Peter is the vice chairman and clinical director of the Stony Brook University Hospital ED in New York. Under his leadership, Emergency Medicine became a Department in the Medical School. Known for his engaging teaching style, Peter received the Aesculapius Award for Excellence in Teaching from the SUNY School of Medicine in 2003. He is the editor of Handbook of Toxicology. His areas of research include overcrowding, patient safety, medical errors, head and cervical spine injuries, and residency education. Peter has served in numerous leadership positions at the state and national levels of the ACEM and the SAEM. He is a frequent lecturer on emergency medicine topics at the local, state, national and international level.
Stuart Swadron began his career in medicine as a general practitioner in Canada. He emigrated to Los Angeles to pursue his passion for emergency medicine. He is currently Professor of Clinical Emergency Medicine and Medical Education at the University of Southern California and an attending emergency physician at Los Angeles County/USC Medical Center. Stuart served for many years as the residency program director at LAC/USC and he has remained very active in medical education. He appears as a co-host and contributor on the popular EM:RAP series.
Marianne was our very first registrant for DevelopingEM 2014 and was an enthusiastic and very appreciated presenter at our last venture in Havana.
She joins us from UCLA where she is the director of EMS and Paediatric EM fellowships.
She is a multiply awarded educationalist and is acknowledged as one of the leaders in paediatric EM worldwide.
Amongst her many achievements Marianne was named a Hero of Emergency Medicine by ACEP and we know she will bring a dynamic zeal to her involvement in DevelopingEM 2014.
Join Marianne and us in Salvador by registering now and stay tuned for more presenter profiles.
Blog Post By Nat Thurtle
What’s so good about DevelopingEM?
I have been lucky enough to attend a variety of fantastic Emergency Medicine conferences over the time I have been an EM trainee. Conferences with cutting edge research, conferences utilising and explaining the exciting frontier of social media and open access, conferences where the thought leaders of emergency medicine and critical care deliver digestible pearls, conferences with opulent social programmes, conferences where the tea breaks have amazing new airway toys to play with while you drink your latte.
So what’s so good about this one?
It’s certainly not the shiniest. No airway toys, no free pens, not even a latte (don’t worry, there is always coffee!). No cabaret-esque introduction, dancing girls or ‘90’s rave approach to lighting. There’s never to my knowledge been an ICU consultant dressed up as a uterus at DEM either, a la the wonderful SMACC 2013…!
DEM is not as punchy as other conferences. Imagine every presentation being interpreted into another language in real time! This means a slow and measured approach to speaking, not using slang etc, busier slides with 2 languages on them, making information accessible to the many delegates who don’t speak English.
For me, its 3 things that make DEM great – the ethics, the true innovation and the heart.
DEM is really not for profit.
Nobody makes any money out of DEM. There’s a small team of organisers, most of whom work full-time as EM physicians, and give their time and expertise for free. There’s a broad international array of speakers who not only give their time for free, but most of whom pay full registration fees (to support sponsorship of local delegates) and cover all their own costs. These include speakers that really don’t need the gig, people like Judith Tintinalli, Joe Lex and Jerry Hoffman.
DEM is not compromised by industry sponsorship
DEM does not accept pharmaceutical industry sponsorship. In this age of deep controversy over industry influence on practice, this is a meaningful and important stand against this that no other international EM conference has been able to take, to my knowledge. No toys at tea break is a small price to pay.
DEM happens in countries where EM is developing
DEM recognises that people are practising EM outside of the US and Australasia! We were in Cuba in 2013, and now Brazil, bringing high calibre speakers to practitioners that would not otherwise have live access to them and building connections. #FOAMed is awesome, but if you only speak Portuguese, and work in a developing context, or in Cuba where there is essentially no internet, what is available or relevant to you is limited.
DEM recognises the ‘dirty’ side of medicine
Many conferences focus on the practice of medicine in an ideal fully equipped setting with the assumption that practice is scientific. For me, recognising and understanding the political and inexact nature of health care provision – inequality of access, inequality of standard of care and the undue influence of corporate needs on research and guidelines, as well as pragmatism in the face of limited evidence, limited expertise or limited resources and our own fallibility – is a critical part of being a real physician. DEM does not ignore these factors, despite them being complex and ‘dirty’. Bringing politics to an EM conference? To me this is brave and innovative.
