The resuscitation and treatment of acutely unstable patients is one of the four cardinal roles of the Nordic anaesthesiologist, along with anaesthesia (including perioperative medicine), intensive care medicine, and pain management. The SSAI has established advanced educational programmes for these four pillars of anaesthesiology as well as for various subspecialist roles within anaesthesiology, such as paediatric-, obstetric-, and cardiothoracic anaesthesia. Although every anaesthesiologist is expected to have a solid foundation in caring for unstable patients through their training and practice in theatres and in the intensive care department, keeping up with the advancing science and treatment possibilities for the emergency management of critically ill and injured patients can be a daunting task. To further strengthen anaesthesiologists in this role the SSAI established the advanced postgraduate training programme in Critical Emergency Medicine (CrEM, previously referred to as Emergency Critical Care). CrEM deals with advanced resuscitation science and practice in a broad sense, for both trauma and acute illness, in various patient categories and settings.

Despite the similar nomenclature, CrEM should not be confused with the primary specialty of Emergency Medicine, which is focused on the diagnosis, risk stratification, emergency treatment and disposition of any and all patients that present to the emergency department of the hospital. A small subset of these patients will be critically ill and unstable and in the Nordic countries, anaesthesiologists will be summoned to resuscitate, stabilise or otherwise manage this subset of patients and these are the focus of the postgraduate training in Critical Emergency Medicine.

At the end of the programme the candidate should have scientifically based clinical proficiency in assessing and treating critically ill and injured patients and stabilising them during transport to a department or facility where they can receive further care. The skillset for these tasks can also be of use in other clinical settings, for example in the intensive care department, operating suite, in wards and so on. The CrEM candidate should have systems level knowledge of prehospital emergency medical services including dispatch and response, protocols and quality indicators.

These doctors will go on to be the resident experts in CrEM within their departments, establishing and leading resuscitation teams as well as influencing local policy and practice. They will be well equipped to further develop the role of the CrEM physician within the specialty of Anaesthesiology. Others may continue on to (or already be established in) careers in prehospital and retrieval medicine.

The overarching topics / training objectives for the programme are

1. Advanced resuscitation practice in the widest sense
2. Emergency anaesthesia and airway management for trauma and medical emergencies including prehospital emergency anaesthesia
3. Emergency care of the unstable trauma patient including initial assessment, resuscitation and stabilisation, and transportation to and within the hospital
4. Emergency medical management of the critically ill patient in all patient groups and age categories, in various settings. This includes the decisions on treatment level and termination of resuscitation attempts.
5. Extensive knowledge of the pre- and inhospital emergency systems

This will be supported by theoretical and practical training in

6. Relevant emergency procedures
7. The non-technical skills to be able to put these practical skills to use in various situations, in the prehospital settings as well as in other environments and team compositions

• Applicants must be a full paying member of the SSAI.
• Upon entering the programme, the candidates will already have completed specialist training in anaesthesiology and intensive care medicine and should have at least two years of experience as consultant anaesthesiologists.
• They should have training and experience in resuscitation of both adult and paediatric patients for both medical emergencies and trauma (a minimum requirement is ALS, EPALS, and ATLS / ETC, or comparable courses). Instructor level experience in at least one such course is desirable.
• They should ideally also have completed training in major incidents and mass casualty management.
• Applicants should have familiarity with the pre-hospital emergency medical services (EMS) including relevant clinical knowledge, dispatch training and procedures, level of training and competencies of prehospital practitioners, techniques for rescue and extrication, transport logistics, and local EMS system structure and funding.
• They should also have some experience from prehospital care (this can include research, teaching and volunteer response or ride-alongs).
• An interest in and professional focus on the management of critically ill and injured patients during various emergency situations is a must.

Selection is based on the SSAI Guidelines for AEP steering committees. In accordance with this guideline there is a set number of places in the programme reserved for each participating country in proportion to the countries’ populations. 16 out of 24 spots in the SSAI CrEM programme will be reserved by nation (SWE 6, DEN 3, FIN 3, NOR 3, ICE 1) assuming enough eligible candidates. Unfilled spots and the remaining 8 spots will be awarded to the most eligible remaining candidates regardless of nationality.

Spots will be awarded based on the steering committee’s rating of the following criteria for the applicants:

1. Work experience
   • Documented work in critical emergency medicine (CrEM)
   • Documented work experience in the prehospital environment specifically
2. Documented research activity in CrEM or related fields
3. Proposed research project (interest of and applicability to CrEM)
4. Motivational letter and other sections of the application
5. Documented funding and guaranteed position for clinical training
6. Additional criteria
   • Leadership experience
   • Relevant academic or pedagogical experience

The criteria will be rated by the following scale: Substandard 0; Fair 1; Good 2; Excellent 3.

