ratified as law in New Zealand. The House of Representatives is democratically elected, and a government is formed from the party or coalition with the majority of seats. If no majority is formed,
11658-594: The Pacific Community and the Pacific Islands Forum . It enjoys particularly close relations with the United States and is one of its major non-NATO allies ; the United Kingdom; Samoa , Fiji , and Tonga ; and with Australia , with a shared Trans-Tasman identity between the two countries stemming from centuries of British colonisation. Nationally, legislative authority is vested in an elected, unicameral Parliament , while executive political power
11832-666: The Statute of Westminster , confirming that the British Parliament could no longer legislate for the country without its consent. The British government's residual legislative powers were later removed by the Constitution Act 1986 , and final rights of appeal to British courts were abolished in 2003. Early in the 20th century , New Zealand was involved in world affairs, fighting in the First and Second World Wars and suffering through
12006-573: The Tasman Sea and south of the islands of New Caledonia , Fiji , and Tonga . The country's varied topography and sharp mountain peaks, including the Southern Alps , owe much to tectonic uplift and volcanic eruptions. New Zealand's capital city is Wellington , and its most populous city is Auckland . The islands of New Zealand were the last large habitable land to be settled by humans. Between about 1280 and 1350, Polynesians began to settle in
12180-698: The United Kingdom and negotiate a treaty with the Māori. The Treaty of Waitangi was first signed in the Bay of Islands on 6 February 1840. In response to the New Zealand Company's attempts to establish an independent settlement in Wellington , Hobson declared British sovereignty over all of New Zealand on 21 May 1840, even though copies of the treaty were still circulating throughout the country for Māori to sign. With
12354-600: The United States Department of State noted that the New Zealand government generally respected the rights of individuals, but voiced concerns regarding the social status of the Māori population. In terms of structural discrimination , the New Zealand Human Rights Commission has asserted that there is strong, consistent evidence that it is a real and ongoing socioeconomic issue. One example of structural inequality in New Zealand can be seen in
12528-646: The University of Cincinnati . Furthermore, the first department of emergency medicine at a US medical school occurred in 1971 at the University of Southern California . The second residency program in the United States soon followed at what was then called Hennepin County General Hospital in Minneapolis, with two residents entering the program in 1971. In 1990 the UK's Casualty Surgeons Association changed its name to
12702-616: The West Coast of the South Island to semi-arid in Central Otago and the Mackenzie Basin of inland Canterbury and subtropical in Northland . Of the seven largest cities, Christchurch is the driest, receiving on average only 618 millimetres (24.3 in) of rain per year and Wellington the wettest, receiving almost twice that amount. Auckland, Wellington and Christchurch all receive
12876-473: The caldera of one of the world's most active supervolcanoes . New Zealand is prone to earthquakes . The country owes its varied topography, and perhaps even its emergence above the waves, to the dynamic boundary it straddles between the Pacific and Indo-Australian Plates . New Zealand is part of Zealandia , a microcontinent nearly half the size of Australia that gradually submerged after breaking away from
13050-477: The reserve powers (e.g. the power to dissolve Parliament or refuse the royal assent of a bill into law). The powers of the monarch and the governor-general are limited by constitutional constraints, and they cannot normally be exercised without the advice of ministers. The New Zealand Parliament holds legislative power and consists of the king and the House of Representatives . It also included an upper house,
13224-544: The seven-continent model. New Zealand's climate is predominantly temperate maritime ( Köppen : Cfb), with mean annual temperatures ranging from 10 °C (50 °F) in the south to 16 °C (61 °F) in the north. Historical maxima and minima are 42.4 °C (108.32 °F) in Rangiora , Canterbury and −25.6 °C (−14.08 °F) in Ranfurly , Otago . Conditions vary sharply across regions from extremely wet on
13398-552: The "Kiwi dollar"; it also circulates in the Cook Islands (see Cook Islands dollar ), Niue, Tokelau, and the Pitcairn Islands . Historically, extractive industries have contributed strongly to New Zealand's economy, focusing at different times on sealing, whaling, flax , gold, kauri gum , and native timber. The first shipment of refrigerated meat on the Dunedin in 1882 led to the establishment of meat and dairy exports to Britain,
13572-680: The #ChileEM initiative that brings together the programs of the Universidad San Sebastián / MUE, Universidad Católica de Chile and Universidad de Chile, intend to hold joint clinical meetings between the leading training programs, regularly and open to all the health team working in the field of urgency. The specialists already trained are grouped in the Chilean Society of Emergency Medicine (SOCHIMU). The two routes to emergency medicine certification can be summarized as follows: CCFP(EM) emergency physicians outnumber FRCP(EM) physicians by
13746-549: The 1970s. Since then, this healthcare sector has rapidly expanded to approximately 10,000 centers across the United States. Many centers were started by emergency medicine physicians , responding to a public need for convenient access to unscheduled medical care. A significant factor for the increase of these centers is significant monetary savings when compared to EDs . Many managed care organizations (MCOs) now encourage or even require customers to utilize urgent care options. While urgent care centers are usually not open 24 hours
13920-437: The 1980s, which transformed it from a protectionist to a liberalised free-trade economy. The service sector dominates the national economy , followed by the industrial sector, and agriculture ; international tourism is also a significant source of revenue. New Zealand is a member of the United Nations , Commonwealth of Nations , ANZUS , UKUSA , Five Eyes , OECD , ASEAN Plus Six , Asia-Pacific Economic Cooperation ,