DEM sponsors local delegates and has local speakers
DEM fully sponsored 65 local delegates from Cuba and other Caribbean nations last year, bringing local speakers to their own peers, and to an international audience, and will be doing the same in Brazil this year.
DEM does real-time interpretation
DEM does real-time bilingual interpretation of all presentations and question and answer sessions, making information truly accessible to delegates and allowing people to converse who would otherwise not be able to.
What happens after DEM is cool.
Matt Dawson and Mike Mallin from the Ultrasound Podcast ran an ultrasound course in Castries, St. Lucia and Ricardo Hamilton and Mary Langcake (trauma surgeon from Sydney) ran the first fully accredited ATLS course in the Bahamas in the week after DEM 2013. The first ever Paediatric Intensive Care BASICs course in St Lucia was also organized following DEM 2013, to name but few follow-ons.
Delegate registration fees contributed to computers and USB drives loaded with #FOAMed resources, and EZIO kits that were donated to Cuba, St Lucia and the region after DEM 2013.
A letter signed by conference organisers and delegates was published in the BMJ calling for an end to the US-Cuba embargo in the name of access to health care, raising awareness in the medical community on this complex topic.
The social is awesome
Never got to bed before 2 or 3 in Havana – mojitos, cuba libres, music and Caribbean heat, similar minded folks to share stories and ideas with, hoping Brazil will be the same.
Lee and Mark
These two are brilliant. They are the heart of DEM and have my total confidence and respect.
So, that’s what I think is so good about DevelopingEM. Come and see for yourselves!!
Well we’ve told you a little about some of the components of our program headed by an amazing dynamic group of program leads.
Now for our amazing faculty.
Over the last two years we have had some incredible presenters and this year is no exception.
We have a number of presenters rejoining us from Havana including John MacKenzie, Joe Lex, Peter Viccellio, Marianne Gausche, and Camilo Gutierrez.
Joining this incredible group will be a truly fantastic cohort including some leading lights in their fields including Billy Mallon and Mary McCaskill as well as some incredible personalities from the field of Emergency Medicine in Brazil and around the world.
Come to Salvador and get some incredible education from this amazing group at DevelopingEM 2014.
DevelopingEM 2014 Faculty
Frederico Carlos De Sousa Arnaud (BRA)
Colin Banks (AUS)
Sue Beno (USA)
Jessica Best (USA)
Luis Alexandre Borges (BRA)
Anne Creaton (AUS / FIJI)
Anthony Crocco (CAN)
Carlos Fernando Dornelles (BRA)
Steffan Eriksson (AUS)
Sanj Fernando (AUS)
Ana Paula Da Rocha Freitas (BRA)
Pablo Fuenzalida (CHILE)
Marianne Gausche (USA)
Camilo Gutierrez (USA)
Jon Kerr (USA)
Charisse Kwan (CAN)
Joe Lex (USA)
Luis Lovato (USA)
John MacKenzie (AUS)
Mary McCaskill (AUS)
Fergal McCourt (AUS)
Billy Mallon (USA)
Regan Marsh (USA / HAITI)
Khaled Menapal (HOL / AFG)
Ravi Morchi (USA)
Michael Mullins (USA)
Oscar Navea (CHILE)
Rodrigo Brandao Neto (BRA)
Marcela Preto-Zamperlini (CAN)
Aurelio Rodriguez (CUB)
Paolo Silveira (BRA)
Paolo Sampaio (BRA)
Todd Slesinger (USA)
Carlos Trotta (ARG)
Joachim Unger (GER)
Peter Viccellio (USA)
Steve Wall (USA)
Janna Welch (USA)
David Wallace (USA)
Brian Wright (USA)
Tracy Catlin (USA)
Marcos Coelho (BRA)
Matt Dawson (USA)
Camilo Gutierrez (USA)
Saundra Jackson (USA)
Charisse Kwan (CAN)
Mike Mallin (USA)
Jorge Otero (USA)
Marcela Preto Zamperlini (CAN)
Gabriela Santos (USA / VEN)
One of our standards with DevelopingEM has been a focus on Adult Emergency Medicine and Critical Care.
