Title: Academic physician quarterly
Full Citation
Permanent Link: http://ufdc.ufl.edu/UF00088871/00010
 Material Information
Title: Academic physician quarterly
Physical Description: Serial
Language: English
Creator: College of Medicine, University of Florida
Publisher: College of Medicine
Place of Publication: Jacksonville, Fla.
Publication Date: July 2009
 Record Information
Bibliographic ID: UF00088871
Volume ID: VID00010
Source Institution: University of Florida
Holding Location: University of Florida
Rights Management: All rights reserved by the source institution and holding location.


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Dear colleagues:

It's that time again when a new crop of trainees are joining
the Department. They will be joining a strong training pro-
gram that recently received a five year approval from the
Residency Review Committee. The strength of this program
lies not only in the breadth of clinical experience the trainees
receive but it also extends to developing the minds of these 4\
bright young physicians to think as scientists, educators and
community leaders. Indeed, trainees are offered a wide range
of research opportunities that accounts for the Department's continued success
at our Annual Research Day with platform and poster presentations of fellows
and residents.

On this year's Research Day, one quarter of platform and poster presentations of
fellows and residents were made by members of the Department. Of the platform
presentations, Dr. Tausef Qureshi was the second place prize winner and Dr. M.
Kamran Aslam received the fourth place prize. In addition, among the poster pre-
sentations Dr. Senan Sultan received the third place prize and Dr. Abdul-Razzak
Alamir received the 5th place prize. I am very happy to see that research produc-
tivity of the house staff is excellent. The challenge for all of us is to maintain this

Our faculty continue to receive the highest honors for teaching. This year, eight
faculty members of the Department were recognized for their exceptional contri-
butions to the teaching mission of the University of Florida.

It's been a wonderful and a productive academic year and we are looking for-
ward for another year full of academic accomplishments.

Arshag D. Mooradian, M.D.
Professor of Medicine
Chairman, Department of Medicine


Luis Guzman, M.D.

Assistant Professor of Medicine

Medical Director, Peripheral
Program and Cath Lab

Division of Cardiology

Integrating Cardio-Vascular Care at
Shands/UF Cardiovascular Center:
Lower Extremities Atherosclerotic Disease

Atherosclerosis is a complex and systemic disease involv-
ing mainly medium and large arteries. Even though the most
common clinical presentation of the disease affects the coro-
nary arteries, multiple vascular beds are usually implicated,
including the aorta, the carotid, the renal and the lower ex-
tremity arteries. For this reason, at UF/Shands Cardiovas-
cular Center we have developed a comprehensive program
to detect these patients early and offer a variety of diagnos-
tics tests, created a vascular clinic and offer a state of the art
technology in the interventional percutaneous treatment of
these patients, including the newest technology in percuta-
neous revascularization of the lower extremities, renal stet-
ting and the recently FDA approved stenting with cerebral
protection to the carotid arteries.
Atherosclerosis affecting the lower extremities is the most
common form of peripheral vascular disease (PVD). Its in-
volvement appears to be an expression of a more advanced
process associated with worse prognosis. The understand-
ing of this process is critical for the development of preven-
tive strategies, and institution of appropriate treatment.

Atherosclerosis is a heterogeneous and dynamic process.
Even though initially described in a coronary arteries, recent
advances have demonstrated similar process in all different
territories. According to the plaque composition, atheroscle-
rotic lesions have been classified in 7 different types.1 The
different lesion types develop as a consequence of a complex
pathophysiologic mechanism at the cellular and molecular
level with participation of multiple pro-inflammatory cy-
tokines, growth factors, matrix metalloproteinase and coag-
ulation factors. In the early phases, endothelial dysfunction
is the main contributor. Endothelial exposure to multiple ho-

modynamic (shear stress, high blood pressure) and serum
factors (high cholesterol, high glucose, etc), gradually leads
to loss of its protective function and vessel wall homeostasis.
Increased permeability to circulating lipoproteins and mono-
cytes creates an intraplaque inflammatory state which stim-
ulates the proliferation of smooth muscle cells, causes
deposition of extracellular matrix, as well as development of
a prothrombotic environment, leading to lipid accumulation,
necrotic core and fibrous cap formation, characteristics of the
more advance atherosclerotic process.