14094-595: The 2000s. 51 closed between 2010 and 2014. 95 more were closed between 2014 and 2017 according to 38 Degrees . The Yeovil centre, opened in 2009, closed in 2017; the Somerset clinical commissioning group said too many people were misusing the town centre facility because it was convenient for them. It was replaced by an urgent care service at the hospital open from 10am to 6pm on Saturdays and Sundays. Walk-ins in North Ormesby and Eston were closed in 2017 and replaced by
14268-938: The 2024 Global Peace Index , New Zealand is the 4th most peaceful country in the world. New Zealand's military services—the New Zealand Defence Force —comprise the New Zealand Army , the Royal New Zealand Air Force , and the Royal New Zealand Navy . New Zealand's national defence needs are modest since a direct attack is unlikely. However, its military has had a global presence . The country fought in both world wars, with notable campaigns in Gallipoli , Crete , El Alamein , and Cassino . The Gallipoli campaign played an important part in fostering New Zealand's national identity and strengthened
14442-627: The A&;E department. The Care Quality Commission reported in June 2018 that about 10% of the urgent care services in England require improvement. They inspected 64 urgent care and walk-in centres. There has been a lack of public information about what services are provided and when. It has been pointed out that people need guidance to overcome an historic reliance on accident and emergency. Different words— walk-in centres , minor injury units and urgent care centres—have been used for similar facilities, but without
14616-743: The ACEM training program. For medical doctors not (and not wishing to be) specialists in emergency medicine but have a significant interest or workload in emergency departments, the ACEM provides non-specialist certificates and diplomas. The Australian College of Rural and Remote Medicine (ACRRM) is the responsible body for the training and upholding of standards for practice and provision of rural and remote medical care. Prospective rural generalists undertaking this four-year fellowship program have an opportunity to complete Advanced Specialised Training (AST) in emergency medicine. In Belgium there are three recognised ways to practice emergency medicine. Until 2005 there
14790-562: The Affordable Care Act (ACA), emergency medicine was leveraged primarily by "uninsured or underinsured patients, women, children, and minorities, all of whom frequently face barriers to accessing primary care". While this still exists today, as mentioned above, it is critical to consider the location in which care is delivered to understand the population and system challenges related to overutilization and high cost. In rural communities where provider and ambulatory facility shortages exist,
14964-578: The Anglo-American model. In countries such as the US, the United Kingdom, Canada and Australia, ambulances crewed by paramedics and emergency medical technicians respond to out-of-hospital emergencies and transport patients to emergency departments, meaning there is more dependence on these healthcare providers and there is more dependence on paramedics and EMTs for on-scene care. Emergency physicians are therefore more "specialists" since all patients are taken to
15138-575: The British Association for Accident and Emergency Medicine and subsequently became the British Association for Emergency Medicine (BAEM) in 2004. In 1993, an intercollegiate Faculty of Accident and Emergency Medicine (FAEM) became a "daughter college" of six royal medical colleges in England and Scotland to arrange professional examinations and training. In 2005, the BAEM and the FAEM became a single unit to form
15312-663: The Chatham Islands Council is not a unitary authority, it undertakes many functions of a regional council. The Realm of New Zealand, one of 15 Commonwealth realms , is the entire area over which the king or queen of New Zealand is sovereign and comprises New Zealand, Tokelau , the Ross Dependency , the Cook Islands , and Niue . The Cook Islands and Niue are self-governing states in free association with New Zealand. The New Zealand Parliament cannot pass legislation for these countries, but with their consent can act on behalf of them in foreign affairs and defence. Tokelau
15486-539: The College of Emergency Medicine, now the Royal College of Emergency Medicine , which conducts membership and fellowship examinations and publishes guidelines and standards for the practice of emergency medicine. Many hospitals and care centres feature departments of emergency medicine, where patients can receive acute care without an appointment. While many patients get treated for life-threatening injuries, others utilize
15660-703: The ED. For all systems, regardless of funding source, EMTALA mandates EDs to conduct a medical examination for anyone that presents at the department, irrespective of paying ability. Non-profit hospitals and health systems – as required by the ACA – must provide a certain threshold of charity care "by actively ensuring that those who qualify for financial assistance get it, by charging reasonable rates to uninsured patients and by avoiding extraordinary collection practices." While there are limitations, this mandate provides support to many in need. That said, despite policy efforts and increased funding and federal reimbursement in urban areas,
15834-477: The Government as a major societal issue; the country has 12.0% of children living in low-income households that had less than 50% of the median equivalised disposable household income as of June 2022 . Poverty has a disproportionately high effect in ethnic-minority households, with a quarter (23.3%) of Māori children and almost a third (28.6%) of Pacific Islander children living in poverty as of 2020 . New Zealand
16008-456: The MMP system, each person has two votes; one is for a candidate standing in the voter's electorate , and the other is for a party. Based on the 2018 census data, there are 72 electorates (which include seven Māori electorates in which only Māori can optionally vote), and the remaining 48 of the 120 seats are assigned so that representation in Parliament reflects the party vote, with the threshold that
16182-502: The Ministry of Health since 2013. It has multiple training programs for specialists, notably the University of Chile, Pontifical Catholic University of Chile, Clínica Alemana – Universidad del Desarrollo, San Sebastian University – MUE and University of Santiago of Chile (USACH). Currently, and intending to strengthen the specialty at the country level, FOAMed initiatives have emerged (free open access medical education in emergency medicine) and
