Brown University
Department of
Emergency
Medicine
Newsletter
Our newsletter is
published twice a year
to provide news &
information about
Emergency Medicine
to the health system,
medical school, our
alumni and friends.
Department of
Emergency Medicine
TO PROVIDE EXCEPTIONAL EMERGENCY MEDICAL CARE, EDUCATION, RESEARCH
TO THE PEOPLE OF RHODE ISLAND BEYOND.
VOLUME 11, ISSUE 1
ISSUE:
Anderson EC
3
APP Program
13
Brown Faculty
9
Center for
Sports Medicine
13
CDU
6
EDHI
5
Education
10
EM Residency
11
Global EM
14
Injury Prevention
8
Med. Humanities
16
The Miriam ED
3
NeuroEmergencies
7
New Faculty
2
Newport EP
5
Pediatric EM
4
Research Funding
8
Sex & Gender
12
Stroke Center
7
Toxicology
6
SPRING/SUMMER 2016
Facing the Fire
Message from the Chair
INSIDE THIS
SERVICE
We heat our house primarily
with wood, with a soapstone
woodstove in the lower level.
The radiant warmth is much
Brian Zink, MD
appreciated on a cold evening.
The occasional burn I get on my hands or
arm when I am careless about placing a new
chunk of wood in a glowing hot stove is not
appreciated. As a profession, medicine can
be like that – we can bask in the warm glow
of having helped a patient or family, or we
can get burnt by episodes or situations that
make us wonder why we chose to be doc‐
tors.
burn out when physicians can carve out a
niche of expertise or subspecialty area that
is professionally rewarding and satisfying.
2. The torrent of electronic information and
communication that most of receive 24/7 on
our cell phones or computers needs to be
better managed. Putting the cell phone out
of reach (and earshot) when engaging in
family and social activities allows us to give
real attention to those we choose to spend
time with. Instead of being held in a hypnot‐
ic trance by the dinging signals and flashing
alerts on your phone or laptop, turn them off
and schedule time to check emails once or
twice a day. We need to swing the pendulum
back to de‐digitize and be engaged
with the real world around us.
Academics
In emergency medicine the report‐
ed burn out rate is reported to be
itself
3. The emergency physician’s irregu‐
among the highest of all medical
may be
lar schedule can cause marked disrup‐
specialties – approaching 55%.
tion of regular circadian rhythms.
(Medscape EM Lifestyle Report
protective
Katherine Sharkey, MD gave us tips –
2016) While I question the survey
from
keep to a standard core sleep sched‐
research and methodology used
burn out.
ule (80% of us are “larks”, and only
to assess emergency physicians on
20% “owls”); it’s best to advance con‐
burn out, if it is even half as high as
reported, it is still too much. We focused our secutive shifts with your natural clock; avoid
recent Brown Department of Emergency alcohol and caffeine as sleep regulators;
Medicine annual faculty retreat on physician avoid bright light after night shifts, and sleep
resiliency and preventing burn out. In a very as soon as you can; if you snore, get a sleep
interactive and interesting day we learned study to see if you have sleep apnea or other
more about the factors that contribute to sleep disorder.
burn out, and strategies for being a resilient 4. Outside hobbies, interests, and passions
academic physician. We had a great session are the key to life balance. These must be
on sleep hygiene from sleep expert Kathe‐ scheduled, nurtured and protected as much
rine Sharkey, MD. Some of the lessons that as your work time.
came out of the sessions that were coordi‐
nated by Laura McPeake, MD, Libby Nestor, 5. Take the time to manage your time. Physi‐
and Brian Clyne, and subsequent small group cians who proactively plan their weeks and
months, building in protected time for spe‐
discussions were as follows:
1. Academics may in itself be protective from
continued on page 2
PAGE 2
Facing the Fire ‐ Message from the Chair
cial work projects, family and friends, exercise and out‐
side interests, are more happy and successful than those
who “take what life gives them.” Committing an hour or
two to carefully plan out the next month, and sticking to
that plan, will pay off in reduced stress and anxiety about
your schedule.
It was gratifying to find that in the big picture of physi‐
cian burn out our group does not score as high (badly) as
the national averages for emergency physicians. We dis‐
cussed how it is better to prevent burn out by creating
resiliency rather than try to rescue someone who is al‐
ready burnt out. Resilience is not passively achieved, and
involves many factors. The take home from our Retreat
is that we can promote resilience by being mission and
vision‐focused (our purpose), creating opportunities for
faculty to develop niches, providing the most biologically
continued from page 1
compatible schedule possible, teaching ourselves mind‐
fulness, reducing stress through mentoring relation‐
ships, and protecting outside family time and hobbies
that replenish us. That’s all easier said than done, but the
first step to addressing a problem is acknowledging that
we have one. Burn out in physicians is a problem that
demands our attention. Our patients and families need
resilient physicians who can weather the challenges that
our jobs present, and find joy in our work. 
Brian J. Zink, MD
Frances Weeden Gibson ‐ Edward A. Iannuccilli, MD
Professor & Chair, Physician‐in‐Chief
Department of Emergency Medicine
Alpert Medical School of Brown University
Rhode Island, Newport & The Miriam Hospitals
Department of EM Faculty Retreat ‐ May 20, 2016
Welcome New Dept of EM Faculty!
Victoria Leytin, MD ‐
Assistant Professor (Clinical)
Kristina McAteer, MD ‐
Assistant Professor (Clinical)
Dr. Leytin joined our staff on Febru‐
ary 1, 2016. Dr. Leytin received her
medical degree at the University of
Connecticut School of Medicine.
She is a graduate of the Brown Uni‐
versity EM Residency Program.
Most recently, Dr. Leytin worked at
the Kent Hospital Emergency De‐
partment.
Dr. McAteer joined our staff on April
1, 2016. Dr. McAteer received her
medical degree at the University of
Vermont College of Medicine. She
graduated from the Brown Universi‐
ty EM Residency Program. Most re‐
cently, Dr. McAteer worked at the
Kent Hospital Emergency Depart‐
ment.
Dr. Leytin is working clinically at the
Anderson Emergency Center at
Rhode Island Hospital, The Miriam
Hospital ED & The Miriam Hospital
ED.
Dr. McAteer will be working primarily
at the Newport Hospital Emergency
Department with some shifts at the
Anderson Emergency Center.
Megan Ranney, MD, MPH ‐
Director of EM Special Projects
Dr. Megan Ranney assumed the role of
Director of Special Projects for UEMF and
the Department of Emergency Medicine
at the Alpert Medical School of Brown
University on March 1, 2016.
In this key position, Dr. Ranney is respon‐
sible for exploring, developing, and imple‐
menting clinical innovations that benefit
emergency patients across our four
Lifespan hospitals. As Founder and Direc‐
tor of the Emergency Digital Health Inno‐
vation program (EDHI), Megan has led
our expansion and exploration of the digi‐
tal world as it relates to our departmental
mission. She will continue to lead EDHI.
DEPARTMENT OF EMERGENCY MEDICINE
PAGE 3
David Portelli, MD, Medical Director,
Anderson Emergency Center, Rhode Island Hospital
Anderson Emergency Center
April 5, 2016 marked the 10 year anniversary fundamentally changed
of the opening of the Anderson Emergency the way we deliver care to
Center at Rhode Island Hospital. When it many of our patients. The
opened it was big, beautiful and well‐ change package includes:
equipped and today it can still be described
1. An EM Attending in Tri‐
similarly. So, we built it and the patients came – by foot,
age: This allows doctors
by bus, by car and 40% by EMS. So many came that our
to be able to better assess sick and non‐urgent patients
operational system could not handle the load. As wait
in order to admit or discharge more accurately from the
times increased over the years, many strategies were
start of care. Having a physician in Triage gets our pa‐
implemented to meet the demands of our
tients gets their workup ordered sooner and tri‐
patients, but there was no silver bullet that
AEC 2.0 has
aged accordingly to the various pods in the AEC.
ever put us consistently ahead.
improved patient
2. Vertical Flow Area: Our 10 bed E‐Pod has been
In the second decade of its existence, we flow & efficiency;
converted into a “results waiting area” where pa‐
reduced wait
thought it was appropriate to use data; evi‐
tients sit in recliner chairs (instead of stretchers). 9
times; and
dence‐based literature; and the experiences
of the rooms can hold up to two patients. The 10th
of other large and successful emergency de‐ increased patient
room is reserved for re‐examination or proce‐
satisfaction.
partments to “re‐boot” our AEC operations
dures. The physician in Triage “feeds” this area
with the goal of transforming the way we
with patients that have fairly “focused” or straight‐
deliver care to meet the needs and exceed the expecta‐
forward complaints and differentials. Advanced Practice
tions of our patients.
