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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 pediatric emergency medicine, residents in pediatric and family medicine, 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. Steven 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.

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. 

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.

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 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.
Grants Active
  • Charney RL. Willingness of caregivers to provide personal information on missing children in disasters for the purpose of reunification. Michael Shannon Emergency Medicine Award. Amount: $5000. Role: Charney Co-PI
  • Charney, RL. Exposure and Preparedness For Natural and Man-Made Radiological Events. Washington University’s Clinical & Translational Research Funding Program. Amount: $49,938. Role: Charney Co-PI.
  • Flood RG. St. Louis Area Hospital Based Violence Intervention Program (STL-HVIP): LOV: Life Outside of Violence. Grant through the Missouri Foundation of Health. Amount: $1.6 million. Role: Flood Site PI.
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.
  • Majerus C, Tredway T, Gerard J. Predictors and utility of obtaining chest radiographs in patients with asthma exacerbation and chest pain. Fleur-de-lis intramural grant. 7/1/2016 – 6/30/17, Majerus (PI). Amount: $16,000.
  • Charney RL. Academic/practice partnerships to impact population health in chronic disease and emergency response. CDC/ OPHPR WIP 2016-N-03. 8/15/2016 - 8/14/2017, Lavin (PI). Amount: $144,976. Role: Key person
Grant Proposals Submitted with Pending Decisions
  • Gerard JM. Further development and validation of a virtual pediatric simulator for emergency scenario training of military medical personnel. Office of Naval Research. Amount: $711,768. Project selected for funding pending availability of funds FY18. Role: Gerard (PI).

Publications and Presentations

Original Research Articles Published
  1. 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 Med Public Health Prep. 2017 Dec;11(6):647-651. doi: 10.1017/dmp.2017.3. Epub 2017 May 2.  PMID:28462775

  2.  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. BMJ Simulation and Technology Enhanced Learning. 2017;3:17-22.

  3. 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. 2017 Feb;33(2):80-85. doi: 10.1097/PEC.0000000000000890.

  4. Charney RL, Rebmann T, Endrizal A, Dalawari P. The General Public's Attitudes and Beliefs Regarding Resource Management, Collaboration, and Community Assistance Centers During Disasters. Disaster Med Public Health Prep. 2018 Aug;12(4):446-449. doi: 10.1017/dmp.2017.108. Epub 2017 Oct 2. PMID:28965525

  5. Rivera-Sepulveda A, Garcia-Rivera EJ. Epidemiology of bronchiolitis: a description of emergency department visits and hospitalizations in Puerto Rico, 2010-2014. Trop Med Health. 2017 Oct 2;45:24. doi: 10.1186/s41182-017-0064-7. eCollection 2017. PMID: 29021713

  6. Scalzo AJ, Rivera-Sepulveda A. Poisoning, Overdoses, Toxic Exposures. Mo Med. 2018 Jul-Aug;115(4):302-305. PMID: 30228747

  7. Kaar CRJ, Nakanishi AK. Recreational and Commercial Catfishing Injuries: A Review of the Literature. Wilderness Environ Med. 2017 Dec;28(4):348-354. doi: 10.1016/j.wem.2017.07.007. Epub 2017 Sep 28. Review. PMID:28967487

  8. Forrester KR, Thomas SM, Gupta NK, Karumuri M, Gerard JM. Repeat Intravenous Ketamine Dosing in Children Undergoing Emergency Department Procedural Sedation. J Emerg Med. 2018 Nov 8. pii: S0736-4679(18)30966-1. doi: 10.1016/j.jemermed.2018.09.047. [Epub ahead of print] PMID:30415803

  9. Cundiff KM, Gerard JM, Flood RG. Critical Care Interventions for Asthmatic Patients Admitted From the Emergency Department to the Pediatric Intensive Care Unit. Pediatr Emerg Care. 2018 Jun;34(6):385-389. doi: 10.1097/PEC.0000000000001163. PMID:28538609

