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2011 GEMA Newsletter No. II

The Global Emergency Medicine Academy (GEMA) aims to improve the global delivery of emergency care through research, education, and mentorship as well as to enhance SAEM's role as the international Emergency Medicine organization that augments, supports, and shares advances in global research, education, and mentorship.


What is in GEMA News? From The President Ian B.K. Martin, MD From The Editor Vicken Totten, MD Report from the 8th International NY Symposium Scott Wiener, MD Report from 2011 MEMC Kos� with Pictures from Kos Scott Wiener, MD The Consortium of International Emergency Medicine Fellowships Sassan Naderi, MD Articulating an Agenda for Humanitarian Education and Training Dr. Peter Walker Update from Botswana Andrew Kestler: Andrew.Kestler@mopipi.ub.bw Amit Chandra: Amit.Chandra@mopipi.ub.bw Bits and NewsBites Vicken Totten, MD

GEMA

was born in June of 2011 and has gained 150 members and reached more than 4 countries and continues to grow strong!


From The President Ian B.K. Martin, MD

Greetings! This marks the second of a series of “From the President” installments which will appear in each issue of the GEMA Newsletter. This letter also marks the holiday season, and I wish each and every one of you a safe, happy, and prosperous time! Can you believe it? It has already been six months since we launched GEMA in earnest. I’m proud to say we’re off to a strong start and have, in just a short while, accomplished a lot. In this second installment, I’ll highlight some of our achievements to date. Firstly, we lobbied the SAEM Board of Directors for implementation of a tiered-dues structure for all levels of SAEM general, academy, and interest group membership. This proposal came on many years of “tossing” the idea around, but it was this group that brought it to fruition. Thankfully, the Board approved our proposal, and now, our colleagues from resource-limited countries pay a fraction of the usual membership costs (proportionate to the World Bank economic classification). I think—no, I am certain this will go a long way toward attracting more members to GEMA and to SAEM. Our tiered-dues structure has quickly become a model for other organizations, including the Emergency Medicine Residents’ Association (EMRA). Speaking of increasing numbers…in just the first six months of GEMA, we have amassed 71 faculty and resident members! This is absolutely amazing! As a reminder, we were required to have 100 supporting members when we applied for academy status. And we are required by the Board to have at least 75 active members to maintain academy status. To put our success in perspective, in just our first six months, we have attracted more members than some much older SAEM academies even have. I think we are poised to be the most popular SAEM academy yet! Secondly, GEMA in its first year had two formal didactics selected by the SAEM Program Committee for presentation at the 2012 Annual Meeting in Chicago. Drs. Diane Birnbaumer, Kate Douglass, Susan Promes, Vicken Totten, Mary Jo Wagner, Scott Weiner, and I will be presenting, “Training the Trainers Who Train: A Workshop for Those Who Teach Emergency Medicine Elsewhere in the World”. Drs. Mark Hauswald, Stephanie Kayden, Adam Levine, and I will present, “More Than Just a Hobby: Building an Academic Career in Global Emergency Medicine”.

Additionally, several members have represented GEMA and SAEM at various international meetings, including the New York International Emergency Medicine Symposium (this past summer), Mediterranean Emergency Medicine Conference, in Kos, Greece, and the very recent “Emergency Medicine in the Developing World” conference in Cape Town, South Africa. I look forward to increasing our visibility at such meetings in the near future. GEMA, in its first six months, has also embarked on some very important collaborations: 1) GEMA is collaborating with colleagues from the Council of Emergency Medicine Residency Directors (CORD) and the EMRA International Committee to produce a consensus statement (to be published) on safety standards for learners rotating overseas; 2) GEMA worked with organizers of the Chief Resident Forum to launch a pilot SAEM Chief Resident Forum International Scholarship. The organizers have already selected two deserving residents from overseas to participate in this upcoming Annual Meeting. 3) Finally, GEMA is working closely with the SAEM Program Committee and the European Society for Emergency Medicine (EuSEM) to highlight European advancements in Emergency Medicine and specialty development at our next Annual Meeting. In exchange, several SAEM/GEMA members will be invited to speak at the next EuSEM conference. As you can read, we have had a very productive first six months, and this listing is in no way exhaustive. I look forward to a meaningful and even more productive next six months. Happy holidays! Warmest regards, Ian B.K. Martin, M.D. Founder and President, GEMA


