Manchester, engaged the support of the University Hospital of South. Manchester NHS Foundation Trust, the North West Ambulance Service. NHS Trust, and the ...
Conference Report
The 18 World Congress on Disaster and Emergency Medicine th
Carol Amaratunga is an adjunct professor at the universities of Ottawa and Victoria
T
he World Association of Disaster and Emergency Medicine (WADEM) recently convened the 18th international world congress (WCDEM) in the City of Manchester, UK. Like all ‘field of dreams’ conferences, the organisers believed, ‘if you build it, they will come.’ And indeed, the City of Manchester rose to the occasion and rolled out the red carpet for more than 500 disaster and emergency medicine professionals, first responders, and allied health care workers. Representatives from the University of Manchester, NHS Foundation Trust, the UK Government and World Health Organization (Europe) extended a warm welcome to all. The WADEM organisers hosted a unique, dare I say raucous, congress dinner in the ‘Theatre of Dreams’ (Old Trafford football ground) where the Premiership Trophy, won by Manchester United for the 20th time, was on show in all its grandeur. For a brief magical moment, delegates representing their respective emergency medicine disciplines and diverse nations, linked arms, raised a glass,
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and became honorary members of the Manchester United community. It was a night to remember! The local organising Committee, chaired by Darren Walter, consultant in emergency medicine, University Hospital of South Manchester and senior lecturer in global health, University of Manchester, engaged the support of the University Hospital of South Manchester NHS Foundation Trust, the North West Ambulance Service NHS Trust, and the Humanitarian and Conflict Response Institute, University of Manchester. These actors knew intuitively that the 18th World Congress would present a significant ‘development moment’ to showcase their achievements. One notable event worth mentioning occurred on the final day of the Congress. The organisers hosted the first national Community First Responder Conference in the UK. With 1 400 first responders alone serving in the Manchester environs and ambulance services, the Congress represented the ideal venue. To his credit, Darren Walter made special mention of the first responder paramedic community and invited congress participants to extend a warm welcome to first responders/ first receivers as a part of the greater international WADEM community. And so it was that the 18th World Congress on Disaster and Emergency Medicine
created a heart felt place for first responders and first receivers who work for the public good in pre-hospital care. WADEM President, Paul Arbon, School of Nursing and Midwifery, Flinders University, Adelaide, South Australia, promised that the 18th World Congress would ‘address issues at the forefront of thinking about the cause, impact, and response to the(se) disruptive challenges that affect the health of our communities.’ He did not disappoint. Furthermore, Professor Arbon raised important questions concerning how ‘we can build more resilient and self-reliant communities and bolster our capacity and capability for understanding risk, mitigation, response, recovery and development.’ He noted that (WADEM) ‘has been working hard, alongside its international partners to improve the scientific basis for disaster and emergency medicine practice and to translate emerging scientific evidence into improved practice and outcomes.’ These were important opening thoughts as essentially, disaster/ emergency medicine is still a relatively young, interdisciplinary field in the academy. Let us not forget that the elder brother, academic medicine, although perhaps more structured with its professional colleges and licensing system, is also only slightly more than a century old. As such,
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Carol Amaratunga reports on the World Association of Disaster and Emergency Medicine’s 18th World Congress on Disaster and Emergency Medicine, held this year in Manchester
© 2013 MA Healthcare Ltd
Conference Report
