Here in San Diego we’ve started with a walk through of the convention center.  With the SCCM staff are the key vendors that support the activity.  These include the decorator (who handles signage, furniture, carpet, drape and exhibit floor set up), the audio/visual company (who handles all of our meeting room A/V and computer needs), and staff from the convention center (catering, security, facility engineers, telecommunications, etc.)

We examine every meeting room and corridor contracted for the event and determine placement of everything from scientific sessions to offices and registration areas. Today’s meeting lasts all day and continue into the evening when we meet for dinner and debrief on all of the day’s activities.  We leave the dinner with both space and responsibilities assigned and lists of details we still must confirm.

On day two we tackle the hotels.  Here we view standard guest rooms and suites, discuss the progress of any planned renovations, plans to accomodate attendees with special needs, determine where the ACCM Convocation will be held, where ancillary meeting functions can occur, renegotiate room rates (as prices have fallen since our contract was made) and discuss sign placement within each hotel.  In the afternoon we return to the Convention Center to detail the location of each and every sign and banner in that facility and what text it should contain, as well as determine what our floral needs will be.

Day three we head out to inspect possible off site locations for the myriad of dinners and social events associated with the Annual Congress.  It’s a whirlwind tour organized by the local convention and visitors bureau (CVB) based on a list of events that occured at prior SCCM meetings.  Typically the local bureau will select several possible sites for each event on our list.  We visit each one and look at the facility and discuss with the proprietor menus, pricing, etc.  This year’s meeting is made more complex by the 40th anniversary celebrations that adds additional events to our list.

On Day four we meet with local destination management companies who provide everything from busing  to the many tours and social activities offered by the Society as part of Congress.  We ust select one company from the several we have interviewed.

On the fifth and final day, meetings are held with the CVB staff who have arranged for items such as temporary personnel to assist in registration, housing reservations systems and other local promotions/welcome signage.

In all, it has been a very successful site visit and all of the items on our ‘to do’ list have been achieved.  We go home with a list of detailed notes, check lists, responsibility assignments, and photos/videos to help us remember what we have seen and decided upon.  The 40th anniversary meeting plans are in place.  We’ll spend several months finalizing small details, making last minute changes to those plans based on the circumstances at hand, and getting members registered and ready for the 2011 Annual Congress.  We hope to see you there!

The San Diego Marriott, pictured here, was booked several years ago (we typically select Congress sites 6-10 years in advance) as one of our housing options for registrants. It is undergoing extensive renovations which are expected to continue for at least another year. Guest rooms have been updated to a modern style, and public areas are scheduled to be renovated throughout the next year.   The last time we were in San Diego (2002) the Convention Center proved a bit tight, so in 2011 we will make use of the newer side of the Center which has larger rooms.

If you are not familiar with the San Diego Convention Center and complex of hotels that flank it, you have a treat in store.  The Convention Center is only 15 minutes from the airport by cab and located downtown along the majestic San Diego Bay with the vibrant Gaslamp District and the San Diego Padres’ PETCO Park at our doorstep.  The Gaslamp District is  San Diego’s dining, entertainment and urban shopping district, complete with a large outdoor mall.  Of course the famed San Diego Zoo, bay cruises, Seaworld, and tours into Mexico are all part of the San Diego experience, which you won’t want to miss during your visit.

The Congress Program Committee has been busy putting together a fantastic educational event.  The Program Committee does most of their work online throughout the year in the Society’s iRooms and by conference calls.  Additionally there is a working visit by the committee’s Co-Chairs at SCCM HQ each Spring followed by one full meeting at SCCM HQ in September by the entire committee.  Another meeting at Congress focuses on the next Congress.  So in essence by the time you attend a Congress, the Program Committee is already well into planning the next event.

The 2011 Congress marks the 40th anniversary meeting of the Society, so look for a number of special activities highlighting this event including a free book on the organization’s history for all full registrants.  Many past SCCM presidents and founders of the modern critical care movement will be on hand to tell you about the early development of critical care and to sign your copy of the anniversary publication.

