#ICEM2025 Daily Recap: May 28th

ICEM 2025 – Day 4 Recap 🇨🇦

As we conclude the final day of ICEM 2025, we reflect on a week filled with innovation, collaboration, education, and motivation. The conference brought together emergency medicine professionals from around the world to share knowledge, experiences, and advancements in the field.

Today’s sessions continued to build on the momentum of the previous days, offering insights into the latest research, clinical practices, and global health initiatives. Attendees engaged in discussions that will undoubtedly influence the future of emergency medicine.

We extend our heartfelt thanks to all the speakers, organizers, volunteers, and participants who made this conference a resounding success. Your contributions have enriched the emergency medicine community and will have a lasting impact on patient care worldwide.

As we part ways, we carry with us the connections made, the knowledge gained, and the inspiration to continue advancing emergency medicine in our respective communities.

Read on below for some of the highlights from the last day of the conference.

Safe travels, and we look forward to seeing you at the next ICEM! - ICEM2025 Social Media team

🌟 Plenary Session: Educating Generation AI

Speaker: Dr. Simon Carley

Artificial Intelligence (AI) is no longer a future concept—it’s embedded in clinical practice and reshaping how we educate the next generation of emergency physicians. Educators must adapt quickly to close the widening generational gap in how technology is understood, used, and trusted.

Summary:

Dr. Simon Carley opened his talk with characteristic humour and clarity, reflecting on his multifaceted role in emergency medicine and education. As Dean of the Royal College of Emergency Medicine, he emphasized the responsibility of training future clinicians in a world increasingly shaped by AI.

AI is everywhere—from Tim Hortons menus to trauma resuscitations. But the real transformation lies in how the next generation of learners, digital natives, are already leveraging these tools. A striking example involved a resident using voice-activated AI to plan a pediatric RSI, producing not just doses, but a full, personalized airway and post-intubation plan—within seconds.

“What she got wasn’t just information—it was clinical reasoning, experience, and synthesis. That’s what AI can offer now.”

This generational shift reveals a disconnect between seasoned educators (Gen X) and learners (Gen Z), who are fluent in interacting with tech for real-time problem-solving. For many trainees, using AI is second nature—what surprises their supervisors is normal to them.

Dr. Carley highlighted AI’s current integration in clinical care:

• Ambient listening tools (e.g., Heidi) now transcribe and summarize trauma handovers in seconds.

• AI-generated CXR interpretations offer results with confidence intervals.

• ECG support tools not only read the strip but suggest next steps.

However, he pivoted to education, where AI poses complex challenges and opportunities:

• Assessment integrity is under pressure—essays and written assignments can be easily supplemented or generated by AI.

• Initial responses of banning AI failed. The new solution? Shifting to recorded and observed presentations that better capture a learner’s own work.

• AI alignment—ensuring outputs are safe, unbiased, and clinically relevant—is a crucial risk that educators and clinicians must own.

He cautioned against reactionary policies like “don’t use AI in exams or research,” likening it to the outdated directive: “Don’t use the internet—go to the library.” Instead, we must adapt assessments and expectations, because AI isn’t going away.

Dr. Carley closed with a call to action: educators must stop chasing the problem from behind. Instead, we must lead responsibly, innovatively, and ethically—educating a generation not just in medicine, but in the thoughtful, appropriate use of AI.

🌟 Plenary Session: Educating Generation AI

Speaker: Dr. Ian Stiell

Vernakalant versus procainamide for rapid cardioversion of patients with acute atrial fibrillation (RAFF4): a pragmatic randomized trial (PL01)

The RAFF4 trial is the first head-to-head randomized controlled trial comparing IV vernakalant to IV procainamide for cardioversion in acute atrial fibrillation. Vernakalant was significantly more effective, yielding higher conversion rates, faster time to sinus rhythm, and less need for electrical cardioversion, with a similar safety profile.

Study Summary:

Acute atrial fibrillation (AF) is a common emergency department presentation. While Canadian physicians often use IV procainamide or electrical cardioversion, vernakalant, an atrial-selective antiarrhythmic has emerged as a promising alternative. However, no direct comparison between the two agents had been conducted - until now.

