Yale trauma training preps Navy corpsmen

In two-day workshops at Yale the Navy’s independent duty corpsmen learn the basics of trauma care.

When the Navy submarine USS San Francisco struck an uncharted, undersea mountain in early January, responsibility for the dozens of injured sailors fell to James H. Akin, the vessel’s medical corpsman. For 22 hours, Akin triaged the wounded—whose injuries ranged from bruises and pulled muscles to a fatal blow to the head—and put sailors and officers to work cleaning and irrigating lacerations until he could suture them.

As he stitched up the wounded, Akin’s main concern was machinist’s mate Joseph A. Ashley, who had struck his head during the impact. Akin immobilized Ashley, checked his airway, breathing and circulation, and inserted an IV. He showed other sailors how to monitor Ashley’s airway while he tended to other patients. As rescue vessels approached the stricken submarine, Navy doctors on ships and bases around the Pacific advised the medical corpsman by radio. But when the rescuers arrived, heavy seas made evacuations impossible. Ashley ultimately died of his injuries.

In March, Akin received a Meritorious Service Medal for his performance during the crisis. And he credited his ability to handle the medical emergency to the trauma training he received at Yale, under the direction of Reuven Rabinovici, M.D., professor of surgery and chief of the Section of Trauma, Surgical Critical Care and Surgical Emergencies.

For the past several years, Rabinovici has directed a course in the basics of trauma treatment for the Navy’s independent duty corpsmen, or IDCs, given by trauma surgeons at Yale. It’s part of the 56 weeks of training the corpsmen receive before they’re assigned to submarine duty and the care of crews of between 130 and 170 men.

“Their scope of practice is very narrow—primary care medicine for adult males, 20 to 45 years old,” said Lt. Donald Harris, PA-C, clinical program manager at the Naval Operational Medicine Institute Detachment. The detachment is stationed 50 miles east of New Haven at the Naval Undersea Medical Institute (NUMI) at the Naval submarine base in Groton, Conn. (In May the base appeared on a Pentagon list of military facilities to be considered for closing.)

In addition to medical duties, the IDC monitors shipmates for exposure to radiation, practices preventive medicine and is responsible for environmental and occupational health. Corpsmen are also responsible for the mental health of the crew, not an unlikely concern in a cramped, self-contained environment that recycles its own air, converts sea water into drinking water and can stay under-water for as long as food supplies last—up to 65 days.

“They’re the doctor, nurse, chaplain and psychologist,” said Capt. Paul C. Kelleher, M.D., director of education at NUMI. Their emergency medical supplies and equipment, Kelleher said, roughly correspond to what is available on a paramedic’s ambulance. And their training at Yale covers different kinds of trauma, including blunt injuries as well as gunshot and stab wounds. One classroom scenario involves a wounded Navy seal coming on board for emergency treatment.

The sessions at Yale began three years ago when NUMI sought to enhance trauma training. Yale’s in-house program that teaches residents advanced trauma life support was adapted for IDCs. “This program is less than what the doctor needs, but it’s what the IDCs need,” said Harris. As the first line of care, IDCs learn how to stabilize patients until they can be evacuated to definitive medical facilities.

The training starts with classroom sessions that cover the initial evaluation and resuscitation of a trauma patient. Then corpsmen move on to an animal lab to practice basic surgical techniques such as intravenous access, chest tube placement, opening a surgical airway and emergency amputations. “They are all basic lifesaving procedures that the IDC may need to perform on board,” said Rabinovici.

The next day the IDCs attend interactive sessions with Yale trauma surgeons who pose real-life scenarios— such as a stab wound in the neck—and expect the IDCs to describe the appropriate treatment. The IDCs also rotate through clinical electives in surgery and anesthesia at Yale-New Haven Hospital.

The training made a difference for Akin when the USS San Francisco collided with the uncharted mountain 350 miles southeast of its base in Guam. According to Harris, the program manager in Groton, “he felt confident in his knowledge and management of the injuries to his crew because of the trauma training he received” from Yale surgeons.

Rabinovici said he was glad to learn that the training had paid off. “It is not that we said we could help—indeed, we did help. I feel very good about that.”

—John Curtis

Drugmaker invests in New Haven facility and joint projects at Yale

Like many enterprises with international reach, Pfizer makes its corporate home in New York. But the company has deep roots in southeastern Connecticut, having built what was then the world’s largest manufacturing plant for antibiotics in Groton in 1946. Today, more than 6,000 Pfizer scientists and personnel work in drug discovery in Groton and at the company’s Global Research and Development headquarters in nearby New London.

