#ICEM2025 May 26th Recap!
- Shahbaz Syed
- May 26
- 43 min read
Updated: 6 days ago
Monday delivered another full day of learning and connection, kicking off with a packed plenary session, hands-on educational workshops, and a wide range of engaging concurrent tracks. The day wrapped up in style with the much-anticipated Welcome Gala and a crowd-favorite performance by Docs That Rock!
To read more in depth on the concurrent sessions - click on the dropdown arrow!
🌟 Plenary Session One: Toxic Leadership in Healthcare – How Difficult Doctors Undermine Team Performance.
Speaker: Dr. Victoria Brazil
Bottom Line:
Toxic leadership in healthcare isn’t always someone else’s problem - it’s a cultural issue that affects team performance, patient outcomes, and clinician retention. Building high-functioning teams starts with self-reflection, structured feedback, and collective accountability.
The Case That Hits Too Close to Home
Dr. Victoria Brazil opened with a case many of us know all too well: a straightforward pancreatitis presentation that quickly descends into a fragmented, frustrating phone call to a specialty service. The patient needs admission, but between the curt tone, the contradictory messages, and the eventual hang-up, it’s clear that poor communication and toxic interprofessional dynamics are compromising care.
It’s easy to blame “the other doctor on the phone.” But then she flips the script.
A second moment: a bright-eyed medical student’s first day. The attending’s response?
“Hey mate… that’s my chair.”
We’ve all worked with difficult doctors. But have we ever been the difficult one?
Psychological Safety and Emergency Medicine
This study demonstrated that psychological safety, the belief that team members can speak up without fear is a critical determinant of team performance in the ED.
Trainees reported EM as progressive and non-hierarchical, but nursing staff identified ongoing concerns about arrogance and lack of respect from physicians.
Bad Behaviour: An Insidious Threat
Key Article: Bad Behaviour in Healthcare: A Threat to Patient Safety, Staff Wellbeing, and Organizations (Crowe, Riley)
Unprofessional behaviour in clinical teams undermines morale, increases burnout, and is linked to higher turnover and worse patient outcomes.
The ripple effect of toxic leadership reaches every corner of the system, especially in high-stakes environments like emergency care.
Culture Change Through Teamwork
Dr. Brazil emphasized that high-performing teams are built intentionally, and that change starts from within the team itself.
She shared examples from the High Performance Clinical Teamwork Strategy (2022–2023):
This initiative focused on improving team behaviours and shared culture across disciplines to enhance performance under pressure.
Programs included large-scale simulations in trauma, obstetrical hemorrhage, and the NICU, reinforcing inter-team communication and collaboration.
The unifying message: “Team behaviours shape outcomes.” And at the core of those behaviours are beliefs and attitudes that can be shaped through structured reflection and mutual accountability.
Simulation, Debriefing, and Culture Building
Through regular team debriefs, clinicians reflected on their expectations of one another and how they wanted to function as a team. Notably, participants emphasized how respectful communication between specialties, modeled and reinforced during simulation - translated to better collaboration in actual emergencies.
One example: improving obstetrical hemorrhage outcomes through interdisciplinary simulation fostered stronger inter-team relationships, which over time led to measurable clinical improvements.
What Can We Do Tomorrow?
Culture change doesn’t require a committee or a policy — it starts with small, consistent actions. As Dr. Brazil highlighted, two of the most modifiable factors for improving team performance are:
Leader behaviours
Team familiarity
Even something as simple as a pre-brief or post-shift debrief can shape how a team communicates and collaborates. Individual actions matter — not just in how we perform, but in how we build a culture that lifts everyone up.
Takeaways
Talk with your teams about expectations, normalize the conversation.
Be an upstander, address poor behaviour constructively and support colleagues in real time.
Look in the mirror, acknowledge when you may have contributed to toxicity, and commit to growth.
As Dr. Brazil reminded us: “We often think in silos, but patients are cared for by teams — and teams thrive on culture.”
