Raising a Pint to an Irish ICEM: An Interview with Dr. Fergal Hickey

Published on July 10, 2013
ICEM chair Dr. Fergal Hickey talks conference innovation, IFEM guidelines and how Irish emergency medicine punches above its weight.

EPI: What unexpected challenges did you face while organizing ICEM in Dublin?

Fergal Hickey: Realistically, the biggest issue is the size or our organization. It’s the smallest organization to host an ICEM conference. There are about 66 consultants in emergency medicine in Ireland, and a similar number of trainees. For a small organization, this is a very large undertaking. Fortunately, we’ve had a large percentage of our organization stepping up to help. People have obliged us, done work, chased down speakers. So far, to give you some milestones, we had 1,030 abstracts submitted, which is a record for any ICEM. That all bodes well for the conference.

EPI: Can you describe the abstract review process?

FH: There is a group of EPs who have systematically gone through to score abstracts. We set a scoring system, but most of them met our requirements for being presented. We had two imperatives. One was to insure that the submissions were of a high enough academic quality that they were worth sharing with people. The second was to, where possible, encourage people. But there was clearly a group that didn’t meet the minimum standard. The notices – around 900 – went out to the successful abstract submitters by the end of March. The vast majority of those people who were successful in their submissions will be attending the conference.

EPI: What makes Ireland a unique setting for ICEM?

FH: Irish medicine is very well known internationally. There are Irish doctors working all over the world. We’ve been a nation that has exported a lot of medical talent, therefore people in other countries all over the world will have experience working with Irish doctors. If you look back at the names associated with different conditions, many are named after the Irish doctors who first discovered them. The Irish are also a gregarious group, by their nature, so what we hope to be able to provide people is a combination of good science and a convivial environment. It’s not just a question of coming to learn something, it’s also about meeting people, having a good time, and seeing a bit of beautiful Ireland.

EPI:How are you working to build this convivial attitude into the conference itself?

FH: We’ve tried to be a bit more innovative. We’ve tried to restructure the talks so that they mirror the patient’s pathway through the emergency department. We’re also hoping that people will enjoy the social program we’ve set up. The conference center itself is state of the art, with fabulous views of the Wicklow Mountains, the Dublin Bay, and the River Liffey. So we hope that the general ambience will encourage a convivial atmosphere.

EPI: What’s new about the ICEM academic program, compared to past conferences?

FH: What is particularly special about this ICEM is that IFEM will be publicizing certain landmark developments in EM, such as the quality framework and curriculum development. IFEM has actually created quite a portfolio of these guidelines, working behind the scenes. IFEM’s new pediatric guidelines might not be essential to countries like the United States and Ireland, but for countries in which emergency medicine is early in development, these become important benchmarks to negotiate better standards of care. There’s going to be something for everybody. Most of the sessions are intended to be international – not merely the perspective of a single country – which I think is important. The fact is, people show up with ischemic heart disease all over the world, and our care needs to gradually move towards standardization. There are practices going on in parts of the world that others can learn from, and vice versa.

EPI:Who are the rising leaders in global EM?

FH: The broadness of the research submissions was what really impressed me. We received submissions from over 40 countries, which I suspect is a record. We’ve had submissions from nations which previously were not a part of the global emergency medicine conversation. In many ways, the development of EM tends to start on the shop floor. People try to improve clinical care in the department, and then, as systems mature, academic medicine develops secondarily. So the fact that we’re getting research submissions from countries that are relatively new to emergency medicine reflects that they’re moving forward. That’s good news for the future.

EPI: Why are meetings like ICEM important?

FH: EPs tend to be affable, gregarious individuals who benefit from the communal nature of social networks and conferences. We come together to gain a better understanding of how the problems we face are truly global problems. Take, for instance, ED overcrowding. We’re having a significant session on this because it’s a problem that effects every country. Different countries have different ways of dealing with it, and we can all learn each other’s experiences. The solutions are going to come from a broad range of interventions rather than one single intervention. For the new, aspiring countries in emergency medicine, they can come and actually see how developed nations are handling the problems they’re facing. They can then bring practical solutions home and actually begin to change their healthcare systems. The hope is that at some time in the future, the basic care that one would receive in the emergency department would be pretty much the same the world over. Clearly, some countries have greater access to high tech equipment, but the basic stuff should be standardized. (It should be possible, if you present with ischemic chest pain, to get an aspirin anywhere in the world. Whether or not you get PCI may well vary depending on where you are.) A conference such as ICEM achieves a strong step in that direction. I’ve been to the British conference, and the ACEP Scientific Assembly, and clearly there seems to be a large value placed in feeling part of the cutting edge of development in our speciality, especially from those practicing in less than ideal circumstances. This feeling was so strong that some emergency physicians were taking significant personal risks – one even drove through a war zone to collect trial drugs – in order to participate in our study.

The CRASH2 trial showed that all injured patients who have significant bleeding or are at risk if bleeding should be treated with tranexamic acid within three hours of injury. There is often a long lag phase between the publication of a research result and its implementation into clinical practice, but having developed an international collaborative research team offers the added benefit of giving a ready made structure for the implementation of the research results. The CRASH2 collaborators have been leading dissemination and implementation within their own countries – who better to write new guidelines in each country than those who did the research? To make this process easy, a series of resources need to be provided from the centre: slide sets, information leaflets and ‘Frequently Asked Question’. One issue that we hadn’t anticipated was finding the funding for this central support for implementation, as it is not covered by the research grant and there are no other sources, so it has had to come from our own time and resources.

International emergency medicine research has a huge potential to answer important questions for our speciality. There are a specific set of structures, skills and experience that is required, which we are just beginning to map out. If we are to realise the potential of international research in emergency medicine we need to look at how our future academics are trained in order to acquire the skills to build on our initial experiences.

EPI: Key goals for this conference?

FH: I’d like this ICEM to showcase Irish EM. We are a small country, but in Ireland, EM punches above its weight. There will be speakers from all over the world, but I think the Irish speakers will hold their own with the best. Also, a key goal of this ICEM is the recognition by political figures of the importance of EM. That’s an issue that we all struggle with. We’re hopeful that a senior government official – even the President of Ireland – will make an appearance at the conference, which would be a first for an ICEM meeting. This is an important step for EM, so that it gets the recognition it deserves worldwide. Which is so important, because there is a degree of ignorance about what emergency medicine is, and what EDs do. Every political system in the world is wedded to the notion that emergency medicine can be replaced by something else, be it primary care, hospital care, etc... We need to move to a point internationally where the pivotal role of emergency medicine is recognized.

This article originally appeared in issue 8 of Emergency Physicians International

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