Division of Pediatric Emergency Medicine

Saint Louis University's Division of Pediatric Emergency Medicine has primary responsibility for the care of patients at SSM Health Cardinal Glennon Children’s Hospital emergency department, a Level I Pediatric Trauma Center for Missouri and Illinois.

The division also coordinates and is responsible for medical control for all referrals that come through the emergency department, as well as for all the non-neonatal pediatric transports involving the Cardinal Glennon Children's Hospital transport team and the Cardinal Glennon Access Center.

A member of the department is on site and available to both the Transport Team and the Access Center around the clock for emergency care patient consultations, discussions on the need to transfer, and transport team support. In addition, either a fellow or attending is available 24 hours a day for the rare situations when a physician is required to accompany the transport team. John Peter, M.D., serves as the medical director for both the transport team and for the access center.

Pediatric Emergency Medicine Training

Our division trains fellows in emergency medicine and pediatric emergency medicine, pediatric and family medicine residents, family practice residents from affiliated hospitals, and medical students and physician assistant students from Saint Louis University.

We are also proud to have offered more than 20 years of PACTS/PALS courses to over 7,000 physicians, nurses, EMTs, paramedics and respiratory therapists. A web based PALS course is also offered, streamlining the on-site time commitment and increased access to health care providers. Steve Laffey, M.D., who is the medical director for clinical operations for the SSM Health Cardinal Glennon emergency department, also serves as the medical director of the PACTS/PALS program.

Our division also offers ED-ED telemedicine services to several suburban and rural emergency departments in the bi-state area. In addition, several of our faculty members donate their time to volunteering locally and globally and in serving in leadership roles for professional organizations and conferences.

Research

Research Highlights

Faculty and fellows within the Division of Pediatric Emergency Medicine conduct the majority of their research in three core areas: clinical medicine, disaster medicine and simulation training. 

Clinical Research

Core Leader:  Robert Flood, M.D.

Faculty and fellows conducted prospective studies on the management of extremity lacerations, the use of subcutaneous Hylenex for treatment of mild to moderate dehydration, and the use of breath-enhanced nebulizers for the treatment of asthma. Faculty and fellows conducted retrospective studies on immediate bedding and patient satisfaction, management of acute asthma exacerbation, and suspected child abuse. This work has included mentoring students from Saint Louis University.

Chelsea Majerus, M.D., was awarded a Fleur-de-lis grant to conduct a retrospective study on the clinical utility of obtaining chest radiographs in patients with asthma exacerbation. This study will utilize a natural language processing program; the first such study to be conducted in the Department of Pediatrics. Clinical research projects resulted in one publication in a peer-reviewed journal, three accepted peer-reviewed manuscripts pending publication, one peer-reviewed case report, three national abstract presentations, and two local abstract presentations.

Disaster Medicine Research

 

Core Leader: Rachel Charney, M.D.

Faculty and fellows conducted studies on disaster medicine including topics related to hospital preparedness, public expectations of hospitals’ responsibilities following a disaster, and the evaluation of a novel combined car seat and influenza vaccination drive-through clinic. This work has included collaboration with the Saint Louis University School of Public Health. Rachel Charney, M.D., completed work on an intramural Fleur-de-lis grant entitled “Racial disparities in public expectations of hospitals for non-medical resources during disasters.”

This work has included mentoring students from Saint Louis University. Disaster medicine research resulted in two publications in peer-reviewed journals, one accepted peer-reviewed manuscript pending publication, one peer-reviewed journal submission with a pending decision, one national abstract presentation, and two local abstract presentations.

Simulation Training Research

Core Leader: James Gerard, M.D.

Faculty completed studies on the use of simulation for skills training on the infant lumbar puncture. This work has included collaboration within a multicenter pediatric simulation research network (INSPIRE) and mentoring students from Saint Louis University. Drs. Gerard and Scalzo completed work on a grant from the Department of Defense – Office of Naval Research (DOD-ONR) to develop and validate a virtual pediatric simulator for training military physicians on high-stakes pediatric emergency medicine scenarios. A proposal for continued funding of this project was worked on during the academic year and submitted to the DOD-ONR in July of 2016 with a pending decision.