16356-553: The Māori of later years. According to an early European synthesized interpretation of various Māori traditional accounts, around 750 CE the heroic explorer, Kupe , had discovered New Zealand and later, around 1350, one great fleet of settlers set out from Hawaiki in eastern Polynesia. However, from the late 20th century, this story has been increasingly relegated to the realm of legend and myth. An alternative view has emerged from fresh archaeological and scientific evidence, which correlates with doubts raised by historians everywhere as to
16530-765: The North Island and South Island had never been formalised, and names and alternative names were formalised in 2013. This set the names as North Island or Te Ika-a-Māui , and South Island or Te Waipounamu . For each island, either its English or Māori name can be used, or both can be used together. Similarly the Māori and English names for the whole country are sometimes used together ( Aotearoa New Zealand ); however, this has no official recognition. The first people to reach New Zealand were Polynesians in ocean going waka (canoes). Their arrival likely occurred in several waves, approximately between 1280 and 1350 CE. Those Polynesian settlers, isolated in New Zealand, became
16704-584: The North Island, and the Kermadec and Tonga Trenches further north. New Zealand, together with Australia, is part of a wider region known as Australasia . It also forms the southwestern extremity of the geographic and ethnographic region called Polynesia . Oceania is a wider region encompassing the Australian continent , New Zealand, and various island countries in the Pacific Ocean that are not included in
16878-600: The North Island, saw thousands of imperial troops and the Royal Navy come to New Zealand and became known as the New Zealand Wars . Following these armed conflicts, large areas of Māori land were confiscated by the government to meet settler demands. The colony gained a representative government in 1852 , and the first Parliament met in 1854. In 1856 the colony effectively became self-governing, gaining responsibility over all domestic matters (except native policy, which
17052-623: The Ross Dependency are New Zealand citizens. During the period of the New Zealand colony, Britain was responsible for external trade and foreign relations. The 1923 and 1926 Imperial Conferences decided that New Zealand should be allowed to negotiate its own political treaties , and the first commercial treaty was ratified in 1928 with Japan. On 3 September 1939, New Zealand allied itself with Britain and declared war on Germany with Prime Minister Michael Joseph Savage proclaiming, "Where she goes, we go; where she stands, we stand". In 1951,
17226-548: The SAE (Sociedad Argentina de Emergencias) is the leading organisation of emergency medicine. There are many residency programs. Also, it is possible to reach the certification with a two-year postgraduate university course after a few years of ED background. The specialist medical college responsible for emergency medicine in Australia and New Zealand is the Australasian College for Emergency Medicine (ACEM). The training program
17400-658: The South American land was a small island in 1643, and Dutch cartographers subsequently renamed Tasman's discovery Nova Zeelandia from Latin , after the Dutch province of Zeeland . This name was later anglicised to New Zealand . This was written as Nu Tireni in the Māori language (spelled Nu Tirani in Te Tiriti o Waitangi). In 1834 a document written in Māori and entitled " He Wakaputanga o te Rangatiratanga o Nu Tireni "
17574-503: The South Tees Access Response service, run by ELM Alliance Ltd, an alliance of local general practitioners (GPs) , which offered late night and weekend appointments at four GP surgeries. NHS England decided in 2019 that all areas of England should be served by a network of urgent treatment centres which must be GP-led, open at least 12 hours a day, every day, offer appointments that can be booked through NHS 111 or through
17748-471: The Tarawera eruption except for three of a decade or so earlier. Radiocarbon dating and pollen evidence of widespread forest fires shortly before the eruption might also indicate a pre-eruption human presence. Additionally, mitochondrial DNA variability within the Māori populations suggest that Eastern Polynesians first settled the New Zealand archipelago between 1250 and 1300, Therefore, current opinion
17922-466: The Treaty of Waitangi. In 1975, a Waitangi Tribunal was set up to investigate alleged breaches of the Treaty, and it was enabled to investigate historic grievances in 1985. The government has negotiated settlements of these grievances with many iwi, although Māori claims to the foreshore and seabed proved controversial in the 2000s. New Zealand is located near the centre of the water hemisphere and
18096-642: The United Kingdom became increasingly focused on its European interests, while New Zealand joined Australia and the United States in the ANZUS security treaty. The influence of the United States on New Zealand weakened following protests over the Vietnam War , the refusal of the United States to admonish France after the sinking of the Rainbow Warrior , disagreements over environmental and agricultural trade issues, and New Zealand's nuclear-free policy . Despite
18270-835: The United Kingdom, all consultants in emergency medicine work in the National Health Service , and there is little scope for private emergency practice. In other countries like Australia, New Zealand, or Turkey, emergency medicine specialists are almost always salaried employees of government health departments and work in public hospitals, with pockets of employment in private or non-government aeromedical rescue or transport services, as well as some private hospitals with emergency departments; they may be supplemented or backed by non-specialist medical officers, and visiting general practitioners . Rural emergency departments are sometimes run by general practitioners alone, sometimes with non-specialist qualifications in emergency medicine. During
18444-467: The United States's suspension of ANZUS obligations, the treaty remained in effect between New Zealand and Australia, whose foreign policy has followed a similar historical trend. Close political contact is maintained between the two countries, with free trade agreements and travel arrangements that allow citizens to visit, live and work in both countries without restrictions. In 2013 there were about 650,000 New Zealand citizens living in Australia, which