Last night, having some free time I took the opportunity to try out the San Diego Opera.  It’s a short 10 minute walk from the convention hotels to the Civic Theater.   Last night’s opera was the third of four productions in San Diego Opera’s 2010 season.  Gounod’s “Romeo and Juliet” featured beautiful music, the famous balcony scene, some well-choreographed fighting and the world-class voice of recent Met star Stephen Costello.  In short, if you can squeeze it into your schedule, don’t miss a chance to see this stellar opera company.

Full registration and additional information will be available starting June 1, so watch the Society’s Congress webpage to reserve your place at this special anniversary event.

For the first time this year, the MCCKAP exam will be offered online, providing almost immediate feedback to participants on their level of critical care knowledge. In addition, since the exam is now paperless, mailing and administrative costs are reduced. Programs will still receive the same advanced statistical analysis of their fellows as a group, but this year that comprehensive feedback will be provided more quickly.  The 2010 exam will take place March 1-5 and sales have been comparable to prior years.  We are preparing to provide extra support this year to handle technical and other calls which may be caused by the transition to the online platform.

The HHS sponsored Critical Care Cross-Training for Hospital-Based non-ICU Health Care Professionals (CCXT) Course is being received very positively.  Since the initial posting of the course in December 2009, 793 healthcare professionals have registered for the course.  This number represents 582 individuals from the US States, District of Columbia and Territories and 207 international participants from 45 countries. The majority of participants are physicians and nurses who practice in academic medical centers or community hospitals.  Even as H1N1 and seasonal influenza incidence decline, interest in the course continues with approximately 50 participants registering so far this February.  Ongoing monitoring of the course reveals that a number of participants complete the course over an extended period of time.  Participants often complete the skill station modules (mechanical ventilation) early in their course progress and then return to complete the didactic modules.

Based on customer and committee feedback, we continue to make changes to the adult and pediatric resident education program (RICU).  While minor corrections and bug fixes have occurred since Congress, an improved test reporting system is planned for release this summer.  A conference call with the committee leadership, Council staff liaison, support staff and me is planned in March to further work on developing this important online learning tool.  Look for major improvements in the next iteration of the program planned for this summer.

The web-based, peer-review platform for Critical Care Medicine and Pediatric Critical Care Medicineis transitioning from ScholarOne to Editorial Manager.  The conversion began in January 2010 and full integration is expected by July 2010. Currently, all new journal submissions are being entered into Editorial Manager while revisions of 2009 submissions are being maintained through completion in ScholarOne. Use of Editorial Manager will facilitate post-acceptance production processes, reducing costs and labor needs and will allow for eventual single sign-on through MySCCM. 

In addition to all of this recent activity, the new version of LearnICU (a more comprehensive and interactive learning website) is in development.  I had the plesaure of attending several design meetings and the plans look most impressive and comprehensive.  The Society’s Accreditation and Online Learning Committee is already gearing up to provide topic editors and staff are working on new online learning activities which will be incorporated into the new site.  Most notably all presentations from meetings will be made available here, as well as the ability to take a variety of online self-assessment exams.

These are just some of the highlights of SCCM’s growing online capabilities and I’m pleased to be a part of this exciting activity.

As some of you may know,  I am a ‘foodie’ and also have a food blog (Cooking with Julian).  There I have posted about my visit to a Sikh Langer (community kitchen.)  Check it out if you have some time and the interest.  I found it quite fascinating and enjoyable. 

I wrap up with thanks to our many members and friends in India, without whom this special journey would not have been possible.