Cardiac death represents 70% of the overall mortality of
the disease.2 Cerebrovascular diseases account for approxi-
mately 15% of mortality and an additional 10% mortality is
related to aortic aneurysm and visceral infarction. Even
though peripheral arterial diseases (PAD) represents only
1%-3% of the overall mortality in these patients, it is associ-
ated with a 3 fold increase in mortality due to cardiovascu-
lar diseases.3,4 The diagnosis of PAD (symptomatic or not)
is associated with a 50% 10 years mortality due to cardiac
and/or cerebrovascular disease. Approximately 60%-70% of
patients with clinical manifestations of PAD will have asso-
ciated coronary artery diseases.2,5,6,7 The incidence of asymp-
tomatic lower extremity arterial disease in the 55- to
74-year-old age general population group is about 10%.8
However, the incidence varies according to age with 2.5% in-
cidence in < 60 years, 8.3% between 60-69 years and >19% in
older than 70 years.9 It is important to mention that smoking
is a major risk factor, with 10 fold increase in symptoms as
compared with non-smokers and the development of the dis-
ease appears approximately 10 years earlier.

Although the clinical manifestations of the disease define
a small subset of the population at risk, early detection of
the sub-clinical forms is important. The PARTNERS study
has demonstrated that there is a large proportion of patients
who are without diagnosis.10 More aggressive preventive
measurement could be initiated if detected early, with the
intended reduction in clinical events. Framingham risk score
is most commonly used to define groups at higher risk. Mul-
tiple serum markers, also known as "emerging risk factors",
like HS-CRP have been recently introduced as a potential
screening tool. The most cost/effective, highly specific and
sensitive diagnostic screening test for PAD is the
Ankle/Brachial index (ABI) (Figure 1).
This test can be performed in the physician's office and

Continued on Page 3

Focus continued from Page 2

provides valuable diagnostic and prognostic information. Pa-
tients with an abnormal ABI (<0.9) had a two fold increase in
cardiovascular morbidity (myocardial infarction and stroke)
and mortality.11 In patients with abnormal ABI's and symp-
toms of limiting claudication or critical limb ischemia, further
diagnostic modalities will be indicated if revascularization is
considered. CTA and MRA are currently widely accepted as
the preferred non-invasive imaging modalities. Angiogra-
phy still remains the gold standard.


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Figure 1: Ankle-Brachial Index

Only a small proportion of patients complain of typical
symptoms or claudication and the majority are either asymp-
tomatic or present with atypical symptoms (Figure 2). 10 Even
in the group of patients with known history of PAD, only 12%
will complain of symptoms of claudications.

Figure 2: The clinical presentation of PAD as described in the PART-
NERS study. The majority of these patients are either asymptomatic
or present with atypical symptoms.

Approximately 5% of patients will progress to clinical signs
of critical limb ischemia (CLI), including pain at rest and/or
the presence of skin lesions (ulcer, gangrene). An important
concept to remember is that the majority of patients with CLI
do not have symptoms of claudications prior to development
of clinical signs of critical ischemia.
A smaller percent will present with clinical signs of acute
limb ischemia. The classical 5 P's in a cold foot are helpful for
the diagnosis (pallor, pulselessness, paresthesias, pain, paral-
ysis). Appropriate and prompt recognition is vital for limb

The vast majority of the patients with PAD have a high risk
for cardiovascular morbidity and mortality. Myocardial in-
farction and stroke will occur in 30% at 5 years, with an ap-
proximately 25% cardiovascular mortality. For this reason,
the main target of treatment in this patient population is the
prevention of cardiovascular events. All patients with PAD
should achieve blood pressure control, antiplatelets treat-
ment, lipid lowering, use of ACEI and participation in smok-
ing cessation programs.12

Approximately 30% of this population will have symptoms
or clinical situations in which revascularization modalities
will be considered. It is important to emphasize that at the
present time, no revascularization procedure has proven to
prolong life. The main indication is to improve quality of life
and/or to preserve limb viability. The recently published
ACC/AHA guidelines give a Class 1 recommendation for
revascularization for symptomatic patients with significant
functional impairment.12 Although surgical revascularization
has been the treatment of choice for many years, in the last
15 years, several percutaneous interventions including bal-
loon angioplasty, stent, cover stents, laser, atherectomy de-
vices and other adjunctive modalities have offered less
invasive treatment, rapid recovery, and outcomes compara-
ble to surgery. Currently, percutaneous intervention is the
first line of treatment for patients with critical limb ischemia.

