Tag Archives: Emergency Medicine

SimWars team places second in regional competition during Simulation Week

A team of School of Medicine students placed second in a regional SimWars competition in St. Louis.

Students from the School of Medicine’s Emergency Medicine Interest Group put their skills to work in an annual simulation contest at the Society for Academic Emergency Medicine’s Great Plains Regional Meeting in St. Louis.

The team of fifth and sixth-year medical students, Nick Keevan, Deven Bhatia, Chris Favier, Dane Stephens, Dylan Schwindt, Luke He, Lauren Bulgarelli, Jordann Dhuse, Manna Varghese, MS5 finished runners-up to a team from Washington University.

The event took place during Healthcare Simulation Week, a nation-wide event to raise awareness about the importance of simulation activities in improving the safety, effectiveness, and efficiency of health care delivery. It also fosters collaboration and celebrates the professionals who work in simulation.

Amy Stubbs, M.D., serves as program director for emergency medicine, and helped prepare the team for the competition.

The contest places teams in an emergency patient scenario in which they must work together to assess a patient, intervene and manage a medical emergency working on a human simulator. Judges review teamwork, communication and clinical decision-making skills.

Throughout Simulation Week in September, simulation education took place at the School of Medicine’s Clinical Training Facility on a daily basis. The simulation events ranged from procedural task training to high-fidelity interprofessional simulations at the undergraduate and graduate medical education levels.

The Simulation Interest Group also attended a regional simulation conference at Johnson County Community College where students learned about a variety of topics including basic debriefing techniques, the various roles of standardized patients and how to execute simulation in unconventional spaces.

UMKC’s PacerMan simulation trainer for transvenous pacing was also showcased at a cardiology conference in Kansas City. Sanjaya Gupta, M.D., program director for UMKC School of Medicine’s electrophysiology fellowship, led a hands-on session featuring the PacerMan.

School of Medicine cardiology fellows regularly use the simulator and faculty development sessions are being planned for the future, said Emily Hillman, M.D., assistant professor of medicine ant medical director for the Clinical Training Facility.

UMKC alumnus, TMC involved in latest antibiotic research

Mark T. Steele, M.D. ’80.

The addition of a second antibiotic to treat cellulitis skin infections did not result in significantly better cure rates in research recently published in JAMA, the Journal of the American Medical Association.

The study was the latest from an emergency medicine research group that includes Truman Medical Centers and Mark T. Steele, M.D. ’80. Steele is associate dean for TMC Programs at the UMKC School of Medicine and chief medical officer and chief operating officer for Truman Medical Centers.

“I’ve been involved with this group for more than 20 years,” Steele said. “It has 11 sites across the country and studies infectious diseases relevant to emergency medicine. This latest study used five of those sites, including Truman.”

The study involved 500 patients who had cellulitis that was not accompanied by abscess or a wound. Half of those patients were treated with cephalexin, an antibiotic effective against streptococci that typically is used in such cases. The other half got cephalexin plus trimethoprim-sulfamethoxazole, an anti-staph antibiotic that more patients with skin and soft-tissue infections have been receiving “just in case” MRSA — methicillin resistant Staphylococcus aureus — is present.

For the entire group treated, the added antibiotic seemed to help, producing a cure rate of 76.2 percent, versus a 69 percent cure rate for those who received just cephalexin. But that difference was not considered statistically significant. In addition, when the results were narrowed to the patients who were known to have taken at least 75 percent of the recommended doses of their antibiotics, the cure rates were almost identical, 83.5 percent for those who also got the second antibiotic, and 85.5 percent those who received just cephalexin.

MRSA has been showing up as a cause of more severe, abscessed skin infections, which has led to more dual prescribing of the antibiotics. Steele said this study’s results could inform emergency physicians that for cellulitis, absent abscess or a wound, the addition of the second antibiotic wasn’t more effective.

Amy Stubbs, M.D.

Amy Stubbs, M.D., helped oversee Truman’s portion of the research. She’s an assistant professor of emergency medicine at the School of Medicine and director of the school’s emergency medicine residency program. She completed her residency in emergency medicine at UMKC and was chief resident.

The National Institutes of Health sponsored the study, which Steele said was particularly well constructed to meet the standards of JAMA, the world’s most widely circulated medical journal.