18618-610: The United States, the employment arrangement of emergency physician practices are either private (with a co-operative group of doctors staffing an emergency department under contract), institutional (physicians with or without an independent contractor relationship with the hospital), corporate (physicians with an independent contractor relationship with a third-party staffing company that services multiple emergency departments), or governmental (for example, when working within personal service military services, public health services, veterans' benefit systems or other government agencies). In
18792-438: The arrival of humans, an estimated 80% of the land was covered in forest, with only high alpine , wet, infertile and volcanic areas without trees. Massive deforestation occurred after humans arrived, with around half the forest cover lost to fire after Polynesian settlement. Much of the remaining forest fell after European settlement, being logged or cleared to make room for pastoral farming, leaving forest occupying only 23% of
18966-722: The benefits cited include, shorter wait times, no need to make an appointment, and a large staff which can handle mutltiple tasks relatively quickly. In the United Kingdom , urgent treatment centres (also called walk-in centres or minor injury units ) are provided by the National Health Service , not on a commercial basis. They are intended for the treatment of conditions which require urgent medical attention but are not life-threatening , such as broken bones, minor infections, sprains and strains, cuts, grazes, minor burns or scalds, and bites and stings. Urgent treatment centres are not often located in retail facilities and are generally on hospital sites where they take patients who may not need
19140-413: The best use of limited health care resources. For example, specialty training and pre-hospital care in developed countries are too expensive and impractical for use in many developing countries with limited health care resources. International emergency medicine provides a critical global perspective and hope for improvement in these areas. A brief review of some of these programs follows: In Argentina,
19314-404: The canoe of Aoraki ' ) for the South Island . Early European maps labelled the islands North (North Island), Middle (South Island), and South ( Stewart Island / Rakiura ). In 1830, mapmakers began to use "North" and "South" on their maps to distinguish the two largest islands, and by 1907, this was the accepted norm. The New Zealand Geographic Board discovered in 2009 that the names of
19488-459: The case is prosecuted by OIG (whereas hospitals are subject to penalties regardless of who brings the suit). Additionally, the Centres for Medicare and Medicaid Services (CMS) can discontinue provider status under Medicare for physicians that do not comply with EMTALA. Liability also extends to on-call physicians that fail to respond to an ED request to come to the hospital to provide service. While
19662-518: The complex needs of their community, improve population health, and implement strategies such as telemedicine to improve health outcomes and reduce ED utilization for preventable illnesses. (See: Rural health .) Alternatively, emergency medicine in urban areas consists of diverse provider groups, including physicians , physician assistants , nurse practitioners and registered nurses who coordinate with specialists in both inpatient and outpatient facilities to address patients' needs, more specifically in
19836-474: The consequences of these decisions. The 42nd and current prime minister, since 27 November 2023, is Christopher Luxon . A parliamentary general election must be called no later than three years after the previous election. Almost all general elections between 1853 and 1993 were held under the first-past-the-post voting system. Since the 1996 election , a form of proportional representation called mixed-member proportional (MMP) has been used. Under
20010-461: The country has extensive marine resources. Its exclusive economic zone is one of the largest in the world, covering more than 15 times its land area. The South Island is the largest landmass of New Zealand. It is divided along its length by the Southern Alps . There are 18 peaks over 3,000 metres (9,800 ft), the highest of which is Aoraki / Mount Cook at 3,724 metres (12,218 ft). Fiordland 's steep mountains and deep fiords record
20184-497: The criminal justice system. According to the Ministry of Justice , Māori are overrepresented, comprising 45% of New Zealanders convicted of crimes and 53% of those imprisoned, while only being 16.5% of the population. The early European settlers divided New Zealand into provinces , which had a degree of autonomy. Because of financial pressures and the desire to consolidate railways, education, land sales, and other policies, government
20358-459: The disclosure include "honesty, explanation, empathy, apology, and the chance to lessen the chance of future errors" (represented by the mnemonic HEEAL). The nature of emergency medicine is such that error will likely always be a substantial risk of emergency care. However, maintaining public trust through open communication regarding a harmful error can help patients and physicians constructively address problems when they occur. Emergency medicine
20532-686: The early 19th century, Christian missionaries began to settle New Zealand, eventually converting most of the Māori population. The Māori population declined to around 40% of its pre-contact level during the 19th century; introduced diseases were the major factor. The British Government appointed James Busby as British Resident to New Zealand in 1832. His duties, given to him by Governor Bourke in Sydney, were to protect settlers and traders "of good standing", prevent "outrages" against Māori, and apprehend escaped convicts. In 1835, following an announcement of impending French settlement by Charles de Thierry ,
20706-778: The emergency department (ED) for non-urgent reasons such as headaches or a cold. (defined as "visits for conditions for which a delay of several hours would not increase the likelihood of an adverse outcome"). As such, EDs can adjust staffing ratios and designate an area of the department for faster patient turnover to accommodate various patient needs and volumes. Policies have improved to assist better ED staff (such as emergency medical technicians , paramedics ). Mid-level providers such as physician assistants and nurse practitioners direct patients towards more appropriate medical settings, such as their primary care physician , urgent care clinics or detoxification facilities. The emergency department, welfare programs, and healthcare clinics serve as
