Ethical Standards in International Medical Care: Establishing Guidelines for Emergency Medicine Providers
Our project is designed to improve patient care in the relief setting by establishing consensus ethical guidelines for the provision of medical care.
About Your Organization
International Emergency Medicine Ethics Work Group
United States, LA, New Orleans
Country where this project is creating social impact
Is your organization a
How long has your organization been operating?
Less than a year
Has the organization received awards or honors? Please tell us about them
Invitation for poster presentation at the American College of Emergency Physicians Leadership and Advocacy conference, May 2011;
Invitation for Oral Presentation at the 6th Annual Mediterranean Emergency Medicine Congress, September 2011;
Invitation for poster presentation at Louisiana Health Sciences Center Medicine Research Day February 2011
References - Please provide two references with a two-sentence biography, email address, and phone number for each
Dr. Peter Deblieux: Dr. Deblieux is the Director of Emergency Services and Director of Resident and Faculty development at the Louisiana State University Emergency Medicine residency in New Orleans Louisiana. Dr. Deblieux is a nationally recognized speaker on current topics in Emergency Medicine and Critical Care with regular participation in educational podcasts and residency lectures. firstname.lastname@example.org, 504-903-3594
Dr. Keith Van Meter: Dr. Van Meter is the Chief of the Section of Emergency Medicine at Louisiana State University in New Orleans, Louisiana as well as the Medical Director of the JESM Baromedical Research Institute. He is also a clinical professor at the Tulane School of Medicine in the Department of Surgery and is published extensively in both emergency medicine and hyperbaric medicine literature. email@example.com, 504-366-7638
The Co-Principle Investigator of this initiative is Dr Annelies De Wulf (504)382-9283, also reachable at firstname.lastname@example.org.
Our Co-Investigators and advisers are: Dr Lisa Moreno-Walton, Assistant Residency Director, Director of Resident Research and Clinical Instructor at Louisiana State University [email@example.com, (917)583-5486] and Dr David Beran, Fellow in International Emergency Medicine at Tulane University and Clinical Instructor in Emergency Medicine at Louisiana State University [firstname.lastname@example.org (504)432-1321].
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Select the stage that best applies to your solution
Growth (your pilot is up and running, and starting to expand)
How long have you been in operation?
Operating for less than a year
Which of the following best describes the barrier(s) your innovation addresses? Choose up to two
The Need: What problem are you trying to solve?
Through providing humanitarian assistance, disaster relief, short term medical care, refugee care, establishing EMS systems, providing training in emergency care, and establishing Emergency Medicine as a global specialty, medical providers working in the international arena are faced with numerous ethical dilemmas. Issues arise in providing equitable health care in a culturally competent, responsible, and sustainable fashion. Because Emergency Medicine providers are on the forefront of providing international medical aid, a set of ethical standards established by Emergency Medical physicians should be available as a framework for clinicians providing medical care in the global setting. Currently these guidelines do not exist.
The Solution: What is your solution? Be specific!
In response to the lack of formal guidelines by emergency medicine practitioners for the provision of international medical care and disaster relief, we propose a global collaboration to establish such guidelines based on consensus. A representative body of emergency physicians including practitioners, educators, and experts in international medical experts have been invited to participate in this collaboration. Ethical dilemmas, challenges, and themes are being solicited from respondents. From these responses a list of ethical priorities is being identified. This working document will be basis of a consensus conference that will be held as part of the Humanitarian Track at the upcoming International Conference of Emergency Medicine in June of 2012. Through an ongoing process of review via web-based participant feedback, a final consensus statement of ethical guidelines will be created with the goal of publication and wide distribution among international medical care providers.
The Model: Walk us through a specific example of how your solution makes a difference; include your primary activities
Recent large scale humanitarian crises, complex emergencies, and trends in international medical demand a robust ethical framework to ensure responsible, sustainable, culturally competent medical care and education. The need for such a framework was observed by the principle organizers of this initiative while providing medical care in an urban emergency department in Port Au Prince, Haiti following the 2010 earthquake. Through discussions with many clinicians with experience in humanitarian relief, it has been observed that ethical dilemmas are common in international medical practice and that providers are often ill-prepared when these dilemmas arise. There is an urgent need for consensus guidelines to serve as a resource to support an ethical decision making process for medical providers confronted with the issues inherent in the provision of care in a multi-cultural, politically diverse international arena. Our plan is to ensure that in the near future, all providers engaged in international emergency medicine will have this ethical consensus statement as a reference when providing care in diverse settings.
The Marketplace: Who are your peers and competitors? Identify others also working to address the needs you are and what differentiates you from them. What challenges could these players pose to your success or growth?
While medical ethics is a broad field, multiple comprehensive literature reviews confirm that there is no set of ethical guidelines established for the practice of international emergency medicine. The impetus of this initiative emerges, in large part, from this knowledge gap in the field of medicine. The spirit of this effort is one of collaboration and we are actively engaged in obtaining broad input from the global emergency medicine community.
This Entry is about (Issues)
Founding Story: We want to hear about your "Aha!" moment. Share the story of where and when the founder(s) saw this solution's potential to change the world.
