|CONFERENCE ABSTRACTS AND REPORTS
|Year : 2016 | Volume
| Issue : 3 | Page : 72-78
The 11th annual INDO-US world congress of academic emergency medicine, “Synergizing science to sustain systems“, a level one international meeting, all india institute of medical sciences, New Delhi, India, september 30 to october 4, 2015
Sagar C Galwankar, Mamta Swaroop, Sanjeev Bhoi, Rebecca Jeanmonod, Donald Jeanmonod, Michael S Firstenberg, Manish Garg, Lorenzo Paladino, Harry L Anderson III, Bonnie Arquilla, Stanislaw P Stawicki
Members of the 11th Annual INDO-US World Congress of Academic Emergency Medicine Planning Committee, USA
|Date of Submission||07-Jul-2016|
|Date of Acceptance||08-Jul-2016|
|Date of Web Publication||19-Aug-2016|
Sagar C Galwankar
University of Florida, Jacksonville, Florida
Stanislaw P Stawicki
St. Luke’s University Health Network, Bethlehem, Pennsylvania
Source of Support: None, Conflict of Interest: None
The Annual INDO-US World Congress of Academic Emergency Medicine (WoCAEM) continues to be India's premier level one conference encompassing emergency care, trauma management, cutting edge critical care, and the corresponding component of translational science. The 2015 Summit provided additional high profile sessions on burn care, cardiovascular, and cerebrovascular topics, as well as environmental and disaster medicine. Competitive faculty selection ensures a high-quality educational experience. In addition to extensive didactic sessions, the WoCAEM incorporated outstanding small group learning and state-of-the-art simulation experiences in thematic blocks. The WoCAEM Leadership Council is pleased to report on the most recent conference that took place from September 30 to October 4 in New Delhi, India. We hope that this report, in addition to serving as a historical record, will generate additional interest regarding the meeting among potential faculty and attendees alike.
The following core competencies are addressed in this article: Medical knowledge, patient care, communication and interpersonal skills, system based practice.
Keywords: Emergency medicine, global health, medical education, public health, traumatology, critical care
|How to cite this article:|
Galwankar SC, Swaroop M, Bhoi S, Jeanmonod R, Jeanmonod D, Firstenberg MS, Garg M, Paladino L, Anderson III HL, Arquilla B, Stawicki SP. The 11th annual INDO-US world congress of academic emergency medicine, “Synergizing science to sustain systems“, a level one international meeting, all india institute of medical sciences, New Delhi, India, september 30 to october 4, 2015. Int J Acad Med 2016;2, Suppl S1:72-8
|How to cite this URL:|
Galwankar SC, Swaroop M, Bhoi S, Jeanmonod R, Jeanmonod D, Firstenberg MS, Garg M, Paladino L, Anderson III HL, Arquilla B, Stawicki SP. The 11th annual INDO-US world congress of academic emergency medicine, “Synergizing science to sustain systems“, a level one international meeting, all india institute of medical sciences, New Delhi, India, september 30 to october 4, 2015. Int J Acad Med [serial online] 2016 [cited 2020 Jan 28];2, Suppl S1:72-8. Available from: http://www.ijam-web.org/text.asp?2016/2/3/72/188739
| Introduction|| |
Beginning September 30, 2015, the 11th Annual INDO-US World Congress of Academic Emergency Medicine (WoCAEM) took place in New Delhi, India. The meeting titled “Synergizing Science to Sustain Systems” concluded on October 4, 2015. The global WoCAEM faculty consisted of experts from India, the European Union, Israel, and the United States of America. The overall attendance exceeded 3000 participants - the largest number since the inaugural Congress 11 years prior.