20880-412: The emergency department. Most developing countries follow the Anglo-American model: the gold standard is three or four-year independent residency training programs in emergency medicine. Some countries develop training programs based on a primary care foundation with additional emergency medicine training. In developing countries, there is an awareness that Western models may not be applicable and may not be
21054-483: The establishment of the Crown Colony of New Zealand in 1841. Subsequently, a series of conflicts between the colonial government and Māori tribes resulted in the alienation and confiscation of large amounts of Māori land. New Zealand became a dominion in 1907; it gained full statutory independence in 1947, retaining the monarch as head of state . Today, the majority of New Zealand's population of 5.25 million
21228-405: The extensive ice age glaciation of this southwestern corner of the South Island. The North Island is less mountainous but is marked by volcanism . The highly active Taupō Volcanic Zone has formed a large volcanic plateau , punctuated by the North Island's highest mountain, Mount Ruapehu (2,797 metres (9,177 ft)). The plateau also hosts the country's largest lake, Lake Taupō , nestled in
21402-630: The facilities of the Accident and Emergency Department, but can be transferred from one to the other if necessary. They are intended to divert patients from the A&E departments, which are under great pressure. Some centres are run by hospital trusts. Royal Devon and Exeter NHS Foundation Trust took over Exeter's NHS walk-in centre from Northern Devon Healthcare NHS Trust in March 2018. It also runs Honiton Minor Injury Unit. The trust said they were more able to share skills and expertise and work as one team with
21576-481: The formation of the Pasifika New Zealander pan-ethnic group, the fourth-largest ethnic grouping in the country. Permanent migration is regulated under the 1970 Samoan Quota Scheme and the 2002 Pacific Access Category, which allow up to 1,100 Samoan nationals and up to 750 other Pacific Islanders respectively to become permanent New Zealand residents each year. A seasonal workers scheme for temporary migration
21750-502: The goals of EMTALA are laudable, commentators have noted that it appears to have created a substantial unfunded burden on the resources of hospitals and emergency physicians. As a result of financial difficulty, between the period of 1991–2011, 12.6% of EDs in the US closed. Despite the practice emerging over the past few decades, the delivery of emergency medicine has significantly increased and evolved across diverse settings related to cost, provider availability and overall usage. Before
21924-415: The hospital on a rotating basis, among them family physicians, general surgeons, internists, and a variety of other specialists. In many smaller emergency departments, nurses would triage patients, and physicians would be called in based on the type of injury or illness. Family physicians were often on call for the emergency department and recognized the need for dedicated emergency department coverage. Many of
22098-430: The hospital, a triage nurse first contacts the patient, who determines the appropriate level of care needed. According to Mead v. Legacy Health System , a patient-physician relationship is established when "the physician takes an affirmative action with regard to the care of the patient". Initiating such a relationship forms a legal contract in which the physician must continue to provide treatment or adequately terminate
22272-732: The initial investigations and interventions necessary to diagnose and treat illnesses or injuries in the acute phase. Emergency medical physicians generally practice in hospital emergency departments , pre-hospital settings via emergency medical services , and intensive care units . Still, they may also work in primary care settings such as urgent care clinics. Sub-specializations of emergency medicine include; disaster medicine , medical toxicology , point-of-care ultrasonography , critical care medicine , emergency medical services , hyperbaric medicine , sports medicine , palliative care , or aerospace medicine . Various models for emergency medicine exist internationally. In countries following
22446-662: The islands and subsequently developed a distinctive Māori culture . In 1642, the Dutch explorer Abel Tasman became the first European to sight and record New Zealand. In 1769 the British explorer Captain James Cook became the first European to set foot on and map New Zealand. In 1840, representatives of the United Kingdom and Māori chiefs signed the Treaty of Waitangi which paved the way for Britain's declaration of sovereignty later that year and
22620-573: The islands are uninhabited except for about six people at Raoul Island station. These islands put the northern border of New Zealand at 29 degrees South latitude. After the 1982 UNCLOS , the islands contributed significantly to New Zealand's exclusive economic zone . In 1891, the Liberal Party came to power as the first organised political party. The Liberal Government , led by Richard Seddon for most of its period in office, passed many important social and economic measures. In 1893, New Zealand
22794-436: The judiciary to interpret the law based solely on the legislation enacted by Parliament without other influences on their decisions. New Zealand is identified as one of the world's most stable and well-governed states. As of 2017, the country was ranked fourth in the strength of its democratic institutions, and first in government transparency and lack of corruption . LGBT rights in the nation are also recognised as among
22968-511: The land in 1997. The forests were dominated by birds , and the lack of mammalian predators led to some like the kiwi , kākāpō , weka and takahē evolving flightlessness . The arrival of humans, associated changes to habitat, and the introduction of rats , ferrets and other mammals led to the extinction of many bird species, including large birds like the moa and Haast's eagle . Other indigenous animals are represented by reptiles ( tuatara , skinks and geckos ), frogs , such as
23142-519: The largest share of UCCs (17.6%). Authors noted unexplained state-by-state variation in hospital system partnership with UCC and retail clinic models. Corwin, et al., considered Medicare beneficiaries presenting to an UCC emergency department (ED) or physicians office with upper respiratory or urinary tract infections, bronchitis, sprains or contusions, and back or arthritic pain, in 2012. Patients who presented to an ED were more likely to be female (67% of ED presentations) compared to those who presented to
