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International Emergency Medicine Section Newsletter - March 2010, Vol 12, #2

	Section News
	E-mail Bag
	US Emergency Medicine Training Accepted in Sweden
	Ukraine Ambassador Update 2010
	Emergency Medicine in Botswana
	Emergency Medicine – Europe Report
	University of California at Irvine, International Disaster Medical Sciences Fellowship
	Africa Updates
	Saudi Arabia 2010 Medical Conferences
	Call for Abstracts – Danish Society for Emergency Medicine
	Targeting trauma in Ghana
	A Small Step in the Right Direction: Top hospitals start casualty management courses
	Inter-American Emergency Medicine Conference
	Global Emergency Care Collaborative
	Vietnam Emergency Medicine Symposium brochure
	Haiti Visit and Update

Section Newsletter Index

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Section News

ACEP International Ambassador Program

If you are a U.S.-based practicing emergency medicine physician and are interested in becoming more involved in the global development of emergency medicine as a specialty we would like to encourage you to submit for consideration an ACEP International Ambassador application. Please keep in mind that all ACEP ambassadors are required to maintain active ACEP and Section on International Emergency Medicine memberships.

You will be required to submit a current CV as well as a formal letter of interest reflecting the following information in relation to your specific country/region of interest:

History/involvement (past work/experiences)
Existing/established relationships/contacts
Ties to developing emergency medicine
Recent visits
Fluency/familiarity with primary language

Links to our International Ambassador Program web page, International Reports by Country, and the ACEP International Strategic Plan can be accessed from our section Web site home page.

If you are interested in becoming an ACEP Ambassador please submit the information reflected above to Dina Gonzales .

Calendar of International Conferences

Please visit the section Web site to access our Calendar of International Conferences .

Membership

As of January 31, 2010 the Section on International Emergency Medicine had a total of 1,170 members!

Newsletter

Newsletter Copyright Agreements

Copyright assignment agreements and background information have been posted to all section Web sites. All newsletter contributors are required to visit the Web site and complete the click-through International EM Section Copyright Assignment Agreement . The accept/reject replies will then be forwarded to the section staff liaison for inclusion in upcoming newsletter issues.

We are currently accepting member submissions for the June 2010 issue. The submission deadline is May 25, 2010. Please e-mail submissions to Dina Gonzales .

Future submission dates are as follows:

Wednesday, August 25, 2010

Past section newsletters beginning with April 2003 may be accessed via the link on the section Web site home page .

E-mail Bag

From: K. Forrestal
Sent: Sunday, February 21, 2010 11:57 PM
To: Dina Gonzales
Subject: Haiti

Dina:
Thanks for the help, we got a tremendous response and Dr. Rob Jones will be going with us.

Could you post the following to the server:

To all the marvelous ER docs who responded, thank you sincerely from the bottom of my heart. I tried to reply to everyone individually, but if I missed someone, please forgive me. Things are a bit frantic at the moment and I'm writing to you from a hotel in Ft. Lauderdale about 8 hours before the flight into Cap Haitian.

Again many thanks and hope to try this again so you'll be hearing from me. I take tremendous pride in being part of a group who so readily stepped up and in such numbers to help those in Haiti.

Best regards,
Kerry Forrestal, MD, MBA

From: Dorothy Harris
Sent: Wednesday, February 17, 2010 10:46 PM
Subject: 3rd International Swine Flu Conference, UK

Attachment: Int’l SwineFluConference

Dear Colleague,

Please find enclosed information on our upcoming 3rd International Swine Flu Conference in London, UK on March 10-11, 2010.

Your participation in the conference will allow you to know the latest and crucial pandemic prevention, preparedness, response, and recovery strategies being developed by international bodies to curb and eventually end the human-to-human transmission of the AH1N1.

Ten breakout sessions, which the medical experts will facilitate, will be offered during the conference. The breakout sessions will teach delegates to plan in times of disease outbreak, protect their communities, respond to the pandemic, and continue business processes.

The sessions will cover the following topics:

Business Continuity Planning
Continuity of Operations and Continuity of Government Planning
Emergency Management Services
Law Enforcement Agencies
Hospital and Emergency Medical Services
Workplace Planning
School/University Pandemic Planning
Airlines, Travel, Airport, Quarantine and Border Health Services
Infectious Medical Waste
Swine Flu: Agriculture Perspective and Interventions

Seats are limited at the conference. For reservation, simply fill in the attached registration form and fax it back to me at 202-280-1239.

If you have any queries do not hesitate to contact me at 202-536-5000 or email me .

For more information on the event, please visit http://new-fields.com/isfc_uk/

Regards,
Dorothy Harris
Project Coordinator
New-Fields Exhibitions, Inc.
1101 Pennsylvania Avenue, NW 6th Floor
Washington, DC 20004

From: Arif Alper Cevik
Sent: Tuesday, February 16, 2010 3:05 AM
To: International Emergency Medicine Section
Subject: 2nd EACEM – Antalya, Turkey

Dear List Members,

2nd EurAsian Congress on Emergency Medicine will be held between 28 and 31 October, 2010 at Gloria Golf Resort Hotel in Antalya, Turkey.

You can check the details of Congress via www.eacem.org.

