Presenter Profile – Marianne Gausche-Hill

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.

More great news from St Lucia as a result of DevelopingEM 2013

Amazing things keep happening in St Lucia as a result of connections made during DevelopingEM 2013. Here’s a letter from our friend and colleague Lisa Charles to explain the latest news.

Victoria Hospital in Castries St. Lucia hosted our first ever Basic PICU course, May 20th to 21st, under the leadership of Drs. Elena Cavazzoni and Bruce Lister. The course was a resounding success with participants expressing renewed commitment and energy as they returned to work driven to implement the new information and techniques which will change their practice.

It all began with a casual conversation during the Developing EM conference in Cuba less than one year ago where Elena asked Caribbean delegates what they thought of having the PICU course taught locally. The power of networking within international conferences such as Developing EM where people meet face to face to learn of and appreciate the challenges of EM in the developing world first hand can not be understated. Nor can the commitment of groups such as the Paeds Basic instructor group and Ultrasound Podcast who self finance these trips to make a difference.

A special thank you goes out from all twenty eight participants in St. Lucia and the many patients who will benefit from the information imparted to us through this most recent spin off of the Developing EM network.

Thanks to those instructors who travelled from around the world: Dr. Peter Skippen, Dr. Nga Pham, Dr. Bruce Lister, Dr. Elena Cavazzoni, Chris Barstow and our newly trained regional trainers Dr. Kandamaran Kishnamurthy, Dr. Joanne Bradford and Dr. Martin Plummer. Special thanks also to Dr. Michele Lashley, University of the West Indies, Barbados for all the work in pulling the course together.

Developing EM Resuscitationalists in Training Articles! Part 1- Hugo Gemal

Hello friends & colleagues,
With our Brazil conference just around the corner we thought we might share with you the experiences of two young Brazilian doctors.
Hugo Gemal & his cousin Pedro Gemal Lanzieri are “Resuscitationalists in Training” with a passion for EM. Hugo is currently an EM Registrar at St.Vincent’s Hospital in Sydney, Australia. Pedro works as a trainee in Rio de Janeiro at the Hospital Universitário Antônio Pedro.
They sent us the following piece to give you a greater insight into EM practice in their respective countries. We think you’ll enjoy their perspectives through “A day in their lives.”
Abracao,
Lee

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.

Hugo Gemal

Registrar in Emergency Medicine

Sydney, Australia

 

PORTUGUESE TRANSLATION

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.

 

Hugo Gemal

Residente em Medicina de Urgencia

Sydney, Australia

 

 

 

 

 

 

 

 

 

 

 

 

 

Developing EM Resuscitationalists in Training Articles! Part 2- Pedro G. Lanzieri

ORIGINAL ARTICLE – Portuguese (Scroll down for English translation)

 

Medicina de Urgência e Emergência no Brasil

Sou médico formado em 2012 no Brasil, atualmente no 2o ano de residência de medicina interna. Trabalho com medicina de emergência (ME) há 2 anos.

A ME é diferente daquela praticada em qualquer outro setor. Variáveis como tempo, falta de acesso à história pregressa completa dos pacientes e a necessidade de estabelecer um vínculo com um paciente até então desconhecido são desafios da prática diária.

A formação do médico com especialização em emergência e urgência é relativamente nova no Brasil. Até então, o médico que se disponibilizava em trabalhar nesse setor era, em geral, aquele com formação geral. Nos últimos anos, tem crescido o número de instituições que oferecem cursos teóricos e práticos para especialização, bem como eventos e congressos sobre o tema. A primeira disciplina de graduação em emergências clínicas que se tem registro foi criada pela USP em 1992; a primeira Residência foi documentada em 1996.

No Brasil, este setor tem grande importância, pois responde por um grande volume diário de atendimentos. O médico de urgência, no Brasil, possui dois campos principais de trabalho: o Pronto-Socorro (ou Pronto-Atendimento) e o SAMU (Serviço de Atendimento Móvel de Urgência).

