LEADERTHE

When you are at your weakest, we are at our strongest.VOL 2 ISSUE 3

The ebola ImpacT

An Interview withmary verghese

Emergency MedicineSpecial Interest Groups

The New IUEMVISUAL MEDIA

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2 The leader 2014 | VOLUME 2 ISSUE 3

editor-in-chiefDaniel Rusyniak

managing editorMegan Palmer

executive editorPamela Durant

creative DirectorLauren Hernandez

05

student outreach clinicproviding free care to the uninsured and underinsured of the near-Eastside

The ebola Impacthow this deadly disease has impacted the department

06

Julie Welch’s hat-Trickthree honors and a close fourth place finish at the IUPUI regatta

07

mother maryan interview with Mary Verghese on her life outside the ED 08

The call of the Wilda look into the Wilderness Medicine Special Interest group

10

em-sIg historya history of the Emergency Medicine Special Interest Group.

11

The New visual mediasee the new visual media department inside of IUEM12

leading in Research

The

CHOICE

TRIALby: Dana Musapatika

researchpublications

The Choice Trial is currently recruiting low risk chest pain

patients with no previous cardiac history in the IU Methodist ED. Patients are randomized to either have the physician speak with them utilizing a Decision Aid (next page) which indicates their calculated risk of having a heart attack or pre- heart attack within the next 45 days; or usual care without the use of the Decision Aid. The CHOICE Trial investigates the impact of providing low risk chest pain patients with this additional information and engaging them in the shared decision making process has on reducing hospital cost and increasing patient satisfaction while maintaining safety. Patient and physician interactions are videotaped in order to further evaluate the educational process and the degree of satisfaction within both groups.

At 45-days a follow-up assessment phone call is conducted with the patient and UB04 billing data is obtained for the 45 day time period. The hypothesis is that the decision aid information will further educate the

patient allowing them to make a more informed decision with the physician regarding their need for further cardiac testing and thereby reduce admissions, testing, and cost while maintaining safety. Every patient who comes to the emergency department with chest pains should be empowered with the information necessary for them to make an informed decision regarding their specific need for follow-up care. In addition they should also understand the limitations of what can be expected in the ED, and informed of all options available and recommended for them.

The study is being conducted primarily during the patient’s ED visit. The primary investigator for the trial is Dr. Eric Hess, MD (Mayo Clinic) and Dr. Jason schaffer is the IU Health Methodist site principal investigator. This multi-center trial is actively enrolling at five sites and has an anticipated total enrollment of 1160 patients. IU Health Methodist has 82 patients presently enrolled with an enrollment goal of 232 by the end of 2016.

Kline Ja, Hernandez J, Garrett JS, Jones AE. Pilot study of a protocol to administer inhaled nitric oxide to treat severe acute submassive pulmonary embolism. Emerg Med J 31:459-462, 2014. PMID: 23585574.

LaMantia MA, messina Fc, hobgood cD, Miller DK. Screening for delirium in the emergency department: a systematic review. Ann Emerg Med. 63:551-560. PMID:24355431.

Insenser M, Montes-Nieto R, Martínez-García MÁ, Durán EF, Santiuste C, Gómez V, Kline Ja, Escobar-Morreale HF, Jiménez D. Identification of reduced circulating haptoglobin concentration as a biomarker of the severity of pulmonary embolism: a nontargeted proteomic study. PLoS One:9(6):e100902. PMID: .

Kline Ja, Neumann D, Haug MA, Kammer DJ, Krabill VA. Decreased facial expression variability in patients with serious cardiopulmonary disease in the emergency care setting. Emerg Med J. Epub Jul 14, 2014. PMID: 25022275.

pang ps, Collins SP, Sauser K, Andrei AC, Storrow AB, Hollander JE, Tavares M, Spinar J, Macarie C, Raev D, Nowak R, Gheorghiade M, Mebazaa A. Assessment of dyspnea early in acute heart failure: patient characteristics and response differences between likert and visual analog scales. Acad Emerg Med. 21:659-666, 2014. PMID: 25039550.

Russell RT, Griffin RL, Weinstein e, Billmire DF. Esophageal button battery ingestions: Decreasing time to operative intervention by level I trauma activation.J Pediatr Surg. 49:1360-1362. PMID: 25148737.

Maisel A, Xue Y, van Veldhuisen DJ, Voors AA, Jaarsma T, pang ps, Butler J, Pitt B, Clopton P, de Boer RA. Effect of Spironolactone on 30-Day Death and Heart Failure Rehospitalization (from the COACH Study).Am J Cardiol 114:737-742. PMID: 25129066.