Today during our meeting with the leadership of ISCCM, we discussed our partnernship, the many successes we have already achieved, and how we can continue to work together to improve care of the critically ill and injured. We also discussed specifics, such as printing FCCS in India to reduce costs and shipping times and improving the overall FCCS business process. SCCM committed to working with ISCCM on these important issues. Additionally, we discussed online learning opportunities and shared with ISCCM some business management strategies that have proved successful at SCCM. ISCCM also presented us with copies of their latest newsletter, which featured many photos and articles related to the ISCCM/SCCM partnership signing ceremony held in Miami Beach during the 39th Critical Care Congress.

The SCCM booth displayed many of our popular publications. The booth was often crowded with members and individuals wanting to become members. We also talked with members attending the meeting from outside India. I always enjoy spending time in the SCCM booth talking with members from all over the world.

We look forward to strengthening the partnership between ISCCM and SCCM as well as our international partnerships worldwide.

The SCCM Booth at CritiCare 2010 in Hyderabad, India

India's most famous land mark, the Taj Mahal at sunrise located in Agra.

It’s been whirlwind start to the new year, which began with record attendance at the SCCM Critical Care Congress in Miami.  Immediately on the heels of Congress, the Society stepped up to respond to the earthquake that devastated Haiti.  With our team freshly arrived home, several others have deployed to Hyderabad, India, where we will participate in the Indian Society of Critical Care Medicine (ISCCM) annual meeting, “Criticare 2010.”

As the CEO of SCCM, it’s my honor to join the elected leadership in representing the Society at a number of important meetings such as Criticare 2010.  SCCM president Judi Jacobi, PharmD, FCCM, and immediate past-president Mitchell Levy, MD, FCCM, as well as Ken Klarich, from the SCCM FCCS staff, and I are here in Hyderabad. 

The City of Hyderabad, originally named Bhagyanagar in ancient times, was renamed in 1512.  Legend has it that the Shah rode out from Golconda Fort to meet his beloved, braving the flood waters of the local river.  He re-christened her Hyder Mahal and named the city Hyderabad in her honor.  It was during this period that the area developed, becoming famous for its diamonds, steel and printed cloth drawings. 

India is a country of contrasts, where you see modern development alongside ancient buildings – a contrast of wealth and poverty.  Here in Hyderabad, the convention center and meeting hotel are pristine and boast modern designs. 

During our time here, we will be engaging with SCCM members in India and discussing with colleagues about how we can continue to develop and strengthen our partnership.  India already hosts many Fundamental Critical Care Support (FCCS) courses and recently added the Fundamental Disaster Management (FDM) course to their line-up of training programs.  We share articles between our news publications (Critical Connections), and we welcome representatives from ISCCM on the SCCM Critical Care Congress planning committee.  This week, we look forward to discussing new ways to work together to improve care of the critical ill and injured in India, the United States and around the world.

It is very clear to me that our mission is not over.  I am very proud of the SCCM response to the initial request for help from Dr. Baez on behalf of the Dominican Republic health system to respond to the earthquake induced surge in critical care demand.  I must say that I have learned more from Dr. Baez and his amazing leadership performance during this crisis than I could have ever imagined.  Navigating the politics in any health care system under crisis is challenging, however this situation remains more difficult than anyone on the outside could imagine.  Dr. Victor Matos and Dr. Pablo Smester are clearly part of the leadership team for critical care in the DR, and I am grateful for their friendship and support during my stay in the DR. 

The international family of critical care professionals seems small in the age of instant electronic communication.   Our ability to create an instant connection with Dr. Baez and his team in the DR led to rapid activation of the response from SCCM, recruitment of team members, performance of the need assessment, obtaining material to perform educational interventions, delivery of the education and creation of instructor and course administration infrastructure.  I believe we have helped the medical system in the DR move forward towards its own vision of multidisciplinary critical care led by intensivists and other experienced professionals.  The establishment of a training centre for FCCS, and soon PFCCS and FDM, will lead to an increase in the quality of care of patients from this disaster and for those patients in the DR with their usual needs for critical care.  Beyond this, the strengthening of links between the critical care community in the DR with SCCM, and our own institutions in the United States and Canada, will likely bear further fruit in the near future.  For example, we have already begun discussions on linking future stars in Critical Care in the DR with international critical care fellowships in Canada, along with opportunities to have our trainees spend time learning about critical care in the DR. 

