**2. Background**

Early in the history of medicine, "healers", who we would now call physicians, had a general scope of practice and were looking at every all types of complaints from patients [4]. Before the widespread of telecommunication technology, patients were often expected to report to the physician as opposed to the physician receiving an emergency call to then travel to meet their patient. Then there was specialization into medicine and surgery. Those main branches were gradually divided into many others increasing number of subspecialties [5] and lead to the advancement of medical care in general. This has played a role into increasing our life expectancy, especially in the most developed countries. On the other hand, it has also led to the fragmentation of health services. There is a tendency for each service to concentrate on their narrow scope of practice, generally limiting patient access to other services. Some patients' health issues may not be diagnosed and the complaints they might raise may not be carefully considered and addressed. There was a need for a specialty to look at patients as a whole entity so they can be appropriately referred and benefit from the best line of management from other more specialized physicians or other healthcare professionals. Acting as a patient advocate is often the role of the modern family physician or general practitioner, but it can also be perceived as a gatekeeping activity which raises concerns [6, 7].

Furthermore, there was difficulty in accessing health services in emergency situations. This elicited the need for out of hospital emergency services, primarily started as a transport service, eventually with first aid capability, to pick up patients wherever they were and take them to a hospital where they could be seen by a medical professional [8]. This was followed by the development of the emergency medicine specialty. The role of the emergency medicine specialist is not to provide long-term care and follow up patients until they recover from their illness or injury, but simply to provide immediate urgent care and act as one of the possible entry points into the healthcare system. That healthcare system can then provide longer terms support with follow up appointments organized with the appropriately specialized department(s) and clinicians, or if necessary, the patient may be admitted as an in-patient into the hospital for longer-term care. The issue is that many patients are either playing with the system to their personal advantage to gain quicker treatment to the detriment of others or that they do not understand the real function of an ambulance service and the emergency department (ED). Many people call an ambulance or use emergency departments to obtain quicker service and avoid long delays in obtaining appointments in outpatient clinics. The crowding of EDs has become a growing global problem [9, 10]. There is a need for a new way of dealing with the varying degrees of emergency cases to decongest emergency departments so patients in a real emergency condition can be seen in a timely matter. It could play a significant role in decreasing mortality and morbidity, and making more cost-effective use of healthcare resources.
