President Newsletter 03

Dear Colleague,

After a very successful Annual Scientific Meeting and AGM held in Athlone in October it is timely to update members about a range of issues of importance to the Association.

Our Athlone AGM attracted a record number of attendees. Those that attended will agree that the standard of the academic content was excellent with informative presentations and good science presented. Generally the posters were of high standard as were the free papers and this augurs as well for the specialty in the future. Our thanks go to Drs. Rob Eager and Sean O’Rourke for their efforts in bringing the conference project to such a successful conclusion.

Comings and Goings

At the AGM a number of important things happened and it is appropriate to reflect on these. Demitting from the Executive were Mr. Gerry McCarthy who has stepped down as the Training Standards Committee representative to the College of Emergency Medicine and Dr. Sean Walsh who demits office as an Ordinary Member of the Executive. I wish to take this opportunity to publicly thank Gerry and Sean for their significant contributions to the specialty and no doubt they will be pressed into service in other roles within the Association and the specialty in the future. Joining the Executive are Dr. Rob Eager who is the new Ordinary Member on the Executive and Dr. John McInerney who will take over the Training Standards Committee representative role. We wish them well in their efforts and look forward to working closely with them over the next few years.

For the first time ever we had 3 recently retired colleagues awarded Life Membership of the Association. Dr. Peter O’Connor, former President and Treasurer; Mr. Colman (Stan) O’Leary, former President and Mr. Geoff Keye, former Secretary of the Association have retired from clinical practice. We take this opportunity to wish them well in their retirement; thank them sincerely for their efforts for the Association and the specialty and look forward to seeing them in the future, certainly at the Association’s social events!

Financial Matters

As you will be aware the Association has been frustrated in its quest to achieve charitable status. In an attempt to get round the roadblocks placed in our path, we have opted to become an incorporated body. This will serve the dual roles of limiting members’ liability in the unlikely event that ICEM 2012 is a financial failure but this mechanism will also improve our chances of achieving our goal of charitable status. We have researched the matter in considerable detail and have chosen a solicitor with a proven track record of achieving both objectives with similar representative organisations and we are confident that we will achieve our important goals over the next six months or so. This will allow us to be able to avail of our share of the proceeds of the joint CEM/IAEM meeting from September 2008 (which is currently in the CEM account in London) without a tax liability and also allow us to regularise our tax affairs without having to pay tax on previously earned income.

The Association has also moved its bank account. Whereas previously we would have banked in a local branch adjacent to where the Treasurer lived we have decided to move our banking affairs to a centre city, marquee bank branch and have opened accounts in the Bank of Ireland, College Green accordingly. Arrangements are being put in place to have internet access / control over these accounts which will help in making financial processes more efficient.

In addition, the Treasurer has negotiated the bank’s support for us using direct debit as a means of collecting our subscription income. The current standing order process is extraordinarily rigid and administratively nearly impossible to manage and the Association and its members would benefit greatly from a streamlined system. This requires all current members to fill in a direct debit mandate form and return it to Mr. Niall O’Connor at their earliest opportunity. Although the Association raised its annual subscriptions at the recent AGM, there is a substantial discount for those paying by direct debit and the efficiencies that the direct debit system brings are beneficial for both members and the Association alike. Currently management of the subscription process is cumbersome and time-consuming and none of us have the time for such unnecessary work. Please also note that the Direct Debit process provides the standard guarantees and any personal information kept by the Treasurer will be encrypted.

Milestones for the Specialty

Some of you will be aware of the significant academic milestones that have been achieved in and for the Specialty within recent weeks. Mr. Stephen Cusack, Consultant in Emergency Medicine, Cork University Hospital has been appointed the first Professor of Emergency Medicine in Ireland and becomes a UCC Professor. A few days later Dr. Ronan O’Sullivan, Consultant in Paediatric Emergency Medicine at Our Lady’s Children’s Hospital, Crumlin was appointed UCD Professor of Paediatrics based at Crumlin Children’s Hospital. This is the first time that a Consultant in Emergency Medicine has been appointed to a “mainstream” academic appointment. Both of these appointments, in their different ways, are major milestones and greatly further the academic and political development of the specialty. We sincerely wish the new ‘Profs’ well in their future roles.

You will also no doubt be aware that for a number of years Mr. Patrick Plunkett, Consultant in Emergency Medicine, St James’s Hospital has been a Senior Lecturer at Trinity College, Dublin. In recent months Mr. Conor Egleston, Consultant in Emergency Medicine at Our Lady of Lourdes Hospital, Drogheda has been appointed to a similar ad hominem post at RCSI based in OLOLH, Drogheda.

Over the past year or so, two research units have been set up with leadership from Consultant colleagues in Emergency Medicine. The Centre for Pre-hospital Research in the University of Limerick is headed by Dr. Cathal O’Donnell, Consultant in Emergency Medicine at the Mid Western Regional Hospital, Limerick and Prof. Ronan O’Sullivan has set up a Paediatric Emergency Research Unit in Our Lady’s Children’s Hospital, Crumlin with links to a number of Universities. These developments clearly help to improve the academic base of Emergency Medicine and this will be to the betterment of the Specialty and the patients we serve. In view of these developments, consideration will need to be given to reconfiguring the IAEM Academic Committee to take account of recent developments.

