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            A Message from the Toxicology Program Director          

 

 

 

Welcome to the UT Southwestern Toxicology Program and the North Texas Poison Center, Parkland Memorial Hospital, and Childrens Medical Center!  Thanks for visiting our “home.”  I am truly fortunate to be affiliated with this program; based within the world class facilities of the University of Texas Southwestern (UTSW) Medical Center campus.  This has been an active fellowship; with new fellows arriving every year since the program began.  

  

Our faculty continue to grow.  As of July 1, 2015, we will have 12 toxicology faculty; 10 from an Emergency Medicine background and 2 from Pediatrics. This is one of the largest collections of faculty within any one program in the nation. Kurt Kleinschmidt, MD serves as the Division Chief and as the Program Director of the Fellowship. Paul Wax, MD is on service every month despite functioning also as the Executive Director of the American College of Medical Toxicology. Before that, he served as the President of the College. Paul is also the Medical Director of the North Texas Occupational and Environmental Toxicology clinic. He also does work in forensic toxicology and he brings these experiences to the education forefront.  Kapil Sharma, MD, also works in the North Texas Occupational and Environmental Toxicology clinic. Dr. Sharma is also one of the few physicians on the UT Southwestern Biological and Chemical Safety Committee. This committee manages the safety protocols for the phenomenally large and dangerous collection of chemicals used on this research driven campus. Collin Goto, MD and Sing-Yi Feng, MD are the Co-Directors of the Lead Clinic at Childrens Medical Center. This clinic mostly sees children with elevated lead levels but also sees kids with other possible toxic exposures. Stacey Hail, MD, brings her love of chemistry to the classroom. She also does forensic toxicology and uses material from her case work in the education program. Brett Roth, MD, is the Medical Director of the North Texas Poison Center; where the fellowship program is based. Amy Young, MD, is an Assistant Program Director. As such, she coordinates our Grand Rounds and our field trips. Fields trips are to a variety of settings including the Botanical Research institute of Texas, the Dallas Zoo (which has the largest collection of venomous critter collection of any zoo in the US), and Dallas Fire Haz-Mat headquarters. Amy also prepares monthly, joyful quizzes for the fellows! Ellen O’Connell, MD, is also one of the toxicology faculty. She works closely with the EM program in helping to oversee IT considerations. She is also the Chair of the Pharmacy & therapeutics Committee for Parkland. Larissa Velez, MD, is another busy member of our toxicology faculty. She is also the Program Director of the Emergency Medicine Residency Program (that would be the largest EM training program in the nation). Jakub Furmaga, MD joins the faculty in July 2015. He has an interest in toxicology operations and he will oversee the continued development of the business of our toxicology service. James Cao, MD starts with us in August 2015. He is particularly interested in education and he will grow in his efforts to support the fellowship training program. While not one of our formal faculty, we are also very excited that Adebesi Obafemi, MD, assists the training program. He graduated from the toxicology fellowship in 2012 and then he remained on with UT Southwestern as the new Medical Director of Occupational Health – helping oversee such services for the 14,000 employees. He is going to initially get his operation up and running and we look forward to working with him closely.


We provide medical care in various ways. The faculty and the fellows together provide bedside consultations to the EDs, floors, and intensive care units of Parkland, Childrens Medical Center, and UT Southwestern. These services are provided 24/7. The fellows and faculty also support the North Texas Poison Center on cases called to the center. Some of the faculty and all of the fellows support outpatient services. Drs. Collin Goto and Sing-Yi Feng together run the “Lead” Clinic at Childrens Medical Center.  They follow a large number of children with elevated lead levels. They also see children with other toxicology related issues.  Dr. Paul Wax is the medical director of the North Texas Occupational and Environmental Toxicology clinic at UT Southwestern. Dr. Kapil Sharma also provides faculty support to this clinic. The toxicology service at Parkland has also begun to work with emergency medicine to create protocols for the care of toxicology patients within the emergency department observation unit located on 2SS. This 25-bed unit is run my emergency medicine. We are steadily increasing the types of patients that we can place in our “own” unit. We are very excited by this development because we will be able to better address our patients’ issues.   

 
Education of our fellows and other health providers is a primary focus.  I have developed a very focused curriculum that ensures exposure to the full core content of medical toxicology.  Our Tuesday conference is very focused on the fellows.  In addition, the service provides education to rotators from various backgrounds. We have over 130 “rotators” yearly. Our service has become very popular and we unfortunately have to limit the number of rotators because of space limitations.  The rotators, however, don’t just sit back and learn; they help teach us! They have weekly assignments that provide education to the toxicologists.