Dates: October 28 – 31, 2010

Venue: Gloria Golf Resort Hotel , 360 degree tour:

http://www.gloria.com.tr/vrtour/ggr/html/de/golfresort_9262.html

Co-Organizers: Emergency Medicine Association of Turkey (EMAT), SUNY-DownState,Brooklyn,NY, Singapore Society for Emergency Medicine (SSEM)

Endorsing Parties: Ministery Health of Turkey, International Federation for Emergency Medicine (IFEM), Emergency Physicians Associations of Turkey (EPAT), American College of Emergency Physicians (ACEP)

Abstract Deadline: August 9, 2010

Sincerely.
Dr. Cevik

From: Cabrera, Daniel, M.D. [mailto:Cabrera.Daniel@mayo.edu]
Sent: Friday, February 05, 2010 10:12 AM
To: International Emergency Medicine Section
Subject: Invitation to Lecture - Chilean EM Scientific Assembly

Dear Colleagues,

On behalf of the Chilean Society of Emergency Medicine (CSEM) I would like to extend an invitation to lecture in the CSEM Scientific Assembly 2010.

The Society is looking for speakers in the fields of Trauma, Cardiovascular Emergencies and Emergency Ultrasound. The local organizing committee will be able to provide hotel, but NOT the air travel (US$ 1600 US-SCL, US$ 700 SCL-ANF).

The Scientific Assembly will take place from November 10 to 13, 2010; in Antofagasta (about 800 miles north of the capital Santiago).

Antofagasta is the gateway to the Atacama Desert (including San Pedro) and Chile also offers great hiking conditions during November to hike in Patagonia.

If you are interested, please contact Rodrigo Rosas, MD (rarcrosas@yahoo.com) who is the interim president of the CSEM and Organizing Committee. Also, I’m happy to help in any way possible.

Thanks,

Some links:
Chilean Society of Emergency Medicine: http://www.medicina-intensiva.cl/urgencias/
Chile: http://en.wikipedia.org/wiki/Chile
Antofagasta, Chile: http://en.wikipedia.org/wiki/Antofagasta
Tourism: http://en.wikipedia.org/wiki/Tourism_in_Chile

Daniel Cabrera, M.D., Senior Associate Consultant, Department of Emergency Medicine; Residency Program Associate Director; Assistant Professor of Emergency Medicine, Mayo Clinic College of Medicine

From: Buresh, Christopher T
Sent: Thursday, February 25, 2010 1:14 PM
To: Dina Gonzales
Subject: RE: Haiti

Hi Dina,

Here's a write up for you to use however you choose. My wife edited it once (severely) but you guys are welcome to make changes as you see fit. Thanks for helping me get the word out.

If people are interested in volunteering we'd love to have them, but would ask that they fill out a brief application at: http://www.worldwidevillage.org/leogane-community-health-initiative/community-health-initiative-volunteers-needed

Chris Buresh, M.D, FAAP, FAAEM

Assistant Clinical Professor of Emergency Medicine; Associate Residency Director

From: Buresh, Christopher T
Sent: Tuesday, February 02, 2010 12:46 AM
To: Dina Gonzales
Subject: Haiti

Hi there,

I'm ACEPs ambassador to Haiti and just got back from 2 trips in the last month. The first trip was a few days before the quake; the one I just returned from was a week afterwards. I've been working in Leogane for the past 7 years, and upon going back this time, I didn't recognize the city I'd left the week before. We managed to set up a field hospital with 3 ORs. Our daily averages were around 300 patients per day with 20 cases in the OR and one delivery. We had "inpatient" beds in tents next to mine where we cared for patients overnight. We've had a foundation donate a mobile hospital which we are setting up this week to replace the one that has been closed for years and has now been damaged in the quake. As part of setting up this new hospital, we will also be setting up an ED or "selle d'urgence". The new hospital will be run, at least in the short term, by me and 2 other EM physicians. I'd be interested in communicating some of this stuff to members, and am looking for some guidance on how best to do that. Thanks.

Chris

Chris Buresh, M.D, FAAP, FAAEM
Assistant Clinical Professor of Emergency Medicine; Associate Residency Director

From: Nagi Souaiby
Sent: Sunday, December 20, 2009 3:13 AM
To: Nagi Souaiby
Subject: Tawarek – The Journal of Emergency Actors

Dear All:

Thanks to ACEP, Tawarek the Journal of Emergency Actors (edited in Lebanon and distributed over the Arab and Mediterranean countries) is shared now by thousands of ACEP members worldwide.

International Emergency Medicine Section Newsletter article link .

Thank you to support Tawarek and emergency medicine.

With the best wishes of Tawarek editorial board

www.newhealthconcept.net

US Emergency Medicine Training Accepted in Sweden

Bjorn Nicholas Aujalay MD, Fairbanks, AK

During the last 10 years Sweden has developed the concept of Emergency Medicine, from basically nonexistent to 10-15 sites with Emergency Medicine residency training sites. The Swedish Society of Emergency Medicine (SWESEM) has been formed and is advocating Emergency Medicine as a specialty of its own. At present Sweden accepts Emergency Medicine only as a subspecialty to another established specialty.

Recently however, I submitted my application for specialist status in Sweden. I am Swedish and did my medical schooling in Sweden but did my residency training here in the US at North Shore University Hospital. Thus formally, I would not be granted specialty status in Sweden since present directives require specialty status in another established specialty apart from EM training. However, Iceland does approve Emergency Medicine as an independent specialty, so I applied and got my specialty status there first. With this qualification I eventually got specialty approval in Sweden since the Nordic countries (Denmark, Norway, Iceland, Sweden and Finland) by agreement have to recognize their specialists and give them approval in any Nordic country.

