The Future of Emergency Medicine Jonathon M. Sullivan MD, PhD Wayne State University Detroit Receiving Hospital.

The Future of Emergency The Future of Emergency MedicineMedicine

Jonathon M. Sullivan MD, PhDJonathon M. Sullivan MD, PhD

Wayne State UniversityWayne State University

Detroit Receiving HospitalDetroit Receiving Hospital

Purpose of this LecturePurpose of this Lecture

Put away your pencils, classPut away your pencils, classThis won’t be on the testThis won’t be on the testRaina Burke wouldn’t stop bugging meRaina Burke wouldn’t stop bugging meSullydog just wants to have funSullydog just wants to have funSome of us might actually learn somethingSome of us might actually learn something

OutlineOutline

Science fiction vs. futurismScience fiction vs. futurismHow futurism (doesn’t) workHow futurism (doesn’t) work Identifying trends:Identifying trends:

Technological trendsTechnological trendsSociological and demographic trendsSociological and demographic trendsEconomic and political trendsEconomic and political trendsGlobal trends (megatrends)Global trends (megatrends)

Summary (how I failed to predict the Summary (how I failed to predict the future)future)

Science Fiction vs. FuturismScience Fiction vs. Futurism




““The difference between fiction and The difference between fiction and reality? Fiction has to make sense.” reality? Fiction has to make sense.”

––Stephen KingStephen King

FuturismFuturism

Historical antecedentsHistorical antecedents1919thth century Comte's discussion of the century Comte's discussion of the

metapatterns of social change metapatterns of social change Early 20Early 20thth century systems science in century systems science in

academia, academia, National economic and political planning:National economic and political planning:

FranceFranceSoviet Union and Eastern bloc countries. Soviet Union and Eastern bloc countries.

Emerged as an academic discipline after Emerged as an academic discipline after WWIIWWII

FuturismFuturism Two broad approaches: Two broad approaches:

American: “Quaterly Report/Bottom Line” mentalityAmerican: “Quaterly Report/Bottom Line” mentality applied projectsapplied projects quantitative tools quantitative tools systems analysis systems analysis

analysis of complex, large scale systems and the interactions analysis of complex, large scale systems and the interactions within those systems. within those systems.

Identification of units, processes and structuresIdentification of units, processes and structuresgame game theory analysis and modeling—signficant $$$ appstheory analysis and modeling—signficant $$$ apps

European: “What about our Great-Grandkids?” European: “What about our Great-Grandkids?” mentalitymentality

more speculative and interested in long-term future of more speculative and interested in long-term future of humanity, planetary systems, etchumanity, planetary systems, etc

Increasing crossoverIncreasing crossover

FuturismFuturism

FuturismFuturism An increasingly An increasingly dismaldismal science science

Wild cards (Asimov’s Mule)Wild cards (Asimov’s Mule) Butterfly effects (chaos theory)Butterfly effects (chaos theory) Uncooperative marketsUncooperative markets Uncooperative societies and electoratesUncooperative societies and electorates Self-organizing systemsSelf-organizing systems Singularities – point at which f(x) = ∞; also describes historical or Singularities – point at which f(x) = ∞; also describes historical or

technological discontinuities:technological discontinuities: Advent of agricultureAdvent of agriculture Printing pressPrinting press InternetInternet 9-119-11 War, Famine, Plague, BushWar, Famine, Plague, Bush The odd asteroidThe odd asteroid

FuturismFuturism Anticipatory thinking (futures)Anticipatory thinking (futures)

Causal layered analysis (CLA) Causal layered analysis (CLA) Environmental scanning Environmental scanning Scenario method Scenario method Delphi method Delphi method Future history Future history Monitoring Monitoring

Backcasting (eco-history)Backcasting (eco-history) Back-view mirror analysis Back-view mirror analysis Cross-impact analysis Cross-impact analysis

Futures workshopsFutures workshops Failure mode and effects analysis Failure mode and effects analysis Futures biographies Futures biographies Futures wheel Futures wheel Relevance tree Relevance tree

Simulation and modellingSimulation and modelling Social network analysis Social network analysis Systems engineering Systems engineering

Thinklets Thinklets Visioning Visioning

Trend analysisTrend analysis

Morphological analysis Morphological analysis Technology forecasting Technology forecasting

If you can’t dazzle ‘em with prophecy….If you can’t dazzle ‘em with prophecy….