23316-614: The latter being common. New Zealand is a member of the Five Eyes intelligence sharing agreement, known formally as the UKUSA Agreement . The five members of this agreement compromise the core Anglosphere : Australia, Canada, New Zealand, the United Kingdom, and the United States. Since 2012, New Zealand has had a partnership arrangement with NATO under the Partnership Interoperability Initiative. According to
23490-456: The long white cloud') is the current Māori name for New Zealand. It is unknown whether Māori had a name for the whole country before the arrival of Europeans; Aotearoa originally referred to just the North Island . Māori had several traditional names for the two main islands, including Te Ika-a-Māui ( ' the fish of Māui ' ) for the North Island and Te Waipounamu ( ' the waters of greenstone ' ) or Te Waka o Aoraki ( '
23664-574: The longest recession in over thirty years, and unemployment rising back to 7% in late 2009. The lowest unemployment rate recorded using the current methodology was in December 2021 during the COVID-19 pandemic , at 3.2%. Unemployment rates for different age groups follow similar trends but are consistently higher among youth. During the September 2021 quarter, the general unemployment rate was around 3.2%, while
23838-450: The massacre and virtual extinction of the Moriori. In a hostile 1642 encounter between Ngāti Tūmatakōkiri and Dutch explorer Abel Tasman 's crew, four of Tasman's crew members were killed, and at least one Māori was hit by canister shot . Europeans did not revisit New Zealand until 1769, when British explorer James Cook mapped almost the entire coastline. Following Cook, New Zealand
24012-459: The most highly trained physicians in the world and are responsible for providing immediate recognition, evaluation, care, and stabilisation to adult and paediatric patients in response to acute illness and injury. As well as being the first point of care for many patients in emergency situations. There are a variety of international models for emergency medicine training. There are two different models among those with well-developed training programs:
24186-480: The most tolerant in Oceania . New Zealand ranks highly for civic participation in the political process, with 82% voter turnout during recent general elections, compared to an OECD average of 69%. However, this is untrue for local council elections; a historically low 36% of eligible New Zealanders voted in the 2022 local elections , compared with an already low 42% turnout in 2019 . A 2017 human rights report by
24360-690: The nebulous United Tribes of New Zealand sent a Declaration of Independence to King William IV of the United Kingdom asking for protection. Ongoing unrest, the proposed settlement of New Zealand by the New Zealand Company (which had already sent its first ship of surveyors to buy land from Māori) and the dubious legal standing of the Declaration of Independence prompted the Colonial Office to send Captain William Hobson to claim sovereignty for
24534-475: The number of dairy cows doubling between 1990 and 2007, to become New Zealand's largest export earner. In the year to June 2018, dairy products accounted for 17.7% ($ 14.1 billion) of total exports, and the country's largest company, Fonterra , controls almost one-third of the international dairy trade. Other exports in 2017–18 were meat (8.8%), wood and wood products (6.2%), fruit (3.6%), machinery (2.2%) and wine (2.1%). New Zealand's wine industry has followed
24708-566: The number of uninsured people and thereby reduce uncompensated care. In addition to decreasing the uninsured rate, ED overutilization might reduce by improving patient access to primary care and increasing patient flow to alternative care centres for non-life-threatening injuries. Financial disincentives, patient education, and improved management for patients with chronic diseases can also reduce overutilization and help manage costs of care. Moreover, physician knowledge of prices for treatment and analyses, discussions on costs with their patients, and
24882-501: The outset by specialty doctors such as surgeons or internal physicians. However, this may lead to barriers through acute and critical care specialities disconnecting from emergency care. Emergency medicine may separate from urgent care , which refers to primary healthcare for less emergent medical issues, but there is obvious overlap, and many emergency physicians work in urgent care settings. Emergency medicine also includes many aspects of acute primary care and shares with family medicine
25056-497: The pioneers of emergency medicine were family physicians and other specialists who saw a need for additional training in emergency care. During this period, physicians began to emerge who had left their respective practices to devote their work entirely to the ED. In the UK in 1952, Maurice Ellis was appointed as the first " casualty consultant " at Leeds General Infirmary . In 1967, the Casualty Surgeons Association
25230-513: The principle of providing the necessary equipment and staffing levels required to provide safe and adequate care, not necessarily on the number of patients. Emergency physicians are compensated at a higher rate than some other specialities, ranking 10th out of 26 physician specialities in 2015, at an average salary of $ 306,000 annually. They are compensated in the mid-range (averaging $ 13,000 annually) for non-patient activities, such as speaking engagements or acting as an expert witness; they also saw
25404-442: The protected endangered Hamilton's Frog , spiders , insects ( wētā ), and snails. Some, such as the tuatara, are so unique that they have been called living fossils . Three species of bats ( one since extinct) were the only sign of native land mammals in New Zealand until the 2006 discovery of bones from a unique, mouse-sized land mammal at least 16 million years old. Marine mammals, however, are abundant, with almost half
25578-642: The public understanding what exactly was on offer. In Blackpool , the Walk-in centre and the Same Day Health Centre were both renamed Urgent Treatment Centres in August 2018. This was said to be a clear and comprehensive offer to patients. These urgent treatment centres were "open for at least 12 hours a day, every day of the week, every week of the year, including bank holidays—and offering pre-bookable appointments." About 230 walk-in centres were opened in England in