This will hopefully be a step towards recognizing EM as a specialty on its own as it is not acceptable in the long run to require Swedish trained emergency physicians to be double boarded while physicians like me can achieve specialty status with EM training only. Also SWESEM has pointed out that training residents in two specialties leads to higher costs, longer training time and more complicated administration of rotations, which in turn makes emergency medicine less attractive as a carrier choice for junior physicians. Hopefully this will soon be changed.

Ukraine Ambassador Update 2010

Brian R. McMurray, MD, FACEP, FACP

It was a joy to recently complete a trip to Ukraine from January 25^th to February 4^th with colleague and fellow ACEP member Dr. Mark McLean. It was my 26^th trip to Ukraine and Mark’s first. It was a pleasure to watch Mark enjoy and get to know many fine professionals in Ukraine, and to see him catch the vision of how we can collaborate and assist our colleagues in Emergency Medicine in Ukraine.

We arrived just after the initial Presidential election, and then left 3 days before their runoff election apparently won by Victor Yanukovich. There was a lot of political "electricity" in the air, which made it an even more interesting time to be in Ukraine. We just hope their government can finally deliver with true servant leadership and diminished corruption….the people deserve such.

This trip was highlighted by renewed friendships in Kyiv and in Vinnitsa and with a new focus of collaboration in Kharkiv. Our initial days were in Kyiv, where we lectured on emergency airway management. We were blessed in Kyiv, Vinnitsa and in Kharkiv to demonstrate with donated Levitan optical stylets donated by Clarus Medical of Minneapolis; with donated laryngoscopes, bougies, pulse oximeters, LMA’s from Project CURE and others of Nashville; and with an intubating mannequin donated by the Vanderbilt Resuscitation Program. These airway emergency adjuncts that we take for granted are seldom in use in Ukraine because of the limited medical economy. We also left behind esophageal detector devices, which can provide a relatively inexpensive intubation verification technique.

As in the past, we were able to ride ambulances with their EMS providers. In most cases, this team is the driver, the physician assistant and the physician. These rides occurred in all three cities after the demonstration/lecture. In Ukraine, as in much of Europe, their emergency physicians are on the ambulances. It is very interesting to see this approach in action, where only about 25% of ambulance runs result in the patient being transported back to a Hospital. Only in larger cities are there Hospitals with an actual ER. Outpatient medicine is provided at the Polyclinic, which is a separate building near the Hospital. Most Hospitals greet the ambulance crew and their patient at a receiving area where the appropriate specialist comes to see the patient and then the patient proceeds to their room or the OR.

Central Dispatch in each city is computerized and the crew going out is a crew designated to the type of call that comes in. The ambulance then is advised where they should take their patient if returning with a patient needing hospital care. It may not be the closest hospital, but rather the one best equipped for the needs of the patient.

Our new English-speaking liaison in Kyiv is Dr. Dmitry Serbin. He has been with the Kyiv Central Dispatch for over 15 years. Only 37 years old, he is an enthusiastic and clinically adept ER doctor. I sense that he will play a special role in future clinical collaboration, and I would like to see him come to an ACEP meeting or spend some time at Vanderbilt and other US sites. He has worked with some Israeli emergency medicine folks, and that experience has served him and his patients well. If you wish to communicate with Dr. Serbin, let me know and I will get you his contact info.

Our time in Vinnitsa was spent with not only their emergency medicine specialists, but also at their cardiac care hospital holding a consultative clinic and revisiting their HIV treatment center, run by Dr. Igor Matkovskiy. Dr. Matkovskiy and my friend and colleague at Vanderbilt, Dr. Steven Raffanti, are in the process of setting up a clinical exchange program.

The clinic at the Vinnitsa cardiac facility focused on many patients with rheumatic heart disease, which is still very prevalent in Ukraine. With Mark’s prompting, a recent call to St. Jude’s in St. Paul, MN has led to the promise of some donated valves for needy patients in Vinnitsa Oblast.

The new initiative was our trip to Kharkiv. I had learned on a prior trip about Dr. Vadim Nikonov, who is considered the father of modern day emergency medicine in Ukraine. He is the Founder and Editor of Ukraine’s Emergency Medicine journal. He leads the ER residency program and emergency care in Kharkiv, a large industrial city in eastern Ukraine only 20 miles from the Russian border. Mark and I along with trauma surgeon Dr. Sergei Bolyukh of Vinnitsa and Foster Home parent/translator/driver/dear friend Ruslan Tkachuk of Nemia, Ukraine took the overnight train from Kyiv to Kharkiv. There we were treated to great hospitality by Dr. Alexander Lyska and translator Dr. Olga Klimenko as we visited the 1000 bed Emergency Care Hospital in Kharkiv, where Dr. Nikonov heads up the ER residency program. It is an impressive facility. Kharkiv, along with several other cities in Ukraine, is gearing up to host the World Cup in 2012.

Dr. Nikonov is very receptive to collaboration with the West. He had not hosted any Americans for a long time, and Mark and I had the privilege of being the first Americans to ride on their ambulances. Their Kharkiv Central dispatch is impressive, computerized with a projected active map of the city on the wall and all ambulances with GPS. We left behind not only the airway adjuncts and the teaching mannequin, but also a new rather complete US Emergency Medicine library of new donated texts.

Mark and I are certainly committed to many future trips, and to getting some of their leaders such as Dr. Nikonov and Dr. Serbin to America. As well, we hope to get some EM leaders from the US to spend time teaching and collaborating in Kharkiv, Kyiv, Vinnitsa and other larger cities. We hope that there will be other ACEP members interested in future trips.

