SECTION ONCRITICAL CARE

October 2004

A Note from the Chairby Michele Moss, MD

IN THIS ISSUEDistinguished Career AwardSOCC Fall Education ProgramScientifice Abstract PresentationsEmergency Medical Services for ChildrenTransport Medicine CourseDrug Update - Fall 2004Pediatric Critical Care ScientistsDevelopment Program (PCCSDP)PCCSDP Application InstructionsGrand RoundsPCCMCalendar of EventsSOCC Executive Committee Roster

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Copyright © 2003, American Academy of Pediatrics Section on Critical Care

At the end of August the AAPconducted the first AcademyLeadership Forum (ALF) inChicago. This was a somewhatmonumental occasion in the life ofthe AAP. Previously the leadershipof the AAP has included thechapter presidents and vicepresidents and the chairs ofcommittees and sections. Eachgroup has previously held their own leadership forum. Theleadership from the Section on Critical Care has previouslyattended the Council of Sections meeting usually held inMarch. The chapter leadership has traditionally met at theChapter Forum in September prior to the National Conference& Exhibition (NCE). Much of the activity of the AAP springsforth from the Chapter Forum. As you know the chapterscomprise the various geographic districts. The District Chairsmake up the Board of Directors so the overall leadership of theAAP grows out of the chapter process.

There has been a chasm between chapters and committees andsections in the AAP and yet all are important for the work ofthe AAP. The AAP has acknowledged that chasm and hasbegun working to close it. Initially the leadership of thecommittees and sections started meeting together several yearsago. This has proven to be a great success with bettercommunication and understanding of each others goals and

missions. There has been more Section input at the Board levelwith the Chairman of the Council of Sections being invited toBoard meetings, although not a voting participant.

The ALF held this past month provided a bridge for this chasmto be closed even further. It was the first time all the leadershave come together. At first there was some discomfort as theprocesses of the Chapters and the Committees and Sectionswere melded. But as the meeting continued it was apparent thata lot of useful communication was occurring and the partici-pants could see the improvements before our eyes. The bestexample occurred during the discussion of the chapter resolu-tions. Chapters and districts can put forth resolutions that arethen voted on by the complete Chapter Forum. In the pastthese resolutions would then be sent to the appropriateCommittee or Section for further comment and study, and finallypresented to the Board. The Top Ten would be priorities for theBoard to deal with. What occurred at the ALF last month wasthat during discussion of the resolution on the floor, there wasimmediate input from the appropriate committee or section. Theinformation was very useful for the chapters and often resolu-tions would be withdrawn based on what input was available.That immediate input from all parties involved resulted instronger and more appropriate resolutions that will now becleaner as they are put forward to the Board of Directors. TheBoard members also were able to hear all the discussion, thushelping them in dealing with the resolutions in the future.

The bottom line to all this discussion is that it appears that theAAP has developed a new and better forum for its leadership toshare ideas and goals. This is surely going to allow for devel-opment of better working relationships within the AAP betweengeneral pediatricians, academic pediatricians, and medical andsurgical subspecialists. Children will only benefit if we all cometogether.

One continuing concern voiced by chapter leaders to sectionleaders was their desire to get more subspecialists involved atthe local level. I personally am surprised to hear how fewsubspecialists join their local chapter. The chapters are for all ofus. Often the feeling is that the local chapter does not careabout or want to involve itselfin subspecialty issues. Thatdoes not appear to be the caseafter speaking with severalchapter presidents and districtchairs. The chapter leadershipwas very interested in hearingabout subspecialists concernsand they share many of thesame concerns. They are justas worried as we are about thelack of subspecialists availableand the bleakness of the

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future numbers of subspecialists. They too suffer from poorMedicaid reimbursement and recognize that is a major limitation to access to care for our children. I would like to encourage all ofyou to join your local chapter. I am sure you will be welcomed.The chapter leadership wants subspecialty involvement andwants to know your concerns. There may be projects you canhelp with when critical care or subspecialty input is needed. Alsoyour district leaders want your input and are continuing to seekways to get more subspecialty input at the chapter and districtlevel. Let your district chair know who you are and that you areavailable to help with issues that may be pertinent to critical careor subspecialty issues.

We have had a recent disappointment in our section. ThePediatric Critical Care Practice Management Course was plannedto occur at the end of the Pediatric Critical Care Colloquium inNew York. We had hoped for and budgeted for 100 participants.At our previous course given with the Colloquium we werelimited to 100 participants and were turning people away so it wasfelt that 100 was a reasonable number to plan for. The budget wasdeveloped very tightly – basically no profit. We realized that rana risk of being under budget. Unfortunately one month prior tothe course we only had 37 registered and that number had notincreased in a few weeks. It did not appear that we were going tocome even close to our anticipated registration. Because of thatour section stood to lose around $10,000. That was perceived bythe leaders of the course to be too much of a loss and the coursewas cancelled. That was a very uncomfortable decision for thecourse leaders because of the inconvenience and disappointmentof the registrants and speakers. But the monetary loss wouldhave seriously hampered the Section’s other goals and projects.The Executive Committee will be “dissecting” this event at our fallmeeting and will try to come up with answers as to why thecourse did not have better registration.

In closing this is my last newsletter as your Section chair. Whatan honor it has been for me to serve you all. I have enjoyed somuch getting to work closely with several of you through theExecutive Committee and many other projects. I have heard frommany of you and trust me, if you volunteered for a project yourname was sent to the project leader! We have been able tocelebrate some great successes – the Pediatric Coding Course andthe new CPT code for pediatric critical care. We still havechallenges as with the Practice Management Course but thebiggest challenge is to meet the needs of the membership. Welook forward to new and upcoming projects particularly thelifelong learning project headed by Tim Timmons which is beingdesigned to serve as the lifelong learning component for oursubspecialty recertification.

I personally want to thank Sue Tellez for all the help and supportshe has been the last several years to me and to our section. I canalways zip her an email with a question or request and magically itis answered! If she doesn’t know the answer, she scouts it out.She also keeps me on task and reminds me of my many commit-ments. But because of her, the work of the Section on CriticalCare moves forward and does not languish in a pile on my desks.Thanks, Sue.

A Note From the Chaircontinued from page 1

2004 Section on Critical CareDistinguished Career Award

Congratulations!

Bradley P. Fuhrman, MD

Dr Fuhrman graduated from NYU School ofMedicine (1971), then pursued Residency,Cardiology and Neonatology Fellowships at theUniversity of Minnesota. He directed theirPediatric ICU before relocating to Children’sHospital of Pittsburgh (1985) and Children’sHospital of Buffalo (1991). He has chaired thePediatric Critical Care Sub-Board and served onEditorial Boards of the Journal of Pediatrics,Critical Care Medicine and Pediatric Critical CareMedicine. He and Jerry Zimmerman edit thetextbook, Pediatric Critical Care. Dr Fuhrman isProfessor of Pediatrics and Chief of PediatricCritical Care at SUNY Buffalo, and Medical StaffPresident at Children’s Hospital of Buffalo.

I wish you all continued success in your own practices. I hopeyou can let your section know what your needs are. Please letyour leaders know if you are interested in any projects or evenstarting one of your own! Also getinvolved with your chapters and workon advancing subspecialty issuesthrough that mechanism.

Happy trails!

Michele Moss, MD, FAAP

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American Academy of PediatricsNational Conference & ExhibitionOctober 10 - 11, 2004 San Francisco, CASECTION ON CRITICAL CARE MEDICINE PROGRAM SCHEDULE

Sunday, October 10, 2004

8:00 – 8:15 pm Continental BreakfastIntroduction and WelcomeJames D. Fortenberry, MD

8:15 – 9:45 am Abstract Session IModerators: Alice Ackerman, MD, FAAP and Barry Markovitz, MD, MPH, FAAP

9:45 – 10:00 am Coffee Break and Poster Review

10:00 - 11:20 am Abstract Session IIModerators: Michele Moss, MD, FAAP and Mary Lieh-Lai, MD, FAAP

11:20 - 11:50 am Presentation of Distinguished Career AwardRecipient: TBA

12:00 - 1:00 pm Lunch & SOCC Business MeetingM. Michele Moss, MD, FAAP

1:00 - 4:30 pm “Patient Safety in the Pediatric ICU”

1:00 - 1:05 pm IntroductionModerator: James Fortenberry, MD, FAAP

1:05 - 1:40 pm Patient Safety in the PICU: An OverviewVicki Montgomery, MD, FAAP

1:40 - 2:10 pm The Cost of Patient SafetyFiona Levy, MD, FAAP

2:10 - 2:40 pm The Impact of Information Technology on PICU Patient SafetyMatt Scanlon, MD, FAAP

2:40 - 2:50 pm Break

2:50 - 3:20 pm Disclosing Medical Errors: The Problem and ApproachesJohn Straumanis, MD, FAAP

3:20 - 3:50 pm The Impact of Physician and Nurse Workload on PICU SafetyVicki Montgomery, MD, FAAP

3:50 - 4:30 pm Identifying and Responding to Safety Issues: Practical ExperiencesJohn Straumanis, MD, FAAP; Fiona Levy, MD, FAAP and Matt Scanlon, MD, FAAP

4:30 - 4:45 pm Best Abstract/Physician-in-Training Awards Presentation

Monday, October 11, 2004

8:30 - 11:30 am “Intensive Care Issues in Organ Transplantation”

8:30 - 8:45 am Welcome and IntroductionJames Fortenberry, MD, FAAP

8:45 - 9:15 am Transplant Immunology and Pharmacology: A PrimerMaite DeLaMorena, MD, FAAP

9:15 - 9:45 am What’s New in Pediatric BMT For the Intensivist?Jeffrey Schmidt, MD, FAAP

9:45 - 10:00 am Coffee Break

Mechanical Ventilation and Advanced Technology in BMT Patients with Respiratory Failure: Two Perspectives10:00 - 10:45 am Sam Shemie, MD and Jeffrey Schmidt, MD, FAAP

10:45 - 11:30 am The Intensivist as Organ Donor Specialist: Ethical and Practical IssuesSam Shemie, MD

American Academy of PediatricsSection on Critical Care MedicineScientific Abstract Presentations2004 AAP National Conference and ExhibitionOctober 10, 2004San Francisco, California

James D. Fortenberry, MD, FAAP, FCCM, Guest Editor

ORAL A BSTRACT PRESENTATIONS1

RANDOMIZED CLINICAL TRIAL OF KETOROLAC AFTER CONGENITAL HEART SURGERY IN INFANTS AND CHILDRENAnuja Gupta, Casey Daggett, Stacey Drant, Niurka Rivero1 and Alan Lewis. Pediatrics, Childrens Hospital Los Angeles, LosAngeles, CA and Pediatrics, UCLA Medical Center, Los Angeles, CA.

