Heritage Snapshot Part 230: Dr. Kathleen J. Clem

LOMA LINDA>> Dr. Kathleen J. Clem, MD, a 1989 graduate of Loma Linda University School of Medicine is the current chair of the Department of Emergency Medicine and a professor of emergency medicine and pediatrics at LLUMC. Years ago, Clem started an organized approach to trauma care in China at the Sir Run Run Shaw Hospital, in Hangzhou. After completing her residency at LLUMC in 1992, she started the first international emergency medicine fellowship at LLUMC in 1993. In doing so, she also started the first one in the United States, now the longest running program of its kind in America. Today, almost every academic center has one. She was asked to go to SRRSH as a new member of the faculty of the School of Medicine because of her interest in international emergency medicine. Her enthusiasm for international work resulted from her medical education at Loma Linda University, where students learn the importance of global involvement from the beginning. She acknowledged that international outreach is “part of our DNA.” Because emergency medicine was a new specialty undergoing tremendous growth in China, Clem, as a consultant, not only helped SRRSH set up its trauma system, a first in China, but also its emergency medicine residency training program. When she first arrived at Sir Run Run Shaw Hospital in 1995, she found it already had a large emergency department and an impressive resuscitation area. But, she said she noticed potential areas of improvement. She worked with the hospital to have wall-mounted soap dispensers installed to replace hand soap which was not always available. A standard practice in China was to immediately shave the hair from each head-trauma patient, just in case the patient might need neurosurgery. While there was a pile of Chinese hair accumulating on the floor, Clem was thinking about the importance of an airway, breathing and circulation, the way she had been trained. During her in time in China, she also helped develop China’s first defined crash carts that provided equipment and supplies necessary to save lives without patients having to pay for them first. This made it possible to provide emergency life-saving care before payment, which was not a standard practice at the time in China. Before her involvement, a member of the patient’s family would have to purchase emergency supplies from the hospital pharmacy, including endotracheal tubes, before emergency care could begin. In China at the time, only the rich would call for an ambulance because of its expense and prepayment requirement. Most major traumas arrived on the back of bicycles, draped over the handlebars or in the back of a car. In order to protect a patient’s cervical spine during emergency medical services transport, Clem introduced a standard Western-medicine-style backboard. The backboard enhanced the transportation of trauma patients by protecting and immobilizing the cervical spine. SRRSH personnel had never before seen one so Chinese ambulances had never used them. She drew the shape of one out on the floor, cut and assembled the backboard in the hospital’s woodshop, and arranged for a seamstress from the local marketplace to make the straps. She then taught the use of the backboard in order to avoid causing additional harm to the patients. Even though the hospital did not start with a pediatrics unit, the Emergency Department needed to be prepared to care for all patients, including pediatric trauma cases. According to Dr. Clem, “In the United States, we use something that is called a ‘flying carpet.’ We keep all of the supplies that we need for a child. We have a color-coded packet with the right-size endotracheal tubes, all of the doses of the different medications we might need, all right inside of a packet, so that you don’t have to try to figure it out what you need for each size/weight of a child.” Clem went to a seamstress once again and bought the material for the first color-coded ‘flying carpet’ in China. Everything needed to care for children of different sizes and ages was put in it with Chinese writing and Chinese tools. “It worked out really well,” Clem said. “I was able to incorporate that into the crash cart. So it was one of those tools that we were able to use before the family paid.” Clem decided that all emergency physicians that were being trained at SRRSH would also be trained in how to deal with pediatric emergencies. Part of the responsibility of educating an emergency physician was to be able to care for a patient of any age.