I am grateful for the opportunity to have made new friends, learned many lessons, and contributed in some way to the humanitarian and medical relief effort for the victims of this disaster.  Just as Dr. Marie Baldisseri stated in her recent blog entry, I too was feeling pulled to the bedside, and wanted to get hands dirty in patient care.  However, as Dr. Baez and Dr. Ian Butler taught us in their efforts, sometimes the most important thing a critical care professional can do in a crisis is step back, take a breath, and get the team organized.  Teaching leadership, communication, personal survival strategies and other non-medical skills to our trainees is absolutely necessary if we are to save more lives in similar circumstances.

My thanks to my friends in the Dominican Republic, my teammates Marie Balidsseri, MJ Reed, Dana Braner, Bruce Sawadsky, Gervaise Nicklas, Mike Huerta.  The support from SCCM as an organization, and in particular from Judi Jacobi, David Martin, Chris Farmer, and the whole SCCM staff was so important to the success of our mission so far.

Now we all need some time to reflect further on the lessons learned.  In the meantime, many of our friends are still engaged in active disaster relief, and I wish them success and safety in their efforts.  I have to admit I feel a little guilty being home while there is still so much work to do.   I know I will be back in the DR soon, and in the meantime the victims of this disaster and those still remaining on the ground to help are in my thoughts.

Randy Wax, MD, FCCM

I have watched Dr. Alejandro Baez, a Dominican Republic intensivist, trained both at the Mayo and Harvard, work countless hours trying to help organize his country’s resources to accomodate the inflow of seriously ill patients coming in from Haiti. I can’t imagine him without a cell phone in his hand trying to talk to us in between incessant calls he would receive asking for his assistance. His is man with a vision and the DR is blessed that he is helping both countries plan for now and the future, not only supplying beds for the sick but as well, in creating a system for responding to disasters should another disaster occur in either Haiti or the DR. His colleagues, Drs. Victor Matos and Pablo Smester have spent innumerable hours during these past few weeks helping Dr. Baez. All of them deserve our gratitude as do all the workers in the DR and Haiti who have responded to a horrific disaster with skill, expertise, and human compassion.

On a final note, I want to thank the Society of Critical Care Medicine, including those staff members (Diana, Trudi, Geri, Mike, Lynn, Diane), who made all our arrangements and faciliated our stay in the DR. Both David Martin and Judi Jacobi responded to this crisis immediately by having our team assembled and ready to go very quickly and stayed in touch with our team on a daily basis. A great big thank you and goodbye to my fellow team members – Randy Wax, MJ Reed, Dana Braner, Gervaise Nicklas and Mike Huerta.

The Fundamental Critical Care Course with elements of FDM and PFCCS was well received and another course is already being planned for another large group to help increase the knowledge of the workforce that will be caring for quake victims long into the future.

As we review the stories of the volunteers in Haiti on this website, amazing efforts such as Louisdon Pierre MD FAAP who posted his experience on our Jan 28 entry come to light. A Haitian born pediatric intensivist  and member of SCCM,practicing in Brooklyn, his team left for Haiti forty eight hours after the quake and hit the ground running. With already established ties to medical missions in Milot, they were able to affect change quickly and effectively. Dr Pierre is already planning to return and is consider using FCCS and PFCCS as part of his team’s mission.  Please see his post.

There are more stories out there of self sacrifice and deep caring for victims of all kinds.  There are many levels on which we can help. Giving our time, our comforts, our expertise, covering our colleaugues who are away, donating money or supplies or just keeping these people in our prayer and thoughts is a incredible gift.

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The goal is to help recognize the patient at risk early and to intervene to preventing deterioration.  Elements of Fundamental Disaster Management (FDM) and Pediatric Fundamental Critical Care Support (PFCCS) course were included. The Society expedited the translation of parts of the FDM and PFCCS  lectures specifically for this course.