FuturismFuturism

The Delphi MethodThe Delphi MethodAn explicit approach developed by the Rand An explicit approach developed by the Rand

corporation for Defense/Strategic planningcorporation for Defense/Strategic planningUtilizes panels or pools of expertsUtilizes panels or pools of expertsHighly rigid methodology and information flowHighly rigid methodology and information flowLousy track recordLousy track record

Identify opposing trends andextrapolate

Extreme Scenario 1

Extreme Scenario Extreme Scenario

Extreme Scenario x

Extreme Scenario 1

Extreme Scenario x

p p

↑t, p

pp

And Voila! A Stunningly Accurate And Voila! A Stunningly Accurate Prediction Emerges!Prediction Emerges!

I’d like to thank the

Nobel Academy…

You wantfries wit’

dat?

My Wife

The Match

Identify opposing trends andextrapolate

p p

↑t, p

pp

Trend

TrendTrend Trend

TrendTrend Trend Trend TrendTrend Trend

?

Enough CYA, DogEnough CYA, Dog

Step One In This Fool’s Errand:Step One In This Fool’s Errand: Identify Trends:Identify Trends:

Technological trendsTechnological trendsSociological and demographic trendsSociological and demographic trendsEconomic and political trendsEconomic and political trendsGlobal trends (megatrends)Global trends (megatrends)

Technological TrendsTechnological Trends Information TechnologiesInformation Technologies Artificial Life, Genetic Algorithms, Cellular AutomataArtificial Life, Genetic Algorithms, Cellular Automata Molecular biology, proteomics, computational protein Molecular biology, proteomics, computational protein

foldingfolding Artificial organsArtificial organs Medical imagingMedical imaging Materials science and nanotechnologyMaterials science and nanotechnology Drug delivery technologies for deep organ and organ-Drug delivery technologies for deep organ and organ-

spec txsspec txs Point-of-care testingPoint-of-care testing Resuscitative adjuntsResuscitative adjunts

Technological Trends: ITTechnological Trends: IT More than just data storage and collectionMore than just data storage and collection Increasing penetration into EM is manifestIncreasing penetration into EM is manifest Pros: efficiency, safety, info availabilityPros: efficiency, safety, info availability Cons: info overload, privacy concerns, Cons: info overload, privacy concerns,

infrastructure vulnerabilityinfrastructure vulnerability Important sub-trends:Important sub-trends:

Decreasing processor sizeDecreasing processor size Moore’s lawMoore’s law Wireless networksWireless networks HIPAA considerations, security issuesHIPAA considerations, security issues Neural networks, diagnostic algorithmsNeural networks, diagnostic algorithms

Technological Trends: ITTechnological Trends: IT

Question: does more information = better Question: does more information = better care? care? Available evidence casts grave doubt on such Available evidence casts grave doubt on such

a presumptiona presumptionSwan-Ganz CathetersSwan-Ganz Catheters

Question: does increased information Question: does increased information increase the resolution of the increase the resolution of the retrospectoscope? retrospectoscope?

Tech Trends: ITTech Trends: ITInformation vs. ExformationInformation vs. Exformation

As disorder in a system increases: As disorder in a system increases: The entropy of the system The entropy of the system

increasesincreases

the amount of information “encoded” in the the amount of information “encoded” in the system system increasesincreases

Tech Trends: ITTech Trends: ITInformation vs. ExformationInformation vs. Exformation

Work

Information Entropy↑ Work

“Value Added”

Tech Trends: ITTech Trends: ITAccelerating AccelerationAccelerating Acceleration

Kurzweil: Kurzweil: Human technological progress tends to accelerate over the Human technological progress tends to accelerate over the

course of historycourse of history IT accelerates the rate of acceleration of technological progressIT accelerates the rate of acceleration of technological progress Have we passed the singularity? Have we passed the singularity?