📝 Plenary Session Two: Hybrid Warfare and a New Era of Mass Casualty Response
Speaker: Dr. Eveline Hitti
Bottom Line:
Mass casualty events are no longer isolated to war zones. In a world marked by instability and rising global conflict, emergency departments must prepare for mass trauma on an unprecedented scale. Scalable, hospital-wide protocols and rapid activation systems are now critical to emergency preparedness.
A Career Shaped by Conflict
Dr. Eveline Hitti did not begin her career with an interest in disaster medicine. But growing up in civil war-era Lebanon, training in Baltimore, and eventually returning to help build academic emergency medicine in her home country, she found herself thrust into a world where mass casualty response became routine.
In 2013, a car bombing near her hospital resulted in 37 casualties arriving at once. Over the next six years, she led the response to 12 mass casualty events. From this experience, her team developed a rapid protocol known as the “golden 15 minutes” — a critical window in which to mobilize staff, secure the department, begin triage, and activate surge capacity before losing operational control.
August 4, 2020 – A Catastrophic Turning Point
The Beirut Port explosion changed everything. With 2.7 tons of ammonium nitrate detonating just kilometers from her hospital, the injuries were on a different scale — including among hospital staff and family members. Institutional protocols designed for earlier mass casualty incidents proved insufficient.
This tragedy led to a fundamental shift in their approach: mass casualty response had to move beyond the emergency department and become hospital-wide.
Scaling Up: Moving From ED-Focused to Hospital-Based Response
Dr. Hitti emphasized the need to engage the entire hospital — from medicine and pediatrics to surgical subspecialties — in disaster preparedness. This meant:
Training non-EM staff in basic trauma and mass casualty care
Developing secondary triage protocols for identifying patients who could be stabilized and transferred to inpatient units
Establishing systems to offload the ED rapidly and maintain capacity
This shift was put to the test on September 17, 2024, during a coordinated attack in which explosive devices were hidden in pagers. With over 180 patients arriving in just hours, many with complex facial, hand, and ocular injuries, the team had to scale their response immediately.
Key Challenges in Modern Mass Casualty Events
Triage and Patient Flow
Secondary triage systems were used to identify stable patients without torso injuries for early transfer upstairs, often within 20 minutes of arrival.
Imaging Bottlenecks
With dozens of CT scans needed urgently, imaging became a limiting factor. The team used point-of-care ultrasound and physician-led prioritization to manage the flow.
Surgical Capacity
In the first 12 hours, 35 patients required surgery, many for specialized procedures. Prioritization was handled dynamically, often within the OR itself.
National Health System Coordination
The response quickly exceeded institutional capabilities. Hospitals across the country delayed elective surgeries and mobilized to support the surgical and supply demands of specialized care.
Psychological and Structural Impacts
Beyond the immediate medical response, there were significant secondary effects:
Pervasive psychological trauma among victims and providers
Disrupted communication systems, as pagers were no longer trusted
Strain on healthcare infrastructure, with long-term implications for continuity of care
This pattern, described as hybrid warfare, involves not only physical attacks but also the targeted disruption of healthcare infrastructure, communication, and public trust.
Lessons From the Frontline
Dr. Hitti’s message was clear: in an era of global instability, every healthcare system must be ready for mass casualty events. Hybrid warfare is no longer theoretical. It threatens not only the acute care response, but also long-term access to care for chronic illness, elective surgery, and essential medication.
A Message of Endurance
Dr. Hitti closed with a deeply personal reflection on her 15 years in Lebanon, and the strength she draws from colleagues working under immense pressure in conflict zones.
“In times of uncertainty, two things are certain. This moment will pass, and we will live with the decisions we made during the crisis. May we all reach the other end knowing we did all that we could.”
🧠 Educational Marketplace
The Educational Marketplace at ICEM 2025 offered a dynamic, hands-on space where emergency medicine educators, innovators, and learners came together to share, explore, and inspire. With stations representing institutions and organizations from around the world, the marketplace celebrated diversity in educational strategy, creativity in delivery, and commitment to global collaboration.
From low-fidelity simulation models and procedural trainers to digital learning platforms, visual case-based tools, and open-access curricula, the exhibits highlighted practical, scalable, and globally relevant innovations in emergency medicine education.