25752-439: The quality of care across all patients. While overuse is not limited to the uninsured, the uninsured constitute a growing proportion of non-urgent ED visits. Insurance coverage can help mitigate overutilization by improving access to alternative forms of care and lowering the need for emergency visits. A common misconception pegs frequent ED visitors as a significant factor in wasteful spending. However, frequent ED users make up
25926-705: The quality of care and control costs, despite the differing opinions on the existing evidence to show that this payment approach is effective in emergency medicine. Initially, these incentives would only target primary care providers (PCPs), but some would argue that emergency medicine is primary care, as no one refers patients to the ED. In one such program, two specific conditions listed were directly tied to patients frequently seen by emergency medical providers: acute myocardial infarction and pneumonia. (See: Hospital Quality Incentive Demonstration .) There are some challenges with implementing these quality-based incentives in emergency medicine in that patients are often not given
26100-414: The relationship. This legal responsibility can extend to physician consultations and on-call physicians even without direct patient contact. In emergency medicine, termination of the patient–provider relationship prior to stabilization or without handoff to another qualified provider is considered abandonment. In order to initiate an outside transfer, a physician must verify that the next hospital can provide
26274-561: The reliability of interpretations drawn from the oral evidence of indigenous peoples, including from Māori. Regarding the arrival of these Polynesian settlers, there are no human remains, artefacts or structures which are confidently dated to earlier than the Kaharoa Tephra, a layer of volcanic debris deposited by the Mount Tarawera eruption around 1314 CE. Samples of rat bone, rat-gnawed shells and seed cases have given dates later than
26448-583: The signing of the treaty and declaration of sovereignty, the number of immigrants, particularly from the United Kingdom, began to increase. New Zealand was administered as a dependency of the Colony of New South Wales until becoming a separate Crown colony , the Colony of New Zealand , on 3 May 1841. Armed conflict began between the colonial government and Māori in 1843 with the Wairau Affray over land and disagreements over sovereignty. These conflicts, mainly in
26622-645: The skills necessary for this development. The field of emergency medicine encompasses care involving the acute care of internal medical and surgical conditions. In many modern emergency departments, emergency physicians see many patients, treating their illnesses and arranging for disposition—either admitting them to the hospital or releasing them after treatment as necessary. They also provide episodic primary care to patients during off-hours and those who do not have primary care providers. Most patients present to emergency departments with low-acuity conditions (such as minor injuries or exacerbations of chronic disease), but
26796-467: The total workforce in 2016. In 2017, international visitor arrivals were expected to increase at a rate of 5.4% annually up to 2022. Wool was New Zealand's major agricultural export during the late 19th century. Even as late as the 1960s it made up over a third of all export revenues, but since then its price has steadily dropped relative to other commodities, and wool is no longer profitable for many farmers. In contrast, dairy farming increased, with
26970-478: The training is in the emergency department; the other part is a rotation between disciplines like pediatrics, surgery, orthopedic surgery, anesthesiology and critical care medicine. Alternative an attending physician with one of following specialties (anesthesiology, internal medicine, cardiology, gastro-enterology, pneumology, rheumatology, urology, general surgery, plastic & reconstructive surgery, orthopedic surgery, neurology, neurosurgery, pediatrics) can follow
27144-547: The triple aim (of improving patient experience, enhancing population health, and reducing the per-capita cost of care) remains a challenge without providers' and payers' collaboration to increase access to preventive care and decrease in ED usage. As a result, many experts support the notion that emergency medical services should only serve immediate risks in urban and rural areas. As stated above, EMTALA includes provisions that protect patients from being turned away or transferred before adequate stabilisation. Upon making contact with
27318-486: The two regions. This free trade agreement expanded on the pre-existing free trade agreement and saw a reduction in tariffs on meat and dairy in response to feedback from the affected industries. The service sector is the largest sector in the economy, followed by manufacturing and construction and then farming and raw material extraction. Tourism plays a significant role in the economy, contributing $ 12.9 billion (or 5.6%) to New Zealand's total GDP and supporting 7.5% of
27492-481: The unemployment rate for youth aged 15 to 24 was 9.2%. New Zealand has experienced a series of " brain drains " since the 1970s that still continue today. Nearly one-quarter of highly skilled workers live overseas, mostly in Australia and Britain, which is the largest proportion from any developed nation. In recent decades, however, a " brain gain " has brought in educated professionals from Europe and less developed countries. Today New Zealand's economy benefits from
27666-645: The uniqueness of seeing all patients regardless of age, gender or organ system. The emergency physician workforce also includes many competent physicians who have medical skills from other specialities. Physicians specializing in emergency medicine can enter fellowships to receive credentials in subspecialties such as palliative care, critical care medicine , medical toxicology , wilderness medicine , pediatric emergency medicine , sports medicine , disaster medicine , tactical medicine, ultrasound, pain medicine, pre-hospital emergency medicine , or undersea and hyperbaric medicine . The practice of emergency medicine
27840-459: The use of regional or general anesthesia (more than topical local anesthesia), those procedures requiring a full operating room or suite, having lengthy recovery times, or requiring more than the level of imaging or specialists available at the center. An estimated 13.7 to 27.1 percent of all emergency department care could be administered at an urgent care center, generating a potential cost savings of approximately $ 4.4 billion annually, according to