Em tese, o fluxo apropriado dos pacientes é ter a unidade básica de saúde como porta de entrada de acesso à saúde. Entretanto, devido a motivos culturais – resquícios de uma medicina hospitalocêntrica praticada no passado – um grande volume dos atendimentos de emergência é por queixas ambulatoriais.

 

Dia-a-dia: A rotina básica de um plantão de emergência começa com a reavaliação dos pacientes que permaneceram sob observação ao longo do último plantão. A depender da situação clínica, pode-se optar pela manutenção no próprio setor de emergência, pela internação em unidade hospitalar (própria ou transferência) ou alta com seguimento ambulatorial. Problemas frequentemente encontrados neste cenário são a indisponibilidade de leitos suficientes para internação e a dificuldade de garantir uma continuidade de atenção em nível ambulatorial da maneira apropriada.

 

Um turno na emergência: Os plantões no Brasil costumam ser de 12 ou 24 horas, sendo trocados às 7:00-19:00 ou 08:00-20:00. A dinâmica é muito diferente em serviços públicos ou privados. No primeiro, há grande número de estudantes de medicina, o grau de organização é menor (em geral, o atendimento conforme os níveis de prioridade é falho) e há, por vezes, falta de alguns recursos (materiais e humanos). No setor privado, por outro lado, há melhores condições de trabalho. No meu serviço, em geral, contamos com uma equipe de 7 médicos, sendo 4 clínicos gerais, 1 cirurgião geral, 1 ortopedista e 1 obstetra. O serviço de pediatria atua separadamente, com sua equipe própria de 2 a 4 integrantes, fazendo atendimentos de pacientes até 12 anos de idade.

 

Lembro-me de um plantão, em um hospital público, durante uma manhã de segunda-feira, em que tive a experiência de atender um paciente de meia idade, operário, trazido por colegas de trabalho, com o relato de perda súbita da consciência e queda. O paciente estava comatoso e com pressão arterial elevada. Infelizmente, como a maioria dos serviços ainda não trabalha com prontuários eletrônicos, não tínhamos acesso a qualquer histórico médico pessoal ou contato imediato com familiares. Isso tornou a condução do caso mais difícil, pois a decisão inicial sobre a condução clínica dependeria da maior probabilidade diagnóstica. Foi realizada uma tomografia de crânio, em princípio normal, mas que não descartaria acidentes vasculares cerebrais ou estado epiléptico não convulsivo. Para prosseguir com a investigação, porém, não haveria pronta disponibilidade de uma Ressonância Magnética e de um eletroencefalograma. Por esse motivo, tivemos que conduzir o paciente com base na maior probabilidade e grau de suspeição clínica, tendo conseguido realizar os exames somente depois de transferi-lo para outra unidade. Felizmente, a suspeição clínica maior era de um AVE, e o paciente foi tratado clinicamente da maneira correta.

 

Em outra ocasião, em um hospital privado, estava em um plantão noturno em que toda a unidade estava lotada. Havíamos recebido muitos pacientes que precisavam de reavaliação – para considerar alta hospitalar ou internação. Fui então comunicado, pela equipe de enfermagem, que um paciente havia apresentado parada cardiorrespiratória. O chefe do plantão – médico mais experiente – assumiu o comando da situação, orientando a equipe para os cuidados, com base no protocolo de ACLS. Felizmente, a equipe médica do hospital recebe esse treinamento regularmente. Um falha é que a maioria dos profissionais não médicos não é treinada com a mesma qualificação.

 

Funcionamento: Existem centros que atendem diferentes níveis de complexidade, bem como locais em que se trabalha na modalidade de “referenciação” – recebem somente os casos mais complexos, que necessitam de recursos físicos ou humanos indisponíveis em outros hospitais. À medida que o grau de complexidade sobe, diminui o número de unidades disponíveis. Em alguns casos, o médico do serviço público tem dificuldade de transferir o paciente para o local mais adequado para atendimento. A equipe necessária para o adequado funcionamento dessas unidades deve ser composta por médicos especialistas, enfermeiros, técnicos de enfermagem, fisioterapeutas, psicólogos e assistentes sociais.

