2015ACEM

Prof. Takeshi Shimazu

Professor, Department of Traumatology and Acute Critical Medicine
Osaka University Hospital

Session: Plenary Session 1

Date: Nov. 8th (Sun) 09:45-10:15

Challenges and Opportunities of Emergency Medicine in Asia

Emergency Medicine is a rapidly growing specialty among various specialties, and Asia is also a rapidly growing corner of the world with the diversity of society, culture, economy and medical care system among Asian countries. As such, the Asian Society for Emergency Medicine should take the lead to help all the Asian countries develop Emergency Medicine according to their local needs in terms of social system, undergraduate education, postgraduate training, and EM specialist training, as well as prehospital EMS systems.

Emergency medicine is generally regarded as the medical specialty that deals with the acutely ill or injured who require immediate medical treatment. However, our task and field are not limited to the care of the acutely ill, but Emergency physicians are the foundation of the country�s health care system's patient safety net (from the ACEP definition). Another characteristics of EM include, 1) EM is the origin of medicine as EM is primarily focused on relieving the suffering patients, and 2) there is no Universal Model in EM to successfully run the Emergency department since the background is so diverse in each region or country, 3) EM should satisfy the needs of the society which is affected by the locality and/or historical changes. An example of Japan will be shown to demonstrate the relationship between temporal changes in the number of motor vehicle accident death and the number of ambulance dispatched in relation to social changes.

Considering the significant diversity among Asian countries� background of EM, it is worthwhile to know and recognize once again the difference and similarity among us. At the 7th ASEM in Tokyo in 2013 we had a Joint JAAM and ASEM Special Symposium on �EM as a specialty in Asia�. During the Symposium Dr. Lim Swee Han summarized the data from the 10 member countries that time and then Dr. Jen Heng Pek of Singapore published an original article on the Journal of Acute Medicine and Surgery (27 Aug 2015). I will introduce some of the interesting similarities and difference among us in order to facilitate the awareness on our situation in Asia and set the future goals, which may include to help countries in the process of developing EM system and propose common curriculum for residents and EM specialists among Asian countries, which may finally achieve trans-national EM Board Certification of Asia.

Biography

Dr. Takeshi Shimazu obtained an M.D in 1980 from the School of Medicine, Osaka University, Osaka, Japan. He had postgraduate clinical training at the Department of Traumatology and Acute Critical Medicine, Osaka University Hospital and the Department of Surgery at the Saiseikai Kanagawaken Hospital, Yokohama, Japan. He was involved in basic research at the US Army Institute of Surgical Research (USA-ISR) as a staff researcher from 1984 to 1987 in San Antonio, Texas, USA. In 1985 he obtained his board certification from the Japanese Society for Acute Medicine (JAAM). He obtained his Ph.D. degree from the Osaka University Graduate School of Medicine, Japan in 1989. From 1990 to 2008 he continued his clinical, educational and research activities at the Department of Traumatology and Acute Critical Medicine, Osaka University School of Medicine as the Assistant Professor, Associate Professor and then as the Clinical Professor. In 2008 he became the Professor of the Department of ER Medicine, Kindai University, Osaka, Japan. He has been the Chairman and the Professor of the Department of Traumatology and Acute Critical Medicine, the Graduate School of Medicne, Osaka University and the Director of the Trauma and Acute Critical Care Center of the Osaka University Hospital since 2010.

Dr. Shimazu is the current President of the Asian Society for Emergency Medicine (ASEM) from 2013, and is a Member of the Board of Directors of the Japanese Association for Acute Medicine (JAAM) and the Chairman of the International Liaison Committee and the Committee on ER-style Emergency Medicine of the JAAM. He also serves for several professional societies such as the Japanese Society of Clinical Toxicology (Chair, Board of Directors), Japan Surgical Society, Japanese Society for Burn Injuries, Japanese Association for the Surgery of Trauma, American Association for the Surgery of Trauma (AAST) and the International Society of Burn Injuries (ISBI). His social activities and appointments include the Executive Director of the Japan Poison Information Center (JPIC), Committee member for the National License Examination for Paramedics of the Japan Foundation for Emergency Medicine, Committee member and Lecturer of the Nuclear Safety Research Association and the Representative of the Japan MIMMS Committee.