20 years ago, could we have predicted:20 years ago, could we have predicted: Internet porn, PDAs, MyYahoo!, the Y2K scare, SETI@home, CIS, Internet porn, PDAs, MyYahoo!, the Y2K scare, SETI@home, CIS,

genetic algorithms?genetic algorithms? 10 or so10 or so years ago we actually DID predict: years ago we actually DID predict:

The Internet would make everything perfect foreverThe Internet would make everything perfect forever email, dial-ups and Yahoo! would free China and N. Koreaemail, dial-ups and Yahoo! would free China and N. Korea Less paperwork for everybody! Yipee!Less paperwork for everybody! Yipee! A sudden return to neolithic civilization at midnight, 12-31-1999A sudden return to neolithic civilization at midnight, 12-31-1999

(Cruz told me he was dissappointed when it didn’t happen)(Cruz told me he was dissappointed when it didn’t happen) A better informed public and more honest politiciansA better informed public and more honest politicians The Internet was going to change EVERYTHING!The Internet was going to change EVERYTHING!

Network evolution: emergent and unpredictableNetwork evolution: emergent and unpredictable

Trends: ITTrends: ITOppos. Trend

Overwhelming (Info Overload), low E/IDecreased EfficiencyUsed to enforce rigid protocolsSpawns non-pt-care “busywork”Cart > HorsePrivacy at RiskPulls physician FROM bedsidePromotes balkanized healthcare

I am Dr. Borg.Your files will deleted within 29 minutes. I may contain malicious programs. If you wish to continue, hit “pay.”

Streamlined information, hi E/IMaximizes efficiencyPromotes innovation and flexibiity Minimizes non-pt-care responsibilitiesTransparent ITMaximizes privacyPulls physician TO the bedsideIntegrates healthcare systems

Hmm…650 delinquent charts,

an expiring license and a transfer from Providence.

There. All done. Back to patient

care!

Trends: BioimagingTrends: Bioimaging UltrasoundUltrasound

More compact: every doc with a unitMore compact: every doc with a unit enhanced resolutionenhanced resolution contrast materialscontrast materials expanded utilization by EPsexpanded utilization by EPs

Continued evolution of computed tomographyContinued evolution of computed tomography MRIMRI

Magnetic resonance spectroscopy—more info about Magnetic resonance spectroscopy—more info about chemical and physical properties of a region than MRIchemical and physical properties of a region than MRI

Multinuclear imaging—tweak nuclei other than HMultinuclear imaging—tweak nuclei other than H Internal imagingInternal imaging

Tech Trends: BioimagingTech Trends: Bioimaging

The M2A capsule endoscopeThe M2A capsule endoscopeminiature video camera, light source, batteries miniature video camera, light source, batteries

and a radio transmitter. and a radio transmitter. Video images transmitted by radio telemetryVideo images transmitted by radio telemetry50,000 images / seven-hour procedure. 50,000 images / seven-hour procedure.

Data recorder: walkman-like device worn Data recorder: walkman-like device worn by the patientby the patient

Computer workstation imaging softwareComputer workstation imaging software

Tech TrendsTech Trends

Neural networks and pattern recognitionNeural networks and pattern recognitionCurrently used to look for Osama bin Currently used to look for Osama bin

Laden at the JFK airportLaden at the JFK airportSystems require mimimum processing Systems require mimimum processing

power to “learn” complex patternspower to “learn” complex patternsNever miss a pneumonia on CXR againNever miss a pneumonia on CXR again

Tech Trends: TMSTech Trends: TMS

Uses Uses electromagnetic electromagnetic induction to set up induction to set up currents in neuronal currents in neuronal populationspopulations

Already being used Already being used in neuropsychiatry in neuropsychiatry and brain researchand brain research

This one could be a This one could be a singularitysingularity

Tech Trends: Point-of-Care TestingTech Trends: Point-of-Care Testing

Tech Trends: Point-of-Care TestingTech Trends: Point-of-Care Testing

“We got blind diabetics out there taking their own blood sugar, but JCAHO says I’m not certified to do it.”

- Rick Bukata

Tech Trends: Biomolecular Tech Trends: Biomolecular MedicineMedicine

Comprises several fields:Comprises several fields: Genomics, proteomics, computational protein folding, Genomics, proteomics, computational protein folding,

molecular genetics, molecular immunology, molecular genetics, molecular immunology, computational protein folding, etc. computational protein folding, etc.