RAFF4 Design:

• Setting: 12 tertiary care EDs across Canada

• Participants: 354 patients with acute AF eligible for pharmacologic cardioversion

• Randomization: 1:1 to either IV vernakalant or IV procainamide

• Primary Outcome: Conversion to sinus rhythm within 30 minutes of infusion

• Secondary Outcomes: Time to conversion, need for electrical cardioversion

Interventions:

• Vernakalant: 3 mg/kg over 10 min, followed by 2 mg/kg if needed

• Procainamide: 15 mg/kg over 60 min

Key Results (Intention-to-Treat Analysis):

• Conversion within 30 minutes:

  • Vernakalant: 67%

  • Procainamide: 52%

  • Absolute difference: +15% (favouring vernakalant)

  
  

• Median time to conversion:

  • Vernakalant: ~12 min

  • Procainamide: ~25 min

  
  

• Need for electrical cardioversion:

  • Vernakalant: 33%

  • Procainamide: 48%

  
  

• Adverse events: Mild and transient in both groups, slightly more hypotension with procainamide

• 30-day outcomes: Excellent in both groups—minimal recurrence, no strokes, nearly all patients discharged in sinus rhythm

  
  

Interpretation:

Vernakalant demonstrated superior efficacy and comparable safety in the ED setting, offering a faster and more reliable pharmacologic option for acute AF management. While not currently available in the U.S., it is widely accessible in Canada and Europe, and should be considered a first-line agent where available.

Speaker: Dr. Jeffrey Perry

Prospective Multicenter Validation of the Abbreviated Canadian TIA Score for Predicting Subsequent Stroke Within 7 Days

The Abbreviated Canadian TIA Score is a newly validated clinical tool that accurately predicts 7-day stroke risk following a transient ischemic attack (TIA) or minor stroke. With fewer variables than the full version, this score is practical, reliable, and ready for real-world use in emergency departments.

Why It Matters:

Transient ischemic attacks are harbingers of major stroke, but current risk tools like ABCD2 are limited. Dr. Perry’s team has previously shown the Canadian TIA Score outperforms other tools (CJEM, 2021), and now brings forward a simplified version validated in a new multicenter cohort. This helps to provide a tool to further help risk stratify patients in resource limited enviornments. It is able to identify 25% of patients who require a less intensive workup and follow up based on being low risk.

🧠 Features of the Abbreviated Canadian TIA Score:

Clinical Feature	Points
Past history of carotid stenosis	+3
History of unilateral weakness	+2
History of vertigo	-2
Dysarthria or aphasia (history or exam)	+1
CT infarction (if done in ED)
• No infarct	0
• Old infarct	+1
• Acute infarct	+2

Score	Risk Category
–2 to 0	Low
1 to 3	Medium
4 to 8	High

🔍 Key Findings from ICEM 2025:

• The abbreviated score was successfully validated in a new cohort of TIA/minor stroke patients.

• It is ready for clinical use and helps guide investigations and follow-up based on stroke risk.

• Management recommendations depend on risk level and available resources:

🟢 Low Risk (–2 to 0)

• CT head (if available), ECG

• Antiplatelet/anticoagulation if atrial fibrillation

• Outpatient follow-up

🟡 Medium Risk (1 to 3)

• CT head + vascular imaging

• ECG, DAPT or anticoagulation

• Early outpatient stroke prevention clinic (SPC) follow-up

🔴 High Risk (4 to 8)

• All above plus in-ED consultation with a stroke specialist

  
  

🧠 Clinical Relevance:

• Validating this streamlined score makes it easier for ED clinicians to triage TIA patients efficiently.

• Promotes resource-appropriate care: rapid imaging and follow-up for high risk; reassurance and outpatient pathways for low risk.

• Further implementation research is needed to assess long-term outcomes and real-world adoption.

Reference to Original Full Score Study:

Perry JJ, et al. Predicting stroke within 7 days after a TIA. CMAJ. 2021;193(5):E151–E161. PMID: 33526704

Speaker: Dr. Megan Landes

Significant gender gap in age at leaving emergency medicine: A national Canadian physician cohort (PL03)

Emergency departments across Canada are facing worsening physician workforce shortages, leading to ED closures and strain on remaining staff. While U.S. data previously suggested that women leave EM at a younger age than men, Canadian data had yet to confirm or explore this trend — until now.

Using national data from the Canadian Medical Protective Association (CMPA) — covering over 95% of physicians in Canada — this large cohort study aimed to describe the rates and factors associated with physicians leaving EM practice.

📊 Methods

• Data Source: CMPA database (2017–2023)

• Population: 15,874 physicians with either exclusive EM practice or diversified EM practice (e.g., EM + Family Medicine)

• Definition: Leaving EM = retirement or transition to non-EM practice

• Outcomes Measured: Annual attrition rates, age, gender, practice setting, and medicolegal history

Two analytic models were used to distinguish patterns in exclusive vs diversified EM physicians.