All of us and the Dominican health professionals recognized the need to hold this course immediately in the Dominican Republic to give their health care providers some fundamental concepts  to help manage the influx of seriously ill  Haitian quake victims. In addition, to Drs. Baldisseri and Reed, Drs. Alejandro Beaz, Victor Matos,Jose Yunen and Pablo Smester were the instructors for the course. Emphasis on specific topics such as tetanus, crush injuries, and medical transport of patients were added to the preexisting curriculum.

Dr Baez instructing students at FCCS

Dr Stephen Fletcher and other volunteers worked at Hopital Sacre Coeur in Milot, Haiti approximately 70 miles north of Port au Prince. He reports that in only 2 days they expanded the hospital from 2 operating rooms with 70 beds to 4 operating rooms and 300 beds. Receiving greater than 40 pts per day. See his posted comments.

Dr Ian Butler, a second year CCM fellow at Cooper Medical Center,Camden NJ helped bring order to chaos at Jimani, Dominican Republic on the Haitian border over the course of a few days. As part of a team of several doctors, nurses and other volunteers from the region and across the globe, numerous lives were impacted because of their interventions.

Dr Ian Butler updates our field team, DrsVictor Matos, Dr Alex Baez, Dr Dana Braner and Dr Randy Wax at Jimani, DR

One common thread that stands out, if it wasn’t for people caring for people on all levels, there would be even more tragedy on this island. So much has been done in less than 3 weeks, but so much more to do. It is now a marathon and as the acute phase is ending, the need for volunteerism and donation will continue.

SCCM Disaster field team joining the Haiti/ DR daily update from the Iberoamerican University.

The team spent considerable time today touring educational facilities at the Iberoamerican University medical school in preparation for the FCCS/FDM/PFCCS course early next week.  A decision was made to identify potential instructor candidates to be certified as FCCS instructors, thus creating the infrastructure for future courses.  An estimated enrollment of 60 medical residents is being confirmed.

Dr. Pablo Smester, director of the first FCCS course in the Dominican Republic, discussing details of the course with Dr. M.J. Reed.

There remain persistent challenges in the distribution of health care delivery to patients throughout regions of the DR near the Haiti border, along with huge demands in Haiti.  As the initial excitement of the disaster response wanes, many medical and humanitarian groups are leaving or have already left the area.  The political issues related to the transfer of patients across the DR/Haiti border remain complex.  The DR will likely be faced with ongoing demand on their healthcare and ICU resources. Members of the team will remain in Santo Domingo to continue planning and delivery of the requested SCCM courses and will provide ongoing updates to SCCM over the coming days.

Hatian quake victims donation box at the Iberoamerican University in Santo Domingo.

Disaster physicians: Dr. Victor Matos, Dr. Alejandro Baez, Dr. Juan Rodriguez SCCM Disaster Field Team: Dr. M.J. Reed, Dr. Marie Baldisseri, Dr. Randy Wax, Dr. Dana Braner, Gervaise Nicklas, Province of Ontario Emergency Medical Assistance Team: Dr. Bruce Sawadsky

The SCCM Disaster Field Team met today with multiple representatives from different disaster-related organizations in the Dominican Republic, including the Pan American Health Organization, Project HOPE and the DR Ministry of Health. Dr. Lucas, Director of Special Services for the Public Health System in the DR, provided an overview of the current ICU bed capacity in the public hospital system in country.  75% of the population in the DR relies on the public hospital system for care. There are a limited and inadequate number of ICU beds in the public health system at varying states of readiness meant to serve a population of 7.5 million on the island. It was agreed that there was a need to increase bed capacity for patients with or at risk of critical illness within the DR public hospital system. ICU bed occupancy and availability will be added to the daily briefing for leadership in the Ministry of Health.  A patient tracking system is being evaluated in a pilot project to see if better real time situational awareness can be improved to better allocate resources and move patients to the right place at the right time.

