Department of EMERGENCY MEDICINE at the University of Mississippi Medical Center Jackson, Mississippi http://emergencymedicine.umc.edu/ What a job! Look for me to be in this picture SOON!! I hope to be able to make some runs on Air Care before I finish my residency program.

Amtrack Derailment

One Dead, Dozens Injured in Amtrak Crash
April 06, 2004


YAZOO CITY, Miss. (AP) - An Amtrak passenger train derailed in rural central Mississippi late Tuesday, killing at least one person on board and injuring as many as 70.

The 10-car train, traveling from New Orleans to Chicago, toppled onto its side about 25 miles north of Jackson, authorities said, leaving in its wake twisted and heavily damaged track.

"We have one confirmed dead,'' said Amy Carruth, a spokeswoman for the Mississippi Emergency Management Agency in Jackson. "We understand some of the injured are possibly critical.''

Lee Stokes, also of MEMA, said that while the derailment was believed to be an accident, the FBI had sent agents to the scene. Gov. Haley Barbour declared a state of emergency.

The train appeared to leave the track in an elevated area and landed on its side several feet below the track surface. The train had an engine and nine cars, and most of the cars derailed.

Stokes said it appeared about 65 people suffered "minor to critical injuries.'' She said the injured were initially treated at emergency stations, then moved to hospitals.

At least four Jackson-area hospitals received injured, including two very critical patients taken by helicopter to the University of Mississippi Medical Center. Dr. Bob Galli, head of the UMC trauma center, said the two were Amtrak employees - a 38-year-old female and a 43-year-old male.

Jim Pollard of American Medical Response, an area ambulance service, reported two passengers in critical condition, three others identified as serious and 52 reported with less than serious injuries.

Dan Stessel, a spokesman for Amtrak, said the train's manifest showed 72 passengers and a 12 crew members but that a review indicated perhaps only 68 passengers were on the train.

Carruth said her agency "was sending every resource we can get our hands on out there. ... At last report we've still got people trapped.''

Besides search teams, portable lights and other equipment were being rushed to the scene, she said. Red Cross staffers were on hand to assist passengers.

Yazoo County sheriff's dispatcher Mary Whisenton said at least five ambulances had also been sent to the scene.

Stessel said he had no information on what caused the accident.

Stessel said the train made several stops after leaving New Orleans about 1:55 p.m., including Jackson. He said the train derailed at about 7 p.m., near the Yazoo-Madison county line, before its scheduled stop in Yazoo City.

A physician in a rural Mississippi town who has witnessed the development of the University of Mississippi Medical Center's TelEmergency system firsthand likened the state-of-the-art technology to a newborn child. "We've gone through some severe pains and difficulties," said Dr. Richard Waller of the marriage between technology and science that produced the new system, "but now that we've got it, we wouldn't take anything for it." Speaking from the emergency room at Quitman County Hospital in Marks, Waller addressed a host of hospital administrators, physicians, media and others through the TelEmergency system during a press conference March 16 at the Norman C. Nelson Student Union. The event unveiled the latest phase of the Medical Center's program that links physicians to emergency departments at select hospitals in rural areas throughout the state. An initiative of the Department of Emergency Medicine, the TelEmergency system allows the Medical Center to provide 24-hour-a-day, seven-day-a-week physician coverage to emergency rooms in Belzoni, Lexington, Magee, Marks, Morton, Port Gibson, and Richton. Dr. Robert Galli, professor and chair of emergency medicine who spearheaded the program, said the system directly addresses one of the Medical Center's stated goals. "It is our responsibility and our mission to provide health care to people throughout the state," Galli said. "The TelEmergency system has been working to the tremendous satisfaction of hospital administrators, physicians and patients alike. Now, we've been able to upgrade this technology to provide even more comprehensive coverage for these emergency departments." Indeed, the service is so vital to these hospitals that David Paris, hospital administrator at Perry County Hospital in Richton, freely admitted that "without this service to cover the Emergency Department, my hospital would close." Television monitors and cameras located bedside at these hospitals are connected via the TelEmergency system to the Emergency Department at the Medical Center, which now boasts a robust 50-inch plasma screen, a 17-inch flat-panel display for "one-on-one" consultation, and a large touch screen keypad. Specially trained nurse practitioners at the hospitals take patients' initial histories and conduct physical exams, then "dial up" physicians at the Medical Center who can manipulate the TelEmergency camera to supervise the cases. "Our goal is to provide emergency care for patients right where they are," Galli said. "Even very sick patients can be stabilized so they can stay in their home hospitals - which is an important factor for the patients' families." The first system to extend telecommunications technology into emergency rooms in Mississippi began as a pilot project approved by the Boards of Medicine and Nursing on Oct. 1, 2003. Originally designed and conceived by Dr. Wallace Conerly, vice chancellor emeritus for health affairs, the system is funded by a grant from the John D. Bower Foundation with further support from the Mississippi State Department of Health. "But internally, we could not do this without the support of the TelEmergency staff, Emergency Department attending physicians and residents, and the invaluable expertise and support from the Division of Information Systems," Galli said. The system has helped emergency room physicians treat approximately 6,000 patients - 5,000 of whom have had face-to-face consultation with an emergency physician at UMC - in rural areas during the last six months alone, covering all manner of procedures - from shoulder separations to cardiac resuscitations. But the overall effect the system has had on patient health in these areas is immeasurable, according to Richard Manning, hospital administrator at the Quitman County Hospital. "TelEmergency has extended the capabilities of our local physicians," said Manning, who noted three physicians on his staff must cover the hospital, three clinics, three nursing homes and the emergency room. "TelEmergency allows us to bring in nurse practitioners to access the Medical Center and help us take care of patients more efficiently." Before the system was introduced in Belzoni, physicians had to leave their clinics to cover emergency cases at the Humphreys County Memorial Hospital. "This was not appropriate care for our citizens," said Debra Griffin, hospital administrator. "Now with this 21st century approach to medicine, I am confident that everything can be done for any patient that comes to our hospital. For more information about the Medical Center's TelEmergency system, call 1-866-ER-TELMED, or visit the TelEmergency Web site (http://telemergency.umc.edu). Bruce Coleman (3/22/04)

