Jim Holliman, M.D., F.A.C.E.P ., F.I.F.E.M.

1. The International Federation for Emergency Medicine : Its Efforts in Emergency Medicine System Development Jim Holliman, M.D., F.A.C.E.P., F.I.F.E.M. Past-President, International Federation for Emergency Medicine Professor of Military and Emergency Medicine Uniformed Services University of the Health Sciences Bethesda, Maryland, U.S.A. Professor of Emergency Medicine & Public Health Sciences Penn State University, Hershey, PA, U.S.A. Adjunct Professor of Emergency Medicine, Nanjing Medical University, Nanjing, P.R.C.

2. Disclosure • I have no conflict of interest financial disclosures to report (I am the past President of the International Federation for Emergency Medicine but do not receive any financial compensation from the organization) except being a medical consultant for the National Hot Rod Association

3. The International Federation for Emergency Medicine (IFEM) : Its Efforts in EM System Development : Lecture Goals • Present background information on the structure and resources of IFEM • Present the current resources IFEM has developed for Emergency Medicine (EM) system development • Present proposed additional activities for IFEM to undertake • Encourage participation in IFEM activities and collaborations by Emergency Care practitioners

4. Origins of IFEM • Started in the late 1980’s as a consortium between the British Association of Accident and Emergency Medicine (BAEM), the American College of Emergency Physicians (ACEP), the Canadian Association of Emergency Physicians (CAEP), and the Australasian College of Emergency Medicine (ACEM) (representing Australia and New Zealand) • Its original main activity was just conducting the International Conference on Emergency Medicine (ICEM) every 2 years • First ICEM held in London, United Kingdom (U.K.) in 1986 • Then held every two years in one of the four founding countries in rotation

5. IFEM’s Current Goals • Over the last decade, IFEM has expanded its goals to not just conduct the ICEM, but to be a “service” organization in promoting the development of the specialty of EM throughout the world, thereby improving emergency patient care worldwide • IFEM is also developing policy statements that put the weight of the organization behind important international principles to promote

6. Recent IFEM Policy Statement • Expressed IFEM’s opposition to the proposal for World Health Organization countries to “schedule” (i.e., to designate as a controlled narcotic) ketamine

7. Categories of Membership in IFEM • Founding Members : BAEM (now the Royal College of Emergency Medicine (UK) ), ACEP, CAEP, ACEM • Full Members : EM organizations which are the “leading national EM organization in a country which recognizes EM as a specialty and has at least one EM specialist training program” • Affiliate Members : Other national EM organizations in a country already represented by a Founding or Full Member or in a country where EM is not recognized or no residency training programs yet exist • Ex-officio Members : other multinational or regional EM organizations Note that Affiliate and Ex-officio Members do not have voting privileges ; non-physician organizations may join through a memorandum of affiliation agreement

8. IFEM’s Current Membership • As of June 1, 2016 IFEM has 70 members: • 47 Founding or Full • 18 Affiliate • 5 Ex-Officio • 3 new full members (Oman, Finland, Saudi Arabia) and one affiliate member (Nigeria) were added in October 2015 • Iceland was added as a full member and Norway as an affiliate member in April 2016

9. Current IFEM “Three Level” Structure • Executive : President, President-Elect or Past-President, Vice-President, Treasurer, Secretary, Member at Large (representative from the Planning Committee for the next ICEM) • Board of Directors : all the members of the Executive plus 6 regional representatives (Africa, Asia, Australasia, Central / South America, Europe, North America) • Assembly : Representatives from the Founding, Full, Affiliate, and Ex-officio members (now total 66) • Executive and BOD have periodic phone conferences and all 3 levels have face to face meetings at the ICEM and ACEP’s Annual Scientific Assembly

10. IFEM’s Permanent Committees Designated to Carry Out EM System Development Efforts • Finance • Governance • Communication • Core Curriculum and Education • Clinical Practice • Specialty Implementation • Continuing Professional Development • Research • ICEM Site Selection Sub-committee

11. IFEM’s Designation of Task Forces and Special Interest Groups to Carry Out Focused EM Development Efforts • Standard Terminology Task Force • Access and Availability Task Force • Global EM History Book Project • Disaster Medicine Special Interest Group • Pediatric Standards Special Interest Group • Ultrasound Special Interest Group • Triage Special Interest Group • Gender Issues Task Force • Sustainability Task Force • Geriatric Emergency Medicine Interest Group • International Trainees Association • Spanish Translation Task Force • Public Health Special Interest Group • Quality Special Interest Group

