San Diego Union-Tribune (Sunday)
TRI-CITY ER RESUSCITATION ROOM NAMED AFTER DOCTOR
Karas considered a local pioneer in emergency medicine
Dr. Steve Karas, 76, was one of the first residency-trained emergency physicians in the country when he came to work at Tri-city Medical Center in the mid-1970s. During his 45-year career in Tri-city’s Emergency Department, he is credited with collaborating on an estimated 2,000 lifesaving resuscitations.
But he is known just as much for his work teaching, mentoring and inspiring fellow doctors in emergency medicine and is considered a local pioneer in the field. He helped train some of the area’s first paramedics and worked on building an emergency room residency program with UC San Diego and the Navy using Tri-city Medical Center as one of their community emergency department rotations.
He is known for his love of the practice of medicine, working with colleagues and discussing ideas in the quest to find a diagnosis and the best treatment.
“That interaction with patients and with fellow doctors as we ask ‘what will work best’ is why I stayed so long,” said Karas, who received the American College of Emergency Physicians’ Tenure Award for holding the longest active career in the same emergency department in the continental United States in 2017 after 42 years at Tri-city.
As a way of thanking Karas, Tri-city named its Emergency Department resuscitation room in his honor.
At his recent dedication ceremony, Karas recalled one incident about 15 years ago that stood out over the decades.
“A patient came into the Emergency Department in cardiac arrest and the team and I were able to restart the patient’s heart, but he remained in a coma for 24 hours,” Karas said. “We decided to treat the patient with therapeutic hypothermia, a relatively new treatment, in which we lower the body’s core temperature to reduce brain damage. Amazingly, the patient regained consciousness the next day and walked out of the hospital two weeks later, first stopping by the Emergency Department to shake my hand.”
Karas is considered a pioneer in the field of emergency medicine and was one of the first to practice that specialty in San Diego County in the 1970s.
“He was instrumental in developing a coordinated paramedic response system in North County, and assisting Tri-city Medical Center in becoming a central hub for paramedic education, training, and oversight,” said Dr. Cary Mells, chairman of Tricity’s Department of Emergency Medicine and facility medical director.
He worked closely with the nursing staff to teach the first paramedics, including establishing Oceanside as one of the first cities in the county to staff ambulances with paramedics.
“At that time North County was starting to blossom and I said we’ve got to get paramedics going here,” Karas said. He talked to the Oceanside City Council and the fire department. “Paramedics are the key link to emergency medicine.”
“Now, during the pandemic, people have come to recognize emergency doctors as frontline troops heroically helping patients.”
Karas has served as a mentor to physicians, residents and paramedics, and spearheaded the development of a physician training partnership with both UC San Diego and the Navy.
“He has always been committed to medical education, and in 1990 Dr. Karas fostered agreements with UCSD and Balboa Naval Medical Center to allow their residents to complete a portion of their training in Tricity’s Emergency Department,” Mells said. “Dr. Karas has a genuine love for the practice of medicine, and particularly for the specialty of emergency medicine.”
Karas led Tri-city’s residency program as its director from 1990 to 2002. In 2000, he was named Tri-city Emergency Medical Group chairman and served in that role for two years. He has also served several rotations as director of Tri-city’s Department of Emergency Medicine.
“Dr. Karas has been an inspiration throughout my career at Tri-city Medical Center, and his impact on both our team and the community at large is immeasurable,” said Dr. Gene Ma, who was one of the residents who rotated through the medical center and now serves as Tricity’s chief medical officer. “During my residency, he mentored me and helped me become the physician I am today.”
Karas has tried to give the hundreds of doctors he has mentored over the years the support he found when he first came to Tri-city in 1975. “I chose Tri-city because it was supportive and was a place where I could grow in emergency medicine,” Karas said.
Dr. Karas is known for his positive interaction with others in the emergency room.
“When I was a resident in training with Dr. Karas, I was amazed at the end of the shift he would go up to each person on the team, including the nurse, tech, secretary and me — the resident, and say, ‘thank you for your hard work today,’” said Dr. Michelle Voigt, a Teamhealth West emergency physician who works at Tri-city and Scripps Health and serves as QA chairperson of the Tri-city Emergency Department.
“Besides being brilliant and being able to carry on four conversations at once, he is humble,” said Voigt, who trains residents from UC San Diego School of Medicine.
“He is a deeply empathetic person and became more humble as he progressed in his field — few people do that,” Voigt said.
For nearly two decades, Karas has taught clinical emergency medicine one-onone, working side by side with doctors through Tricity’s residency programs with UC San Diego and Navy medical centers at Balboa and Camp Pendleton.
“Steve Karas put a lot of effort into developing the ED rotation for the emergency medicine residents from the Naval Hospital San Diego,” said Dr. John Siefert, a doctor at Naval Medical Center San Diego. The effort required buy-in from the leadership of Tri-city hospital and the Naval Medical Center San Diego as well as the local community and his group of ED physicians. “There were a lot of negotiations — it was not like flipping on a light switch. The rotation has been a great benefit for the Navy residents and continues to this day,” Siefert said.
“Young physicians are always asking challenging questions. Thus as a teacher, you must have a greater depth of knowledge of your area to teach effectively. Dr. Karas recognized this and knew that his group and the Emergency Department and the community as a whole would benefit,” said Siefert, who was one of the first doctors in the Naval Medical Center’s residency program to rotate at Tri-city in the early 1990s. He served three emergency room rotations training under Karas and his team.
“He was a positive, forward thinking guy — he was always asking, ‘How can we do this better,’” Siefert said. “It was great for a young physician to see new technology incorporated to serve patients.”
“It was close to his heart to teach and further the advancement of emergency medicine,” said Dr. Dorothy Brown, M.D., who was a resident under Dr. Karas and now serves as a doctor in Tricity’s Emergency Department.
Karas has published a number of journal articles, book chapters, and clinical policies in the field of emergency medicine throughout his career.
Karas came to Tri-city after completing his emergency medicine residency at the Los Angeles County and University of Southern California Medical Center in 1975. He served as a surgical intern in the emergency room at UC San Diego in 1971 after graduating from John’s Hopkins University School of Medicine in 1970.
“The idea of becoming a doctor goes back to fifth grade,” Karas said. He had a supportive science teacher who encouraged him to pursue various science projects, such as building a model of Manhattan out of sugar cubes, which he ended up showing on a public TV program on WQED in Pittsburgh, Pa.
“I knew I wanted to go into the sciences and I thought as a doctor I could use the sciences to take care of people,” Karas said. He was at first interested in becoming a neurosurgeon but then became interested in the emerging field of emergency medicine. “It is a highadrenaline job — the mind is constantly thinking quickly,” Karas said.
He earned a bachelor’s degree in psychology from Yale University in 1966 and headed to Vietnam in 1968 as a volunteer physician with the State Department. Karas did public health work, treated civilians and created health informational booklets to help pregnant mothers. “For a medical student, it was an incredible experience,” Karas said.
“When I started in medicine I was intrigued by the science of it, but now I realize how important it is to be an empathetic doctor. I think that is the key for medicine in the future,” said Karas, who retired in May from emergency medicine at Tri-city. “It is important to get back to the humanity of medicine.”
In his retirement, Karas is continuing medical pursuits. He works for Houston-based Veteran Evaluation Services performing medical evaluations to determine whether a veteran meets the criteria for VA benefits. “This is my new passion,” Karas said. “I try to help veterans get the benefits they deserve.”
Karas also works in telemedicine.
“We’ve got to keep in touch with patients and spend more time listening and getting to know them,” Karas said. “If we don’t listen, the patient won’t listen to us.”