🧠 Key Findings

• 20.4% (n = 3,236) of physicians left EM over the 6-year period

• Most left by switching to another specialty rather than retirement

• Annual attrition rate: 3.2% to 5.0%

• No significant change in attrition pre- vs post-COVID

🧓🏼 Age at Leaving EM

• Overall average age: 49 years

• Men: 53 years

• Women: 43 years

  ⏳ 10-year gap in career duration

  
  

⚠️ Early-Career Attrition

• 31% of those who left EM did so within their first 5 years of practice

• Among these:

  • 41% were women

  • 25% were men

  
  

This highlights a particularly vulnerable period in early EM careers, especially for female physicians.

🔍 Factors Associated with Leaving EM

🚑 Exclusive EM practice:

• Female gender

• Age >50

• Rural practice

• ≥5 medico-legal cases

  
  

🏥 Diversified EM practice:

• Female gender

• Age <35 or >65

• Urban setting

🗣️ Conclusions

This study confirms a significant national gender gap in the age of leaving EM practice — with women, on average, exiting the field a full decade earlier than men. The trend mirrors prior U.S. data and emphasizes a growing issue in Canada’s physician workforce.

🧩 Implications:

• Early-career physicians, especially women, are at risk of burnout and early attrition

• Workforce sustainability in EM depends on addressing gendered drivers of exit

• Medico-legal burden and practice setting also play key roles in career longevity

🚨 Call to Action

To solve the human health resource crisis in emergency medicine, we must do more than just recruit — we must retain. That means:

✅ Investing in physician wellness

✅ Creating supportive early-career environments

✅ Addressing gender equity in retention

✅ Reducing systemic pressures that disproportionately affect women

Future work should focus on qualitative insights into why physicians are leaving, and most importantly, how we can keep them.

⚡Morning Concurrent Sessions - Featured

Speaker: Dr. Daniel Kim

Top 5 PoCUS Papers you Should Know

These five high-impact studies from 2024 showcase how point-of-care ultrasound (POCUS) continues to shape emergency medicine—from legal protection to procedural safety and diagnostic efficiency.

1. POCUS and Medico-Legal Risk

📄 Prager et al. Ultrasound J 2024;16:16

Key Finding: Of 58,626 closed medico-legal cases (2012–2021), only 15 involved POCUS.

• 7 due to failure to use POCUS

• 8 due to misuse or inadequate documentation

✅ Take-Home Point:

To reduce legal risk, use POCUS when indicated and document it clearly.

2. SPEED Protocol for Aortic Dissection

📄 Gibbons et al. Acad Emerg Med 2024;31:112-118

A 10-year review of 1314 scans by EM residents and attendings using the SPEED protocol identified:

• Sensitivity: 93%

• Specificity: 91%

• 3 missed dissections out of 44

⚠️ Limitations: Small number of cases, unblinded design, no suprasternal view.

✅ Take-Home Point:

POCUS can aid—but cannot rule out—aortic dissection. Look for PCE, aortic root dilation, and intimal flaps.

3. NURVE Block Safety in the ED

📄 Goldsmith et al. JAMA Netw Open 2024;7:e2444742

From 11 U.S. EDs, 2735 patients underwent 2742 ultrasound-guided nerve blocks:

• Major complications: 1 (0.04%)

• Minor complications: 9 (0.33%)

• 71% had >50% pain relief

✅ Take-Home Point:

Ultrasound-guided nerve blocks are safe and effective, with exceedingly low complication rates.

4. TEE During Resuscitation—Watch Your Compressions

📄 Chu et al. Crit Care Med 2024;52:1367-1379

In this prospective cohort of 76 OHCA patients:

• Sustained ROSC: 54% in uncompressed aortic valve group vs. 24% in compressed

• ICU admission: 33% vs. 8%

• Hospital discharge: 5% vs. 0%

✅ Take-Home Point:

Avoid compressing the aortic valve during CPR—this may significantly improve ROSC.

5. POCUS for Pediatric Intussusception

📄 Katz-Dana et al. CJEM 2024;26:235-243

Compared to standard workflow, acting on positive POCUS scans for intussusception resulted in:

• 70-minute faster time to reduction

• Shorter ED length of stay (502 vs. 557 minutes)

✅ Take-Home Point:

Implementing a POCUS-first approach can accelerate definitive treatment for pediatric intussusception.

Final Recap:

1. 📋 Document your POCUS use to reduce legal risk

2. 🫀 POCUS helps with—but doesn’t exclude—aortic dissection

3. 💉 Nerve blocks are safe and effective

4. 💓 Avoid compressing the AV during CPR

5. 🧒 Faster care for intussusception with POCUS-first pathways

Speaker: Dr. Liz Welsh

Life Through a Lens: A Synergistic Approach to Wellbeing, Education, and Clinical Governance

In a system under strain, fostering a psychologically safe culture isn’t just about kindness—it’s a patient safety imperative. Through the lens of trauma-informed reflection, shared storytelling, and creative education, Dr. Liz Welsh presents a powerful, practical model for strengthening clinical governance and staff wellbeing in emergency care.