As the population ages, and the new advances in preven-
tive measures and treatment of coronary artery diseases con-
tinue to reduce the mortality, health care providers will
increasingly face the problem of concomitant "non-coronary"
arterial diseases. Atherosclerosis has a common systemic
pathogenesis and simultaneously affects multiple vascular
beds. Early diagnosis and preventive treatment is the main
goal. For symptomatic patients, revascularization is appro-
priate with the incorporation of percutaneous alternatives as

Continued on Page 4

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Focus continued from Page 3

less invasive modalities. These patients currently seek con-
sultation and care from multiple specialists. A team ap-
proach as used at UF/Shands Cardiovascular Center with
an integrated management has clearly improved the care of
these patients.

1. Virmani R1,.I d...I.... F, Burke A, Farb A, Schwartz S. Lessons from sudden
coronary death: a comprehensive morphological classification scheme for ather-
osclerotic lesions. Arterioscler Thromb Vase Biol. 2000;20:1262-75.
2. Fowkes F, Housley E, Cawood E, Macintyre C, Ruckley C, Prescott R. Edin-
burgh Artery Study: prevalence of asymptomatic and symptomatic peripheral
arterial disease in the general population. Int J Epidemiol. 1991;20:384-92.
3. Jackson M, Clagett G. Antithrombotic therapy in peripheral arterial occlusive
disease. Chest. 2001;119:283S-299S.
4. Ogren M, Hedblad B, Isacsson S, Janzon L, Jungquist G, Lindell S. Non-inva-
sively detected carotid stenosis and ischaemic heart disease in men with leg ar-
teriosclerosis. Lancet. 1993;342:1138-41.
5. Criqui M, Denenberg J, Langer R, Fronek A. The epidemiology of peripheral
arterial disease: importance of identifying the population at risk. Vase Med.
6. Leng G, Fowkes F, Lee A, Dunbar J, Housley E, Ruckley C. Use of ankle


brachial pressure index to predict cardiovascular events and death: a cohort
study. BMJ. 1996;313:1440-4.
7. Zheng Z, Sharrett A, Chambless L, Rosamond W, Nieto F, Sheps D, Dobs A,
Evans G, Heiss G. Associations of ankle-brachial index with clinical coronary
heart disease, stroke and preclinical carotid and popliteal atherosclerosis: the
Atherosclerosis Risk in Communities (ARIC) Study. Atherosclerosis.
8. Weitz J, Byrne J, Clagett G, Farkouh M, Porter J, Sackett D, Strandness DJ, Tay-
lor L. Diagnosis and treatment of chronic arterial insufficiency of the lower ex-
tremities: a critical review. Circulation. 1996;94:3026-49.
9. Criqui M, Fronek A, Barrett-Connor E, Klauber M, Gabriel S, Goodman D. The
prevalence of peripheral arterial disease in a defined population. Circulation.
10.Hirsch A, Criqui M, Treat-Jacobson D, Regensteiner J, Creager M, Olin J,
Krook S, Hunninghake D, Comerota A, Walsh M, McDermott M, Hiatt W. Pe-
ripheral arterial disease detection, awareness, and treatment in primary care.
JAMA. 2001;286:1317-24.
11.Newman A, Siscovick D, Manolio T, Polak J, Fried L, Borhani N, Wolfson S.
Ankle-arm index as a marker of atherosclerosis in the Cardiovascular Health
Study. Cardiovascular Heart Study (CHS) Collaborative Research Group. Circu-
lation. 1993;88:837-45.
12. No authors listed. ACC/AHA 2005 practice Guidelines for the Management
of Patients With Peripheral Arterial Disease (Lower Extremity, Renal, Mesen-
teric, and Abdominal Aortic). Circulation. 2006;113:1474-1547.