Emergency Medicine in Botswana

Andrew Kestler, MD, MBA

In the last month, Accident & Emergency at Princess Marina Hospital, or A&E as the Emergency Department is called, has run out of soap, clean suture kits, and betadine though fortunately not all at the same time. The phones were just down for over a week, and the pager system is still out to lunch. Some staff members arrive late for shifts, some disappear after lunch, while others work very hard. And yes, critical septic patients occasionally get forgotten in the hallway for hours. On the street outside the hospital, no less than 4 ambulances (perhaps 3 private, one government) could report to the scene of a crash accident. Botswana has plenty of cell phones, but no centralized dispatch of pre-hospital services.

Less than a year now remain until the launch of a new emergency medicine residency in Gaborone, Botswana. Sound challenging? Of course, starting a new training program can be difficult under the most routine of circumstances.

Now also factor in the following:

The main government hospital is now the de facto teaching hospital. Most employees will rightfully claim that teaching is not explicitly included in their job descriptions.
The government rotates most nurses every year to different units, hampering the development of nursing expertise and team spirit.
The prevailing mindset dictates that the emergency department is a triage station rather than a site of care.
Human resources move very slowly in the government, deterring qualified staff.

On the bright side:

The Department of Emergency Medicine just doubled in size. With a new hire, Dr. Ngaire Caruso from Australia, we are now two.
The head nurse in A&E is stellar, and she "gets" emergency medicine.
A few shining stars among the medical officers are planning to apply for the emergency medicine residency.
The Permanent Secretary in the Ministry of Health is an emergency physician!
No shortage of patients: HIV and trauma roll on as the #1 and #2 causes of morbidity and mortality.
The brand new University of Botswana School of Medicine is off the ground and running: 36 first year students, and more due to start in August.
A brand new African Federation of Emergency Medicine provides an exciting avenue for collaboration with South Africa, Ghana, Tanzania and other African countries developing emergency medicine.
A country that has had the resources to provide anti-retrovirals to over 80% of its HIV+ people in need of therapy, also has the resources to make great strides in emergency care.

The frustrations are many and it’s fun to complain. On the other hand, I am never ever bored. The potential rewards are great: The relative lack of qualified emergency care provides a blank slate for improvement. For the moment, it’s hard to imagine returning to a "regular job" in emergency medicine.

Outside of work, Botswana is a great place to raise a family: a child-friendly country with decent schools, modern conveniences, and a stable, democratic government. Strong cultural traditions and big game, among other things, will still remind you that you are indeed in Africa.

We are still recruiting in emergency medicine, so if any of the above craziness sounds appealing to you, then please contact Andrew Kestler.

Emergency Medicine – Europe Report

Gordian Fulde, MBBS, FRACS, FRCS(Ed), FRACS/RCP (A&E) Ed, FACEM
Director, Emergency Medicine, St Vincent’s Hospital; Professor, Emergency Medicine, The University of Notre Dame; Associate Professor, Emergency Medicine, University of New South Wales; Sydney, Australia

As one of the founding grandfathers of the Australasian College for Emergency Medicine in the early 1980’s, I believe I have some insight into the hard cross country marathon of setting up a new specialty.

It has always been interesting, a challenge, and rewarding to observe, and at times, aid such journeys in other countries. Even superficial reflection underscores the absolute necessity for local conditions, obstacles, and politics to be individually recognized and worked through.

Surprisingly, at first glimpse, it seems the "old world"-Europe, has generally taken longer to embrace Emergency Medicine as a separate specialty.

The adages "Professions are their own worst enemies" or "the bitterest enemies come from within", unfortunately apply to the medical profession as well, when a new interest group forms.

European countries, as a generalization – some more than others – have long established conservative medical disciplines which often hold all the power and influence. This is at all levels – universities, hospitals, government.

These colleagues have often actively blocked the emergence of emergency medicine.

However, this has now changed, see table 1, with the majority of Europe recognizing Emergency Medicine. The European Union has 27 nations.

Table 1. EM Specialty Status of European Countries

Emergency Medicine is recognized as a Specialty

Belgium
Bulgaria
Czech Republic
Estonia
Hungary
Iceland
Ireland
Italy
Latvia
Malta
Netherlands
Poland
Romania
Slovakia
Slovenia
Spain
United Kingdom
(Turkey = non EU member)

Emergency Medicine is a Supra-Specialty. Where it has been added to an existing specialty.

* to change to independent recognition in 2012

Denmark
Finland
France*
Sweden
(Switzerland = non EU member)

Emergency Medicine is not recognized

+ Applied in 2009, currently still under process, no outcome as yet

Austria
Germany+
Greece
Lithuania
Norway
Portugal

In the Hospitals, for a long time, a lot of European Medicine and Surgery disciplines occupied space – "reception areas" – on the ground level of a hospital. This reception area often was separated physically into medical or surgical sections. These also have separate staffing, systems and their own diagnostic equipment. Organizational lines went up to the Professors, who at times, have feudal powers and total financial control. This was a classical silo set up for the main specialties.

This set up, for reasons that are "mother’s milk" to modern emergency physicians and administrators, is not cost or patient outcome efficient. Some examples being: expensive, inefficient, poor outcomes with multi-diagnoses (medical and surgical) diseases, delay to definitive care (often a junior person was sent down to assess the patient, etc.).

The old system started to crumble and reorganization commenced. Often then, a group of colleagues would become difficult. This was, at times, our critical care siblings, the anesthesiologists. The thought that anybody else could care for an airway, sedate or intubate a patient was an anathema to them, thus to be violently resisted. This still occurs. Outsiders would just see it as a turf war or a potential loss of income issue. They would not realize the significance of timely expert resuscitation at a front door of a hospital.