3 VOLUME 2 ISSUE 3 | The leader 2014

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4 The leader 2014 | VOLUME 2 ISSUE 3

leading in Education

Julie Welch’s HAT-TRICK These past few months

have been a busy time for Julie Welch. She

will receive the 2014 EMRA Mentorship award at the ACEP Scientific Assembly during the EMRA fall award ceremony on October 29th from 3:30 p.m. to 5p.m. This award recognizes a current EMRA alumnus who has demonstrated exceptional service as a mentor for medical students and/or residents in Emergency Medicine. Julie was also elected by the Alpha Omega Alpha (AOA) Honor Medical Society along with chief residents Katy Ash & Alex Rhea. This professional medical organization recognizes and advocates for excellence in scholarship and the highest ideals in the profession of medicine.

To keep her streak going she was recognized as a 2014 American Medical Association Inspirational Physician Award Honoree. The award provides an opportunity for physicians

to express appreciation to the special men and women who have offered their time, wisdom and support throughout their professional journeys

Along with these great accomplishments Julie led this year’s IUSM regatta team, Women in Medicine for the Win, or “WIM for the Win,” to a fourth place finish in the Women’s division. Over 150 teams compete at this annual event and this group of women did an amazing job representing the IU School of Medicine & the Emergency Department. Additional members of the team were lauren bosshardt, third year emergency medicine resident, Krista Hoffman-Longtin, director of programs and evaluation for OFAPD, and Lindsay Leech a second year medical student.

Congratulations on these well-deserved awards and honors!

humbert aJ, Miech EJ. Measuring gains in the clinical reasoning of medical students: longitudinal results from a school-wide script concordance test. Acad Med.89:1046-1050. PMID: 24979174.

malka sT, Kessler CS, Abraham J, Emmet TW, Wilbur l. Professional E-mail Communication Among Health Care Providers: Proposing Evidence-Based Guidelines. Acad Med. Aug 26, 2014. PMID:25162617.

education publications

5 VOLUME 2 ISSUE 3 | The leader 2014

Lindsey Leech, Lauren Bosshardt, Julie Welch, and Krista Hoffman-Longtin row to 4th place in the

Womens Division at the IUPUI Regatta.

THE CALL OF THE WILD by Jonathon Drew and Jake Shopp

The Wilderness Medicine Student Interest Group (WMSIG), officially approved in April of

2014, explores methods of acute patient care in the wilderness and austere environments.  Formation of the group began with Jake Shopp (MS4), who received guidance from Drs. Julie Welch, Josh mugele, Kaia Knutson, and Jonathan “JD” Drew. These dedicated physicians were an integral part of the group’s establishment. Beyond being avid outdoors enthusiasts, cumulatively these physicians hold national certifications in Advanced Wilderness Life Support, PADI- Rescue Diver, American Academy of Snowboard Instruction, and Whitewater Raft Guiding. The WMSIG, currently with over 75 members, is open to those with a wide range of interests in the outdoors and includes medical students going into Emergency Medicine, Pediatrics, Surgery, and Family Medicine.

The WMSIG has had a number of activities this year. Topics for group lectures have included “Heat Injuries” and “Water Safety & Drowning.”  Thanks to the connections that Dr. Julie Welch has established with the University of Michigan’s Wilderness Medicine program, residents Jonathan and

Kaia were invited to instruct and guest lecture at the Advanced Wilderness Life Support Course (AWLS) in July. Jake Shopp (MS4) also attended this course and received his AWLS certification. Jonathan returned to guest lecture for their Wilderness Medicine medical student elective.

In September, two teams from IU’s WMSIG traveled to Chelsea, MI to participate in the “Midwest MedWAR,” an adventure race based around Wilderness Medicine skills and challenges.  IU had an outstanding showing, with one team finishing 3rd out of 31 teams.  Participants included Jonathan Drew, Jake Shopp, Lindsay Leech, Taylor Duncan, Jen Yu, and Anja Sklijarevski.