It was the third in a series of published studies by the emergency research group, called the EMERGEncy ID NET. One dealt with treatment of abscesses and was published in the New England Journal of Medicine. Another looked at infected wounds seen by emergency physicians and was published in the journal Clinical Infectious Diseases.

Emergency medicine students win regional Sim Wars competition

The School of Medicine’s Sim Wars team (front row): Bradee Gabel, Alana Hoffman, Emily Hillman, M.D.; back row: Sean Mark, Brendan Kurtz, Alie Reinbold, Caroline Baghdiikian, Jesal Amin, Dylan Wyatt and Devan Bhatia. Not pictured is Maggie Kirwin.

Students from the UMKC School of Medicine returned from the Great Plains Regional Meeting of the Society for Academic Emergency Medicine with more than new insights into emergency medicine.

For the first time, UMKC also brought home the championship trophy from the annual Student Sim Wars competition. The event was held in Iowa City, Iowa.

“They were so well prepared,” said Emily Hillman, M.D., assistant professor, assistant program director and clerkship director for emergency medicine. “They represented the school so well. I was really happy for them.”

School of Medicine students take part in a Sim Wars competition.

The contest places four-person teams in an emergency patient scenario in which students must work together to assess a patient, intervene and manage the situation. Students work on a manikin simulator that serves as the patient, while also managing the patients’ family members, played by actors. Judges review and grade the students on their teamwork, communication and clinical decision-making skills.

Seven teams from six regional medical schools, including two from UMKC, competed in a bracketed format. The winning team of Alie Reinbold, Jesal Amin, Caroline Baghdikian, Sean Mark and Brendan Kurtz, defeated teams from the University of Iowa, Washington University and Southern Illinois University to capture the championship trophy. Maggie Kirwin, Alana Hofmann, Bradee Gabel, Dylan Wyatt and Deven Bhatia made up UMKC’s second competition team. Five more students, Joseph Bennett, Alex Willis, Timothy Chow, Kent Buxton and Danielle Graves, were part of the school’s Sim Wars teams that practiced and helped prepare the competition teams.

Students met with faculty and residents from the Department of Medicine twice a week for two months in the Youngblood Medical Skills Lab at the School of Medicine’s Clinical Training Facility to practice and train for competition using the SIMman simulator and other low-fidelity procedural models.

“They worked hard to prepare,” Hillman said. “Some of the students had been on the team for a number of years. It was very exciting to see them win.”

School of Medicine Alumni Award winner stresses importance of immunization

Global Health panel
Karen Remley, M.D. ’80, center, discussed vaccination and other topics at a panel with fellow UMKC Alumni Award winners Alex Garza, M.D., left, and Bernard Beall, Ph.D.

A School of Medicine alumna who leads an organization of 64,000 pediatricians reiterated the safety and effectiveness of immunization at a panel discussion at UMKC.

Karen Remley, M.D. ’80, MBA, M.P.H., received the School of Medicine’s Alumni Achievement Award at a luncheon on April 21. Later that day, she participated in a panel discussion on global health. Raymond Cattaneo, M.D. ’03, M.P.H., president of the UMKC Alumni Association and assistant dean for years 1 and 2 medicine, moderated the discussion.

Remley became chief executive officer of the American Academy of Pediatrics in 2015. She said one of the organization’s objectives is to provide accurate and timely information to the public.

Last September, when Remley had been on the job only a few days, she reacted quickly when false statements about immunizations were made during a Republican presidential debate. Within hours, she issued a statement that vaccines are “one of the safest, most effective and most important medical innovations of our time.”

Remley also spoke out after the Tribeca Film Festival in New York City scheduled the showing of anti-vaccine film. The film was eventually dropped from the lineup.

“One of the most important roles that the academy has is to be the fair broker of honest information, because we are a trusted voice,” she said at the panel, which took place at the Student Union on the Volker campus.

Remley described her career as a “series of fellowships.” She has been a pediatrician, a pediatric emergency physician, an academician, a health plan medical director and a hospital’s chief medical officer. From 2008 to 2012, she was the commissioner of health for the Commonwealth of Virginia.

Working as a state health commissioner required a wide range of expertise. Remley said she used to joke that regulating power plants and septic systems was not taught in medical school. But, she added, the six-year B.A./M.D. program had prepared her to meet a challenge.