Especially over the last few years there has been great progress made with recognizing emergency medicine. This can be seen from the European Society of Emergency Medicine (EuSEM) Policy Document, EuSEMPolicy October 2009 (Figure 1) Europe is well on its way to standardizing emergency training and care.

Personally, I hope Europe, being a later developer of Emergency Medicine, can benefit from relevant innovations and experience as well as avoiding mistakes we have made in developing Emergency Medicine in our regions.

Acknowledgement

For his advice and information, I would like to pass on my gratitude to:

Thomas Fleischmann M.D., Director, Emergency Department, Northwest Hospital, Sanderbusch, Sande, Germany; Past Vice President, German Society of Interdisciplinary Emergency Departments D.G.I.N.A; Past National Representative for Germany, EuSEM. E-mail: t.fleischmann@sanderbusch.de

University of California at Irvine, International Disaster Medical Sciences Fellowship

Kristi L. Koenig, MD, FACEP, FIFEM; Tareg Bey, MD, FACEP, FACMT, FIFEM; Carl H. Schultz, MD, FACEP

Disaster Medicine, while still being defined, is clearly a global field. It is thus no surprise that scholars from all parts of the world seek additional education and training. Due to increasing numbers of unsolicited international requests, Disaster Medicine faculty at the University of California at Irvine (http://www.emergencymed.uci.edu/emsdms_faculty.htm) created an International Disaster Medical Sciences (DMS) Fellowship. A key goal of the fellowship is to share knowledge and skills that can be brought back to the home country to improve future disaster management. The applicant’s sponsoring country must confirm the need for qualified disaster medicine practitioners.

After a 6-month pilot program completed by a fellow sponsored by the Ministry of Health of Singapore, the first 2-year fellow from Kuwait began training on July 1, 2009. The 2-year fellowship involves a rigorous curriculum, practical training, and completion of a Masters of Public Health (currently at UCLA). It includes teaching, research, clinical, and administrative aspects of disaster management. The current applicant is also obtaining a certificate in Global Health, a new offering at UCLA. A detailed description of the DMS Fellowship program, key considerations for its establishment and a model core curriculum are available in the November 2009 issue of the Western Journal of Emergency Medicine at: http://www.escholarship.org/uc/item/2006v8f4.

The same Disaster Medical Sciences Fellowship is available for U.S. applicants; however, U.S. candidates are not subject to sponsorship and visa requirements. The DMS Fellowship curriculum (Table) was based on expert consensus opinion and modeled after the Cambridge University Press 2010 publication: Koenig and Schultz’s Disaster Medicine, Comprehensive Principles and Practices (published in association with ACEP: http://secure2.acep.org/BookStore/p-10545-koenig-and-schultzs-disaster-medicine-comprehensive-principles-and-practices.aspx). Core content categories are divided into a Conceptual Framework and Strategic Overview of Disasters (including terminology), Operational Issues, and Clinical Management. This Core Curriculum was submitted to the American Board of Emergency Medicine (ABEM) and the Accreditation Council for Graduate Medical Education (ACGME) as part of the approval process for the Fellowship. Off-site rotation opportunities include those with the Emergency Medical Services and Fire Authorities, Public Health, the State and Federal government, and international organizations.

As stated in our article cited above… "In the future, a comprehensive multidisciplinary national or even international core curriculum should be developed and endorsed by major academic societies involved in disaster management. A consortium for international disaster medicine fellowships would be desirable. These fellowships should contribute to an international database of Disaster Medical Sciences literature (including non-English language works) and research projects should be completed as part of each fellowship to further improve the science. International research databases would improve access to seminal and cutting-edge work and foster collaboration on future initiatives… A standardized disaster nomenclature that integrates across all languages and cultures is urgently needed." We look forward to learning of other approaches to establishing international DMS fellowships.

Table: ABEM/ECFMG–Approved - International Disaster Medical Sciences Fellowship Core Curriculum