Providers (APPs) then follow up on the plans outlined by
We call this endeavor “AEC 2.0”, which is a “package” of the MD in triage. Not every patient needs a bed and
changes that have been applied together which have some are more comfortable waiting in a
continued on page 15
Gary Bubly, MD, Medical Director,
The Miriam Hospital, Emergency Department
The Miriam Hospital Emergency Department
sis of our existing architecture; collaboration with
As I have written in pretty much
nursing leadership; and invaluable input from one
TMH ED has
every newsletter, TMHED re‐
mains extremely busy and con‐ record patient of our EM attendings, Dr. William Binder. In this
tinues to grow. For the first volumes and has split flow model, we have turned our Team 3 area
quarter of the fiscal year, our implemented a into a "provider‐just‐behind‐triage" screening area
volume rose to 174 patients per day. In Janu‐ ‘rapid evaluation to assess hemodynamically stable patients who can
generally sit in a chair. The EDMDs enter patient
model’ for
ary, we experienced another growth spurt to
orders; perform the bulk of the note; and then care
patient flow.
180 per day. This trend has continued. As I
is completed by the APPs in Team 4. Team 4 has
write this, we are currently seeing about 193
patients per day. Some small amount of this increased essentially been converted into a ‘results waiting’ area
volume appears to be related to the flu. Some part of outfitted with recliners and chairs for higher capacity.
the increase appears to be related to changes at a near‐ After piloting this model two days a week in January, we
by emergency departments north of us. But, some of expanded this process to Monday through Thursday in
the volume increase, I believe, is due to our Depart‐ February. In June, we hope to expand this process
ment's exceptional reputation. Over the winter, the vol‐ change to 7 days a week. Although the new model start‐
ume increase coincided with a period of extremely high ed off with a
few bumps, we
inpatient census .
made modifica‐
Challenged for space and staff, we launched a new flow
tions based on
project In January 2016 dubbed the "Rapid Evaluation
staff input. Our
Model." This was the single biggest change we have im‐
team seems to
plemented to our patient flow in the last 4 years. We
be
adjusting
based the model on ideas gleaned from a tour of the
well. As our
Massachusetts General Hospital ED last summer,; analy‐
continued on page 13
team
has
DEPARTMENT OF EMERGENCY MEDICINE
PAGE 4
Frank Overly, MD
Medical Director, HCHED
Pediatric EM (PEM) at Hasbro Children’s Hospital
In January, Frank Overly, MD, became the
HCHED Medical Director, taking the reins
from Susan Duffy, MD, MPH, who did an
outstanding job in her tenure as Medical
Director. Physical changes are also under‐
way including the addition of a new clinical care space
called the “Initiation of Care Area”; a redesigned waiting
room; and an updated triage and registration area. The
renovations are on target
to be completed in the
next several months. But,
staff and patients’ families
are already appreciative
of the improvements thus
far. The Initiation of Care
Area provides additional
flexible space for patient
care, which is a timely ad‐
dition as the census is on
target to reach 53,000 patient visits this year.
Another exciting development is construction of the Pe‐
diatric Short Stay Unit. Dr. Duffy has been leading the
effort. Plans are well underway for this new 6 bed unit
which will be an extension of the HCHED. The unit will
provide care to patients who are in need of an extended
period of observation or ongoing treatment beyond
their ED visit. The Short Stay Unit is expected to open
later this year.
Dr. Duffy has accepted a new leadership role in UEMF/
Pediatric Emergency Medicine. She is now Director of
Pediatric EM Special Projects. Dr. Duffy will be focusing
her talents and energy on a variety of areas, including
community outreach and multiple academic and re‐
search projects. Dr. Laura Chapman has joined the lead‐
ership team as the new Associate Medical Director. In
addition, Dr. Deirdre Fearon has taken on the role of Di‐
rector of the Patient Experience Program. Dr. Fearon
will liaison with families and patients about recent visits.
She plans to develop new and creative projects focused
on making the Hasbro ED patient experience a more pos‐
itive one. Dr. Frances Turcotte‐Benedict will assume the
role of liaison to the Trauma Committee.
With the increased resources and growing patient vol‐
ume, the PEM group has continued to expand. We are
thrilled to announce that Dr. Robyn Wing, one of our
PEM Fellows, will become the newest member of the
group starting in August 2016. She will work closely with
Dr. Linda Brown, Medical Director of the Lifespan Medi‐
cal Simulation Center (LMSC) on educational and aca‐
demic simulation enhanced pro‐
jects. The PEM group is also very
proud to announce that Dr. Mariann
Nocera, one of our PEM Fellows
graduating in June, has accepted a
position at Connecticut Children’s
Hospital following completion of
her training. Her fellowship projects
including the introduction of an in‐
tubation checklist will serve as a lasting legacy here at
Hasbro. Dr. Nocera will be missed. Finally, we are looking
forward to welcoming our incoming fellows, Dr. Julie
Leviter (Yale) and Dr. Matt Lecuyer (Northwestern), who
will join us in July.
Due to our continuing growth, we are actively recruiting
for additional PEM attendings and Pediatric Advanced
Practice Practitioners.
In pediatric quality area, we continue to track time to
antibiotics for febrile neonates and meet the 3‐hour goal
more than 80% of the time. Some friendly competition
amongst staff has spurred on this initiative. We also con‐
tinue to participate in a multi‐institutional pediatric sep‐
sis collaborative and plan to have a new best practice
alert (BPA) in LifeChart/Epic soon. Creating a "smart"
algorithm in LifeChart with BPAs has been 2 years in the
making, so we are excited report a final product is nearly
a reality.
The Hasbro Emergency Department continues to be ac‐
tively involved in clinical research, and is currently re‐
cruiting for over 10 federally funded or industry‐
sponsored studies. Hasbro continues to meet and ex‐
ceed study enrollment goals. We are the top enrolling
site for ED STARS (PI: Sue Duffy), an NIMH‐funded study
that aims to develop and validate a novel adolescent sui‐
cide screen. Our site is also recruiting for a number of
diagnostic‐related studies, including a rapid stool test
(PI: Sue Duffy) and a Lyme evaluation blood test (PI: Aris
Garro). Hasbro will soon launch the Established Status
Epilepticus Treatment Trial (PI: Dale Steele), which is
only the second exception‐from‐informed‐consent study
to be done in the State. Also, Dr. Aris Garro was recently
awarded a NICHD, 2‐year granted for $450,000 for his
project “A Computer‐Based ED Intervention
to Improve Pediatric Asthma Medicine Ad‐
herence”. This is to investigate a technolo‐
gy based intervention to improve asthma
medication adherence.
Bill Lewander, MD ‐ Vice Chair
for Pediatric Emergency Medicine
DEPARTMENT OF EMERGENCY MEDICINE
PAGE 5
Anthony Napoli, MD
Medical Director
Newport Hospital Emergency Department
A lot has changed since our last newsletter. I
have been part of the Newport family for just
over 6‐months and I am extremely proud of
our team’s accomplishments.
As many of you know, we have been working hard over
the last several months to improve our operational pro‐
cesses to ensure that patients are seen sooner and more
efficiently; and to translate these changes into more sat‐
isfied patients with better outcomes. We are happy to
report that we have met and are exceeding those expec‐
tations to date. For the first six months of this year, we
have reduced our door to provider times by more than
50%, averaging 22 minutes. We have reduced our overall
length of stay for the average patient by
11%. Our left without being seen metric now
stands at 0.5% for the year, with a record 0.18%
for the month of March. We have been re‐
warded for this in our patient satisfaction sur‐
veys; our most recent survey placed us in the
top 10% of similar size emergency depart‐
ments nationwide. I particularly
thank each of the core Newport
providers as well as the many
providers who have started
working shifts and contributed
to this culture of being on the
move. Our success has been
recognized and celebrated by senior leadership in the
hospital and by Lifespan administration.
We now move into the busy summer season and we are
not sitting idle. We have a received support for an en‐
hanced provider staffing plan to match the expected 20‐
30% increase in daily volume. We are also in the process
of finalizing an enhanced triage process with a provider
in triage for a portion of the day on our
busiest days. Lastly, this summer we wel‐
come the arrival of senior emergency
medicine residents and look forward to
adding the Newport experience to their
training.