From The Editor Vicken Totten, MD

Welcome to the second issue of GEMA News! So much has happened that instead of waiting until April, we have a second issue already. I hope you enjoy reading our newsletters, and find them informative. Unfortunately, if you haven’t renewed your Academy dues, you may suddenly find yourself no longer a member of your favorite Academy or interest group. Remember, Academy and Interest Group membership is NOT automatically renewed by most groups, so please remember to go to SAEM (http://www.saem.org/membership-dues) to check on your status. If you forgot when you renewed, well, you can do it now! In this issue, you will be updated on what’s happening in emergency medicine around the world, and you will learn about the Consortium of International Emergency Medicine Fellowships. “Global emergency medicine” or “International Emergency Medicine” means different things to different people. Currently, there are about 30 “International Fellowships,” of which most are located in the USA. Since global (or international) medicine is not an official subspecialty of emergency medicine it does not have a standardized curriculum. There are significant conceptual differences among the programs. Some programs have close relationships with specific sites in undeveloped countries. Others focus on disaster response, on infrastructure development, or on the development of EM as a specialty. Most programs have only 1 or 2 fellows per year, and most of the programs last 2 years. The fellows support their programs though work as attendings in their home institution, and by the work they do abroad. To date, there has been no official “home” for the Fellowships, although their goals are clearly aligned with those of GEMA. Dr. Terry Mulligan, the ‘instigator’ of the Consortium, pointed out that all the programs would benefit from further coordination through communication. He therefore proposed the Consortium during the 8th NY Symposium, where a planning meeting was held. At Scientific Assembly, there were further discussions. By such cooperation, the Fellowships will be able to accomplish more together than each alone. At any one time, some programs will have more Fellows than grant-funded projects; others have grants which call for more work than they have Fellows. Sharing opportunities and

projects will help to even the work load. The Consortium (CIEMF) discussed various venues for a WebSite on which each Program can have a presence, and where potential applicants can compare programs, or even search for jobs after graduation. To this end, Emergency Physicians International (EPi) is beta testing a new page called the EM Global Link. (www.emgloballink.com). There, you will find the Fellowships listed. Speaking of communication, email and blogging have more or less replaced personal letters and newsletters. For example, one of our members, Adam Levine, blogged in near realtime from Libya, where he assisted local physicians during the rebellion. You can read his blog at http://epinternational. ning.com/profiles/blog/list?user=35pqdrnmh01dw. GEMA and EPi have begun discussion regarding an official affiliation to give academicians in emergency medicine their own social network space. Stay tuned! GEMA’s Web page is located at: http://www.saem.org/globalemergency-medicine-academy. How to get there is not yet intuitive. GEMA is listed under “Membership”. The new WebSite still needs tweaking. Please go to your Academy’s webpage and suggest changes. Suggestions for change should be sent to HGouin@saem.org. The GEMA newsletter is currently being posted on our WebPage under Resources / Communications and is freely available to all who wish to read it. There is also a clickable link to upcoming international meetings. Please help us to keep it updated. Our vision is that SAEM will be the intellectual home for every academic emergency physician, be she in Russia or China, be he working in Africa or in Belgium or in Brazil. Rather than being divided by our countries of origin, we are united as academic EPs. Have a story to tell? Working internationally? Why not tell GEMA about it! Get your international voice heard with GEMA News. Also, it is said a picture is worth a thousand words. We welcome your submissions from around the globe! All article ideas and submissions can be sent to Vicken Totten, GEMA Editor for review and approval. Vicken.Totten@UHhospitals.org


Report from the 8th International NY Symposium on International Emergency Medicine Scott Weiner, MD

The Eight Annual New York Symposium on International Emergency Medicine was held at the Lenox Hill Hospital in New York City on August 17-18, 2011. I have attended several of these conferences in the past and am pleased to report that they get better each year. What started as a sort of grand rounds for the local residencies has evolved into the de facto International EM Fellowship conference, and is, at this point, the premier conference specifically discussing International Emergency Medicine (IEM) held in the U.S.