Dr. Michael Gerardi

President
American College of Emergency Physicians

Session: Plenary Session 2

Date: Nov. 8th (Sun) 10:15-10:45

The Future is Now: Changes in Emergency Medicine and Health Care in the United States in 2015

The United States, despite the incredible advances it has created in health care, has been criticized as having one of the most expensive health care systems per capita compared to the rest of the world. It also allegedly falls short in quality measures. In addition, significant portions of the population have no medical insurance. This has been exacerbated by premiums being unaffordable to ALICE (Asset Limited Income Constrained Employed� � United Way Northern New Jersey) These factors have led to the Affordable Care Act (ACA) in 2009 and its accompanying regulations that are driving changes in medical care delivery and financing.

Emergency Medicine is one of the newest medical specialties but is increasingly being viewed as the �hub� of the medical enterprise and a leader in producing the ACA�s �Triple Aim�, i.e. improved patient experience with better outcomes at lower cost. In addition, emergency Medicine is the critical specialty that deals with time-sensitive diagnoses such as heart attacks, trauma and stroke. It t also accounts for 70% of admissions to the hospital. There are new roles evolving for specialty of EM in that it will have responsibility for admissions versus transfer to other care options for treatment. Emergency physicians will have at their disposal advanced diagnostic and imaging tools to make definitive diagnoses in a more rapid fashion so treatment can be given on a moment�s notice.

Advances in electronic health records (EHR) are leading to more efficient medical information exchange between hospitals and physicians. It is also leading to an ability to enact quality improvement programs that will enhance the ability to develop and adhere to specialty society guidelines and pathways. The use of qualified clinical data registries (QCDRs), such as ACEP�s Clinical Emergency Data Registry (CEDR�), are linking measurement of quality outcomes and payment reform.

Biography

Dr. Michael Gerardi is the Director of Pediatric Emergency Medicine at the Goryeb Children�s Hospital and faculty in the Pediatric Emergency Medicine Fellowship and the Residency in Emergency Medicine at Morristown Medical Center in Morristown, New Jersey. He is an Associate Professor of Emergency Medicine at the Mount Sinai School of Medicine in New York. He obtained his B.S. and M.D. at Georgetown University and completed residencies in Internal Medicine and Pediatrics at Emory University. He is Board Certified in Emergency Medicine, Internal Medicine and Pediatric Emergency Medicine and practices clinically in adult and pediatric emergency medicine.

He has been an advocate for advancing pediatric emergency care for children around the world with the American College of Emergency Physicians (ACEP) and the American Academy of Pediatrics (AAP). He served for 10 years as a member of the Pediatric Subcommittee of the American Heart Association�s Emergency Cardiovascular Care Committee. During this tenure, he evaluated the international body of resuscitation research and worked with international researchers in developing evidence-based guidelines for pediatric advanced life support. He is a past Chair of ACEP�s Pediatric Emergency Medicine Committee and during his tenure, helped forge collaborative relationships between AAP, ACEP and EMSC.

Over the last 25 years, Dr. Gerardi has served on many ACEP Committees and Task Forces including the Medical Legal Committee. He has also served as ACEP Liaison to National Conference of Insurance Legislators and FAIR Health�s Physician Advisory Group. He lectures regularly throughout the United States on health policy, emergency medicine practice, pediatric emergency medicine and risk management issues.

He served on the Board of Trustees of the Emergency Medicine Foundation and served as its Chair in 2011, during which he promoted health systems research. Dr. Gerardi was a founding member of the Board of Trustees of the Emergency Medicine Patient Safety Foundation and served as a trustee from 2005 - 2013. He also serves on the Board of Directors of the Los Cabos Children�s Foundation whose mission is to provide pediatric care for all of Baja, Mexico.

Dr. Gerardi served in the United States Air Force until 1993 when he joined Emergency Medical Associates, a democratic emergency physician partnership in the Northeast, for which he is a Senior Vice President for Quality. He was a founding Board Member and President of Superior Insurance Co., RRG, a professional liability company from 2003 � 2013. He is a former Director and Chairman of the Board of the South Carolina Captive Insurance Association.

