Emergency Care For UH Medical School
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Lucky he lives Hawaii. And lucky for the rest of us too - especially if you or a loved one ever needs emergency room care.
He is Dr. Jerris Hedges, dean of the University of Hawaii John A. Burns School of Medicine. His name is known - and appreciated - in ERs around the country and across the world as coauthor of what is regarded as the field’s “bible,” Robert & Hedges’ Clinical Procedures in Emergency Medicine. Now in its fifth edition, Hedges estimates that roughly 15,000 of each edition is in circulation. This text helped define the discipline and set the standard for procedures for emergency medicine.
“Initially, when emergency medicine as a field developed, patients would come in to seek help, and no one was particularly trained in a broad manner to deliver that care,” says Hedges. “What the discipline did is brought the generalist knowledge with the surgeon’s interventional approach. The procedures were what was needed to be emphasized and taught, so as a beginning emergency physician, I worked with other talented individuals and we collectively thought to go about this in a more objective and definitive manner, and write a book that tells people how and why you would do a procedure, but also how you might vary that. So the result was to provide information to people in the emergency room, so they would have all the resources they needed.”
Hedges also is well-known for his work on trans-cutaneous cardiac pacing in the early 1980s, helping introduce that modality into daily emergency practice.
It’s one of his accomplishments that he says touched him in a very special way.
“One of the things I got interested in as a young faculty member is how to treat patients whose heart was either beating too slowly or had stopped,” says Hedges. “You could do that by passing wires through the veins and stimulating the heart. Or we were looking at a technique, which was to use a large electrical pad that you put on the front and back of chest, and you put an electrical current through the chest to cause the heart to contract. Fifteen years later I helped develop this technique and get it popularized. This was used on my own father when he went in for heart care. He developed a slow heartbeat and required this pacemaker for about eight hours. I had no idea that this would have an impact on my own family. He could have done poorly if he hadn’t had that.”
And the interesting thing is that Hedges’initial training was in aeronautics and astronautics, and he later received his master’s degree in chemical engineering.
It all began growing up as a farm boy near Olympia, Wash., where he spent his time raising cattle, growing crops and figuring out how all the equipment worked. “I got interested in engineering, and then from engineering I got interested in how it could apply to medicine,” says Hedges. “And when I got into medicine, I didn’t want to really focus on one area, so I decided to try this new field called emergency medicine because it would allow me to see patients of all ages and a variety of conditions both surgical and medical.”
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His farm-boy curiosity has allowed him 30 years contributing to the medical field as a physician, professor, assistant dean and currently dean of Hawaii’s only medical school.
“I went from working as a trainee in emergency medicine to going into academics because I felt it was there that I could have the most impact on the next generation,” says Hedges, who spent 20 years at Oregon Health and Science University’s School of Medicine in Portland before coming to Hawaii. “I’ve had a lot of opportunities, and one of the nice things I’ve found is that you have an interest in doing things, and you go out and approach people and ask what you can do to help, they’ll often give you the chance to prove yourself. And I guess from my childhood, I’ve been one who always looked for opportunity and the chance to help others and experience new things.”
His new role as dean of JABSOM has come with its challenges and triumphs, but mostly admiration for the foundation that was built before his move with his wife Susan. Their son
Andrew, 32, is a paramedic and daughter Emily, 29, is a social worker.
“JABSOM is so special and unique in several ways,” says Hedges, an elected member of the National Academy of Sciences’ Institute of Medicine. “Most Mainland medical schools are set up out of an academic center where the hospital, medical school, faculty and students are under one umbrella defined by the university. But at JABSOM, we’re embedded in the community, so our faculty is seeing patients in community clinics; our students also are being trained within the community.”
Nearly half of all practicing physicians in Hawaii are graduates of JABSOM.
And JABSOM’s faculty comprises 30 percent of Hawaii’s practicing physicians.
“Many folks think that students go into the school and come out a doctor, but while they’re attending JABSOM they’re training in the community in outreach, hospitals and physician practices,” says Hedges. “We contribute a number of ways to the local work force.”
Also unique to JABSOM is its problem-based learning curriculum and its Department of Native Hawaiian Health.
“JABSOM has the only active medical school department focusing on the health issues related to an indigenous population,” says Hedges. “Other schools may have that as part of the curriculum, but we have a full program.”
The Imi Hoola program addresses disadvantaged students’ academic and social-emotional needs by offering up to 10 students each year from economic, social and or educational disadvantaged backgrounds to participate in the post-baccalaureate program. Upon completion, the students can enter JABSOM as first-year medical students.
JABSOM also is committed to preparing and training our local population for medical school - 90 percent are required to be kamaaina.
“In our selection process, we focus on those from Hawaii and with ties to Hawaii,” says Hedges, “and we give them a higher priority for entry.”
Since taking on the position, in 2008, formerly occupied by interim deans, Hedges’ first big task was to work with the administration to declare a common vision, and also sort through and strengthen the existing programs.
From there it was addressing accreditation.
“There were a number of years JABSOM went without full accreditation, so during my first year here our team came together and we got the full eight-year reaccreditation by the Liaison Committee on Medical Education,” he says. “It’s a real crowning achievement for this institution.”
And it’s been about building bridges within the community, including hospitals and institutions, that Hedges explains is so important to our educational process.
He recently teamed up with Hazel Beh, director of the Health Law Policy Center at UH’s William Richardson School of Law.
“I try to keep my hands in what we call systems research, and one of the things we are doing of interest is that I’m working with Hazel Beh. We’re working on a grant proposal to look at medical legal issues to find ways we can better resolve issues when something happens and patients need support and compensation. And at the same time, minimize that problem from happening again. Basically looking for a more rapid, patient-focused solution without the lengthy legal process we have now.”
High on Hedges’to-conquer list is the state’s physician shortage.
“Here in Hawaii, it’s interesting because when people look at the licensing bureau to see how many people have a medical license, the numbers are about 8,000 physicians,” he says. “But when you look at how many are actually seeing patients, it’s under 3,000. So fewer than half who have licenses are actually seeing patients, and some of those who are seeing patients are limiting their practice and aren’t taking new patients. So we have a significant shortage, and it’s much worse on the Neighbor Islands. We could probably use another 500 doctors.”
A recent development to help bridge that gap is the opening of the Hawaii Island Family Health Center in Hilo. The multi-disciplinary hub, where patients can consult with physicians, nurse practitioners, nurses and pharmacists under one roof, is the first of its kind in the state.
“The goal of the Hilo clinic is to help alleviate the tremendous physician shortage,” says Hedges. “It couples with our goal of expanding training on the Neighbor Islands. If this works well, then we’ll use the parts that are really positive to launch centers on other islands.”
It seems only fitting that the expert on emergency medicine get involved with Hawaii’s trauma system. Hedges has been working with the state and hospitals to help design a formal trauma system.
And then there’s dealing with budget cuts, bridging education and research, and obtaining more research dollars. Hedges says it’s all about adjustment and keeping focused on the school’s important role to not only provide education and research, but deliver health services throughout the community.
“This school is not on a static position at all, it’s really at a position of change,” says Hedges, “some of it is growth, and some of it just strengthening what it does on an everyday basis.”
So the author of “the ER bible” and other publications such as The Punctilious Writer (a guide on punctuation and capitalization) and Outsmart Outback II (a guide on first aid procedures and backcountry skills) will put his writing skills aside to carry out the vision of former Hawaii Gov. John A. Burns. The vision of ALOHA: to Attain Lasting Optimal Health for All.
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