Disaster Medicine Core Content Categories

1.0	Conceptual Framework and Strategic Overview of Disasters
	1.1	Disaster Nomenclature
	1.2	Disaster Research and Epidemiology
	1.3	Disaster Education and Training: Linking Individual and Organizational Learning and Performance
	1.4	Surge Capacity
		1.4.1 Critical Thinking in a Resource Poor Environment
		1.4.2 Alternate Care Sites
	1.5	International Perspectives on Disaster Management
	1.6	Ethical Issues in Disaster Medicine
	1.7	Emerging Infectious Diseases: Concepts in Preparing for and Responding to the Next Microbial Threat
	1.8	Disaster Mental and Behavioral Health
	1.9	Special Populations
2.0	Operational Issues
	2.1	Public Health and Emergency Management Systems
		2.1.1 National Incident Management System
		2.1.2 Incident Command System
		2.1.3 Communications
		2.1.4 Media
		2.1.5 Phases of Emergency Management (Mitigation, Preparedness, Response, Recovery)
		2.1.6 All-Hazard Approach
		2.1.7 Resource Management
		2.1.8 Volunteer Management
		2.1.9 National Disaster Medical System
		2.1.10 Personal Preparedness
	2.2	Legislative Authorities and Regulatory Issues
	2.3	Syndromic Surveillance
	2.4	Disaster Triage
	2.5	Personal Protective Equipment
	2.6	Decontaminatio
	2.7	Quarantine
	2.8	Mass Dispensing of Antibiotics and Vaccines
	2.9	Management of Mass Gatherings
	2.10	Transportation Disasters
	2.11	Emergency Medical Services Scene Management
		2.11.1 Recognition, Notification, Initiation
		2.11.2 Scene Safety
		2.11.3 Search and Rescue
		2.11.4 Transportation
	2.12	Health Care Facility Disaster Management
		2.12.1 Hospital Incident Command System
		2.12.2 Allocation of Scare Resources
		2.12.3 Evacuation
	2.13	Mortuary Affairs
	2.14	Crisis and Emergency Risk Communication
	2.15	Telemedicine and Telehealth Role in Public Health Emergencies
	2.16	Complex Public Health Emergencies
	2.17	Patient Identification and Tracking
3.0	Clinical Management
	3.1	Chemical-Biological-Radiological-Nuclear and Hazardous Materials
		3.1.1 Traumatic and Explosive Events
		3.1.1.1 Management of Crush Injury
		3.1.1.2 Management of Compartment Syndrome
		3.1.1.3 Management of Crush Syndrome
		3.1.2 Burn Patient Management
		3.1.3 Clinical Aspects of Large-Scale Chemical Events
		3.1.4 Biological Events
		3.1.5 Nuclear and Radiological Events
		3.1.5.1 Dirty Bomb
		3.1.5.2 Nuclear Detonation
		3.1.6 Hazmat, Toxic, and Industrial Events
	3.2	Environmental Events
		3.2.1 Floods
		3.2.2 Hurricanes
		3.2.3 Tornadoes
		3.2.4 Earthquakes
		3.2.5 Tsunamis
		3.2.6 Winter Storms
		3.2.7 Heat Waves
		3.2.8 Volcanoes

Africa Updates

Formation of the African Federation for Emergency Medicine (AFEM)
November 26, 2009

African Federation for Emergency Medicine Inaugural Meeting Minutes
November 26, 2009

Formation of the Emergency Nurses Society of South Africa (ENSSA)
November 25, 2009

Emergency Medicine Society of South Africa (EMSSA) Newsletter
December 2009

Botswana Meeting Minutes
November 24, 2009

African Journal of Emergency Medicine Meeting Minutes
November 25, 2009

Saudi Arabia 2010 Medical Conferences

Call for Abstracts – Danish Society for Emergency Medicine

Targeting Trauma in Ghana

Dr. Bhakti Hansoti, Emergency Medicine Resident, University of Chicago

Two thirds of the world’s population live in the developing world, most of which are on the African continent, and suffer from a lack of access to primary health care. In 2001, injuries accounted for about 5.1 million deaths (about 20% of which are preventable by simple surgical intervention)¹. Africa has the highest road traffic injury mortality rate in the world at 28/100,000 people, and has 50 deaths/10,000 vehicles compared to 1.7 deaths/10,000 vehicles in high-income countries². Injury accounts for more than deaths caused by tuberculosis (2.5%), diarrhea (4.3%) and malaria (2.9%), human immunodeficiency virus (6%) or cancer (5.2%)³. The worldwide leading cause of death among young life between 5 and 40 years is injury². Projections show that, between 2000 and 2020 road traffic deaths will increase by 83% in low- and middle-income countries. In contrast, there will be a further 30% decline in road traffic deaths in high-income countries, continuing a pattern that has been established in recent decades⁴. Yet, the world’s focus, although important, remains focused on the prevention and care of communicable diseases such as malaria, HIV / AIDS and nutrition.

However, as nations simultaneously address their infectious contributors to mortality and as well develop transportation infrastructure, increasingly, trauma is becoming a major cause of morbidity and mortality in poverty stricken developing countries like Ghana. Effective trauma care requires sustenance and sufficiency of three components: Emergency Medical services (EMS), Emergency Departments to stabilize acute trauma victims and Orthopaedic/Trauma healthcare resources. Motec Life – UK (Motec) is a multi-disciplinary charity organization based in the United Kingdom looking at developing a self sustaining Trauma Care in developing countries like Ghana⁵.

In October 23^rd 2008 a paramedic workshop was organized by Motec and the Ministry of Health represented by the Ghana National Ambulance Service, Directorate of Occupational Health and the Eastern Regional Directorate with the co-operation of the Ghana National Fire Service (ER) and the Professional Drivers Union of Ghana. The event held in Kofordiua was attended by 120 participants, and was the first national paramedic training program of this kind. The training workshop supported a morning of didactic teaching comprised of ambulance aid skills, paramedic aid skills and a broad overview of applicable ALS/ATLS. The afternoon comprised of split practical skills sessions – 4 stations: Cardio-Pulmonary Resuscitation, Spine Immobilization, Emergency Intubation and Handling of Accident Victims. There was also a highly attended session on reinforcement of Cardio-Pulmonary Resuscitation, practical teaching on chest compressions and airway management, and updating the resuscitation algorithm.

Given the size of Ghana and the relatively few centers able to provide trauma care, transport times can vary from 30mins to 6 hours. There is also significant regional and seasonal variation in transport times as rains and flooding can obstruct major roadways and impede traffic. Thus, a significant proportion of injury deaths occur in the pre-hospital setting, which emphasizes the role of the paramedic team in providing temporizing medical care while en route to a definitive treatment facility. Effective trauma care development is slow as the government funds 80% of the public health services through general taxation and donor funds⁶. The first approach to address this issue is to improve pre hospital care via paramedic training with workshops similar to the Motec conference. Of course, efforts to improve pre-hospital medical care should be mated with significant investments in improving hospital-based emergency care.