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IMPACT OF NEW PEDIATRIC CRITICAL CARE CPT CODES IN AN ACADEMIC CRITICAL CARE DIVISIONOtwell D Timmons. Department of Pediatrics, Carolinas Medical Center, Charlotte, NC.

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MICROALBUMINURIA LEVELS ARE CORRELATED WITH PELOD SCORES IN CRITICALLY ILL CHILDRENMartin K Wakeham, Kari L Rajzer, Denise B Angst, Luis E Torero, and David G Jaimovich. Pediatrics, Hope Children’s Hospital,Oak Lawn, IL.

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A RETROSPECTIVE COHORT STUDY OF PROGNOSTIC FACTORS ASSOCIATED WITH OUTCOME IN PEDIATRIC SEVERESEPSIS; WHAT IS THE ROLE OF STEROIDS?Barry P Markovitz, Denise M Goodman, R Scott Watson, David Bertoch, and Jerry Zimmerman. Anesthesiology & Pediatrics,Washington University School of Medicine, St. Louis, MO; Pediatrics, Northwestern University Feinberg School of Medicine,Chicago, IL; CRISMA (Clinical Research, Investigation, and Systems Modeling of Acute Illness) Laboratory & Critical CareMedicine, University of Pittsburgh, Pittsburgh, PA; Child Health Corporation of America, Shawnee Mission, KS and Pediatrics,University of Washington, Seattle, WA.

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NITRIC OXIDE SYNTHASE (NOS) INHIBITION PREVENTS THE DECREASE IN ANGIOTENSIN CONVERTING ENZYME mRNA AND ACTIVITY BY ACTIVATED NEUTROPHILS IN BOVINE PULMONARY ARTERIAL ENDOTHELIAL CELLS (BPAEC)Renuka Mehta, Connie Snead, Anthony L Pearson-Shaver, and John D Cataravas. Pediatrics, Medical College of Georgia,Augusta, GA and Vascular Biology, Medical College of Georgia, Augusta, GA.

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FAMILY PRESENCE DURING PEDIATRIC RESUSCITATION: A NATIONAL SURVEY OF PREVALENCE AND ATTITUDES AMONGHEALTHCARE PROVIDERSKatherine J Gold, Susan L Bratton, and Daniel W Gorenflo. Department of Family Medicine, University of Michigan,Ann Arbor, MI and Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI.

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ELIMINATION OF DANGEROUS ABBREVIATIONS IN THE PEDIATRIC AND NEONATAL INTENSIVE CARE UNITSSusan H Schrock, Elora Hilmas, and John P Straumanis. Department of Pediatrics, University of Maryland, Baltimore, MD andDepartment of Pharmacy, University of Maryland, Baltimore.

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PATTERNS OF MEDICATION USE AND ERRORS IN A PEDIATRIC INTENSIVE CARE UNITIlyas Burny, Mary W Lieh-Lai, Ken Gaynor, and Ronald L Thomas. Pediatric Critical Care Medicine, Children’s Hospital ofMichigan/Wayne State University, Detroit, MI.

POSTER ABSTRACT PRESENTATIONS

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VITAMIN D DEFICIENT RICKETS PRESENTING AS CARDIOPULMONARY ARRESTAmanda M Brandow, Sheila J Hanson, and Larry Greenbaum. Department of Pediatrics, Children’s Hospital of Wisconsin,Milwaukee, WI ; Department of Critical Care, Children’s Hospital of Wisconsin, Milwaukee, WI and Department of Nephrology,Children’s Hospital of Wisconsin, Milwaukee, WI.

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A REDESIGNED AMBULANCE TROLLEY AS A MOBILE PEDIATRIC INTENSIVE CARE UNIT FOR INTERHOSPITAL TRANSPORTDirk RG Danschutter and Jose Ramet. Pediatrics, AZ VUB, Brussels, Belgium.

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INFANTILE KAWASAKI DISEASE AND PERIPHERAL GANGRENEAmy L Durall 1, John R Phillips 1, Martin E Weisse 1 and Charles J Mullett 1. 1 Pediatrics, West Virginia University, Morgantown,WV.

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ONCE-DAILY CICLESONIDE DOES NOT CAUSE HPA-AXIS SUPPRESSION IN PEDIATRIC ASTHMA PATIENTSJohn W Georgitis, Stanley Galant, Mark Lloyd, Sudeep Kundu, James E Fish, Donald Banerji, and Parvez Hamedani. RespiratoryTrials PLLC, Kernersville, NC; Clinical Trials of Orange County, Orange County, CA and Aventis Pharmaceuticals, Inc,Bridgewater, NJ.

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STANDARD DOSE CONCENTRATIONS AND SMART PUMP TECHNOLOGY REDUCE INFUSION ERRORS IN A PEDIATRICHOSPITALMary O’Connell, Jared Cash, Howard Parker, Mark McKay, Marc Holley, Mary Jo Grant, and Gitte Larsen. Pediatric CriticalCare, Pharmacy, Quality, Primary Children’s Medical Center (Intermountain Health Care), Salt Lake City, UT and Department ofPediatrics, University of Utah, Salt Lake City, UT.

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URINE COTININE CORRELATES WITH ENVIRONMENTAL TOBACCO SMOKE EXPOSURE AND INCREASED HOSPITALI-ZATION IN PREMATURE INFANTS WITH BRONCHIOLITISNancy G Hoover1 and Atul Vats. Division of Critical Care Medicine, Children’s Healthcare of Atlanta, Atlanta, GA.

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HOME TRANSITION WITH A PEDIATRIC TRACHEOSTOMY: IMPEDIMENTS TO PARENTAL EDUCATION AND DISCHARGEBarbara A Montagnino, Mona L McPherson, Remi Hueckel, and Jeanine M Graf. Pediatrics, Texas Children’s Hospital, Houston,TX; Pediatrics, Baylor College of Medicine, Houston, TX; Pediatrics, Duke University Medical Center, Durham, NC and Center forPediatric Health Services Research, Texas Children’s Hospital, Houston, TX.

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ATYPICAL KAWASAKI DISEASE PRESENTING WITH ACUTE RESPIRATORY DISTRESS SYNDROME (ARDS) AND SHOCKJayendra Sharma, Mudit Mathur, Hiren Trivedi, Gilbert Goldman, and Rubin Cooper. Pediatrics/Division of Pediatric Cardiologyand Critical Care, The Children Hospital at Downstate/SUNY, Brooklyn, NY and Pediatrics/ Division of Pediatric Cardiology, TheNew York Presbyterian Hospital/Cornell Medical Center, New York, NY.

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THE RELIABILITY AND VALIDITY OF PEDIATRIC SEDATION SCALERenuka Mehta, Jennifer L Waller, and Anthony L Pearson-Shaver. Pediatrics, Medical College of Georgia, Augusta, GA andBiostatistics, Medical College of Georgia, Augusta, GA.

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AN UNUSUAL CASE OF HYPERNATREMIA: A DIAGNOSTIC CHALLENGEUmakanth A Khatwa, Lin Lin Kin, and Gerard Prosper. Pediatrics, Lincoln Medical and Mental Health Center, Bronx, NY.

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PEDIATRIC TRACHEOSTOMIES: EPIDEMIOLOGY AND DISPOSITIONMona L McPherson, Barbara A Montagnino, Remi Hueckel, and Jeanine M Graf. Pediatrics, Texas Children’s Hospital, Houston,TX; Pediatrics, Baylor College of Medicine, Houston, TX; Pediatrics, Duke University Medical Center, Durham, NC and Center forPediatric Health Services Research, Texas Children’s Hospital, Houston, TX.

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THE RISK FACTORS FOR ACUTE RHABDOMYOLYSIS IN STATUS ASTHMATICUSRenuka Mehta and Derek S Wheeler. Pediatrics, Medical College of Georgia, Augusta, GA.

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MYOCARDIAL BRIDGE WITH EVEDENT CORONARY ISCHEMIA : SURGICAL MANAGEMENT AND FOLLOWUPJayendra Sharma, Robert Pass, Ralph Mosca, Seema Mital, and William Hellenbrand. Pediatrics/Division of Pediatric Cardiol-ogy, The Children Hospital at Downstate/SUNY, 450 Clarkson Avenue, Brooklyn, NY and Pediatrics/ Division of Pediatric Cardiol-ogy and Cardiac Surgery, The Children Hospital of New York, 3959 Broadway, NY.

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USE OF ACTIVATED PROTEIN C IN A PRETERM NEONATE WITH GROUP B STREPTOCCAL SEPSISBradly Strohler, Neal Patel, Marek Grzeszczak, and Kevin Churchwell. Pediatrics, Vanderbilt Children’s Hospital, Nashville, TN.

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THE USE OF NITRIC OXIDE IN A PEDIATRIC ONCOLOGY ICURobert F Tamburro, Jeffrey E Schmidt, and Surender Rajasekaran. Pediatric Critical Care Medicine, St Jude Children’s ResearchHospital, Memphis, TN and Pediatric Critical Care Medicine, University of Tennessee Health Science Center, Memphis, TN.