“They did teach me at UMKC how to learn and how to keep moving forward and how to trust in your team,” she said.

Remley appeared on the panel with Alex Garza, M.D., M.P.H., and Bernard Beall, Ph.D., who also received awards from the UMKC Alumni Association Governing Board. Each year, the board and the campus recognize outstanding alumni at a luncheon event that also serves to raise funds for student scholarships.

Garza received the UMKC Alumnus of the Year Award. Beall was the School of Biological Sciences’ Alumni Achievement Award winner.

Garza was chief medical officer for the U.S. Department of Homeland Security from 2009 to 2013. Now on the faculty of the College for Public Health and Social Justice at Saint Louis University, he trained in emergency medicine at UMKC after receiving his medical degree from the University of Missouri-Columbia.

During the panel discussion, Garza acknowledged Matthew Gratton, M.D., professor and chair of emergency medicine at the UMKC School of Medicine. Gratton was medical director of the Metropolitan Ambulances Services Trust, where Garza worked as a paramedic before starting medical school. Their paths crossed again when Garza began training in the emergency department at Truman Medical Centers. Both served in the Iraq War.

Garza echoed Remley’s comments about the safety and effectiveness of vaccines. “The science is clear,” he said. “There is no doubt vaccines work and that they do not cause harm.”

Beall leads the Streptococcus Laboratory at the Centers for Disease Control, where he and his team study and characterize the bacterial strains causing strep throat, skin and blood infections and pneumonia. Conducting population-based surveillance of invasive pathogens, Beall said, “You get the opportunity to be a participant in the larger possible kind of experiment.”

Graduate writes reader-friendly emergency medicine review book

Sajid Khan, M.D. ’05
Sajid Khan, M.D. ’05
A School of Medicine graduate and instructor has written a book designed to help emergency physicians review for the exams they take to become and stay board-certified.

Sajid Khan, M.D. ’05, clinical assistant professor of medicine, wrote The Ultimate Emergency Medicine Guide: The Only Book You Need to Succeed to fill a void he saw in existing review books — many of which become outdated by the time they are released and which he found were not reflective of actual test content. “There is no book that incorporates practice questions, mnemonics and pictures,” he said. “And why does it take three paragraphs to say something that can be written in one?”

The Ultimate Emergency Medicine Guide addresses these issues and more. It is organized around the different aspects of emergency medicine — cardiology, neurology, trauma, etc. — and concludes with a practice test. It contains dozens of illustrations, photographs and X-rays, which Khan presents clearly and supports with conversational language.

“I’m more of a visual learner,” he said. “If you hand me a paper on stroke and ask me to memorize it, I know there are better ways for me to learn.”

Emergency medicine residents take an in-service exam every year, something Khan likens to a practice test for the American Board of Emergency Medicine qualifying exam, which is taken the first year after graduating from residency. Another exam is taken every 10 years to maintain their emergency physician certification. Khan designed his guide to better prepare physicians for each of those steps.

Khan said residents preparing for the boards often make a mistake by focusing on exotic cases. In reality, he said, residents are more likely to face uncommon questions about common diseases. “To be a good EM physician, you have to know a little bit about everything, and each of those subjects are covered in this book. But those zebras aren’t the things you’re going to miss on the test,” he said.

The Ultimate Emergency Medicine Guide includes some of Khan’s favorite mnemonic devices. “AEIOU summarizes the indications for emergency dialysis,” he explained. “It stands for acidosis (refractory), electrolyte abnormalities (hyperkalemia), ingestion, overload and uremia. Taking that one step further, another helpful mnemonic is I-STUMBLED, which refers to ingestions that can be dialyzed: isopropyl alcohol, salicylates, theophylline, uremia, methanol, barbiturates, lithium, ethanol/ethylene glycol, depakote. That’s a hard list to memorize without a mnemonic.”

Khan used a publishing company which allows him to make regular updates based on feedback received from residents and test takers, ensuring that it is always up to date. The book is available at Amazon and other online sources.

The Ultimate Emergency Medicine Guide is Khan’s second book. In 2013, he published Khan’s Cases: Medical Ethics 101 with his wife and co-author, Maryam Arshad, M.D. That book addresses the ethical principles featured in the Step 1 exam and provides real-world cases — many drawn from Khan’s personal experiences.

