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

## TL;DR

This study defines critical emergency medicine (CrEM) as a subspecialty in Scandinavia, focusing on rapid stabilization and life-saving care in various settings.

## Contribution

The study provides the first consensus-based definition and framework for CrEM in Scandinavia.

## Key findings

- CrEM was defined with six thematic domains including core functions, training, and ethical responsibilities.
- A structured definition of CrEM was established through expert consensus and external validation.
- The findings emphasize the need for structured training and ongoing research in CrEM.

## Abstract

Critical emergency medicine (CrEM) is one of four subspecialty pillars within anesthesiology and intensive care medicine, as defined by the Scandinavian Society of Anesthesiology and Intensive Care Medicine (SSAI). Despite its recognized clinical relevance, a comprehensive definition of CrEM has until now been lacking. The aim of this study was to establish a consensus‐based definition of CrEM and delineate its core components, competencies, and operational domains.

A modified Delphi study was conducted among experts from the SSAI‐CrEM education program. The process involved two iterative rounds followed by external validation with alumni from previous CrEM programs. Statements for evaluation were generated from participant essays and refined by a steering committee of experienced consultants. Consensus was defined as ≥ 90% agreement.

Of 44 initial statements, 37 reached consensus and were organized into six thematic domains: (1) Core Function and Scope, (2) Competence and Training, (3) Work Environment and Challenges, (4) Interdisciplinary and Teamwork Approach, (5) Ethical and Decision‐Making Responsibilities, and (6) Need for Research and Continuous Development. CrEM was defined as a physician‐led, context‐adapted subspecialty focusing on rapid stabilization, life‐saving interventions, and high‐acuity care across diverse clinical, and prehospital environments. The results emphasize the need for structured training, ethical competence, leadership in multidisciplinary teams, and ongoing scientific development.

CrEM constitutes a distinct and essential subspecialty within anesthesiology and intensive care medicine, bridging advanced emergency care across institutional boundaries. This study provides a structured definition and framework that may support curriculum development, clinical governance, and research initiatives within the field. Future work should aim to further validate these findings and guide the evolution of CrEM in both clinical and academic contexts.

This Delphi process report presents the practice and training concepts for critical emergency medicine as a subspecialty of Anesthesia and Intensive Care Medicine in the Nordic country medical context. Perhaps particular for the Nordic countries, which combine medical specialty expertise and practice areas for perioperative medicine, intensive care medicine, pain medicine, and emergency (critical) prehospital care, this document describes current goals in susbpecialty education for the Nordic practice tradition for critical emergency medicine.