11 February 2019 (online)
“9-1-1 what is your emergency?” These words are hardly common vernacular for most neurologists. In our field, the abundance of cases appropriately take place in an outpatient setting. When emergencies occur, they uncommonly but most certainly do, the patients are handled initially (and sometimes exclusively) by emergency responders in the field and emergency medicine experts in the hospital.
As an emergency physician (J.N.G.) and a neurologist and firefighter (J.M.E.), we feel this distancing between neurologist and emergency physician can be a disservice to the patient. We strongly believe that a team approach here is the best. Neurologists are a key part of that team.
We contemplated many possible reasons why neurologists are not more involved initially in emergency neurological cases. Workflow and culture play a role. Unlike the neurologist, where a detailed history and exam are routine, the emergency physician is accustomed to brief, focused evaluations, and interrupted workflow. Unfortunately this can often mean limited opportunity to obtain a broad history, or perform a detailed neurologic exam. This can be both challenging and frustrating for a neurologist unaccustomed to highly dynamic patient-care environments. Geography is another barrier for the neurologist's engagement in the emergency case; running back and forth between clinic and emergency department isn't practical.
Workflow and geography aside, our worry was that another key variable creates a barrier for neurologists' full engagement in emergency cases, the intimidating reality that our field is broad, encompassing disorders across the entire neuroaxis, from brain to muscle. Even the neurologists may be challenged by the breadth of possibility captured the category of neurological emergencies.
To that end, we approached Dr. David Greer about the possibility of putting together an updated and wide collection of articles aimed at practical and contemporary insights about a range of emergencies in neurology. We're particularly grateful to Dr. Greer for his enthusiasm, expertise, and leadership in guiding our construction of this special issue of Seminars in Neurology. We hope these articles are valuable across specialties, from prehospital provider to emergency medicine, neurology, even nurses, and advanced practice providers and physicians. Our primary goal is to highlight the best practices for the initial diagnosis and early management of the most critical neurologic conditions, and to help build collaborative teams consisting of emergency physicians and neurologists.