Last summer, the Red Duke Trauma Institute launched a new one-year clinical Trauma Anesthesiology Fellowship, the only one of its kind in Texas and one of only a handful in the country.
Fellowship program director Dr. Christopher Stephens explains how the fellowship came about and how Memorial Hermann trauma patients, the medical and EMS communities and the fellows will benefit from it.
RDTI Newsletter: Describe the new fellowship and the impetus for it.
Dr. Stephens: The Red Duke Trauma Institute Fellowship is a one-year clinical fellowship in trauma anesthesiology. Our first fellow will graduate this summer.
When people say they’ve never heard of this specialty before, I tell them if a trauma surgeon and an emergency medicine physician were to have a baby, the baby would be a trauma anesthesiologist.
The goal is for these fellows to understand, from the point of injury out in the field, what happens in the field, the trauma bay, the operating room, the ICU and ultimately the patient’s discharge to the floor and to rehab. The fellows follow patients through that whole pathway, similar to what the trauma surgeon experiences in their training.
RDTI Newsletter: How were you chosen to spearhead the new fellowship?
Dr. Stephens: Before coming to Houston, I was a Trauma Anesthesiology Fellow at the University of Maryland, which had the first trauma anesthesiology fellowship in the country. When I arrived here four years ago, my chairman, Dr. Hagberg (anesthesiologist Carin Hagberg, MD), expressed an interest in starting a similar fellowship here. Given the huge volume of Level I trauma cases we handle here, Memorial Hermann was the perfect place to do this fellowship.
I was really excited. I had never started a fellowship before, and I really wasn't sure what I was doing. But I just jumped in the saddle and went for it.
RDTI Newsletter: How did you approach developing the fellowship?
Dr. Stephens: I got some of my colleagues who had been working here a while together and asked them how things had been going and what they would envision for a fellowship here. Then we approached Life Flight® and Tom Flanagan (Vice President of Trauma Service Line and System Integration, Memorial Hermann Health System), who put his full support behind the idea. With Tom and Dr. Hagberg on board, we secured initial approval by the Texas Medical Board, which we had to do to get an approved academic GME-accepted fellowship for the hospital. That was really the first big step. Then I began writing the curriculum and figuring out how to develop all the rotations for our first fellow. That took about a year and a half. Then we spent another six to eight months posting the fellowship and interviewing applicants.
RDTI Newsletter: Who is the lucky first fellow?
Dr. Stephens: Our first fellow is anesthesiologist Dr. Brent Eaton, who is originally from Abilene, Texas. After he finished his residency in anesthesiology at Cleveland Clinic Foundation in Cleveland, Ohio, he joined a private practice group in Northern California. But he and his wife really wanted to move back to Texas to be close to family.
In his application, he expressed an interest in furthering his capabilities as an anesthesiologist, especially with the really sick, taking care of very sick patients and resuscitation patients that are bleeding to death, essentially. He wanted to better himself as an anesthesiologist, and this fellowship, he said, was unique. He was a good candidate. Very motivated.
RDTI Newsletter: What is included in the fellowship curriculum?
Dr. Stephens: Overall, the curriculum is designed to produce a trauma resuscitation specialist.
Each fellow spends about six months in the trauma ORs—handling, supervising or shadowing orthopedic, neurotrauma, burn and general surgery cases. The rest of the year is spent in one-month specialty rotations—in the STICU (shock trauma intensive care unit), in the ER trauma bays, on the burn unit and in pre-hospital care.
In addition, there is a whole list of electives that fellows can choose from, including advanced regional anesthesia, echocardiography (TEE/TTE), ultrasound, pediatric anesthesia, Neuro-ICU, burn ICU, hyperbaric medicine, trauma radiology, research (basic science or clinical) and acute pain.
Dr. Eaton has an interest in learning more about echo and doing some transesophageal and transthoracic echos. That's a personal interest of his. So that's going to be a big goal of his during the fellowship—to get better at those exams. Another fellow might be interested in learning more about peripheral nerve blocks for pain control after orthopedic trauma. This will vary by fellow.
RDTI Newsletter: You mentioned a rotation in pre-hospital care. Can you elaborate on that?
Dr. Stephens: One of Dr. Eaton’s required rotations, in addition to his rotations in the STICU and the ER, is a pre-hospital month which will include shifts with Life Flight and with the Houston Fire Department and probably a couple of other agencies, like HCESD48.