A cake from a recent celebration of our excellent service.
EDHI continues to be the only dig‐
ital health program in the nation
that focuses on the acute care
environment. Our mission is to
use digital health to transform the care of patients with
acute care needs ‐ before, during, and after their visit.
We continue to work on creating evidence that digital
health tools are acceptable and effective, for both clini‐
cians and patients in the emergency care setting; provid‐
ing expertise in the implementation of these tools; and
providing training in their use in clinical care.
Our members have been busy! Mark Zonfrillo, MD,
MSCE is getting trained as a physician‐builder of LifeC‐
hart/ Epic, which will be a huge help to all of us. We are
excited to welcome back Rebecca Armitage, Information
Projects Manager, who will help us to continue to inno‐
vate in the clinical sphere. We are also looking forward
to the summer assistantships of Kate Magid (Brown ’17)
and Margie Thorsen (AMS ’19). We wish best of luck to
Dr. Esther Choo, one of our founding members, who has
moved to Oregon Health and Sciences Institute; and to
our medical student intern, Faith Birnbaum MS‐4, who is
moving on to a residency in ophthalmology starting in
June.
It has been an active Spring season with grant submis‐
sions and paper publications. Our group has presented
at the New England Regional Directors (NERDS) annual
meeting and also the Society for Academic Emergency
Megan Ranney, MD, MPH
Director. EDHI & EM Special Projects
Medicine’s Annual Meet‐
ing.
We have developed a strong working rela‐
tionship with the Brown Bioinformatics
Core. We also continue to mentor students, and are de‐
veloping a pre‐clinical elective on digital health for medi‐
cal students.
Our clinical work has also advanced quickly, thanks in
large part to the support of Dr. Cedric Priebe, Lifespan’s
Chief Information Officer. We sit on the Lifespan‐wide
Research IT Council, which helps to prioritize Lifespan IT
projects to help the research community. Upcoming
projects include developing and testing a post‐discharge
text‐message program to improve follow‐up and satis‐
faction among subsets of ED patients. We hope this will
be one of our BCBSRI quality programs. Stay tuned for
news about this starting in the Summer and Fall.
We continue to hold monthly meetings, which range
from topic‐specific discussions to journal clubs to re‐
search‐in‐progress meetings. We also continue to host
undergraduates and medical students from a variety of
stages (MS‐1 to MS‐4) for electives.
And of course, if you have ideas for how we can study or
develop digital health tools to improve clinicians’ and
patients’ experiences, please let us know!
DEPARTMENT OF EMERGENCY MEDICINE
PAGE 6
Clinical Decision Unit at RIH’s Anderson Emergency Center
The Clinical Decision Unit (CDU) has undergone an excit‐
ing expansion in the types of patients we care for, which
has been made possible by our group fundamentally
changing the way we identify and manage low risk chest
pain patients. After standard emergency department
evaluation, providers now apply the HEART Score to risk
stratify our patients presenting with chest pain. In stud‐
ies, patients identified as low risk by HEART Score who
have serial negative troponins
at 0 and 3 hours have a 0.2% ma‐
jor adverse cardiac event rate at
30 days. Implementation of this
algorithm has resulted in a 33%
reduction in CDU chest pain ad‐
missions, without sacrificing
quality of care or patient safety.
This evidence‐based practice
change has created CDU capaci‐
ty for patients with a variety of
other diagnoses, from anaphy‐
laxis to pyelonephritis. We have collaborated with the
Jason Hack, MD
Director of Toxicology
EM Toxicology
The Division of Medical Toxicology would like
to wish a warm 2016 Summer welcome to eve‐
ryone. The Division continues to be both pro‐
ductive and innovative in the realms of local,
regional, and national presence.
This past season, the Division has lectured at the Depart‐
ment of EM educational conferences on various subjects,
including acetaminophen poisoning (Dr. Haag); pediatric
"One Pill Can Kill" (Dr. Karb); beta blockers and calcium
channel blocker toxicity (Dr. Blackwood); a talk on the in‐
toxicants available for sale on Amazon.com (Dr. Hack); and
an innovative performance piece on the difficult topic of
management of opioid seeking patients in the emergency
department (Dr. Hunnihan and Dr. Wolfe).
Our commitment to regional education was exhibited at
the RIACEP second Toxicological dinner symposium that
was held in December. The evening’s program involved a
dinner lecture by Dr. Hack on "Big Pic‐
tures of Toxicology" followed by cir‐
cuit lecturing given by residents from
both Brown and Kent hospitals. This
format allowed us to cover eight sepa‐
rate topics in medical toxicology in just
over two hours! Good friends, good
food, good education!
Patrick Sullivan, MD
Lead Physician, CDU
Departments of Urology, Hematology, Pulmo‐
nology, Infectious Disease and Internal Medi‐
cine to create the evidence‐based protocols
that guide the management of our CDU pa‐
tients with these diagnoses. These protocols provide
parameters for patient safety, standardized care, and
decreased resource utilization.
The outcomes for our CDU TIA patients for March 2016
show the benefits of our evidence‐based protocols. 26%
of our March TIA patients with no focal findings on exam
were found to have acute infarcts on MRI. Many other
essential, management changing findings were also
found during CDU observation, including: central venous
sinus thrombosis; microhemorrhages secondary to amy‐
loid angiopathy; and new onset atrial fibrillation. All of
this during our highest TIA volume month while main‐
taining a length of stay more than 60% shorter than an
inpatient TIA admission. This demonstrates the excel‐
lent care you are providing to our CDU patients – making
essential diagnoses in an efficient and safe manner that
patients truly appreciate. 
In April, Dr. Hack lectured the wilderness medicine interest
group on the ins‐and‐outs of poison snake bite manage‐
ment.
We recently released the new issue of the Toxic Natter—
the newsletter our Tox Division here at Brown.
In my new role as the editor for the Medical Toxicology Sec‐
tion of national ACEP, we just released our second issue. I
have named the publication “Toxicology Doc.” Hopefully
you will all read and enjoy this new newsletter. Please con‐
sider submitting a piece for publication.
The fourth work from our research group has been accept‐
ed for publication by the Journal of Emergency Medicine.
This article reports our findings when we administered In‐
tralipid to rats after inducing cardiac arrest with IV cocaine.
The Division has also recently completing writing three
medical toxicology chapters for a new online core text with
Dr. Naomi George. The work should be available before the
end of the year.
The ACEP Toxicology App that Dr. Hack assisted in editing
(available for the IOS and Android) was voted one of the
Best Medical Apps by iMedicalApps, in February. Please
consider downloading a copy (its free!) for your smart de‐
vice today.
And finally, Dr. Hack was very pleased to discover that his
review article on hyperglycemia with Dr. Van Ness‐Otunnu
was chosen for the 2016 LLSA test.
Photograph by Dr. Jason Hack
DEPARTMENT OF EMERGENCY MEDICINE
PAGE 7
Matthew Siket, MD
Co‐Director
Stroke Center
UEMF remains committed to providing progressive
stroke care at each of our EDs, including the primary
stroke centers at The Miriam and Newport Hospitals, the
Comprehensive Stroke Center (CSC) at Rhode Island
Hospital, and at Hasbro Children’s Hospital where pediat‐
ric stroke protocols have been developed. Together, our
providers provide emergent care to well over one thou‐
sand acute strokes per year.
Recently, thanks to a widely coordinated effort led by
the Rhode Island Stroke Task Force, we established a
statewide protocol for patients with emergent large ves‐
sel occlusion (ELVO). Our process was published in
the Journal of Neurointerventional Surgery in March of
this year and is serving as a model for other states. In
fact, since launching our new endovascular stroke pro‐
cess on July 1st of 2015, we have treated 113 patients
with embolectomy, making us by far the busiest endo‐
vascular stroke center in the Northeast. In doing so, we
have decreased the LOS for stroke patients with ELVO by
50% compared to historical averages, and have markedly
improved outcomes for the majority of patients. Moreo‐
ver, we implemented a hyperacute MRI process for pa‐
tients who previously would not have been offered
Lisa Merck, MD, MPH
Director, DEN
treatment, including those with “wake up”
symptoms. 12 patients beyond the standard
limit of 6 hours from time last known well (up
to 16 hours) have been selected for embolec‐
tomy by MRI, and 9 (75%) have improved clinically, in‐
cluding 5 who were discharged directly home with mini‐
mal deficits. We will soon be enrolling in the DEFUSE 3
clinical trial, which aims to provide convincing evidence
of the benefits of extended time‐window endovascular
care.
