Emergency Medicine Update: Greece

- I'll try to keep it brief. I'm working here with my liaison in Greece who's a very interesting guy, Dimitrios Tsiftsis, he's done some training in the US. His English is probably better than my English and his Greek is definitely better than my Greek, so I'm very happy to present. And let me just get right to it. Next slide. So basically the update's gonna be a little brief history of our efforts over the last decade. Then we're gonna go to short and long-term goals that'll be presented by, mostly by Dr. Tsiftsis as well as the educational initiatives that he is been working on and the health policy initiatives for the future of emergency medicine in Greece. Next slide please. So, just a brief history and thanks again to ACEP for and someone earlier had mentioned Joe Lex. I think we should have a special appreciation, Dave, for Joe Lex. I mean he is worldwide, an inspirational guy and for those of you that don't know, he does a weekly podcast called "Dr. Joe's Groove." And it is a really good musical program. So a definite nod to Joe Lex who got me involved with ACEP in the international section. When I first became Ambassador, Greece was kind of like we were back in the 60S in the States. And for those of you that really want a great history of emergency medicine, you should definitely look at Brian Zink's book, "Anyone, Anything, Anytime," it reads more like a great novel than a history of emergency medicine. So that is really required reading. And for those of us that are working internationally, it'll give you a lot of the problems we had initiating emergency medicine in the United States. And it'll be really inspirational for our colleagues in different parts of the world 'cause they may feel like, wow, we're going through a hell of a time doing this. And they'll appreciate the fact that emergency medicine was no walking the park back in the 60s when it started outside of Virginia. Anyway, so when I first became the call ambassador, I went to my colleagues in Greece, specifically Dr. Askitopoulu who introduced me to Dr. Agouridakis. And well, you can go on the ACEP website and see some of the previous country reports for more details about this. But when I became ambassador, I really, you know, my parents were born in Greece. I was the first born in the States, so I wanted to kind of pay it forward and go back to the old country. And Dr. Askitopoulu and Agouridakis said very simply, "You can help us by starting an exchange program." So we developed an exchange program at the New York Presbyterian Queens, in Queens, New York, and five years we were funded by Stavros Niarchos Foundation. We brought in attending physicians from Greece. So obviously there were no emergency physicians, but there were people that were working in the emergency departments Aula USA in the 60s and 70s. And they became our Nidus, our critical mass of people that we trained in the US style of emergency medicine. Next slide please. And the office had given us a really nice grant of $500,000 over five years and we were able to bring people over, train them, ultrasound, critical appraisal, in a Taste of New York. Some of 'em took a lot of advantage of that and really found places I didn't even know existed in New York City. Okay. So that became something that developed. And just briefly before I kick it off to Dr. Tsiftsis, and just to let you know that with the efforts of going over to Greece and working with them, not just in conferences and helping educate them in the US style of emergency medicine and the ACEP inspiration that got us there in the first place, we went to the Ministry of Health pretty much every year 'cause every time Dr. Agouridakis and I would go over to the Ministry of Health, they'd be really interested and yeah, we really need like a super specialty or a subspecialty of emergency medicine in Greece. And then they have elections, they call elections in Greece quite frequently. So by the time we got the okay, that Minister of Health was gone and there was a new Minister of Health that we'd have to go to. So our efforts paid off just before the pandemic. They approved in their version of the federal register a super specialty of emergency medicine where in the beginning there were two, one of them was in Herakles and Crete and the other was at Athens at Attikon Hospital, which is the university hospital of their great Athens Medical School, the National and Kapodistrian Medical School, of which I became a visiting professor. And so now to take us from the past to the present and the future, it's kind of like a Christmas carol here, you know, with Dickens. I'd like to kick it over to Dr. Tsiftsis, Dimitri. Are you there?

- Yes. Hello, can you hear me?

- [Michael] Yes.

- Okay. Thank you very much Dr. Radeos. It's a pleasure being with you again. So for us, the great turning point was our visit to the global village in the past American College for emergency physicians. Under the guidance of Dr. Radeos, who had the great opportunity of meeting most of you there. It was a great networking experience and we got a lot of support among other things. We got a support letters from ACEP and IFEM. Considering the creation of residency program for emergency medicine in Greece, we presented these support letters and our case both to our Ministry of Health and our National Health Council. Both seem to be embracing the idea, but it'll take quite some time before it is actually implemented. So until we have a residency program, we are focusing on how we can expand our existing training program for the super specialty. So if I have next slide please. Okay. So we have expanded our training sites for the super specialty program to another 5 hospitals. Now we have about 70 or 75 positions for training. Our society is providing continuous education for all emergency department physicians since there's a lack of formally trained accredited emergency physicians. So we work with doctors not being trained in emergency medicine, but positioned in emergency departments and we're focusing on training them. We have almost completed creating a generic course on mechanical ventilation. We are working close in a core collaboration with all relevant national medical societies in creating educational programs for emergency department physicians. Next please. And at the same time, the government seems to be investing in emergency departments and the emergency care. They have finalized the bylaws regulating the exam of the super specialty of emergency medicine. The Ministry of Medicine has decided the Ministry of Health has decided to grant permission to all emergency department physicians to be accredited in emergency medicine through the exam process. The Ministry of Health is renovating more than 20 emergency departments in Greece. And that's something like rebuilding, not actually renovating. We have for the first time designated trauma centers and for the first time we have designated stroke centers. Next please. So in summary, creating a formal emergency medicine residence program remains our primary objective. Since then, the HeSEM in collaboration with Dr. Radeos and then international partners are working on training emergency department physicians, working the Greek emergency departments and developing the basis for safe and high quality emergency services. The Ministry of Health seems to be investing the development of emergency departments at emergency care thanks to ACEP for the great support that has allowed our dedicated emergency department physicians to achieve so much in the past 14 years. I have to say that Dr. Radeos has more experience with emergency care in Greece than I do. He's been working on this even before I had finished my residency. We look forward to continue our protective partnership and create an exemplary emergency medicine system in Greece. Thank you very much, Michael.

- Okay, so let me just wrap things up. Next slide right there, yeah. So again, thanks a lot to Dr. Tsiftsis because the talent pool in Greece has just been awesome. And you know, obviously, you know, one ambassador can't do much by themselves, but the team of colleagues and brothers and sisters I've found in Greece has just been awesome. And from this I wanna show that Greece has a very remarkable history. And the next slide is going from the ancient to the present in the future. This is actually a place, if you haven't been to Athens, it's amazing about what goes around, comes around. The Niarchos Foundation really stepped up when we needed them in the beginning of our collaboration with ACEP and Greece in order to develop the ability to bring the physicians over to train them. And these physicians have gone back and have become the critical mass of educators in the training programs in Greece right now. So I'm just absolutely full of gratitude as a first born in this country and to be able to pay it back and see Greece just develop a great future as well as a great past. And this is Stavros Niarchos Foundation Cultural Center in Greece. So the Niarchos Foundation is really impressive and this was developed by the Italian Renzo Piano, who's a world renowned architect. If you haven't been to Greece, you should go just to go to the cultural center just south of the Acropolis. And from the air you don't see it because it blends into the environment so perfectly, you don't see a thing 'cause there's grass on top of the structures. There's like these gardens, so from the air you don't see it. But when you get down there, you'll actually see on the ground level these beautiful libraries and cultural centers and operas. Just one more reason that you really need to go to Greece and it's just an amazing thing. So thanks again to everybody. Appreciate you and any questions, we'll take the questions.