Congress has introduced legislation that would eliminate adedicated national program for emergency medical servicesfor children and $20 million in funding. The legislation’s (H.R.3999) main purpose is to reauthorize the federal trauma grantprogram. However, it includes a provision that eliminates thenational Emergency Medical Services for Children (EMSC)program. The loss of this dedicated program for emergencyservices for children and millions in funding would bedevastating to the children. It has taken 20 years for EMSC togrow from a $2 million to $20 million program and there are stillsignificant projects left to complete. Many emergencydepartments and ambulances lack specialized equipment andsupplies needed to care for children, and many emergencymedical personnel still do not have the necessary educationor training to provide quality pediatric emergency care.Without the national EMSC the emergency care of millions ofchildren will suffer.

Background:

Created in 1984, EMSC is a fully authorized program thatsupports demonstration projects to expand and improveemergency medical services for children who need treatmentfor trauma or critical care. The EMSC program has beenreauthorized 5 times since its creation, received $20 million inFY 2004 and is currently authorized through 2005. ThePresident has requested level funding for the program in FY2005. H.R. 3999, was drafted to reauthorize the federal traumacare grants program. However, as introduced, H.R. 3999would eliminate the national EMSC program by strikingsection 1910 of Title XIX of the Public Health Service Act.Section 1910 is the authorizing language for EMSC - withoutthat section in place, the national EMSC program will cease toexist. Although H.R. 3999 includes language to allow traumacare grant funds to be used to improve emergency medicalservices for children, history has made clear that unlessEMSC has distinct and dedicated authority and support,children’s emergency medical needs will go unmet.

Key Points:

1. The national EMSC program is a program that is responsive tothe nation’s needs. Examples of cutting-edge work underway withsupport from the program include projects to develop emergencyeducational and training programs for school officials and staff;design national, evidence-based quality measures for assessingcare to children who have suffered serious injuries; and ensurethat all state disaster plans address pediatric needs.

2. The national EMSC program and the federal trauma care grantsprogram are complimentary − not competing, not collapsible. Inaddition to funding projects that ultimately improve systems ofcare, the national EMSC program supports a broad array ofinitiatives that improve basic knowledge about pediatric emer-gency medicine.

3. While much has been accomplished to improve children’semergency medical services across the country, much remains tobe done. Many emergency departments and ambulances still lack

4. The elimination of the national EMSC program, and the co-opting of $20 million in EMSC funds into the $3 million traumacare grants program, is a step back for children. If children losetheir dedicated resource and are forced to complete with adultpopulations, we know from experience that children will suffer.

5. We know from experience that without dedicated, separateauthority for children’s emergency services, critically ill andinjured children will not receive the care they need when theyneed it.

6. Children have unique physiological needs that must beaddressed in all aspects of emergency care. From supplies andequipment, to therapeutics, to provider education and training,children’s unique needs must be addressed if they are to surviveemergency situations.

7. The Institute of Medicine (IOM) started a study on the Futureof Emergency Care in the USA, which includes an assessment ofemergency medical services for children, as well as pre-hospitaland emergency department care. Any proposed changes to thenational EMSC program will benefit from the IOM’s study andshould be considered only after this study is complete.

Take Action:

Contact your Representative today and urge them to save thenational Emergency Medical Services for Children (EMSC)program. E-mail a letter directly to your Representative from theAAP’s Legislative Action Center, www.aap.org/moc, (member idrequired, use subscription label on back of AAP News) click onFederal Affairs, then Legislative Alerts and Issues, then click on“Save the National Emergency Services for Children Program” oruse the sample letter and key points below to fax a letter usingyour own letterhead.Having Trouble Logging In? If you are having trouble logginginto the AAP Members Only Channel, find your representatives’contact info at http://www.house.gov/writerep/. Draft your ownletter from the key points or simply cut and paste the sample letterfrom below and send.

Helpful Hints:

• Personalizing your letter has the most impact on legislators.

• Give as much data as you can about how this will affectyou, your patients and the people where you live.

For More Information: Contact Cynthia Pellegrini , AssistantDirector, or Katy Grossman, Legislative Assistant, in the AAPWashington Office via E-mail (cpelligrini@aap.org orkgrossman@aap.org) or phone (800/336-5475).

Emergency Medical Services for Children

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specialized equipment and supplies needed to care for children

I write today as a concerned constituent and pediatrician to urge you to save the national Emergency Medical Services forChildren (EMSC) program.

For more than 20 years, the EMSC program has sought to improve the nation’s ability to care for critically ill and injuredchildren. While much has been accomplished during this time, much work remains to be done. For example, while supportfrom the EMSC program led to the creation of national guidelines on the care of children in emergency departments, recentdata indicate that fewer than half of the nation’s emergency departments are approved for pediatric care, and only halfhave written inter-facility transfer agreements for critically ill and injured children. Similarly, while the EMSC program isbacking development of a model pediatric component for state disaster plans, data reveal that only 13 states are workingwith EMSC to ensure their planning efforts meet the emergency medical needs of children following a disaster or terroristevent.

It is an unfortunate but well-known truth that without a distinct, separate authority for children’s emergency medicalservices, many critically ill and injured children will not receive the care they need when they need it. If children lose theirdedicated resource, we know from experience that their prospects will suffer. I therefore urge you to save the nationalEMSC program by rejecting provisions in H.R. 3999 that would eliminate EMSC. Your continued commitment to this vitalnational program is needed if all children are to have an equal opportunity to survive a life threatening illness, injury orevent.

Sincerely,

Emergency Medical Services for Children(Sample Letter)

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2004 Course on Neonatal and Pediatric Critical Care Transport Medicineand Section Program

OCTOBER 10-12, 2004San Francisco, California

American Academy of Pediatrics (AAP) National Conference & Exhibition Sponsored by the AAP Section on Transport Medicine

If you are a physician, nurse, respiratory therapist, paramedic, emergency medical technician or administrator ofa transport team, please plan on being a part of the 2004 Course on Neonatal and Pediatric Critical Care Trans-port Medicine. The Course, held as part of the AAP National Conference & Exhibition (NCE), is scheduled forOctober 11 and 12, 2004, in San Francisco. By registering for the Course, attendees have access to all educa-tional sessions and activities that are offered during the NCE, including the Section on Transport Medicine’sacademic and scientific program that immediately precedes the Course on October 10.

Topics that will be covered during this year’s Course and Section program include: “Legal Aspects of Transport Medicine,” “TheReferring Center’s Perspective,” “Transport Enigmas,” “Advances in Neonatal Transports,” “Septic Shock: News You Can Use,”“Survival Training for Transport Personnel,” “Family Presence During Transport,” and “Procedural Sedation and Analgesia forPediatric Patients.” In addition, there will be an opportunity to hear abstract presentations and view posters on the latest neonatal andpediatric transport research.

For a nominal fee, attendees also have the chance to observe and participate in workshops at the Center for Advanced PediatricEducation (CAPE) at Lucile Packard Children’s Hospital at Stanford. CAPE employs leading edge simulation-based technology thatenhances training in the pediatric sciences. This is a fabulous opportunity to experience challenging medical scenarios that could befound on transports of critically ill children.

The Course is an excellent venue to network with other transport teams around the world, share ideas, andlearn more about the ever-growing specialty of transport medicine. We hope to see in the Bay Area inOctober!

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Drug Update - Fall 2004

I. MEDICATION ERRORS

1. A small bottle of propofol was mistaken as a small bottle of intralipids.

2. A patient received a syringe full of air IV through an automated power injector which was supposed to be injecting contrastmedia during a CT scan. Contrast media and air both appear “clear”, especially when the room is dark, and the syringe may beobscured by drapes, etc.

3. Verbal telephone orders: a physician reportedly called in an order for 5200 mcg per hour of fentanyl. Fortunately the pharmacisthad questions regarding this large dose and called the physician himself to verify. The physician actually wanted fentanyl, 50 to100 mcg per hour. When confirming telephone orders, always express the numbers as single digits, for example in this case, theread back would be five-two-zero-zero mcg per hour.

4. Don’t confuse NOVOLIN 70/30 (70% NPH, human insulin isophane suspension, 30% regular, human insulin) and the newerpreparation NOVOLOG MIX 70/30 (70% insulin aspart protamine suspension, 30% insulin aspart). Numerous errors have beenreported where patients experienced wide fluctuations in blood sugar after they received Novolin instead of NovoLog.

5. PCA pump programming errors: Bear with me on this one – it is a bit complicated - one patient died and one patient recovered(luckily) from this error. The physician ordered fentanyl by PCA 50 mcg/mL with a 10 mcg demand dose, a 6-minute lockout, andclinician boluses of 20 mcg (every 5 minutes x 3, repeat every 4 hours as needed). The nurse accidentally programmed 1 mcg/mLinstead of the actual concentration of 50 mcg/mL. Then she programmed the demand dose as 0.10 mcg instead of 10 mcg, suchthat each demand dose delivered only 0.1 mL. Despite an actual concentration of 50 mcg/mL the patient received only half of theintended dose (0.1 mL of 50 mcg/mL or 5 mcg). The patient kept complaining of severe pain, at which point the nurse on the nextshift decided to give the patient a 20 mcg bolus. She correctly programmed the bolus dose, but since the pump had been setincorrectly at 1 mcg/mL concentration, the patient received 20 mL of the 50 mcg/mL actual concentration or 1000 mcg. The patientwas later found unresponsive, was resuscitated and treated in the ICU but died 3 days later. A similar incident occurred in anotherpatient at the same hospital, but the pulse oximeter alarmed, the patient was found unresponsive with poor respiratory effort, andwas then brought back to the OR for presumed post-op bleeding. The error was subsequently discovered. The patient recoveredfollowing an ICU stay.

6. One of the treatments for priapism is the intracavernous injection of an alpha-agonist - phenylephrine or epinephrine toproduce vasoconstriction and reduce blood flow to the penis. The typical concentration used is 1:1,000,000 of epinephrineprepared by adding 1 mg (1:1000) epinephrine to a liter of normal saline. The urologist thought an epinephrine preparation of1:1000 on the label meant that the epinephrine had been prediluted with 1000 mL of normal saline and proceeded to inject 4 mL (4mg) of the solution into the penis of a 16 year old who had presented with priapism. The patient arrested and could not beresuscitated.