  10. Majerus CR, Tredway TL, Yun NK, Gerard JM. Utility of Chest Radiographs in Children Presenting to a Pediatric Emergency Department With Acute Asthma Exacerbation and Chest Pain. Pediatr Emerg Care. 2018 Sep 25. doi: 10.1097/PEC.0000000000001615. [Epub ahead of print] PMID:30256317

  11. 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 Medicine Scenarios. Simul Healthc. 2018 Jun;13(3):168-180. doi: 10.1097/SIH.0000000000000283

  12. Oriaifo I, Qureshi N. Pediatric Traumatic Aortic Dissection. A Case Report.
    Manuscript accepted by Visual Journal of Emergency Medicine
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

  • Rivera-Sepulveda AV. Risk factors associated with bronchiolitis in Puerto Rican children. Poster presentation at the Pediatric Academic Societies' Annual Meeting, San Francisco, CA, May 8th, 2017.
  • Majerus C, Tredway T, Gerard J. Predictors and utility of obtaining chest radiographs in patients with asthma exacerbation and chest pain. Poster presentation at the Pediatric Academic Societies' Annual Meeting, San Francisco, CA, May 8th, 2017.
  • Forrester K, Scalzo A. Leader-board gaming and simulation to teach CPR to high school students and practitioners. Platform presentation at the Pediatric Academic Societies' Annual Meeting, San Francisco, CA, May 7th, 2017.
  • Le N, Charney R. Feasibility of the novel combination of influenza vaccinations and child passenger safety seat fittings in the drive-thru clinic setting. Platform presentation at the World Association for Disaster and Emergency Medicine (WADEM) International Conference, Toronto, Canada, April 26th, 2017.
  • Oriaifo I, Qureshi N. Traumatic aortic dissection. Poster presentation at the 23rd Annual Scientific Assembly of the American Academy of Emergency Medicine, Orlando, FL, Mar 18th, 2017.
  • Forrester K, Gupta N, Karumuri M, Thomas S, Gerard J, Frequency of repeat ketamine dosing in children undergoing emergency department procedural sedation. Poster presentation at the Pediatric Academic Societies' Annual Meeting, Toronto, Canada, May 8th, 2018.
  • Charney R, Gerard J, Rivera-Sepulveda A. Adherence to Bronchiolitis Guidelines in Pediatric Emergency Departments. Poster presentation at the Pediatric Academic Societies' Annual Meeting, Toronto, Canada, May 5th, 2018.
  • Charney R. Separated after a disaster: trust and privacy issues in sharing children's personal information. Poster presentation at the Pediatric Academic Societies' Annual Meeting, Toronto, Canada, May 5th, 2018.
  • Oriaifo I, Ferguson W, Gerard JM. Diagnostic value of lactate dehydrogenase and uric acid as screening tools for malignancies in children. Poster presentation at the Pediatric Academic Societies' Annual Meeting, Toronto, Canada, May 6th, 2018.
  • Coleman K, Esposito F, Charney RL. Speeding up children reunification in disaster scenarios via serverless computing. Platform presentation at the 2nd Workshop of Serverless Computing (WoSC), Las Vegas, NV, December, 2017
  • Thé T, Curfman AL, Burnham CA, Hayes EV, Hagelskjaer Kristensen L, Cruz AT, Frenn KA, Lane RD, Cohen DM, Kaplan RL, Rominger A, Kam A, Freedman SB, Russo CJ, Gerard JM, Pickett ML, Ruttan TK, Meltzer JA, Navanandan N, Ulrich SL, Schnadower D. Presentation and outcomes of emergency department patients with Fusobacterium spp. bacteremia in an international multicenter study. Poster presentation at the Pediatric Academic Societies' Annual Meeting, Toronto, Canada, May 6th, 2018.
  • Charney RL. Personal preparedness of medical professional students and program administrators.  Poster presentation at the Disaster Health Education Symposium at the Uniformed Services University of the Health Sciences, Bethesda, MD, September, 2017
  • Forrester K, Qureshi N. Ocular trauma in a patient with Hemophilia A. Forrester/Qureshi. Poster presentation at the American Academy of Emergency Medicine 2018 Annual Scientific Assembly, San Diego, CA, April 9th, 2018.