Those who were able to get out of bed the next morning after a fantastic networking dinner at a delicious Manhattan Indian restaurant enjoyed the second day of the conference. It was a truly a discussion about “where the rubber meets the road”, talking about the work of the International Medical Corps, (represented by Dr. Ross Donaldon), who described their important work in austere and crisis-struck areas around the world. There were also discussions about funding projects, the Fulbright Scholar Program and working with NGOs.

This year’s theme was “Global Collaborations in Emergency Medicine” and the course directors, Drs. Sassan Naderi, Terry Mulligan, Kumar Alagappan and John Acerra are to be congratulated for putting together an interesting and informative 1 ½ day program. (Joe Lex was there and recorded the proceedings. You can listen in by downloading the mp3s from the confrencefrom http://freeemergencytalks.net/ - editor.)

The conference stimulated many ideas and subsequent discussions. Because it was a small conference of relatively focused and similarly minded folks, people got to know each other a little more deeply than they would have at a larger conference. The conference could have been improved by the addition of a little more unstructured time. Since one function of such a conference is “backhallway” conversation, small break-out groups and semistructured or unstructured time within the conference itself would have promoted more networking.

The conference opened with a keynote address by Dr. Joseph O’Neill, the former Deputy Coordinator for the U.S. AIDS program. His talk was inspirational, describing the millions of people that were helped by providing antiretroviral medications, and the power of a governmental program when done correctly. The next two sessions were focused on humanitarian relief, disaster medicine and IEM development. Drs. Robert Bristow, Peter Cameron, Jim Holliman, Terry Mulligan, Lee Wallis, Emilie Calvello and others discussed disaster relief in Haiti, South Africa and Japan, as well as the role of national and international specialty organizations in developing EM. This theme was reinforced when Dr. Peter Cameron discussed the role of the International Federation for Emergency Medicine, the organization for which he is currently president. A panel describing the role of national societies in EM development was convened, including representation from African and Australia. Dr. Sandy Schneider (president of ACEP) and myself (representing GEMA and AAEM) were also invited to participate. The afternoon session was particularly interesting. Dr. Terry Mulligan convened a follow-up meeting to discuss a proposed IEM Fellowship Consortium. The consensus of those in the room was that there could be much benefit from IEM fellowships working together and pooling resources and expertise. There was also discussion of GEMA’s potential role in such a consortium, particularly in providing an infrastructure and easy means of communication amongst the participants. Finally, to close the day, Dr. Latha Stead gave a talk about getting one’s work published. Her talk was informative and entertaining.

Overall, the conference was informative, interesting and high-level. As with IEM in general, this conference has matured significantly since its beginnings, and I look forward to attending next year. If the trend continues, this conference will become that in which all of the IEM fellowships get together on an annual basis. The combination of the international flavor of New York City and the interesting talks and panels made this conference exceptional.


Report from Kos, Greece. MEMC 2011 Scott Weiner, MD

From its humble beginnings at the Italian lake town of Stresa in 2001 to its journey to the island of Kos, Greece this year, the Mediterranean Emergency Medicine Congress (MEMC) has achieved marked success. I had the incredible fortune of attending the conference in Kos this September. In case you have not heard about it, Kos is a small Greek island of only about 100 square miles. It is located in the far east corner of the Aegean Sea, and Turkey is visible from its coast. The island also happens to be the birthplace of Hippcrates, the “Father of Medicine.” Looking at his teachings, including descriptions on dislocation reduction and wound care, I like to believe that he was the father of Emergency Medicine as well!

which was interesting and well-received. Additionally, the conference’s original creators, Antoine Kazzi, Roberta Petrino and Francesco Della Corte were honored with the “Founders Award”. Top research submitted to the conference was also presented.

The conference itself began with two days of precongress courses. The courses, for which I had the privledge of being the track chair, went exceptionally well. Among others, the courses included well-attended and informative beginner and advanced ultrasound courses, a course on advanced EKG interpretation, on management of Improvised Explosive Device (IED) injuries, and a train-the-trainers course on simulation for those with mannequins or simulation centers who want to learn how to return to their home countries and train others using simulation.

The second part that caught my attention was the level of talks. Whereas ten years ago, the lectures felt more basic, teaching to a less-educated audience, now the level of the talks is as high as anywhere else. Talks cover everything from advanced and cutting edge resuscitation techniques to procedural sedation; from old to brand new indications for ultrasound. In sum, these advanced talks were reflective of the highlevel of the participants.