7. Infant TPN and insulin: a prescription was written for 1 unit of regular insulin in each 327 mL bag of TPN for a 1.3 kg infant.The pharmacy technician mistakenly added 100 units of insulin to the TPN which was then administered to the infant. The infantdeveloped severe hypoglycemia (3 mg/dL) which was fortunately successfully treated.

II. WARNINGS

1. Balloon inflation ports of medical devices (Foley catheter, cuffed tracheostomy tube, cuffed endotracheal tube) – designed tomeet ISO (International Organization for Standardization) to accommodate parenteral syringes which are used to inflate non-parenteral balloon cuffs. Medications have been mistakenly injected into the balloon inflation ports. In one case, hyperinflationof a tracheostomy tube cuff resulted in airway obstruction and respiratory arrest.

2. Before suturing a patient’s laceration, an ED physician accidentally injected a wound-cleansing agent (SHUR-CLENS – 20%poloxamer 188) into the skin, instead of Xylocaine MPF 1%. Both plastic ampules had been placed side by side during prepara-tion for the procedure. Ampules look similar and lettering on both is difficult to read.

3. Never draw up oral medications (suspensions, other liquid preparations) in syringes used for parenteral injection. Use oralsyringes instead. In preparation for MRI, chloral hydrate was drawn up in a parenteral syringe to administer to a patient whorefused to take the medication from a medication cup. A second dose was subsequently needed. The physician called the nursewho drew up a second dose of chloral hydrate in a parenteral syringe. She left the syringe uncapped, without a needle, and

included the tear-off label from the unit-dose cup for reference. Despite all these “safeguards,” the physician proceeded to administerthe chloral hydrate through the IV. The error was noted when the patient started screaming. The infusion was stopped, and the patientsuffered no harm.

III. MISCELLANEOUS

MEDWATCH

1. FDA and Arjo Inc notified healthcare professionals of a Class I recall of the Minerva Patient Lift (models ML-20 and ML-30), a batteryoperated lift designed for lifting and transport of patients. There are three mechanical problems for which the Minerva patient lift iscurrently being recalled. The first involves the hanger bar detaching from the lift resulting in the patient falling to the ground becauseof a missing spring washer. The second problem involves a bolt in the foot pedal assembly becoming loose which allows the foot pedalassembly to fall off of the lift. This results in the lift becoming unstable and the patient possibly falling. Thirdly, some units may havefaulty actuator brackets on the mast assembly that can also cause the lift to become unstable.

2. FDA and Centocor revised the warnings and adverse reactions sections of the labeling for Remicade, indicated for the treatment ofrheumatoid arthritis and Crohn’s disease. Cases of leukopenia, neutropenia and pancytopenia, some with fatal outcome, and cases ofCNS manifestation of systemic vasculitis, were described in patients receiving Remicade. The adverse reactions section was updated toinclude neutropenia, pericardial effusion and systemic and cutaneous vasculitis.

3. Enoxaparin: FDA and Aventis Pharmaceuticals revised the clinical pharmacology, precautions, and dosage and administrationsections of labeling, describing the need for a dosage adjustment for patients with severe renal impairment (creatinine clearance <30mL/min) who have increased exposure to enoxaparin. No specific dosage adjustment is required in patients with mild or moderate renalimpairment and in low-weight patients. However, low-weight patients should be observed carefully for signs and symptoms of bleed-ing.

4. FDA and Nellcor/Tyco notified healthcare professionals of a Class I recall of the Shiley Tracheosoft XLT Extended Length Tracheo-stomy Tube and Cannula. This recall affects 73,355 disposable units that the firm has shipped to the U.S. and international customersover the last four years. The tracheostomy tube is secured in place through the tube’s hub and flange assembly with the use of a holderor neck strap. The outer cannula may separate from the hub and neck flange allowing the outer cannula to travel farther into thepatient’s airway, leading to obstruction of the airway and subsequent lack of ventilation. Airway obstruction can lead to permanentneurological injury or death.

5. Neonates exposed to Effexor, other SNRIs (Serotonin and Norepinephrine Reuptake Inhibitors), or SSRIs (Selective SerotoninReuptake Inhibitors), late in the third trimester of pregnancy have developed complications requiring prolonged hospitalization,respiratory support, and tube feeding. Such complications can arise immediately upon delivery.

6. FDA and McNeil alerted healthcare professionals that one manufacturing lot (Lot # JAM108, exp 1/06) of Children’s Motrin(ibuprofen) Grape Chewable Tablets may mistakenly contain Tylenol 8-Hour extended release (acetaminophen) Geltabs. Lot # JAM108was distributed nationwide to wholesale and retail customers between February 5 and April 1, 2004. The bottles are labeled as contain-ing 24 tablets. The Tylenol 8-Hour product provides an adult dose of acetaminophen, and use of this adult product could provide morethan the recommended dose (overdose) for children.

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Did you know that the first case ofEhlers-Danlos Syndrome was described

in the New Testament?A passage states: “Joseph tied his ass to a tree

and walked all the way to Jerusalem”.

Source of Informaiton: ISMP Newsletters

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The NationalInstitute of ChildHealth and HumanDevelopment(NICHD) hasfunded thePediatric CriticalCare Scientist

Development Program (PCCSDP) tofoster the development of highlypromising young faculty in pediatriccritical care, into physician scientists.The PCCSDP Scholar and sponsoringinstitution must make a five-yearcommitment to the program, whichconsists of two phases. Phase I normallylasts 2 years and provides up to $75,000salary support, as well as support forlaboratory supplies, travel, and tuitionsupport. Indirect expenses are limited to8% of eligible direct expenses. Duringthe remainder of the five-year program(Phase II), PCCSDP Scholars aresupported by their institution, preferablywith extramural funding such as K08 orK23 NIH awards. In exceptional cases,Phase I support may be extended for athird year, but Scholars are expected toapply for K or R award support duringthe second year of Phase I.

Eligible applicants must be facultymembers who have completed pediatriccritical care fellowship training. Nor-mally, applicants will be within five yearsof completion of fellowship, as thisprogram is focused on development ofyoung faculty. Interested applicantswho completed fellowship training morethan five years prior to entering thePCCSDP should contact me to discusseligibility before submitting an applica-tion.

Throughout the PCCSDP program,Scholars will have an oversight commit-tee consisting of the PCCSDP ProgramDirector and two additional members ofthe National Advisory Committee (NAC).This oversight committee will regularlymonitor the progress of each Scholar,comparing the Scholar’s progress withthe prospective research and develop-ment plan outlined in the application.The NAC will site visit institutions withPhase I PCCSDP Scholars on an annualbasis, and the NICHD may conduct

additional site visits to help monitorScholar and mentor performance. Thepurpose of the NAC and site visits isaimed at assuring the success of everyPCCSDP Scholar.

The initial funding period will begin inJanuary 2005. Applications are dueOctober 18, 2004. Applicants will beexpected to attend the first AnnualRetreat from November 11–14, 2004 wherethe applicants will be engaged in careermentoring and scientific exchange withmembers of the NAC and additionalinvited speakers. Committee members willinterview each applicant during theretreat as part of the application process.Limited funding will be available to helpoffset the expense of travel to this retreatfor prospective Scholars. Mentors arealso invited, at institutional expense.

This program is similar to a K award,requiring a trainee to work under theguidance of a skilled research mentor.Basic or clinical research in any aspect ofpediatric critical care (e.g. molecularbiology of sepsis, trauma care, cardiacintensive care, etc.) is eligible. Applicantsare encouraged to identify talentedmentors in their own institution or atother institutions. For example, acandidate at Institution A might move toInstitution B for Phase I training, andreturn to the original Institution A duringPhase II. This will enable talented youngfaculty to secure exceptional scientifictraining outside their initial facultyappointment, with the anticipation andexpectation of returning to the institutionwith new scientific skills. ProspectiveScholars are encouraged to contact theProgram Director for assistance inidentifying research mentors outside theircurrent institution. We understand thatapplicants may identify excellent mentorsin their current institution, particularly inthe first year of the PCCSDP, but in futureyears, applicants are encouraged toexplore potential mentors outside theircurrent institution if appropriate to theirscientific development.

The PCCSDP is focused on extremelypromising young faculty, and successfulapplicants will be protected from clinicaland administrative responsibilities at

least 75% of their time during Phase I.Phase II Scholars must be protected at least50%, but continued 75% protection ispreferred. Letters of support from thesponsoring and, when different, thementoring institution, must indicatecommitment to this protection for theScholar.

This is a unique opportunity to developtomorrow’s scientists who will improve thecare of infants and children who requirecritical care.

For those interested in this program,please contact the Program Director, DrMichael Dean at mike.dean@hsc.utah.edu

A. Background of Program

Pediatric critical care is a relatively newsubspecialty, with initial subspecialtyboard designation and fellowship programcertification occurring in the late 1980’s.Pediatric critical care is high risk and timeconsuming; the clinical intensity offellowship training has not been conduciveto adequate development of physicianscientists in this specialty. Public recogni-tion of the clinical value of intensivists hasincreased clinical demand, and this reducesthe available time for trained intensivists todevote to research. As a result, carefulresearch of the pathophysiology andtreatment of critical illness, with emphasison long-term outcome, has been verylimited. Special needs children represent alarge fraction of children requiring criticalcare, and survival of critically ill childrenwith residual disability or chronic diseasehas become more common. To meet theseproblems, the National Institute of ChildHealth and Human Development (NICHD)has established the Pediatric Critical CareScientist Development Program (PCCSDP),administered by the University of UtahSchool of Medicine. The Program Directoris J. Michael Dean, MD, MBA, Professorand Vice Chairman of the Department ofPediatrics. The program will select themost outstanding junior faculty candidatesfor sustained training as PCCSDP Scholarsin excellent research settings throughout

Pediatric Critical Care Scientist Development Program (PCCSDP)

B. Program Plan and Organization

The Pediatric Critical Care ScientistDevelopment Program (PCCSDP) is anational training program, administeredat the University of Utah School ofMedicine by the Program Director, Dr.Dean. The National Advisory Commit-tee is composed of outstanding scien-tists and leaders in pediatric critical care,provides oversight for the program,selects applicants for funding asPCCSDP Scholars, and providesmentorship for PCCSDP Scholars.Potential applicants may identifyoutstanding mentors from their owninstitutions, or from the roster ofmentors that will be maintained by thePCCSDP. The training program requiresinstitutional commitment to the Scholar,and provides an annual PCCSDP retreatto facilitate interaction with the NationalAdvisory Committee members, and sitemonitoring by the Program Director toassure quality of the training environ-ment for each Scholar.