With the April opening of the $35 million New Haven Clinical Research Unit (CRU), a 50-bed dedicated facility for Phase I drug trials, Pfizer further strengthened its ties to Connecticut and added new luster to a three-year-old research alliance with Yale.

At the CRU, volunteers will participate in trials of potential medicines that have cleared several years of safety studies in the laboratory. Pfizer will collaborate with bioimaging experts at the School of Medicine, who will use positron emission tomography (PET) and other technologies to track the action of drugs in the human body, especially in the brain.

Diane K. Jorkasky, M.D., Pfizer’s vice president of clinical pharmacology, said that the ability to draw on the expertise of Yale scientists figured heavily in the company’s decision to locate the CRU in New Haven. But those collaborations are just one example of Pfizer’s partnerships with Yale.

In 2003, the company established a fellowship in memory of the late Patricia S. Goldman-Rakic, Ph.D., a renowned Yale neurobiologist, to support a graduate student in neuroscience in Yale’s Combined Program in Biological and Biomedical Sciences. Through Pfizer Faculty Development grants, five assistant and associate professors in the School of Medicine have been granted up to $50,000 worth of research time at the medical school’s Magnetic Resonance Research Center. And in a new joint effort of Pfizer’s Women Leaders Network and the medical school’s Office for Women in Medicine, a female medical school faculty member will spend 12 weeks working alongside Pfizer researchers in Groton and New London each year.

“The relationship is one of win-win for Yale and Pfizer,” said Jorkasky, “and the biggest winners will be the patients who will benefit from the science that the partnership explores.”

—Peter Farley

For stem cell researcher, Connecticut’s initiative offers a new avenue for progress

In her Yale laboratory in 2001, Diane S. Krause, M.D., Ph.D., surprised the scientific community with her discovery that adult stem cells taken from the bone marrow of mice can produce liver, lung, intestine and skin cells. To her dismay, her studies and similar findings have provided ammunition to opponents of embryonic stem cell research, who have used her results to argue that research with stem cells derived from human embryos is unnecessary. Speaking in January at a hearing of the Connecticut General Assembly, the associate professor of laboratory medicine and pathology said, “To close off this avenue of research based on the early promise of adult stem cells is to play the odds with people’s lives.” She called upon the legislature to support both adult and embryonic stem cell research in the state.

In May the state legislature did just that as it approved a bill to commit $100 million to embryonic stem cell research over 10 years. At a ceremony in Farmington a few weeks later, with Krause and medical school Dean Robert J. Alpern, M.D., looking on, Gov. M. Jodi Rell signed the bill into law. The bill’s passage is expected to boost this research at Yale and the University of Connecticut. The legislation establishes a two-step process in which experts in both science and ethics review requests for funding.

Unlike adult stem cells, which have shown a limited ability to develop into other cells, embryonic stem cells can generate virtually any type of cell in the body. Biologists believe they have the potential to help treat diseases such as diabetes and Alzheimer’s and to repair the spine, heart and other organs. Along with Alpern, Krause advised the General Assembly as it drafted legislation to make Connecticut a “safe haven” for embryonic stem cell research.

This field of study has been limited in the United States by guidelines established by President Bush that restrict federal funding exclusively to specific embryonic stem cell lines established prior to August 9, 2001. Supporters of the research contend that many of those pre-existing lines have been tainted by cells from other animals, such as mice, and that the limited number of lines hampers opportunities for study.

The controversial research received a major boost last year after California voters approved $3 billion in funding for stem cell research over 10 years. New Jersey’s acting governor, Richard J. Codey, announced in January that his state would invest an additional $150 million in its stem cell institute, created in 2004 with $11.5 million in startup funding.

In her Yale office, Krause pointed to an increasingly competitive research environment. “I’ve been contacted by states that have announced funding to see if I’d be willing to move,” she said. “Connecticut doesn’t want to lose the opportunity and researchers.”

Krause is spearheading the effort to establish a stem cell program at Yale, and is one of more than 20 scientists across the university doing stem cell-related work. Recruitment of a senior leader for the Yale program began this past winter with an international search and will likely be followed by the recruitment of five to seven additional faculty members whose work is focused solely on stem cell biology.

