By Linda Satter 

Aug. 14, 2023 | A $1.5 million grant from the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) will allow the University of Arkansas for Medical Sciences (UAMS) Department of Emergency Medicine to revolutionize the ways in which it treats pain and trains new doctors.

The award funds a three-year project to train UAMS emergency physicians, advanced practice providers and nurses about pain management strategies that treat pain aggressively but don’t rely on opioid medications.

Michael Wilson, M.D., Ph.D., an associate professor in the UAMS College of Medicine departments of Emergency Medicine and Psychiatry, said he expects the project to lead to better pain management throughout Arkansas.

“We believe that training providers on how to treat pain more effectively, but without using opioids, will not only help current UAMS patients, but will also help the rest of the state for years to come,” Wilson said.

Wilson is the co-primary investigator with Carly Eastin, M.D., an associate professor in the UAMS Departments of Emergency Medicine and Pediatrics, who added, “This is because approximately 45% of UAMS emergency medicine residents remain in Arkansas after graduation, and the majority of emergency department physicians currently working in Arkansas were trained at UAMS.”

The project is called “Improving Emergency Department Management of Acute and Chronic Pain Using Non-Opioid Strategies.”

“We are also hopeful,” Wilson said, “that the UAMS Department of Emergency Medicine can serve as a statewide model for successful pain management without opioids, since Arkansas has had the second-highest opioid prescribing rate in the nation since the early 2010s.”

In 2016, Arkansas physicians prescribed 114.6 opioid prescriptions for every 100 people. While the number declined to 75.8 prescriptions for every 100 people by 2020, the rate remains 75% higher than the national average of 43.3 prescriptions for every 100 people, he said.

The project aims to improve pain relief but reduce the use of opioids through three initiatives: provider education and electronic medical record optimization, using peer navigators to help patients manage pain without opioids and, for patients whose use of opioids is either ineffective or hazardous, implementing interventional pain procedures such as acupuncture and nerve blocks.

“The impact of these initiatives will be profound,” Wilson predicted. “We estimate that we will be able to affect care for more than 8,000 patients each year who come to the emergency department with painful conditions. We hope the program will become a statewide model for aggressive pain management without opioids.”

UAMS is the state’s only academic medical center and has the largest residency training program in emergency medicine, which serves more than 65,000 patients annually. On average, 11,000 patients each year come to the UAMS emergency department complaining of pain.

A predominantly rural state, Arkansas has the sixth-highest poverty rate in the nation, and many patients have poor access to treatment providers and facilities. It ranks among the top 10% of states whose patients need treatment for opioid use disorder.

This study is supported by grant 1H79TI086020-01, issued through the U.S. Department of Health and Human Services (HSS)’ Substance Abuse and Mental Health Services Administration (SAMHSA).UAMS is the state’s only health sciences university, with colleges of Medicine, Nursing, Pharmacy, Health Professions and Public Health; a graduate school; a hospital; a main campus in Little Rock; a Northwest Arkansas regional campus in Fayetteville; a statewide network of regional campuses; and seven institutes: the Winthrop P. Rockefeller Cancer Institute, Jackson T. Stephens Spine & Neurosciences Institute, Harvey & Bernice Jones Eye Institute, Psychiatric Research Institute, Donald W. Reynolds Institute on Aging, Translational Research Institute and Institute for Digital Health & Innovation. UAMS includes UAMS Health, a statewide health system that encompasses all of UAMS’ clinical enterprise. UAMS is the only adult Level 1 trauma center in the state. UAMS has 3,240 students, 913 medical residents and fellows, and five dental residents. It is the state’s largest public employer with more than 11,000 employees, including 1,200 physicians who provide care to patients at UAMS, its regional campuses, Arkansas Children’s, the VA Medical Center and Baptist Health. Visit www.uams.edu or uamshealth.com. Find us on Facebook, Twitter, YouTube or Instagram.

###

UAMS Faces: Ari Filip

Meet Ari Filip, M.D., Medical Director of the Arkansas Poison and Drug Information Center. He completed his residency at UAMS, left for a fellowship but came back to UAMS to work in the center. Watch and learn what brought him back as well as everything the center is doing to help address multiple public health challenges.

Red Sash Awards

Dr. Marc Phan was selected as a Red Sash Award winner at the College of Medicine Honors Convocation. The award is given to faculty members recognized by members of the senior class as among the most outstanding teachers during their four years in medical school.

Deans Honor Day

Physician of the Year
Randy Maddox, M.D.
Professor, Department of Emergency Medicine
Director, Emergency Medicine Service Line

Collaborations and Teamwork
Zachary Lewis, M.D.
Assistant Professor (Associate Professor as of July 1)
Department of Emergency Medicine
Ultrasound Director, Emergency Medicine Residency Program

Read the article on the UAMS News website for details.