Over the last two years we’ve had some amazing presentations by some incredible presenters.
Following some positive feedback from our delegates we’ve quarantined two sessions for this topic.
Our session lead Brian Wright has collected together a group of fantastic presenters to put together a program that I think is our best ever.
Brian is an attending physician at the Stony Brook University Hospital where he is also a clinical assistant professor.
He has received several teaching and educational awards and as well as delivering one of our most appreciated lecture topics, ED:ICU Bridging the Gap, he has also brought together a truly incredible group of educators for the Adult EM and Critical Care track.
A number of our previous faculty including Joe Lex, Peter Viccellio and John MacKenzie will be joined by David Wallace, Billy Mallon, Todd Slesinger, Oscar Navea, Janna Welch, Jo Unger and Jon Kerr to deliver an unsurpassed program for you.
What a way to kick off DevelopingEM 2014 Brazil!
Register now to make sure you have a front row seat. We will have more news soon on the amazing program.
ORIGINAL ARTICLE – English
Having been born in Brazil, raised in England and now practicing in Australia, Developing EM understandably caught my attention. After medical school and a few postgraduate years in the UK as a junior doctor, I moved to Australia and have started my Emergency Medicine (EM) training here, like an ever-growing cohort of British doctors. Although the specialty is well known for it’s high stress levels and antisocial working hours, the experience in Australia has been overwhelmingly positive, continuing to challenge and humble me in equal proportions. When I visited Brazil for high school and medical school holidays, I would shadow my father, an Associate Professor in Anaesthesia, in various operating theatres across public and private hospitals in Rio de Janeiro. As I progressed through my undergraduate training, it was fascinating to be able to compare and contrast the hospitals in Rio with the UK’s National Health Service (NHS). I have had limited exposure to the ER in Brazil but my cousin, who is a resident in clinical medicine in Rio, has provided a snapshot of this in another post.
A typical evening shift (14:00-24:00) tends to have the highest volume of patients. Working in a trauma centre, the department is well-staffed 24 hours a day with each team of emergency physicians consisting of a consultant, registrar and one to two junior medical officers. During peak times there will be three full teams and the night team operates with two registrars, residents, an intern and a consultant on call. Working on the ‘acute’ team tends to involve managing several sick patients whilst being on standby for top priority ‘resus’ calls in our three resuscitation rooms.
My first patient, an elderly lady with abdominal pain, is from a non-english speaking background and is unaccompanied, making the history a challenging process. I ask the medical student to arrange a telephone interpretation consultation whilst I write up analgesia, cannulate her, take baseline bloods, assess the ECG and consider any further tests I might need with what little information I have. I pull up a mobile computer and thankfully the patient has been here before – I’m able to get a recently updated medical history and medication list, making the language barrier much less of an issue. Following the initial assessment, a provisional diagnosis of diverticulitis is made. We ask a few more questions, explain our findings to the patient via the interpreter and I discuss the case with my EM consultant who approves a CT.
In the psychiatric emergency care area, a man in his late twenties, who has a background of long term marijuana and alcohol abuse is shouting aggressively. He has recently started using crystal methamphetamine after being evicted from his temporary accommodation and has presents with an acute paranoid psychosis. He becomes increasingly combative – before I am able to take a history, security is called and we have to IV sedate him for his and everyone else’s safety. This is done in a structured way with the approval of the supervising consultant and only when there is no other reasonable way to protect both the patient and healthcare professionals. Once the situation is safe, routine observations are taken, a medical examination performed and a collateral history is taken from our community psychiatric team and his family.