Evaluation of the process for caring for patients, moving patients from makeshift health facilities to more definitive care, was conducted. After mapping out a very complicated existing system, attempts were made to simplify the command and control structure for critical care resources in the country with advice from the groups.  Three regions in the country will be targeted for efforts to increase ICU capacity to better serve patients in hard hit areas. Need for additional work in clarifying the referral process and transport system was identified.

Working together to move patients back in as a storm approaches. Fearing another quake Hatians had built a tent city at the steps of the Jimani Clinic.

The SCCM team has moved from initial reconnaissance activities to assisting with brainstorming solutions along with the leading organizations on the ground to improve efficiency of the critical care system.

“Swallow your egos…this is the REAL world"

As the staff on the front lines in Jimani so eloquently stated, “Swallow your egos…this is the REAL world”. This sentiment was seen at the strategic and leadership level as well. The team was impressed with the willingness of the different organizations to work together in a constructive and creative manner to make a difference.

Haitian quake victims line the halls of a Dominican hospital.

The SCCM team has met with organizations that are coordinating relief efforts across the border and exploring additional opportunities to expand the care of seriously ill patients and augment critical care resources across the island.  Although the numbers of acute trauma patients has been decreasing, a second wave of patients with complicated wound infections and need for surgical revisions is creating a sustained demand for a higher level of care while the competing healthcare needs of the Dominican population continue.

SCCM staff mobilized resources as Gervaise and Mike joined the effort in the Dominican Republic along with Randy Wax, MJ Reed, Dana Braner, and Marie Baldiserri.  They are on the ground assessing needs and preparing to teach FCCS to the DR professionals.  We hope they can link up with our colleagues from Cooper Health who are already in the DR.

On-line disaster resources are available to volunteers on the SCCM website.

Thanks to everyone at home for covering the ICU’s for these volunteers while they travel.

The need for CC support will continue for months. Volunteers, please stay tuned as organizations develop the infrastructure to place you in a safe and effective process.

SCCM met with the physicians coordinating the efforts of several international groups. Surgeries were being performed and post-operative care was being provided with very limited resources. A small pharmacy was setup and limited laboratory testing was able to be performed. Mostly orthopedic injuries and subsequent complications were being treated.

ICU in the Jimani clinic

Particularly poignant was a 7 week old infant that was brought to the hospital last evening. Arriving without family, the child was actively seizing. The presumptive diagnosis was hyponatremia, but without ability to measure electrolytes, the care was essentially intuitive provided by staff not specializing in pediatrics.

With only ability to measure pulse and oximeter, the baby was treated and this morning was sleepy but easily arousable and interactive.

Although numerous patients were treated and moved to a post operative center in the nearby Haitian countryside, there is still a need for nurses  and other personnel to treat the many remaining. What is needed is critical care beds in a stable health care setting. At present there are no critical care beds in all the Dominican Republic. The Society hopes to help develop a plan the aleviate this situation.

Filled to capacity patients spill out in front of the post-operative building.

Hospital bed capacity for Haiti as of January 24 was reported as follows:

• 53 beds, USS VINSON
• 10 beds, Guantanamo Bay, Cuba
• 50 beds, USS BATAAN
• 8 beds, FST-Forward Surgical Team
• 250 beds growing to 1,000 by mid-week USNS COMFORT
• 10 beds, AF Expeditionary Medical System (EMEDS)
• 150 beds, Expeditionary Medical Facility (EMF)
• 8 Haitian hospitals operational, 9 partially operational in PaP
  • General Hospital
  • Hospital de la Paix,
  • Isaie Jeanty
  • Hospital Choscal
  • Carrefour Diquini Hospital
• 6 field hospitals operational
• 500 known IDP Camps ( addresses are ambiguous)
• DHHS: 5 Disaster Medical Assistance Teams (35 person teams)