Regarding intravenous thrombolysis, RIH recently
learned that it is the 8th highest consumer of rt‐PA in the
country. So far in 2016, 72 thrombolytic patients were
treated at RIH (one‐third having been transferred to RIH
after treatment at another facility). The median admis‐
sion and discharge NIHSS was 13 and 1.5 respectively,
and the mean LOS was 4.1 days. The Miriam Hospital has
also further refined its process and has recently experi‐
enced its fastest door‐to‐treatment times ev‐
er. Although our imaging and treatment processes con‐
tinue to evolve, our providers have remained steadfast
in being committed to providing exceptional care, and
for this I am very proud and grateful.
Division of Emergency Neurosciences (DEN)
This is a very busy time for the DEN. We had
an outstanding first year. Special thanks for
the groups’ hard work in supporting our clini‐
cal trials. The success of this effort is com‐
pletely dependent upon the group’s collabora‐
tive force ~ from EMS through the critical care bays.
RIH and Hasbro are preparing to start ESETT ‐ The Estab‐
lished Status Epilepticus Treatment Trial (please stand by
for “green light” email). This is a multicenter, randomized,
double‐blind, comparative effectiveness study of fos‐
phenytoin, levetiracetam, and valproic acid in subjects with
benzodiazepine‐refractory status epilepticus.
Key Updates:
We have completed enrollment for the national random‐
ized clinical trial Shunt Check, this was a combined Hasbro
and RIH effort! The results for the study are positive and
were presented as a plenary session this May at the Ameri‐
can Association of Neurological Surgery, titled: Thermal
Flow Detection Improves Diagnostic Accuracy of Shunt Mal‐
function: A Prospective, Multicenter, Operator‐Blinded Study.
The study showed that the combination of neuroimaging
and ShuntCheck improves diagnostic accuracy and may di‐
minish the need for hospital admission, additional invasive
tests, and avoidable surgeries.
Patients will be recruited through the Neurology Emergen‐
cy Treatment Trials (NETT) network and Pediatric Emergen‐
cy Care and Applied Research Network (PECARN). ESETT
has been approved to be completed under exception from
informed consent (EFIC). We anticipate a start date soon.
Our lead research assistant for the international trial
ATACHII, Jena Lerch, was sponsored by the NETT to repre‐
sent our group at the study’s close out meeting in Hawaii.
Jena from her hard work in Hasbro and RIH, she has done
an exceptional job with enrollments in the clinical trials.
The DEN continues to recruit for multiple studies in neuro‐
logical emergencies, please stop by the office in Davol for
extra pocket cards, information, or a quick chat.
Several Brown medical students, PhD candidates
(Engineering / Computer Science), and undergraduate stu‐
dents have taken advantage of the DEN clinical research
program. Due to its success, Dr. Lisa Merck and Dr. Derek
Merck will lead a new Scholarly Concentration at the Alpert
Medical School: Translational Research in Medicine (TRM).
Students will have the opportunity to work within the DEN,
or with TRM faculty collaborators including Drs. Jay
DEPARTMENT OF EMERGENCY MEDICINE
continued on page 16
PAGE 8
Injury Prevention Center
Community:
The IPC car seat program recently launched a
new partnership with the Hasbro Children’s
Hospital primary care clinic and the Health
Leads Program. Health Leads is a national non
‐profit organization aimed at providing basic resource
needs to families. The program at Hasbro Children’s Hospi‐
tal is staffed by passionate Brown University undergraduate
students who volunteer an average of 7 hours per week
assisting families with obtaining basic resources such as
food, heat, clothing and other essential items. Clinic staff
refers families needing car seats to Health Leads and they
assist in making an appointment with one of the certified
child passenger safety technicians at the IPC. The IPC CPS
tech will assist families in providing car seats for their chil‐
dren, as well as education on how to properly use and in‐
stall the seat. Through this new partnership, we hope to
improve the safety of children in these vulnerable Hasbro
Children’s Hospital primary care clinic families.
Michael J. Mello, MD
Medical Director, Injury Prevention Center
at the Injury Prevention Center has developed a one‐hour
web‐based SBIRT training module for emergency medicine
teaching faculty to precept medical students and residents’
use of screening, brief intervention, and referral to treat‐
ment (SBIRT). It includes a 13 minute video produced by IPC
staff on opportunities and challenges of precepting train‐
ee’s delivering SBIRT in the ED. We presented our video at
a national SAMHSA conference in March 2016 with several
other institutions requesting access to it for use with their
faculty.
Research:
Three recent research highlights from IPC faculty. The IPC is
leading a multisite project funded by NIAAA that examines
a parenting intervention at three pediatric trauma center ‐
Hasbro Children’s Hospital, Connecticut Children’s Medical
Center and Pittsburgh Children’s Hospital. Parents of ado‐
lescent trauma patients who screen positive for alcohol or
drugs use will be asked to participate in online parenting
program after their child is discharged home. Parents and
This Summer the 4‐Safety van will be travelling to communi‐
children will be followed for changes in parenting style and
ties throughout Rhode Island and Southeastern Massachu‐
adolescent substance abuse. Janette Baird, PhD presented
setts. Some of the events we will attend include events at
“Improving opioid prescription safety in trauma patient” at
local YMCAs, 5K walk/runs, various Health and Safety Fairs
the National Rx Drug Abuse and Heroin Summit. Atlanta,
in the community. This Spring, our safety topic is focused
GA in March 2016. Conference keynote speaker, President
on Distracted Driving and in the summer, we will be fo‐
D E P A R T M E N T O F E M E R G E N C YObama,
M E D released
I C I N E his new initiatives for controlling the opi‐
cused on Sun and Hot Weather Safety. For a complete list
oid crisis. Mark Zonfrillo, MD, MSCE completed four sepa‐
of
events,
check
out
our
calendar:
http://
rate three‐day Physician Builder training course at Epic in
www.hasbrochildrenshospital.org/4‐Safety‐Events‐
Verona, Wisconsin this winter: Basic, Advanced, Analytics,
Calendar.html.
and Orders. He plans on applying this new skillset to his
injury prevention research, and several grant applications
Education:
are being prepared that incorporate clinical informatics into
As part of a grant funded by the U.S. Substance Abuse and
the project’s research protocol.
Mental Health Services Administration (SAMHSA), our team
RECENT EXTRAMURAL RESEARCH FUNDING
Elizabeth Goldberg, MD was awarded a 1‐year $22,222 award from the Rhode Island Foundation for her project entitled
Home Blood Pressure Monitoring to Track Post‐Discharge Blood Pressures In At Risk Individuals. This project will examine
whether ED patients presenting with elevated BP truly have hypertension, and will use validated home blood pressure mon‐
itors to follow the BPs of individual patients into the community to make a HTN diagnosis using an accepted reference
standard.
Mark Zonfrillo, MD, MSCE was awarded a 1‐year, $15,000 award from the Rhode Island Foundation for his project entitled
Merging a National Hospital Trauma Registry with Post‐Acute Care Assessment Data in Older Adults with Traumatic Brain
Injury. The primary goal of this project is to create a longitudinal database by merging a trauma registry, healthcare claims,
and PAC patient assessment instruments, that will follow a national cohort of patients and allow for future research to iden‐
tify the main factors related to meaningful health outcomes of elderly TBI patients.
Gregory Jay, MD, PhD was awarded a 5‐year $2,190,726 R01 grant from NIH/NIAMS for his project entitled Non‐tribologic
Bioactivity of Lubricin. Along with co‐PI Khaled Elsaid, PhD, PharmD Dr. Jay will focus on a novel non‐lubricating role of
PRG4 (lubricin) and its interaction with the CD44 receptor, which is inherently anti‐inflammatory. By occupying this recep‐
tor, PRG4 may decelerate the progression of inflammation in the synovium, caused by pro‐inflammatory cytokines such as
IL‐1β, which is elevated following a joint injury and in patients with osteoarthritis. This effect will in turn slow the rate of car‐
tilage degeneration. PRG4 as a biologic may both lubricate cartilage surfaces and have a distinct and novel anti‐
inflammatory role. These results may also be valuable in understanding PRG4’s role in management of acute gout.