“Ethical scenarios are never black or white,” he said, “but using the AMA’s Code of Medical Ethics, you can have a framework for how to make difficult decisions.”

Khan completed his residency in emergency medicine at UMKC/Truman Medical Center in 2008 and joined the Department of Emergency Medicine faculty in 2010. His clinical experiences include a period of service as the medical director of the emergency department at Golden Valley Memorial Hospital in Clinton, Missouri. He is currently the assistant medical director of the emergency department at Cartersville Medical Center in Cartersville, Georgia.

SOM’s Litzau earns national honor in emergency medicine

Litzau Megan 5x7_5803
Megan Litzau

Megan Litzau, MS 6, has been selected as a winner of the 2015 American College of Emergency Physicians National Outstanding Medical Student Award.

The award recognizes a medical student who intends to pursue emergency medicine careers and has displayed outstanding patient care and involvement in medical organizations and the community. Litzau will continue her training in emergency medicine with a residency at the Indiana University School of Medicine.

Litzau has served as president of the school’s Emergency Medicine Interest Group and organized teams and training sessions for students who participated in the Society for Academic Emergency Medicine’s annual SimWars competition last September. A team from the School of Medicine finished second in the competition by one point.

Litzau has also been an active research participant, working on numerous research projects as a student. She presented two posters at the 2015 UMKC Health Sciences Student Research Summit in April and received the second prize for best student poster.

She has also been selected for a number of School of Medicine Senior Awards given to graduating students including Missouri State Medical Association Honors Graduate; Society for Academic Emergency Medicine Award; Thomas R. Hamilton, M.D., Award for Excellence in Microbiology; Thomas R. Hamilton, M.D., Award for Excellence in Pathology; Vice Chancellor’s Honor Roll Recipient Award and the Women in Medicine Scholarship Achievement Citation.

Litzau will receive her American College of Emergency Physicians award in October at the organization’s annual scientific assembly in Boston.

Responder discusses effort to control Ebola outbreak in Liberia

Thomas Kirsch, M.D., M.P.H.
Thomas Kirsch, M.D., M.P.H.

An expert in disaster management and science who responded to the Ebola outbreak in Liberia said the disease had essentially been eradicated there.

Thomas Kirsch, M.D., M.P.H., director of the Center for Refugee and Disaster Response and an associate professor of emergency medicine at Johns Hopkins University, traveled to Monrovia, the Liberian capital, to work in an emergency operations center during the crisis late last year. He presented the W. Kendall McNabney, M.D., Lecture at the School of Medicine on April 30.

The largest Ebola outbreak ever recorded primarily affected the West African countries of Liberia, Sierra Leone and Guinea. More than 10,000 people died, according to the World Health Organization. “We went from a small, isolated outbreak of a very scary disease, that is a horrible way to die, that has a mortality rate of up to 90 percent, to this massive outbreak, which clearly caught the attention of the world,” Kirsch explained.

When he arrived in Liberia, Kirsch said he expected to find himself in a “zombie apocalypse.” Instead, he found that life in Monrovia was relatively normal. Shops were open, and people were going about their daily lives.

But there were washing stations with bleach solution in front of every building. Also, hand shakes and other forms of touching were forbidden, which Kirsch found disorienting. “Try to go through life like that,” he said. “It’s very odd, it’s very disturbing. But that’s the way people lived there.”

Kirsch was modest and stressed that the focus of his efforts in Liberia was on public health and that he did not provide clinical care. “I was a bureaucrat,” he said.

The United States spent hundreds millions of dollars and deployed troops to Liberia, a historical ally, when estimates suggested failure to act would result in 1 million people in West Africa becoming infected. But the disease was on the wane before the military opened its first treatment center. “Clearly, it was not the Ebola treatment beds that turned this epidemic,” Kirsch said.

What had changed was people’s behavior, Kirsch said. In addition to hand washing stations, isolating the sick and safer burial practices helped to bring the disease under control. “When a first spike occurs in your community, and you watch your neighbors vomiting on the street and dying, you change your behavior,” Kirsch said.

