The fourteenth annual International Conference on Emergency Medicine (ICEM) was held in the newly completed and stunningly presented Dublin convention centre from 27–30 June this year.
Assimilating everything from the base and mundane with the exciting and highly unusual aspects of emergency medicine, guests from every inhabited continent shared research, opinion and experiences to further and better pre-hospital healthcare, stimulate debate and ultimately benefit patient outcome worldwide.
A significant presence of remote and disaster emergency medicine was evident at the conference, including a great deal of new research in contemporary disaster-based emergency-care medicine, which aimed to deliver those practices and findings honed in the many large, and small-scale natural disasters that have occurred in the past decade.
An abundance of wilderness and remote pre-hospital care specialists, exhibitors and attendees suggested a growing interest in research and development in this arena of paramedicine but also, due to the many recruitment companies present at the conference, that this is a growing trend within the profession as many established paramedics look to diversify and stimulate their career.
The conference also showed that the process of professionalisation for practitioners of paramedicine, currently taking place in the UK is being echoed loudly around the world—with greater emphasis being placed on advanced skills, specialised practitioners and workforce structure and organisation.
‘the process of professionalisation for practitioners of paramedicine, currently taking place in the UK is being echoed loudly arround the world’
Jürgen Schäfer, hospital director of Frankfurter Diakonieinical, Frankfurt, Germany, concurreed: ‘The main subject seems to have changed from health issues to human resource management,’ he said, adding with surprise that ‘many institutions are looking for professionals by themselves, without involving head-hunters—every country, including the English-speaking countries are looking for professionals from all over the world.’
Carol Amaratunga, co-investigator and research associate for the Justice Institute of British Columbia (JIBC) commented positively on the source of fresh research and engaging agenda of attendees. ‘I was pleased to see where various sub disciplines of emergency medicine are able to meet at the intersection/nexus of arts and science—especially to see so many researchers, presentations, and case studies from Southern nations, particularly Africa.’
Aramatunga impressed the importance of conferences such as the ICEM in progressing the pre-hospital field, as she put it, ‘to ensure evolution, as opposed academic “involution”, practitioners, research theorists and students need to be exposed to diverse opinions and perspectives. This can only come about when disciplines like medicine embrace transdisciplinary thought and practice. This is why I was so pleased to see other professions, including paramedics, social scientists, participating in the sessions’.
One of the most widely covered and prominent focuses of ICEM 2012 was that of disaster medicine. Representatives, researchers, witnesses and present practitioners reported, discussed, speculated and presented evidence from dozens of natural disasters across the globe. A presentation on the Christchurch earthquake given by Michael Ardagh, one of the emergency physicians in Christchurch at the time of the earthquake who provided pre-hospital care to the affected population. Titled: Lessons learned from the Christchurch Earthquake, it explored the shortcomings and strengths of emergency healthcare care following the earthquake, particularly within the first 48 hours of the disaster.
A notable and unexpected issue in delivering care after the earthquake highlighted by Ardagh was not the shortage of emergency practitioners (of which there was an abundance) but a scarcity of mundane and practical objects such as torches, blankets and spare clothes which was the greatest challenge to the physicians.
In his presentation, EM Planning at the provincial level, Brian Schwartz spoke on the subject of localised emergency healthcare; iterating the benefits of a thoroughly thought through, yet pragmatic strategy in which to attain the best possible patient outcome. Among his recommendations, Schwartz argued for ‘sustainability’ and longevity, a clear ‘evidence based’ scheme which ‘matches capacity with need’ and encompasses ‘regular evaluations’ so that it ‘adapts to changes’ over time.
Lauding the fragmentation of recovery services in accordance with local need, Swartz recommended a structure of ‘regionalisation for different types of contamination, dependant on likelihood of emergency’.
Schwartz also called for an increase in confidence from EMS personnel in the patient by setting up areas for the walking wounded post-event (‘as people who are injured will find their way to areas of benefit themselves’) and stating that emergency care practitioners should move away from ‘faulty assumptions on patient behaviour’ toward a more positive, sensible and altruistic perspective of the average patient.