28014-847: The world's cetaceans (whales, dolphins, and porpoises ) and large numbers of fur seals reported in New Zealand waters. Many seabirds breed in New Zealand, a third of them unique to the country. More penguin species are found in New Zealand than in any other country, with 13 of the world's 18 penguin species. Since human arrival, almost half of the country's vertebrate species have become extinct, including at least fifty-one birds, three frogs, three lizards, one freshwater fish, and one bat. Others are endangered or have had their range severely reduced. However, New Zealand conservationists have pioneered several methods to help threatened wildlife recover, including island sanctuaries, pest control, wildlife translocation, fostering, and ecological restoration of islands and other protected areas . New Zealand
28188-464: The wounded to centralized field hospitals, effectively creating a forerunner of the modern MASH units. Dominique Jean Larrey is sometimes called the Father of Emergency Medicine for his strategies during the French wars. Emergency medicine as an independent medical specialty is relatively young. Before the 1960s and 1970s, hospital emergency departments (EDs) were generally staffed by physicians on staff at
28362-569: Was centralised and the provinces were abolished in 1876. The provinces are remembered in regional public holidays and sporting rivalries. Since 1876, various councils have administered local areas under legislation determined by the central government. In 1989, the government reorganised local government into the current two-tier structure of regional councils and territorial authorities . The 249 municipalities that existed in 1975 have now been consolidated into 67 territorial authorities and 11 regional councils. The regional councils' role
28536-461: Was co-established with Maurice Ellis as its first president. In the US, the first of such groups managed by Dr James DeWitt Mills in 1961, along with four associate physicians; Dr Chalmers A. Loughridge, Dr William Weaver, Dr John McDade, and Dr Steven Bednar, at Alexandria Hospital in Alexandria, Virginia , established 24/7 year-round emergency care, which became known as the "Alexandria Plan". It
28710-543: Was created in 2007. In 2008 the second residency program was started at Messejana Hospital in Fortaleza. Then, in 2015, emergency medicine was formally recognized as a medical specialty by the Brazilian Medical Association. After formal recognition, multiple residency programs were created nationwide (e.g. Universidade Federal de Minas Gerais in 2016 and Universidade de São Paulo in 2017). The residency consists of
28884-425: Was founded in 1997 to provide certification to urgent care physicians. Urgent care centers are not emergency departments and as such do not offer surgical services , particularly invasive surgical procedures (more than cutaneous or subcutaneous procedures—those involving body organs and organ parts, and/or deep penetration of deep fascia, tendons, ligaments, bursae, joints, muscles, or bones), any procedures requiring
29058-472: Was granted in the mid-1860s). Following concerns that the South Island might form a separate colony, premier Alfred Domett moved a resolution to transfer the capital from Auckland to a locality near Cook Strait . Wellington was chosen for its central location, with Parliament officially sitting there for the first time in 1865. In 1886, New Zealand annexed the volcanic Kermadec Islands , about 1,000 km (620 mi) northeast of Auckland. Since 1937,
29232-595: Was introduced in 2007, and in 2009 about 8,000 Pacific Islanders were employed under it. New Zealand is involved in the Pacific Islands Forum , the Pacific Community , Asia-Pacific Economic Cooperation , and the Association of Southeast Asian Nations Regional Forum (including the East Asia Summit ). New Zealand has been described as a middle power in the Asia-Pacific region, and an emerging power . The country
29406-414: Was no accredited emergency medicine program. Emergency medicine was performed by general practitioners (having followed a 240-hour course, Acute Medicine) or by specialists (surgeon, internal medicine, neurologist, anesthesiologist) with or without supra-specialty training in emergency medicine. Since 2005 residency training exists for acute medicine (3 years) or emergency medicine (6 years). At least 50% of
29580-610: Was not until Dr. John Wiegenstein founded the American College of Emergency Physicians (ACEP) the recognition of emergency medicine training programs by the AMA and the AOA , and in 1979 a historic vote by the American Board of Medical Specialties that emergency medicine became a recognized medical specialty in the US. The first emergency medicine residency program in the world began in 1970 at
29754-446: Was the first nation in the world to grant all women the right to vote and pioneered the adoption of compulsory arbitration between employers and unions in 1894. The Liberals also guaranteed a minimum wage in 1894, a world first. In 1907, at the request of the New Zealand Parliament, King Edward VII proclaimed New Zealand a Dominion within the British Empire , reflecting its self-governing status. In 1947, New Zealand adopted
29928-429: Was the first to introduce a minimum wage , and the first to give women the right to vote . It ranks very highly in international measures of quality of life , human rights , and it has one of the lowest levels of perceived corruption in the world. It retains visible levels of inequality , having structural disparities between its Māori and European populations. New Zealand underwent major economic changes during
30102-544: Was translated into English and became the Declaration of the Independence of New Zealand . It was prepared by Te W(h)akaminenga o Nga Rangatiratanga o Nga Hapu o Nu Tireni , the United Tribes of New Zealand , and a copy was sent to King William IV who had already acknowledged the flag of the United Tribes of New Zealand, and who recognised the declaration in a letter from Lord Glenelg . Aotearoa (pronounced [aɔˈtɛaɾɔa] in Māori and / ˌ aʊ t ɛəˈr oʊ . ə / in English; often translated as 'land of
30276-528: Was visited by numerous European and North American whaling , sealing , and trading ships. They traded European food, metal tools, weapons, and other goods for timber, Māori food, artefacts, and water. The introduction of the potato and the musket transformed Māori agriculture and warfare. Potatoes provided a reliable food surplus, which enabled longer and more sustained military campaigns. The resulting intertribal Musket Wars encompassed over 600 battles between 1801 and 1840, killing 30,000–40,000 Māori. From
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