Thanks to the generosity of the class of 2010, I was afforded the chance to participate in Kaiser Permanate's elective in mass gather medicine during America's Cup. The elective took place during the latter part of the summer of 2013 and involved a fascinating combination of policy discussion, large scale medical operations, and daily shifts in a makeshift emergency room. The fact that the provision of care was no different than any emergency department was itself remarkable; the coordination and planning required in this undertaking was laid out in a series of lectures and meetings with city and hospital administrators as well as regional disaster experts.
I walked into this elective wanting to expand my breadth and depth of both experience and knowledge in the field of mass gathering medicine. I walked out with an expansive appreciation for a burgeoning academic field, spurring on an interest in arenas of remote medicine, telemedicine, international medical ethics and operations. Most of the faculty mentors/instructors have ongoing involvement in disaster medical response teams and USAR and through them, I too have been moving in that direction through regional and state fire and rescue training and service.
Thanks to the Spirit of 2010 award, I was able to spend my elective in Ireland, getting to know the healthcare system as well as the ins and outs of emergency care. I spent my time with Dr. Andy Neill, an avid proponent of #FOAMed (Free open access medical education) and emergency physician at the Mater Misericordiae University Hospital in Dublin.
During my clinical time there, I realized that there are as many similarities as there are differences in the way we practice. Many of the similarities lie in the shared frustrations of EP's everywhere, though we have much more litigation concerns here in the US than they do in Ireland. The differences are many. One of the most striking differences is the structure of staff there. Very few doctors seek out EM as their specialty. Their equivalents of attendings play a much more administrative, hands-off role and do few clinical shifts, if any. Most of the resident staff in the ED at a given time are rotating residents from other specialties who spend as much as six months at a time there.
Another observation was that of the lack of a regulated trauma system (though it is something they are working towards). Right now traumas can go to any ED and most rely on a general surgeon taking home call overnight to respond to emergencies. Luckily traffic is tight in Dublin, so they don't see a lot of high speed MVCs.
Lastly, I was able to learn a lot from Andy about the FOAMed movement. Andy's blog "Emergency Medicine Ireland" contains tips, tricks and pearls for EM physicians everywhere. We reviewed podcasts and spoke a lot about emergency medicine education and where it is headed. Exciting things are in store and I was glad to be a part of it. Thank you, 2010!