DEPARTMENT OF EMERGENCY MEDICINE
PAGE 9
Emergency Medicine Faculty
Professor
Brian Zink, MD ‐
Frances Weeden Gibson ‐ Edward A. Iannuccilli
Professor of Emergency Medicine
Bruce Becker, MD, MPH
Gregory Jay, MD, PhD
William Lewander, MD
James Linakis, MD, PhD
Michael Mello, MD, MPH
Selim Suner, MD, MS
Clinical Professor
Gary Bubly, MD
Andrew Nathanson, MD
Elizabeth Nestor, MD, M Div.
Lawrence Proano, MD
Associate Professor
Janette Baird, PhD (Research)
Jay Baruch, MD
Adam Chodobski, PhD (Research)
Thomas Chun, MD, MPH
Brian Clyne, MD
Susan Duffy, MD, MPH
Aris Garro, MD, MPH
Traci Green, PhD , MSc (Research)
Jason Hack, MD
Leo Kobayashi, MD
Otto Liebmann, MD
Alyson McGregor, MD, MA
R. Clayton Merchant, MD, MPH, ScD
Anthony Napoli, MD, EMHL
Frank Overly, MD
Daniel Savitt, MD
Dale Steele, MD, MS
Jonathan Valente, MD
Clinical Associate
Professor
Catherine Cummings, MD
Thomas Germano, MD
Thomas Haronian, MD
Ilse Jenouri, MD, MBA
Achyut (Mihir) Kamat, MD
Matthew Kopp, MD, CPC
James Monti, MD
David Portelli, MD
Francis Sullivan, MD
Associate Professor (Clinical)
William Binder. MD, MA
Deirdre Fearon, MD
John Foggle, MD , MBA
Frantz Gibbs, MD
Gregory Lockhart, MD
Jessica Smith, MD
Kenneth Williams, MD
Assistant Professor
Siraj Amanullah, MD, MPH
Francesca Beaudoin, MD, MS
Linda Brown, MD, MSCE
Geoffrey Capraro, MD, MPH
Bryan Choi, MD, MPH
David Curley, MD, PhD
Elizabeth Goldberg, MD
Adam Levine, MD, MPH
Tracy Madsen, MD, ScM
Lisa Merck, MD, MPH
Christopher Merritt, MD, MPH
Dina Morrissey, MD, MPH (Research)
Megan Ranney, MD, MPH
Neha Raukar, MD, MS
Steven Rougas, MD, MS
Matthew Siket, MD, MS
Joanna Szmydynger‐Chodobska, PhD
(Research)
Robert Tubbs, MD
Frances Turcotte‐Benedict, MD, MPH
Mark Zonfrillo, MD, MSCE
Clinical
Assistant Professor
David Bouslough, MD, MPH
Laura Forman, MD
Mark Greve, MD
David Kaplan, MD
Gita Pensa, MD
James Rayner, MD
John Riedel, MD
Marcia Robitaille, MD
Eric Schwam, MD
Dana Sparhawk, MD
Stuart Spitalnic, MD
Tenny Thomas, MD
Assistant Professor (Clinical)
David Bullard, MD, MEd
Sarah Case, MD
Laura Chapman, MD
Lydia Ciarallo, MD
Jamieson Cohn, MD
Erika Constantine, MD
Jeffrey Feden, MD
Whitney Fisher, MD
Rachel Fowler, MD, MPH
Sarah Gaines, MD
Nadine Himelfarb, MD
Nathan Hudepohl, MD, MPH
Elizabeth Jacobs, MD
Devin Kato, MD
Joseph Lauro, MD
Alexis Lawrence, MD
Victoria Leytin, MD
David Lindquist, MD
Melanie Lippmann, MD
Kristina McAteer, MD
Laura McPeake, MD
Lynne Palmisciano, MD
Jane Preotle, MD
Noah Rosenberg, MD
Patrick Sullivan, MD (Clinical)
Elizabeth Sutton, MD
Lynn Sweeney, MD
Otis Warren, MD
Teaching Associate
Karina Bertsch, MSW
Christine Garro, PA
Rebecca Hassel, PA‐C
Allison Jackson, PA
Lisa Murphy, FNP
Research Associate
Julie Bromberg, MPH
Clinical Instructor
Coleman, Nicole, DO
Jeffrey Gaines, MD
Raneem Islam, DO
Katherine Kimbrell, MD
Mark Muetterties, MD
Matthew Sarasin, MD
Charles Stengel, MD
Keri Tilman, MD
Teaching/Visiting Fellows
Fahad Mishal Alharbi, MBBD
Adam Aluisio, MD ‐ Global EM
Rebecca Barron, MD ‐ Sex & Gender
Antoinette Golden, MD ‐ Medical Simulation
Naz Karim, MD ‐ Global EM
Sarah Michael, DO ‐ Medical Education
DEPARTMENT OF EMERGENCY MEDICINE
PAGE 10
Brian Clyne MD
Vice Chair, EM Education
Section of EM Education
It’s been a year since we formally established
the Education Section within our Department
to “promote a culture of educational excellence
through faculty collaboration, educational
scholarship, and professional development.” In
that time, section members have come to‐
gether regularly to exchange important ideas around medi‐
cal education. One of the first things we created is a re‐
source page on BoardEffect for all things Med Ed. Each Sec‐
tion meeting includes a member update about current pro‐
jects or a mini‐faculty development presentation. For exam‐
ple, we’ve learned about Just in Time Teaching from Liz
Jacobs; the Mendeley reference manager from Bob Tubbs;
Professional Identity Formation from Sarah Gaines; and
Free Open‐Access Medical Education (FOAM) resources
from Gita Pensa. Chris Merritt recently lead an informative
Know & Grow session on how to get published in
MedEdPortal. Rachel Fowler and Beth Sutton presented an
analysis of our medical student programs to identify
growth opportunities and ways to integrate our preclinical
and clinical experiences. We’ve also had some lively discus‐
sions around designing a peer‐review process for our resi‐
dency program’s increasingly popular educational blog
(check it out at brownemblog.com).
Section members have formed working groups and submit‐
ted didactic proposals to the SAEM, CORD, and the NEGEA
(Northeast Group on Educational Affairs) conferences. Jeff
Feden, Neha Raukar, and Sarah Michael led a SAEM didactic
on “Tech Tools: Top 10 Apps and Electronic Resources for
the Medical Educator” in New Orleans in May. Rebecca Bar‐
on and Alyson McGregor also presented their sex and gen‐
der curriculum at SAEM. Many other members are currently
working together on didactics, manuscripts, and curriculum
projects. Kudos to Steve Rougas and Dave Bouslough on
achieving Advanced Medical Education Certification
through the Alpert Medical School Program in Educational
Faculty Development. Many Education Section members
contributed to the success of the recent NEGEA Annual Re‐
treat hosted by Alpert Medical School. Special thanks to
Sarah Gaines, Courteney MacKuen, Jane Preotle, Chris Mer‐
ritt, Jeff Feden, Sarah Michael, Bob Tubbs, and Steve Rou‐
gas for planning, moderating, presenting, and above all
showcasing our Department’s talent.
It’s been a busy and productive year for the Education Sec‐
tion, and we have plenty of work ahead of us. In June, we
will have a presentation on the audience response system
PollEverywhere, plan a faculty development session on
bedside teaching, and make some key decisions about es‐
tablishing a medical student sub‐internship. If you are inter‐
ested in participating in the section meetings, have an idea
to share, or suggestions to improve our educational pro‐
grams, please let me know.
The Brown/RIH ‐ Class of 2020
Shihab Ali
Alisa Anderson
Timothy Boardman
Paul Cohen
Alpert Medical School
Brown U
SUNY Upstate
Medical University
U Massachusetts
Medical School
Vanderbilt U
School of Medicine
Tracy Madsen, MD, ScM assumed
the role of Associate Director for the
Division of Sex & Gender in EM
(SGEM) within our Department on
May 1, 2016. Dr. Madsen graduated
from our Brown EM residency pro‐
gram and completed our Sex & Gender 2‐year
fellowship as well.
In this new position, Tracy is responsible for as‐
sisting the Division Director in accomplishing the
objectives of the SGEM mission to advance per‐
son‐specific research, education and advocacy.