Emergency medicine continues to operate in an overstretched and understaffed system, often at the cost of clinician wellbeing and patient safety. Dr. Liz Welsh challenges us to reimagine how we engage and support healthcare teams through a new paradigm: Life Through a Lens.

At the heart of her model is the concept that psychological safety and collective reflection must replace hierarchical blame and shame in our approach to clinical governance.

Key Concepts:

🧠 Cognitive Bias & Diagnostic Error

• 10–15% diagnostic error rate in EM

• 75% of those are attributed to individual cognitive biases (e.g., tunnel vision, confirmation bias)

• Systemic failures often present as individual protocol deviations

✅ Solution: Promote metacognition and reflective clinical practice to counteract fast, biased System 1 thinking.

🌪 Zones of Emotional Risk

Dr. Welsh describes two dysfunctional zones:

• Disconnect: marked by martyrdom, cynicism, bullying

• Enmeshment: heroic posturing, favouritism, burnout

  
  

✅ Antidote: Cultivating shared values, recognizing vicarious trauma, and addressing system-level issues—not just individual errors.

💬 Safety Message of the Week (SMotW)

A standout innovation from Dr. Welsh’s team is the Safety Message of the Week:

• A weekly email and graphic poster, authored by any team member

• Uses humour, pop culture, and graphic medicine to reflect on adverse events

• Turns traditional safety education into an engaging, psychologically safe learning opportunity

This low-cost, high-impact intervention:

• Encourages peer reflection and shared storytelling

• Destigmatizes clinical error

• Helps build career portfolios and a culture of transparency

Feedback from colleagues highlighted how SMotW:

“Gives permission to share anxieties, transforms learning into something relatable, is funny, engaging, and thought-provoking.”

Final Thought:

Dr. Welsh reminds us that language, reflection, and humour are powerful tools for healing systems—not just people. By reframing governance through a trauma-informed, human-centered lens, we can create emergency departments where both clinicians and patients are safer.

Speaker: Dr. Stuart Rose

Clinical Event Debriefing: Feeling better while we do better

Clinical event debriefing improves care and supports well-being — it’s a low-cost, high-impact practice that belongs in every ED.

Why Debrief?

What do you do after stabilizing and transferring a critically ill patient? Do you pause to connect with your team and reflect on what just happened — or rush to see the next patient and only revisit the case when it keeps you up at 4 a.m.?

Debriefing helps bridge that gap. It offers a structured moment to process, learn, and grow — both individually and as a team.

Why It Works

Debriefing after clinical events is shown to:

1. Identify opportunities to improve clinical practice

2. Help health care teams cope with high-stress environments

Despite its benefits, it can feel challenging in a fast-paced ED. The good news? Debriefing doesn’t need to be long or complex. With a few core principles and a structured approach, it can become a practical part of everyday practice.

Key Elements of an Effective Debriefing Program

• 🔄 Voluntary, not forced – debriefing should feel supportive, not mandatory

• 🧠 Use a cognitive aid – a short script or checklist keeps things focused

• 🧑‍🤝‍🧑 Facilitator training – helps guide the conversation

• 🧭 Trigger-based debriefing – use predefined clinical events (e.g., trauma, cardiac arrest)

• 🌱 Focus on what went well – shift from “Safety-I” (what failed) to “Safety-II” (what worked)

• 🧩 Integrate into workflow – link debriefs to QI, resuscitation committees, or safety huddles

• 🌟 Champion support – identify key advocates to drive the culture change

• 📣 Feedback loops – use infographics and updates to show the impact

Common Pitfall: “We Don’t Have Time”

The biggest barrier is perceived time. But debriefing is not a 45-minute simulation review — it can be 10 focused minutes that yield long-term gains. Reframing debriefing as an investment in:

• Patient safety

• Team communication

• Personal well-being

… makes it easier to prioritize.

Pearls to Remember

✔ It’s Possible – EDs around the world are already doing it

✔ It’s Helpful – Improves care, builds team resilience, and reduces burnout

✔ It’s an Investment – For future patients, and your future self

Final Thought

Debriefing isn’t a luxury — it’s an essential tool for thriving in emergency medicine. So next time a critical case wraps up, take a breath, grab your team, and debrief. The next 10 minutes might just change everything.