Upcoming events and lectures for the WMISIG include a weekend “hike and learn” camping trip, snow sports injuries/avalanche safety activities, and learning about venomous animals. If you would like more information on the WMSIG, or would like to be involved on the resident/faculty level, please do not hesitate to contactJake Shopp at jshoop@iupui.edu or Jonathan Drew at drewj@iupui.edu We look forward to expanding our group and embracing new opportunities in Wilderness Medicine!

leading in Education

6 The leader 2014 | VOLUME 2 ISSUE 3

7 VOLUME 2 ISSUE 3 | The leader 2014

EM-SIG A HISTORY BY BO STUBBLEFIELDThe Emergency Department at IU boasts one of the most successful and active student interest groups in the School of Medicine. The Emergency Medicine Student Interest Group (EMSIG) has been active for over a decade, and has flourished under the faculty leadership of Drs. chisholm, rodgers, Kirschner, Welch, pitre, beckman, and Weaver, among others.

Each year, five EM bound students are elected by a group of their peers to serve on the EMSIG board. The board members are a motivated group of students who facilitate medical student exposure to EM, and promote student-faculty and student-resident interactions. The SIG accomplishes these goals by hosting faculty lunch lectures on EM-related topics, scheduling EM informational sessions, and organizing EM social events, including the annual Rathskeller social. The SIG also sponsors annual EM simulation and skills labs, allowing interested students to work-up common emergency medicine cases, and practice procedures preformed in the emergency department in a controlled, educational environment.

The strength of the SIG is not only made possible by the dedicated faculty and exceptional students, but also the EM residents who are actively involved with the group. IU residents are continually willing to donate their time to attend EMSIG social events, lead informational sessions, and serve as educators during simulation and skills labs. Current residents including Drs. cantor, corson-Knowles, rhea, ash, rutz, blythe, phillips, Fitz, genovesi, Desai, Trotter, beard, elliott, and patel, among others, have been instrumental to the success of the SIG.

EMSIG is one of the oldest and most active student groups, and the overwhelming involvement of faculty and residents is a testament to the outstanding character of the residency program at IU. The SIG is proud to partner with The LeadER to provide quarterly EMSIG updates. This year, EMSIG is thrilled to host both simulation and skills labs at Fairbanks Hall under the direction of Dr. Dylan cooper. There will be newly collaborative simulations with the nursing school, and expanded skills lab opportunities. The EMSIG board graciously welcomes all new faculty and resident interest in the organization.

leading in EducationCurrent EM Sig president Krystin Thomas (left), poses with former presidents Bo Stubblefield (middle), and Rob Cantor, third year resident.

January 19, 1998 is a day mary verghese will never forget. Stepping off a plane in Detroit, Michigan, she was greeted by three and a half feet of snow,

and aside from her fellow passengers she did not see another human in site. Mary was born and raised in Northern India. Seeing pictures of snow, it turned out, was nothing like being surrounded by snow. Furthermore when you step off a plane in India you are enveloped by a mass of humanity. She arrived in the US as a new bride in an arranged marriage (yes—but she likes to note she did have veto power if she didn’t like the groom). Luckily her sister had found a great guy in America. The snow wasn’t the only thing she had to battle; she also had to become certified as a medical doctor in America. This meant she would have to do her residency again.

MotherMARY

Mary is the youngest of four girls, two sets of twins. By tradition the first two girls were named after their grandmothers, Sylvia and Rachel, and the second set after women in the Bible, Martha and Mary. The Christian faith was and is a central part of her life. Her father, a lawyer, devoted all his time to Christian ministry. Her parents instilled in her a strong sense of service to others. This became the core foundation for her life’s work and why she decided to become a doctor.

Always wanting to do medical mission work, the summer after high school she volunteered with the missionaries of charity, a group which focuses on serving the poorest of the poor in India. It was here that she spent time alongside the Mother Teresa who founded the organization. Mary describes her

featured Story

8 The leader 2014 | VOLUME 2 ISSUE 3

by Pamela Durant

Mary Verghese with her son Josh, and her husband Thompson.

as small in stature, but big on love. Mary loves telling stories about this woman whose selfless dedication had such an impact on her life: “Once Mother Teresa was walking along a crowded city street when she suddenly stopped. She asked, ‘Does anyone else hear that?’ Everyone in her group stopped, and tried to figure out what she was talking about. She said, ‘Listen, there is a baby crying.’ They tracked down the source of the noise, and there was a baby girl who had been discarded in a box next to a trash can. Mother Teresa picked the baby up and took it to her orphanage”.

Mary volunteered at this orphanage while she attended the Christian Medical College and throughout her pediatric residency. Here she did physical exams and cared for the children (mostly girls). Some of who had suffered terrible abuse often at the hands of a parent who had wanted a boy.