TELEMERGENCY LINKS UMC ER DOCS, RURAL HOSPITALS In a press conference Wednesday, Oct. 23, Dr. Richard Summers, associate professor of emergency medicine, examined, diagnosed and prescribed treatment for a patient - all from across the Medical Center's campus. The demonstration of the TelEmergency system brought home the practicality of the one-year pilot project that will allow emergency physicians at UMC to team with onsite nurse practitioners to provide ongoing care to areas of the state physicians don't ordinarily go. The TelEmergency system "is a way for us to reach patients in various locations - such as the Mississippi Delta - where emergency services are not always readily available," said Dr. Robert Galli, UMC professor and chair of emergency medicine. Working under the protocol of UMC's Emergency Department, nurse practitioners in select rural hospitals will see low-acuity emergency patients without assistance. Higher- to critical-acuity emergency patients will be jointly seen by a nurse practitioner and an emergency physician at UMC, using telecommunications technology. "With this new initiative, we'll be bringing state-of-the-art emergency care to rural Mississippians," said Ben Bloom, executive director of the network. "Many of our rural hospitals have problems providing physician coverage for their emergency rooms on a 24-hour, 7-day-per-week basis. This TelEmergency program is a solution to this issue. "Ultimately, the program will increase access and quality emergency care to our rural communities in Mississippi." A television monitor and camera located at the foot of the patient's bed will be connected via the TelEmergency system to similar equipment in the Emergency Department at UMC. A nurse practitioner will take the patient's initial history and conduct a physical exam, then "dial up" the department. A physician - who can manipulate the camera in the distant hospital - will appear on the monitor and have instant access to close supervision of the case via telecommunications technology. The Emergency Department will offer an emergency medicine program to prepare nurse practitioners for the TelEmergency System. These nurses will receive instruction from physicians and nurses at UMC before being assigned to the rural hospitals. "One ongoing problem our rural hospitals have is finding access to quality medical education," Bloom said. "This program will enable continuing education to be offered onsite at our rural hospitals with the telemedicine equipment." Since 1998, the Medical Center has used telecommunications technology to treat inmates at Mississippi Department of Corrections facilities. This March, UMC began a joint project with the National Aeronautics and Space Administration (NASA) to use telecommunications and medical imaging to link with two hospitals in Japan. But the TelEmergency system is the first to extend that technology into the emergency room. "If proven effective through rigorous analysis, this program has the potential of becoming the first true solution for providing health care in rural Mississippi emergency departments," Galli said. UMC is seeking nurse practitioner candidates for the program. Qualifications include certification as Family Nurse Practitioner and, ideally, Acute Care Practitioner, but the latter can be obtained during training. Bruce Coleman (11/4/02)

NASA/UMC STUDY MAY PUT ASTRONAUTS ON THEIR FEET
Before NASA rockets into the next frontier, the space agency and UMC aim to solve some astronauts problems with gravitational changes.

It could determine whether women will have equal opportunity on future interplanetary missions.

Some astronauts especially women have trouble standing, or even faint, after reentering Earths gravity on space flights. This poses a potential safety problem because it could impair astronauts abilities to perform their flight duties during landings or to exit from spacecraft in emergency landings. The longer the mission, the higher the percentage of astronauts who have the problem.