Short-term effects on EM probably moderate, Short-term effects on EM probably moderate, compared to disciplines like oncology, hematology compared to disciplines like oncology, hematology and rheumatologyand rheumatology

Long term effects are critical:Long term effects are critical: Molecular adjuncts to resuscitationMolecular adjuncts to resuscitation Molecular/genetic diagnosticsMolecular/genetic diagnostics Rapid protein repairRapid protein repair Early prevention of cell-death triggersEarly prevention of cell-death triggers

Tech Trends: Drug DeliveryTech Trends: Drug Delivery

Organ/tissue-specific delivery systemsOrgan/tissue-specific delivery systems Ability to deliver engineered or recombinant proteins Ability to deliver engineered or recombinant proteins

to tissues will be keyto tissues will be key Targeted tissue delivery will be a major step forwardTargeted tissue delivery will be a major step forward

innovations in interventional radiologyinnovations in interventional radiology Computational protein foldingComputational protein folding recombinant proteins, eg, active group + targeting domainrecombinant proteins, eg, active group + targeting domain engineered virionsengineered virions nanotechnologynanotechnology engineered microorganismsengineered microorganisms antisense RNA technologiesantisense RNA technologies micelles, microspheres micelles, microspheres

Tech Trends: Materials ScienceTech Trends: Materials Science New materials technologies will have New materials technologies will have

implications for all areas of medicine:implications for all areas of medicine: Prosthetic limbs, organs and jointsProsthetic limbs, organs and joints Drug development and delivery systemsDrug development and delivery systems Medical imagingMedical imaging

Emerging technologies:Emerging technologies: Superconducting materials, esp ceramicsSuperconducting materials, esp ceramics CompositesComposites Self-assembling layers/vapor depositionSelf-assembling layers/vapor deposition Nanolithography and nanomatricesNanolithography and nanomatrices

Who is this Man?Who is this Man?

Dr. K. Eric Drexler

Tech Trends: NanotechnologyTech Trends: Nanotechnology

You’re going to feel a little prick now…

Note: This is NOT a nanomachine!

Note: You should NEVER say this to a patient.


Engineering at the molecular and atomic levelEngineering at the molecular and atomic level Progress is explosive: Progress is explosive:

nanomaterials: nanotubes, buckyballs, nanomaterials: nanotubes, buckyballs, nanocompositesnanocomposites

elementary nanocircuitselementary nanocircuits nanophotonics and nanolasersnanophotonics and nanolasers nanolithographynanolithography Preliminary work with ATP’ase-driven nanomotors Preliminary work with ATP’ase-driven nanomotors

hacked out of natural casetteshacked out of natural casettes Holy grails: Holy grails: kinematic replicators, rod logic, kinematic replicators, rod logic,

molecular-level quantum processorsmolecular-level quantum processors


Nanogears operating at room temp. Han and Globus, et al, NASA.


Carbon nanotube deposits carbon on a diamond matrix.


Carbon Nanotube Microarray for Chip Cooling (JPL)



An example of an artificial microstructure created with carbonnanotube nanolithography

Tech Trends: Materials Science Tech Trends: Materials Science and Nanotechnologyand Nanotechnology

National Nanotechnology InitiativeNational Nanotechnology Initiative Instituted during the Clinton AdminInstituted during the Clinton Admin Bush increased funding to $3.63 BBush increased funding to $3.63 B Incorporates dozens of Federal agencies, including Incorporates dozens of Federal agencies, including

HHS and NIHHHS and NIH Already moving rapidly into the commercial sectorAlready moving rapidly into the commercial sector

hydrogen sensorshydrogen sensors chip manufacturechip manufacture manufacture of night vision and solar-power technologiesmanufacture of night vision and solar-power technologies textiles textiles



Implications for Emergency Medicine:Implications for Emergency Medicine: Drug deliveryDrug delivery Antibiotics, antiviralsAntibiotics, antivirals tissue stabilization and repairtissue stabilization and repair Diagnostics and imagingDiagnostics and imaging MicrotelemetryMicrotelemetry ThrombolysisThrombolysis ““cell surgery”cell surgery” gene excision and repairgene excision and repair Artificial tissues and organsArtificial tissues and organs


Challenges:Challenges:New technologies always mandate new skill New technologies always mandate new skill

setssetsSome nanotechnologies will be biohazards; Some nanotechnologies will be biohazards;

handling and regulationhandling and regulationadverse reactions to nanomachinesadverse reactions to nanomachinespotential for abuse: neo-protists, potential for abuse: neo-protists,

microexplosives, “Gray Goo” scenariomicroexplosives, “Gray Goo” scenario

Tech Trends: Artificial OrgansTech Trends: Artificial Organs

Continued progress with mechanical Continued progress with mechanical organs and tissues, especially pumps organs and tissues, especially pumps (hearts), tubes (vascular, ducts), joints, (hearts), tubes (vascular, ducts), joints, bone and muscle.bone and muscle.New materials and processesNew materials and processes

A new generation of artificial tissues and A new generation of artificial tissues and organs, representing a confluence of organs, representing a confluence of several technologiesseveral technologies

Tech Trends: Artificial OrgansTech Trends: Artificial Organs

Biodegradable TissueScaffold

(see “nanolithography”)

Inoculate with tissue-specific

cultured cells or stem cells

Ya got ya kidney, there.