Key themes included:
Equity in access to training materials and educational design
Interprofessional collaboration and team-based learning
Digital scholarship, FOAMed tools, and asynchronous education models
Culturally contextualized curricula for low-resource and rural settings
Above all, the Marketplace embodied the spirit of ICEM: building bridges between continents, disciplines, and ideas — and reminding us that education is not just content delivery, but connection
🔍 Morning Concurrent Tracks
EMS: Presentations focused on pre-hospital care innovations, including community paramedicine programs and strategies for improving response times.
Speakers: Dr. Daniel Beamish, Dr. Connor Ingles, Shannon Leduc, Robert Leduc
Empowering Paramedics to Rethink 911: Supporting New Models of Prehospital Care and Enhanced ED Diversion
The traditional 911 model assumes every call signals a medical emergency requiring ED transport. But in practice, many patients calling 911 are low acuity, often not requiring hospitalization at all. In Ottawa, this disconnect contributes to severe offload delays, with 100,000 hours of paramedic time lost annually — equivalent to 47 full-time paramedics per day.
This team developed a novel prehospital care model aiming to reduce unnecessary ED visits by empowering paramedics to safely identify and divert low-acuity patients away from the emergency department.
Key Elements of the Program:
Targeted paramedic training in low-acuity triage, frailty scoring, and shared care planning
Mentorship from emergency physicians through case-based classroom sessions
24/7 Online Medical Consultation to guide real-time triage decisions
Follow-up by community paramedics within 24 hours for safety, satisfaction, and referral.
Results:
590 patients diverted from the ED
95% reported stable or improved symptoms
Only 3.2% re-accessed 911 within 72 hours
94% felt safe staying at home
91.5% were satisfied or very satisfied with the care they received
Bottom Line:
This model demonstrates that low-acuity patients can be safely triaged by paramedics, supported by targeted training, infrastructure, and physician consultation. The program reduced ED burden, improved patient experience, and delivered safe, community-based care — a scalable model for system-level change.
Speaker: Dr. Saleh Fares Al-Ali (IFEM president)
EMS Global Challenges and Opportunities
Emergency Medical Services (EMS) cannot afford to remain stuck in outdated structures and legacy thinking. In this powerful talk, the speaker called for a bold rethink of EMS models, urging the global community to break down silos, modernize systems, and recognize EMS as a critical component of public health infrastructure — not a standalone service.
🐴 The Dead Horse Theory: Time to Dismount
Legacy EMS systems often rely on inefficient or outdated frameworks, even when evidence shows they no longer serve patients or providers. The “Dead Horse Theory” — the tendency to keep riding a failing system rather than change direction — was used as a central metaphor to emphasize the urgent need for innovation.
🔗 Integration, Not Isolation
A core message: prehospital care must be integrated with hospital services and positioned within a broader health emergency management model.
Key takeaways:
EMS should not function in isolation — it is a key pillar of public health
Stronger collaboration is needed between EMS, EDs, public health, and community systems
Rethinking structures will allow for faster response, better patient outcomes, and more resilient systems
🌍 A Call for Global Coordination
The speaker proposed the formation of an International Prehospital Care Federation — a collaborative global body that could:
Align prehospital care standards and priorities
Facilitate international partnerships
Collaborate with IFEM and other global emergency medicine organizations
Support existing efforts, such as the new Emergency Nursing Federation
💬 “Emergency care is global — our coordination should be too.”
Final Thought
If we want EMS to meet the demands of the future, we must stop reviving the dead horse and start building systems that reflect today’s realities. The time for siloed thinking is over. The future of EMS is interconnected, integrated, and international.
Hardcore EM, Just the Facts: Rapid-fire sessions delivered concise, evidence-based updates on critical emergency medicine topics.
Lighting Orals: Just the Pearls from some of the latest research in the Emergency Medicine world.
Rural Emergency Medicine: Talks explored the unique challenges and innovations in delivering high-quality emergency care in rural and remote settings.
