Revolutionizing Care: USF Emergency Medicine Research Updates

The USF Department of Emergency Medicine is proud to provide superior support for our residents and faculty interested in research. Love emergency medicine but not sure how research fits into the field? Take a moment to check out some of the incredible work being done by our group. In this post, Dr. Wilson, Chief of Emergency Medicine and Director of Research, provides an annual update.

Overview

The USF Department of Emergency Medicine, in collaboration with the TGH Acute Care Research Team and USF Health Office of Clinical Research have witnessed continued growth and improved collaboration over the past year. Our model of conducting clinical trials in collaboration with the TGH Acute Care Research team allows enrollment in most studies 24 hours a day. Ashley Bader, RN leads that team which includes multiple research nurses, coordinators, and assistants.

As our program grew, and transitioned from Division to Department, more formal utilization of the USF Office of Clinical Research has allowed faculty and residents to expand their overall research and sponsored projects footprint. A special shout out to Amanda McNamara, Brenda Flam and Gabrielle Parker here for all their research support. Our USF EM Research Chief represents the bridge between faculty efforts and resident involvement. Sam Harris, MD did an excellent job in 2023-2024 and we are excited to have KC Grimes, MD step into that role for 2024-2025.

USF EM has had significant increases in scholarly and research output. Faculty and residents have presented at SAEM, as well as national/international toxicology, anthropology, simulation, EMS, ultrasound, and sports medicine conferences. Publications can now be tracked in real time on our website. There has been a clear upward trend over the last decade in USF EM publications. This figure is updated annually and also available on the website.

Clinical Trials

USF EM Faculty have successfully led multiple clinical trials. Every section has had active scholarly production in EM this past year.

Dr. Justin Arnold and the tox team with Dr. Diana Dean and Dr. Cory Howard, opened an ongoing new antivenom trial for treatment of both rattlesnake and coral snake envenomation. Dr. Arnold is also close to opening a study examining lab testing for acetaminophen toxicity. Dr. Diana Dean applied for an SAEM EMF grant to investigate toxic alcohols. While the first application submission was not accepted, the feedback has propelled the work forward. These are the types of projects that can become career cornerstone and long-term investigation.

Dr. Jason Wilson and Dr. David Wein are continuing and expanding their investigations of a calcium release-activated calcium channel (CRAC) inhibition therapy for the treatment of Acute Pancreatitis and ARDS in the setting of septic shock. Dr. Wein took over from Wilson as the site PI of the Auxora Phase 2b trial that enrolled the final patient in the spring of 2024. How cool would it be to have an actual therapeutic intervention for acute pancreatitis? A study considering the same drug in the setting of ARDS is planning to launch in late 2024, early 2025 at USF/TGH with Dr. Wilson as the site PI.

Diagnostic Biomarkers

A lot of work has been done in the diagnostic/severity stratification biomarker space. Dr. Enola Okonkwo has continued to have consistent enrollment in her r-TEG study examining TEG levels in participants with GI bleed. This foundational work will lead to larger investigations that consider whether r-TEG can be used to guide resuscitation of the GI bleed patient in real time. Dr. Wein has wrapped up a high sensitivity troponin study and, through collaboration with the TGH Acute Care Research Team, led our site to a top tier enrollment status. Dr. Wilson is wrapping up a manuscript to disseminate findings of one year of operational data as the first site to use GFAP and UCH-L1 in patients presenting to the ED with mTBI. Dr. Wilson is also examining a bacterial/viral biomarker index (TRAIL, IP-10, CRP) to diagnose and guide management of patients with sepsis with the support of senior resident Daniel Wind, MD, as well as multiple medical students. That work has been presented to the TGH Sepsis Oversight Committee and will move to real time enrollment and observation of physician/provider behavior based on test results.

Traumatic Brain Injury & Hyperbaric Medicine

**Dr. Mala Trivedi,** pictured, will serve as the medical director for the USF Hyperbaric Oxygen Program. Dr. Trivedi and others, including **Dr. Daniel Lende** from the USF Department of Anthropology, will be investigating Hyperbaric Oxygen Therapy in Veterans with TBI. This trial receives state funding allocated to USF. The USF EM group has a significant fingerprint in this trial. **Dr. Wilson** is leading a funded, collaborative mixed methods study of the TBI trial that both examines potential barriers to implementation of clinical trial results, as well as the role of ritual by leveraging a unique opportunity to assess a cultural outcome on top of a randomized clinical intervention. We are actively recruiting a faculty level anthropologist researcher to join the HBOT team and our Social EM division.