Once established, the new program will likely have investigators performing both adult and embryonic stem cell research, with separate laboratories for any research using embryonic cell lines not approved for federal funding. “No one can predict,” Krause said, “which lines of investigation will lead to development of effective and safe treatments. We can say with 100 percent certainty, though, that what we learn from embryonic stem cells will be useful for developing new therapies.” Although she does not currently work with embryonic stem cells, she said, “I want the freedom to use embryonic stem cells as a tool when I need to use that tool.”

—Marc Wortman

From the operating room to hospitals in need, REMEDY provides surgical supplies

In 1991, after several volunteer missions to Latin America, William H. Rosenblatt, M.D., HS ’90, FW ’91, professor of anesthesiology and surgery (otolaryngology) at the School of Medicine, made an observation that was to have far-reaching effects: many of the hospitals he visited were in dire need of medical supplies, while at Yale-New Haven Hospital (YNHH) many of those same supplies were discarded without being used.

Thus was born REMEDY (Recovered Medical Equipment for the Developing World), a nonprofit committed to recovering surplus medical supplies and teaching others how to do it.

What started as a local program at YNHH to collect opened but unused surgical supplies—which have never touched a patient but can’t be reprocessed due to liability concerns—has grown into a grass-roots organization involving hundreds of hospitals around the United States. From Yale alone, the REMEDY program has donated more than 30 tons of medical supplies to hospitals overseas. “Each of these pieces of material, whether it be a suture, a glove or a sponge, is going to wind up in another part of the world and be useful,” said Rosenblatt. The program has also saved the hospital over $30,000 in disposal costs since its inception, at a cost of about $200 per year for disinfecting and bagging the supplies.

Today, REMEDY trains hospitals to organize their own programs and has helped 358 hospitals begin recovery activities. The organization provides teaching packets free of charge, and with Yale’s Office of International Health, has developed a notification program called AIRE-mail, in which medical supplies donated by hospitals and vendors are advertised via e-mail to 125 participating nonprofit humanitarian organizations. It has also developed a catalog called REMEDY Atlas, consisting of the 240 supplies most often recovered, which will help ensure that recipients are getting supplies they need.

Meanwhile, the collecting, sorting, packing and shipping of surplus medical supplies has largely been taken over by students. In 2001, RYSA (REMEDY at Yale Students Association) was started by Jonathan S. Cohen, PA ’04, who is now a pa surgical resident at The Johns Hopkins Hospital.

“It’s been incredible to see all this stuff come from what would have been the garbage in New Haven and end up being packaged and shipped all over the world,” said Cohen. Between last August and January, RYSA volunteers shipped 3,500 pounds of supplies from the New Haven area to eight countries.

For RYSA volunteers, long hours organizing medical supplies has its rewards. “The volunteers are having a direct effect with everything that they do,” said Rosenblatt.

—Jill Max

Alumni interested in starting a local REMEDY program may contact Silvia Botero at info@remedyinc.org.

et cetera

CIRA opens office in India

President Richard C. Levin inaugurated a new office for the Center for Interdisciplinary Research on aids (CIRA) in India in January. Joining him in the city of Chennai were CIRA’s director, Michael H. Merson, M.D., and University Secretary Linda K. Lorimer, J.D. ’77.

The new office will initially administer three projects. Project Parivartan, which is supported by a three-year grant from the Bill & Melinda Gates Foundation, will study community interventions designed to reduce HIV risk among sex workers, truckers and injection drug users.

A second project, supported by the Children’s Investment Fund Foundation, will evaluate a model program that provides medical, psychosocial and nutrition services to families with a child infected with or affected by HIV/AIDS. The third project is a research and training program that will study the influence of religious and cultural factors on the mental health and transmission risk behavior of HIV-infected persons.

—John Curtis

CIS contract renewed

The National Cancer Institute (NCI) has renewed a five-year, $5 million contract with the Yale Cancer Center to operate the NCI’s Cancer Information Service (CIS) in New England. The cancer center has operated the New England service since it was created in 1976 to provide up-to-date cancer information to the American public. The CIS partners with state and regional organizations to develop education efforts for people lacking access to cancer information and services, provide current scientific information in understandable language and study ways to promote healthy behaviors.

“The CIS is a critical resource for the American public, and we feel privileged to be able to continue to provide this service,” said Linda Mowad, R.N., program director for the CIS at Yale.

The contract also includes a research component covering New England and seven other states to help the CIS educate the public about cancer and contribute to the nation’s cancer control efforts.

—J.C.


			Originally published in Yale Medicine, Summer 2005. Copyright © 2005 Yale University School of Medicine. All rights reserved.