Mehta Creative Writing Awards

Our resident Beth Hanson was the Creative Nonfiction Award Winner for her work “The Window.”

Read the article on the UAMS News website for details.

Chancellor’s Teaching Award

Gregory Snead, M.D., Professor and Vice Chair of Emergency Medicine, received the Chancellor’s Teaching Award for Teaching Excellence at the UAMS Commencement ceremony.

A shout-out to Dr. Travis Eastin, Associate Professor and Director of the Education Division in the Department of Emergency Medicine, on being selected for the 2022 Association of Academic Chairs in Emergency Medicine (AACEM) Chair Development Program. He becomes the department’s second participant for the highly competitive program, which is known for developing future leaders in academic emergency medicine. The acceptance comes on the heels of Dr. Gregory Snead’s selection last year – a real credit to the department, chaired by Dr. Rawle A. “Tony” Seupaul, and the caliber of our Emergency Medicine faculty.

By Linda Satter 

The Emergency Medicine Interest Group at the University of Arkansas for Medical Sciences (UAMS) recently received top honors nationally from the Emergency Medicine Residents’ Association  (EMRA). The UAMS group was named the EMIG of the Year.

EMRA is the largest and oldest independent resident organization in the world and has a membership of more than 16,000 residents, medical students, fellows and alumni. It recently announced the prestigious honor in its newsletter along with a photograph of 32 members of the UAMS team who participated in a local cleanup event – one of numerous events the group participated in during the 2020-21 academic year to earn the national honor.

“This award was established to recognize the outstanding achievements of the most productive Emergency Medicine Interest Groups on a regional and national scale, along with the hardworking student leaders who provide a diverse range of valuable Emergency Medicine-related learning and networking opportunities to their student members,” according to EMRA’s website.

Paige Dailey and Morgan Sweere served as co-presidents of the UAMS group, which has more than 100 members.

Dailey, who held office as a fourth-year medical student, now has her medical degree and is a first-year resident in the Department of Emergency Medicine at UAMS. Sweere, a third-year medical student, also plans to specialize in Emergency Medicine, though not everyone in the interest group plans to make a career out of emergency medicine.

Ethan Clement, a third-year medical student who is now junior president of the UAMS group, said Dailey and Sweere “did a lot of hard work that resulted in a UAMS group being awarded EMIG of the Year.”

The group participates in activities and events throughout the year to further the skills and knowledge that are endemic to emergency medicine but useful in many other medical specialties. Because Emergency Medicine isn’t a required rotation for medical students, the basic skills honed during some interest group activities are often especially beneficial for students focused on other medical specialties, Dailey and Sweere said.

Among the learning and network opportunities that Dailey and Sweere organized and painstakingly documented – one of the requirements of the award – were simulation events, Journal Club events, presentation scenarios and monthly faculty lectures covering a variety of emergency medicine specialties.

At simulation events, participants practice emergency techniques on mannequins, such as intubation, establishing a central line or splinting.

During Journal Club events, interest group members discuss articles on emerging research in the emergency medicine field, with students giving presentations about different components of the research.

In the presentation scenarios, students discuss the steps they would take when a patient presents with a particular scenario – say, an 85-year-old patient complaining of weakness. Students discuss what tests they would order and ultimately what kind of disposition plan they would create.

“That’s really good practice for us,” Sweere said.

The interest group also participates in community events, such as helping with neighborhood cleanup efforts or perhaps volunteering in a food bank or with a clothing drive.

“We wanted to get our group really involved,” Dailey said. To that end, she said, the ongoing COVID-19 pandemic created quite a challenge.

For example, the group had to obtain special permission from the dean’s office and agree to follow strict mask-wearing mandates to hold some activities in person, such as simulation events involving mannequins.

Despite those obstacles, Sweere said, “One of the nice things about it was that medical students are generally very motivated to get involved.”

“We still had a lot of turnout,” Dailey said.

That turnout helped the UAMS group obtain the national title.

Meryll E. Bouldin, M.D., assistant professor in the UAMS Department of Emergency Medicine, was the faculty advisor for the UAMS EMIG group for the 2019-2020 academic year.

“I’m very proud of this group,” Bouldin said. “They have grown tremendously since I have known them and have to be one of the most active and impactful interest groups on campus. Their student leadership team is very innovative and driven to provide the best content and resources to the rest of their classmates.”

“When COVID brought things to a halt, this group pushed forward, continuing to enhance their curriculum even though things had to be virtual. This national award is a HUGE deal and it couldn’t have gone to a more deserving group.”

By Linda Satter 

An idea for increasing COVID-19 vaccination rates in Arkansas while providing an educational experience for University of Arkansas for Medical Science (UAMS) students has proven successful on both fronts.

It all started with Travis Eastin, M.D., and wife Carly Eastin, M.D., both associate professors in the College of Medicine’s Department of Emergency Medicine, who saw an opportunity to enlist students to help educate unvaccinated patients about COVID-19 vaccines.

