Cameron and Bodiwala: 10 Years Later
In the summer of 2010, Emergency Physicians International published its first edition in Singapore, in partnership with the International Conference on Emergency Medicine. In that issue, I interviewed Drs. Peter Cameron and Gautam Bodiwala, former heads of the International Federation for Emergency Medicine (IFEM), to get a high-level view of the present and future of global emergency medicine. A decade on, we decided to revisit this interview, and give the good physicians a chance to review and annotate their answers. Here’s what they said the second time around.
EPI: What trends are you seeing in international emergency medicine?
Dr. Peter Cameron (2010): I think the positives are that emergency medicine is expanding into virtually every country in the world, in some form or another. It is still not a specialty in many countries, but roughly one-third of all countries have some formal emergency medicine organisation and training. Along with this, IFEM has been able to bring the disparate concepts around emergency care delivery into a more consistent approach through conferences, committees and most recently a curriculum that has been agreed to around the world. This is very exciting, even in comparison with other more established specialties. In addition to the expansion of emergency medicine as a specialty, there has been increasing interest in broadening the scope of subspecialization. Now we have prehospital care, toxicology, disaster medicine, ultrasound and so on. I guess the other really big positive for IFeM is that it is the only true global emergency medicine organisation – this is most unusual in international medical specialties. It means that potentially IFeM can play a big role in advocating for improvements in emergency medicine systems around the world.
Dr. Peter Cameron (2020): As far as international expansion goes - this is continuing. The WHO initiatives are helping with this and ensuring that countries with little/no emergency system are at least doing some planning. In many countries there may be only one or a handful of specialists but there is a program to develop basic emergency skills in nurses/technicians.
It is worrying, that in this time of a COVID pandemic, many relationships that have taken decades to develop, are being tested because of travel restrictions. The technology of virtual meetings can only go so far....
Dr. Gautam Bodiwala (2020): International acceptance of Emergency Medicine as a specialty is very encouraging and expansion of IFEM is a good proof of it. There are global participants with less number of EPs willing to encompasse other emergency care providers.
EPI: What are IFEM’s primary weaknesses moving forwardS?
Cameron (2010): The main negative for IFEM is that it is still essentially a loose conglomeration of national organisations with minimal funding. The IFeM Board has been examining ways to improve financial viability through conferences and so on. It is important that funding does not constrain the organization, either by association with large corporations or through lack of finance. It is a complicated path to follow.
Cameron (2020): The role of IFEM in promoting the specialty continues and with a very limited budget, has been able to affect some important changes. It would be great if we could get more resource to increase IFEM initiatives, but this has not eventuated. The enthusiasm of individuals and support of national organisations remain the cornerstone of this organisation.
Bodiwala (2020): Financial weakness is the biggest and ways are to be found to make IFEM self sufficient. That is also a factor for less affording counties to send their members to ICEMs and IFEM activities
EPI: Dr. Bodiwala, how have you seen international EM change during your term in office?
Dr. Gautam Bodiwala (2010): To start with statistics, there are now more than 40 national societies that are members of IFeM, not counting three regional ones covering Asia, europe and Latin America. There is more awareness in providing emergency care and setting up emergency care systems around the world, particularly in countries where emergency medicine does not exist as a specialty and certainly where there is no eM national organisation. IFeM has brought awareness of the importance of organised eMS, delivery of quality emergency care and that too by trained staff. WhO now recognizes the importance of these aspects of medical care and with the help of IFeM and other interested parties has worked towards it. World health As- sembly has passed a resolution in favour of providing appropriate emergency care. There are more and more national and regional meetings exchanging science of eM and practice round the world. With IFEM producing undergraduate and postgraduate curriculum, it will promote the quality even further.
Bodiwala (2020): International EM is accepted widely now and its recognision is encouraging. It is heartwarming to see how many countries with less number of EPs are using nurses, paramedics and other staff to enhance emergency care.
EPI: In regions where attending international conferences might not be feasible, what first steps can be taken towards improving EM systems?
Cameron (2010): One of the first steps is to get a group of interested people together – often we are all fighting the same battles with- out realising it. Once there is an organisation with local cham- pions, the group can learn from international experience. There is extensive help available online at no cost. Avoid making the same mistakes that everyone else has made. get a “jump start” by using the collective experience of 30-40 years of hard labour in other countries. visiting experts are also useful. They can say the same thing that the locals say, but have more authority because they are “experts” and they have no local vested interest. There are many people willing to help. vietnam, for example, recently hosted a conference in Hue where 60 overseas emergency experts came at their own cost to assist in specialty implementation.
Cameron (2020): International conferences will be difficult to run for the next few years. We have to become more innovative with technology and many institutions are producing high quality, virtual conferences, fora and learning packages at low/zero cost. So for the next few years, I think this is the avenue we have to take.
Bodiwala (2020): Use of technology is the only way forward in absence of ability to participate in conferences due to financial constraints. A lot of EM and IFEM material is available on line.
EPI: Is there a role for IFEM in disaster relief efforts, in conjunction with organizations like Doctors Without Borders?