Note: Only merits described in the application will be scored.

All SSAI members, including applicants, participants, and steering committee members are expected to maintain a high standard of personal conduct and to treat members and others with respect. See also the SSAI Ethical Code of Conduct.

The programme consists of a virtual start-up meeting and the following four components woven together with precourse assignments and group discussions

During the two-year programme, the participant must work in a setting where they are regularly tasked with providing emergency care to critically ill or injured patients. This can be at institutions such as university clinics or regional general hospitals in clinical settings such as emergency rooms or trauma bays, in anaesthetic teams with regular delivery of emergency and trauma anaesthesia, intensive care units with outreach systems and a high volume of emergency admissions, or in physician staffed prehospital systems (HEMS/EMS) or some combination thereof.

It is important for the participant to have a written agreement with the host department outlining their participation in the programme as well as additional clinical, tutorial, and quality improvement work relevant to the programme during the two years. This also includes time to fulfil the required tasks and assignments.

The residential courses, four of them in all (Norway/Iceland, Finland, Sweden, Denmark) tie the programme together, allowing the candidates to meet up, build a network and share knowledge and experience. Each course is 4 days in duration and focuses on different aspects related to emergency care of the critically ill and injured patient in various settings and patient populations.

Topics covered include relevant (clinical) practical skills within advanced resuscitation practice and trauma anaesthesia but also important non-technical skills such as communication, leadership, and decision making, all of which are of critical importance when working in ad-hoc teams and low resource environments. In one course we do a 360-degree evaluation of the participants to further their skill of self-leadership.

We also address emergency response systems (including prehospital dispatch and EMS) and major incidents, including management and response. Teaching includes a mix of hands-on technical skill development, case-based problem solving, scenario simulations, lectures, and group discussions.

For each course there will be several pre-course assignments. The assignments must be done before going on each course as to not lower the academic level for the other participants. Time to finish these assignments must be expected.

The participant will organise an exchange period with a department, clinic, or EMS/HEMS service or any combination of these in a different country. The period may be arranged as an exchange, a visit, or a locum position with a foreign clinic or service. While exchanges between Nordic countries are acceptable, the candidates are also encouraged to seek experience from less familiar systems in other parts of the world. Only a smaller part of the exchange can be done in a different region of your own country, and this should be cleared with the steering committee before planning.

The exchange should ideally be at least 1 month but may be split into smaller segments of at least 1 week duration each. The participant must have a clear learning goal for the exchange periods as well as a plan for how the hosts can help facilitate this.

The Exchange Period must be done after the enrolment into SSAI CrEM.

The candidate is expected to deliver a report from their exchange, sharing their experience and highlighting the differences and similarities between their local systems and the system in the exchange country.

The steering committee – and former participants white book – can help facilitate a variety of geographical wishes. Good ideas for the exchange are welcome in the application.

Scientific project

Each participant is required to do a scientific project which will run through the two years of the programme. The projects are individual. The projects planned by the participants will be introduced during the programme

Participants – no matter their former academic level – are required to submit and get their research project accepted as an abstract/poster at an approved congress (for example the next biannual SSAI Congress or the Congress of your National Society of Anaesthesiology) as a minimum, OR submit the project as a scientific paper to a relevant Pubmed indexed journal.

We would like to emphasize that the workload of the research project is not negligible.

A programme mentor from the SSAI CrEM steering committee will be provided to each participant to help with any difficulties along the way.

Upon completion of the programme the participants will be granted the SSAI Diploma in Critical Emergency Medicine (CrEM). Completion is dependent on the following conditions:

• Attendance of all four residential courses
• Completion of 4 weeks in an exchange programme
• Approval of all course assignments
• Passing the written test after the third residential course
• Approval of the research project
• Completion of 2 years of the clinical practice programme

The SSAI programme in Emergency Critical Care is intended to be a self-sustaining, not-for-profit programme. The cost of participation in the programme amounts to:

€11.500 which covers the educational programme and residential courses (including meals and accommodation)

Travel expenses are not included.

Payment is divided into four instalments payable before the onset of each residential module.

Expenses for the exchange programme are not included.

1 September, 2025.

Replies are expected out by 1 November, 2025.

If you have any questions regarding the application, please contact programme director, Nanna Kruse, nanna.kruse@regionh.dk