A barrier to development of trauma centers with Emergency medicine departments is the cash and carry system that is currently in place for supplies and medicines. As such many existing hospital models focus on making a diagnosis, and not on triage or rapid stabilization, and as such there is no conception of what we would consider emergency medicine. Once patients are dropped off by EMS there has to be a pick up on the part of the receiving hospital to provide rapid, effective emergency medical and surgical care. Thus only by simultaneous development of EMS, Emergency medicine care and Orthopaedic/trauma care will there be a significant dent in mortality and an improvement in injury related outcomes.

In conclusion there is a large burden of morbidity and mortality from injury particularly as nations make the epidemiologic transition and develop both approaches to the prevention and treatment of infectious diseases and as well develop industrial and transportation infrastructure. My name is Bhakti Hansoti and I am a UK graduate, who with Motec organized the above workshop, I am currently based at the University of Chicago and a proud member of their Emergency Medicine residency program.

References

Murray CJ, Lopez AD. Mortality by cause for the eight regions of the world: Global Burden of Disease Study. Lancet.1997 May 3;349(9061):1269-76.
Lagarde E. Road traffic injury is an escalating burden in Africa and deserves proportionate research efforts. PLoS medicine. 2007 Jun;4(6):e170.
Beveridge M, Howard A. The burden of Orthopaedic disease in developing countries. The journal of bone and joint surgery (American). 2004. 86:1819-1822
World Health Organization. 2004 World report on road traffic injury prevention.
Motec-Life UK. Online at [www.moteclife.co.uk] as of 11/20/09
Challoner K. Emergency Medicine in Ghana. Online at [http://www.medscape.com/viewarticle/556969_2] as of 11/20/09

A Small Step in the Right Direction: Top hospitals start casualty management courses

A Small Step in the Right Direction: Top hospitals start casualty management courses
New Delhi, India

Inter-American Emergency Medicine Conference

Inter-American Emergency Medicine Conference
May 19-21, 2010, Buenos Aires, Argentina

Global Emergency Care Collaborative

Vietnam Emergency Medicine Symposium Brochure

Vietnam Emergency Medicine Symposium brochure
March 22-26, 2010, Hue College of Medicine & Pharmacy, Vietnam

Haiti Visit and Update

Christopher Buresh, MD, FAAP, FAAEM, ACEP Ambassador to Haiti

We were working underneath trees and shrubs, doing our best to stay out of the blazing sun. Our patients included a child with meningitis who had been in the throes of febrile seizures for hours, a newborn going into renal failure from posterior uretheral valves, an old woman who was too wracked with pneumonia to walk, children incapacitated from malaria and malnutrition, and people permanently maimed from untreated injuries. That was our experience in Haiti exactly one week before the earthquake.

Before Haiti had its brief moment in the media spotlight, each day held small scale disasters for the people of this island nation. While many people live in the cities that have recently made the news, the majority of the population lives a rural existence. Many are subsistence farmers who walk for miles each way to get their crops to market. The healthcare infrastructure consisted of about 2000 physicians for the country of over 9 million people. These physicians lived in the cities and operated mostly out of small private clinics during business hours. The few hospitals scattered around the country are a mix of governmental institutions, private facilities, and charitable operations, but are virtually unreachable for huge swaths of the population. One mother we met departed from her home in a panic when her meningitic infant had her first febrile seizure. She made it to our clinic 16 hours later, but was too late by a long shot. While we all rail against the lack of access to care here in the United States, while we work collectively to shape the future of our specialty and ensure its proper place in the pantheon of medical specialties, it is instructive to see what a world is like where there is no 24-hour emergency care.

We had just returned home from a week in Haiti where we’ve been working to set up a system of primary care in a few villages by training, augmenting, and utilizing the skills of village health care workers. I had just gotten home from a shift and was about to start unpacking my bags when I got a text page about the earthquake from a friend. I became pretty obsessed with getting as much information as I could and trying to figure out how best to respond.

There were two competing impulses at play. I know that well-intentioned people who aren't trained in disaster response can get in the way and absorb resources that can be better put to use. These folks run the risk of being medical adventurers and disaster tourists, and I didn't want to be one of those people. On the other hand, we'd been working down there for a long time, we know the area, and we know the people. We had a great team put together, many of whom had just been on the ground there 3 days before. We’d been asked to come by 2 different local organizations, had 3 different deployment plans, and we had a lot of local support. In the end, we judged that we'd be able to help more than hinder.

Immediately following the quake there was a pretty brisk response in Port au Prince, but there was nothing happening in Leogane, the city in which we normally work. It was nearly 3 days before any media made it the 20 miles west to Leogane and another 2-3 days before any medical teams arrived. The day before we got there disaster response teams from Japan and Doctors Without Borders had made it to the region. The team that we brought was composed of 3 emergency medicine doctors, a pediatrician who’d been coming to Leogane for 14 years, 3 paramedics that had military experience, an emergency room pharmacist, and 2 people who were familiar with the area.

We weren't really sure what to expect. We brought all of the food that we needed, brought tents, and water purifiers. Since we were at the end of the dry season, we discussed water rationing before we hit the ground. The first 2 locations where we'd hoped to set up in Leogane were full of tent cities where displaced people were living, so we went instead to the nursing school where we knew the Dean. She and the nursing students had been treating patients almost without stop for the last 6 days. Their first patients arrived within minutes of the earthquake. They’d been out of gauze, sutures, antibiotics, and gloves for several days when we arrived.