Educational content was carefully designed and organized into tracks that appeal to the following groups of health professionals and trainees: Medical and nursing students, resident and fellow trainees, junior academic and clinical faculty, and experienced practitioners seeking to enhance their knowledge of “cutting edge” topics. Competitive faculty selection employed by the WoCAEM planning committee ensures high-quality educational experience. Similar to previous years, the mission of WoCAEM faculty was to provide theme-based education in emergency, trauma, and critical care topics. [Table 1] provides information regarding faculty member participation during each of the three respective pillars of the WoCAEMs curriculum.
|Table 1: Faculty members participating in the three main pillars of the World Congress of Academic Emergency Medicine curriculum|
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Lecture tracks were divided into several categories and focused on the full spectrum of emergency medical care, fundamentals of resuscitation in trauma (FORT), and critical care [Table 2]. The audiences for all of the sessions were diverse and consisted of medical and public health students, nurses and nursing students, as well as physicians of all levels of training and experience. The 2015 Congress attracted academic faculty from around the world - all of whom were dedicated to the common goal of sharing and learning about the management of the acutely and often critically-ill patient. Photographs from educational sessions for the WoCAEM and the Satellite Symposium in Rohtak (discussed in subsequent section of this report) are shown in [Figure 1] and [Figure 2].
|Table 2: Outline of the 2-day schedule of trauma/injury and critical care didactic activities at World Congress of Academic Emergency Medicine, New Delhi, India, September 30 to October 4, 2015|
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|Figure 1: Faculty presentations at the Rohtak Satellite Symposium and the World Congress of Academic Emergency Medicine. Dr. Rebecca Jeanmonod (top left) and Dr. Michael Firstenberg (top right) presenting at Rohtak. Dr. Donald Jeanmonod (bottom left) at Rohtak and Dr. Mosche Michaelson (bottom right) at the All India Institute of Medical Sciences|
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|Figure 2: Photographs from the Emergency Preparedness Workshop. Left, course attendees participate in a simulated case scenario. Right, Dr. Dimitros Papanagnou is directing a disaster drill exercise|
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In addition to the primary educational activities outlined in [Table 2], Dr. Michael Firstenberg led an educational session on advanced end-organ support, with particular emphasis on extra-corporeal membrane oxygenation (ECMO) in acute cardiopulmonary failure [Table 3]. Dr. Anderson presented a summary of existing and investigational approaches to support patients with end-organ failure, including a focus on hemodialysis and a discussion of current and future avenues for clinical management of hepatic dysfunction. Wearable microsensor and implantable technologies are now being introduced to continuously measure glucose levels and provide feedback for exogenous insulin or glucagon infusion, providing hope for patients with pancreatic endocrine disorders. Additional lectures in this session included an update on the use of intra-aortic counterpulsation and the theoretical framework for the use of stem cell therapies to promote healing and recovery in patients requiring ECMO for acute cardiogenic shock.
|Table 3: Advanced end-organ support: Extracorporeal and intracorporeal assist technologies|
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| The Indo-Us/indusem Joint Working Group|| |
The INDO-US/INDUSEM Joint Working Group (JWG) continued to forge ahead in areas critical to both India's and global public health in emergency medicine, trauma, critical illness, and scientific discovery. Publications from the JWG highlight the active role and the growing influence of this “think tank” as an internationally recognized entity. Key strategic initiatives successfully enunciated by the JWG in the recent years include the implementation of a universal emergency phone hotline for India, the establishment of a framework for global biomarker discovery network, a call to formalize emergency medicine across India, increasing child abuse awareness, advocating for prevention via regulatory action, and constructing a framework for academic pediatric emergency medicine in India.
| Overview of the 2015 Wocaem|| |
On the 1st day of the Summit, Dr. Michael P. Lucchesi was the Shri Tarsem Kurmar Garg Oration Inaugural Endowed Keynote speaker. The oration discussed the development of the Department of Emergency Medicine at the University Hospital of Brooklyn. Challenges and opportunities associated with establishing the first dedicated emergency medicine unit in New York City were discussed. A 20-year history of accomplishments was outlined, including inpatient services integration, development of disaster management capabilities, residency and fellowship training, as well as simulation and ultrasound program development. The importance of team building and outside-the-box thinking was highlighted in the context of emergency medicine leadership and program development.
The Shri Tarsem Kumar Garg Oration was followed by an Invited Special Keynote talk by Ronald Maio, Professor Emeritus from the University of Michigan. Professor Maio spoke about the pivotal role of emergency medicine in the field of injury prevention. He highlighted the importance of emergency physicians in the area of public health, with a focus on reducing mortality due to trauma - one of the top causes of death across the world. Professor Maio shared his transformative experiences from various injury prevention initiatives spearheaded by the University of Michigan.
