Chair's Report to the Board

International Advisory Board Chair: Dr. Christopher Carpenter

Chris Carpenter

Welcome to the 6th Annual Schwartz/Reisman Emergency Medicine Institute (SREMI) International Advisory Board (IAB) Meeting. History will remember 2020 as the year when a catastrophic viral pandemic cost humanity dearly, and a time when society relied upon medical science to generate evidence-based solutions at an unprecedented pace. As the front porch to the hospital, emergency medicine stood at the center of this population storm and stood tall during our generation’s darkest hours, despite inadequate supplies of almost every resource required to combat COVID-19. The clinical researchers and educators at the foundation of SREMI provided a beacon of continued awe-inspiring scholarly productivity despite COVID-19.  Director Dr. Bjug Borgundvaag and Research Director Dr. Shelley McLeod never lost focus on SREMI’s mission, while adjusting to confront COVID-19 head-on. This report highlights a portion of SREMI’s accomplishments and 2020 progress in the midst of historical challenges.

NYGH and Sinai Health Collaboration – EDAC

Immediately following the IAB meeting in 2019, the annual two-day EDAC occurred again at the Toronto office of the Ontario Medical Association. The conference featured several members of the IAB, exhibiting the intercontinental transdisciplinary leadership available to SREMI. The conference also included SREMI scholar Catherine Varner as part of a panel discussion reviewing early pregnancy care in the emergency department. This year, EDAC will be held virtually on November 24, with a focus on COVID-19 and the impact of technology to overcome the pandemic, rapid change agents, and maintaining healthcare team wellness while surviving an international tragedy.  

SREMI Research Activities

SREMI has arrived as a hub of innovative international healthcare outcomes investigators. SREMI investigators were authors on three of the four CAEP 2020 plenary abstracts, and Dr. Catherine Varner received the CAEP Top New Investigator Award. Dr. Rebecca Schonnop received a CAEP Junior Investigator Award to evaluate the under-recognition of emergency department delirium. 

Between November 2019 and October 2020, SREMI investigators published 56 manuscripts, including original research in prestigious journals like The BMJ, Lancet, Age and Ageing, Journal of the American Geriatrics Society, Critical Care Medicine, Annals of Emergency Medicine, and the Canadian Medical Association Journal. For perspective, the early career assistant professor academic emergency physician in the United States who publishes one manuscript per year is in the 95th percentile for productivity and the 99th percentile is 4.2 manuscripts per year. SREMI scholars remain impressively prolific over a broad range of topics including resuscitation, geriatrics, triage, and trauma, as well as emergency medicine’s response to COVID-19.

SREMI Accelerates Knowledge Translation 

EM Cases (https://emergencymedicinecases.com/) was developed by Dr. Anton Helman of NYGH and is disseminated with SREMI support. EM Cases began as a podcast, with nearly 12 million podcast downloads since inception and episodes average more than 220,000 downloads per month. The website had approximately 2,300,000 podcast downloads thus far in 2020. In the early months of COVID-19, Dr. Helman created a series of apropos podcasts on SARS-CoV-2 pathophysiology, hospital surge capacity, healthcare provider wellness and personal protective equipment, and a dozen updates in later months as the science of COVID-19 evolved. I listen to dozens of emergency medicine, critical care, and geriatric podcasters as part of my approach to lifelong learning. Bar none, Dr. Helman’s syntheses to his immense and continually expanding EM Cases audience is the best COVID-19 Free Open Access Meducation (FOAMed) resource available. Undoubtedly, his platform, network of experts and communication style saved both patient lives as well as healthcare teams and their families.  

Similarly, Dr. Don Melady became the solution for the Geriatric Emergency Department Collaborative (GEDC, see https://geriatric-ed.com/) during the COVID-19 era. Whereas GEDC was built upon a foundation of in-person “Boot Camps” to provide external expertise and a structured approach to implementing older adult emergency medicine quality improvements across healthcare systems, travel and large gatherings became impossible this year. Consequently, Dr. Melady developed a series of monthly webinars ranging from emergency department approaches to COVID-19 diagnosis and management, to nursing home transitions and telehealth solutions (all archived on https://gedcollaborative.com/events/past). 

The education efforts of Drs. Helman and Melady speak to the full potential of SREMI. Writing grants and publishing papers in isolation will never be sufficient strategies to deliver optimal healthcare to patients in a reasonable timeframe.  

Reflections from the Chair

This will serve as my final IAB Chair’s perspective. In my academic career, I have witnessed the birth and demise of numerous ideas that appeared as disruptive innovations initially, but never attained momentum.  Malcolm Gladwell noted “the tipping point is that magic moment when an idea, trend, or social behavior crosses a threshold, tips, and spreads like wildfire.” SREMI is at the precipice of that tipping point. By demonstrating the capability to adapt on the fly as COVID-19 emerged, SREMI is a guidepost for emergency medicine researchers worldwide. Unanticipated challenges undoubtedly remain ahead for SREMI as the full economic and societal impact of COVID-19’s scourge unfolds in coming years. Nonetheless, emergency medicine’s research community would be wise to engage with SREMI to understand how one community’s investment in emergency medicine research can reverberate globally. Personally, I have made that statement in meetings for different organizations in response to numerous challenges confronting clinical research – SREMI’s mission and vision illuminates a path for all of emergency medicine from the pre-hospital setting through the emergency department to the intensive care unit or hospital floor and back home.  

Worldwide, emergency medicine challenges accelerated unexpectedly, as did the opportunities to lead. As stated by Winston Churchill “A pessimist sees the difficulty in every opportunity; an optimist sees the opportunity in every difficulty”. SREMI represents emergency medicine’s eternal future and the IAB remains an indispensably engaged SREMI partner.
 

Respectfully submitted,

Christopher R. Carpenter, MD, MSc, FACEP, AGSF
Chair, SREMI International Advisory Board
Associate Professor, Department of Emergency Medicine
Washington University in St. Louis