In addition, Drs. Nakanishi and Gerard are Co-PIs on a C-STARS grant proposal submitted to the DOD-Air Force during the academic year with a decision pending. This goal of this project is to develop virtual scenarios for training military medics on vascular access and rehydration of pediatric patients in a humanitarian relief setting. Simulation training research resulted in two publications in peer-reviewed journals, one peer-reviewed journal submission with a pending decision, two national abstract presentations, and one local abstract presentation.

Ongoing Research Studies

  • Troponin and Pediatric Trauma: Retrospective and Prospective
  • Poison Center Survey
  • Cat Gut and Facial Lacerations
  • PALS and Videotaping
  • Absorbable Sutures for Extremity Lacerations
  • "Increase Flow Utilizing Subcutaneous Enabled Pediatric Rehydration (INFUSE) II Study: Subcutaneous Rehydration with Recombinant Human Hyaluronidase Compared to Intravenous Rehydration in Infants and Young Children with Mild to Moderate Dehydration"
  • A Prospective, Randomized Study of Subcutaneous Hyaluronidase Augmented Fluid Versus IV Fluid in Children with Mild to Moderate Dehydration
    Carbon Monoxide Measurement in Triage
  • Asthma Protocol-Safety and Efficacy
  • Disaster Drill - Patient/Family Survey
  • Interstate Disaster Medical Cooperative- Survey
  • US and CV Access: Simulation Training
  • Saphenous Vein Location using US
  • CVP Measurement and Bedside US
  • Procedural Sedation Effectiveness and Obesity
  • Influenza-Like-Illness (ILI) Clinic Experience
  • Disaster Medicine Elective for Residents
  • Pediatric Resident's Current Level of Disaster Training (Survey of Peds Residents Across the Country)
  • Patient Outcomes in Simulation Education (POISE)
  • Abscess Study (Multi-Centered)

Research Projects in Progress

  • Screening residents for infant lumbar puncture readiness with just in time simulation-based assessments – Gerard. Manuscript submitted, decision pending.
  • Feasibility of the novel combination of influenza vaccinations & child passenger safety seat fittings in the drive-thru clinic setting – Le, Gerard, Charney. Manuscript submitted, decision pending.
  • Current trends and risk factors for bacteremia in pediatric patients – Forreter, Gerard. Manuscript in preparation.
  • Feasibility of hyaluronidase augmented subcutaneous administered ampicillin in a mouse model – Nakanishi. Manuscript in preparation.
  • Conservative versus suture repair of hand lacerations in the pediatric population – Nakanishi.  Data collection in process.
  • Prospective evaluation of efficacy, and parental, patient and staff satisfaction with Hylenex augmented subcutaneous fluid administration in the treatment of children with mild to moderate dehydration – Nakanishi.  Data collection in process.
  • Utility of chest radiographs in pediatric patients presenting to a pediatric emergency department with acute asthma exacerbation and chest pain – Majerus, Tredway, Gerard. Data collection in process.
  • Breath-enhanced nebulizer treatments in children with acute asthma: A comparative trial – Nakanishi. Data collection in process.
  • Clinical presentation of Fusobacterium infections in children: A PEMCRC multicenter study – Gerard. IRB protocol submission in process.
  • Correlation between LDH and uric acid in children with malignancies – Oriafio/Thomas. IRB protocol submission in process.
  • St. Louis area hospital-based violence intervention program – Flood. Study implementation in process.
  • Clinical characteristics of septic joint versus subperiosteal abscesses – Hartman/Flood. Study protocol development in process.
  • Ability of non-pediatric hospitals to care for trauma patients in a disaster setting – Charney. Study protocol development in process.

