Speaker:

Takeshi Shimazu

Country:

Japan

Abstract:

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.

Speaker:

Michael Gerardi

Country:

USA

Abstract:

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.

Speaker:

Michael Bullard

Country:

Canada

Abstract:

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.

Speaker:

Chor Chiu Lau

Country:

Hong Kong

Abstract:

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.

Speaker:

Judd Hollander

Country:

USA

Abstract:

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.

Speaker:

Teodoro Herbosa

Country:

Philippines

Abstract:

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.

Speaker:

Matthew Huei-Ming Ma

Country:

Taiwan

Abstract:

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.

Speaker:

Jason Frank

Country:

Canada

Abstract:

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.