⚕️ Afternoon Plenary: Saving Emergency Medicine - A Global Perspective on Current Challenges and Potential Solutions
Speakers: Dr's. Paul Atkinson, Ffion Davies, Salah Fares Al-Ali and Modearted by Dr. Eillyne Seow
“Saving Emergency Medicine” 🩺💬
Dr. Paul Atkinson (@paulatkinsonem) reminds us that compassion isn’t a soft skill — it’s core to how we survive and sustain emergency care.
🧠 Emergency medicine is not failing because we don’t care — it’s failing because we’re working in broken systems. Click here for a longer breakdown of his conversation and practical tips to help improve your compassion.
Dr. Ffion Davies reminds us that thriving in emergency medicine isn’t about resilience alone — it’s about systems and culture that prioritize basic human needs, strong leadership, and individual control. Burnout is real, but so is the potential to thrive. Dr. Ffion Davies shared key insights into what actually sustains emergency physicians and staff in high-stress environments.
1. Your Basic Needs Must Be Met
It sounds simple, but it’s often overlooked. You cannot thrive if you can’t meet your most basic physiological and psychological needs. Ask yourself:
Can you take breaks during your shift?
Do you have easy access to bathrooms, food, water, and a quiet space?
Do you feel safe getting to and from work, and while you’re there?
📌 Key message: Safety and self-care are foundational, not optional.
2. You Need Someone Fighting for Good
Great leaders make all the difference. Not because they fix every problem, but because they make people feel seen, supported, and valued.
Leadership should focus on fulfilling three core human needs:
Competence – “I’m good at what I do.”
Autonomy – “I have a say in how I do it.”
Relatedness – “I’m part of something bigger than myself.”
📌 Strong leadership doesn’t just guide – it protects.
3. A Sense of Control Over Your Destiny
One practical example? Self-rostering.
Allowing clinicians to contribute to their schedules gives them a sense of ownership over their time, improves work-life balance, and can significantly reduce stress.
📌 Agency is one of the most protective factors against burnout.
Final Thoughts
Thriving in emergency medicine doesn’t require superhuman endurance. It requires:
✅ Systems that support staff
✅ Leaders who advocate and listen
✅ Environments that promote control, connection, and care
🔍 Afternoon Concurrent Tracks 1
Digital EM and Tech Innovation: Sessions explored the integration of digital tools in emergency settings, highlighting advancements in telemedicine, electronic health records, and AI-driven diagnostics.
Speakers: Dr's. Henry Li, Hashim Kareemi, Ilitea Kina, Yih Yng Ng, Gabreille Bunney
What does the everyday emergency physician need to know about artificial intelligence?
Artificial intelligence is already shaping emergency medicine — from triage to documentation. But with growing hype comes the need for clarity, caution, and clinical responsibility. This session broke down what frontline physicians actually need to know about AI, machine learning, large language models, and digital integration.
🧠 Understanding the Types of AI
While AI can be categorized in many technical ways, emergency physicians should focus on three practical domains:
Computer Vision
AI that analyzes images and videos.
Example: Radiograph interpretation, fall detection systems.
Natural Language Processing (NLP)
AI that processes human language.
Example: LLM-powered charting tools, billing support, clinical documentation.
Prediction Modeling
AI that uses historical data to forecast outcomes.
Example: Sepsis alerts, triage prioritization models.
🩺 Clinical Use Cases & Warnings
🔹 Dr. Gabrielle Bunney (Stanford, USA): Predictive Models & ECG Screening
Delayed ECGs mean missed early pathology
ACS patients often mis-triaged at registration
Predictive AI models could flag high-risk cases earlier — especially with ECG and triage data integration
Ethical Considerations
AI in medicine must be handled with care. Key concerns include:
Patient Privacy and Data Security
Especially relevant for third-party apps outside the EHR environment.
Informed Consent
Patients deserve transparency about the use of AI in their care—and its limitations.
Equity and Bias
Models trained on non-representative datasets may perpetuate systemic inequities, particularly across race, ethnicity, and gender.