The next two and a half days were filled with lectures on just about ever topic in emergency medicine imaginable. There were tracks on resuscitation, toxicology, ultrasound, trauma, prehospital medicine and pediatrics. There was also a dedicated track for administration, which was useful for department leadership from around the world to share ideas about how to make their departments run more smoothly. The research section was also formidable, with dedicated oral poster presentations and the standard printed The island is home to several amazing ar- posters on display. Over 500 abstracts were presented chaelogical and cultural sites. The two that are at the conference! best known are the Asklepieion, a massive three level complex of temples and a hospital where Having had the fortune of attending several MediterHippocrates studied, and the Plane Tree, an an- ranean congresses, including the first one and this cient tree now supported by metal beams, under most recent sixth conference, I was struck by several which Hippocrates was reported to have taught things. The first is that EM is growing internationally, his students. Combine these sites with a blue sky and there is no stopping it. Dr. Helen Askitopoulou, an even bluer sea and perfect weather, and the from the Helenic and European Societies of Emerconference was held in perhaps the most perfect gency Medicne, gave a talk on the status of EM in of locations. It was quite a trek for most attend- Europe. EM is spreading like wildfire. Regions and ees, who first had to arrive in Athens then board countries are recognizing the importance of EM for a ferry or small plane to Kos, but it was worth the the health of their citizens and therefore training projourney. grams and specialty recognition are now widespread.

Finally, I was so glad to see participants from all over the world discussing EM, how it is practiced locally, and searching for innovative ways from other parts of At the opening ceremony, Dr. Stefanos Gerou- the world that they could “import” to help make their lanos gave a talk on the origins of Hippocrates practice of EM better. It is really what many of


Kos cont. us in GEMA believe in, and it was great to see it practiced real time. Overall, the conference was a great success. I congratulate the conference’s major sponsoring oranizations: the European Society for Emergency Medicine (EuSEM), the American Academy of Emergency Medicine (AAEM) and the Hellenic Society for Emergency Medicine (HeSEM) for a job well-done. The next congress, in Fall, 2013, will be held in Marseilles, France. I hope to see you there!

The Consortium of International Emergency Medicine Fellowships is founded! Sassan Naderi, MD

“Communication is the key to effective collaborative work.” As the Director of the IEM fellowship at Long Island Jewish Medical Center, I am involved in various projects aboard, grant proposals and conferences, and often find myself in need of manpower. Recently, I was surprised to discover there are other fellowships working in the same region of India where I work, and we decided to share resources. From a single random interaction, I suddenly had twice the manpower and educational material! For years we have all talked of a network that bridges the silos of International EM fellowship programs—an entity that would eliminate our reliance on random meetings. Recently, this concept has become more concrete. A widespread interest has become apparent among representatives of various IEM fellowships. At the October ACEP meeting, IEM fellowships directors and interested parties came together to discuss the existence of a Consortium of IEM Fellowships. We decided to move forward to create a centralized information tool—a highly interactive website. Currently, we are pooling the various ideas and visions of interested parties to create the design and format of the website as well as to choose a name and host for this interactive tool. By laying the foundation

for open lines of communication between fellowships, we hope to pool funds, manpower, educational material and ideas. Together we can nurture current projects and create projects that would be impossible for any single fellowship to undertake alone. Our website will include details on all fellowships and projects, searchable by region, fellowship format and topic. Physicians interested in getting involved will be able to find existing projects in their regions of interest and those interesting in applying for IEM fellowships will have a centralized place to learn about our fellowships and apply. Most importantly, the website will also be a place for members to communicate and collaborate. Those who are interested can contact me at the email address below. Sassan.naderi@gmail.com Director of International Emergency Medicine Fellowship North Shore-LIJ Health System Assistant Professor Emergency Medicine Hofstra University School of Medicine


