Reflections on emergency medical care after one year as President of IFEM

Professor James Ducharme

One can get discouraged when looking at how emergency medicine is (or is not) progressing around the world. From a systems point of view, crowding is an ever worsening problem in an increasing number of countries. The rise in road traffic fatalities is not being adequately addressed in entire continents. Looking at it from a ‘people’ perspective instead of a systems one, we are witnessing medical tourism rapidly increasing, as ever larger numbers of physicians spend 2 or 3 weeks in another country thinking their brief stay will somehow advance care. Despite the evidence to the contrary, far too many well intentioned people continue to believe that they ‘know’ what a country or a hospital needs, and that they can show them the ‘right’ way if somehow they would just listen.

Yet these areas of discouragement should not sway us from our path, based just on what has been witnessed this year alone. On May 27, 2019 the WHO adopted a key resolution on trauma and emergency care. “”No one should die for the lack of access to emergency care, an essential part of universal health coverage, said WHO Director-General Dr Tedros Adhanom Ghebreyesus. “We have simple, affordable and proven interventions that save lives. All people around the world should have access to the timely, life-saving care they deserve.””

In this past year, the WHO has rolled out its Basic Emergency Care program, supported by IFEM, establishing minimal standards of emergency care. IFEM has produced position papers on Pediatric EM care, Quality and Safety standards, as well as Ethics on International Research. The IFEM/WHO task force had been set up, with representatives from all 6 United Nations regions, ensuring collaboration and continuing progress.

With recognition that non-infectious diseases are becoming the ‘leaders’ in mortality, with motor vehicle collisions at number one in Africa, quality emergency medical care is now accepted as a necessity in every country. Emergency Medical Systems and proper ambulance transportation must be developed. The question still seeking an answer is: ‘how do low income countries find funding to enable the building of such an infrastructure’?

Within IFEM, there has been a renewal of energy and purpose. We are moving ever closer to a stable financial model that will allow us to reach out and guide the growth of EM care. A communication strategy – the backbone for every organization’s success – is appearing and has already shown strong results. Our more robust head office staff is allowing IFEM to get on top of its workload and be responsive to communications from its members as well as initiating its communication strategy so that we can be proactive in our communications. With an operational structure and greater accountability, our Special Interest Groups are producing high quality work at a remarkable rate. The white papers, the marketplace successes, the position statements – all are pushing IFEM in the right direction to be the umbrella organization necessary to oversee and guide EM care worldwide.

There is a critical need for collaboration among the various NGO’s to optimize results. Patient and system outcomes cannot be compromised by groups competing for opportunities within the same country, for despite a desire to help they can unfortunately give mixed messages that create confusion and conflict. Constant awareness, communication and collaboration toward a common goal is required to avoid such scenarios. We must avoid actions that undermine – even unintentionally – those of another. We have seen in the just-passed 18th ICEM in Seoul fantastic cooperation and support of the various national and international societies. All groups, be they universities, national societies, international federations, or private organizations – we need to communicate, and make each other aware of our activities and objectives so that we can optimize our efforts and resources. The American Academic Chairs of Emergency Medicine has agreed with this approach and is working with IFEM to survey all US universities involved in international EM work so that we can know who is doing what. By compiling such a database IFEM, the WHO and others can make suggestions to these passionate and motivated groups how to best target their efforts and expertise.

There are so many positives that have occurred this year alone; by continuing to work together we can achieve so much more. So let us join hands, let us roll up our sleeves and continue this great work with the goal of providing the best possible emergency medical care around the world.