Pediatric EM

EM Critical Care Research

USF EM can support any level of research interest amongst our residents and fellows – from case reports all the way to PI driven investigator initiated prospective studies. Dr. Jared Senvisky, our graduating Critical Care fellow, designed and developed a clinical trial analyzing the use of UCH-L1 and GFAP biomarkers to predict neurological outcomes in out of hospital cardiac arrest in the acute setting. That study, which is continuing to currently enroll, may help risk stratify patients with return of spontaneous circulation in the ED. Dr. Senvisky will stay involved in this study with the help of Drew Rice, MD, PGY 3.

Social EM Research

The Social EM, Population and Global Health team has been very busy as we continue to grow structurally. We recruited three faculty members to Social EM (**Dr.** **Heather Henderson, Dr. Bernice McCoy**, **and Dr. Rebecca Campbell-Montalvo**). These PhD EM faculty will help lead our USF EM research efforts in obtaining increased external federal funding and come with a portfolio of exciting research programs. The Social EM Division has multiple active studies and clinical QI projects over a broad range of topics such as HIV/HCV routine screening and linkage to care, standards of care for acute substance use disorder treatment, intimate partner violence, sexual assault care, sickle-cell related pain, soft-tissue infection and endocarditis in patients with substance use disorder, integrating harm reduction principles in direct care delivery for structurally vulnerable patients, gun violence related injuries, and more.
In the past year, our Social EM work has examined and addressed healthcare inequities while also overlapping with clinical trials. Graduating resident **Autumn Bass, MD** was awarded a GME grant to explore inequities in arrhythmia diagnoses through use of a remote superficial heart monitor program. That work is part of **Dr. Okonkwo’s** long-term project examining the implementation of a superficial remote heart monitor for discharge and transitions of care of participants with syncope and/or palpitations.
**Dr. Wilson** has continued work as a site-PI on a multi-site PCORI funded study examining transitions of care interventions in underrepresented people with Medicare using peer support (similar age, similar health care condition, similar race/ethnicity) to reduce racial disparities in hospital readmissions and negative outcomes post-hospitalization. **Dr. Wein** will take over the site PI duties **and Dr. Wilson** will join the PCORI team as a co-I for the multi-site study.
**Dr. Okonkwo** is continuing her work on the intersection between emergency medicine, and transitions of care in patients who present following sexual assault. This project has resulted in improved awareness of gaps in care and translated to the development of care pathways that improve medical care inside the ER and in the community. Most recently, Dr. Okonkwo partnered with **Dr.Howard** and the Poison Center to investigate substance-facilitated assault patterns in our community.
Read more about the impact our Social EM Division is having on substance use disorder and infectious disease treatment below!

Substance Use Disorder

Dr. Henderson, in collaboration with Dr. Wilson, leads the USF EM sponsored project work with our new partner, Central Florida Behavioral Health Network (CFBHN). This is the first time CFBHN, a behavioral health managing entity, has partnered with a hospital system to provide services and represents over $1.5 million a year in funding for expansion of buprenorphine and substance use treatment. This project helps to hard wire us as leaders in medication for opioid use disorder treatment in the ED but also across the community on the heels of the ED-INNOVATION study, a NIH NIDA funded study that wrapped up in the spring of 2024. In that study, led by Dr. Wilson at TGH/USF, participants were randomized to sublingual versus injectable buprenorphine during acute withdrawal. Through a funded collaboration with Live Tampa Bay, Heather Henderson and Jason Wilson are now expanding that work across multiple hospital sites and establishing best practices for MOUD programs across our region via an implementation science approach.

Syndemic Models and Infectious Disease

The Social EM team also has funding from the Gilead FOCUS program, entering year 9, to support ED based HIV and HCV testing as well as the IDEA Exchange (Syringe Services Program). This sponsored project, operated by Drs. Wilson, Henderson, and McCoy, is responsible for testing and linking to care over 1,000 people a month. Dr. Wilson completed his PhD dissertation in October 2023 examining a co-located syndemic model that treats people who inject drugs that also have HCV with HCV direct acting antivirals via telemedicine or on site. This program continues to expand and offer numerous research opportunities. The Abbvie Acute HCV trial, led by Dr. Wilson and then Wein, touched on broader issues of HCV screening versus testing our team has been exploring the last couple of years. In groups with high prevalence (injection drug users) of HCV, HCV Ab may be negative, but RNA levels might be detected during seroconversion. Our work has explored RNA testing and DAA treatment in those groups. Anthropology graduate student Megan Sarmento receives funding and mentorship from USF EM and is actively involved in these HCV syndemic projects. Drs.Wilson and McCoy were awarded an extension of an Ending the HIV Epidemic (EHE) award that considers ways to conduct HIV testing during acute medical encounters (e.g. the ED, hospital and syringe exchange). The Social EM team is now pursuing funding from multiple fronts to implement HIV PrEP (oral and, potentially, injectable) across multiple acute encounter locations. In addition, the group is implementing improved care models for delivering nPEP for HIV prophylaxis in the setting of sexual assault.