As I head to see the next patient, a middle aged man with central chest pain which has now resolved, a resus team call is made over the department as a trauma call comes through on the red phone. The consultant leads the trauma call and assembles the team. This consists of an EM consultant, registrars in EM, intensive care, anaesthetics, general surgery, orthopaedics, an EM resident, registered nurses, a radiographer and a social worker. A 19-year old girl has been struck by a car at a pedestrian crossing and from the pre-hospital assessment is suspected to have a femoral fracture, closed head injury, rib fractures and multiple skin abrasions. As she is wheeled in, full spinal precautions in place, there is an air of calm in Resus One before the ambulance handover. The trauma victim is managed using the principles of ATLS and the orchestration of healthcare professionals ensures that she has an efficient, controlled resuscitation. After a good initial response she is able to progress to imaging, before going to the Intensive Care Unit.
As the evening passes by, each trainee typically juggles 3-5 patients at a time, keeping the supervising consultant up to speed with frequent discussions. Later on, when I’m squeezing in a meal between patients, I flick through each of my patient’s findings and plans in my head, making sure I’ve checked everything through and have updated the patients and their families about their journey. Back to the ER. At 23:00 there is a formal handover meeting where we discuss every patient in the department with the evening consultant and the senior registrar on night duty. There are often loose ends to tie up after handover but this crucial meeting allows for structured troubleshooting before the night shift, essential when there aren’t as many providers in the department. As the evening team departs, the senior registrar is making her plan of attack, allocating the junior medical staff to each area of the department and reviewing the sickest patients discussed on the handover round.
Behind the scenes, there is weekly registrar teaching with peer-peer teaching, consultant-led teaching and guest specialties keeping us up to date on the latest management for the emergent presentations in their field. In addition to this there are Health Education and Training Institute (HETI) workshops and the NSW Institute of Trauma and Injury Management (ITIM) holds events on a regular basis.
I hope this has given you a brief snapshot of a metropolitan ER in Sydney, keep your eyes on the Developing EM website for more articles with perspectives on EM from around the world.
Registrar in Emergency Medicine
Tendo nascido no Brasil, criado na Inglaterra, e atualmente trabalhando na Austrália, o Congresso “Developing EM” me chamou a atenção! Após a escola médica e alguns anos de pós-graduação como medico junior no Reino Unido, eu me mudei para a Austrália e comecei meu treinamentoem Medicina de Emergencia (EM) com um grupo cada vez maior de médicos britânicos. Embora a especialidade seja bem conhecida por seu alto nível de estresse e horas de trabalho anti-sociais, a experiência na Austrália tem sido extremamente positiva, desafiando e educando em proporções iguais. Quando visitei o Brasil durante o ensino médio e férias durante a faculdade de medicina, acompanhei meu pai, um professor de Anestesiologia, em vários centros cirúrgicos de hospitais públicos e privados no Rio de Janeiro. Enquanto eu avançava na minha graduação, foi fascinante poder comparar e contrastar os hospitais do Rio com Serviço Nacional de Saúde do Reino Unido (NHS). Eu tive exposição limitada aos pronto-socorros no Brasil, mas meu primo, que é residente em clínica médica no Rio, proporcionou uma impressão mais clara sobre isso em outro poster.
Um tipico plantão da tarde tende a concentrar o maior volume de pacientes no período entre 14 e 24 horas. Trabalhando em um centro de trauma , o departamento funciona 24 horas por dia, com a equipe de médicos emergencistas constituida por um clínico, residentes seniore um ou dois médicos júnior. Durante os horários de pico, há três equipes completas, e a equipe noturnaatua com dois médicos residentes, um estagiário e um clínico geral. Trabalhar na equipe “aguda” tende a envolver o gerenciamento de vários pacientes instáveis, estando sempre alerta à prioridade de chamadas de ressuscitação em nossas três salas de reanimação.