The committee membership has beenselected from established leaders inpediatrics and pediatric critical care andconsists of the following individuals:

• Jeffrey Blumer, PhD, MD• Jeffrey Fineman, MD• Thomas Green, MD• Margaret K. Hostetter, MD• Patrick Kochanek, MD• George Lister, MD• M. Michele Mariscalco, MD• Daniel Notterman, MD

Je

Jeffrey L. BlumerDr. Blumer is Professor of Pediatrics andPharmacology at Case Western ReserveUniversity, and has a distinguishedresearch career in pharmacology andpediatric critical care. Dr. Blumer bringsexperience with pediatric critical careclinical drug trials, as the Center for DrugResearch at Rainbow Babies and Children’sHospital, partly supported by an NIHPPRU grant, is the largest pediatric clinicaltrials program in the country. Dr. Blumerhas trained numerous critical care scien-tists over the past two decades.

Jeffrey FinemanDr Fineman is Professor of Pediatric CriticalCare Medicine at the University of Califor-nia, San Francisco, and Associate Investi-gator in the Cardiovascular ResearchInstitute (CVRI). Dr Fineman has adistinguished career in pediatric criticalcare (practicing pediatric cardiac intensivecare), basic science research, and trainingphysician scientists. He has longstandingNIH funding, His experience at the CVRI, apremiere training center for physicianscientists, will be of great value to thePCCSDP.

In addition to these named committeemembers, the National Advisory Committeehas liaison representatives from thePediatric Section of the Society of CriticalCare Medicine (Stephanie Storgion, MD),and the Section on Critical Care in theAmerican Academy of Pediatrics (JeffreyBurns, MD). The Program Director chairsthe National Advisory Committee meetings,except for Scholar selection (discussedbelow). These 11 persons (eight namedabove, two societal liaisons, and ProgramDirector) will be voting members. NICHDis represented by Carol Nicholson, MD, anex-officio, non-voting representative whoattends and participates on the NationalAdvisory Committee.

Tom GreenDr. Green is Professor and Chairman of theDepartment of Pediatrics at NorthwesternUniversity Medical School, and has adistinguished career in pediatric pulmonarymedicine and critical care. Dr. Green has anoutstanding research career and is wellpublished. His experience and understand-ing of the required interdisciplinaryapproach to accomplish critical careresearch will be important to the PCCSDP.

Patrick KochanekDr. Kochanek is Professor of Critical CareMedicine at the University of Pittsburghand is the Director of the Safar Center forResuscitation Research. He also serves onthe Advisory Board for the National Centerfor Medical Rehabilitation Research(NCMRR) at NICHD. He directs a T32program “Training in pediatricneurointensive care and resuscitationresearch”, and has a long, distinguishedrecord of research in mechanisms of braininjury. His research experience andadministrative experience with the T32program will be of great value to theProgram Director and the National Advi-sory Committee.

George ListerDr. Lister is Professor and Chairman of theDepartment of Pediatrics at the Universityof Texas, Southwestern Medical School,and has a distinguished career in pediatriccritical care and basic science research. Hehas been the editor for the Subboard ofCritical Care Subboard of the AmericanBoard of Pediatrics since it was estab-lished. He has maintained a T32 program“Development of cardiovascular andpulmonary function” that is currently in its26th year of funding. Dr. Lister has pub-lished, over 100 papers, including manu-scripts concerning the development ofacademic pediatricians and researchscientists. His clinical, teaching, andresearch experience will be of tremendousvalue to the Program Director, the NationalAdvisory Committee, and PCCSDPScholars.

the United States. These NIH fundedresearch settings may be clinical or basicscience, and may be in any field relevant topediatric critical care. Translationalresearch, moving clinical problems into thelaboratory and incorporating scientificfindings into bedside care, requires aphysician scientist who maintains a soundresearch career, in addition to providingclinical care. The goal of the PCCSDP is toincrease the number of highly trained,successfully funded and sustainablepediatric critical care physician scien-tists, who will do translational research toenhance the scientific understanding,clinical management and rehabilitation ofcritical illness in children, leading tobetter long term outcome.

Margaret HostetterDr. Hostetter is Professor and Chairman ofthe Department of Pediatrics at YaleUniversity School of Medicine, and has adistinguished research career. She hasbeen the Program Director for the PediatricScientist Development Program (PSDP)coordinated by the Association of MedicalSchool Pediatric Department Chairs(AMSPDC), which is a unique programproviding fellowship support for researchcareer development in any pediatric field.The PSDP also has an established trackrecord, and Dr. Hostetter has excellentknowledge of proven successful strategiesthat assure development of physicianscientists.

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The National Advisory Committee willprovide external mentorship to PCCSDPScholars. Obviously, each Scholar will beprovided mentorship at their traininginstitution, especially from the researchmentor with whom they pursue theirscientific training. The PCCSDP willprovide external “suprainstitutional”mentorship by enabling the Scholar tointeract closely with the National Advi-sory Committee members, by assigningtwo Committee members to specifically actas personal contacts for the Scholarthroughout the year, by having Committeemembers discuss academic developmentwith each Scholar at the annual PCCSDPretreat (and more frequently via their

personal contacts), and by providing sitevisits from the PCCSDP to the traininginstitution (either by the Program Directoror a designated member of the NationalAdvisory Committee). The two assignedCommittee members and Program Directorwill act as a personal advisory committeefor the Scholar. These three individualswill provide an annual assessment to theScholar and the mentor. In addition,Scholars will be expected to seek extramuralfunding between 15 and 18 months intotraining, and Committee members willprovide an external peer review to theseproposals as they are prepared for submis-sion to funding agencies.

The Committee will also providementorship during the application process.In initial years, applicants will be invited toattend the annual PCCSDP retreat, wherethey will be interviewed by members of theCommittee, and will participate in thescientific portion of the meeting. This willenable contact with Committee members,even for applicants who are not funded asScholars, providing added richness to thevalue of applying to this program. Allapplicants will be expected to discuss theircareer development with Committeemembers, and even unsuccessful appli-cants will derive constructive feedback andbenefit from this process.

Michelle MariscalcoDr. Mariscalco is Assistant Professor ofPediatrics at Baylor College of Medicine.She has been the director of the ClinicalLeukocyte Function Laboratory since 1988and director of the critical care fellowshipprogram since 1989. She directs a T32program “The critically ill developing host:from pathogenesis to outcomes”, and herexperience with training pediatric criticalcare fellows via this mechanism will be veryvaluable to the PCCSDP.

Daniel NottermanDr. Notterman is University Professor ofPediatrics, Molecular Genetics, Microbiol-ogy and Immunology and Chairman of theDepartment of Pediatrics at UMDNJ-RobertWood Johnson Medical School. Dr.Notterman directed Pediatric Critical CareMedicine at Cornell University MedicalCollege until 1994, when he took leave topursue a mid-career training program inmolecular biology at Princeton University.He remained at Princeton to conductresearch and maintained clinical skills byattending in the PICU at Robert WoodJohnson Medical School, where he wasappointed Chairman in 2002. Dr. Nottermanis a recognized leader in pediatric criticalcare, and his career change into a labora-tory setting provides a valuable perspec-tive to the PCCSDP Program Director andNational Advisory Committee.

The National Advisory Committee willnormally be chaired by the ProgramDirector, but for purposes of selection ofPCCSDP Scholars, the Committee will electan ad-hoc chairman. The Program Directorand the NICHD representative will outlineand reiterate important aspects about theprogram and the peer review process. TheProgram Director will report the totalnumber of application inquiries, and willdescribe any applications that have beenexcluded from consideration by theNational Advisory Committee (e.g. applica-tions from ineligible candidates, incompleteapplications). The conflict of interestpolicy used by NIH Study Sections will beexplained and used in the review processfor PCCSDP, and signed conflict of interestforms will be obtained from all participantsin the peer review process. The peerreview process will be carried out under thedirection of the ad-hoc chairman. TheProgram Director and NICHD representa-

tive will not participate in this process, andwill function as NIH personnel functionduring Study Section deliberations.

The National Advisory Committee willevaluate each application using standardNIH criteria, and each application will bescored in the standard way. The Commit-tee will provide the scores and evaluationsfor each application to the ProgramDirector, who will notify each applicant ofthe funding decision. The applications willbe funded, in order of priority score, to thelimit of available funds. The ProgramDirector will not alter this funding ap-proach without prior approval from amajority of the Committee and the NICHDrepresentative. (This might occur, forexample, if an applicant was subsequentlyfound to violate eligibility criteria, orsignificantly altered their career aspira-tions.) Each applicant shall receive peerreview comments that may be edited by theProgram Director prior to being mailed.

The exclusion of the Program Director fromapplication evaluation and scoring isintentional. The administrative organizationof this program, including the ProgramDirector, functions as a “friendly” resourcefor all prospective applicants and mentors.The Program Director will facilitate devel-opment of an application in a mannersimilar to an NIH program manager. Forthese reasons, the Program Director has apotential conflict of interest during the peerreview process, and will not participate inthe scoring or evaluation of the applica-tions.

Select Applicants for Funding asPCCSDP Scholars

Provide External Mentorship forPCCSDP Scholars

PCCSDP Mentors

The PCCSDP is a national program opento outstanding applicants and mentorsfrom throughout the United States. In atraditional K12 or T32 program geo-graphically located at a single institu-tion, the mentors are preselected by theProgram Director, and trainees arerecruited to that institution to bementored by these specific scientists.This program is fundamentally differentbecause PCCSDP Scholars will train inlaboratories that are geographicallydispersed in different institutions. TheNational Advisory Committee willevaluate the quality of the mentor foreach specific Scholar during the peerreview process.