Here Be Dragons

Tech Trends: Resuscitative Tech Trends: Resuscitative AdjunctsAdjuncts

Synthetic oxygen carriersSynthetic oxygen carriers HypothermiaHypothermia Reperfusion cocktailsReperfusion cocktails

Cardiac, cerebral, renal, spinal cord, muscleCardiac, cerebral, renal, spinal cord, muscle caspase and calpain inhibitorscaspase and calpain inhibitors insulin, growth factorsinsulin, growth factors mitochondrial stabilizersmitochondrial stabilizers free radical scavengersfree radical scavengers thrombolytics post-arrest? thrombolytics post-arrest?

Refinement of the EGDT approachRefinement of the EGDT approach

Tech Trends: AL, GAs, CAsTech Trends: AL, GAs, CAs

How’s this for sci-fi….How’s this for sci-fi….You will use artificial life forms to plan for You will use artificial life forms to plan for

staffing and maximize ED patient staffing and maximize ED patient flowthrough. flowthrough.

Tech Trends: AL, GAs, CAsTech Trends: AL, GAs, CAs Genetic AlgorithmsGenetic Algorithms

a form of Artificial Life that uses principles of natural a form of Artificial Life that uses principles of natural selection and fitness to evolve solutions to complex selection and fitness to evolve solutions to complex problemsproblems

Already being used to optimize “just in time” shipping Already being used to optimize “just in time” shipping strategies, flight plans, traffic volumes, etc. strategies, flight plans, traffic volumes, etc.

Social and Demographic TrendsSocial and Demographic Trends

Your patient’s getting older: Your patient’s getting older:


Your patient’s getting older:Your patient’s getting older:


Your patient’s getting more complex: Your patient’s getting more complex:


Your patient is smarter (maybe)Your patient is smarter (maybe)Patients have more access to Patients have more access to

medical informationmedical informationLess trusting of doctorsLess trusting of doctorsMore likely to ask questionsMore likely to ask questionsWe treat them like customers, We treat them like customers,

they act like customersthey act like customers

Social and Demographic TrendsSocial and Demographic Trends Your patient speaks Urdu. How’s your Urdu?Your patient speaks Urdu. How’s your Urdu?

Actually, he/she probably speaksActually, he/she probably speaks SpanishSpanish ChineseChinese FrenchFrench GermanGerman TagalogTagalog VietnameseVietnamese ItalianItalian KoreanKorean RussianRussian PolishPolish

Notwithstanding all the rhetoric, America will become increasingly polyglot Notwithstanding all the rhetoric, America will become increasingly polyglot in the next century. in the next century.

More important is the issue of cultural diversity.More important is the issue of cultural diversity.


Your Patient Does T’ai Chi and Your Patient Does T’ai Chi and smokes Tigoba Rootsmokes Tigoba Root New Age Freaks from Royal Oak will New Age Freaks from Royal Oak will

rock your worldrock your world Use of alternative medicine is Use of alternative medicine is

increasing:increasing: in 2002, 36% of Americans had used some in 2002, 36% of Americans had used some

form of alternative therapy in the past 12 form of alternative therapy in the past 12 months (NIH data)months (NIH data)

Many issues of safety, efficacy and Many issues of safety, efficacy and regulation remain unresolvedregulation remain unresolved

Increased immigration affects this trendIncreased immigration affects this trend

““Apocalypse is boring.”Apocalypse is boring.”-Bruce Sterling-Bruce Sterling

Economic and Business Trends:Economic and Business Trends:Apocalypse NowApocalypse Now

114 million ED visits annually114 million ED visits annuallymore than 1 for every 3 people in the United more than 1 for every 3 people in the United