Day 1 of the conference continued with a lecture series entitled the adult ABCs of resuscitation. The didactic lectures highlighted the need for emergency practitioners to become knowledgeable and proficient in the acute care of the acutely ill and/or injured person. The lectures by combined Indian and US faculty discussed resuscitation, various types of shock, neurologic emergencies and stroke care guidelines, airway management and rapid sequence intubation, as well as the newest trends in fluid and blood product resuscitation. This served as an excellent introduction to the subsequent advanced clinical courses, including the Trauma and Critical Care Resuscitation Course, which covered patient care starting in the Emergency Department (ED) and continuing to the operating room and/or the Intensive Care Unit. Multiple workshops were held along with courses and symposia for over 3000 delegates, spanning 5 days, 15 venues, and more than 250 hours of educational, research, and policy sessions [Figure 3] and [Figure 4].
|Figure 3: Highlights of INDUSEM-World Congress of Academic Emergency Medicine: Injury Prevention Walkathon on September 27, 2015, led by Member of Parliament Dr. Pritam Munde (top left). This event marked the beginning of the World Congress of Academic Emergency Medicine and commemorated Mr. Gopinath Munde, the Late Member of Parliament who died tragically in a vehicular crash. The first INDUSEM Awards Night was held on October 2, 2015, at Santosh University and was a huge success. This event honors the best in emergency medicine, with Dr. Bonnie Arquilla entered into the Hall of Fame for 2015 (right). A special issue stamp was issued by India Post to celebrate this occasion. The honor was formally announced by Post Master General Shri Kashyap during a special ceremony (bottom left)|
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|Figure 4: Major initiatives launched by INDUSEM during the World Congress of Academic Emergency Medicine 2015: Emergency Medicine Association of India (see www.emaindia.net for details) (top left). PRADHAN-BHARTI or the Policy Research and Development of Health and Nation Initiative - A forum for experts from legal, health policy, and medical professions to work jointly with the Government on patient-centered legislation (top right). Female Leadership Academy for Medicine and Entrepreneurship designed to foster the growth of female leaders within the health-care sector in India (bottom left). Diplomatic meeting of NETWORK-ASIA with Ambassadors from various Asian nations (bottom right). The NETWORK-ASIA acronym stands for “Network for Emergency and Trauma Work in Asia.” Countries represented at the World Congress of Academic Emergency Medicine 2015 included Japan, Maldives, Nepal, Sri Lanka, Bhutan, Afghanistan, and India|
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| The Fundamentals of Resuscitation in Trauma Symposium|| |
The FORT is a comprehensive trauma course taught annually at the WoCAEM conference. The course started with Dr. Swaroop discussing case vignettes and reminding the audience about the critical importance of collaboration and teamwork in the setting of trauma care. These introductory remarks set the stage for the subsequent lectures and the concluding roundtable discussion. The audience included medical students, nurses, and academic faculty from various disciplines.
The next lecture was presented by Dr. Paladino who reviewed updated international trauma guidelines (ITGs). Multidisciplinary participation and team building were highlighted. New technological advances were discussed, including the use of video and optic intubation assist devices for trauma airway placement. Another important update to ITGs pertains to pediatric endotracheal tubes and the use of “cuffed” tubes for patients older than 1 year of age. The concept of “aggressive resuscitation” is being replaced with the term “balanced resuscitation,” focusing on achieving clearly defined physiologic end points and restoring end-organ perfusion while attempting to minimize the risks of rebleeding. The use of “balanced resuscitation” helps to maintain the delicate equilibrium between end-organ perfusion pressure and the risk of provoking episodic hypertension and hemorrhage due to clot dislodgement. The movement away from aggressive crystalloid resuscitation and toward earlier use of blood products (e.g., starting blood transfusion after 1 L versus the more traditional 2 L crystalloid bolus infusion). The benefit of hypertonic saline in acute trauma resuscitation is becoming questionable, prompting corresponding ITG changes. Also included in the ITG update was the emphasis on pelvic hemorrhage as an under-recognized source of blood loss that often manifests clinically in a delayed fashion. Discussion of “heat stroke” and “heat exhaustion” then took place, followed by a lecture on trauma in pregnancy as well as the recognition, reporting, and management of domestic violence.