 

Público X Privado: Trabalhar em um serviço privado, em que os pacientes tem acesso mediante pagamento, ou por possuírem um plano de saúde, difere do serviço público, no qual todos têm direito a atendimento. A disponibilidade de recursos técnicos e humanos é, muitas vezes, um fator limitante para a prática de uma medicina de qualidade nos hospitais públicos. Por vezes, ocorrem situações em que, por problemas de gestão, há carência de materiais, ou há necessidade de compras em forma de “licitação” – compra de urgência, o que representa aumento dos custos.

 

Pontos positivos de trabalhar no setor de emergência no Brasil: Diversidade de atendimentos; Resolutividade; Grande fluxo de pacientes.

 

Pontos negativos: Não há seguimento dos pacientes que se apresentam com queixas ambulatórias; Dificuldade de transferência para centros de maior complexidade.

 

Conclusão: Trabalhar com medicina de emergência no Brasil é um desafio diário. A dificuldade do aspecto clínico se soma às questões técnicas e assistenciais, e exige do médico a tomada de decisões em diversas situações críticas. Esperamos que a troca de experiências entre profissionais de diversos países sirva para melhorar nossa capacidade de lidar com os problemas mais comuns da medicina de emergência.

 

Pedro Gemal Lanzieri

www.pebmed.com.br

ENGLISH TRANSLATION

 

Emergency Medicine in Brazil

 

I am a second year internal medicine resident, having graduated in 2012 in Brazil. I’ve worked in and around Emergency Medicine (EM) over the last two years.

 

General aspects: EM differs greatly from other medical specialities. Factors such as time pressures, lack of access to a patient’s full medical history and the need to quickly establish a relationship with a patient are major challenges of daily practice.

 

Training of doctors specialized in emergency and acute care is a relatively new concept in Brazil. Previously, the most suitable doctor to work in this sector would typically be one with general training. Recent years have seen a significant increase in the number of institutions offering theoretical and practical courses specific to EM. In addition to this, there are now more events and conferences focused on EM. The first official documented programme in ‘Clinical Emergencies’ was created by Universidade de São Paulo in 1992; Medical residency in EM was first documented in 1996.

 

In Brazil, as in many countries, EM is of great importance because it accounts for a large portion of the hospital’s clinical workload. The emergency physician in Brazil has two main fields of work: the Emergency Department (or ‘emergency care’) and SAMU (Mobile Emergency).

 

In theory, the appropriate flow of patients is to have the basic health unit as a gateway to access to healthcare. However, due to cultural reasons – remnants of a hospital-centered medicine practiced in the past – a large volume of emergency visits are for outpatient complaints.

 

Day-to-Day: A typical Emergency shift begins with the reassessment of patients who remained under observation from the last shift. Depending on the clinical situation, you may choose to keep the patient in the emergency department, admit, or discharge with outpatient follow-up. The follow up may be in the primary presentation hospital or another facility. Problems frequently encountered are a poor availability of hospital beds and the difficulty of ensuring appropriate continuity of care on an outpatient basis.

 

A shift in the ER: The shifts in Brazil usually last 12 or 24 hours, with handover at 7am/pm or 8am/pm. There are great differences between private and public service emergency services. In the former, there is a large number of medical students on rotation, the department is less organized (medical triage systems do not always function) and there is, sometimes, a lack of material or human resources. In the private sector, on the other hand, there are better working conditions. In my service, in general, we have a team of 7 doctors: 4 general physicians, one general surgeon, one orthopedic surgeon and one obstetrician. The pediatric service operates separately, with its own 2-4 team members, attending patients under 12 years of age.