12. What are the Aspects of EM System Development IFEM Wants to Work On ? • EM specialty recognition • Starting EM training programs • Developing training resources • EM faculty development • Coordination of prehospital and emergency department care • Certification exams • Starting national EM specialty organizations • Fostering international and transnational EM collaborations

13. EM Training Programs IFEM Wants to Help Develop • Medical student training • EM residency training • Training for other specialties which provide emergency care (such as general practice doctors) • Post-graduate training (“Continuing Professional Development or “CPD”) • Prehospital personnel training • Emergency nursing training • Public education programs • Injury and illness prevention • How to utilize the emergency care system

14. Activities of the IFEM Core Curriculum and Education Committee • Published in multiple journals a standardized international curriculum for medical student training in EM and a curriculum for residency training in EM (these are on the IFEM web site) • Is working on writing a standardized international curriculum for paramedic training • Has published a standardized curriculum for CPD for EM physicians in practice (Can J Emer Med 17, 1-15, 2015) • Has published a manuscript on “Mapping the EM Curriculum to Assessment Methods” (Can J Emer Med 17, 462-7, 2015) • Collaborating with the U.K. Royal College of EM on its “RCEM Learning” virtual learning resource • Collaborating with SAEM on its “NextGenU” online clerkship

15. IFEM’s Medical Student Curriculum Published on the IFEM Web Site International Federation for Emergency Medicine INTERNATIONAL FEDERATION FOR EMERGENCY MEDICINE MODEL CURRICULUM FOR EMERGENCY MEDICINE Cherri Hobgood, MD,1 Venkataraman Anantharaman,MD,2 Glen Bandiera, MD,3 Peter Cameron, MD,4 Pinchas Halperin, MD,5 Nicholas Jouriles, MD,6 Darren Kilroy, MD,7 Terrence Mulligan, MD,8 Andrew Singer, MD,9 for the International Federation for Emergency Medicine Cherri Hobgood, University of North Carolina School of Medicine, Chapel Hill, NC, USA 2Venkataraman Anantharaman, Singapore General Hospital, Singapore, Singapore 3Glen Bandiera, University of Toronto, Toronto, ON, Canada 4Peter Cameron, MD 5Pinchas Halperin, Tel Aviv Medical Center, Tel Aviv, Israel 6Nicholas Jouriles, Akron General Medical Center, Akron, Ohio, USA 7Darren Kilroy, College of Emergency Medicine, London, United Kingdom 8Terrence Mulligan, Erasmus University School of Medicine, Rotterdam, The Netherlands 9Andrew Singer, Canberra Hospital, Woden, Australia CONTACT INFORMATION: Cherri Hobgood, MD, Associate Professor, Associate Chair, Department of Emergency Medicine, UNC School of Medicine, CB 7594, UNC Hospitals, Chapel Hill, NC 27599; 919-966-6442; hobgood@med.unc.edu RUNNING HEAD: IFEM Model Curriculum KEY WORDS: curriculum, international emergency medicine, medical education, WORD COUNT: 2372 IFEM UGE

16. IFEM’s Recommended EM Residency Curriculum (available on IFEM’s web site)

17. IFEM’s Postgraduate (CPD) Curriculum • “IFEM Model Curriculum for Continuing Professional Development”, Hobgood C et al., published in the Canadian Journal of EM (CJEM) 17, 1-15, Jan. 2015

18. Activities of the IFEM Clinical Practice Committee • Its Pediatric Standards Special Interest Group produced the widely acclaimed document “International Standards of Care for Children” which is on the IFEM web site • Its Ultrasound Special Interest Group developed a standardized international curriculum for point of care ultrasound training which has been submitted to CJEM for publication • Partnering with the Guidelines International Network to make more international clinical care guidelines openly available • Endorsed collaborative activities connected with “World Sepsis Day” • Cooperating with the Specialty Implementation Committee in accumulating and posting on line web resources

19. Recent Clinical Practice Committee Activity • The IFEM Trauma Update Symposium • Organized and sponsored by the Emirates Society of Emergency Medicine • June 5 to 6, 2015 • Abu Dhabi, U.A.E. • Over 300 registrants • Two parallel lecture tracks • First Welsh International Symposium on EM, Cardiff, Wales, May 16 to 17, 2016

20. Activities of the IFEM Specialty Implementation Committee • Conducted a Needs and Resources Assessment survey of the IFEM membership • Has posted a number of open access lectures as references on the IFEM web site • Is collaborating with the Clinical Practice Committee to accumulate, categorize, and post a listing of useful EM web sites on the IFEM web site • Has published in the African Journal of EM a manuscript on “How to Start and Operate a National EM Specialty Organization” (the full manuscript is also available on the IFEM web site)