In October 2008, Dr. Gerardi was elected to the Board of Directors of the American College of Emergency Physicians (ACEP) and re-elected in October 2011. The Board of ACEP elected him Secretary-Treasurer for 2012, Vice President for 2013. He was elected President-elect of ACEP for 2013-2014 and was inducted as President on October 26, 2014.

Prof. Michael Bullard

Professor, Department of Emergency Medicine
University of Alberta

Session: Plenary Session 3

Date: Nov. 8th (Sun) 10:45-11:15

Challenges and Innovations for Emergency Medicine Care Delivery

During the birth of emergency medicine AMI was treated with morphine and bed rest, CT scans were in development, and surgeons and anaesthetists wanted patients �stabilized� in the ED. Four decades later we have highly trained emergency physicians with access to a wide array of technology for diagnosis, therapy, and communication. We have helped shift the philosophy from �call me in the morning if they are still alive� to �the golden hour�. With advances have come challenges. Globally ED overcrowding has become the new normal due to increasing patient populations along with changing demographics and changing patient expectations. Simultaneously health care budgets are unable to keep pace, leading to a lack of system capacity to meet current care needs.

Innovations are required in many domains, most importantly society and politicians need to achieve a health care vision that is sustainable in terms resource utilization and outcome expectations. Enhanced scene to hospital communication will help utilizing prehospital care providers deliver ever more advanced care using on-line telehealth. To limit ED transport, personal health robots and EMS providers, in coordination with ED or other providers to decrease hospital utilization, will provide more care at home. Empowering patients through knowledge and personal control will be the most challenging and important innovation affecting care delivery. Patients will be able to access health information through their �patient portal�, add data to share with physicians through their �wearable devices� (monitoring BP, rate, rhythm, glucose, pacemaker, stroke onset, etc.). In addition many will have mapped their personal genotype with an expectation of a personalized investigation strategy and therapy based on their genetic risks and documented presenting features. Advances in stem cell research, 3-D printing, nanotechnology combined with genetics, all integrated into seamlessly designed clinical decision support make Star Treck�s view of the medical future look simplistic.

Biography

Dr. Michael Bullard graduated from the University of Alberta in 1972. He then trained and worked in Canada, England & South Africa from 1972-1977and then as an Emergency Physician in Calgary, Alberta from 1977-89. From 1989-1998 he was a consultant at Chang Gung Memorial Hospital in Taiwan assisting in program development, the training of residents and the development of emergency medicine (EM) as a new specialty. From 1998 to present he has been an academic faculty member in the Department of Emergency Medicine at the University of Alberta, Director of EM Informatics and Co-Chair of the CTAS National Working Group and lead for international agreements/collaborations for the adoption and implementation of CTAS. He has currently taken on the role of Knowledge Coordinator for the province helping create foundational knowledge to populate a provincial clinical information system (CIS).

His research and development focus areas include: triage and the development, implementation and dissemination and evaluation of evidence-based clinical decision support applications. Our team has developed electronic clinical decision support tools for triage (eTRIAGE) and clinical care (eCPG). He has published more than 100 peer reviewed journal articles, book chapters, and educational manuals. He has been honored by awards from: the Department of Health, Republic of Taiwan for service to the nation for contributions to the development of emergency medicine in Taiwan in 1998; the Certificate of Individual Achievement in International EM Development from ACEP�s Section on International EM in 2003; the International Federation of Emergency Medicine (IFEM) Humanitarian Award in 2008; the Dr. Garnet E Cummings Lifetime Achievement Award in 2010; and the Honorary Life Membership Award from the Canadian Association of Emergency Physicians (CAEP) in 2015.

Dr. Chor Chiu Lau

Cluster Chief Executive of Hong Kong East Cluster
Hong Kong Hospital Authority

Session: Plenary Session 4

Date: Nov. 8th (Sun) 11:15-11:45

Risk Reduction Strategies to Ensure Patient Safety in Emergency Department

Ensuring patient safety is our prime concern in health care services. New strategies for quality improvement have been explored and implemented in a time of frustration and losing hope with the system. Yet not much have been achieved as shown in the increasing number of incidents and adverse events being reported. What are the missing links? When taking a closer look- the key rests with the real understanding of human factors in our complex day to day practice ie teamwork, communication, effective use of monitoring, staff engagement ...The first step desperately needed is cultural change in the patient safety journey.