 

I remember a shift at the public hospital, on a Monday morning, when I saw a middle-aged laborer, brought in by coworkers, after a sudden loss of consciousness followed by fall. The patient was comatose and hypertensive. Unfortunately, because most services here do not work with electronic medical records, we had no access to any personal medical history or immediate contact with relatives. This made the case far more challenging, because the initial decision on the clinical course depended on the most likely diagnosis. A CT scan of the brain was performed – normal, but that does not rule out stroke or non-convulsive status epilepticus amongst other differentials. To proceed with investigations, we needed access to an urgent MRI and EEG. For this reason, we had to manage the patient based on our primary differential and degree of clinical suspicion, only obtaining diagnostic imaging after transfer to another facility. Fortunately, our primary differential was that of a stroke, which turned out to be the case and the patient was medically managed, making a good recovery.

 

On another occasion, now at a private hospital, I was on a night shift and the entire unit was full. We had received many patients requiring assessment with a view to deciding on discharge or admission, as previously mentioned. Suddenly, I was called by the nursing staff as a patient had collapsed from a cardiac arrest. The chief clinican – the most experienced doctor – took command of the situation, guiding the team to care, based on the international ACLS/ALS guidelines. Fortunately, the medical team receives resuscitation training regularly, and the arrest was managed well. One of the issues is that most non-medical professionals are not trained in ALS, which means that during cardiac arrests there is an even stronger onus on the physicians’ performance.

 

‘Operation’ (Tertiary Referral Centres): These are centers that cater for escalating levels of complexity, in addition to accepting the more complex cases that require physical or human resources not available in other hospitals. As the complexity increases, the number of available units decreases. In some cases, a public service doctor can have difficulty transferring the patient to the most appropriate place for care. The staff required for the proper functioning of these units is composed of general physicians, medical specialists, nurses, nurse technicians, physiotherapists, psychologists and social workers.

 

Public vs. Private: Working in a private hospital, where patients have access by direct payment, or by having a health care plan, differs from the public service, which is free at the point of care. The availability of technical and human resources is often a limiting factor for the practice of quality medicine in public hospitals. Sometimes, due to management issues, there is a shortage of medical supplies, which results in ‘last minute’ buying at a premium, which ultimately costs the hospital more money.

 

Positive aspects: Diversity of care, solving problems, wide exposure to patients.

 

Negative aspects: Lack of follow-up of patients who present with outpatient complaints, difficulty transferring patients to facilities offering specialist input.

 

Conclusion: Working with EM in Brazil is a daily challenge. The complexity of the clinical picture, compounded with technical and healthcare issues, requires firm decision making by the provider in critical situations. We hope that the exchange of experiences among professionals from different countries at Developing EM serves to improve our ability to deal with common problems of EM.

 

Please contact me if you have any questions or will be visiting Rio in the interim. Feel free to check out my website www.pebmed.com.br and the PEBmed applications on your smartphone.

 

Pedro Gemal Lanzieri

Resident in Internal Medicine

Hospital Universitário Antônio Pedro

 

Acute CT Interpretation in the ED – Why we shouldn’t always wait for the radiologist

The next in our series of presentation from Havana is Sanj Fernando’s presentation from the Adult ED and Critical Care session.

Sanj is an emergency and retrieval medicine physician from Sydney. He has an interest in education and has taught around the globe. During DevelopingEM 2013 he gave this presentation, organised a fantastic CT interpretation workshop and assisted with the Ultrasound Workshop. This year he is chairing our Trauma Program which is shaping up to be a standout component of the program in Salvador.

Sanj’s presentation was a great reminder that as critical care physicians we really have to own the CT so we can institute life saving therapies in a timely manner.

Listen to the audio file here.

 

Slide01

This year’s Trauma Program – DevelopingEM 2014 – Emergency Medicine Conference

Our trauma program this year will be one of the stand out components of the academic program.

The trauma program chair Sanj Fernando has organised an innovative and multifaceted program that will create a standard for our future conferences.

By combining case presentations with targeted lectures and demonstrations Sanj and his panel or experts will immerse you the audience in a novel educational medium.

To cap it off there will be as close to a real life trauma resuscitation as there is possible to be using a novel simulation device, The Cut Suit. I don’t want to give too much away, but this may be the most convincing visual, auditory and olfactory simulation you have ever seen.

