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An incredible impact

David M. Jaffe advances pediatric emergency medicine across the world
By Kim Leydig

During his pediatric emergency medicine fellowship, David M. Jaffe was struck by a news story that would forever impact his career.

One summer afternoon in 1976, 26 kids riding a school bus were hijacked at gunpoint on a rural road in Chowchilla, Calif. They were taken to a quarry and entombed in a sweltering moving van. For 16 hours, the bus driver and kids dug their way out.

During the psychological debriefing of the ordeal, the children were asked to compare the trauma with something they've experienced. The No. 1 answer: going to the emergency room.

David M. Jaffe, M.D. (left), plays with finger puppets to help put 1-year-old Amar Robinson at ease before she's examined. Her father, Andrew, brought his daughter into the ED for treatment of an ear infection last week. Robert Kennedy, M.D., associate professor of pediatrics, says Jaffe has an amazing ability to connect with children.

Photo by Steve Truesdell

David M. Jaffe, M.D. (left), plays with finger puppets to help put 1-year-old Amar Robinson at ease before she's examined. Her father, Andrew, brought his daughter into the ED for treatment of an ear infection last week. Robert Kennedy, M.D., associate professor of pediatrics, says Jaffe has an amazing ability to connect with children. "It is rapidly clear to patients and their families how much he cares."

"If I had not already known, I learned again that day how much work we had to do to address issues of pain and anxiety in pediatric emergency medicine," says Jaffe, M.D., head of the Division of Pediatric Emergency Medicine and the Dana Brown/St. Louis Children's Hospital Professor of Pediatrics. "The emergency department can be a place of high anxiety, but it doesn't have to be traumatic. During that brief encounter, we can have a tremendous impact on patients and their family's lives."

Jaffe oversees the St. Louis Children's Hospital Emergency Department — the largest pediatric emergency center in the region and the third-largest emergency department (ED) in the state — where his staff treats more than 50,000 kids annually.

Robert Kennedy, M.D., associate professor of pediatrics, explains that Jaffe has an amazing ability to connect with children.

"It is rapidly clear to patients and their families how much he cares," Kennedy says. "Dave is a very empathetic and compassionate human being who never loses sight of trying to do the right thing."

Daring and diligent

When Jaffe earned his medical degree from the University of Chicago in 1978, emergency medicine wasn't even acknowledged as a specialty.

After medical school, Jaffe began a pediatric residency at Children's Hospital of Philadelphia, where he met his longtime mentor, Stephen Ludwig, M.D., who encouraged him to become one of the first fellows in pediatric emergency medicine.

The American Board of Medicine recognized emergency medicine as a specialty in 1979. But it wasn't until the mid-1980s that pediatric emergency medicine emerged as a specialty with academic training programs at universities.

Even as a young fellow, Ludwig knew his protégé would have an incredible impact on the field.

"Dave took the bold step of entering into the emerging field of pediatric emergency medicine," says Ludwig, the associate chair of the Department of Pediatrics at the University of Pennsylvania School of Medicine. "At that point, there was no board certification and no guarantee of a job."

Jaffe (left) and David Lewis take a break from their biking trip to enjoy the beautiful sites of Les Beaux in southern France.

Courtesy photo

Jaffe (left) and David Lewis take a break from their biking trip to enjoy the beautiful sites of Les Beaux in southern France.

By using the funding from a pediatric fellowship, Ludwig and Jaffe crafted the first fully continuous pediatric emergency medicine fellowship in the United States.

"Dave was a model fellow not only because he's daring but also because of his diligence," Ludwig says. "It's been a thrill to watch him become a national leader. He has become a trusted friend and adviser. No teacher could ask for more."

Alan L. Schwartz, Ph.D., M.D., the head of the Department of Pediatrics and the Harriet B. Spoehrer Professor, also considers Jaffe a champion of the field.

"Dr. Jaffe has been at the forefront of this discipline since its birth two decades ago," Schwartz says. "He is an advocate for education, training, clinical care and research. He has a broad command of the issues and fosters the development of approaches and solutions."

The ouchless ED

When Jaffe came to the University in 1991, he could tell how busy the ED was by the decibel level of screaming kids.

He explains that some still think of the ED as the old characterization of "the pit," a noisy place where things are out of control and patients are miserable.

Eradicating that belief is some of the reason Jaffe and his colleagues, Kennedy and Jan Luhmann, M.D., associate professor of pediatrics, are dedicated to advancing the management of pediatric procedural pain — with the aim of making the ED as "ouchless" as possible.