The Division of Medical Toxicology is within the Department of Emergency Medicine at UTSW.  Emergency Medicine became a full Department on September 1, 2014 under the leadership of our first Departmental Chair, Deborah Diercks. The emergency medicine (EM) program began in 1997 with 16 residents per class and has 22 per class as of July 2015. It is the largest EM training program in the nation!  The Department is very busy academically. Besides toxicology, the other ACGME based programs include EMS and Hyperbaric and Undersea Medicine. Other non-ACGME fellowships include Tactical Medicine, Global Health, Disaster Medicine, and Ultrasound.  Different members of the EM faculty, led by Ahamed Idris, are working on various projects that are supported by more than 10-million dollars of NIH funding. Dr. Idris’ primary work is as the PI on the Resuscitation Outcomes Consortium.  The Department is very involved in Nuclear-Biological-Chemical warfare and Weapons of Mass Destruction.  Various faculty, under the direction of Ray Swienton (Chief of the Division of Global and Disaster Medicine) and Ray Fowler (Chief of the Division of Emergency Medical Services) have created the National Disaster Life Support Course that is endorsed by the American Medical Association.


The Toxicology Services works closely with three world class institutions including UT Southwestern Medical Center, Parkland Memorial Hospital, and Childrens Medical Center.


UT Southwestern Medical Center. UT Southwestern, one of the premier academic medical centers in the nation, integrates pioneering biomedical research with exceptional clinical care and education. The institution’s faculty includes many distinguished members, including six who have been awarded Nobel Prizes since 1985. Numbering approximately 2,800, the faculty is responsible for groundbreaking medical advances and is committed to translating science-driven research quickly to new clinical treatments. UT Southwestern physicians provide medical care in 40 specialties to about 92,000 hospitalized patients and oversee approximately 2.1 million outpatient visits a year. The medical center operates two hospitals on campus. Zale Lipshy hospital functions primarily for neurologic care. The University opened the new $800 million state-of-the-art clinical facility – the William P. Clements Jr. University Hospital – in December  2014. The 12-floor, 460-bed hospital replaced St. Paul University Hospital.


Parkland Memorial Hospital.  The Parkland Emergency Department (ED) is a very busy facility that triages more than 200,000 patients per year and sees more than 145,000 patients in the main ED (most of the other triaged patients are sent to the urgent care clinic). The pathology is phenomenal.  Untold diseases I had only read about before coming here; now I see them almost routinely.  Multiple toxic exposures present to the Parkland ED daily.  The local EMS system is aware of our “toxic” interest and our psychiatric emergency room.  Thus, they often bypass other facilities to bring patients to us. The new Parkland is in the midst of being built. Thanks to the overwhelming 82 percent voter approval in November 2008, the new hospital opens August 2015. It is the largest hospital construction project in America. The facility encompasses 2.5 million square feet with 862 private rooms.


Children's Medical Center.  It is a major referral center for North Texas and sees over 90,000 patients per year with in the ED.  Providers at other facilities are often nervous caring for toxic children and frequently refer these patients to Childrens Medical Center.  We are more than happy to assist in their care.  The Children's system is licensed for 559 beds and has more than 50 subspecialty programs.  It is the only Level 1 pediatric trauma center in North Texas.


The North Texas Poison Center is the home of the Toxicology service and fellowship. The fellows, program director, and some of the faculty are based there. While funding comes from various state and federal sources, it is a Parkland entity. It provides 24/7 care to the public and health care providers. The Specialists in Poison Information (SPIs) who answer the phones work closely with the toxicologists in optimizing patients care. Dr. Brett Roth, one of the faculty, serves as the Medical Director.


The Toxicology service reputation has rapidly grown within and outside the campus and many health care providers wish to do rotations with us.  Our rotators routinely come from the Parkland and John Peter Smith EM programs, osteopathic EM programs in Oklahoma and Missouri, the Pediatric EM Fellow program based at Children's Medical Center, pediatric residents, pharmacy students from various pharmacy schools, and medical students from UTSW and other medical schools. 


It has been a pleasure to share some aspects about our program.  Please contact us for further information or questions.


Have a great day…


Kurt Kleinschmidt

 

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