Cameron (2010): At this point, IFEM can’t be a relief agency like MSF. It is not organised to respond in this way and it is not part of its mission. however, by bringing groups together and develop- ing consistent approaches, IFEM can play a major role in assisting countries with training and planning for disasters. IFeM can also coordinate interested parties to get together and help after the immediate disaster relief operation.
Cameron (2020): The role of IFEM has not changed with respect to disasters. It has an interest group, that has produced guidance and acted as a forum for sharing ideas and information. IFEM has also acted as a conduit for requests for assistance.
Bodiwala (2010): There is a definite role for IFeM in major disaster events. However, we must remember that as IFEM is still evolving. It is limited to notifying member countries/associations where there is a need. After the recent earthquake in haiti, IFEM successfully circulated information about the need for medical help. IFEM has established committees which are intended to create some basic, generic disaster management plans in due course. IFeM has also taken the first step by producing guidelines for pandemic flu.
Bodiwala (2020): IFEM has a special Interest Group on Disaster Management. However IFEM currently unable to send teams in disaster affected area due to mainly yet again financial and manpower constraints.
EPI: Given the difficulties of global communication, how would IFEM go about disseminating something like the pandemic flu guidelines?
Bodiwala (2010): English remains the language of communication as it has become an international tool for communication. Once information is sent to national organisations, they disseminate it in their usual way to their members. electronic communication has made life easy.
Bodiwala (2020): English remains the International language. Translation of some documents are available in Spanish.
Cameron (2020): IFEM has produced up to date guidance on emergency medicine responses and has an active website on COVID 19. This has been useful. WHO and other organisations have produced a lot of material that has also been very helpful
EPI: Does IFEM prefer to cast a broad or more narrow net when it comes to defining “emergency medicine”?
Cameron (2010): The definition, as defined on the IFeM website, is fairly broad. I think within eM there is room for subspecialisa- tion. There is also the opportunity to collaborate with other specialty organisations. For example, in CPR training, ILCOR, AHA and other organisations have long established track records. We just need to link in with these groups.
Cameron (2020): The practice of Emergency Medicine is a broad branch of medicine as defined by IFEM. Doctors who specialise in EM are a specific group of doctors who focus on EM practice. Many GPs, nurses and other groups undertake emergency care in various settings and have an interest in the domain of emergency medicine.
Bodiwala (2010): IFeM’s definition of emergency medicine is on the web. Many countries have adopted that definition broadly. Whilst its purpose is clearly de- fined, I would remind that it does include prehospital care. IFeM does and hopes to continue to collaborate with these organisations too.
Bodiwala (2020): IFEM has a clear definition of EM. However practice of EM and provision of emergency care has to be tailored according to a need of a country.
EPI: In your traveling around the world, have you been surprised about an element of emergency medicine that is similar across borders?
Cameron (2010): This is a difficult question to answer as we subconsciously expect things to be the same! I guess it is mostly the en- thusiasm and dedication of people work- ing in emergency medicine, in whatever form, under very different and sometimes difficult circumstances.
Cameron (2020): I don't think my answer has changed in 10 years!
Bodiwala (2010): I have found that wherever I went, a bunch of hospital and general practitioners wanting to either establish eMS or eM as a specialty which is profoundly encouraging.
Bodiwala (2020): Ditto!
EPI: What about an element of EM that is surprisingly different from country to country?
Cameron (2010): One thing that has taken me a bit by surprise – even within my own country – is the variation in how we process patients on arrival at the hospital. When we look at other businesses with high volumes – banks/supermarkets etc., – there is a standard process for the initial interaction. In high risk areas, such as ours, this is even more important. However, the second-by-second process of ambulance arrival, clerical registration, handover, prioritisation, documentation, and movement to eD cubicle is very different everywhere! Why??
Cameron (2020): Standardisation of practice, especially in high risk clinical pathways is happening and has improved over the last 10 years. The Advent of EMRs and the ability to standardise documentation and pathways will drive this quickly in countries with access to the technology.
Bodiwala (2020): Understanding the importance of provision of quality emergency care, recognition of its need and recognition of the specialty has made a difference.
EPI: As per IFEM bylaws, only one national society can be a full member of IFEM. How do you think IFEM should handle countries that have multiple competing EM societies?
Bodiwala (2010): Usually there is no problem, but should there be a competition we will seek to have clarification from either the government health department or a na- tional medical organisation looking after all specialties to signify which one is the representative of emergency medicine.
Cameron (2020): This is still the same
Bodiwala (2020): No change
EPI: What if the rival societies are extremely entrenched? What is the criteria for choosing a dominant player?
Bodiwala (2010): In my personal opinion (as there is no written bylaw on this specific matter) I would suggest to clarify from the government which of the two or many eM societies is ‘recognised’ by them, which one do they communicate with and other medical admin authorities and which one has the ability to conduct examinations and issue certification. I would also suggest that two or more societies decide among themselves who should represent emergency medicine in the International Federation based on who represents eM on their national scene.
Cameron (2020): No change
Bodiwala (2020): No change