After Residency, Mary did two years of Medical Mission work in rural India. Often the only doctor on site she had to do every procedure and surgery—which she got very good at. How many amputations, hysterectomies, or cholecystectomies have any of us done? For Mary these became routine. For example she estimates that she’s done 1,000 Cesarean Sections. Mary is a person who loves what she does and is good at it. One skill she developed from all her time treating patients with cholera is the ability to start an IV on

anyone…Jen Walthall swears she could start an i.v. in a turnip.

No wonder completing her pediatric residency at the New York Medical College in Westchester went smoothly. As a second year resident she received the Resident Teaching Award and as a third year she was a Chief Resident and received the Outstanding Outgoing Resident award.

Even though many in the Department may not know her, she actually came on board as full time faculty at Riley in July 2004, and until recently she worked mostly the overnight shift. She loves working with kids, interacting with them, talking to them, and most off all—making them feel better.

Able to operate on little sleep, she and her husband Thompson have managed to raise an amazing son Josh, an athletic soccer player. Josh has been lucky to have his grandparents come visit from India regularly and he gets to visit them about every other year. Like his mother he is driven to serve. He has already gone on three missions including a recent ten-day trip to Haiti and wants to be a doctor, probably a pediatrician.

One question always asked of the faculty for this LeadER feature is, “Do you have a restaurant you would recommend?” Mary chose the Asian Grill in downtown Noblesville. Owned by two physicians, one from India, the other from Vietnam, they feature Pan-Asian dining. A new question just for fun, Mary was asked to name a member of our faculty who she’d like to see on “Dancing with the Stars”—she nominated Elizabeth Weinstein. Elizabeth is another great Riley physician who we’re sure would entertain audiences, the cast and crew, and give her mother something to be proud of.

An amazing woman and physician, we are lucky to have Mary in our Department, no wonder they call her Mother Mary.

9 VOLUME 2 ISSUE 3 | The leader 2014

St. Teresa’s Church and School: Mother Teresa as a Loreto nun, was assigned teaching and administrative duties at the school and Sunday Apostolate. Later, the first dispensary of the Missionaries of Charity was established here in 1949.

Mary is the youngest of four, two sets of twins, Mary is pictured here with

her twin sister Martha.

Indiana University student outreach clinic (IU-SOC) provides free care to the uninsured and underinsured of

the near-Eastside. While ethnically, culturally, and economically diverse, this neighborhood is known for its united sense of community. Unfortunately, 50% of area residents live at or below the poverty level, and most report unmet health needs.

In 2009, Dr. Javier Sevilla-Martir and medical students from the IU School of Medicine established the clinic in collaboration with Neighborhood Fellowship Church and Butler College of Pharmacy. IU-SOC was founded with the mission of providing quality healthcare to the underserved while enriching the professional development of students through service-learning. The clinic has since integrated the contributions of many more disciplines (medicine, pharmacy, dentistry, social work, law, physical therapy,

Indiana University

Student Outreach Clinicby Katie Meyer, Janice Farlow and Haig Setrakian

and occupational therapy) across three institutions (IU, Butler, and University of Indianapolis). During each four hour clinic, volunteers treat disease and address the socioeconomic concerns of their patients. Despite limited operating hours, close to 2,000 patient encounters are logged each year. The savings to the community for this care is immense; in 2012; almost 1,900 medications, $6,000 of lab work, dental services estimated at over $45,000, and countless referrals and resources were provided for free to community members.

The department of Emergency Medicine has a strong clinical presence at the clinic, staffing 4 months of the clinic this academic year and often contributing staff and residents whenever needed. Medical students are often surprised at the EM staff and resident’s facility with primary care in addition to acute illness.

leading in Clinical Services

Welch J, palmer m, mitchell a, house D, rodgers K, Wilbur l, Kline J, Ciccarelli M, rusyniak D. Faculty Mentoring Workshop. MedEdPORTAL; 2014. Available from: www.mededportal.org/publication/9778

mcIsaac e, Walthall J, sharp a. A trip through the Emergency Department: Cost Conscious Care. MedEdPORTAL; 2014. Available from: www.mededportal.org/publication/9784

Handel DA, Fu R, Vu E, Augustine JJ, Hsia RY, shufflebarger cm, Sun B. Association of emergency department and hospital characteristics with elopements and length of stay. J Emerg Med. 46:839-846. PMID:24462026.

Kirschner Jm, Kline Ja. Is it time to raise the bar? Age-adjusted D-dimer cutoff levels to exclude pulmonary embolism. Ann Emerg Med 64:86-87. PMID: 24951413.

clinical servicepublications

10 The leader 2014 | VOLUME 2 ISSUE 3

The Neighborhood Fellowship Church located on 3102 E.10th Street, Indianapolis, IN 46201 hosts the free clinic on most Saturdays from 10am - 2pm.