Articulating an Agenda for Humanitarian Education and Training Dr. Peter Walker

Geneva, Switzerland hosted a 2 day conference entitled, “Articulating an Agenda for Humanitarian Education and Training” held the 27th & 28th of October 2011. This conference brought together some 200 attendees representing aid work, agencies, donors and universities from US, European, and African institutions, all interested in teaching humanitarianism. Key emerging issues were:

for self-assessment, or should there be some external way by which they can be measured? Can they be taught? How can agencies judge staff merit? Which begs the question, how shall Universities cover the core competencies in their humanitarian education? Professional Association: There was great support for creating some form of global association to promote the core competencies and to give legitimacy to humanitarian trainings offered around the world. The notion that such an association would be able to offer individual members a training “passport” got a lot of traction. This would be a certified document where accredited training and experience in the sector can be recorded and where an individual’s level of competence can be officially verified. More importantly, I think, there was support for such an association to promote the basic ethics of humanitarianism. There was agreement that to start this requires a few dedicated individuals to set it going, and their employers to be willing to give them the space (which means the time) to start things.

University education: The huge growth in distance learning degrees allows people to gain a Masters degree at a fraction the price of a residential degree. For example, Deakin University in Melbourne (Australia) offers two year distance learning Masters at cost of USD9,000 total. Each year about 150 students graduate from this program. The distance learning degrees and the residential degrees are not offering quite the same education. Deakin makes it clear that the distance degree is a vocational training qualification with an emphasis on specific skills and knowledge in water, sanitation, nutrition, logistics etc. The residential degree has a greater emphasis on Dr. Peter Walker academics. Irwin H. Rosenberg Professor of Nutrition and Human Security Research: There was also a long discussion over Director, Feinstein International Center the role of research in humanitarian work. Much Friedman School of Nutrition Science and Policy of the discussion was about helping operational Tufts University agencies see that humanitarian research is not 200 Boston Avenue, Suite 4800, Medford, MA 02155, just a form of consultancies to deign better prod- USA ucts for the agencies, but is also about under- Tel: +1 617 627 3361 standing the environment of humanitarian crises Mobile: +1 978 387 5772 and critiquing the workings of the humanitarian Fax: +1 617 627 3428 system. Many participants express worry that Skype: pcwalker33 traditional funders of research in the humanitar- Blog: http://sites.tufts.edu/gettinghumanitarianaidian sector (basically the government aid donors right in Europe) will respond to the European mon- Web: http://fic.tufts.edu etary crisis by drastically cutting their humanitarian aid and research budgets. This report is also posted as a blog on the North America Hub site http://phs-us.ning.com Core competencies: For some years, the humani- Additional information on this topic can be found at: tarian aid sector has been discussing which skills http://content.healthaffairs.org/content/29/12/2223. should be considered core competencies. There abstract?sid=99015d1f-5ae3-4fdc-a250-334bcwas fierce debate on questions of assessing these 832fa34 competencies. Should they be considered a tool


Botswana Emergency Medicine Update, December 2011 Andrew Kestler & Amit Chandra

In January 2011, Botswana became the 4th SubSaharan African country (following South Africa, Ghana, and Tanzania) to offer emergency medicine post-graduate training. Three residents, all Batswana (citizens of Botswana), are continuing their training at Princess Marina Hospital, the main government referral hospital in the capital, Gaborone. Our in-country emergency medicine faculty includes two emergency physicians from the United States and one from Australia. Although we are stretched thin between clinical, didactic, and administrative commitments, our staff to resident ratio still manages to make our South African colleagues envious. Following a rigorous interview process, our second intake of 4 residents is schedule to start next month.

Two of our first year residents took the part 1 exam in October and we’re proud to report that they both passed. A few months ago, we were excited to obtain our department’s first ultrasound machine. With the help of our South African colleagues, we recently conducted an ultrasound training course for all of our residents and several anesthesiology residents and specialists. Over the coming months we hope to provide additional bedside training so they can all become accredited emergency sonographers.