Kirsch said the competence of the political leaders and public health officials in Liberia was key to the social mobilization and education efforts. While there have been no known community transmissions in 80 days, a Liberian woman’s infection was confirmed in March. It is believed she contracted Ebola from unprotected sex with a man who survived the virus. The virus has been found in the semen of some men who have recovered from the infection. “This disease is now endemic in West Africa,” Kirsch said.

Kirsch, however, sounded optimistic that an Ebola vaccine would be developed eventually. “Ebola is a stupid little virus,” he said. “It’s not HIV.”

Gaddis keeps busy teaching, speaking schedule

Gary Gaddis, M.D., Missouri Endowed Chair for Emergency Medicine, spoke to more than 800 physicians at the Pan-Pacific Emergency Medicine Congress in Daejeon, South Korea, on Oct. 15.
Gary Gaddis, M.D., Missouri Endowed Chair for Emergency Medicine, spoke to more than 800 physicians at the Pan-Pacific Emergency Medicine Congress in Daejeon, South Korea, on Oct. 15.

Gary Gaddis, M.D., Missouri Endowed Chair for Emergency Medicine, gave two lectures at the Fifth World Congress of Emergency Medicine conducted Nov. 19-22 in Guadalajara, Jalisco, Mexico. He also traveled to Daejeon, South Korea, where he gave two talks on Oct. 15 at the Pan-Pacific Emergency Medicine Congress. He then spent Nov. 7 and 8 in Irving, Texas., presenting 14 hours of instruction in biostatistics at the American College of Emergency Physicians Emergency Medicine Basic Research Skills course.

In Mexico, Gaddis spoke on how to recognize and treat drug related problems in the emergency room and gave another talk on the muscle disease Rhabdomyolysis and its adverse consequences. He presented his topics to more than 300 Mexican emergency medicine physicians and nurses with the help of Saint Luke’s medical interpreter Carlos Rodriguez who aided in translating the presentations into Spanish.

His presentations in South Korea included a keynote/plenary presentation “Medication Related Problems in the Emergency Department: How to Recognize Them and What Do About Them,” and a research methods presentation, “Testing for Non-Inferiority: An Overview.”

Gaddis said the official recognition of the emergency medicine specialty in South Korea and the existence of emergency medicine residency training programs has a much shorter history in Korea than in the United States. Many of the struggles of the specialty in Korea are the same struggles that the specialty of emergency medicine underwent in the United States 20 to 30 years ago, Gaddis said.

The American Academy of Emergency Medicine partnered with the Korean Society of Emergency Medicine to present the congress to foster education and the development of the specialty. The American academy has partnered with a  number of emergency medicine societies around the world to foster development of the specialty.

Gaddis said his keynote talk on medication-related problems covered a common, yet poorly recognized issue by emergency physicians.

“In Korea, as in the United States, patients may not fill all of their prescriptions with one pharmacy,” Gaddis said. “They may not understand their medications. They may be taking problem-prone medications and their medication regimens may be confounded by extreme poly-pharmacy.”

Gaddis made practical suggestions to make the audience more aware of medication-related problems so that physicians might be able to recognize them more frequently and act upon them more appropriately.

His second presentation explored how most clinical studies are concerned with demonstrating a hypothesized difference between groups being studied. A “non-inferiority” study design should be utilized when a new treatment might or might not be similarly effective as the current treatment, and when that new treatment constitutes less burden to the patient or to the medical team delivering it, he said. The main question when evaluating for “non-inferiority” is how much difference between the new, less burdensome treatment and the standard treatment can be tolerated to permit the conclusion that the two treatments are so similar that the difference between them is too small to matter.

Gaddis used a highly animated presentation to demonstrate that these studies are not as complex or as difficult to understand as most physicians believe. The key to understanding non-inferiority designs is to understand how to set the “cutoff” for the margin of difference between treatments and to understand the use of the confidence intervals for the amount of difference between treatments to determine whether or not the two treatments are sufficiently similar that “non-inferiority” can be concluded.

More than 800 physicians attended the joint effort between the Korean Society of Emergency Medicine and the American Academy of Emergency Medicine. The event promotes the exchange of academic advancements in emergency medicine through three days of workshops and lectures from renowned scholars and experts. This year’s event also celebrated the 25th anniversary of the Korean emergency medicine society.

