DEM 2013 hits the mark

In this article, rural emergency SMO Amy Neilson talks about her experience at the 2013 DevelopingEM conference, and why she was in “rural generalist heaven”. Thanks Amy for a great article! Lee + Mark.

During September 2013 the DevelopingEM conference welcomed a broad array of critical care, emergency and generalist doctors to Havana, Cuba.  The brainchild of Mark Newcombe and Lee Fineberg – FACEMs of Wollongong fame – DevelopingEM is “an Emergency Medicine conference with a difference”.  

I was attracted to the event by the sense that it was designed to export tertiary medical skill and training, with focus on the availability of information for all who benefit.  Funds generated were used to subsidise the attendance of local emergency medicine practitioners.  Slides and resources were made freely available.

A great deal of money, research, study, education, time and effort has gone into the ongoing development of the practice of Emergency Medicine in Australia.  As a Senior Medical Officer in a regional Emergency Department, a Rural Generalist and a registrar of ACRRM, I have seen the work of both ACEM and ACRRM colleges, trainees and consultants to improve the delivery of emergency care in Australia.  When gathering to up skill, to share and develop knowledge, I believe there is merit in doing so in settings that encourage broadening the reach of said continuing medical education.

Many Australians travelled via Sydney, Vancouver and Toronto, and on to Havana.  The circuitous route was a consequence of the persisting poor relations between the United States of America and Cuba.  I commenced this journey by looking at a map, thinking I could just pop over to Los Angeles, then on to Miami, then a mere hop skip and jump to Havana.  Not so.  I tried to order Euros online.  ‘Are you going to Cuba?’, the Commonwealth Bank and American Express online services asked me.  A tick in the box of ‘yes’ (a doomed moved, of course, but curiosity won) returned the reply that these services were therefore not for me.

In anticipation of the conference I read about Cuba’s impressive literacy and primary health care outcomes.  I maintain a belief that Primary Health Care in Australia has some serious obstacles and that looking well outside the box for ideas is a worthwhile exercise.  And so, as the Cuban and Caribbean doctors sought to learn about excellence in tertiary emergency care, I was curious to learn from them about robust primary health care systems.

DevelopingEM was attended primarily by FACEMs from Australia and their American equivalents.  However there were a smattering of Rural Generalists, and some Anaesthetics and Intensive Care colleagues.  The conference was accredited by ACEM, ACRRM, and AAEM for continuing medical education, and attracted the full three days of funding for the Rural Procedural Grants Program (Emergency Medicine). The conference was also supported by ACEP and IFEM.

The mood and conversation were open and convivial.  From junior Cuban doctors and ACRRM registrars (well, just me I think) to Joe Lex and Judith Tintinalli, health practitioners contributed, discussed, listened, and learned something new.

Professor of Emergency Medicine Joe Lex kicked off with a reminder of why and how we read medical literature.  Sanj Fernando detailed how important CT diagnoses can be made in ED pending radiology reports, and exhorted his listeners to be able to do so.  Peter Viccellio explained how to observe high intracranial pressure with simple bedside USS by measuring the diameter of the optic nerve.

Lisa Charles, in her disarmingly honest, positive and practical talk on the first afternoon, embodied the event.  Lisa fascinated the audience with the tale of returning from EM training in the United States to her home of St Lucia to essentially build an Emergency Department from the ground up.  She explained that Emergency Medicine is not a priority in developing countries.  Global health policy in St Lucia focuses on maternal and child health and infectious disease. However, the timely treatment of emergencies can mitigate burden of disease in low and middle income countries.

Judith Tintinalli reminded the audience of salient issues associated with trauma in pregnancy.  Simon Binks explained why reviewing the evidence means he no longer uses codeine in children and often prefers absorbable sutures for paediatric facial lacerations.  Marianne Gausche-Hill spoke of teaching ‘BLS plus’ in Iraq. Ricardo Hamilton covered finger or tube thoracostomy, tying of vessels, hysterotomy and lateral canthotomy.  Mike Abernathy explained his great loves as a flight physician –  the bougie, intra-osseous access, video laryngoscopy and capnography.

Jerome Hoffman reminded us that health outcomes are only marginally related to health care, and apologised for his own government as he rose to the mammoth task of following the Cuban speakers.  Sobering statistics were presented to explain the daily effect of archaic sanctions by the United States of America.  Ships with Cuban products cannot enter the States.  Banks in foreign countries cannot trade accounts with Cubans in US dollars.  $4 million of UN funds for AIDS and TB was stopped from coming to Cuba.  This is one of many, many examples.  Trade sanctions mean no access to alzheimer’s medications, or to some medications required by Cuban children with heart disease and leukaemia.  An old, old story with ongoing consequences.

Natalie Thurtle presented her experience of working in Emergency Medicine in Botswana and explained there are currently two funded FACEM posts available there.  (If interested email or  Bradley Dreifuss explained his experience working in Uganda.  The deleterious health impacts of climate change were discussed.

Judith Tintinalli greeted the final day’s audience with a discussion of emerging challenges of Emergency Medicine.  She explained Emergency Medicine as the only population-based specialty.  Any person, any age, any time of day, any condition.  As a Rural Generalist, I hold this definition dear.  We take all comers.  In planning for future needs Dr Tintinalli emphasised the importance of Public Health and Public Education in developing Emergency Departments that meet the needs of the population.

The 2013 Developing Emergency Medicine conference covered a lot of ground.  Emergency Medicine, Rural Generalism, and Public Health are inextricably entwined. My daily goal is see any patient that walks in the door, and to be able to act appropriately.  Achieving that goal requires extensive ongoing continuing medical education.  The DevelopingEM conference was an exceptionally worthwhile use of my professional development time and money.  Warm, intelligent and kind people.  A look at a health system vastly different to our own, yet notable for its own successes.  New knowledge, inspiring colleagues, an appreciation of the practice of medicine in various settings, and a challenging reminder of the ethics and politics of health.  I was in Rural Generalist Emergency Doctor heaven. I encourage Rural Generalists far and wide to consider meeting in Salvador, Brazil on September 12-18, 2014.


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