Accident-prone travelers take note: “If you get hit by a moped in a country like the Netherlands, you will most likely be taken care of by a first-year doctor — one who has not had any specialized training in emergency medicine,” says Terrence Mulligan, D.O., M.P.H. ’03. “Outside of the United States, a fully developed emergency medicine system is hard to find, even in otherwise well-developed countries.”
Though few ever stop to consider it, an emergency medicine system is dizzyingly complex. From ambulance networks, to emergency room administration, to specialty training, the system involves many interacting components that must be built in the countries where they are lacking.
Thanks to GW — where he simultaneously achieved an M.P.H. and became the Medical Center’s first International Emergency Medicine Fellow — Mulligan is helping to create these systems, one country at a time.
“Your residency teaches you how to practice medicine, but it doesn’t teach you how to build the system. My fellowship at GW taught me how to build the system,” he says, citing training in hospital administration, finance, management, economics, public health, and health policy, among other disciplines.
Mulligan’s public health training, he says, complemented his fellowship by teaching him how to “think on the right scale” in a multifaceted field. “If you don’t have public health training, your thinking is usually too small in terms of medical development,” he says.
In 2003, Mulligan joined a team from GW who helped to establish Emergency Medicine residencies in Iran, Chile, and India; start a paramedic training school in Oman; begin an emergency nursing training school in Kuwait; and implement ambulance and disaster training in the United Arab Emirates.
Mulligan moved to the Netherlands in 2006 to help create one of the nation’s first emergency medicine residencies at Erasmus University in Rotterdam. He has since helped develop a similar program at UMC Utrecht, another of the country’s eight medical schools. Over the last 10 years,Mulligan has initiated and participated in international emergency medicine development programs in more than two dozen countries and assisted in establishing training schools for paramedics, relief agencies for underserved areas, disaster medicine and preparation programs, and hospital trauma development systems in more than 20 countries.
Among other international leadership roles in emergency medicine, Mulligan currently acts as co-director of the Emergency Medicine Residency at UMC Utrecht and clinical assistant professor in the Department of Emergency Medicine at the University of Maryland School of Medicine.
“The things that are killing health care systems around the world are emergency problems related to non-communicable diseases such as cardiovascular disease, strokes, cancer, and trauma, yet most of the world doesn’t have the capacity to handle them,” says Mulligan. “So, to me, helping countries develop systems for emergency care is the way I can make the greatest public health impact.”