Recent studies by Jaffe, Luhmann and Kennedy report on methods they've developed to safely and effectively sedate pediatric patients during painful emergencies.

The team's most profound advances have been with sedation methods of potent medications such as ketamine and nitrous oxide to effectively reduce pain and stress with little respiratory depression.

Jaffe explains that one of the advances that places the School of Medicine at the forefront of the field is the use of nitrous oxide.

The team developed a delivery method especially designed for kids, and several of the researchers studies found nitrous oxide is highly effective in a number of clinical situations, such as suturing, IV insertion and foreign-body removal.

The team is also investigating the use of ketamine.

"In the past, we haven't had alternatives to help kids through painful procedures, but now we have the means to reduce pain," Jaffe says.

University studies reveal that only 10 percent to 12 percent of pediatric patients experience easily measurable adverse effects of ketamine. The team is researching ways to further reduce the drug's after-effects using other mediations.

"It's very exciting for us to take the national lead for advancing the management of procedural pain for children," he says.

An excellent example

Each year, 23 million American children visit the emergency department, but only a small percentage of them are treated by pediatric emergency medicine specialists.

To help improve the care of pediatric patients across the nation, Jaffe has played a leading role in the Pediatric Emergency Care Applied Research Network (PECARN) since its inception in 1991. PECARN, a federally funded research group of 25 U.S. emergency departments, conducts multicenter studies on a variety of issues related to pediatric emergent services.

As one of the first fellows in the field, Jaffe says directing the University's pediatric emergency medicine fellowship program is especially gratifying. Many of the fellows are actively involved in PECARN studies.

Jaffe also helped found the Pediatric Emergency Medicine Fellowship Conference 11 years ago, which annually unites fellows across the United States for three days of workshops, interaction and research.

David M. Jaffe

Family: Life partner, David Lewis, a social worker who's worked in the Bone Marrow Transplant Unit at Barnes-Jewish Hospital for 10 years.

Why did you pursue pediatrics? "I really have two lines of thought," he explains. "During my residency, I realized that it was unlikely that I would have kids of my own, but I wanted children to be part of my life.

"I also love to help kids and have a special connection to them. Many adult diseases and illnesses are caused by personal choice to neglect health. With children it's not an issue, there's no passing judgment."

What drew you to emergency medicine? "I love the variety and I like solving problems," he says. "As emergency medicine specialists, we have to know how to treat a variety of medical conditions, and I love that we can immediately help people feel better."

Hobbies: Playing the French horn and singing in the Gateway Men's Chorus. "I love classical music, and I'm a big fan of Opera Theatre. We also love to travel and combine it with physical activities like hiking and biking."

Years at the University: 13

"I think what truly epitomizes Dr. Jaffe is that he truly cares about what is best for his fellows," says fellow Julie McManemy, M.D. "He has impacted me as an emergency physician by providing an excellent example as a physician and as a teacher. He's expanded my views not only as a clinician, but also as a future physician in academia."

A global influence

As head of the Division of Emergency Medicine, Jaffe also is involved with projects and research that impact emergency pediatric medicine worldwide.

He works with Robert C. Strunk, M.D., professor of pediatrics, on studies involving asthma — the No. 1 reason kids visit the ED — to improve follow-up care and long-term outcomes, especially with inner-city kids.

Jaffe is also proud of the efforts of Mark J. Manary, M.D., associate professor of pediatrics, to combat malnutrition in Malawi, Africa. Manary's "Peanut Butter Project" has already saved hundreds of lives and has the potential to benefit millions of children in the developing world.

"It's very exciting to be involved with research that has the potential to have a major impact on world health," Jaffe says.

Whether it's overseeing the University's Child Protection Group, which investigates signs of child abuse and neglect in the ED to improve injury prevention, to community action program like Healthy Kids at Play, a project that teaches kids street safety, Jaffe's leadership touches children worldwide.

"There is hardly an area within pediatric emergency medicine that hasn't been impacted by Dave Jaffe," Kennedy says. "He has significantly impacted widely divergent areas while nurturing many of today's leaders in the field both as a mentor and as a colleague. Our division's greatly disparate academic interests speaks volumes about Dave's leadership."

But in the midst of all those diverse projects, Jaffe still works overnight shifts in the ED. He stresses to his staff that while treating patients is a routine for them, it can be one of the most critical times in a patient's life.

"A patient's experience in the ED can be a life-changing event," he says. "We have the opportunity to help people through a very vulnerable time and make an immediate difference in their lives."

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