Em uma noite, minha primeira paciente era uma senhora idosa com dor abdominal e dificuldades de comunicação – não falava inglês. Estava desacompanhada, o que tornava a história um processo desafiador. Pedi ao estudante de medicina quefizesse uma breve consulta usando um aparelho telefônico de tradução automática, enquanto prescrevia analgésicos, puncionava uma veia e solicitava exames laboratoriais gerais. Avaliei seu ECG e considerei quaisquer outros testes que eu viesse a precisar com o pouco de informação disponível. Acessei um computador e felizmente, o paciente ja tinha estado aqui antes. Consegui um histórico médico atualizado recentemente e alista de medicamentos, o que tornou a barreira da língua um problema menor. Após a avaliação inicial , foi feito um diagnóstico provisório de diverticulite. Mais algumas perguntas e dei explicações à paciente, através de um intérprete. Logo após, discuti o caso com o meu orientador, que concordou com a indicação de uma Tomografia Computadorizada de abdomen e pelve.
Na área de cuidados de emergência psiquiátrica, atendi a um homem na casa dos vinte anos com um histórico de consumo de maconha e abuso de álcool em longo prazo. Ele estava agitado, gritando de forma agressiva. Após ter sido despejado de seu alojamento, recentemente, começou a usar metanfetamina, tendo apresentadouma crise psicótica paranóica aguda. Ele se tornava cada vez mais combativo, e antes que fosse capaz de ter obter sua história chamei a segurança e tivemos que sedá-lo, para sua propria segurança e dos outros. Isso foi feito de forma estruturada e protocolar , com a aprovação do meu orientadore somente por não haver outra maneira razoável de proteger o paciente e os profissionais de saúde envolvidos . Uma vez que a situação foi considerada controlada e segura, as observações de rotina foram tomadas, um exame médicorealizado e a história foi obtida junto a sua família por nossa equipe psiquiátrica.
Enquanto me encaminhava para ver o próximo paciente, um homem de meia idade em observação por dor torácica retroesternal,foi feita uma chamada para a equipe de reanimação através do telefone vermelho. O medico orientador recebeu a chamada “trauma” e imediatamente montou a equipe. Esta foi constituída por um orientador de ME, o residente em ME , o intensivista, o anestesista, o cirurgião geral , o ortopedista , a equipe de enfermagem, um técnico de radiologia e um assistente social. Era uma menina de 19 anos atropelada por um carro em um cruzamento de pedestres. Pela avaliação pré-hospitalar suspeitava-se de uma fratura de fêmur, além de lesão fechada na cabeça, fraturas de costelas e várias escoriações de pele. Como ela foi levada em uma prancha de imobilização, houve maior tranquilidade no prosseguimento do atendimento. A vítima de trauma foi gerenciada utilizando a sequência de princípios da ATLS, ea orquestração dos profissionais de saúde garantiu que houvesse uma reanimação eficiente e controlada. Depois de uma boa resposta inicial, ela estava habil para ser encaminhada a Tomografia e depois para a Unidade de Terapia Intensiva.
À medida que a noite passava, cada formando normalmente manipularia de 3 a 5 pacientes, mantendo o orientador ciente, e com discussões frequentes. Mais tarde, quando consegui um tempo para lanchar, entre um atendimento e outro, revisei cada um dos resultados e planos de meus pacientes na minha cabeça, certificando-me de que não havia deixado ninguém sem cuidado, atualizado os pacientes e suas famílias sobre os fatos. Às 23:00, houve uma reunião formal onde discutimos cada paciente no departamento com o orientador eo residente sênior do plantão noturno. Muitas vezes, há “pontas soltas” para amarrar após o encontro, mas esta reunião permite a resolução de problemas estruturados antes do turno da noite, o que é essencial quando não se tem muitos médicos à disposição no departamento. Com a saida da equipe da noite, o residente sênior fez seu planejamento, alocando a equipe médica júnior para cada área do departamento, revendo os pacientes mais graves que já foram discutidos no round.
Nos bastidores, temosatividades de ensino semanais com ensino “ponto a ponto”, onde o orientador e especialistas nos mantem atualizados sobre as mais recentes publicações em seu campo. Além disso, há seminários e eventos periodicamente promovidos por institutos de pós graduação médica.
Espero que esta breve narrativa lhes mostre a impressão geral do movimento em uma sala de emergência em um hospital da região metropolitana de Sydney, Austrália. Estejam atentos ao nosso site para mais artigos com perspectivas sobre a ME em todo o mundo.
Residente em Medicina de Urgencia