Professor Jim Ducharme 
President 

Welcome to a new year, and a new decade – where will we be 10 years from now?

If we believe projections from scientists, there will be both great and terrible events: individualized treatment based on our DNA, nanotechnology to cure cancer and remove atherosclerotic plaques etc. It is believed that the predicted singularity event will occur near the end of this decade: where computer intelligence and capacity so exceeds human capacity that we alter the world to the point of being incomprehensible to previous generations. The possibility of ‘downloading’ a human being into a computer will probably become a reality, redefining what we mean by ‘life’. Consequences of pollution, fossil fuel use, population growth and global warming will be ongoing threats. All terrifying as we look forward, and yet we will move forward.

The resolution from the WHO supporting emergency medical care as a basic human right will encourage many countries to focus health care improvements in both prehospital and hospital acute care – countries are already changing their health system plans to prioritize such care.

We must ask, however, how does moving forward in emergency medicine fit into such a rapidly changing landscape? New and advancing technologies should allow us to introduce high level emergency medical care in low resource countries to a level previously impossible. Innovation should allow modification of current technology to be provided at much lower cost. The concern I have is that the (recurrent) promise of less expensive technology or medicines never seems to be realized. Profits are the only priority for business. In Canada, the last decade has seen the cost of medications rise by 5 billion dollars due to the arrival of biologics. Inability of national health care models to cover the rising costs of health care has resulted in many countries introducing a 2-tiered system, with private care as an integral part of offered care. Given the rising costs, and the inability for any government to pay for these health care costs, we must look at potential consequences:

1. Top level health care for the privileged, with health care stratification even worse than that seen today.
2. Society having to decide what will or will not be available within any health care model (who we will not treat).
3. A radical restructuring of health to actually become health care, with lifestyle and prevention as the underpinnings. This would be far less expensive and help the greatest number of people. Priority would be for the best for society, making any one individual’s outcome less of a priority. Health systems would have to insist people adhere to these healthy lifestyles, while providing the tools for them to be able to do so. Health education, for example, would have to be a critical part of every school’s curriculum.
4. In low resource countries, the huge costs of transportation infrastructure required before establishing a responsive prehospital care system may overwhelm any WHO mandate or national desire to raise EM care to the desired level. Yes, quality emergency medical care can save millions of trauma lives each year – if you can afford it – but in the long run, a focus on health, lifestyle and prevention may well be the most cost effective approach. Less attractive to emergency medicine supporters, but perhaps necessary?

It is hard to look at the above and not be quailed. Yet IFEM, as the international emergency medicine leader must embrace these challenges and find a pathway that ensures quality emergency medical care for all. We must extend our relationships further, as we will need to collaborate with forces outside emergency medicine to help build a new global health care vision. We will need to bring on technology and IT experts to allow us to see where lies the future, and how we will integrate technology with care – as a group only of physicians, we will fail in future development without such partners. We can help define what care is needed, then ask the non-medical experts how to best accomplish this.

IFEM must continue to define what is and is not emergency medicine, while working with everyone within health care to ensure seamless patient care from cradle to grave. Turf battles – seen all across medicine – must stop. We must base every step forward on 2 priorities: optimizing patient outcomes (not the same as improving) and improving the health care model. Emergency medicine while being distinct must be ‘part of the whole’. Our SIGs and committees will need to continue to define standards of care and promote optimal evidence-based practice, but will need to be able to adapt to the rapid changes that will occur. In 2020, we can no longer afford to practice in isolation. Documents will need to be fluid and cloud based as publications in the old sense will be considered dated before seeing the light of day. The world of social media will not tolerate health care having knowledge translation times of years as they are today.

IFEM must work diligently on the ‘bigger picture’ to ensure quality emergency medical care in a rapidly changing future. At the same time, we must we able to work with individual national societies to focus on details that foster needed local changes – changes that will occur far more rapidly than they did in countries with already mature systems.

2020 going forward: it will take your breath away, and outcomes will be difficult to predict at best. IFEM has to monitor that we stay on target during these tumultuous times and oversee changes going forward  so that the focus on continually improving care for our patients is not lost. Are we ready for this heady ride?