We set up our tents and got to work putting the clinic up. We constructed the clinic by stringing some webbing between 2 wings of the nursing school and putting up tarps over the courtyard. Within 2 hours of getting out of the Landcruiser, we were seeing patients. The first patient we treated was a 2 year old girl who had a quarter of her scalp peeled back in the earthquake. She’d been walking around for 6 days with her skull exposed but blessedly intact. We did all of our work outside on desks that the students had been using the week before. There were a lot of badly injured people and we didn't have much to offer them. For the first 3-4 days the only analgesics that we had for people open fractures was Tylenol.

On the afternoon of our second day, a Blackhawk helicopter landed with a team from Minnesota and Wisconsin that included an orthopedic surgeon and critical care PA. In the following days other teams arrived bringing more orthopedists, general surgeons, anesthesiologists, primary care physicians, and nurses. We were able to barter with other non-governmental organizations in the area for some supplies that we needed, particularly ketamine. Our surgical teams started doing amputations in the classrooms without any patient monitors or supplemental oxygen. After the ketamine wore off, however, all we had was Tylenol. Postoperatively patients were kept in tents next to our own so that we could deliver some postoperative care.

The Haitians were incredibly tough. We didn’t have wheelchairs or stretchers, so we often had to carry people around in our arms when they had a broken pelvis or broken legs. It’s just not possible to stabilize the fracture when you’re supporting someone in your arms, so it’s incredibly painful. But patients never complained. In fact, when you would set them down they would look right at you, sometimes with a tear running silently down their cheek, and say "Mesi anpil". Thanks a lot.

More supplies and expertise arrived over the following days. We began to link up with teams from Japan, Canada, Cuba, Switzerland, Austria, and others. We worked through the United Nations to share resources in terms of medicines and expertise. We’d trade IV tubing for plaster, crystalloid for ketamine. Shipments of anesthetics and narcotics began to come in. A week later we began to get crutches. Every day we’d rearrange the tarps that had become our clinic to repair the damage the wind had wrought and to try to keep our patients cool. Twice the thermometer in the shaded "pharmacy" climbed above 105 F. The duct tape melted.

In the subsequent weeks, a foundation has donated and help us set up a field hospital with a generator. We now have 50 climate controlled beds and 2 operating areas. We’ve begun hiring a Haitian staff to run the place and are working with the Episcopal Church, who runs the healthcare system in the area, to integrate the facility into their long-term planning for the region. We hope that the field hospital can be used to support them in their mission to provide excellent primary, secondary, and tertiary care to the region. In our first 30 days that we’ve been on the ground we’ve seen approximately 9,000 patients, done hundreds of surgeries, and delivered about 50 newborns.

After having worked with dozens of different physicians since the earthquake and perhaps hundreds of different physicians over the years in Haiti, there are a few qualities that I’ve come to value above all others down there. These include a broad area of expertise, be comfortable in a chaotic and ever changing environment, ability to work with people from diverse backgrounds with a variety of agendas, be able to fulfill a variety of roles, and most of all flexibility. It struck me after one of my more recent trips that these are the same qualities that we look for in our colleagues and our residents in Emergency Medicine. In fact, it sort of sounds like a job description.

I do not want to diminish the role that our colleagues in other specialties have played. There were pediatricians, family medicine doctors, internists, anesthesiologists, obstetricians, and surgeons of many different stripes down there. Many of them have been there for longer than I have and are heroes of mine. They have expertise and experience that I will always envy but never posses. This sort of response would never have happened without them. The only way that we were able to set up that clinic and hospital was by having everyone work together in a coordinated fashion towards a common purpose. Each provider found their role and fulfilled it beautifully. The focus was on what was best for the people living around us; there was no place for politics or personal agendas. There was never any hesitation to lend each other a second opinion or a helping hand. Nobody complained about being woken up at night for an emergency. In some strange respect, it was an ideal of what life could be like in the emergency department.

Nevertheless, as Haiti slowly picks itself up on injured limbs and dusts itself off, emergency medicine physicians have a definite role to play in the rebuilding and bolstering of Haiti’s medical infrastructure. In the near term, there needs to be the provision of round-the-clock emergency care. People still have heart attacks, perforating gastric ulcers, overwhelming infections, and complications from untreated diabetes. Babies are still born every night in the shanties that have been erected in the streets. Many of the NGOs that are working right now board up the doors and turn off the lights after sunset, but somebody needs to care for the sick and the wounded in the off-hours.

More importantly, there is virtually no training in emergency medicine available in Haiti. It is one thing to have physicians volunteering their time to work in Haiti in the short term. A sustainable long-term solution must be Haitian-born, though. Emergency medicine physicians have always been advocates for the poor and the marginalized. I would suggest that our specialty is uniquely suited to assist Haiti, both in the medium-term response to the earthquake, but perhaps more importantly in the restructuring and capacity-building process. We should focus some attention on augmenting the education of healthcare providers, physicians, nurses, and community health workers, in Haiti such that they are better able to respond to natural calamities and every day disasters.

This publication is designed to promote communication among emergency physicians of a basic informational nature only. While ACEP provides the support necessary for these newsletters to be produced, the content is provided by volunteers and is in no way an official ACEP communication. ACEP makes no representations as to the content of this newsletter and does not necessarily endorse the specific content or positions contained therein. ACEP does not purport to provide medical, legal, business, or any other professional guidance in this publication. If expert assistance is needed, the services of a competent professional should be sought. ACEP expressly disclaims all liability in respect to the content, positions, or actions taken or not taken based on any or all the contents of this newsletter.