WADEM congresses provide a unique venue for practitioners from all disciplines, and from all over the world, to exchange knowledge, experience, and lessons learned. WADEM itself has a solid social memory rooted in resuscitation and ambulance services, and as such, the congress has always had an imperative to share the social memory of paramedicine with physicians and allied health professions. Over 4 days, the WCDEM hosted hundreds of speakers in plenary and concurrent breakout sessions. Topics and special sessions ranged from triage, mass gathering, disaster medicine, emergency preparedness, emergency medicine—burns, vulnerable populations, safe hospitals, to CBRNe, civilian and military collaboration, trauma epidemiology and the psycho-social. Keynote and plenary presentations covered the disaster of mass atrocities and crimes against humanity, disaster metrics, evidence-based research, evaluation methodologies, and recent advances and the future of resuscitation science. Special sessions were convened for the WADEM working groups, e.g. the Nursing Executive committee, Editorial Committee of the PDM journal, the Psychosocial working group, and the WADEM General Assembly. As the discipline is growing, likewise new special interest sub-groups and communities of practice are emerging within WADEM, e.g. mass gatherings and disaster metrics. Overall the imperative for prehospital and disaster medicine research to develop ‘good science’ was a cross-cutting theme for the 18th congress. Like all new and emerging academic disciplines, WADEM is required to invest a huge effort to support and showcase the gold standard research of its membership, particularly evidence-based research that will help shape and
inform public policy and practice. The selection, presentation, and publication of peer reviewed papers serves as a critical indicator for scholarship in pre-hospital and disaster medicine research. As we learned, there is a new shift away from observational and anecdotal studies towards more rigorous scientific method in disaster medicine research, particularly research studies involving statistics and epidemiological models. During the WADEM editorial board meeting, we learned that the journal, Prehospital and Disaster Medicine (PDM), is indexed in the National Library of Science and is currently being assessed for a ranking impact factor—something that will be critical for academic peer review. Importantly, the journal is currently bundled and is included in all 300 Cambridge journal titles. Challenges abound in laying the foundation for a new academic discipline, not least of which is the need to develop consensus around common terminology and research standards. To the credit of the WADEM editorial office and Editor-in-Chief, Sam Stratton, WADEM published all the Manchester conference abstracts in PDM, Volume 28, Supplement 1, 2013. This excellent supplement was included in the registration packages of all congress delegates and may be accessed through the journal. For the information of our readers, the mission of PDM is ‘to distribute information relevant to the practice of out-of-hospital and in-hospital emergency medical care, disaster health, and public health and safety.’ The WADEM journal makes a significant contribution each year to our collective knowledge in prehospital and emergency medicine. PDM, with its supplementary publication containing the Manchester abstracts, also provides an excellent opportunity to read and catch up on the latest research, including qualitative
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and quantitative research studies. Furthermore, PDM provides pragmatic, clear language coverage of recent empirical studies. Content ranges from the care of patients in medical emergencies, i.e. mass casualty disasters and accidents to pandemics and public health crises. PDM also publishes findings on the prevention and mitigation of intentional and unintentional risks and threats to human health and wellbeing. Indexing of the journal includes the National Library of Medicine (MEDLINE), Cumulative Index to Nursing and Allied Health (CINAHL), and the Health Star Cumulative Index. One should note that the publishing and production of PDM is now coordinated by Cambridge University Press, New York. Through its publishing and editorial work, WADEM has made a significant contribution these past 18 years to both the art and science of pre-hospital and disaster medicine. On an international scholarship level, the World Health Organization (WHO, Europe Office, Copenhagen) speaker, Dr. Gerald Rockenschaub, recognised WADEM as a membership organisation with an important membership pool of researchers. WHO further recognises WADEM as a key agency to generate and share evidence through regional meetings and collaborations. Having said this, the WADEM congress is more than a theatre for academics and practitioners to share and display their wares. WADEM strikes me as a unique community of practice and as I alluded to above, WADEM is a community of practice with an important social history. To illustrate this point, one of the most notable and memorable plenary sessions I have attended in many years, the Safar Oration, involved a kind and generous talk by Professor Douglas Chamberlain, CBE. It was appropriate that Professor Chamberlain was 59
