Professor Jim Ducharme 
President 

It is raining – with thunder – outside as I write my final message as IFEM President. A fitting atmosphere, perhaps. The world is trembling from Covid-19.

Countries have taken incredibly different approaches to this pandemic, despite very clear and standard information coming from the medical experts. When I look at the ‘let’s safely acquire herd immunity’ approach in Sweden and compare it to the rigid controls in Hong Kong or the ‘this is nothing’ approach in Brazil, I ask myself how is it that people somehow know better than the experts and come up with such varying responses? Are politics that much more important than human lives? I am far from an expert in public health and make no claim to knowing which approach is best – only time will give us that answer. This variability in approach to Covid-19 reminds me eerily of physician variability in medical practice. In both situations there exists consensus opinions as to the best approach, while not quite having hard evidence for all points. Before we ask too loudly why politicians seem ‘all over the place’, perhaps we should first answer that question about our own practices. I am hoping that together, the world can find a way out of this terrible situation, but (sadly) believe a year from now we will still be wearing PPE at work, still uncertain as to the future. I truly hope I am wrong about this.

My travels have come to a complete halt, as with everybody else. It helps that I have encountered so many amazing people around the world, so I can continue to communicate globally and advocate for emergency medical care. We must find innovative ways to continue this goal of improving emergency medical care, for we are seeing every day that the fight is not equal for everyone. With Covid-19, lower resource countries risk collapsing. Choices between exposure to the virus versus isolation and starvation are being made. The New York Times has quoted there are an additional 140 million people at risk of death from starvation as a result of Covid-19 because of an inability to produce crops, and an inability to ship produce to where it needs to go. Medical care in low resource countries is overwhelmed, as it was barely sufficing before the pandemic. Worse, the high resource countries are able to outbid them to obtain PPE, placing low resource countries at even greater risk. Due to lack of PPE, there have been well documented instances of health care workers being assaulted because they are being seen as the vectors of disease. Is it that easy for humans to lose control and rather than help each other, attack each other?

My term as President is therefore ending under a cloud of uncertainty. In many ways this pandemic will alter society and the lives we lead. There is always opportunity in a situation of duress – and we in emergency medicine must find those opportunities to convert the way we work and communicate to make us stronger, to allow us to provide even better emergency medical care. The pandemic has exposed gaping holes in many health care models – are we brave enough and strong enough to face those challenges and fix them? We must resist the inevitable momentum, as the pandemic eases, to slide back into old habits – we have been shown brutally the old way is not the best way.

I have made my involvement in IFEM and improving global emergency medical care one of my life long pillars of professional activity. My signature is on the original IFEM charter, something of which I am very proud. We have come a long way since that momentous event in 1991, constantly growing, and more recently, changing our approach. We started out as a gathering of people with a common interest but with minimal resources. Yet we did so much with so little! We relied on national societies to fund our existence – for which we are very grateful. We have matured, and are now self sufficient. We have seen, however, how fragile that existence still is. Our greatest revenue source – our annual ICEM – was unfortunately cancelled this year due to Covid-19. The financial strain this has placed on the organization validates even more the recent approach we have taken to conduct ourselves as a business – using SMART objectives, ensuring we meet timelines for our projects, establishing and heeding budgets. We need to become more diverse in our revenue streams to be less fragile and less at risk – just like any good business. With the arrival of Sally McCarthy as our new President next month, I have no doubt that such steps will be taken, for her track record in that area is exactly what we need. She will provide the leadership we need at the exact time we need the skill set that she possesses. Welcome Sally!

My primary objectives over my two years included installing SMART objectives as our way of functioning for all committees and SIGs. My expectations have been wonderfully surpassed because the volunteers within IFEM are an amazing group. The productivity from the SIGs has been remarkable – thank you everyone for such hard work. I also wished to expand Head Office staff – which we have – and have 3 great people in our Melbourne office: Carol, Miranda and Diana. Lee Wallis came before me, and provided IFEM an exceptional vision to move forward. I have been a ‘mechanic’ who tried hard to make sure the new engine worked right. As with any leader, an important skill is choosing the right person for a job and then getting out of their way. I believe I have found that right person most of the time – we have outstanding Chairs for our SIGs and Committees. All credit for IFEM’s productivity and success goes to those hard working leaders, without whom we would go nowhere. My thanks to all of you. We will all see in their annual reports just how much they have accomplished.

Those who have dedicated the most time of course are our Board Members. In 2020, we will be seeing five of the Board stepping away. I want as many of you within IFEM as possible to reach out and thank those stepping down – where would we be without their energy and commitment? We have to be careful to maintain institutional memory (Those who cannot remember the past are condemned to repeat it. George Santayana-1905) while ensuring the newcomers can spread their wings and show us new ways to move forward.

Perhaps fittingly, it has stopped raining. My time as President is ending, so I will go outside and see if I can find that ‘brave new world’ with new challenges to take up. My best and most cherished memory will be of the incredible people I have come to know and call friends. I have been lucky enough to have been asked to lead you for a short time. You have rewarded me with glowing accomplishments and friendship. Who could ask for more?