Senthil Meenrajan, M.D.,

Assistant Professor of
Medicine, General Internal

Associate Program Director,
Internal Medicine Residency

Maturation is a process of evolution and development over
time and is very commonly studied in pediatrics. It is a com-
plex interaction of personal wants and environmental wants
interacting and resulting in personal growth. When I reflect
on the last year for the Internal Medicine Residency Program
this is the only term that came to mind. So here we go.... the
year in retrospect and how the program has MATURED.

The first three quarters were consumed in the following:

1. Finding reasonable associate program directors
2. Interviews
3. Board pass rate
4. Site visit

A lot of the internal and external wants for the program
seemed like one and the same! The last quarter was really
spent on waiting for the results of our actions from the first
Now that I am one of the associate program directors along
with Dr. House, I'd like to think that we had our best results
in the first objective! As for the second objective, we want to
make our program better each year and this year we achieved

it. We filled all our categorical and preliminary positions and
did not have to scramble. Our incoming class would have
the highest USMLE step 1 scores of any class so far.

PGY1 step 1 USMLE scores

2004 2005 2006 2007 2008 2009
The program has done extremely well with the internal
medicine boards as well. Over the last few years we have had
an upward trend.

ABIM pass rate


2002 2003 2004 2005 2006 2007 2008

Finally the site visit the pinnacle of accreditation would
have to be a five year cycle. The IM program, along with all
the fellowships that were visited, were awarded this status.
While we pause to gloat over the achievements of the last
year we also realize the bar is now set high eternally. Look
forward to the next year to move that bar just a tad bit higher
still!! To all who have given us untiring support to make us a


Joe M. Chehade, M.D.

Associate Professor of

Division of Endocrinology,
Diabetes & Metabolism

Unusual Presentation of a Malignant
Follicular Carcinoma of the Thyroid
in Struma Ovarii

A 58 year old woman was referred for evaluation of
metastatic thyroid cancer. She presented initially to her pri-
mary care physician with symptoms of persistent cough.
Chest x-ray revealed a 5.4 x 3.4 cm right upper lobe mass
with adjacent rib and vertebral body erosion. A CT of the
chest revealed a right upper lung mass and a 4.9 x 2.4 cm
perivertebral mass in the right upper thorax; there was also
some calcification noted in the right lobe of the thyroid with
a possible cyst. CT guided biopsy of the mass confirmed
metastatic follicular carcinoma of the thyroid. At that point
she was referred to an oncologist for further evaluation. A
PET/CT scan did not show any hypermetabolic activity in
the thyroid bed area but there was a multiseptated mass in
the pelvis measuring 16 x 9.9 cm arising from the left ovary
and uptake identified in the soft tissue mass in the posterior
right lung apex which appeared to be causing rib destruc-
tion. The decision was made to refer the patient to a gyneco-
logic oncology surgeon to remove the ovarian mass. The
pathology showed right ovary strumaa ovarii with thyroid
tissue that suggests a teratoma primarily composed of thy-
roid tissue, there was no evidence of vascular invasion. Some
of the thyroid tissue was primarily composed of microfolli-
cles and there was a component of malignant thyroid follic-
ular carcinoma". Patient referred to Endocrinology for
further evaluation.
Her past medical history was significant for hypertension,
hyperlipidemia and depression. Family history was signifi-
cant for mother with some ovarian or uterine cancer. The pa-
tient was married, never smoked and did not consume any