Grants

Grants Completed  
  • “A virtual pediatric simulator for emergency scenario training of military medical personnel” – Gerard. Office of Naval Research Contract # N00014-14-C-0046.
  • "Racial disparities in public expectations of hospitals for non-medical resources during disasters" - Charney. Fleur-de-lis grant.
Grants Awarded  
  • “Utility of chest radiographs in pediatric patients presenting to a pediatric emergency department with acute asthma exacerbation and chest pain” – Majerus/Tredway/Gerard. Fleur-de-lis grant.
Active Grants

 

  • "Feasibility of hyaluronidase augmented subcutaneous administered ampicillin in a mouse model" - Nakanishi. Fleur-de-lis grant.
Grant Proposals Submitted with Pending Decisions
  •  "A pediatric vascular access and rehydration simulator (PVARS) for training military medical personnel" - Nakanishi/Gerard. Proposal submitted to Air Force C-STARS funding agency.

Publications

Original Research Articles Published
  • Le N, Charney RL, Gerard J. Feasibility of a Novel Combination of Influenza Vaccinations and Child Passenger Safety Seat Fittings in a Drive-through Clinic Setting. Disaster Medicine and Public Health Preparedness, May 2017, DOI: 10.1017/dmp.2017.3
  • Le N, Charney R, Gerard J. Feasibility of the novel combination of influenza vaccinations and child passenger safety seat fittings in the drive-thru clinic setting. Disaster Med Public Health Prep. Accepted 11/5/16, publication pending.
  • Braun C, Kessler DO, Auerbach M, Mehta R, Scalzo AJ, Gerard JM. Can residents assess other providers' infant lumbar puncture skills?: Validity evidence for a global rating scale and subcomponent skills checklist. Pediatr Emerg Care. 2016 Oct 18. [Epub ahead of print]
  • Payne BS, Kutz TJ, Di Maio A, Gerard JM. Prevalence of retinal hemorrhages in infants presenting with isolated long bone fractures and evaluation for abuse. J Emerg Med. 2016 Oct;51(4):365-369
  • Kessler DO, Chang TP, Auerbach M, Fein DM, Lavoie ME, Trainor J, Lee MO, Gerard JM, Grossman D, Whitfill T, Pusic M. Screening residents for infant lumbar puncture readiness with just-in-time simulation-based assessments. Accepted by BMJ Simulation and Technology Enhanced Learning 8/5/16, publication pending.
  • Charney RL, Rebmann T, Dalawari P, Endrizal A. Public expectations of hospitals to provide resources and services to the uninjured during disasters: A qualitative study. Health Secur. 2016 Nov 11. [Epub ahead of print] Project funded by a Fleur-de-lis grant.
  • Flood R, Szwargulski P, Qureshi N, Bixby M, Laffey S, Pratt R, Gerard J. Immediate bedding and patient satisfaction in a pediatric emergency department. J Emerg Med 2016; 50:791-8.
  • Auerbach M, Fein DM, Chang TP, Gerard J, Zaveri P, Grossman D, Van Ittersum W, Rocker J, Whitfill T, Pusic M, Kessler DO. The correlation of workplace simulation-based assessments with interns' infant lumbar puncture success: A prospective, multicenter, observational study. Simul Healthc 2016; 11:126-33.
  • Kaar C, Gerard J, Nakanishi A. The use of a pediatric migraine practice guideline in an emergency department setting. Pediatr Emerg Care 2016; 32:435-9.
  • Pasternack JR, Dadiz R, McBeth R, Gerard JM, Scherzer D, Tiyyagura G, Zaveri P, Chang TP, Auerbach M, Kessler D. Qualitative study exploring implementation of a point-of-care competency-based lumbar puncture program across institutions. Acad Pediatr 2016; 16:621-9.
  • Cundiff KM, Flood RG, Gerard JM. Critical care interventions for asthmatic patients admitted from the emergency department to the pediatric intensive care unit. Accepted by Ped Emerg Care 10/21/15, publication pending.
  • Charney RL, Rebmann T, Flood RG. Emergency childcare for hospital workers during disasters. Pediatr Emerg Care. 2015 Dec;31(12):839-43.Charney RL, Rebmann T, Flood RG. Hospital employee willingness to work during earthquakes versus pandemics J Emerg Med. 2015 Nov;49(5):665-74.
Book Chapters
  • Pediatric Emergency Medicine Question Review Book 2017. Wang VJ, Flood RG, Godambe, SA (eds). www.lulu.com., 2016. (Early Release date 12/1/16)
  • Tredway TL. Medical Emergencies: Pulmonary. In: Pediatric Emergency Medicine Question Review Book 2017. Wang VJ, Flood RG, Godambe SA (eds). www.lulu.com., 2016.
  • Thomas SM. Medical Emergencies: Endocrinology. In: Pediatric Emergency Medicine Question Review Book 2017. Wang VJ, Flood RG, Godambe SA (eds). www.lulu.com., 2016.
  • Nakaknishi AK, Liu D. Medical Emergencies: Rheumatology. In: Pediatric Emergency Medicine Question Review Book 2017. Wang VJ, Flood RG, Godambe SA (eds). www.lulu.com., 2016.
  • Gerard JM. Medical Emergencies: Infectious Diseases II. In: Pediatric Emergency Medicine Question Review Book 2017. Wang VJ, Flood RG, Godambe SA (eds). www.lulu.com., 2016.
  • Charney R, Hoffman RJ. Environmental Emergencies. In: Pediatric Emergency Medicine Question Review Book 2017. Wang VJ, Flood RG, Godambe SA (eds). www.lulu.com., 2016.
  • DiMaio A. Child Abuse. In: Pediatric Emergency Medicine Question Review Book 2017. Wang VJ, Flood RG, Godambe SA (eds). www.lulu.com., 2016.
  • Laffey SP. Administrative, Legal, and Ethical Issues. In: Pediatric Emergency Medicine Question Review Book 2017. Wang VJ, Flood RG, Godambe SA (eds). www.lulu.com., 2016.
  • Qureshi NU, Gerard JM, Fayyadh J. Sickle Cell Disease in Children. In: Harwood-Nuss’ Clinical Practice of Emergency Medicine, 6th edition. Wolfson AB, Hendey GW, Ling LJ, Rosen CL, Schaider JJ, Cloutier RL (eds). Wolters Kluwer Health/Lippincott Williams & Wilkins, 2015.
  •  Chang TP, Gerard J, Pusic MV. Screen-Based Simulation, Virtual Reality, and Haptic Simulators. In: Comprehensive Healthcare Simulation: Pediatrics, 1st edition. Grant VJ, Cheng A (eds). Springer, 2015.
Abstract Presentations