Dr. Donald Jeanmonod and Dr. Manish Garg discussed application and utility of radiological studies in the trauma bay. Dr. D. Jeanmonod discussed chest and pelvis radiography as adjuncts to the secondary trauma survey, reviewing radiographic findings that warrant immediate intervention and providing an evidence-based refutation of routine use of pelvic X-rays. Dr. D. Jeanmonod also performed an evidence-based review of decision rules that guide responsible use of radiographic imaging of the head and cervical spine in the setting of trauma. Dr. Garg continued this discussion on focused ultrasound imaging. His lecture outlined the use of Extended Focused Assessment with Sonography for Trauma (E-FAST) in chest, abdominal, or pelvic injury detection and presented an evidenced-based clinical pathway algorithm for FAST in blunt abdominal trauma. Within this pathway, 12% of all FAST exams will be positive, 1/3–2/3 of hypotensive patients will have a positive FAST, and nearly all hypotensive patients with a positive FAST required operative intervention compared to 50% of normotensive patients with a positive FAST. Dr. Garg also reviewed novel applications of ultrasound in head, neck, and extremity trauma as useful adjuncts to the secondary survey.
Dr. Mosche Michaelson and Dr. Rebecca Jeanmonod discussed the interpersonal and team-building aspects of trauma care. Dr. Jeanmonod provided a synopsis of learning theory as it applies to traumatology. She discussed resident and student education before a trauma occurs, both in simulation and didactic settings. She covered principles of education during the resuscitation itself and discussed the appropriate way to address learning points after the resuscitation is over, through structured review and debriefing. Additional details of the FORT curriculum, including lectures on obesity in trauma (Dr. Worlton) and pulmonary embolism (Dr. Firstenberg), are provided in [Table 2].
| Trauma Critical Care Symposium|| |
The critical care symposium consisted of a full day of education on cutting-edge critical care topics. The symposium kicked off with an evidence-based synopsis of emergency airway management by Dr. Rebecca Jeanmonod that was followed by an algorithmic approach to mechanical ventilator support by Dr. Mamta Swaroop. Dr. R. Jeanmonod provided a tutorial on neurosurgical emergencies in the setting of novel oral anticoagulants and Dr. Maura Sammon discussed the essentials of neurocritical care including evidence-based stroke intervention, seizure management, and therapeutic hypothermia. Dr. Donald Jeanmonod discussed the use of bedside imaging techniques, as well as innovative hemodynamic monitoring to guide resuscitation end points. Dr. Ashika Jain followed with an approach to hemodynamic support using targeted pressors and inotropes. Dr. Harry Anderson provided novel perspectives on sepsis care and essentials of fluid and blood transfusions. The discussion included both pro and con perspectives on colloid based resuscitation in the acute setting. The day concluded with evidence-based pearls and pitfalls of cardiovascular critical care by Dr. Alyssa Green.
| Emerency Medicine Sessions and the Emergency Preparedness Workshop|| |
Dr. Paladino opened this part of the conference with a lecture on the topic of tactical emergency response, a part of the “emergency and wilderness medicine session“. Differences between tactical response and everyday civilian emergency medical service response to trauma were highlighted, including unique considerations regarding corresponding management priorities. The Tactical Combat Casualty Care course used in the military was also discussed.
The 2015 Emergency Preparedness Workshop was titled “When the unimaginable becomes reality - Preparing for a response to challenges in the New Millenium.” The workshop was based on the concept of an all-hazards approach to emergency preparedness and focused on the importance of understanding fundamental steps required for adequate preparation and mitigation of events that threaten the health and well-being of affected communities. The curriculum applied to scalable scenarios - both local and global events that affect health-care facilities and their staff – covering optimal approaches to disaster preparation, mitigation, response, and recovery. Faculty members emphasized the importance of team building and crisis leadership, including considerations of positive team behaviors and leader characteristics required to maintain synergies within the responder group. In addition, the workshop took an in-depth look at various aspects of problem solving and universal leadership skills via multiple simulation exercises. The participants gained skills in developing “incident action plans” for various disaster response scenarios. Hands-on simulation experience was incorporated via multiple case presentations characterized by the presence of injuries and clinical features unique to chemical, biological, radiological, nuclear, and explosive events. The course was directed by Dr. Bonnie Arquilla and Dr. Dimitros Papanagnou. Faculty included Joseph Freeman, Pia Daniel, Shruti Chandra, Brenda Oiyemhonlan, and Elizabeth Abram. Photographs from the Emergency Preparedness Workshop are shown in [Figure 2].