Future Challenges

Consultant Appointments

Although there have been a number of Consultant Appointments in Emergency Medicine in the past year the majority of these have been either regularisation of temporary posts or replacements posts. There have been very few new posts, leaving Ireland still very short of Consultants in Emergency Medicine when compared with international norms. We will continue to press for widespread Consultant expansion as we are particularly aware of the benefits that additional Consultants bring to emergency care. In the current climate however, there is unlikely to be the degree of Consultant expansion either promised or indeed necessary and I would advise all colleagues to continue to press local management to address shortcomings and shortages in their own individual services, notwithstanding the difficult financial situation we are in.

ICEM 2012

Progress continues slowly in our arrangements to host ICEM 2012. At this stage we have reduced the number of PCOs competing for the role as Conference Organiser to two. We are also intensifying our efforts to obtain the best venue but at the most competitive price. Given that the conference venue represents the single largest outgoing for the Organising Committee it is important that value is obtained. We have a preferred PCO and preferred venue very much in mind but we need to ensure that the price meet the Association’s needs As soon as this process is completed and we would anticipate that this would happen by early January 2010, the Association will need to set up various committees to oversee different elements of the ICEM 2012 project. Clearly the Academic Committee will lead out on the academic programme but there are a considerable number of roles that also need to be addressed including Finance and Governance (under the Treasurer’s direction), the social programme etc. As I made very clear at the AGM, there is a need for all members (both Full and Associate) to play their role in making the ICEM 2012 project the success we know it can be. Given our very positive experience of organising the CEM Autumn Scientific Meeting 4 in conjunction with the regular IAEM meeting back in September 2008, we know that the Association is capable of delivering an excellent and enjoyable conference with top-rate academic and research elements and a social programme our delegates will remember. At a time when we all feel that the role of Emergency Medicine is not well understood and indeed undervalued in the Irish healthcare system, ICEM 2012 represents a major opportunity to showcase what the specialty is capable of delivering. It is clearly in all our interests to ensure that the venture is a success both from a conference and a financial perspective.

Development of Major Policy Documents

As some of you will be aware, I have commissioned three groups to develop wellreferenced, researched documents on issues of importance to Irish Emergency Medicine with a view to their final drafts being presented to the Executive in the early New Year. You will be aware that one group is looking at Clinical Care at Events and will be the driver to hopefully bring about improvements in the provision of services at such events and improve relationships with the EMS and hospital services. This group under the chairmanship of Mr. Conor Egleston began its work this week.

A second group to look at the role of Advanced Paramedics, Paramedics and Advanced Nurse Practitioners in the delivery of emergency care has also been set up. This group chaired by Dr. Cathal O’Donnell is an attempt to ensure that the place of “alternative” practitioners in the delivery of emergency care is appropriately defined. In the various reconfiguration “debates,” it is clear that there is an assumption that other practitioners can step into the breach created by the closure of smaller EDs without any meaningful consideration of how this model will work and what exactly such Practitioners are realistically capable of doing.

A third group under the chairmanship of Prof. Ronan O’Sullivan will report on the future of Paediatric Emergency Medicine. Whereas this latter issue is often seen as being of particular relevance in the greater Dublin region, the reality that the majority of care provided to children in EDs takes place outside of the Dublin Paediatric Hospitals should not be lost sight of. It thus requires a vision document as to how care should be delivered across the generality of EDs in Ireland.

All three of these groups are looking at issues of major importance to both emergency care but also Emergency Medicine in Ireland. We wish them well in their efforts and look forward to the product of their work in the New Year.

Other Issues

The Association continues to campaign for improvements in road safety and has recently aggressively supported proposed changes in legislation to reduce the permissible blood alcohol level for drivers.

We continue to seek improvements in the current difficult environment which EDs find themselves in. ED overcrowding has certainly not gone away and our concern is that with further financial cutbacks, the number of available beds will fall greatly compounding the already difficult situation. We continue to press anybody who is prepared to listen to us, to face up to these issues which heretofore have not been satisfactorly addressed. In this regard, we met the Chief Medical Officer, Dr Tony Holohan in early September and very strongly impressed on him the need for action.

We are continuing to work on a scientific paper which will examine the Full Capacity Protocol (FCP) and show the clear benefits that such a policy would bring. This document is currently at near final draft stage. We hope to get this published and generate some momentum on the back of this.

In conclusion please put in your diary the date of the next IAEM Annual Scientific Meeting and AGM. The meeting will take place in Waterford from 14th to 16th October 2010. Further details will be provided about this meeting in due course. Between now and then we will consider further how we should proceed on the project to develop a unitary body to be responsible for all aspects of Emergency Medicine in Ireland as mandated at the recent AGM.

With best wishes for the remainder of 2009 and the upcoming Christmas season – and yes, it is almost that time of the year!

Yours Sincerely,