National/International

  • Leonard KB, Heffner VA, Mistry RD, Eldridge C, Kennedy RM, Floyed RL, Tredway T, Mahajan P, Schnadower D. Development of a regional clinical skills boot camp curriculum for first year PEM fellows. Poster presentation at the Pediatric Academic Societies' Annual Meeting, Baltimore, MD, May 3rd, 2016.
  • Leonard KB, Mistry RD, Heffner VA, Eldridge C, Kennedy RM, Floyed RL, Tredway T, Mahajan P, Schnadower D. Implementation and evaluation of a regional clinical skills bootcamp for PEM fellows. Poster presentation at the Pediatric Academic Societies' Annual Meeting, Baltimore, MD, May 3rd, 2016.
  • Le NK, Gerard JM, Charney RL, Endrizal A. Feasibility of the novel combination of influenza vaccinations and child passenger safety seat fittings in the drive-thru clinic setting. Poster presentation at the Pediatric Academic Societies' Annual Meeting, Baltimore, MD, May 2nd, 2016.
  • Gerard JM, Scalzo AJ, Borgman MA, Watson CM, Byrnes CE, Chang TP, Auerbach M, Kessler DO, Feldman BL, Payne BS, Nibras S, Chokshi RK, Lopreiato JO. Validity evidence for a serious game to assess performance on critical pediatric emergency scenarios. Poster presentation at the Pediatric Academic Societies' Annual Meeting, Baltimore, MD, May 2nd, 2016.
  • Pahalyants V, Nagamuthu C, Gohel C, Jani P, Mitchell D, Dewan M, Khattab M, Frissell K, Pirie J, Rutledge C, Forrester K, Aitken D, Lemke D, Wolfe H, Pikwer A, Ornstedt T, Doughty C, Auerbach M, Walsh C, Kessler D, Tofil N, Alyssa R, MacKinnon R, Scalzo A, Gerard J, Castro D, Bastero P, Bray-Aschenbrenner A, Chang T. Implementing an international QCPR Leaderboard enrollment and data protocol using QR codes. Poster presentation at the 8th International Pediatric Simulation Symposia and Workshop, Glasgow, UK, May 10th, 2016.
  • Majerus C, Qureshi N. The case of a stubborn baby bottle, a photo case presentation. Poster presentation at the 22nd Annual Scientific Assembly of the American Academy of Emergency Medicine, Las Vegas, NV, February 19th, 2016.
  • Baram M, Gerard J, Quattromani E, Scalzo A. Correlation of acute generalized exanthematous pustulosis and hemolysis in brown recluse spider bites. Poster presentation at the Annual North American Congress of Clinical Toxicology, San Francisco, CA, October, 2015. NACCT.
  • Payne B, Gerard J, Kutz T. Prevalence of retinal hemorrhages in children without head injuries presenting with long bone fractures and concern for abuse. Poster presentation at the Pediatric Academic Societies Annual Meeting, San Diego, CA, April 28, 2015.
  • Cundiff KM, Gerard JM, Flood RG. Critical interventions for asthmatic patients admitted from the emergency department to the pediatric intensive care unit. Poster presentation at the Pediatric Academic Societies Annual Meeting, San Diego, CA, April 28, 2015.
  • Kessler DO, Auerbach M, Fein D, Chang T, Lee M, Mehta R, Gerard J, Trainor J, Pusic M. Implementation and impact of a just-in-time assessment to determine intern readiness to perform their first infant lumbar puncture. Poster presentation at the 15th International Meeting on Simulation in Healthcare, New Orleans, LA, January 13, 2015.