Other topics were more foreboding, including a rather harrowing presentation by Valerie Krym on the prospect of a global influenza outbreak, titled: Are we ready for an influenza outbreak: perspectives on the next global pandemic. Prompted by the aftermath of the recent avian (H5N1 strain) and swine-fu (H1N1 strain) outbreaks, it exposed a certain lack of global preparedness in the case of a more serious and contagious pandemic.
Among the breeches explored were; patient priority, the role and use of the military in pandemic crisis; locality and proximity of temporary emergency care centres and vaccination stockpiles and distribution. It was made very clear by Krym that if a significantly virulent mutation of the virus was to emerge, the repercussions could be calamitous and that a more assimilated global strategy needed to be formulated in order to prevent this.
‘…practitioners should move away from ‘faulty assumptions on patient behaviour’ toward a more positive, sensible and altruistic perspective of the average patient’
In other presentations, patient transport and pre-hospital drug administration were also developing areas of focus, particularly the use of analgesia in pre-hospital care and the growing clinical support for the use of IV paracetamol.
Feedback from various pre-hospital care providers and institutions across the globe suffering from the recent economic downturn were also rife, with reduced research grants, staff budgets and capital available for procurement all starting to feel the effect of the financial stringency.
The most optimistic presentation from ICEM which gained significant notoriety and renown was Grey Henry‘s speech entitled Maintaining excitement in Emergency Medicine. Henry, already noted for his motivational rhetoric and grandiloquence received a standing ovation for his presentation which, among other things, noted the challenges faced by the friends and families of those working in the profession, the mental strain and anguish which can affect practitioners and the huge benefits of taking an empathetic, holistic approach to patient care.
‘…mini talks provided great value for the money and enabled many speakers to deliver their thematic messages in a punchy and efficient style’
The ICEM also thew up a myriad of research, presented, in part, as a wall of posters, each one identifying an individual study, allowing attendees to quickly assimilate the relevant information and research to their particular role. One poster study in particular, conducted by Neil and Anderson, sought to explore the potential value of using an everyday object in the hands of a totally inexpert medical practitioner to maximum effect. Titled: Observational, cadaveric study of emergency bystander Cricothyroidotomy with blade and ballpoint pen by untrained junior doctors and medical students, the study found 58% of cricothyroidotomy attempts to be successful, concluding that in a situation of ‘extremis’, the procedure could be justifably attempted by an untrained layperson. Doubtless, the many medically squeamish and untrained members of the public may fnd the transition from administering established first aid practice such as the Heimlich Manoeuvre or hands-only CPR to visceral and immediate cricothyroidotomy rather daunting.
However, the poster demonstrated the limitless nature of relevant and speculative pre-hospital care research, as well as the importance and benefits of education and awareness in certain facets of emergency healthcare within the public, who will always best the most efficient emergency practitioner's response time. ‘The poster sessions were truly well done, if not excellent,’ said Aramatunga. ‘I was particularly impressed by the posters designed and delivered by graduate students representing various disciplines and backgrounds The trans-disciplinary and interdisciplinary favour of the poster sessions truly enriched the conference,’ she added.
Another innovative medium of presenting new research was delivered the in the form of a precis called ‘lightning orals’, which allowed for a mass of (occasionally arid) statistical research and analysis to be condensed into a single and engaging ten minute presentation. ‘The “lightning orals” format worked exceptionally well—these ‘elevator’ level mini talks provided great value for money and enabled many speakers to deliver their thematic messages in a punchy and efficient style,’ stated Aramatunga. ‘It was a highly effective delivery mechanism and enabled additional speakers to be featured in the program's tight agenda,’ she added.
ICEM provided a rare opportunity for all those within the emergency medical field to trade experineces and knowledge, and though the prominent factors of disaster medicine and personnel management and procurement did dominate debate somewhat, there was a great fount of information available to attendees in their field, given the motivation to source it. ‘The highlight of this and many other conferences is obviously networking,’ concluded Arametunga, ‘not only within one's own academic discipline, but taking the time and opportunity to meet and dialogue with colleagues from other sectors and disciplines.’
With the next ICEM being held rather further away in China in 2014, many UK paramedics may be dissuaded from attending the conference due to its broad coverage of emergency medicine and global focus. However, the point to take from ICEM 2012 above all else is that all who do attend cannot fail to learn, expand and reinvigorate their interest in emergency care if they wish to.