While applicants may identify a mentorat the institution where they completefellowship training, the NIH encouragesconsideration of training at a differentinstitution. In “Special Requirements,

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Section E. PCCSD Candidates”, the RFAreads “Although remaining at the institu-tion of their fellowship is a possibility fortrainees under this award, academicdiversity through research training andclinical practice at a different institutionshould be strongly encouraged.” ThePCCSDP will maintain a national roster ofmentors, rather than an institutional roster,and the Program Director will assistapplicants in contacting mentors. Appli-cants will be encouraged to discussopportunities with the Program Director,and will be directed to contact potentialmentors prior to developing their applica-tion for an award. This mentor roster isused to assist the Program Director and isin no way restrictive – applicants mayidentify outstanding mentors who are noton the PCCSDP roster.

The PCCSDP will actively recruit skilled,outstanding mentors to be added to thisroster, with evaluation and considerationby the National Advisory Committee. Westrongly encourage applicants to exploreopportunities that are outside theirfellowship institutions to gain morediversity with respect to research andclinical aspects of critical care. We antici-pate that in the first year, simply because ofthe time constraints of developing applica-tions in time to start funding in January2005, applicants are likely to identifymentors at their fellowship institution, orvia contacts developed through theirfellowship mentors. In later years of thePCCSDP, we expect that applicants willincreasingly select mentors who are not attheir fellowship institution, as there will bemore time for the applicant to establishcontact and consider training with poten-tial mentors from the PCCSDP roster.

The criteria for selection of mentors are 1) a record of outstanding scientificaccomplishment; 2) a strong record ofextramural funding, preferably from NIH; 3)scientific expertise and interests related topediatric critical care; and 4) demonstratedexcellence in mentoring trainees. Thesecriteria are used when adding mentors tothe PCCSDP roster, and are applied duringpeer review of PCCSDP applications.During review of applications, the selectioncommittee will examine the record of thementor’s previous trainees, especiallysubsequent academic positions, publica-tions and grant awards. PCCSDP Scholarswill provide an annual evaluation of theirmentor to the Program Director andNational Advisory Committee members.

C. Details of Training Program

The PCCSDP is a national program, andtraining is distributed among differentinstitutions throughout the United States,with the intention of funding the very bestyoung faculty to train in the most out-standing laboratory settings. The goal ofthe PCCSDP is to increase the number ofhighly trained, successfully funded andsustainable pediatric critical care physicianscientists, who will do translationalresearch to enhance the scientific under-standing, clinical management andrehabilitation of critical illness in children,leading to better long term outcome. Thetraining program consists of local trainingand mentorship that will occur at theinstitution at which the training is located.In addition, the PCCSDP itself will providea “suprainstitutional” level of mentorshipfor the Scholars and mentors in thisprogram.

The PCCSDP requires five years ofcommitment and participation fromPCCSDP Scholars and their institutions.During Phase I, the PCCSDP will providesignificant funding (see below) for theindividual as he or she pursues intenseresearch training. During Phase II, as theScholar transitions to an independentinvestigator, the PCCSDP will providelimited support in the form of travel to theannual PCCSDP retreat.

Phase I will last two to three years. Duringthis period, the Scholar will pursue intensetraining in a mentored laboratory or clinicalresearch setting. The Scholar will developa short and long-term career developmentplan, including plan for future researchactivities. This development plan must beoutlined in the application for funding,refined upon entry into the program, andevaluated on at least an annual basis. TheScholar must be protected from clinical andadministrative responsibilities so that aminimum of 75% time is protected forresearch training. The Scholar will meetwith the National Advisory Committee atthe annual PCCSDP retreat, and protectionfrom clinical and administrative responsi-bilities will be discussed and evaluated.During Phase I, the Program Director (or adesignee from the National Advisory

Description of Program Support

Committee) will site visit each traininginstitution and will verify that the Scholar isbeing provided with the institutionalcommitment described in the Scholar’sapplication and the department chair’sendorsement letter Renewal for two years,and in exceptional circumstances, threeyears, will be dependent on satisfactoryprogress of the Scholar, as judged by theNational Advisory Committee and theProgram Director.During Phase I, Scholars may receive up to$75,000, benefits, limited laboratory supplysupport, travel to the annual PCCSDPretreat and to appropriate scientific meet-ings, and limited tuition support for specifictraining opportunities. Indirect expenseswill be provided to training institutions at8% of all outlined costs except tuition,which is not eligible for indirect expensereimbursement.

During Phase II, Scholars must be sup-ported by their institution, preferably withextramural funding such as K08 or K23 NIHawards. Scholars in Phase II must beprotected from clinical and administrativeresponsibilities at least 50% of their time,according to the RFA for this program.Institutions are strongly encouraged toprotect Phase II Scholars for 75% of theirtime, reflecting our goal that these Scholarswill be supported by K awards. Phase IIScholars will attend the annual PCCSDPretreat, and discuss their long-term careerdevelopment with the National AdvisoryCommittee at these annual retreats. DuringPhase II, the Program Director will not sitevisit the training institution. The PCCSDPwill provide up to $1,500 for travel to theannual meeting for Phase II Scholars.

PCCSDP Training Activities

The PCCSDP provides “value added” to thetraining of pediatric critical care scientistsby acting in a complementary manner to thelocal institution. Activities of value to thePCCSDP Scholar include the following:

• Assistance with original applica-tion, by the Program Director

• Interviews and interactions withNational Advisory Committeemembers

• Assignment of personal advisorycommittee for each Scholar

• Assistance with preparation ofextramural grant proposals

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The PCCSDP will have an annual scien-tific retreat in October or November ofeach year, lasting 2 1/2 to 3 days. In thefirst two years, this retreat will be at TheLodges in Deer Valley. The setting isconvenient to the Salt Lake International

• Site visits of Phase I Scholartraining institutions to verifytraining environment

• Participation at the annualPCCSDP retreat

Applicants may contact the ProgramDirector, who can provide assistance incontacting potential mentors, and providehelpful input into career development ideasand research proposals. The ProgramDirector will not assist with writingapplications, but can provide helpfuladvice to applicants because he does notplay a role in selection of PCCDSP Schol-ars. Selection of Scholars is the responsi-bility of the National Advisory Committee,as previously described.

Interaction with the leaders and outstand-ing scientists who comprise the NationalAdvisory Committee is a major benefit toparticipants in the PCCSDP. Theseinteractions will include interviews forapplicants during the selection process,scientific interaction at the annual retreat,discussion of the applicants’ and Scholars’academic and research development plans,and presentation of selected facultydevelopment topics by Committee facultyand guest speakers. In addition, theCommittee will convey expectations toeach applicant and Scholar, particularlywith respect to the timeline for seeking thenext level of research funding.

Each Scholar will have two individuals onthe National Advisory Committee specifi-cally assigned to monitor their progressand act, with the Program Director, as theirpersonal advisory committee. The Scholarwill maintain contact with these advocateCommittee members throughout the year,may seek advice from these individuals,and will obtain input into the refinement oftheir faculty development plan as theprogram proceeds. This is an importantbenefit for Scholars, particularly when theyquestion the advice of their local mentor.The Scholar’s personal advisory commit-tee, acting as the Scholar’s advocate, canprovide a “reality check” for the Scholarsand their mentors throughout the program.

Phase I Scholars will begin early prepara-tion of K08 or K23 proposals for submis-sion to the NIH. The PCCSDP will helpprovide structure to this timeline byinteractions between the National Advi-sory Committee and the Scholar, both atthe annual retreat and throughout the year.Phase I Scholars will write a two to threepage draft outline of a K08 or K23 proposal

or, in rare instances, an R01 proposal, bythe end of the first 12 to 15 months in theprogram. This draft will be submitted tothe PCCSDP and will be disseminated viaeRoom™ to National Advisory Committeemembers for constructive feedback. Thepersonal advisory committee assigned toeach Scholar will provide a written critiqueof the proposal concept, though anyCommittee member may provide input tothe Scholar. The Scholar will develop theapplication for submission to the NIH by18 months into the PCCSDP, with the goalof obtaining funding by the end of Phase I.At least six weeks prior to the NIH submis-sion deadline, the Scholar will send anearly complete draft and the PCCSDP willdo a “mock review”, providing “pinksheets” back to the Scholar and mentor inample time for the Scholar to improve theproposal based on those comments. If theNational Advisory Committee does nothave appropriate expertise to provide thisreview, the Program Director will identify adhoc reviewers to supplement the review. Inthis manner, the Scholar will have anopportunity to obtain an initial, external,rigorous scientific evaluation for theirproposal in time to not “waste a cycle” inthe NIH peer review process. If a Scholarachieves K award funding on the first cycle(without a resubmission), then the Scholarwill automatically transfer into Phase II,and the PCCSDP may be able to fund anadditional Phase I Scholar.

The Program Director or a designee fromthe National Advisory Committee will sitevisit each training institution on an annualbasis during Phase I training. During thesesite visits, the Program Director will meetwith the Scholar, the training mentor, thecritical care Division Chief, and thepediatric Department Chairman. TheProgram Director will verify that theinstitution is meeting its obligations to theScholar as outlined in the original applica-tion submitted by the Scholar. TheProgram Director will solicit criticalfeedback from these individuals about thePCCSDP (and how it might be enhanced inthe future).

Airport, but is in a relatively secludedlocation, facilitating interaction amongmeeting participants in a beautiful environ-ment. The location of future PCCSDPretreats will be determined in discussionswith the National Advisory Committee andthe NICHD.

At the time of the first annual retreat(November 2004), there will be no Scholarsin the program, since awards are antici-pated to begin January 2005. For thisretreat, the program has limited financialsupport for applicant travel. Mentors ofthese applicants are also invited to attendthe retreat, at their own institutionalexpense. The National Advisory Commit-tee will interview the applicants, and willthen review and prioritize the applications.During this closed-session peer reviewmeeting, the applicant and mentor partici-pants will be free to visit Park City orexplore the mountains. The selectiondecision will not be discussed or an-nounced at the retreat, and the ProgramDirector will send out notification lettersafter the retreat.