Sanj is an emergency and retrieval physician with an interest in medical education. He has taught throughout Australia and around the globe. Last year in Havana he organised an outstanding CT interpretation workshop and also presented during the Adult Emergency Medicine and Critical Care session as well as assisted with the Ultrasound workshop. We’re very glad he’s involved again as he has put together an amazing program with incredible presenters which Im sure you will enjoy.

Stay tuned for more updates.

Letter to President Obama

As a result of the 2013 DevelopingEM conference in Havana, Cuba, a resolution was made to write to President Obama to end the embargo on Cuba. Here is what we sent.

President Barack Obama

The White House

1600 Pennsylvania Avenue NW

Washington, DC 20500

October 24, 2013

Dear President Obama,

We implore you to end the embargo of Cuba. It accomplishes nothing worthwhile, and is a humanitarian catastrophe for the Cuban people.

We are not a political party, or an organization; nor do we even have a shared social agenda. We are simply doctors who met in mid-September at the “DevelopingEM” medical conference in Havana, in order to share our clinical knowledge & experiences in emergency and critical care medicine. This letter stems from a resolution passed by the participants at the conference.

Approximately 185 doctors came to the conference from 18 countries, including the United States, Cuba, Australasia, Europe, and throughout the Caribbean. We heard talks by presenters from the US and other nations on clinical aspects of emergency care, as well as on related aspects of public health. One of the latter talks, given by Mr. Jorge Soberon, from the Cuban Health Ministry, addressed the impact of the US embargo on both health and healthcare in Cuba, and was extremely sobering. The following facts were presented:

The embargo, currently in its 55th year, severely limits Cuba’s ability to import medicines, medical equipment and new technologies, including some that are essential for treating life-threatening diseases and maintaining public health programs that are important for ordinary Cubans.

The embargo has prevented Cuba from purchasing, among other things, medicines to treat childhood leukemia, and enteric formula for children in danger of dying from treatable diarrheal diseases.

In addition to blocking direct purchases from U.S. companies, the embargo prohibits foreign companies from doing business with the U.S. if they also trade with Cuba. The Office of Foreign Assets of the U.S. Treasury Department stopped Cuba from receiving $4 million worth of drugs from France to combat AIDS and tuberculosis. Fines for doing business with Cuba have doubled under your administration compared to that of your predecessor, George W. Bush.

We believe that political considerations should not supersede the health needs of several million ordinary human beings. We are sure you know that many prominent individuals, including from the US, have expressed concern that the embargo violates both moral standards and international law (and even adversely impacts American business). By continuing to enforce this policy not only would you be counter to the expressed belief of the international community, but also of the majority of the American people (62% in one poll). You would also be abetting what continues to be a humanitarian catastrophe for the people of Cuba.

The embargo simply makes no sense. Flora Roca, a Cuban psychiatrist suggested that “the U.S. thinks the embargo will make Cubans rise up against the Cuban government, but it doesn’t work that way.” Fifty-five years have proven as much. What the embargo does cause is immense suffering, to people we claim to want to help. What value is there in denying medicine to a child with leukemia?

As physician specialists in emergency medicine, we may be fortunate enough in our careers to have a positive impact on our communities, helping to ease suffering and occasionally even saving a life. By ending this senseless embargo against Cuba you would ease the suffering of millions of people, and save thousands of lives. In 2009 you were awarded The Nobel Prize for Peace for your “extraordinary efforts to strengthen international diplomacy and cooperation between peoples.” Please extend this effort to include the people of Cuba. We call upon you please to put an end to this senseless and inhumane embargo.

Sincerely,

S. Lee Fineberg, MD, FACEP, FACEM

Mark A. Newcombe BMed, FACEM

Jerome R. Hoffman, MA, MD, FACEP

Faculty & Delegates of DevelopingEM 2013 – Havana, Cuba
569 Lawrence Hargrave Drive
Wombarra, NSW 2515
Australia
e-mail: developingEM@gmail.com