Local/Regional

  • Gerard JM, Scalzo AJ, Borgman MA, Watson CM, Byrnes CE, Chang TP, Auerbach M, Kessler DO, Feldman BL, Payne BS, Nibras SA,Chokshi RK, Lopreiato JO. Validity evidence for a serious game to assess performance on critical pediatric emergency scenarios. Platform presentation at Pediatric Science Days, Department of Pediatrics, Saint Louis University, St. Louis, MO, April 21, 2016.
  • Le NK, Charney R. Feasibility of the novel combination of influenza vaccinations & child passenger safety seat fittings in the drive-thru clinic setting. Platform presentation at Pediatric Science Days, Department of Pediatrics, Saint Louis University, St. Louis, MO, April 21, 2016.
  • Tredway TL, Garrett JS, Clark MG, Scalzo AJ. Minty fresh breath, coma and hypoglycemia in a 4 year old. Poster presentation at Pediatric Science Days, Department of Pediatrics, Saint Louis University, St. Louis, MO, April 21, 2016.
  • Majerus C, Qureshi N. The case of a stubborn baby bottle, a photo case presentation. Poster presentation at Pediatric Science Days, Department of Pediatrics, Saint Louis University, St. Louis, MO, April 21, 2016.
  • Charney RL, Remann T, Dalawari P, Endrizal A. Expectations of hospitals by the uninjured during disasters. Poster presentation at Pediatric Science Days, Department of Pediatrics, Saint Louis University, St. Louis, MO, April 21, 2016.
  • Baram M, Gerard J, Scalzo A. Correlation of acute generalized exanthematous pustulosis and hemolysis in brown recluse spider bites. Platform presentation at Pediatric Science Days, Department of Pediatrics, Saint Louis University, St. Louis, MO, April 16, 2015.
  • Payne B, Gerard J, Kutz T. Prevalence of retinal hemorrhages in children without head injuries presenting with long bone fractures and concern for abuse. Poster presentation at Pediatric Science Days, Department of Pediatrics, Saint Louis University, St. Louis, MO, April 16, 2015.
  • Rallo J, Forrester K, Gerard J, Sarin A, O'Connor D. Current trends and risk factors for bacteremia in pediatrics. Poster presentation at Pediatric Science Days, Department of Pediatrics, Saint Louis University, St. Louis, MO, April 16, 2015.