2011 GEMA Newsletter No. I
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 UNC Global Emergency Medicine Christine Ngaruiya, MD Upcoming EM Meetings Around the World Emergency Medicine in India Rejeesh Menon, MR Update on PACE and from Spanish America Haywood Hall, MD, FACEP, FIFEM GEMA Membership Holly Gouin, MBA The Tech Corner Christopher Johnson, MBA Kudos
GEMA
was born in June of 2011 and has gained 41 members and reached 4 countries in just 3 months. Imagine where we will be in a year!
From The President Ian B.K. Martin, MD
This marks the first of a series of “From the President” installments which will appear in each issue of the GEMA Newsletter. Despite my excitement, I must admit that it has been difficult to prepare this. What does one write for the inaugural “From the President” piece? Surely, it should be something memorable. After much deliberation, I came to the conclusion that the real story is that I have the opportunity to write this “From the President” at all. Said another way, this piece is a poignant reminder that we’ve done it—that we have become an Academy! I have been given much of the credit for the creation of GEMA. But the truth is that I had a lot of help in bringing this Academy to fruition. You see, the wheels for this were set in motion years ago—by members like Dr. Jim Holliman, Dr. Kris Arnold, Dr. Kathy Clem, Dr. Mark Hauswald, Dr. Kumar Alagappan, and Dr. Bobby Kapur, to name just a few. Members of the erstwhile International Committee and International Emergency Medicine (EM) Interest Group laid the foundation for this dynamic new Academy by creating a space in which all of us globally-minded members could congregate, network, and flourish within this great SAEM organization. I can vividly remember my entree into this organization years ago: I attended a Business Meeting conducted by the then International EM Interest Group Chair, Dr. Kris Arnold. One of my mentors, Dr. Kathy Clem, invited me to attend with her. Before I knew it, I had been elected the new Interest Group Secretary! I was in the “right” place, at the “right” time, surrounded by the “right” people. And, as they say, the rest was history—serving in some leadership capacity ever since—whether in the International EM Interest Group or the International Committee. As I rose up the ranks, ultimately becoming the last International EM Interest Group Chair (and for that, the last International Committee Chair), years of discussion of becoming an Academy peaked. The momentum was with our group. We had amassed a critical number of members who believed becoming an Academy was the next best step for the organization. And, perhaps as important, in my time as Chair of the International EM Interest Group, I had assembled one of our most capable, creative, and in-
dustrious teams the SAEM international groups had ever seen. With the likes of Dr. Scott Weiner, Dr. Vicken Totten, and Dr. Kathy Clem, and so, so many more, we pushed forward with a proposal to the SAEM Board of Directors. We had wide support from the membership and hard work from a dedicated few. After months and countless working conference calls, and edits to various supporting documents, I received word from our Board of Directors March 16th, 2011 that we had been granted Academy status! All these years later, we have become the Global Emergency Medicine Academy! So now, as the newest SAEM Academy, we are poised to and charged to improve the delivery of emergency care through research, education, and mentorship - only not just in the US anymore. We (SAEM) were a US organization by accident of birth. Now we have grown up to include the whole world. GEMA’s mission is to enhance SAEM's role as the academic emergency medicine organization that augments, supports, and shares advances in research, education, and mentorship in EM, everywhere in the world. So writing this piece wasn’t so hard, once I decided the story is that I actually get to write this at all. After many years, many trailblazers before me, and much hard work, we are now an Academy. I am honored to lead such an able group and am proud to share in the organization’s success. As your President, I look forward to working with you all to realize our many aspirations and to make SAEM the global representative of Emergency Medicine teachers and researchers the world over.
From The Editor Vicken Totten, MD
Welcome to the first issue of GEMA News! The Global Emergency Medicine Academy was launched in June 2011, and we are committed to producing two newsletters this year. This is our very first one! Each issue will have a note from the President (Dr. Ian Martin) and a note from the editor (yours truly, Vicken Totten). The rest of the newsletter will contain non-scientific articles of international interest on a variety of different topics. Topics will be prepared by members of GEMA’s Media and Communications Committee, and from all of you! I want articles from any and all of you on the listserv and also from your friends. Please send me short articles about topics of international interest. Please also send me information about upcoming international conferences, links to articles of interest, and anything else that you think might be of interest to other GEMA members. The Society for Academic Emergency Medicine (SAEM) is an organization that is American only by accident of birth. By that accident, and because the US is the country which has the most mature EM specialty, SAEM is also the most mature organization in the world which is dedicated to serving those of us whose professional focus is training the next generation of Emergency Practitioners, and to furthering our specialty by scientifically investigating its underpinnings. The torch in our logo is there to remind us that our job is to light the way for those who follow us. GEMA, as one of the Academies within SAEM, is working together with the Board of Directors to broaden the membership base, to move SAEM forward as a global organization, to improve SAEM’s services to academic emergency physicians wherever they practice, while staying committed to improving the teaching of, research in, and delivery of emergency medical care throughout the world. 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. Again, welcome to the first issue of GEMA News!!