The timing couldn’t have been better. A year and a half into the pandemic, Arkansas is making national headlines over its simultaneous surge in new COVID-19 cases while an estimated two-thirds of residents remain unvaccinated. The Eastins knew that every effort to increase vaccinations was needed.

“We started by doing a needs assessment using Emergency Medicine Interest Group students just asking patients if they’d like to be vaccinated during their Emergency Department (ED) visit if it was available, and enough said yes that we just moved to actually administering the shots,” Carly Eastin said. “We are trying to get as many students mobilized to assist with approaching patients, educating them, offering the vaccine and then ordering it and facilitating giving it for those who accept.”

Emergency medicine residents Brendan Moore, M.D., and Aaron Moulton, M.D., and fourth-year medical student Morgan Sweere Treece, helped the Eastins put out the call for volunteers among students in the emergency medicine group. Later they expanded the request for volunteers to pharmacy students and then all medical students.

“The primary goal is to increase the number of vaccinated Arkansans, and while there is a survey and we are tracking data, the main objective is vaccination,” said Travis Eastin, shortly after the request for volunteers was posted on student listservs.

Less than two weeks later, Carly Eastin reported, “We feel that so far this has been a huge success! We have had volunteer medical students for mostly four hours – sometimes eight hours a day – each weekday since the end of June.”

She said students approach patients whose charts indicate they aren’t vaccinated, offer information about vaccine safety and efficacy, and answer questions the patients may have. The medical students then offer the vaccine. If the patient accepts, the student alerts the patient’s bedside nurse.

She later reported, “In about three weeks, we have offered the vaccine to 152 patients. Of those, the students have assisted in administering 38 vaccines in the ED and have helped schedule 15 others to receive their vaccines in a vaccine clinic.”

The response to the students’ efforts prompted ED providers to offer the vaccines during all shifts, including nights and weekends. By July 21, 61 COVID vaccines had been administered, and another 15 patients had made appointments to get them later.

“There is certainly a mix of reactions, in my experience,” said Fuad “Kikko” Haydar, MBA, who is working toward obtaining a medical degree in 2024 and who has been one of the most active volunteers.

“Some people are very happy to be able to conveniently get vaccinated in the ED,” he said. “Some don’t even want to discuss it. Some have asked questions about safety and side effects, and we were able to give them enough information to alleviate their worry. And then there are some who are upset when we bring up the vaccine entirely.”

The ED patients are being offered the one-dose Johnson & Johnson vaccine or the two-dose Pfizer vaccine. The Johnson & Johnson vaccine is now being stocked in the Emergency Department and is available around the clock.

“I would like to give a shout-out to Pharmacy Specialist Gavin Jones, Pharmacy Director Sherry Myatt and Melissa Jo Easdon, nursing director in the Emergency Department, for helping make this a success,” Carly Eastin said.

Recent statistics show that 60% of Arkansans who are 12 and older aren’t fully vaccinated, yet people are increasingly going out in public and attending large events without masks and without practicing social distancing.

“The best solution is rapid, immediate vaccination of every eligible Arkansans,” UAMS Chancellor Cam Petterson, M.D., MBA, said July 14.

While UAMS is seeing a new influx of patients hospitalized with COVID-19, Patterson has emphasized that vaccines do work, noting that none of the vaccinated patients at the hospital have died.

Zachary Lewis, M.D.

• Assistant Professor, Department of Emergency Medicine
• Co-Director, Emergency Ultrasound Fellowship/Pediatric Emergency Ultrasound Fellowship
• Co-Director, Emergency Ultrasound Education

Zachary Lewis, M.D., has excelled in clinical care, education, patient advocacy and more in his three years on the faculty in the Department of Emergency Medicine.

“We are very proud of Dr. Lewis’ leadership in many areas, exceptional dedication to the educational goals of the department, and passion for improving the experience of patients and providers at UAMS,” wrote his nominator, Gregory Snead, M.D., vice chair and chief of the Division of Emergency Ultrasound. “We certainly see him as a ‘rising star’ at UAMS.”

“Zach has a way of finding simple solutions to address challenging problems in education and the clinical environment for patients and providers,” Snead wrote. “He is a vocal advocate who can help patients foresee and overcome many of the challenges that exist as they navigate complex care systems.”

“Dr. Lewis is an outstanding and compassionate clinical teacher frequently recognized by the residents for his use of evidence-based care and his patience in teaching many of the most complex procedural aspects of our specialty,” Snead added.

Emergency Medicine Chair Rawle A. “Tony” Seupaul, M.D., said Lewis stood out as exemplary while still a medical student and continued to impress as a resident and then ultrasound fellow. “Zach will likely be a full professor here at UAMS in the near future and will likely win more awards because he is that deserving. He is respected by everyone he works with, and everyone he educates.”