UMC is involved because it is home to the worlds first and most comprehensive computer model of the human cardiovascular system.

In general, the human bodys cardiovascular system gradually adapts well to microgravity in space, but it does not readapt quickly enough to Earths gravity. The problem would persist on Mars, which has one-third of Earths gravity, and would be amplified by the long duration of such a mission.

Thus the problem needs to be solved before the next generation of space exploration begins, explained UMCs project team members Dr. Richard Summers, associate professor of emergency medicine, and Dr. Thomas Coleman, professor emeritus of physiology and biophysics.

NASAs preliminary studies on this cardiovascular recovery problem, called orthostasis (which literally means standing position), are promising, Summers said. Were encouraged as well by our initial findings.

But were still in the early stages of solving this problem and of understanding how space affects human physiology, Coleman added. If this were a baseball game, wed be in the third inning.

The NASA/UMC study, called the Medical Microgravity Project, is coordinated under the auspices of NASAs Cardiovascular Laboratory at Johnson Space Center in Houston, Texas. The Medical Microgravity Project currently is a component of the labs Midodrine Station experiment, which studies the effectiveness of the drug Midodrine in alleviating astronauts orthostasis problems.

Midodrine was the first medication approved by the U.S. Food & Drug Administration (in 1996) to treat orthostatic hypotension (or low blood pressure upon standing). Its usually the problem of elderly patients on prolonged bed rest, who upon standing suffer from falling blood pressure and become dizzy or faint. Some shuttle and space station astronauts have been taking the drug since May.

Midodrine targets the smooth muscles surrounding blood vessels, causing them to contract, thereby raising blood pressure. This acts as a countermeasure to the fluid shift and falling blood pressure problems of space travel.

Being in zero gravity has the same effect on astronauts bodies as lying down all the time; that is, astronauts compensatory reflexes to control blood pressure and blood flow are atrophied, or blunted, Summers said.

Womens physiology compounds the problem. With gravitational change, female astronauts blood volume tends to shift from where its needed most - around the heart and brain - to the hips and legs, he said.

Summers has met three shuttle crews after landings at Kennedy Space Center in Cape Canaveral, Fla., for the study including the Atlantis crew that landed Oct. 18. The next crew hell meet, arriving on the shuttle Endeavor, tentatively is scheduled to land the week before Thanksgiving.

So far, Summers has tested six male astronauts who volunteered for the NASA/UMC project and has analyzed the medical records of another 40 past astronauts. He will collect postflight medical data on flight engineer Peggy A. Whitson when she returns from the International Space Station on the November shuttle.

Astronauts receive a battery of medical tests before and immediately after shuttle flights to measure the physiological effects of microgravity (or zero gravity). That includes a tilt test - putting the astronaut on a tilt table and moving the table from a reclining to a standing position and back while measuring body fluid shifts and blood vessel reflexes.

Summers brings that medical data back to UMC, where he and Coleman process it through the famed computer model. Developed at UMC in the 1960s by Dr. Arthur Guyton and his research team, the model today incorporates some 3,000 formulas, with the modern software designed by Coleman.

The model records and analyzes the astronaut data. Ideally, it also will predict the gravitational effects of longer flights and determine whether Midodrine is able to alleviate the orthostasis problem.

The computers manipulation and prediction capabilities are essential to determining whether astronauts will be prepared for a trip to Mars, which would take up to three years.

The time period assumed for the Mars mission includes time for the astronauts to adapt to the one-third gravity of Mars, from zero gravity en route - as well as about six months for surface exploration, said Dr. David Dzielak, UMC associate vice chancellor for research who helps coordinate various UMC/NASA projects. In addition, it would take seven to eleven months to get to the red planet, and the same to return. Travel time depends upon the configuration of the planets in their orbits around the sun.

The longest stay in space to date, by a Russian cosmonaut aboard the space station MIR, was 438 days.

According to various orthostasis studies reported on NASAs Internet site, about 20 percent of crews on short-duration missions and roughly 80 percent of crews on longer-duration missions experience various degrees of orthostatic intolerance after they return to Earth.

The studies say multiple countermeasures may need to be taken - in addition to possibly using Midodrine - to overcome the orthostasis barrier.

The particular concerns for women in space will be the subject of a national conference called Sex, Space and Environmental Adaptation at the University of Missouri-Columbia on Nov. 12-13. Summers and UMCs Dr. Jane Reckelhoff, professor of physiology and biophysics, will address what is known and unknown about gender, to date.

Well talk about what future directions medicine and basic research should take, including space research, Reckelhoff said. Its looking at everything about gender.

For more information on NASAs orthostasis and Midodrine studies, as well as women in space, visit its Web site (http://spaceresearch.nasa.gov).

Leslie R. Myers (11/4/02)

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