Home medications consisted of fluoxitene 20 mg daily, al-
prazolam 0.25 mg as needed, valsartan/HCTZ 80/12.5 mg
daily, ASA daily and loratidine 10 mg daily.
Physical examination: the patient appeared in no distress.
Blood pressure 144/83, heart rate 80 beats/minute. There
was no lymphadenopathy noted in the neck area and there
was a 1.5 cm well defined right thyroid nodule. The rest of
the physical was unremarkable.
A thyroid ultrasound completed during the physical ex-
amination confirmed the presence of a 1.9 x 1.3 x 1.6 cm hy-
perechoic nodule with little vascular flow by Doppler in the
anterior right lobe (that was palpated on exam) along with
another 1.2 x 1.8 cm hypoechoic nodule in the infero-poste-
rior lobe (not palpated by physical examination). Labora-
tory data: Thyroglobulin level 400 ng/ml (<30); TSH 1.6
UIU/ml (0.27-4.6); Free T4 0.99 (0.7-1.85); Calcuim 10.6
mg/dl (8.2-10.2).
The most common germ cell tumor in the ovaries is the be-
nign cystic teratoma (dermoid). 7% of theses tumors contain
thyroid tissue, and 25% of these may be classified as struma
ovarii (i.e. > 50% of the neoplasm consists of thyroid tissue).
Although the typical presentation is that of a pelvic mass,
unusual clinical manifestations such as hyperthyroidism, as-
cites, and Meigs' syndrome have been recognized. In regard
to the occurrence of follicular cell carcinoma in struma ovarii,
there is a paucity of cases reported in the literature (<50
cases). The average age was 44. These patients predomi-
nantly presented with a pelvic mass (45%) and abdominal
pain (40%). Patients also presented with menstrual irregu-
larities (9%) and hyperthyroidism (5%). Papillary carcinoma
was the most common (44%) malignant histopathologic find-
ing followed by follicular carcinoma (30%), and follicular
variant of papillary carcinoma (26%). Metastasis were seen in
nine cases (23%)(1). Histologic malignancy in struma does
not necessarily equate with biologic malignancy, and the ma-
jority of differentiated thyroid carcinomas do not spread be-
yond the ovary.
Malignant struma ovarii is a medical rarity. This paucity of
published cases and the difficulty in distinguishing between
benign and malignant strumas make it difficult for a physi-
cian to discern the natural progression of disease and its best
treatment modality. Should fertility not be a desired option,
and the physician knows the diagnosis beforehand, total ab-
dominal hysterectomy, bilateral salpingo-oophorectomy,
pelvic washings, and pelvic lymph node sampling should be

Continued on Page 6

A Clinical Case continued from Page 5

performed and followed by total thyroidectomy and 1131 ab-
lation. For women of child-bearing age, a thorough under-
standing of the disease both by the patient and physician
must be undertaken to discern the best treatment options. De-
spite its complications, thyroidectomy has an important role
in the treatment of malignant struma ovarii. First, it confirms
normal thyroid histology and excludes a primary thyroid car-
cinoma with subsequent metastasis to the ovary. Second,
large amounts of retained thyroid tissue when treated with
radioactive iodine incite an inflammatory response that may
cause the patient significant pain and disability. Thirdly, less
131I is available to destroy malignant cells. Finally, serum thy-
roglobulin levels provide accurate information on recurrence
only after thyroidectomy. However, the rarity of this tumor
will make it difficult for prospective trials to validate this as-

In general patients presenting with a thyroid nodule 2 10
mm and normal TSH, fine needle aspiration biopsy (FNA)
should be performed as an initial evaluation to differentiate
malignant from benign nodule (4-5). Some thyroid nodule <
10 mm with capsular invasion or other suspicious finding by
ultrasound, by history or on clinical examination should also
undergo FNA. In our case study the patient already pre-
sented with a metastatic follicular thyroid carcinoma based
on her CT guided lung biopsy. Usually the primary lesion is
in the thyroid and total thyroidectomy followed by 1311 abla-
tion is the standard of care. Any other metastatic lesion
amenable to surgical debulking should be performed and pa-
tient should be followed by periodic thyroglobulin level and
131 whole body scan to monitor for any recurrence. For our