Jonathan Fletcher
William Galvin
Travis Hase
Michigan State U
College of
Human Medicine
Georgia Regents U
U of Georgia Medical
Partnership
Geisel School of
Medicine at Dartmouth
Robyn Levine
Case Western
Reserve U
School of Medicine
Alyssa Mierjeski
Ravi Sarpatwari
Allie Schick
Jessie Werner
Michael Wilk
Stony Brook U
School of Medicine
Alpert Medical School
Brown U
U Minnesota
Medical School
U Maryland
School of Medicine
Loyola U
Chicago Stritch
School of Medicine
Linda Brown, MD, MSCE, pediatric
emergency medicine attending physi‐
cian, educator and scholar, assumed
the role of Medical Director of the
Lifespan Medical Simulation Center on
January 1, 2016. Dr. Brown, who
served as Associate Director of the
LMSC is a nationally recognized and funded investi‐
gator in medical simulation, and worked with Dr.
Frank Overly and Dr. Leo Kobayashi and others to
develop the LMSC as a leading academic simulation
center.
DEPARTMENT OF EMERGENCY MEDICINE
PAGE 11
Jessica Smith, MD
Director EM Residency
EM Residency
By now, you have all seen the names and faces of the
new interns joining us on June 17th, you are preparing to
say goodbye to our amazing seniors who are leaving the
nest to make their independent marks on the world of
EM, and you are thinking (I hope!) about how you can
best contribute to the future practice of the wonderful
residents currently in our midst‐‐whether through didac‐
tics, bedside teaching, or mentorship on scholarly pro‐
jects or career trajectory.
Traditionally, the 300‐word allotment for the Residency
blurb is full of positive highlights and accolades, for both
residents and faculty alike, who are fully engaged in the
education and training of the next generation of EM
docs. This article, however, hopes to shine some light on
the devastating trend we are facing in medicine, in our
training Programs, and in our medical schools: the grow‐
ing rate of physician suicide. Physicians commit suicide at
a rate two times the national average, totaling 400 per
year, which is the equivalent of 2 entire medical school
graduating classes lost annually. In the ten years I have
been faculty here at UEMF, this subject has gone from a
once in a blue moon phenomenon whispered among
PDs as something that happened in “other” Programs,
to a sad universal truth, which has personally affected us
here at Brown on the undergraduate and graduate cam‐
puses, and one that many of my EM PD colleagues
across the country have dealt with in the last few years.
When we talk about the issues in front of us, we can help
swing the pendulum back to where we want it to be.
mentees, and your friends and family, to
seek comfort, guidance, or help when it is
needed, and even before it’s needed. The
reality we face is that there are increasing
clinical and administrative expectations, in‐
creasing pressures in our personal and professional lives,
and sometimes the perception that there is little we can
do about it to cope effectively. There are a tremendous
number of resources in the hospital, through our EAP,
through our specialty organizations, and through our
networks of colleagues, who can help.
The more we acknowledge the issues, the more we talk
about them, the more we can help each other get
through times of struggle, no matter how big or small.
Let’s open the conversation up, and bring back our pow‐
er to heal.
They are all looking forward to your involvement in men‐
torship, guidance, and your clinical teaching. Thank you
for all you do for our trainees!
As always, to get in touch with the Chiefs: er‐
[email protected], or call their hotline: 400‐CHIEF (400‐
2443). And to get in touch with the residents, use the
gmail listservs:
Class of 2016: [email protected]
Class of 2017: [email protected]
Class of 2018: [email protected]
Class of 2019: [email protected]
Class of 2020: [email protected]
I urge you to check in with your colleagues, your
Here is a composite of the Class of 2020 Match Day Photos:
Alexis Lawrence
MD, Assistant Pro‐
fessor of EM, has
been named Assis‐
tant Medical Direc‐
tor of the Ander‐
son
Emergency
Center at RIH. She began her
new role on March 1, 2016Alexis
graduated from our own Brown
EM Residency Program as a
Chief Resident in 2014. During
her residency, she received sev‐
eral awards for clinical excel‐
lence and teaching. . Alexis is
also a member of the Substance
Use Disorder Emergency Care
Improvement
Task
Force
(SUDECI).
DEPARTMENT OF EMERGENCY MEDICINE
PAGE 12
Alyson McGregor, MD, MA
Director, Sex & Gender in EM
Division of Sex & Gender
A novel Alpert Medical School Preclinical Elec‐
tive has been introduced throughout this past
semester, “Sex and Gender Based Medicine: An
Overview”, which has successfully engaged 10‐
15 medical students through a myriad of topics and guest
lecturers. Dr. Rebecca Barron has led this group and seized
the opportunity to establish Brown University as one of the
five beta test sites for the Sex and Gender Specific Health
Sex and Gender Curriculum Modules created by Texas Tech
University Health Sciences Center (TTUHSC). We look for‐
ward to continuing to provide the elective opportunity for
incoming students next year as
well as the opportunities to contin‐
ue the collaboration with TTUHSC.
At the recent American Heart As‐
sociation Go Red for Women
luncheon, Dr. Tracy Madsen edu‐
cated attendees (stroke survivors,
family members, and community
members) about sex and gender
differences in stroke using and
educational tool we developed
called ‘Wheel of Differences’. Dr. Madsen also recently pre‐
sented research on sex difference in stroke incidence at the
International Stroke Conference, which highlighted her re‐
search at the closing plenary session.
gaged in Society for
Academic Emergency
Medicine SGEM Inter‐
est Group initiative;
we have established
a SGEM Residency
Education Subcom‐
mittee with our very
own Dr. Rebecca Bar‐
ron serving as Chair. Two successful project were initiated
and posters were presented at the Northeast Group on Ed‐
ucational Affairs (NEGEA) entitled – “A Sex and Gender
Toolkit for Emergency Medicine Residency Educators” and
“Sex and Gender In Emergency Medicine: A Residency Elec‐
tive”. Look for our recurring SAEM Newsletter submissions
“Did You Know?” and check out this years SAEM Didactic
sessions on “Translating Sex and Gender Research into Clin‐
ical Practice”, “Sex, Gender, and Sexual
Orientation” as well as the anticipated
SGEM Geopardy Event!
Finally, our “Sex and Gender in Acute
Care Medicine” textbook is available
for pre‐order! This was a collaborative
effort of EM physicians within UEMF
and across the country. Search for it
on Amazon.com!
Thanks in part to the many SAEM members that are en‐
Upcoming EM Grand Rounds Speakers 2016‐17
August 24th: Michael Blaivas, MD, MBA‐ University of
South Carolina School of Medicine
August 31th: Jill Baren, MD ‐ Perelman School of Medi‐
cine University of Pennsylvania
October 12th: Gus Garmel, MD ‐ Stanford University/
Kaiser Permanente Medical Center
Our Dept. of EM group is pictured at the New England Regional Directors
Meeting of SAEM’s (NERDS) Annual Meeting on March 30, 2016.
The Department was well‐represented with several faculty and residents
presenting lightning orals, posters & didactics. 
November 9th: Joseph Wright, MD, MPH ‐ Howard
University College of Medicine
December 14th: Brian Zink, MD ‐ AMS, Brown
January 25th: To be announced.
Jay Baruch, MD, Associate Professor of EM, was named
recipient of the Arnold Gold Humanism in Medicine
Award given administered by SAEM. This award recog‐
nizes an emergency medicine physician “who exempli‐
fies compassionate, patient‐centered care”. Dr. Baruch
is the Director of Medical Ethics at the Alpert Medical
School and the Director of the Foundry of Arts & Humanities in
Emergency Medicine (FAHEM) program.
He is a previous awardee of a UEMF/Department of EM Outstanding
Physician Award. He is also a noted author, writing 2 books as well
as numerous articles. Congratulations to Dr. Baruch!
February 8th: Thomas Trikalinos, MD, PhD ‐ Alpert
Medical School
March 15th: Richard Levitan, MD ‐ Dartmouth Geisel
School of Medicine
April 12th: Jeffrey Kline, MD (Visiting Professor) ‐ Indi‐
ana University School of Medicine
May 24th: Rebecca Cunningham, MD (EM Research
Symposium) ‐ University of Michigan Health Systems

DEPARTMENT OF EMERGENCY MEDICINE
PAGE 13
TMH ED continued
continued from page 3
adapted and picked up speed, we have handled some of the
highest volume days with acceptable results. The process is
tweaked as needed as we are in the early stages, but we see
excellent potential with fuller APP staffing.
However, we will likely be modifying this plan in the future.