21. Activities of the IFEM Continuing Professional Development Committee • Supervises the ICEM Site Selection Sub-committee • Updated the IFEM Guidelines on operation of the ICEM, and on operation of IFEM endorsed “satellite” symposia, and on IFEM endorsement of other EM conferences • Can assist EM organizations in structuring their EM conferences

22. Activities of the IFEM Research Committee • Decided that IFEM should not formally affiliate with any existing EM journal at this time • Is working on identifying research content experts and their areas of research expertise by country, and on identifying current research networks • Developed criteria for handing requests for research network endorsements • Identifying current educational modules on research techniques which could be made openly available on-line • Published a statement on ethical standards for research • Fostering international research collaborations • Publishing a manuscript on “predatory journals”

23. Activities of the IFEM Site Selection for the ICEM Sub-committee • Review the applications by different IFEM member organizations to host an upcoming ICEM • Has sub-committee members from the planning committees for the last and the next ICEM • Assesses the strengths of each application relative to the scientific and educational content of the proposed program, the tourism attractiveness of the proposed venue, and the ability of the hosting organization to have the financial and personnel resources to conduct the ICEM • Make suggestions for improvements in rejected applications

24. Activities of the IFEM Standard Terminology Task Force • Has conducted a multiple round survey of the IFEM membership on EM terminology and achieved a high degree of agreement on the definitions of key terms in EM • Submitted a manuscript of the definitions list to European Journal of EM Sept. 2015 • This manuscript is a very useful reference for standardization of EM terminology

25. Activities of the IFEM Access and Availability Task Force • Conducted an international pilot survey on the degree of access to EM services in different countries and is developing a journal manuscript with the survey results • Is working on developing sources of funding for larger studies of EM access and availability • One of the Task Force members, Dr. Gautam Bodiwala of the U.K., has served as IFEM’s representative to the World Health Organization’s Trauma Care Committee

26. Activities of the IFEM Global EM History Book Project • Decided on a general content and preliminary chapter list for a book on the history of EM globally • Is identifying specific persons to author chapters in the book (many of the chapters are about the history of EM development in single countries) • We need additional people to write the various chapters on the history of EM development in different countries

27. Activities of the IFEM Disaster Medicine Special Interest Group • Collaborate with the World Association of Disaster and Emergency Medicine and other disaster-related organizations in developing disaster management training resources and in participating in international conferences • Develop presentations on disaster management for the upcoming ICEM’s • Serve as an information resource on disaster management for IFEM members • Accumulate educational resources on disaster management for IFEM’s web site

28. Activities of the IFEM Triage Special Interest Group • Identifying and categorizing different triage systems in use • Developing standardized recommendations for triage system implementation

29. Activities of the IFEM Gender Issues Task Force • Identify gender related problems and issues affecting EM clinical practice • Develop a reference manuscript on methods to correct or ameliorate gender related problems • Currently conducting a survey of IFEM members on gender issues

30. Activities of the IFEM Sustainability Task Force • Identify problems and stressors which are hindering EM physicians from staying in clinical practice • Provide recommendations and policy statements on the need for adequate governmental and health system support for EM clinical practice • Has produced a manuscript “Sustainability of Working Practices of Emergency Physicians” released to IFEM members

31. IFEM’s Activities Related to the Formation of an EM Trainees Association • Goal is to encourage and assist the formation of an organization which represents EM residents and registrars worldwide and coordinates activities and collaborations between the various national EM trainee organizations • Once formed, this organization would be an Ex-Officio member of IFEM

32. Activities of the IFEM Spanish Translation Group • Is a group of volunteers for translation of IFEM documents and resources into Spanish and / or Portugese for posting on the IFEM web site • Also is encouraging EM collaborations throughout the Spanish- speaking world • Will be also translating presentations at upcoming IFEM conferences (particularly the Mexico City ICEM in 2018 and the Argentina ICEM in 2020)

33. IFEM’s Interest in Additional Translation • Has translated and posted the Pediatric Care Guidelines into Chinese and conducted a Chinese language track at the 2014 ICEM • The Vietnamese Society of EM (an IFEM member) has expressed interest in providing Vietnamese translation • Has decided to translate and web post all IFEM documents into Spanish, French, Mandarin, and Arabic

34. The IFEM Framework for Quality and Safety in the Emergency Department • Is a highly regarded consensus document outlining the key components of safe, high quality care in the Emergency Department • Produced from the Proceedings of the IFEM “Quality and Safety in Emergency Care Symposium” held in the U.K. in November 2011 • Reviewed in a plenary session at the ICEM in Dublin, Ireland in June 2012 • Available on IFEM’s web site