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soon adopted the term CPR. CPR was ultimately recognised by the American Medical Association between 1960–1962, and by 1965 it was all over: CPR had indeed become one of the most important emergency medicine procedures to ever be recognised by the American Red Cross. It was a sensitive and heartfelt talk. Upon receiving the WCDEM honours and Safar Award, Professor Chamberlain quietly reflected: ‘Doing pre-hospital research is awfully difficult.’ I had the impression afterwards that we have many to thank for this conference and the very important humanitarian contributions, past and present, of the WADEM membership. As Dr. Judith Fisher reminded us, Peter Safar and Douglas Chamberlain were the founders of resuscitation and modern day ambulance services. As he left the podium, the professor chuckled as he added: ‘One feels very unworthy on getting these things…choose your friends carefully and get carried along by them—they do the work and I claim the credit!’ I also learned that day that Peter Safar later became the first President of WADEM. According to the WADEM website: ‘World Association for Disaster and Emergency Medicine (WADEM) was originally founded as the Club of Mainz on October 2, 1976 with the goal of improving the worldwide delivery of pre-hospital and emergency care during everyday and mass disaster emergencies. The founding members were renowned researchers, practitioners and teachers of acute care medicine, who joined together to focus their energies on the scientific, educational, and clinical aspects of immediate care. Following the constant development of its scope and
extension worldwide, and to better reflect its nature, the organization’s name was changed to the World Association for Disaster and Emergency Medicine”. WADEM has evolved into a virtual community of practice or vCOP as the journal is now an online e-item. There are also members of this unique organisation who serve as present day ‘WADEM shepherds’. These are the volunteers whose names can be found on the WADEM Board of Directors, the Executive Committee, and Conference Program Committees. People like the indomitable Dr. Marvin Birnbaum, Chair of the Board of Directors, Elaine Daily, Fred Burkle, Gloria Leon, Jerry Overton, Sam Stratton, Darren Walter, Demetrios Pyrros and Paul Arbon, to name a few. Over the years, in work and in retirement, they continue, with herculean effort, to make contributions in support of WADEM’s spirit, principles and integrity. No doubt there are many more WADEM shepherds whom I have neglected to mention. Named or unnamed, these are the real WADEM stars for they are the lead actors on the stage of pre-hospital and disaster medicine. They are also volunteers and collectively they have donated thousands of hours of time and professional practice to build this significant global community of practice. In closing, I would like to thank all those, past and present, who have contributed to WADEM. You deserve to take a bow on the stage of pre-hospital and disaster medicine. Peter Safar would have indeed been proud of your performance for you are all humble men and women helping humanity. References Recent advances in emergency resuscitation. Md State Med J 10: 398–411
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introduced, most capably, by the indefatigable Dr. Judith Fisher, VP of WADEM congresses. Professor Chamberlain, whose topic was ‘History, Recent “Advances”, and Future of Resuscitation Science’ apprised his audience that he was really going to speak on ‘historical reflections on humble men helping humanity.’ And so he did! Following his mesmerising talk, the good professor humbly received the Safar Award from Professor Frederick Burkle, the receiver of the 2011 Safar award. A spritely octogenarian, and looking more like the grandfather we would all love to imagine, Professor Chamberlain held his audience spellbound as he moved his wand through history. He traced the nascent days of pre-hospital science back to the Middle Ages and recognised the role of Dominique Jean Larrey, the surgeon in Napoleon’s army who founded the first ambulance service. The good professor recounted the story of the evolution of resuscitation as a lifesaving innovation dating back to ventilation practice in 1543, the adoption of ‘mouth to mouth’ resuscitation in 1773, and cricoid pressure in 1776. By the 20th century, he noted, mouth to mouth, ventrical and tracheal ventilation had been replaced by the Holger Nielson in 1932. According to this dear man, ‘it all went wrong for a very long time...so why did we forget about closed chest compression?’ Then, added the professor, in 1958, Peter Safar, the namesake of the WCDEM plenary Safar Oration Lecture, reportedly experimented on anaesthetised and paralysed volunteers. Safar published in JAMA and re-introduced the art and science of mouth to mouth resuscitation as we know it today. By 1961, Safar and his colleagues published their work in the Maryland State Medical Journal (1961) and the world