SUBMIT YOUR GEMA NEWS 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
UNC Global Emergency Medicine Christine Ngaruiya, MD
International EM: Spotlight on the University of North Carolina. Global Emergency Medicine (EM) experiences have become a part of competitive US-based EM training programs. Residents increasingly seek to become involved in this area. Global EM fellowships are one of the structured mechanisms by which EM graduates can pursue a career in international medicine. Currently, there are over 25 Global EM fellowships in the United States. The program at the University of North Carolina (UNC) is one of the newest additions. The UNC Emergency Medicine Global Health and Leadership Program (GHLP) found roots in the Department of Emergency Medicine beginning this summer*. During the 2-year program, fellows engage in direct clinical work and supervision of residents as junior faculty in UNC Hospitals’ Emergency Department. Fellows also implement an investigative research project, and provide patient care overseas during seven months at the UNC primary clinical site in Kenya, East Africa. Finally, GHLP fellows will complete coursework for a Masters in Public Health (MPH) degree, and will graduate with a certificate in Global Health from the renowned Gillings School of Public Health at UNC. UNC also offers international experiences, including clinical rotations abroad for both residents and medical students. Five of thirty (16.7%) current EM residents have been overseas in the past 2 years. UNC is fairly unique in that residents can go overseas throughout their three years of training. Trainees have provided clinical servicelearning in Haiti, Mexico, and Kenya, among other places. Traveling residents or students are required to complete a scholarly project as part of their international experience (e.g., published manuscripts, didactics, etc.). Additionally, UNC Global EM actively seeks to improve the delivery of emergency care in targeted, underserved regions of the world, in part through investigative research. As an example, it maintains an active acute care registry in Arusha, Tanzania. Further, UNC has established an exchange with institutions in Japan and Korea. This exchange serves to expose trainees and faculty, both at UNC and from the visiting institutions, to alternative EM practices, thus encouraging national EM development in these countries. Visiting foreign physicians are involved in a variety of activities, including clinical “shadowing”; emergency medical systems (EMS) “ride-alongs”; research projects; and participation in research, administrative and educational leadership meetings.
Finally, an enhanced Global Health education curriculum or “Global Health Concentration” is available to EM residents at UNC who have a particular interest in Global Emergency Medicine. The curriculum includes a regimen of global clinical experiences, national leadership and committee activities, research, and as well as supporting Global EM work within the Department. The program will be graduating its first resident from this concentration this year. Overall, international offerings in UNC’s Department of Emergency Medicine have greatly increased over the past two years under the leadership of Dr. Ian Martin, Global EM Director, with strong support from the Department and the parent University. There is continued room for expansion, and we will continue to look forward to further opportunities. *Acknowledgement to Dr. Ian Martin for information provided. Chase J, Evert J. Global Health Training in Graduate Medical Education: A Guidebook 2nd Edition. Kirsch TD, Holliman CJ, Hirshon JM, et al. The development of international emergency medicine: a role for U.S. emergency physicians and organizations. SAEM International Interest Group. Acad Emerg Med. 1997;4:9961001. Dey CC, Gabrowski JG, Gebreyes K, et al. Influence of international emergency medicine opportunities on residency program selection. Acad Emerg Med. 2002;9:679683. Morton M, Vu A. International Emergency Medicine and Global Health: Training and Career Paths for Emergency Medicine Residents. Ann Emerg Med. 2011;57:520-525. Fellowship Directory. SAEM. http://www.saem.org/ fellowship-directory. Accessed July 14, 2010.
Upcoming EM Meetings Around The World 24th ESICM Annual Congress October 1-5, 2011 Berlin, Germany IAEM Annual Scientific Meeting 2011 October 20-22, 2011 Strand Hotel, Limerick, Ireland 2011 International Emergency Department Leadership Institute (IEDLI) October 24-28, 2011 Boston, Massachusetts, USA 3rd Rural and Remote Mental Health Symposium November 14-16, 2011 Mercure Ballarat Hotel, Ballarat, Victoria, Australia IFEM Symposia: Quality & Safety in Emergency Care November 15-16, 2011 British Museum, London, United Kingdom Third Biennial Emergency Medicine in the Developing World Conference November 15-17, 2011 Capetown, South Africa Quality & Safety in Emergency Care Symposium November 15-16, 2011 British Museum, London 28th ACEM Annual Scientific Meeting November 20-24, 2011 Darling Harbour, Sydney, NSW, Australia Basic Echocardiography Workshop 2011 November 21-25, 2011 Broadbeach Waters, QLD 7th WINFOCUS World Congress on Ultrasound in Emergency and Critical Care November 22-27, 2011 New Delhi, India
Did you attend one of these events? Let GEMA know how it was by submitting a small article for the next newsletter along with any pictures we can post!