🔹 Dr. Ili Kina (Alberta, Canada): OpenEvidence & Hallucination Risk
LLMs can hallucinate: Sound confident but be completely wrong
OpenEvidence minimizes this by applying LLMs only to retrieved, cited evidence
Output includes linked references for clinicians to verify
Advice:
Feed the model clear, specific prompts
Maintain critical appraisal
You’re still medico-legally responsible for decisions
🔹 Dr. Henry Li (Toronto, Canada): AI Scribes for Documentation
Documentation burden contributes to clinician burnout
AI scribes offer fast, flexible note-taking:
Conversation → Recording → Transcript → Summary
Faster than traditional scribes, customizable
LLM use here is limited to language tasks, not clinical decision-making — a safer and more immediate application
🔹 Dr. Yih Yng Ng (Singapore): Strategy, Funding & Equity
Demand for AI exceeds current capacity
Clinicians must co-lead AI development and funding decisions
Form AI literacy and policy groups to shape ethical and effective deployment
Sharing code, data, and models across institutions = scale and sustainability
💡 AI is expensive. Collaboration and resource-sharing are key.
Final Takeaways
AI is not a brain replacement — it’s a tool.
Be cautious of “black box” solutions.
Own your data.
Don’t forget: good clinical judgment is not replaceable.
Speakers: Dr's. Jessalyn Holodinsky & Dr. Fareen Zaver
Bias and Ethics in AI: Safeguarding Patient Care in Emergency Medicine
Artificial intelligence is only as fair as the data and assumptions behind it. In this powerful session, Drs. Holodinsky and Zaver explored how bias in AI systems can subtly — and dangerously — influence care in the emergency department. As emergency physicians increasingly adopt AI tools like scribes and triage systems, the need for ethical vigilance has never been greater.
What Is Bias in AI?
Bias refers to any factor that causes an AI system to produce inequitable or inconsistent outputs — particularly across different patient populations. It can arise from:
Training on non-representative datasets (e.g. data skewed toward WEIRD populations: White, Educated, Industrialized, Rich, Democratic)
Missing variables like race, ethnicity, socioeconomic status, or gender identity
Historical patterns of systemic discrimination embedded in the data itself
Case 1: Language and Cultural Barriers
A 55-year-old woman from an ethnic minority background underplayed her symptoms during a clinical encounter. While the clinician was able to interpret nuance and context, the AI scribe struggled — missing subtle information due to a language barrier and lack of cultural awareness.
Case 2: Gender Identity and Clinical Framing
A 28-year-old transgender woman presented with chest pain. The clinician documented a psychosomatic framing, emphasizing hormonal and anxiety-related causes. The AI scribe, however, generated a more neutral and objective summary, without such framing bias.
Final Thoughts
AI doesn’t eliminate bias — it can amplify it unless thoughtfully designed and critically used. For emergency physicians, AI should be:
A tool, not a truth
A prompt for self-reflection, not a replacement for clinical reasoning
Scrutinized for how it handles marginalized populations
As AI continues to expand into emergency medicine, we must stay anchored in equity, ethics, and patient-centered care.
Hardcore EM, Just the Facts: Rapid-fire sessions delivered concise, evidence-based updates on critical emergency medicine topics.
Equity, Diversity, Inclusivity and Accessibility: Sessions emphasize the urgent need to design emergency care systems that are equitable, inclusive, and responsive to diverse populations — both for patients and providers.
Rural Emergency Medicine: Talks explored the unique challenges and innovations in delivering high-quality emergency care in rural and remote settings.
Medical Education and Lifelong Learning: This track highlights evolving strategies to train, support, and sustain emergency clinicians through all stages of their careers.
Resuscitation, Trauma and Critical Care: Cutting-edge updates on high-stakes resuscitation, advanced trauma management, and critical care delivery.
🔍 Afternoon Concurrent Tracks 2
International and Global Emergency Medicine: Global collaboration and innovation in emergency care delivery, with a focus on health system strengthening, disaster response, and advancing equity across diverse international contexts.