EMS & Prehospital Research

Dr. Angus Jameson and members of the Pinellas Technical Rescue Team.

Big news from our EMS section as USF EM was awarded state funding to conduct research regarding prehospital/EMS workforce and policies in order to increase the EMS workforce and to improve EMS education. This funding will launch us into a new era of EMS research beginning July 1, 2024 and will further enhance our collaborations with CAMLS as the center will be housed at that location. In addition, Dr. Angus Jameson continues to study EMS provider wellness as well as the ability to expand substance use treatment efforts through leave behind Narcan programs. Dr. Jameson has also published prolifically as part of the stroke registry. Dr. Lozano has also published on work examining disparities in EMS care delivery over this past academic year (all available via the USF EM Publication Bibliography). Andrew Thomas will begin examining the use of ventilators by EMS and is actively recruiting faculty, resident and medical student support for those projects. Eric Weinstein, MD, with a significant track record and training in disaster medicine, has joined the team with an impact. Dr. Weinstein has conducted a mass casualty incident training at CAMLS with other Department faculty and fellows and also had multiple publications.

Ultrasound Reseach

Dr. Charlotte Derr and Dr. Allyson Hansen have been busy scholars as participants in the nationwide transesophageal echocardiography (TEE) resuscitation registry (one of the few sites in the country able to participate). Dr. Hansen has also applied for SAEM EMF funding to further her work in collaboration with Dr. Derr to target efficient CPR via ultrasound guidance. Current fellow, Dr. Lorena Martinez received a GME Research grant and the Jagdish U. Kothari Award for Excellence in Cardiovascular Research for their CPR Teach proposal that will look at optimal compressions in CPR. In addition, a number of interesting case reports arose out of the ultrasound section this last year, including a bizarre case of an esophageal stent migration. The group also recently completed a Man vs Machine doppler study comparing efficiency of palpation vs ultrasound in finding DP pulses and has a fascia iliaca QI project underway!

Research Networks

Registry studies and large research networks remain excellent ways to grow research networks, develop testable hypotheses and maintain high scholarly production. All investigators should seek a network to be a part of for these purposes. Dr. Wilson has been a member of the Comprehensive Oncologic Emergencies Research Network (CONCERN) group since 2016. The group continues to collaboratively ask new questions and share data across sites to address those questions or build new studies. Currently, Dr. Wilson is working with Danel Voorhees, MD, as well as RISE students, to retrospectively examine patients with cancer who present with NON-neutropenic fever. As mentioned previously, Dr. Derr and the Ultrasound team are contributing to the TEE resuscitation Registry and we have other faculty who have worked with Stroke & Trauma related registries and more.

Conclusions

As with the rest of USF EM, research, sponsored projects and scholarly activity is in a rapid growth phase. You don’t have to love research as much as we do to train or work here, but our goal is to establish ourselves as leaders in Emergency Medicine research and innovation – making it an exceptional place to be for those who want to advance the field. As we recruit more faculty researchers and continue success in obtaining external funding, that growth will continue. Faculty research success not only strengthens USF EM, it also provides opportunities for our residents and medical students, in collaboration with USF RISE (multiple EM faculty have RISE students each summer) and EMIG, as well as our interdisciplinary collaborations with the Department of Anthropology and across Morsani. As always, if you are interested in getting involved in research or building out a research project, please contact Dr. Wilson to discuss next steps!

About the Author

Dr. Jason Wilson, MD, PhD, is the founding Chair of the USF Department of Emergency Medicine. He has also served for many years as the Director of Research for our Department leading the TGH Acute Care team. He’s an established researcher and expert in emergency medicine. In addition, he is a trained Medical Anthropologist with a particular interest in Social Emergency Medicine and establishing pathways that optimize healthcare delivery.

Post edited by Dr. Enola Okonkwo.