StatesStates16 million per ambulance.16 million per ambulance.EDs have become preferred setting for many EDs have become preferred setting for many

patients patients Seen as an djunct to community physicians Seen as an djunct to community physicians

("go to the ED for some labs")("go to the ED for some labs")(recent growth in ED use driven by patients with (recent growth in ED use driven by patients with

private healthinsurance)private healthinsurance)


Between 1993 and 2003:Between 1993 and 2003: population grew 12 percentpopulation grew 12 percent hospital admissions increased 13 percenthospital admissions increased 13 percent ED visits rose 26 percentED visits rose 26 percent

During the SAME PERIOD: During the SAME PERIOD: United States lost 703 hospitalsUnited States lost 703 hospitals 198,000 hospital beds198,000 hospital beds 425 hospital Eds425 hospital Eds

"mainly in response to cost-cutting measures and lower "mainly in response to cost-cutting measures and lower reimbursements by managed care, Medicare, and other reimbursements by managed care, Medicare, and other payors.” (Institute of Medicine)payors.” (Institute of Medicine)

Economic and BusinessTrendsEconomic and BusinessTrendsApocalypse NowApocalypse Now


EDs are the principal sources of care for EDs are the principal sources of care for 45 million uninsured Americans.45 million uninsured Americans.

Hospitals have little financial incentive to Hospitals have little financial incentive to prevent ED overcrowding. prevent ED overcrowding.

"The ED often serves as primary care "The ED often serves as primary care provider, a role for which it is not optimally provider, a role for which it is not optimally designed.“designed.“

Increasing unavailability/reluctance of Increasing unavailability/reluctance of consultantsconsultants


Overloaded EDsOverloaded EDs Waits of hours or days for inpatient beds.Waits of hours or days for inpatient beds. Ambulance diversion daily problem in many Ambulance diversion daily problem in many

cities. cities. EMS fragmented and disorganizedEMS fragmented and disorganized 45 million uninsured Americans. 45 million uninsured Americans. System is ill prepared to handle large-scale System is ill prepared to handle large-scale

emergenciesemergencies natural disaster (more common)natural disaster (more common) Influenza pandemic (more likely)Influenza pandemic (more likely) Acts of terrorism (imminent)Acts of terrorism (imminent)

Economic and Business TrendsEconomic and Business Trends







Overall United States health care performance Overall United States health care performance ranked 37th (WHO)ranked 37th (WHO) Far below the average of developed nations.Far below the average of developed nations. Health care “level” ranked 72nd in the world by WHOHealth care “level” ranked 72nd in the world by WHO

worse than China worse than China comparable to Iraq. comparable to Iraq.

Euro Itchy and Scratchy:Euro Itchy and Scratchy: Have far fewer uninsuredHave far fewer uninsured Get more bang for their health care buckGet more bang for their health care buck Have comparable waiting times and rationingHave comparable waiting times and rationing Achieve comparable patient satisfactionAchieve comparable patient satisfaction Take it up the butthole on taxes, but don’t seem to mindTake it up the butthole on taxes, but don’t seem to mind

Universal Coverage: the Worst Universal Coverage: the Worst Possible SystemPossible System

Would require new Would require new taxes and at least taxes and at least some increase in some increase in Federal bureaucracyFederal bureaucracy

People who hate it:People who hate it: DoctorsDoctors HMOs, insurance cosHMOs, insurance cos Big PharmaBig Pharma Conservatives Conservatives

in powerin power LibertariansLibertarians Trial LawyersTrial Lawyers The publicThe public

Current trends in Current trends in American healthcare American healthcare are unsustainableare unsustainable

Other systems have Other systems have huge problems, but huge problems, but still work better than still work better than oursours

People who want it:People who want it: DoctorsDoctors Progressives & LibsProgressives & Libs

Hate AmericaHate America EmployersEmployers The publicThe public

Oppos. Trend

EM takes up more slack for a sick healthcare system

More uninsured Few social support systems

Lack of regionalization and nationalization

“Highest bidder” technologies crafted to make money, not sense

EM becomes MORE DIVERSIFIED and LESS FOCUSED

“I’m doing a fellowship in Emergency Podiatric Acupunture!”