Speaker: Dr. Tushara Suprapaneni
A Spatial Approach to Addressing Humanitarian Crises
In the face of complex humanitarian emergencies, we often turn to boots-on-the-ground coordination, supply chains, and logistics. But what if we could see the crisis more clearly—through data? Dr. Tushara Suprapaneni invites us to consider a powerful tool for emergency response: Geographic Information Systems (GIS).
📍 What Is GIS and Why Does It Matter?
GIS is software that integrates multiple data layers—geography, infrastructure, environment, population demographics, and health systems—to produce interactive, informative maps. These maps help decision-makers understand where help is needed most, how best to deploy resources, and what barriers exist on the ground.
🧭 Applications in Humanitarian Settings
GIS technology is being used across global crises for preparedness and response, including:
Cyclone Idai in Mozambique
Mapping pre- and post-disaster access to healthcare facilities.
Humanitarian presence in Afghanistan
WHO’s “Who, What, Where” (WWW) database maps operational aid efforts across the country.
This spatial understanding enables real-time awareness and smarter interventions when every minute counts.
⚠️ Field Challenges
Despite its promise, GIS implementation isn’t without obstacles:
Data Gaps: Pre-existing datasets may be outdated, incomplete, or non-standardized.
Data Collection Ethics: In humanitarian crises, obtaining informed consent and maintaining data privacy remains complex.
Duplication: In the scramble for visibility, multiple agencies may release overlapping maps that clutter decision-making rather than clarify it.
💡 Bottom Line
GIS offers a data-driven, scalable, and analytically powerful approach to managing humanitarian emergencies. When used thoughtfully, it can improve health equity, guide timely resource allocation, and empower local response efforts.
In crisis settings, a map isn’t just a map—it’s a lifeline.
Speaker: Dr. Nilanka Mudithakumara
A Trainee's Journey in EM
International Emergency Medicine is a welcoming, inclusive space. Through the efforts of the International Federation of Emergency Medicine (IFEM) and global EM leaders, trainees - especially those from low- and middle-income countries (LMICs) are supported and empowered to participate on the world stage.
There are no barriers based on gender or geography. As a female trainee from Sri Lanka, I found an equal seat at the table.
IFEM fosters growth, connection, and leadership development, especially for those driven by purpose and collaboration.
IFEM: A Pathway for Emerging Leaders
One of the most meaningful opportunities came through the IFEM Leadership & Advocacy Development Program, which intentionally seeks out and nurtures emerging leaders—especially from LMICs. Their mentorship and training have been instrumental in shaping my growth.
Additionally, IFEM Special Interest Groups (SIGs) offered an incredible platform for global networking, allowing me to collaborate with mentors and peers from across the world. These networks have not only helped shape my professional journey but have also reaffirmed a personal mission to contribute back to the global EM community.
Hardcore EM, Just the Facts: Rapid-fire sessions delivered concise, evidence-based updates on critical emergency medicine topics.
Equity, Diversity, Inclusivity and Accessibility: Sessions emphasize the urgent need to design emergency care systems that are equitable, inclusive, and responsive to diverse populations — both for patients and providers.
Francophone Track: High yield pearls, presented in French and disseminated in French and English!
Resuscitation, Trauma and Critical Care: Cutting-edge updates on high-stakes resuscitation, advanced trauma management, and critical care delivery.
🎉 Thank You for an Incredible Day 2 at ICEM 2025!
As Day 2 of #ICEM2025 wraps up, we extend our heartfelt thanks to all attendees, speakers, and organizers who contributed to another enriching day of learning and connection in Montréal. From dynamic plenary sessions to engaging workshops and thought-provoking discussions, your participation made it memorable.
🎸 Tonight: The Gala & Docs That Rock Concert
The excitement continues tonight with our much-anticipated Gala, starting at 7:00 PM, followed by a high-energy performance by Docs That Rock at 9:00 PM. This unique band of medical professionals is set to deliver an unforgettable evening of music and camaraderie.
📸 Stay Tuned for Highlights
We’ll be sharing photos and highlights from tonight’s festivities in our next daily update. Be sure to check back to relive the moments and see if you can spot yourself in the crowd!
Looking forward to seeing everyone tomorrow for another day of inspiration and collaboration at ICEM 2025!
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