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

1. The International Federation for Emergency Medicine : Its History, Structure, and Plans for the Future Jim Holliman, M.D., F.A.C.E.P., F.I.F.E.M. President-Elect, International Federation for Emergency Medicine Professor of Military and Emergency Medicine Uniformed Services University of the Health Sciences Bethesda, Maryland, U.S.A. Adjunct Professor of Emergency Medicine George Washington University and Nanjing Medical University

2. The International Federation for Emergency Medicine (IFEM) : Its History, Structure, and Plans : Lecture Goals • Present the historical background of the development of IFEM and its accomplishments to date • Describe the current structure and operations of IFEM • Present IFEM’s plans for future activities • Encourage participation in IFEM activities

3. 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

4. Early History of IFEM’s ICEM • The IFEM founding organizations agreed to rotate the location of the ICEM every two years in the sequence : United Kingdom, Australia, Canada, United States, and then repeat the cycle • The host country national EM organization was responsible for organizing the ICEM in its country • The IFEM Presidency rotated to the President of the current ICEM host country EM organization

5. Change in Philosophy for IFEM • In the mid 1990’s the IFEM leadership decided to open up membership in the IFEM to other countries’ EM organizations (in addition to the original 4 Founding Member Organizations) • Later it was decided that any IFEM member organization could apply to host the ICEM (so it would not just continue to rotate between the original 4 Founding Member countries) • First ICEM held “outside” the original 4 countries was in Singapore in 2010

6. Categories of Membership in IFEM • Founding Members : BAEM (now the 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

7. IFEM’s Early Years Structure • IFEM President was the President of the host country organization for the ICEM • Board of Directors (BOD) members were the Presidents of the Founding and Full Members Organizations • The IFEM Executive (acting as a leadership committee) positions were elected from the BOD members (Secretary, Treasurer, Member at Large) • BOD meetings were held at ACEP’s Annual Scientific Assembly and at each ICEM

8. Further Changes in IFEM’s Philosophy and Activities • In the 2000’s the IFEM leadership decided the organization should do more than just operate the ICEM and should become more of a “service organization” and undertake major activities to assist its members and other countries which do not yet have good EM services with EM and EMS development • The general goal was for IFEM to become the world’s premier organization for EM development and promotion

9. Background for IFEM’s Recent Structural Changes • As the number of members of IFEM grew to more than 30, the BOD meetings became unwieldy and there was a feeling that there should be more regional representation and input at the Executive level in IFEM • Also as IFEM developed sources of revenue and complexity of operations it was felt necessary to incorporate the organization • So starting in 2005 a multi-year Bylaws revision process was undertaken • New tripartite structure took effect in 2012

10. 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 IFEM) • BOD : 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 > 50) • 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

11. Should IFEM Have Individual Members ? • This has been extensively debated by the IFEM leadership • Idea behind this would be to have IFEM membership be available to EM physicians in countries that don’t yet have an EM organization • But it was decided that having individual memberships might decrease participation in national EM organizations • Individuals can currently be represented in IFEM through the Ex-officio regional society members of IFEM (the Latin American, African, Asian, and European Societies)

12. IFEM’s Designation of Committees to Carry Out EM Development Efforts • Finance • Governance • Core Curriculum and Education • Clinical Practice • Specialty Implementation • Continuing Professional Development • Research • ICEM Site Selection Sub-committee

13. 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

14. Activities of the IFEM Finance Committee • Monitor and report income (IFEM’s main income is from a per capita fee for each attendee at the ICEM and from membership dues) • Maintain and dispense IFEM funds from a bank account in Australia • Develop new sources of income for IFEM

15. Activities of the IFEM Governance Committee • Much of the work of this committee was completed in 2012 with the institution of the new Bylaws structure for IFEM • Provides ongoing review of the IFEM Bylaws and maintains consistency of wording between the IFEM Bylaws and the IFEM Constitution (for reasons of convenience and finances, IFEM has been registered and incorporated in Australia)

16. 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 • Is working on writing a standardized curriculum for continuing professional development for EM physicians in practice, and on a standardized international curriculum for paramedic training • Is preparing a manuscript on “Mapping the EM Curriculum to Assessment Methods” • Collaborating with the U.K. College of EM on its “ENLIGHTENME” virtual learning resource