Biography

Prof. Judd Hollander

Associate Dean for Strategic Health Initiatives
Thomas Jefferson University

Session: Plenary Session 5

Date: Nov. 9th (Mon) 09:40-10:10

Emergency Medicine 2050: A Crystal Ball Prediction

Dr. Hollander will discuss the current health care system in the United States and its evolution from a fee for service system into value based care. He will then talk about trends in consumer driven health care and how he anticipates it will impact healthcare transformation over the next several decades.

Biography

Dr. Teodoro Herbosa

Professor, Emergency Medicine
University of the Philippines, Manila

Session: Plenary Session 6

Date: Nov. 9th (Mon) 10:10-10:40

Challenges and Possibilities of Emergency Medicine from Public and Global Health Perspectives

Health reform is a continuing process. Today, the move to achieve Universal Health Coverage (UHC) has been embarked by many countries to enable governments to have a sustainable strengthening of health systems aligned with the principles of Global Health. Achieving Global Health reforms involves change in financing, payment, organization, regulation and behavior. Reforming these so called "control knobs" are important in achieving health outcomes for a better health status of a population together with satisfaction of all stakeholders, and risk protection to provide health equity to a people. To achieve these health outcomes, intermediate performance indicators include efficiency, quality and access. The Philippine health system has numerous gaps both in structure and processes. This leads to emergency care that is overloaded, diminished in quality and delayed. This paper will discuss the reforms we implemented in the Philippines to improve health financing and achieve universal health coverage of 89% of the population by revising excise taxes for tobacco and alcohol. Since, there is an infrastructure gap in health system as evidenced by the low hospital bed to population ratio (5:10,000), a significant investment in health facilities was invested. This modernization included public financing and public private partnerships to increase access to quality health services. This involved incorporating emergency care at all levels of the health system from prehospital care, emergency room care and definitive surgical care. We also analyzed the use of electronic health technology to be able to facilitate efficiency in the health system. We implemented a National eHealth strategic framework and plan. Emergency Medicine has been at a huge demand with these efforts to modernize the public hospital system in the Philippines. We also saw the need for improvement in Disaster Medicine as evidenced by the recent experience of Typhoon Haiyan in 2013. In summary, a robust Emergency Medicine program is vital in the implementation of universal health coverage in any country that wants to reform and strengthen their health system.

Biography

Teodoro Herbosa(MD), a general and trauma surgeon with extensive experience in emergency medicine and disaster medicine, was the Undersecretary (Deputy Minister) for the Department of Health of the Republic of the Philippines from November 2010 to December 2014. He achieved vital health reforms which led to the implementation of Universal Health Coverage in the Philippines. Worked as lead for the coordination of 155 Foreign Medical Teams and international response during Typhoon Haiyan. he was also in charge of the modernization of public hospitals under the DOH including the Public-Private Partnership (PPP) programs in health. He also led the DOH as the Chief Information Officer, achieved COBIT 5 Certification and completed the National eHealth Strategic Framework and Plan. He also served as Member of the Board of Trustees of Philippine Heart Center, National Kidney and Transplant institute, Lung Center of the Philippines and Philippine Children's Medical Center. Prior to this, he was Vice President at the World Citi Medical Center. He was also a Visiting Professor at the Universiti Kebangsaan Malaysia from 2007-2010. There he developed the Center for Research in Emergency Medicine (CREM) and was a Member of the Board of the World Association for Disaster and Emergency Medicine (WADEM). He also was an International Associate Faculty for the John Hopkins Bloomberg School of Public Health and developed and implemented the program called Hospital Preparedness for Emergencies (HOPE) of the PEER Program. He was a member the the WHO Global Safe Surgery Saves Lives Taskforce that developed the WHO safe surgery checklist. In the University of the Philippines, Manila, he developed the Fellowship Program for Trauma Surgery and the Residency Program in Emergency Medicine. He actively pursued community service through numerous humanitarian works. He is currently Chairman of the Board of Physicians for Peace, Philippines. His awards include: 2011 UPAA Distinguished Alumni Award in Public Service; 2012 UP Medical Alumni Society Outstanding Service Award; 2013 UPAA Distinguished Service Award for an Alumnus; 2012 Rotary International District 3780 Rotary Golden Wheel Award for Health and Nutrition. He is currently member of the Faculty of the College of Medicine of the University of the Philippines, Manila and the Institute for Health Policy and Development Studies of the National Institutes of Health in the Philippines.