TMHED is the next site for consultation with Shari Welch's
group, Quality Matters. We have already begun sending data
to her team as part of phase 1. She will be hosting focus groups
and conducting targeted interviews as part of Phase 2 of the
analysis, which will be completed in the last week of June. Dr.
Welch will be presenting her findings to our group at the July
14th TMH EM attendings’ clinical site meeting. We are thrilled
have her come help us increase our efficiency.
Finally, we were the fortunate recipients of The Miriam Wom‐
en’s Association generosity this year. They graciously pur‐
chased a nitrous oxide delivery system for us. We look forward
to incorporating that into our clinical care. 
Center for
Sports Medicine
Neha Raukar, MD
Director,
Division of Sports Medicine
Jeff Feden has been busy with his Fall preclinical
elective teaching 18 students the basics of Sports
Medicine in "Introduction to Sports Medicine." He
has an upcoming didactic at SAEM: "Off the Beaten
Path: Building a Career in Sports Medicine." Congratulations on
being appointed to represent ACEP on the AAOS performance
measure development work group for the management of ACL
injuries!
Meanwhile, Mark Greve was appointed Chair of the USA Cycling
Safety Committee where he will be developing and integrating a
comprehensive injury prevention program for competitive cy‐
cling in the US. Dr. Greve was featured in a Reuters article‐ http://
www.reuters.com/article/us‐health‐injuries‐amateur‐cycling‐
idUSKCN0WX20Z. He has been traveling quite a bit covering the
Tour of Dubai, Tour of Azerbaijan, and the Training Camp in Calpe
Spain where he found the time to perfect his paella recipe.
Evolving with the Times:
The Mid‐level Provider Program Is Now Called
Advanced Practice Provider (APP) Program
Just wanted to take the time to acknowledge the
Advanced Practice Provider group as a whole who
have done and amazing job with all the changes
that have come with AEC 2.0. The group has been
professional, flexible with schedules, efficient, and
clinically stellar to name a few.
Kevin Bettencourt is leaving our APP ranks to move
to New Mexico with his family. Although he has
only been with us a short time, he has definitely
impressed all those that had the pleasure to work
with him. We will be very sad to see him go.
We have just completed the EMPED enrollment
process and have selected a class of four new APPs
who will start their training on September 1.
Having completed their EMPED training, we wel‐
come both Calleigh Grove and Cheryl Pappas to the
full time ranks of our APP group. The rest of our
current EMPED group will complete their training at
the end of August. We also will be welcoming two
new APPs to the group, Brittany Crane from
Baystate Medical Center and Michelle Ristuccia
from Kent County, who will be starting July 1.
We continue to recruit actively as there is an in‐
creasing demand for the skills of our APP group
with expansion of shifts at Anderson
and TMH, and summer staffing for
Newport.
Wishing the APPs a play hard/work
hard summer ahead. 
James Monti, MD ‐ Asso. Med Director, AEC
& Director, APP Program
Dr. Art Kellermann—AOA Visiting Professor
Brain Week has come and gone. Brought to us by the Cure Alli‐
ance for Mental Illness the goal was to focus on the wonder of
the brain and the wealth of brain‐related science and activity in
Rhode Island. Neha Raukar was a panelist during the kick off
event, Head's Up: A Panel on Concussion and the week ended
with another discussion about the effect of concussion legisla‐
tion with the Brain Injury Association of Rhode Island.
Dr. Neha Raukar was also the associate editor of a combined
Emergency Medicine Foundation/National Football League CME
program on concussion that was released through the American
College of Emergency Physicians. 
DEPARTMENT OF EMERGENCY MEDICINE
Dr. Arthur Kellermann, Dean of the
Hébert School of Medicine at the
Uniformed Services University of
Health Sciences was the Alpha
Omega Alpha Visiting Professor on
March 30, 2016. He was also a
guest of our Department at a mod‐
erated dinner. 
PAGE 14
Dave Bouslough, MD,
Director, Global EM
Global Emergency Medicine
In February in American Samoa, Dr. Bouslough
continued to build the Life Support Training
Program at LBJ Tropical Medical Center. Now
seven years in development, the educational initiative con‐
sists of Neonatal Life Support, Basic Life Support, Advanced
Cardiac Life Support and Trauma Life Support courses
taught annually and with greater than 300 providers contin‐
uously certified! Dr. Bouslough was joined by 7 Bryant Uni‐
versity Physician Assistant students who completed a Glob‐
al Health elective and clinical rotation at LBJ. This repre‐
sents a new curriculum element for Bryant University that
has grown from the participation of UEMF physician educa‐
tors in the Physician Assistant Studies program.
In February in Nicaragua, Drs. Naz Karim and Devon Kato,
again joined forces with Los Angeles County physician edu‐
cators in administering life support education courses in
Leon and Managua. Ultrasound skills are a new addition to
these courses and are highly sought after by local practi‐
tioners.
“Team Rwanda” led by Dr. Adam Levine, enjoyed a fruitful
quarter with successful applications to multiple research
grants; acceptance of abstracts; and presentation invites!
Dr. Adam Aluisio secured both a Framework and Small Pro‐
jects grant to study Emergency Department Outcomes da‐
ta. Dr. Naz Karim secured both EMF and Nora Khan Piore
grants to continue her work with pre‐hospital care process
indicators and training interventions. Dr. Naomi George
secured both Framework and Resident Scholar grants to
study pre‐hospital outcomes data! Congratulations to all for
this amazing body of work!
Dr. Noah Rosenberg was chosen as one of three Human
Resources for Health Emergency Medicine Clinical Faculty
positions beginning August 2016! While we will miss him in
the halls of AEC, we wish him and his family well as they
prepare for living and working in Rwanda!
As a division, we feel fortunate to be able to work with so
many talented resident’s and fellows, even after they grad‐
uate from the Brown University programs! Examples of
these ongoing relationships include burgeoning programs
in Belize fostered by recent residency gradu‐
ate, and now Baylor University faculty, Dr. Joy
Mackey! Drs. Liz Samuels and Tess Wiskell are
working with Drs. Mackey and Bouslough to
develop HIV diagnostic and treatment path‐
ways through the emergency department and acute care
settings. In Kenya, we are fortunate to revive our participa‐
tion in Eldoret (Indiana/Brown/Moi University Collabora‐
tive) and begin new initiatives in Nairobi, thanks to recent
residency graduate and Yale University Fellow in Point of
Care Ultrasound/Global Health, Dr. Grace Wanjiku! Drs.
John Foggle and Elizabeth Sutton joined Dr. Wanjiku in the
administration of trauma and ultrasound curricula at these
sights in February. Kenya remains a wonderful opportunity
for program development across clinical and educational
spectrums and we anticipate greater participation in com‐
ing years!
We are excited to welcome both Drs. Naz Karim and Alexis
Kearney who join our Division as Core Faculty for AY 2016‐
17! Dr. Karim will be serving as Assistant Fellowship Director
with Dr. Adam Levine, and Dr. Kearney will be serving as
the Global Health Elective Coordinator for residents and
students!
Kudos to Dr. Naz Karim for her recent distinguished alumni
designation and article about her work in Rwanda, entitled
“Pillar of Care: Community Across Nations”, in the Helix
Magazine, a publication of the Rosalind Franklin University
School of Medicine & Science
Resident global health electives this quarter included New
Zealand (Alexis Kearney, Jenna Wheelhouse), American
Samoa (Robert Butler, Roger Wu), Belize (Liz Samuels, Tess
Wiskell), and Rwanda (Naomi George, Alexis Kearney). All
participants did a stellar job in representing Brown Universi‐
ty and our Global Health initiatives!
For faculty and residents alike, the Division of Global Emer‐
gency Medicine exists for you to explore the world, devel‐
op emergency medicine abroad, and link your clinical re‐
search interests to our global objectives!
AAMC’s NEGEA Annual Conference Meeting at the Alpert Medical School
Brown University hosted AAMC’s Northeast Group on Educational Affairs (NEGEA) April 8‐9, 2016.
Dr. Brian Clyne was the host Chair. Several Department of EM faculty participated. Drs. Brian
Clyne, Sarah Gaines, Courteney MacKuen, and Steve Rougas were on
the planning committee. Drs. Clyne and Rougas reviewed abstracts.