patient the large asymptomatic pelvic mass (16 x 10 cm) with
hypermetabolic activity on PET scan was an unexpected find-
ing. The question at this point: Is this another metastatic le-
sion (in the ovary) or ectopic thyroid tissue from the ovary
strumaa ovarii) is the source of metastasis? She underwent ex-
ploratory laparotomy, total abdominal hysterectomy, bilat-
eral salpingo-oophorectomy, staging peritoneal biopsies,
selective pelvic periaortic lymphadenectomy and partial
omentectomy. The pathology report was consistent with fea-
tures of teratoma with thyroid microfollicules that are mostly
seen with thyroid follicular carcinoma.
The patient and was found to have two thyroid nodules
and the best approach would have been to refer for thy-
roidectomy and followed by 131I ablation.
In conclusion, this patient had a metastatic follicular thy-
roid carcinoma most likely arising from an ectopic thyroid
tissue in the left ovary strumaa ovarii" although a total thy-
roidectomy was needed to confirm the ectopic origin.
1. Samina Makani, Wooshin Kim and Arthur R. Gaba. Struma Ovarii with a
focus of papillary thyroid cancer: a case report and review of the litera-
ture.Gynecol Oncol. 2004 Sep;94(3):835-9
2. Christopher P. DeSimone, Subodh M. Lele. and Susan C. Modesitt. .Ma-
lignant struma ovarii: a case report and analysis of cases reported in the lit-
erature with focus on survival and 1131 therapy.Gynecol Oncol. 2003
3. M.L. Mattucci, A. Delleral, A. Guerrierol, F. Barbieri, L. Minnelli, and L.
Furlani. Malignant struma ovarii: a case report and review of the literature.
J Endocrinol Invest. 2007 Jun;30(6):517-20.
4. AACE/AME Task Force on Thyroid Nodules .Endocrine Practice Vol 12
No. 1 January/February 2006 63
5. Joe M. Chehade, Alan B. i.Jl I.1, --. Joohee Kim, Christopher Case, Ar-
shag D. Mooradian. Role of repeated fine-needle aspiration of thyroid nod-
ules with benign cytologic features. Endocr Pract. 2001 Jul-Aug;7(4):237-43.


Bernadette S. Belgado, Pharm. D.

Methadone Not Your Average
Controlled Substance
Methadone is a long-acting opiate agonist used for the
treatment of chronic pain and withdrawal symptoms related
to opioid-addiction. Methadone is a Schedule II controlled
substance strictly regulated under federal law. When used as
a treatment for withdrawal, patients must be enrolled in a
Narcotic Treatment Program (NTP) to receive methadone.

No physician, even those registered as a NTP, can write a
methadone prescription for treatment of addiction. Only
when methadone is being used for analgesic purposes can a

physician prescribe methadone.
Although they cannot write a prescription, physicians who
are registered with the Drug Enforcement Agency (DEA) as
a NTP can administer or directly dispense methadone for
treatment of addiction. When arrangements are being made
to enter the patient into a treatment program, physicians who
are NOT registered as a NTP may administer or directly dis-
pense methadone for the purpose of alleviating withdrawal
symptoms ONLY under the following conditions:
No more than a one-day supply of medication may
be administered or directly dispensed to a patient at
one time
Treatment may not be carried out for more than

Continued on Page 7

RX Update continued from Page 6

three days
This three-day period cannot be renewed or extended.
If a patient is enrolled in a NTP and is admitted to the hos-
pital for a reason other than addiction, an unregistered physi-
cian may order methadone for the patient. At Shands
Jacksonville the pharmacist will verify the maintenance dose
with the methadone treatment facility before methadone is
dispensed for this purpose.

1. Section 1306.07 Administering or dispensing of narcotic drugs. 21 CFR
1306.07(b) ONLINE. Available: http://
www.deadiversion.usdoj.gov/21cfr/cfr/1306/1306_07.htm [October 9,
2. Pharmacists Manual. An Information Outline of the Controlled Substances Act
of 1970. April 1994. ONLINE. Available: http://www.deadiversion.usdoj.gov/
pubs/manuals/phann2/2phamnnmanual.pdf [October 15, 2008].
3. Methadone and Buprenorphine +/- Naloxone (Subutex and Suboxone)
Prescribing and Dispensing for Inpatients. Shands Jacksonville Policy # Rx-11-058.
January 2008.