Prof. Matthew Huei-Ming Ma

Professor, Department of Emergency Medicine
National Taiwan University Hospital

Session: Plenary Session 7

Date: Nov. 10th (Tues) 09:40-10:10

Building World-Class Emergency Medical Services Systems and Community
Chain-of-Survival: Translating Science into Education and Implementation

The goals of emergency medical services (EMS) systems in the community are to decrease morbidity and mortality from acute injuries and illnesses, and to maximize patient well being. Due to the changing demographics of the population the complexity of diseases, and the parties involved in the system, the success of systems depends heavily on consensus building among major players and the integration of community resources.

EMS activities in Taiwan rapidly developed in the last two decades, especially after National EMS legislation in 1995 and National Specialty Board Status for Emergency Medicine in 1998. With the joint efforts of emergency physicians, central and local health and fire departments, involved community leaders and stakeholders, ongoing activities over the years have cumulated into the current comprehensive EMS systems and community chain-of-survival. Projects initiated over the last years include: wide-spread citizen CPR training and community-wide early defibrillation programs, medical direction system, the training of EMT-paramedics and implementation of pre-hospital advanced life support. In addition, Taiwan has also strengthened the in-hospital chain-of-survival, including the implementation of post-resuscitation care and CPR with extracorporeal support.

To optimize system implementation, medical direction, performance evaluation and research infrastructure were built early during system design. Discoveries in resuscitation science and epidemiology of cardiac arrests from local communities were made, and have been translated successfully into education and system implementation. Over the years, we have witnessed a 7-fold increase in the survival of out-of-hospital cardiac arrests as well as marked improvement in trauma survival. These would not have been achievable without the commitment and dedication of physicians and organizations in the community.

Biography

Dr. Jason Frank

Director, Specialty Education, Strategy and Standards, Office of Specialty Education
Royal College of Physicians and Surgeons of Canada

Session: Plenary Session 8

Date: Nov. 10th (Tues) 10:10-10:40

The Coming Transformation of Emergency Medicine Training

Modern Emergency Medicine training is arguably the most effective and sophisticated in the history of the profession. So why then are major changes in training coming? This session will describe how research and trends in patient safety, education, health outcomes, and sociodemographics are driving a transformation of how we prepare the next generation of EM physicians.

Biography

Dr. Jason R. Frank is a clinician-educator with a focus on all aspects of health profession training systems.

He currently holds roles of the Director, Specialty Education, Strategy and Standards in the Office of Specialty Education at the Royal College of Physicians and Surgeons of Canada, and the Director of Educational Research & Development in the Department of Emergency Medicine, University of Ottawa. An associate professor at the University of Ottawa, Faculty of Medicine, he is cross-appointed to the Faculty of Education, University of Ottawa and the Department of Graduate Studies, Ontario Institute for Studies in Education.

He obtained his MD from the University of Ottawa, Faculty of Medicine, and his FRCPC in Emergency Medicine at the University of Toronto. He has a Masters of Education from the Ontario Institute for Studies in Education. He has published and presented widely in medical education, where his research interests include: competency-based education, faculty development, program evaluation, and curriculum development. He is known for his work with the Royal College on the CanMEDS Project since 1994, and as an award-winning teacher.

Dr. Frank was the recipient of the 2013 Council Award Honouring Outstanding Physicians, presented by the College of Physicians and Surgeons of Ontario, to recognize physicians whose performance and expertise in their career has been exemplary. He was the 2005 EM Teacher of the Year in Canada, an honour awarded by the Canadian Association for Emergency Physicians (CAEP), and the 2007 Meredith Marks new educator award winner from the Canadian Association for Medical Education (CAME). He was also a finalist for Canada's Globe and Mail Top 40 Under 40 in 2011.

Dr. Frank lives in Ottawa, Canada with his wife Ruth, also a physician, and four sons.