Stockholm, Sweden
Log onto the SAEM website at www.saem.org and view a complete listing of international meetings beyond 2011 within the GEMA page. If you are aware of an upcoming meeting we have not noted please contact: Vicken Totten Vicken.Totten@UHhospitals.org to suggest your meeting be added to the main list.
Emergency Medicine In India Rejeesh Menon, MD
Emergency medicine in India is like a pre-term neonate, delivered by a high-risk patient. The baby is now found to have some congenital anomalies. The medical fraternities of India wonder what to do with him. “What are his risk factors? And whatever are we to do with him? Will he grow up, or will he die?” 1. Mother India is the second most-populated country in the world. There are many different ethnic groups and cultures, and vast poverty. Most of the population lives in rural areas. Illiteracy and lack of health awareness (especially in northeastern part of the country), put the Mother at great risk. 2. Mother India has a stiff, old medical system. It is hierarchical. Primary Health Centers refer to Community Health Centers; District Hospitals and Medical Colleges serve as tertiary health centers. Those in power rarely care for patients in their own environment. It sometimes seems as if they only care for the well-off. 3. Mother wasn’t aware she was pregnant, and isn’t sure what she has delivered. Both the medical system and the general public are confused. “Where do I go when I have an acute problem?” In the private sector, there are many hospitals with good EM departments and well-trained EM physicians. For the general public in India, the private sector has been an inaccessible dream. Fortunately, this is changing. Governmental response has been to classify the population based on social and economic scale into BPL (Below Poverty Line) and APL (Above Poverty Line). Those under BPL will get a Health smart card, known as RSBY (Rashtriya Swasthya Bima Yojna) with a credit of 30,000 Indian rupees $700) for each year. They can use their cards in all specialty private hospitals. The Government also supports public hospitals, where the general public can receive treatment free of cost. This serves the poor in emergency situations.
physician is responsible for deciding if epigastric discomfort is acute gastritis or an acute inferior wall MI. 6. The child doesn’t know who his father is. Lots of organizations claim paternity. Some Indian EPs are trained by the MCEM (Membership of College of Emergency Medicine, a 3-year postgraduate program in the United Kingdom) , others receive an International MEM (Master’s in Emergency Medicine, a 3-year Master’s Degree in EM from George Washington University), some undertake a 1-year Fellowship in EM (FEM), while still others content themselves with only “merit badge” courses like the American Heart Association’s conducted ATLS, BLS , PALS and ACLS training programs. 7. The “Church” is unsure if the baby should be baptized. The Medical Council of India (MCI), had before June of 2011 locations authorized only nine MD emergency medicine training India: at St John’s Medical College, Bangalore; at the Vydehi Institute of Medical Sciences & Research Centre, Bangalore; at the Narayana Medical College, Nellore; in Andhra Pradesh; at the Medical College, Baroda; at the B.J. Medical College, Ahmedabad; and at the N.H.L. Municipal Medical College, Ahmedabad. At each institution, there has been good progress in filling openings in official emergency medicine departments chaired by EM physicians. 8. Today, that pre-term infant is growing. He has passed some milestones, but still needs tender loving care. In this observer’s opinion, the most pressing need is pre-hospital care. Next, India needs to increase the number of post-graduate training positions. At the same time, India needs to improve public awareness of the importance of Emergency Medicine among casualty medical officers and among the general public.