35. Another Useful Reference for EM System Development • Holliman CJ et al., “The efficacy and value of emergency medicine: a supportive literature review” ; International Journal of Emergency Medicine 2011; 4:44. • Online access at : http://www.intjem.com/content/4/1/44. • This is a compilation of 282 published articles which show the value and efficacy of the specialty of EM and EM systems

36. Upcoming ICEM’s(ICEM’s will be held in June every year starting in 2019) - 2018 : Mexico City, Mexico • 2019 : Seoul, South Korea • 2020 : Buenos Aires, Argentina • 2021 : Dubai, U.A.E. • 2022 : Applications under review

37. Educational Value of the June 2014 I.C.E.M. in Hong Kong • 10 preconference workshops • 6 plenary lectures • 10 simultaneous tracks with 100 topic sessions, 323 presentations • 260 speakers • 144 oral abstracts, 555 posters • 4 tracks presented in Chinese • 2287 attendees from 66 countries

38. Summary of IFEM’s Activities Related to EM System Development • Published standardized curricula • Medical student, residency, and Continuing Professional Development (post-residency) • Conducting the ICEM • Web site open access posting of lectures and documents • Consensus manuscripts from the various IFEM committees, interest groups, and task forces • Collaborating with RCEM, SAEM / GEMA, the AAEM International Committee, and the ACEP International Section in their international training efforts

39. Proposed New Undertakings for IFEM Related to EM System Development • Core Curriculum and CPD Committees to develop IFEM endorsed educational podcasts, satellite symposia, preconference workshops, and focused single topic conferences • Support development of regional trans-national E.M. board certification • Latin America, Europe, Asia, Africa

40. Current Challenges for IFEM • Obtaining more funding and expanding its office and support capabilities • Developing a U.S. based financial foundation (now approved by the U.S. government) • Perhaps some competition with other international organizations such as WADEM • Improving relations and collaborations with the regional EM organizations such as EuSEM • Getting more countries to develop national EM societies and then join IFEM

41. Potential Broad Future Activities and Goals for IFEM • With World Health Organization collaboration, establishing and maintaining high quality EM in all countries • Standardizing transnational clinical care and EM training protocols • Using EM to contribute to peace and stability

42. How Can A National EM Society Interact With IFEM? • Have its members volunteer for, and get appointed to, an IFEM committee, task force, or special interest group • Attend the ICEM • Make a bid to host the ICEM • Organize and host IFEM endorsed EM conferences and workshops • Attend the multiple IFEM meetings held at ACEP Scientific Assembly each fall • Assist IFEM with EM specialty development • Provide translation of IFEM products

43. IFEM’s Current Office Structure • IFEM “Secretariat” is located in ACEM’s office in Melbourne, Australia • ACEM provides office and one half time employee staff support • IFEM is incorporated and registered under Australian law, but effectively is independent of Australia • ACEP and CAEP provide committee operation support

44. IFEM’s Current Officers of the Executive • Executive Officer : Carol Reardon • President : Dr. Lee Wallis (EMSSA) • President-elect : Dr. Jim Ducharme (CAEP) • Past-president : Dr. Jim Holliman (ACEP) • Vice-president : Dr. Tim Rainer (RCEM) • Treasurer : Dr. Anthony Cross (ACEM) • Secretary : Dr. Melanie Stander (EMSSA) • Member at Large : Dr. Jesica Bravo (MSEM)

45. Current Regional Representatives on the IFEM Board of Directors • Africa : Dr. Hendry Sawe (EMAT) • Asia : Dr. Swee Han Lim (EMSS) • Australasia : Dr. Tony Lawler (ACEM) • Central and South America : Dr. Edgardo Menendez (SAE) • Europe : Dr. Juliusz Jakubaszko (PSEM) • North America : Dr. Terry Mulligan (ACEP, ACOEP, AAEM)

46. IFEM Contact Information Carol Reardon, Executive Director International Federation for Emergency Medicine 34 Jeffcott Street West Melbourne, VIC 3003, Australia Phone 61-407-042-543, fax 61-(03)- 9320-0400 Emails : carol.reardon@acem.org.au , ifem@acem.org.au . Website : http://www.ifem.cc

47. IFEM’s Efforts in EM Specialty Development : Lecture Summary • IFEM has produced widely accepted standardized curricula for EM training • The ICEM has been an excellent educational venue for emergency physicians • IFEM currently is operating a number of assistive EM specialty development projects • There is huge opportunity for further collaboration of EM physicians and organizations with IFEM in EM specialty development worldwide