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 is developing a standardized international curriculum for point of care ultrasound training • 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. 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 • Is starting work on a manuscript on “How to Start and Operate a National EM Society”

20. 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 • Collaborating with the Core Curriculum Committee on the Standardized Recommendations for Post-graduate CPD manuscript

21. 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 • Developing criteria for handing requests for research network endorsements • Identifying current educational modules on research techniques which could be made openly available on-line

22. 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

23. 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 • Is working on submitting a journal manuscript of the definitions list

24. 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

25. 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)

26. 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

27. 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

28. 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 may be providing even more staff and financial support in the near future

29. IFEM’s Current Officers of the Executive • Executive Officer : Carol Reardon • President : Prof. Peter Cameron (ACEM) • President-elect : Prof. Jim Holliman (ACEP) • Past-president : Dr. Gautam Bodiwala (CEM U.K.) • Vice-president : Dr. Jim DuCharme (CAEP) • Treasurer : Dr. Andrew Singer (ACEM) • Secretary : Dr. Robert Schafermeyer (ACEP) • Member at Large : Dr. P. Ho (Hong Kong College of EM)

30. Current Regional Representatives on the IFEM BOD • Africa : Prof. Lee Wallis (EMSSA) • Asia : Prof. V. Anantharaman (SEMS) • Australasia : Dr. Sally McCarthy (ACEM) • Central and South America : Dr. Edgardo Menendez (SAE) • Europe : Dr. Juliusz Jakubaszko (PSEM) • North America : Dr. Terry Mulligan (ACEP, ACOEP)

31. Map of Current IFEM Members (pink are founding and full members, and gray-green are affiliate members)

32. Countries Currently Represented as IFEM Founding or Full Members • U.S.A., Colombia, Panama, Australia, Bahrain, Canada, China, U.K., Turkey, South Africa, Hong Kong, Hungary, Ireland, Israel, Korea, Malaysia, Netherlands, Poland, Argentina, Dominican Republic, Mexico, Peru, Venezuela, India, Singapore, South Pacific, Sweden, Taiwan, Thailand, Trinidad / Tobago, and Tunisia

33. Countries Currently Represented by Affiliate Members of IFEM • U.S.A. : AAEM, ACOEP, SAEM • Panama, Madagascar, Brazil, Czech Republic, Denmark, Germany, Lebanon, Pakistan, Spain, Sri Lanka

34. Current IFEM Ex-officio Members • African Federation for EM • Asian Society for EM • ALACED (Latin America) • European Society of EM (EuSEM) • Pan American Collaborative EM Development Program (PACEMD)

35. Countries with Current or Recent Applications to Join IFEM • Uzbekistan • Georgia • Costa Rica • Philippines • Ethiopia • Tanzania

36. IFEM Endorsed International Conferences • Symposium on Resuscitation in Mexico, June 2011 • Symposium on Quality and Safety in Emergency Care in the U.K., November 2011 • 8th and 9th New York City International Conferences on EM, New York City, August 2011 and August 2012

37. Upcoming ICEM’s • Hong Kong : June 10 to 15, 2014 • Cape Town, South Africa : April 18 to 21, 2016 • 2018 : Mexico City, Mexico

38. IFEM Awards • “Fellow of the IFEM” • Several nominees every 2 years from any IFEM member ; for service to IFEM or international EM work • “Gautam Bodiwala Lifetime Achievement Award” to be first awarded in 2014 • “Humanitarian Award” • 1 to 2 every 2 years for humanitarian work • “Campbell McFarlane Award” • For best presentation at ICEM

39. Current Challenges for IFEM • Obtaining more funding and expanding its office and support capabilities • 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

40. 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

41. How Can You Interact with IFEM ? • Get appointed to an IFEM committee • Attend the ICEM • Attend the multiple IFEM meetings held at ACEP Scientific Assembly each fall • Help a country you are working in to develop a national society of EM and then have that organization join IFEM

42. 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

43. IFEM’s History, Structure, and Plans : Lecture Summary • IFEM has grown from an original organization representing just 5 countries to now representing more than 50 • IFEM’s International Conference on EM held every two years has been very successful • IFEM is involved in multiple efforts at EM specialty support and development worldwide • There is huge opportunity for further collaboration of EM physicians and organizations with IFEM