4. Fetal risks mainly consist of the lack of awareness regarding the importance of initiating emergency care out of hospital. There is almost no prehospital care in India. The role of EM in disasters is not developed. Pediatric and OB disaster care is hardly even considered. 5. The neonate is poorly differentiated. Although the full spectrum of Emergency Medicine includes prehospital and hospital care delivered by ED-based specialists, India has only “Casualty Rooms,” where the Casualty Medical Officer usually has no specialty training in emergency medicine. This inexperienced
Photo courtesy of The Hindu - Online edition of India’s National Newsletter
Update on PACE and from MedSpanish Haywood Hall, MD, FACEP, FIFEM
The PACEMD Program was started 12 years ago. It was founded by Dr. Haywood Hall and Dr. Darryl Macias. It was incorporated in Mexico as a non-profit organization, and is based in San Miguel de Allende, Mexico. The name has been changed from PACEMD to PACE (Providers Aligned for Care in Emergencies) and the organization now has affiliate organizations in both the US and Mexico. Initially, it was the intention of PACE to create an EM field office for the US emergency medicine community to interact with the EM community from Latin America. We have come a long way.
center, the manikins and other materials for short, focused programs. PACE started one of the most active American Heart Association Centers south of the US, now with almost 300 instructors throughout Mexico. PACE MedSpanish students have assisted in the development of our various projects. The Advanced Life Support for Obstetrics (ALSO) Program, the National Disaster Life Support Program (NDLSP) and the ATT Trauma course are among them. PACE is a center for the National Disaster Life Support Program, the Latin American coordinator for the ATT Trauma course, and the coordinator for other training programs, including a state-of-the-art EM Ultrasound course. We started the first Public Access Defibrillator Program in Latin America. We are currently developing a Chest Pain Center in San Miguel de Allende, and we may be working with the Health Ministry to develop a cardiac care program within the public hospital system. Our "star" program is the Advanced Life Support for Obstetrics (ALSO) Program. Through ALSO, we provide multilevel systems development training in high-risk maternal mortality areas. To date, we have trained over 3,000 government physicians. We have recently been asked to ramp up this program. PACE ALSO trains Obstetrical first responders and Obstetrical Critical Care capability in 2ndlevel hospitals.
Because of our relationships with the Mexican Health Ministry and with the Red Cross, we have developed a unique program for internationalists. Although initially conceived as an emergency medicine development organization, in 2002 PACE also created a total immersion Medical Spanish program (www.PACE-MedSpanish.Org). To date, almost 500 students have participated. Students range from preprofessionals to medical students; and have included residents in EM, IM, FP and Peds. Attending physicians and midlevel practitioners who need CME have been welcomed. The MedSpanish School initially supported community-based medical training. It provided the training
Last year, we started the PACE / University of Texas Southwestern International Emergency Medicine Fellowship Program. Currently, we have 5 fellows. (PACE is responsible for the Latin America components of the UTSW IEM fellowship program).
(Update on PACE, continued) This summer PACE was a proud co-sponsor of the recent International Federation of Emergency Medicine (IFEM) Symposium on Resuscitation. The symposium was a great success. Although not all talks were given in English, 100% of the talks were simultaneously translated into English, and were to have been put up on the web by the end of August. A meeting of iCord was held during the Symposium, attended by professors from residency programs in Mexico, Panama and Colombia. The iCORD meeting reviewed the Latin American EM curriculum.
GEMA Membership Holly Gouin, MBA
Don’t forget, your GEMA dues do not automatically renew. You need to let the SAEM office know you wish to continue your membership prior to your membership expiring. This will ensure there is no interruption in your ability to communicate with other GEMA members. If you are part of a Faculty Group or a Residency Group, ask your Administrator or Program Coordinator to renew your GEMA dues for you. This saves time and ensures you won’t miss any of the latest news coming out to GEMA members. 2012 GEMA Dues Attending Physicians - $100.00 Resident/Fellows – FREE Medical Students - $25.00
The Tech Corner
Christopher Johnson, MBA
If you should be interested in further information regarding PACE, please visit our web pages. http://www.pace-MedSpanish.org/ Write to us at: CENTRO PACE PMB 1051 220 N. Zapata Hwy #11 Laredo, TX 78043 message and Fax number 1-800-770-6853 or Calle 5 de Mayo # 11 Col. Allende C.P. 37760 San Miguel de Allende, Guanajuato Tel-Fax: 011 52 (415) 15 2 7532 US Cell 505-239-0143
In conjunction with the annual meeting, SAEM launched its newly-designed website. Increased functionality, more robust content and improved search capabilities are just a few of the additions to the site. GEMA members will see an immediate benefit from the new website in their own page, available only to GEMA members, in which to post, edit, comment and upload information directly to the site. The goal of giving this ability to the members is to increase communication and make collaboration among GEMA members easier. Migration of legacy data is ongoing, so some materials used by GEMA members may not currently be available. If you are having trouble locating a document, please contact SAEM staff by emailing your request to saem@saem.org.
GEMA Kudos Kudos to Dr. Ian Martin for being nominated for ACEP’s Individual Achievement in International Emergency Medicine Development Award! Awards will be finalized by October and presented at Scientific Assembly.