During this first PCCSDP retreat, theinvited applicants and their mentors will betreated as if the applicants were Phase IScholars. Each applicant will spend timewith Committee members to discuss theiracademic and research development plans,research ideas, and faculty developmentquestions. Each mentor will have anopportunity to present a talk concerningtheir laboratory research, facilitatinginteraction among the applicants fromdifferent institutions. In addition, success-ful scientists will attend the retreat andprovide 45 to 60 minute presentations tothe retreat participants. The goal is tomake this initial retreat a valuable scientificexperience for the applicants and theirmentors, to allow the Program Director andNational Advisory Committee to conductthe peer review process, and to enablebetter planning for subsequent retreats.

In November 2005, applicants, Phase IScholars (from the first year), their mentors,and up to three guest speakers will beinvited to attend. Applicants will beinterviewed and the selection process willproceed as described for the first retreat.The Committee will meet with each Scholarto evaluate progress during the year.Scholars will present their researchfindings, in 20 to 30 minute talks, to theircolleagues, applicants, mentors, andCommittee members. This will be an

Annual PCCSDP Retreat

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exciting “give and take” session,encouraging the candid exchange ofideas and feedback. Guest speakers willbe selected to address specific topics. Inthe year two retreat, the Program Directorwill invite speakers to address importantsurvival skills such as manuscriptpreparation, grant writing, identifyingfunding sources, oral presentations,dealing with one’s mentor, and learninghow to provide mentorship to youngertrainees. The timeline for preparation ofK award proposals will be reinforcedduring the retreat, since initial draftoutlines should be prepared in themonths following this retreat.

Local Institutional Training Activities

PCCSDP Scholars will be able to carry outthe activities described in their trainingproposals if the local institution providesthe resources and academic protectionnecessary to achieve the training goals.The peer review selection process isdesigned to assure that each trainee will beplaced in an outstanding research settingwith an experienced mentor, and the annualsite visit by the PCCSDP Program Directorwill help guarantee that the Scholarreceives suitable protection and resourcesfrom the training institution.

Local training responsibilities include on-going refinement of the Scholar’s long termdevelopment plans, assistance withpreparing grant applications so that theScholar can phase into independentinvestigator status, opportunities topresent research in laboratory researchmeetings, Departmental conferences, andso forth. Journal clubs, didactic trainingsuch as might occur in a K30 program, andother educational activities are a localinstitutional responsibility. These activi-ties will have been described in theScholar’s original application, and thequality of these activities is one of thecriteria for selecting an individual forfunding.

Local institutional training is required forScholars in the responsible conduct ofresearch. Scholars should actively partici-pate in the process of obtaining approvalfrom applicable committees, such as theInstitutional Review Board (IRB) orinstitutional animal use committee. ForScholars involved in clinical research, theinstitution should also provide training in

Good Clinical Practice (GCP), regulations ofthe Food and Drug Administration (FDA),and international harmonization efforts.

The Committee will evaluate the candidate,the mentor, the institutional environment,and the research plan. The candidate musthave demonstrable potential to be anexcellent physician scientist, whoseresearch interests are likely to improvelong-term outcomes and quality of life forchildren who sustain critical illness orinjury. The candidate must make a five-year commitment to the training plan. Thetraining plan proposed by the candidatemust include appropriate didactic material,training in the responsible conduct ofresearch, and should take advantage ofexisting programs such as K30 trainingprograms. Letters of recommendation mustsupport the exceptional caliber of thecandidate. The mentor, even if alreadyincluded on the PCCSDP roster, mustdescribe the mentoring plan in detail. Thisincludes the mentor’s time commitment,and the relationship of the mentor’s planwith the academic goals of the trainee. Thementor statement should also describe thelaboratory facilities, and provide evidenceof expertise in training junior faculty in theresearch setting. This evidence shouldinclude a tabular presentation of previoustrainees (date of training, current academicposition, grants awarded, publications).Such tables will be excluded from the pagelimitation on this section of the application.The institutional environment must besuitable for a PCCSDP Scholar. Mostimportantly, there must be institutionalcommitment to the Scholar, particularlywith respect to protection of the Scholarfrom non-training responsibilities such asteaching, administration, and clinical care.Provision of 75% protection throughoutthe five years of training is highly encour-aged. Opportunity for faculty employmentand academic advancement within theinstitution must be demonstrated. Finally,the research plan should demonstrate theability of the candidate to consider ascientific problem, develop a hypothesis-driven proposal, outline a research design,and describe the implementation. Theresearch plan must address humansubjects or vertebrate animal issues, asapplicable. The applicant is expected towrite the research plan, but should havediscussed the research idea with the

mentor proposed in the application. Theresearch plan will form the major agenda fordiscussion when the National AdvisoryCommittee interviews the applicant at theannual retreat. The applicant shoulddemonstrate a good understanding of theresearch problem and be prepared todiscuss the ideas informally with theCommittee during the interview.

The major criteria for success of thePCCSDP include the retention of PCCSDPScholars in academic positions, outstand-ing scientific productivity of these newscientists over subsequent years, and theability of the Scholars to obtain andsustain extramural grant support of theirresearch. These are relatively long-termmeasurements of performance. Short-termmeasures of success of the PCCSDP willinclude presentations at scientific meetingsand peer reviewed publications byPCCSDP Scholars during their training,completion of didactic courses delineatedin Scholar training plans, documentation ofrequired training in human subjectsprotection and research ethics, documenta-tion of academic protection of the Scholarsduring Phases I and II, and most impor-tantly, submission and funding of K-levelor R-level NIH grants. In addition, annualprogress reports will be obtained from eachScholar and each mentor. The PCCSDP willobtain follow up information from allScholars for at least five years aftergraduation from the program. Scholarsmust agree prospectively to provide thisinformation to assist with program evalua-tion.

Application Procedure

Instructions for applicants are provided ina separate document Instructions forApplicants on the next two pages.

Contact Information:

For inquiries from applicants, potentialmentors, or academic advisors of youngfaculty, please contact the program directorDr Mike Dean at mike.dean@hsc.utah.eduand indicate “K12 Grant Inquiry” as thesubject of the email.

D. Selection of PCCSDP Scholars -Criteria for Review

E. Program Evaluation

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Eligibility

PCCSDP Scholars should normally be within five years of completion of fellowship training in pediatric criticalcare. Interested applicants who completed fellowship training more than five years prior to entering thePCCSDP should contact the Program Director (J. Michael Dean, M.D., M.B.A.) to discuss eligibility beforesubmitting an application.

Individuals who have previously received an NIH K08, K23, or R-type award are not eligible for support underthis program. If you have any question about eligibility, please contact the Program Director before submitting an application (orgiving up!)

Structure of the Application

The application to become a PCCSDP Scholar is similar in organization to training award applications such as NIH K08 or K23 applica-tions. Please follow the organization and page limitations as shown below:

I. Section I. Basic Administrative Dataa. Face page (NIH Form Page 1)b. Budget pages (use NIH Forms)c. Biographical sketches (candidate and mentor, NIH format up to four pages each)d. Other support information for the mentore. Resources (PHS 398 Resources Format page)

II.Section II. Training Applicationa. Description of the candidate (limited to five pages)

1. Candidate Background and education2. Career goals and objectives3. Planned training activities during the award period

b. Statement by the mentor, including description of past trainees (trainee information may be provided in tabular form;non-tabular information is limited to two pages)

c. Environment and Institutional Commitment to Candidate (limited to two pages)1. Description of the institutional commitment2. Commitment to the candidate, including Phase II of PCCSDP

d. Research Plan (parts 1 to 4 limited to ten pages)1. Statement of hypothesis and specific aims2. Background, significance and rationale3. Preliminary studies and any results4. Research design and methods5. Human subjects6. Vertebrate animals7. Literature cited

The application must include three letters of recommendation (submitted in sealed envelopes), including a letter of commitment by thecandidate’s Department Chair. The Chair at the mentoring institution must guarantee 75% protection from clinical and administrativeduties during Phase I. The Chair at the sponsoring institution must indicate a plan to employ the Scholar with at least 50% (preferably75%) protection for continued career development during Phase II. In some instances, these institutions will be the same.

• Applicant is at institution A and will go to institution B for Phase I, with plan to return to institution A for Phase II; intention offaculty appointment and on-going protection from clinical and administrative duties by Chair A required. Endorsement byChair B must include 75% protection, but does not need to express employment commitment beyond Phase I training period..

• Applicant is at institution A and will pursue Phase I and Phase II training at institution A; commitment for Phase I and Phase IIby Chair A required.

• Applicant is at institution A and will go to institution B to pursue Phase I training and will remain at institution B for Phase II;commitment for Phase I and Phase II by Chair B required. Endorsement by Chair A optional.

PedeePed Pediatric Critical Care Scientist Development Program (PCCSDP)Application Instructions

Program Duration and Support

The PCCSDP requires a five-year commitment from the Scholar and the participating institutions. The Program consists of two phases.PCCSDP Scholars may receive salary support up to $75,000 per year during Phase I, as well as support for laboratory supplies, travel,and tuition. Indirect expenses are restricted to 8% of eligible costs. Phase I is normally two years, but in exceptional circumstances,third year awards may be available. During Phase II, individuals are expected to be supported by their institution, preferably with K08,K23, or other NIH grant support.

Application Deadline

The application deadline is October 18, 2004. Applicants should plan to attend a meeting in Deer Valley, Utah, November 11 – 14,2004, as part of the application process. Partial travel support will be available from the PCCSDP for applicants.

Applications should be mailed to: J. Michale Dean, MD, MBA, c/o Paige Elkins (801/581-7373) 615 Arapeen Drive, Suite 202, Salt LakeCity, Utah 84108-1284

Inquiries to Dr. Dean should be sent to mike.dean@hsc.utah.edu. The subject header of your email should be “PCCSDP Applicant” toavoid email filtering and facilitate prompt response to your inquiry.