EM loses its academic momentum Increasing loss of hospitals and

academic centers makes EM a “red-headed stepchild”

EM seen as an economic drain on govts, med schools and hospitals

EM not well integrated in local and national disaster/antiterro planning

EM integrated into a comprehensive EM integrated into a comprehensive national healthcare strategynational healthcare strategy

Innovated technologies selected and Innovated technologies selected and deployed to maximze patient care and deployed to maximze patient care and departmental readinessdepartmental readiness

EM becomes MORE FOCUSED and EM becomes MORE FOCUSED and LESS DIVERSIFIEDLESS DIVERSIFIED

It’s called “EMERGENCY MEDICINE”It’s called “EMERGENCY MEDICINE” EM’s academic momentum continuesEM’s academic momentum continues

More academic chairsMore academic chairs More NIH fundingMore NIH funding More translational researchMore translational research New areas of investigationNew areas of investigation

Stabilization of hospitals and medical Stabilization of hospitals and medical centers stabilizes the standing of Edscenters stabilizes the standing of Eds

EM seen as crucial to the success of EM seen as crucial to the success of local, regional and national health care local, regional and national health care systems, both operationally and systems, both operationally and financiallyfinancially

EM a keystone element in disaster EM a keystone element in disaster planningplanning

Oppos. Trend

““What are your predictions, What are your predictions, Sullydog?”Sullydog?”

You haven’t been listening.

Okay, fine.Okay, fine.

Predictions the next 10-20 yPredictions the next 10-20 y Technological innovation will proceed apaceTechnological innovation will proceed apace

significant deployment of nanotech, TMS, AI, neural nets, significant deployment of nanotech, TMS, AI, neural nets, etc. etc.

Biotech from SingaporeBiotech from Singapore Emergency Medicine will continue its current Emergency Medicine will continue its current

academic trajectoryacademic trajectory Resuscitology, heart failure, stroke, sepsisResuscitology, heart failure, stroke, sepsis Systems analysis, GSystems analysis, GAs, ITAs, IT Physician wellnessPhysician wellness Creation of new National Institute for Creation of new National Institute for

acute/emergency/trauma medicine (as recommended by acute/emergency/trauma medicine (as recommended by IOM)IOM)

Okay, fineOkay, fine

Predictions for next 10-20 yPredictions for next 10-20 y IT IT willwill streamline our workflow and help put streamline our workflow and help put

us at the bedsideus at the bedside Increasing deployment of neural nets and AI-Increasing deployment of neural nets and AI-

like systems to improve diagnosis and tx and like systems to improve diagnosis and tx and reduce errorsreduce errors

Continued refinement and evolution of CQIContinued refinement and evolution of CQIAppearance of more explicit multidisciplinary Appearance of more explicit multidisciplinary

team approach to EMteam approach to EM

Okay, fineOkay, finePredictionsPredictions

EEDs will continue to pick up the slack while Ds will continue to pick up the slack while America gets her s**t togetherAmerica gets her s**t togetherEPs and EDs will continue to do more primary careEPs and EDs will continue to do more primary care

Bad for Emergency MedicineBad for Emergency Medicine Bad for Primary CareBad for Primary Care Bad for patientsBad for patients

Public health mandates (funded vs unfunded)?Public health mandates (funded vs unfunded)?Overcrowding will continue for the foreseeable Overcrowding will continue for the foreseeable

futurefuture

Okay, fineOkay, fine

Increasing regionalization and nationalization of Increasing regionalization and nationalization of health care systemshealth care systems Driven less by public health concerns than disaster / Driven less by public health concerns than disaster /

terror preparednessterror preparedness What is the role of EM in govt surveillance of the public?What is the role of EM in govt surveillance of the public?

Gradual integration of hospital systems and IT Gradual integration of hospital systems and IT networks (this will be rough and slow going)networks (this will be rough and slow going)

GradualGradual evolution of single payer system(s) evolution of single payer system(s) Probably 50 of ‘em, regulated by Feds (carrot-stick)Probably 50 of ‘em, regulated by Feds (carrot-stick) Hospitals, pharmaceutical co.s, PGs, etc, continue to be Hospitals, pharmaceutical co.s, PGs, etc, continue to be

operated on entrpeneurial modelsoperated on entrpeneurial models

CONGRATULATIONS TO CONGRATULATIONS TO THE CLASS OF 2006!THE CLASS OF 2006!

The Future of Emergency Medicine Jonathon M. Sullivan MD, PhD Wayne State University Detroit Receiving Hospital.

Documents

futurism slide

future slide

crossover slide

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futurism science fiction

planetary systems

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