| The Rohtak Satellite Symposium|| |
One of the major benefits of having an internationally recognized faculty convene in one central location is the opportunity for outreach activities that otherwise would be very difficult to organize, such as the “New Vistas in Emergency Medicine” event, hosted by the Pt. B.D. Sharma University of Health Sciences in Rohtak [Table 4]. This Satellite Symposium of the 2015 WoCAEM was organized by Vice Chancellor, Professor O.P. Kalra and brought together local and international experts in the evaluation and management of the acutely injured patient. This symposium was broken down into four mini-symposia, including a clinical medicine symposium, a multitasking symposium, a resuscitation symposium, and an academic emergency medicine symposium. The clinical medicine symposium focused on strategies to assess common medical complaints. The second symposium addressed challenges posed by disasters when caring for the chronically ill. It also featured patient safety and quality of care topics. The third symposium covered fundamental topics in resuscitation. The fourth symposium was an organized overview of the foundations required for the creation of an emergency medicine residency training program. Each symposium was accompanied by a lively and engaging question and answer sessions hosted by local and international experts. A valedictory function honored the efforts and commitments to the development of emergency medicine programs by Dr. Kamboj (the organizing secretary), Dr. Jain, Dr. Gahlaut, and Dr. Sunny. Such programs are valuable in engaging the local community leadership and bringing awareness to the shared goals of improving the overall quality of care and patient outcomes. Local newspaper enabled field reporters to interview presenters, providing further outreach to the community. Hopefully, as additional satellite programs develop and relationships with the worldwide community strengthen, such symposia can expand and bring shared learning opportunities, as well as better care, to the hosting communities.
| Expert Working Group Roundtables|| |
During the 5 days of WoCAEM, multiple expert working meetings were held. Consensus development sessions on pain management in the ED and procedural sedation algorithms were held by emergency physicians from Temple University (Philadelphia, Pennsylvania, USA) and medical schools in India. Regulatory authorities in Indian health care, namely the National Accreditation Board of Hospitals and Health Care Providers, Medical Council of India, National Board of Examinations, and the Indian Council of Medical Research participated in meetings with experts from India and international researchers attending WoCAEM on issues related to health-care research, patient care, and global health security. Leaders from the Centers for Disease Control and Prevention, USA and The World Health Organization also participated in the congress [Figure 3] and [Figure 4] show additional highlights from the 2015 WoCAEM].
| Conclusions and Accomplishments|| |
Key accomplishments of the 2015 WoCAEM included the incorporation of high-quality didactics with evidence-based clinical vignettes for optimal attendee learning experience. In the trauma and critical care education portion, both established fundamental techniques and cutting edge trends in clinical monitoring, diagnosis, evaluation, and treatment were discussed. Despite tremendous progress since the inaugural INDUS-EM Clinical Congress, India continues to have limited educational and clinical resources in the domains of emergency medicine, trauma, and critical care. Consequently, the unique experience of the 2015 WoCAEM has provided valuable education opportunities to attendees from diverse educational and professional backgrounds, including medical students, residents, and fellows from multiple specialties, nurses and nursing students, as well as attending physicians. The curriculum also ensured that the education is grounded in evidence-based techniques, critical thinking, and skepticism toward medical anecdotal thought. Because the World Congress changes its venue each year, dissemination of knowledge offered by the standardized curriculum will occur across ever-widening geographic distributions. This, in turn, will help to modify and transform the quality of educational experience, scientific inquiry, and direct patient care across the Indian subcontinent and beyond.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4]
[Table 1], [Table 2], [Table 3], [Table 4]