Reflecting upon the experiences our medical relief work in Port au Prince following the earthquake of 2010, we reflected upon our experiences and recognized that ethical dilemmas emerged as the most significant challenge of our respective experiences. With this in mind we looked to the medical and ethics literature for resources to guide practitioners such as ourselves. This search demonstrated a complete absence of such a resource. We determined that if there were a guideline to reference, something the international community had agreed upon by expert consensus, we could have implemented it in the Haiti earthquake setting and had a greatly positive influence patient care. By extension, such a set of consensus guidelines could be broad enough to impact not only disaster medicine, but international medical aid during steady-state times of need as well. We viewed this as having tremendous benefit to both the providers of humanitarian efforts and their patients.
Please describe the goal of your initiative; outline what you are trying to achieve
Our goal is to create a Consensus Statement of Guidelines for the Provision of Ethical International Emergency Medical Care based on the contributions of experts in the fields of international emergency medicine and ethics. This consensus statement will guide emergency care providers in the standards of ethical medical care in the international setting. Providers working in unfamiliar, resource limited, dynamic settings will be better equipped to face the ethical challenges that they will invariably encounter. Our vision is that of a living document that will be periodically amended as the field of medicine evolves. Our goal is to develop the first guideline of its kind, to serve those involved in international emergency medical care today and in the future.
What has been the impact of your solution to date?
To date, a global community comprised of experts of international emergency medicine and medical ethics has been established. A dialogue has been initiated and has generated a preliminary set of ethical themes and challenges related to the practice of international medical care. As such, the major impact of our project has been to increase awareness of the need for a guideline and the breadth of issues that fall under such a guideline, and to bring together individuals who share this concern and have both the expertise to formulate the guideline as well as sufficient respect for their peers to insure that it will be a true expert consensus. The full impact of our project will be evidenced when all stages of this project have been completed the guidelines have been published.
What is your projected impact over the next five years?
Throughout the history of modern medicine, there have been numerous tragic examples of violations of ethical standards in both medical research and practice. These violations highlight the need for ongoing discussion of and attention to medical ethical principles. Ongoing and increasing activity in international medical response to humanitarian crises and the expansion of global medical education present areas where ethical dilemmas abound. In recent years, there has been an expansion of international medical care and education and this is very likely to continue for well beyond the next five years. This trend of expansion renders the need for established ethical standards an imperative to ensuring responsible and optimal health care delivery.
What barriers might hinder the success of your project? How do you plan to overcome them?
Barriers to the success of this initiative include insufficiently broad representation of Emergency Medicine physicians in the creation of a consensus statement and lack of a medium (such as publication) with which to create widespread awareness of the statement. To overcome the barrier of inadequate representation of emergency providers, we will extend the process of creating the final consensus statement over two years in order to incorporate as many practitioners as possible. In addition, we plan to meet with as many participants as possible during the symposium this June at the International Conference of Emergency Medicine in order to refine the ethical priorities that have been identified and to begin the work of establishing consensus statements about these priorities.
Winning entries present a strong plan for how they will achieve and track growth. Identify your six-month milestone for growing your impact
To establish and publish a consensus statement of ethical priorities for the practice of international medical care.
Identify three major tasks you will have to complete to reach your six-month milestone
Collect input from group participants
Meet in person with group participants at symposium to refine statements of ethical priorities.
Submit consensus statement of ethical priorities for the practice of international medical care for publication.
Now think bigger! Identify your 12-month impact milestone
To refine the consensus statement of ethical priorities into a consensus statement of ethical guidlines for practitioners.
Identify three major tasks you will have to complete to reach your 12-month milestone
Expand the list of participants for the project to ensure broad, global representation of emergency providers.
Conduct a meeting with participants to refine the expanded collection of ethical priorities and edit this into ethical guidlines
Publish a final consensus statement of ethical guidelines for international medical care providers.
Tell us about your partnerships
We, the two primary organizers of this project are colleagues who developed this initiative through discussions of similar experiences working in the developing world. Our co-authors are additional colleagues who have contributed to the project through logistical support, networking and in an advisory capacity. The International Emergency Medicine Ethics Work Group is comprised of individuals who have contributed to this discussion. Each became involved via web based outreach and/or networking.
Are you currently targeting other specific populations, locations, or markets for your innovation? If so, where and why?
We have targeted both provider and receiver global nationals in the field of emergency medicine and disaster relief, as well as experts in medical ethics. We have solicited involvement through the web via professional organizations and expanded that network through conference attendance, word of mouth and personal and professional relationships. Our aim is to involve as many experts in this field as possible in order to have a truly global consensus statement. Accordingly, our specific population consists of emergency medicine practitioners with no limit to location or market.
What type of operating environment and internal organizational factors make your innovation successful?
The diversity, enthusiasm and commitment of those involved have contributed most to our success. We have experts in the field of Medical Ethics, providers of emergency medical care that practice in diverse environments throughout the world, as well as experts in International Emergency Medicine who are participating in this dialogue. Furthermore, the authors of this project identify that the absence of these ethical guidelines is a void that we are highly motivated to fill. As a result, we have already invested substantially to this project and are committed to seeing this through to completion.
Please elaborate on any needs or offers you have mentioned above and/or suggest categories of support that aren't specified within the list
The main barrier is the financial burden of conference attendance. In order to further refine the guidelines, we will hold a meeting which requires attendee input. Also, using a numerical approach to establish the level of participant agreement with each statement will require statistical analysis. We welcome a volunteer statistician or financial support to hire statistical support.