Dr. Gita Pensa (pictured on the right), Jeff Feden, Sarah Gaines, Jane
Preotle, Chris Merritt, and Clyne were moderators. Numerous faculty
members presented posters, didactics and conducted workshops
including Drs. Sarah Michael, Bob Tubbs and Jessica Smith.
Dr. Gita Pensa pictured moderating a session.
DEPARTMENT OF EMERGENCY MEDICINE
Spring 2016: Dr. Naz Karim
was featured in an article in
the Rosalind Franklin Uni‐
versity of Medicine & Sci‐
ence He‐
lix publi‐
cation. 
PAGE 15
AEC continued
continued from page 3
recliner chair for their workup to be completed.
3. Re‐Opened Fast Track Area: We have carved six beds
out of the C‐pod and created a well‐resourced fast track
with one APP, one nurse and one patient care techni‐
cian. Nearby, staffing the remainder of the C pod beds,
are an attending and another APP to lend a hand for
complex decision‐making or high volume of low‐acuity
patients.
4. Immediate Bedding for Emergency Severity Index
(ESI) Level 2 Patients: These changes help to ensure
that we have a bed for our sickest walk‐ins and ambu‐
lance arrivals when they arrive. To further enable this
system, we have created a “bed ahead” approach in the
pods (similar to Critical Care). Patients who are nearly
ready to go home or go to their room can go to this area,
so that new patients can be assigned to a bed in the AEC
from the waiting area sooner.
The Results: As of the writing of this article, we are 9
weeks into this endeavor and the results are promising.
‘Door to Doc’ Time: Has been reduced to 22 min, down
from 52 minutes.
Median Time from Arrival to Room for ESI Level 2: Has
been reduced to 8 minutes down from 23minutes.
Median Length of Stay (LOS) for Discharged Patients:
Has decreased by 60 minutes, from 290 to 230 minutes.
Left Without Being Seen Patients: The average is 1.82%
down from 4.6%.
The waiting room is EMPTY for most of the day and our
patients are pleased with our efficiency!
There will be ups and downs over the next several
months as new providers and nurses are exposed to our
new roles and practices. We also hope to continue to
use data to tweak our approach and further improve our
performance. Special thanks to all those who have
helped shape the changes in our customer service and
increased efficiency including our physicians, nurses, AEC
staff and administrative staff ‐ it takes a team! 
Join Us & Celebrate!
We are pleased to announce our Mega‐Anniversary Celebration tak‐
ing place on September 23‐24, 2016. This 2‐day celebration will con‐
sist of CME didactics from former faculty; a Friday afternoon recep‐
tion on the Department of EM Terrace at the Alpert Medical School;
panel discussions with various current and former faculty; looks back
on Department history; and the anniversary concludes with a dinner
and awards banquet. More detailed information and invitations will
be sent in the summer. Group child care will be available during the
Friday reception and Saturday banquet festivities. If you have any
historical memorabilia of our Department, please send pictures or
scans to Céleste Carrière at [email protected]. If you have any
questions regarding this event, please contact Brenda Bordieri at
[email protected]. 
Resident Scholarly Development Fund
The Resident Scholarly Development Fund pro‐
vides scholarships for Brown emergency medicine
residents to carry out projects or training in the
research or education realms. The fund was creat‐
ed in 2009 with an initial $5,000 donation from
University Emergency Medicine Foundation.
The fund has received great support from past
graduates and current faculty. And we are again
asking our Brown EM faculty members and alumni
to help build the Resident Scholarly Development
Fund through donations. The strength of any fund
raising effort is not just in the amount of contribu‐
tions, but also in the level of participation of those
who care about the cause. Many of you have in‐
vested a great deal of time and effort in making
the Brown Emergency Medicine residency one of
the premier EM residencies in the nation. Now you
can make a financial investment into an EM resi‐
dent’s future.
Your contribution is tax deductible.
Please consider sending a check as
follows:
UEMF, EM Resident Scholarly
Development Fund, Attn: Michelle
Costa, Department of Emergency Medicine , 593
Eddy Street,
Claverick 2, Providence, RI 02903
DEPARTMENT OF EMERGENCY MEDICINE
PAGE 16
Foundry of Arts & Humanities in Emergency Medicine (FAHEM)
The Program in Medical Humanities extends a
congratulations to our Dr. Noah Rosenberg,
who will finish his Harvard Ethics Fellowship
this spring. He has an essay forthcoming in The
Examined Life literary journal, as well as a book
Jay Baruch, MD chapter in the upcoming book Albert Ca‐
mus’s The Plague: Lessons for Medicine. Edited by Woods
Nash. We will miss him in the upcoming year as he and his
family set down roots in Rwanda. His presence, however,
will remain tethered to our work as he’ll continue to co‐edit
our Littoral Medicine blog.
courage anyone interested in joining our editorial team to
contact us.
The program also salutes Dr. Dina Himelfarb in her new role
in residency leadership. Dina is also co‐leading an ACEP
medical humanities section grant and our new EM residen‐
cy medical humanities elective, Intervention Narratives in
Emergency Medicine. She has started a new EM residency
book club, which began in May with a conversation around
When Breath Becomes Air.
Dr. Jay Baruch began his term as a Director‐at‐Large for the
American Society of Bioethics and Humanities and contin‐
ues to serve as section chair of the medical humanities sec‐
tion of ACEP. As Director of the Medical Humanities and
Bioethics Scholarly Concentration, he’s thrilled to welcome
five students who will begin their projects this summer.
For residents interested in taking Interventional Narrative
in Emergency Medicine as an elective, or faculty interested
in participating, please contact Dr. Himelfarb or Dr. Jay Ba‐
ruch.
The Littoral Medicine blog continues to grow. We’re open
for submissions from faculty, residents, staff and others
who want to contribute to our conversation. We invite you
to visit the blog https://blogs.brown.edu/littoral/. We en‐
EM Neurosciences
continued from page 7
(Emergency Medicine/
Engineering),
Koba‐
yashi (Emergency Med‐
icine),
Silver
(Neurology), D’Andrea
(Engineering/
Orthopaedics),
Luks
(Pediatric and fetal
surgery), and Crisco
(Engineering/
Orthopaedics).
Our staff continues to
evolve ~ we congratu‐
late Brittany Ricci on
her acceptance to
medical school! We
welcome Philip Ras‐
nick to the team. We
wish Shelby Crowley
the best of luck as she
moves to NY.
The UEMF visiting writer program picks up from Dr. Anna
Reisman’s Fall op‐ed writing workshop with Steve Langan
(MFA, Iowa Writers Workshop) poet and director of the
Seven Doctors Project in Omaha, Nebraska. Steve conduct‐
ed an EM Department writing workshop on May 18t. He
also spoke at Brown the evening before as part of the Crea‐
tive Medicine Series. The Creative Medicine Series was also
honored to have our Department Chairman present his cre‐
ative work on April 27, 2016 to a full audience.
In addition to invited talks at several medical schools, he
presented work being done at Brown at the American Soci‐
ety of Bioethics and Humanities national meeting and the
Medical Humanities Consortium meeting, where he was
joined by other members of the Brown community, the
Rhode Island School of Design Museum educators, and Dr.
Bonnie Marr, EM residency graduate and now a fellow in
Palliative Care at Johns Hopkins University.
Brown Dept. of EM at SAEM’s Annual Meeting
At SAEM16 in New Orleans, the Department of EM faculty
was hustling! Faculty members presented didactics; con‐
ducted workshops; presented posters & lightning orals; and
participated in panel discussions, interest groups, & leader‐
ship programs. Here are some, but not all, of our EM facul‐
ty’s participation at SAEM:
Dr. Megan Ranney led 2 workshops and presented 3 didactics on grant writing and social media &
research. Drs. Neha Raukar and Liz Goldberg conducted an AWAEM workshop
on developing a successful career with branding. Drs. Jeff Feden, Brian Clyne,
Rachel Fowler, Sarah Michael, Gita Pensa, Neha Raukar & Jessica Smith teamed
up and presented on tech tools and electronic resources for medical educators.
Dr. Alison McGregor directed a workshop for the Sex & Gender in EM interest
group as well as conducted and participated in several other didactics and post‐
er presentations along with Dr. Tracy Madsen. Dr. Clay Merchant presented a
lightning oral as well as an e‐poster. Dr. Ad‐
am Levine presented 2
didactics on global health
research and humanitarian
efforts. Dr. Chris Merritt
participated in 1 lightning
oral and 1 didactic.
DEPARTMENT OF EMERGENCY MEDICINE