Welcome to the first ACEM President’s blog for 2021.

With every new year comes an opportunity for fresh perspectives and a re-invigorated sense of hope and purpose; 2021 more-so than ever before. For those who managed to have some recent downtime, I hope you are feeling somewhat replenished; 2020 was a tough year.

We all know that our vital work in the emergency department never stops, and that the holiday period can be a trying time. To those who worked, caring for their communities while many of the wider hospital and population were at rest, we offer our resounding thanks – particularly after such a difficult 2020.

Our thoughts remain with our colleagues and communities in other parts of the world – North, Central and South America, Europe, the United Kingdom, Africa, India, Indonesia and other locations where COVID-19 continues to have a devastating impact. Our colleagues in the UK tell us a third of their workforce are off with COVID-19 or in isolation. Their EDs have many patients with COVID and related conditions and many hospitals are building holding bays for ambulance-arrivals to wait (ie be ramped) prior to their prolonged off-loads into full EDs..

While we all wish that the new year meant we could draw a line under the previous 12 months, we are unfortunately still in a pandemic. We saw evidence of this in Australia over the holiday period. Reimposed border restrictions in response to localised outbreaks threw many domestic travel plans into disarray and further uncertainty presented with new and different strains. Such disruption and uncertainty will continue as we grapple with this wicked virus, at least until vaccines are approved and widely rolled out across our two countries.

We are clearly currently in a better position than elsewhere in the world; however, we must not be too complacent. Remember the summer hiatus in the northern hemisphere and what followed.  The virus is endemic in the world and is not going away any time soon.  We can’t keep our borders closed for ever.  Vaccines are our only chance to lessen the impact of this illness on society, our vulnerable populations and our healthcare systems.

For obvious reasons, the vaccines were developed very rapidly and consequently there is a paucity of robust longitudinal data about their efficacy and other impacts. Our friends and colleagues in the northern hemisphere are lining up and receiving theirs and, just as with our flu vaccination, I encourage you to receive the COVID vaccinations when and as approved by our regulators. It is important for the sake of our patients and vulnerable people who we treat every day.

The ideal scenario is that vaccination results in the prevention of serious, life-threatening illness and large scale hospitalisations, as well the prevention of spread – ultimately resulting in the ‘herd immunity’ that has been the subject of much public discussion and speculation. Time, data and experience will tell us if this can be achieved. 

We hope that vaccines prove to be the circuit breaker we all need. Until then, the risks of further localised or major outbreaks remain. And, even with successful vaccination programs, we need to be prepared to continue living with and managing COVID-19 for some time.  It remains an ominous and persistent thought.

As a truly international Emergency Medicine specialty – indeed family – we have all heard about the terrible situations unfolding abroad. Sometimes we are being told first-hand by our colleagues on the ground. Overseas, we are seeing emergency departments and intensive care beds at capacity. We are seeing hospital and healthcare systems overwhelmed. We are seeing healthcare systems – along with our colleagues – on the brink. 

We remain focussed on avoiding such scenarios here, but we are also eager to support our international Emergency Medicine family. Early this year, we will undertake discussions and work with our Intensive Care colleagues in Australia and New Zealand. We will determine what further support and assistance we can offer our friends and colleagues who are struggling overseas, in particular, in the UK.

There are, of course, still significant challenges on the home front. Many of the issues we have strongly advocated for have not gone away. Approaching the end of 2020 and into 2021, we have continued to see issues of ED crowding and access block – in South Australia, Tasmania, Western Australia, New Zealand and specific hot-spots, such as Cairns, among other locations.

Crowded and access-blocked EDs remain an unacceptable risk to patients and staff – particularly in the COVID-19 era. Recently published research by a Fellow has shown that a patient who arrives at an access-blocked ED has a 10% greater chance of dying than a patient arriving at a non-blocked ED. This year, we will maintain our advocacy focus on finding solutions to these longstanding issues. We will capitalise on the lessons we have learned, and on the relationships we have built during the pandemic response.

We will continue to campaign for improvements to the treatment and support provided to people needing mental healthcare. We will seek greater equity of access to healthcare for our indigenous populations. We will advocate for healthcare resource stewardship and action on climate change, and we will seek to address healthcare and workforce disparities between metropolitan and rural and remote areas. We will strive towards the wellbeing of our members, our trainees and the communities we serve.

After a tumultuous 2020, we will retain our crucial focus on supporting our trainees. We will seek to manage difficult and rapidly changing situations in order to allow our next cohort to undertake their training and assessments through 2021, and beyond.

Working towards these important goals cannot be done alone. It requires the commitment, the dedication and the involvement of each of our members and trainees.

Remember; Ma tini ma mano ka rapa te whai – Many hands make light work. Unity is strength.

Your College is here for you. Please get involved. Please put your hand up, volunteer, and be engaged and active in your community.  Engagement can be a helpful antidote to burnout.

I end this blog by again welcoming you to new hope and a new year. We are certainly not out of the COVID-19 woods, but the lessons learned from the past year, our relatively strong positions in the international context, and the fact we have been managing this pandemic for almost a year, means there is space for hope and optimism.

Thank you in advance for all that you will do and contribute this year. I look forward to accomplishing significant and important work with you in 2021.

Dr John Bonning
ACEM President