THE EBOLA IMPACTby: Lauren Herandez

We are all aware of the impact the recent Ebola Outbreak

has had on the world and our emergency medicine community. No one may know this better than Josh mugele who witnessed first-hand the devastation of this highly contagious disease. While completing his Disaster Medicine Fellowship in Nigeria Josh along with Chad Priest, former CEO of

MESH inc. and Assistant Dean for the IU School of Nursing, helped advised JFK memorial center in Monrovia, Liberia on how to handle the first signs of the Ebola Outbreak.

Upon returning to the United States Josh was interview by several local media outlets about his time in Africa. You can see one interview here. Josh & Chad’s friend and colleague Dr. Sam Brisbane unfortunately passed after contracting the disease June. Josh & Chad write about their time getting to know Dr. Brisbane in an article titled “A Good Death – Ebola and Sacrifice”. This article was recently published to the New England Journal of Medicine, for the full story visit here.

A fund has been created in Dr. Brisbane’s name. To learn more about this fundraiser visit here.

leading in Clinical Services

pang ps, Schuur JD. Emergency departments, acute heart failure, and admissions: one size does not fit all. JACC Heart Fail 2:278-280, 2014. PMID: 24952695.

Kline Ja. Making the black box more useful. Emerg Med J. Epub Aug 22, 2014 PMID: 25150196.

LaMantia MA, Boustani MA, Jhanji S, Maina M, Nazir A, messina Fc, Frame A, Alder C, Chodosh J. Redesigning acute care for cognitively impaired older adults: Optimizing health care services. Dementia (London). Epub Aug 15, 2014. PMID: 25128821.

mugele J, Priest C. A Good Death - Ebola and Sacrifice. N Engl J Med. Sep 3, 2014. PMID: 25185215.

clinical servicepublications

11 VOLUME 2 ISSUE 3 | The leader 2014

Josh Mugele with colleague and friend

Sam Brisbane

This summer we welcomed lauren hernandez as the new Technology & Marketing Coordinator. Under her leadership IUEM now offers the following visual media services: within our department.

POSTER PRINTINGThe Department of Emergency Medicine offers large-format printing for Poster Presentations. We have a HP DesignJet Z5200 printer with color output which can print on 24 or 36 in rolls. When ordering a poster please allow 3-4 business days to review your proof and receive your final print.

To submit a poster for print and review our printing policies you can visit here.

TEMPLATES & LOGOSPowerPoint templates are available for posters. We offer three different templates for you to choose from. Be creative and inspired! You can find these resources and more here.

PHOTOGRAPHY

Faculty Photos. The Department of Emergency Medicine offers free Faculty, Staff, Fellow, & Resident photos. Our department uses a Nikon D5200 (DSLR) camera. You may schedule an appointment online here.

Event Photography. If you have an IUEM event that you want photographed please contact Lauren Hernandez at hernanlr@iu.edu. Scheduling may be limited.

OUR NEW IUEM VISUAL MEDIA

Upcoming ConferencesNACCT North american congress of clinical Toxicology October 17-21New Orleans, LA

ACEP american college of emergency physiciansScientific Assembly 2014October 27-30Chicago, IL

Upcoming EventsWomen in medicine & science (WIms) conferenceOctober 10Glick Eye Institute (GK) 103

IUem Workshop – Interactive Teaching TechniquesOctober 16Ruth Lilly Medical Library (IB) 317

steven c. beering lecture 2014October 21Walther Hall (R3)

what’s New

12 The leader 2014 | VOLUME 2 ISSUE 3

Emergency Room Curtains by Chris Salib

He says it as a car accident,but we smell Russian Roulette.A doctor with a southern accenttries to piece together a brokenstory. It’s four minutes ‘tillone in the morning,sleep shies away from fluorescent lightsand the stiffnessof this starched hospital bed.

Pretty nurses with morphine-laced fingersdrip a dream intravenous,steady metronome bleepsand heavy breathing.The scene behind the membranousemergency room curtainsbecomes moredistant.

The ceiling grows whiter, more fibrous.Voices beyond the bedrails flood the room,the awkward clutter of electric machine, stainless steel and warm bodies Grows louder, but I begin to hear it less.All the immiscible colorsof a thousand pains and lesser curesswirl like gun greaseIn bright blood oily,above my head.

First published in The Intima: A Journal of Narrative Medicine Fall 2011 theintima.org Used with Permission.