The emergency physicians’ November research course offered at the American College of Emergency Physicians’ national headquarters is a mini research fellowship for early-career emergency physicians who are beginning their research careers. During a 10-day period in November, younger physicians receive help in preparing an initial research project that they will implement at their home institution. They receive mentoring throughout the period between the initial classes in November and a presentation of their results in April.

Faculty, including Gaddis, who is mentoring three attendees from Lithuania, provide their research experience to mentor younger physicians to plan and execute their own research projects.


EMS Field Day provides new experience for emergency medicine residents

School of Medicine residents from the Emergency Medicine Residency program teammed up with emergency medical services personnel from the Grandview Fire Department on July 21 for EMS Field Day, a joint training session in out-of-hospital emergency and trauyma services.
School of Medicine residents from the Emergency Medicine Residency program teammed up with emergency medical services personnel from the Grandview Fire Department on July 21 for EMS Field Day, a joint training session in out-of-hospital emergency and trauma services.

Smoke billowed from the door of a small Grandview, Mo., structure on July 21 as a group of UMKC School of Medicine Emergency Medicine Residents dressed in fire fighting gear ventured inside to rescue a victim. A short time later, they watched from nearby as an emergency medical crew from the Grandview Fire Department worked to extract an accident victim from a crushed vehicle.

Fortunately, the victims were mannequins and the emergencies mere simulations. But for 11 members of the Emergency Medicine Residency program, the School’s first EMS Field Day provided a first-hand look at what takes place with trauma victims outside the hospital setting before they reach the emergency room.

“Emergency medicine is a specialty field that needs to be involved with out-of-hospital patient care,” said Matt Gratton, M.D., professor and chair of emergency medicine. “This field day is a wonderful up-close-and-personal way to show residents this.”

Before the day was over, residents had climbed to the top of the extension ladder on a Grandview fire truck and been introduced to Life Flight Eagle, an air-ambulance helicopter.

The day-long program, including both classroom and hands-on simulations, was a joint training session bringing together Grandview EMS personnel and the resident emergency medicine physicians from UMKC coordinated by the School’s Department of Emergency Medicine, its Emergency Medical Services Program, the Grandview Fire Department and Life Flight Eagle.

“This is kind of an introduction for emergency medicine residents to what takes place out in the field,” said Paul Ganss, M.S., NRP, NCEE, CHSE, the EMS education director and manager of the School’s Clinical Training Facility. “They get to meet some of the out-of-hospital care providers and experience what happens in the field. In the past, emergency medicine physicians might wonder why they didn’t get a piece of information or why wasn’t something done before the patient got to the emergency room. This gives them an idea of some of the things that happen in the field.”

Ganss said the event provided residents with an eye-opening experience.

“They got the opportunity to pick up some background and knowledge,” he said. “We’re looking at doing this again in the future, refining it and making it even better.”


Noted emergency medicine physician delivers 2014 McNabney Lecture

Jerome Hoffman, M.D., professor emeritus of medicine and emergency medicine at the UCLA School of Medicine, delivered the annual McNabney Lectureship on May 22.
Jerome Hoffman, M.D., professor emeritus of medicine and emergency medicine at the UCLA School of Medicine, delivered the annual McNabney Lectureship on May 22.

Jerome R. Hoffman, M.D., M.A., professor emeritus of medicine and emergency medicine at the UCLA David Geffen School of Medicine delivered the annual McNabney Lecture at the UMKC School of Medicine on May 22.

Hoffman spoke on what he calls a modern epidemic of over-diagnosis in medicine.

The lectureship honors Kendall McNabney, M.D., who founded the Department of Emergency Medicine at Truman Medical Center and the UMKC School of Medicine in 1973. McNabney was the first and longest serving chair of emergency medicine at the School and served as the head of trauma services for many years.

Hoffman served as director of the UCLA emergency medicine residency program and the school’s doctoring program and taught for more than 30 years in the UCLA School of Medicine and the Robert Woods Johnson Clinical Scholars Program.

He was a consultant toxicologist for the Los Angeles Regional Poison Control Center for more than a decade and served as a reviewer, editorial board member and editor for a number of medical journals throughout his career.

Much of his research has focused on health services and clinical decision making, as well as medical education.