Informed consent for the critically ill AAP Grand Rounds, July 2003Heather T. Keenan, MD (p8)

Long-term care for ventilator-dependent children AAP Grand Rounds, August 2003Wan C. Tsai, MD (pp19-20)

Neurodevelopmental outcome after cardiac surgery using ECL AAP Grand Rounds, Ocotber 2003Susan L Bratton, MD (pp 49)

Inflicted traumatic brain injury in young children AAP Grand Rounds, November 2003Kimberly D. Aiken, MD (pp 61-62)

Guidelines address acute management of pediatric brain injury AAP News, November 2003James Fortenberry, MD (pp 234-235)

Excess hospitalization costs attributable to medical injuries AAP Grand Rounds, January 2004Fiona H. Levy, MD (pp 7-8)

Catheter-related blood infections in the ICU AAP Grand Rounds, January 2004Susan L Bratton, MD (p 9)

The consensus conference ob diabetic detoacidosis AAP Grand Rounds, May 2004Susan L Bratton, MD (pp 56-57)

Thrombolytic treatment of infectious endocarditis AAP Grand Rounds, May 2004Gail E. Wright, MD (pp 56-57)

Varicella vaccine decreases hospitalization in varicella-related group AAP Grand Rounds, May 2004A strep infections (pp 50-51)

Thomas V. Brogan, MD

Genes and Meningococcal disease AAP Grand Rounds, June 2004Susan L. Bratton, MD (pp 66-67)

Death, pulmonary hypertension, and sickle cell disease AAP Grand Rounds, June 2004Susan L Bratton, MD (pp 63-64)

Peditric Critical Care PublicationsAAP Grand Rounds

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The PedsCCM website (PedsCCM.org) will be 9 years young this November. Hopefully, the site has grown with our community andcontinues to provide a unique, integrated resource for communication and education for pediatric critical care practitioners. Google, theinternet search engine that has become a verb in common parlance, seems to “think” so. Type in “pediatric critical care medicine” andthe PedsCCM website comes up first on the hit list. (Google prioritizes results based upon links and traffic to a website.) In 2003,PedsCCM processed 2.42 million page requests and 98,133 downloads (a total of 95 gigabytes of data) in 936,017 visits by 288,426unique visitors*. A graphic representation of the visits/year to PedsCCM over the past 6 years appears in the figure.

If there is information relevant to pediatric critical care on the web, there’s a link to it from PedsCCM. New clinical research articles in avariety of journals, clinical tools and calculators, lectures, conferences, NIH grants and announcements are all available. If you findappropriate resources out there that we have not linked to, please let us know.

We are particularly proud of the PedsCCM Evidence-based Journal Club, where over 200 critical appraisals of clinical trials in criticalcare medicine are available. There is a searchable database of these reviews, and even a version you can download into your Palm OSPDA. Each review, done by faculty and fellows from around the world, is edited by at least two of our dedicated editorial staff: AdrienneRandolph, Kathy Meert, Mona McPherson, Scot Bateman and Al Torres. With the exponential growth of clinical research recently,having easily accessible pre-appraised sources of evidence is an integral part of evidence-based practice today.

The site is supported graciously in part by the AAP SOCC, the Pediatric Section of the SCCM, and by the largely voluntary contribu-tions of many institutions in return for listing job positions in our physician and nursing jobs databases.

Nine years is young for humans, old for dogs, and ancient in internet time. The aesthetics and functionality of the site, althoughhopefully still acceptable, have not been updated in several years. With the explosion of new internet technology, the editors haveneither the time nor expertise today to fully overhaul the site. We are exploring various outsourcing options, and would very muchwelcome the input and help of anyone in the community with the time, ideas, energy, interest to help PedsCCM move forward into the21st century. Thanks to everyone for your support as we leave our “childhood” years.

* As determined by their IP addresses; because of dynamic IP address assignment by dial-up Internet Service Providers, this is unlikely to represent this many different human beings!

Barry Markovitz, MD, MPH

Web Site Vistis Per Year

1998 1999 2000 2001 2002 20030

100000

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Meeting Title

CALENDAR OF EVENTS

Meeting Dates Location Contact

Benefits of Being a Section on Critical Care (SOCC) member!

Ü Section on Critical Care Web siteVisit http://www.aap.org/sections/critcare for important information about upcoming eventsand Section related activities.

Ü Section on Critical Care E-mail ListThe E-mail list allows the AAP Staff and SOCC Executive Committee to communicate withmembers through periodic e-mail messages.

If you would like to join the E-mail list, simply: e-mail Sue Tellez at stellez@aap.orgwith “SOCC LISTSERV” in the subject line.**Be sure to include your name and contact information.

AAP National Conference andExhibition

http://www.pedsccm.org/

15th Annual CriticalCare Colloquium

2004 Course on Neonatal andPediatric Critical Care TransportMedicine

9th Congress of the WorldFederation of Societies ofIntensive and Critical CareMedicine

9/30-10/2/04 http://pedsccm.wustl.edu/organizations.html#pccc98

10/9-13/04 http://www.aap.org/nce

5th International Symposium onPediatric Cardiac Intensive Care

10/10 - 12/04

San Francisco, CA

http://www.aap.org/sections/transmed/course.htm

12/1 - 04/04

San Francisco, CA

http://www.pcicsymposium.orgMiami, FL

New York, NY

34th Critical Care Congress 1/15-19/05 Phoenix, AZ htttp://www.sccm.org/education/annual_congress/index.asp

7th European PostgraduateCourse in Neonatal and PediatricIntensive Care

3/10-12/05 Berne, Switzerland http://pedsccm.wustl.edu/org-meet/postgraduate_course.pdf

8/27-31/05 Buenos Aires,Argentina

http://www.sati.org.ar/congreo/2005/index.htm

ChairpersonM. Michele Moss, MDArkansas Children’s Hospital800 Marshall StreetLittle Rock, AR 72202-3591Office: 501/364-1479FAX: 501/364-3667EM: mossmichele@uams.edu

Alice Ackerman, MDDir, Div Pediatric Critical CareUniv of Maryland Medical System22 S Greene St, Rm S5D18Baltimore, MD 21201-1544Phone: 410/328-6777FAX: 410/328-8742EM: aackerma@peds.umaryland.edu

Thomas Bojko, MD, MSDir, Pediatric Critical Care MedicineRobert Wood Johnson Medical School100 Bayard Street, 3rd FloorNew Brunswick, NJ 08901-0000Office: 732/235-7887FAX: 732/235-9340EM: bojkoth@umdnj.edu

Barry P. Markovitz, MD, MPHDiv of Pediatric AnesthesiologySt Louis Children’s HospitalOne Children’s PlSt Louis, MO 63110-1014Office: 314/454-4506FAX: 314/454-2296EM: markovitz@kids.wustl.edu

Richard A. Salerno, MDBox 800386Charlottesville, VA 22908Office: 434/982-1707Fax: 434/982-3842EM: ras2bf@virginia.edu

Otwell Timmons, MDCarolinas Medical Center1000 Blythe BlvdCharlotte, NC 28232Office: 704/355-7815FAX: 704/355-1221EM: otimmons@carolinas.org

Donald Vernon, MDPrimary Children’s Medical CenterCritical Care Division100 N. Medical Center DriveSalt Lake City, UT 84113-1103Office: 801/588-3281FAX: 801/588-3297EM: don.vernon@hsc.utah.edu

SECTION ON CRITICAL CAREEXECUTIVE COMMITTEE

2003-2004

Past ChairpersonTimothy S. Yeh, MDDir, Critical Care, Vice Chair, PediatricsChildren’s Hospital of NJ at Newark BethIsrael Med Center201 Lyons AveNewark, NJ 07112Office: 973/926-3886FAX: 973/926-6452EM: timyeh@sbhcs.com

Program ChairpersonJames Fortenberry, MD1405 Clifton Road NEAtlanta, GA 30322Office: 404/325-6397FAX: 404/325-6233EM: james.fortenberry@choa.org

Newsletter EditorMary Lieh-Lai, MDChildren’s Hospital of MichiganCritical Care Medicine3901 BeaubienDetroit, MI 48201-2119Office: 313/745-5629FAX: 313/966-0105EM: mliehlai@med.wayne.edu

Web Site EditorBarry P. Markovitz, MD, MPHWWW: http://PedsCCM.wustl.edu

Nominations Committee ChairpersonStephanie Storgion, MD

Membership ChairpersonStephanie A. Storgion, MD

Awards ChairpersonsAlice Ackerman, MDThomas Bojko, MD, MS

LIAISONS:Society of Critical Care MedicineStephanie A. Storgion, MDDept of AdministrationUniversity of Tennessee50 N Dunlap, 1st FloorMemphis, TN 38103-2821Office: 901/572-3006FAX: 901/572-4586EM: storgios@lebonheur.org

AAP LIAISONS:

National Conference and Exhibition

Planning Group (NCEPG)Susan Fuchs, MDChildrens Memorial HospitalDiv of Emergency Medicine, Box 622300 Children’s PlazaChicago, IL 60614Office: 773/880-4091FAX: 773/880-8267EM: s-fuchs@northwestern.edu

Committee on Pediatric EmergencyMedicine (COPEM)Thomas Bojko, MD, MS

Section on Transport Medicine (SOTM)Anthony L. Pearson-Shaver, MDChildren’s Medical CenterDept of Pediatrics1446 Harper Street, BT 2641Augusta, GA 30912-3758Office: 706/721-4402Fax: 706/721-7872EM: tpearson@mail.mcg.edu

AAP Staff:Sue Tellez, ManagerDiv of Hospital and Surgical ServicesDept of Committees and Sections141 Northwest Point BlvdElk Grove Village, IL 60007-1098Office: 800/433-9016, ext 7395FAX: 847/434-8000EM: stellez@aap.org

Newsletter Designer:Sandra Prondzinski

Access the Section Membership RosterOn-Line

The AAP has added a link tothe section membership rosteron the Section’s home page onthe Members Only Channel.The roster will first appear asan alphabetical listing, and

each member’s name links to more detailedinformation about that person. Be sure tocontact the Membership Department atmembership@aap.org should any of yourinformation change, such as name, address,phone, fax or e-mail address.

You may also make the changes on-lineon the Members Only Channel. Justfollow the link on the Section’s home page!

MEMBERSHIP DIRECTORYON-LINE!Membership DirectoryOn-Line!

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