Botswana is a vast but sparsely populated country of two million people. Given the low volume of emergencies in most rural facilities, we project that our graduates will initially work clinically in the urban centers of Gaborone and Francistown, and in the larger district hospitals of Maun and Mahalapye. In smaller facilities, we expect our graduThe rest of the medical school continues to grow, ates to play an important role as medical directors and having expanded from a staff of five to forty in emergency care trainers for generalist medical officers. two years. The third intake into the undergraduate medical program (MBBS) occurred in August Needless to say we have plenty to do over the coming year 2011. On the post-graduate side, anesthesia, fam- related to the residency: 1) become accredited as a reily medicine, and public health also launched pro- suscitation training center for our own residents and othgrams in 2011, following internal medicine and ers; 2) organize off-service rotations; 3) launch a national pediatrics which launched in 2010. Surgery and emergency care society, and much, much more. Beyond obstetrics & gynecology are scheduled to come the residency, we are in the final stages of getting a multionline in 2013 or 2014. With some luck, we will disciplinary trauma research centre off the ground. We are move from our temporary warehouse into a new also advising the Ministry of Health on the development School of Medicine building in June of 2012. The of a pre-hospital care and emergency care policy, and are University Hospital under construction is slated to occasionally called on to give input on disaster manageopen in 2013. ment issues‌for example, how to screen the Batswana returning from Japan for radioactivity exposure. The UB Emergency Medicine Residency is a fouryear Masters of Medicine (M Med) program. The And we are almost forgetting the clinical arena: At Prinrotations include about 2.5 years of emergency cess Marina Hospital, we attend a population, which, by department time, and 1.5 years of off-service ro- United States standards, would be considered unusually tations, including medicine, pediatrics, anesthesia, young and sick: Trauma and AIDS complications most and critical care. Third-year residents will spend at affect those between the ages of 20 and 50. We admit beleast six months abroad for exposure to high-tech tween 30-50% of our patients, of whom at least 1-2 per emergency departments and intensive care units. day are suffering from septic shock. To add to the chalBased on discussions in progress, the time abroad lenge, laboratory results are not available in real time, the is most likely to be in Australia or South Africa. CT is often down, and we sometimes run out of IV fluid We have partnered with the College of Emergency and other basic medications and supplies. Medicine of South Africa to enable our residents to sit their Part 1 and Part 2 examinations necessary Botswana remains blissfully safe and stable, and the econfor emergency medicine specialist certification. omy is rebounding as the global demand for diamonds


picks up again. When not at work, there is much do: The Botswana cont. closest game reserves are only thirty minutes away, and many others are within a three hours radius. Interested yet? We can assure you it is quite difficult to get bored with an emergency job in Botswana. We still have several full-time positions to fill, and we welcome residents and attending physicians who want to visit. Our recommended minimum stay is six weeks for those who want to share in the clinical work. For more information please e-mail: Andrew Kestler: Andrew.Kestler@mopipi.ub.bw Amit Chandra: Amit.Chandra@mopipi.ub.bw

Bits & NewsBites Vicken Totten, MD

Society of Emergency Medicine in India (SEMI)

change; more on that later.

A satellite meeting of the SEMI was held during the 2011 ACEP Scientific Assembly. In attendance were physicians from India (representing SEMI) and American physicians, representing the Association of American Physicians of Indian Origin (AAPI) as well as interested others. SEMI was pleased to announce that emergency medicine in India has matured to the extent that at the next Indian EM conference, most of the faculty will physicians practicing in India as opposed to Americans of Indian origin practicing in America. There was much discussion about the appropriate relationship between SEMI and AAPI, as well as the needs and roles of foreign faculty versus the importance of becoming autonomous. SEMI appreciated the support of AAPI. SEMI also discussed the applicability of the IFEM Curriculum to Indian needs.

New Books to Watch for:

IFEM held several satellite meetings. Some highlights were the International Medical Student Curriculum (which outlines what every physician in the world should know about emergency medicine and should be taught in medical school), the International EM Specialist Curriculum, and discussions about if there should be an International Pre-Hospital Providers curriculum. IFEM has undergone an organizational

Protocolos de Bolsillo: Notificación para Sobrevivientes acerca de la Muerte Súbita o Inesperada (Spanish Edition) by Kenneth V. Iserson MD and Dr. Juan Manuel Muñoz Barrett (Jun 29, 2011) – available in Kindle eBook. $5.99 Improvised Medicine (Paperback) by Kenneth Iserson. It should be out by May 2012.) $54 It should also (eventually) come out as an ebook--in multiple languages. It can be preordered at http://www.amazon.com/Improvised-Medicine-Kenneth-Iserson/dp/0071754970 Wilderness Medicine, Expert Consult Paul S. Auerbach, MD, MS, FACEP, FAWM Premium Edition - Enhanced Online Features and Print, 6th Edition 199.00



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