Exemplary Teachers Awards
Eight faculty members in the Department of Medicine
were chosen to receive the 2009 University of Florida-Col-
lege of Medicine's Exemplary Teachers Award.
The awardees include (arranged alphabetically): Drs. Irene
Alexandraki, Dominick J. Angiolillo, Linda R. Edwards, Mal-
colm T. Foster, Jeffrey G. House, Senthil R. Meenrajan, N.
Stanley Nahman Jr., and Elisa M. Sottile.
This award is given in recognition of outstanding teaching
contributions of individual faculty member. The awardees
will receive a plaque, a lapel pin and a financial award de-
termined by the compensation plan's incentive for out-
standing teaching.
Congratulations to the awardees.

UF COM Jacksonville Oncology Group
The University of Florida College of Medicine-Jacksonville
has been approved by the Executive Committee of North
Central Cancer Treatment Group (NCCTG) as an affiliate
site of Mayo Florida. It was announced at the General Ses-
sion of the NCCTG Spring Meeting last week.
Last year the UF College of Medicine's Hematology/On-
cology Department evaluated over 1000 new cancer cases.
They have solid experience in clinical trial participation and
over the years have established productive relationships
with Mayo physicians and researchers.


TraumaOne Rebranded
Mayor John Peyton, Jacksonville City Councilman Johnny
Gaffney and members of the media attended a special event
in May to reintroduce TraumaOne to the community.
While part of Shands Jacksonville, TraumaOne has been
branded as a distinct program. The Trauma Center, Flight
Services, Communications/Dispatch, Trauma Prevention
and Education, and Emergency Preparedness are all part of
TraumaOne rather than the hospital.
TraumaOne was the first trauma program in the state of
Florida. Twenty-six years later, it is still the only adult and
pediatric Level I trauma program in Northeast Florida and
Southeast Georgia.
"TraumaOne is the only trauma program in this area, and
we invest a significant amount of resources to ensure we
maintain our Level I status," said Wayne Marshall, division
director of Emergency/Trauma Services. "Nobody else does
what we do. Nobody."

The Trauma Center is staffed 24 hours a day, seven days a
week with specialty trained healthcare providers in emer-
gency, trauma and critical care. More than 4,000 patients
came through the doors of the Trauma Center in 2008. On
each of its four busiest days, 24 patients were treated by the
team. Motor vehicle crashes, motorcycle crashes, falls, pedes-
trian and other accidents accounted for 74 percent of trauma
cases last year.
TraumaOne flight nurses and paramedics have extensive
training and years of experience in caring for trauma pa-
tients. Interestingly, the pilots have no medical background
at all. Their decisions must be made purely on their aviation
experience. They are not given details of an accident until
after they have accepted the call and determined it is safe to
fly to the scene based on FAA regulations; this practice pre-
vents pilots from making emotional decisions.

Continued on Paae 8

f SHANDS BRAND] continued from Page 6

The communications staff in TraumaOne dispatches four
helicopters within a 100-mile service area. They accept all res-
cue calls for the hospital and notify the trauma, emergency or
pediatric emergency teams of incoming patients. The team
also plays a vital role in mass casualty incidents, serving as a
link between the Emergency Preparedness team, Trauma
Center and Emergency Department, city government and
local agencies, such as police and fire rescue departments.
Shands Jacksonville's Trauma Prevention Program began
20 years ago to educate children and parents in our commu-
nity on important safety topics in an effort to reduce the num-
ber and severity of injuries. Each year, 15,000-20,000 people
learn about injury prevention through lectures, mock simula-
tions, health fairs, hands-on activities and general distribu-
tion of educational materials, helmets and car seats.
TraumaOne's emergency preparedness staff is responsible
for the safety of patients, visitors and staff throughout Shands
Jacksonville's 65-acre campus during natural and man-made
disasters-from hurricanes to terrorist threats. The team is

also responsible for coordinating the hospital's response to
any MCI with the potential to bring in a large number of pa-
tients with serious injuries.
"The community at large would see a significant increase
in the mortality rate of victims of traumatic injuries if Trau-
maOne was not available," said Julia Paul, MSN, RN, Trauma
Program manager.

Mayor John Peyton discussed the significance of TraumaOne in Jack-
sonville and surrounding counties before helping to unveil the new
logo for the trauma program.

College of Medicine
653-1 West Eighth St.
Department of Medicine
Jacksonville, FL 32209-6511
904-244-8846; fax: 904-244-8844


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