When the fellow goes out into the field for a month of pre-hospital, they are going to be learning from the pre-hospital providers what it's like to be out in the field. What it's like for the flight crews that deal with a critically injured patient, whether they’re transferring here from another hospital or going to the scene and picking up from a ground EMS crew. It's important for our trauma physicians to understand that and see it firsthand.
But it will be a two-way street. The fellows will also be able to help teach those EMS crews on the fly as well. They are going to be sitting around the station with them on a shift. They can do some educating for the medics as well. Cover some training for them, too.
RDTI Newsletter: How do you see Memorial Hermann trauma patients benefitting from this new fellowship?
Dr. Stephens: Our patients will certainly benefit from having a trauma resuscitation specialist there when they are brought in, either by Life Flight or an ambulance, and they are essentially bleeding to death. Someone who understands the intricacies of the pathophysiology of major blood loss and traumatic injury. Someone who understands how to prioritize assessing and treating the patient, who knows the best approach and strategies to use. What vascular access we need to put in the patients and where. How to be suspicious of where bleeding is taking place in places other than maybe where they are currently operating. Those are things that you don't get in your normal, run of the mill, residency program.
And we’re there, too, providing post-op care. Getting the patient tucked into the ICU. Helping them with pain control, so they can move on towards their goals of PT, OT and rehab.
RDTI Newsletter: What is the role of anesthesiology in trauma, including pre-hospital, care?
Dr. Stephens: Basically, everything that they do in EMS started with the specialty of anesthesiology. There was no such thing as emergency medicine back then. You had surgeons and anesthesiologists really running all the ICUs. If you look back at the beginnings of paramedicine and pre-hospital care, it was the anesthesiologists and critical care intensivists that got paramedic skills from the hospitals out in to the field. So, they were really the original educators of pre-hospital care providers.
And they were some of the early pioneers in critical care, helping to establish some of the early EMS systems around the country—and the early paramedic skills. The defibrillation, basic airway management, intubations, pharmacology, physiology, ventilation, CPR techniques and so on. The origins of bag-valve masks and resuscitating patients, that was all from anesthesiologists.
RDTI Newsletter: I wonder if these origins are widely known in the EMS community?
Dr. Stephens: Probably a lot of the EMS community—especially the younger ones—don't really have any idea of the origins and the history or pre-hospital care in our country. How a lot of these things started. That's something that's fun to share with people and talk to them about and show papers about. That was really the basis of why I chose my specialty; I wanted to be a really good EMS educator and trainer. And to help the flight crews and ground crews.
RDTI Newsletter: What would you say to an interested fellowship candidate?
Dr. Stephens: We have such a good volume of trauma patients that I know one thing for a fact—you will come out of this fellowship feeling much more confident in caring for severely injured, dying, bleeding patients. That's the biggest goal of the fellowship. And you will gain a much better understanding of the continuity of care, from the field all the way through when a patient leaves the hospital.
Dr. Stephens completed paramedic school in 1995 at Houston Community College with the Houston Fire Department. He worked in EMS until entering medical school at The University of Texas Medical Branch. After finishing his Anesthesiology residency at UTMB, he completed a Trauma Anesthesiology Fellowship at the University of Maryland Shock Trauma Center, where he then joined the faculty as an Assistant Professor of Anesthesiology and Director of Education for the Division of Trauma Anesthesiology. In addition, Dr. Stephens was appointed Medical Director of the Maryland Fire & Rescue Institute as well as clinical Instructor for the Maryland State Police Aviation Command Flight Paramedics. He is an Associate Professor of Anesthesiology at McGovern Medical School, Chief of Trauma Anesthesiology, and Fellowship Program Director at the Memorial Hermann Red Duke Trauma Institute. He is currently an EMS Fellow in the Department of Emergency Medicine at McGovern Medical School and acting Assistant Medical Director for the Houston Fire Department.
After commissioning into the U.S. Army Medical Corps, Dr. Stephens earned his Flight Surgeon wings and recently returned from deployment to Iraq flying combat MEDEVAC missions. He also acted as the Command Flight Surgeon for Operation Hurricane Harvey Relief, where he performed helicopter Search & Rescue missions. As a rated pilot, he enjoys flying helicopters and airplanes in his free time.
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