• Beginnings of the Division

    Pediatric Critical Care as a formal specialty at Children’s of Alabama and within the UAB Department of Pediatrics, began with the recruitment of Dr. Samuel Tilden as the first division director of Pediatric Critical Care in 1987. Dr. Tilden, a Louisiana native, graduated from Tulane University School of Medicine in 1977. He completed his pediatric residency at the Louisiana State University School of Medicine followed by a fellowship in pediatric pulmonology. He was recruited to the Department of Pediatrics from St. Joseph’s Hospital in Phoenix, Arizona, where he was director of the Pediatric Intensive Care Unit (PICU). The initial Pediatric Intensive Care Unit at Children’s of Alabama, developed and staffed under his direction, was an eight bed unit. It was expanded in the early 1990’s into a dedicated space consisting of 16 beds (12 ward type beds and four isolation rooms). Dr. Tilden recruited additional faculty with the hiring of Dr. Scott Curtis, who had completed training at the University of Pittsburgh in pediatric pulmonary and critical care, as well as Dr. James Royall, who had completed his pulmonary fellowship at UAB and elected to remain here.

    With the beginnings of a critical mass of personnel established, Dr. Tilden began expanding the role of the division within the department. Fellowship training was established and the first fellows in pediatric critical care began their postgraduate training in 1990. In this early group of trainees was Dr. Steven Baldwin, who remains a member of the Department of Pediatric within the Division of Pediatric Emergency Medicine. The importance of fellowship training within the division has remained a point of emphasis since its early inception. The fellowship program to date has trained over 40 individuals who have gone on to establish successful private practice and academic careers at multiple institutions across the United States, Canada, Chile and Saudi Arabia. The quality of the division’s trainees is demonstrated by more than a quarter of them being recipients of the prestigious Dixon Fellowship grant, established in 1988 to support outstanding fellows for a career in academic medicine.

    Additional faculty were recruited including Dr. Imad Haddad in 1993, Dr. Mark Buckmaster in 1995, who was trained in both pediatric anesthesia and critical care at the University of Minnesota, and Dr. Neil Kooy, who completed his fellowship at UAB in 1994 and returned in 1997. With these additional faculty members, Dr. Tilden continued to expand the scope of the division with coverage to include involvement with pediatric cardiac intensive care at University Hospital. This early consultative involvement provided the groundwork which later led to the establishment of a Pediatric Cardiac Intensive Care Unit at University Hospital and significant advancement of critical care services for infants and children with a wide variety of congenital heart disease.

    In recognition that the provision of critical care services was important regardless of the location of the patient and the sooner such resources could be mobilized for the patient, pediatric critical care transport services were created to provide high quality, rapid medical care to critically ill pediatric patients regardless of where in the state or neighboring states the patient originated. Initially a ground and fixed wing based service, rotor craft were later added in partnership with University Hospital and later as part of a dedicated Children’s of Alabama’s fleet.

  • New Leadership

    In 1999, Dr. Tilden stepped down as division director of Pediatric Critical Care and Dr. Margaret Winkler, a former fellow from 1994-1997, assumed the position. Dr. Winkler, who returned to the department after a three-year tenure at the University of Kentucky, was directly responsible for one of the fastest periods of expansion in the history of the division. With aggressive recruitment from within the fellow ranks, as well as outside the department, she expanded faculty numbers by almost threefold during her period as division director and director of the Pediatric Intensive Care Unit. She also oversaw the expansion of the Pediatric Intensive Care Unit from its long standing 16 beds to a new 24 bed unit to meet ongoing clinical demands. She became the first recipient of the Ann Dial McMillan Endowed Chair in Pediatric Critical Care.

    Dr. Winkler’s faculty recruits were highly successful in implementing a major expansion of the scope of the division’s services in a wide variety of clinical arenas:

    Nancy Tofil, a former fellow, led the development of the Pediatric Simulation Center for simulation training and education and became associate director of the Pediatric Residency Program. The Simulation Center has subsequently been recognized internally, as well as nationally, for the outstanding quality of its educational experience.

    Jeffrey Alten, recruited after completing his critical care fellowship at Texas Children’s in Houston in 2005, led the expansion and development of pediatric cardiac intensive care at University Hospital and later within the new Benjamin Russell Hospital for Children campus, where a separate 20 bed Cardiac Critical Care unit and 10 bed monitored unit provides comprehensive care to children of all ages with simple and complex congenital heart disease. The unit is now a component of the Division of Pediatric Cardiology and oversees care to approximately 600 open heart cases per year. It is under the direction of Santiago Borasino, also recruited to the department by Dr. Winkler from Children’s Hospital of Philadelphia, after finishing a pediatric residency at UAB.

    Tasked with the development of a procedural sedation service outside the operating room, the Simon Sedation service was created in 2003 under the medical direction of Mark Buckmaster. The service provides clinical services for approximately 1,200-1,600 cases per year to children requiring sedation for a wide variety of therapeutic and diagnostic services.

    With the ongoing need and interest in pediatric critical care subspecialty training, Priya Prabhakaran was appointed director of the Pediatric Critical Care Fellowship Program. Under her guidance, the fellowship program has increased to six fellows. Interest in training at UAB has remained high, reflective of the quality of clinical material available and the dedication of faculty to the commitment of fellowship training remaining an educational experience that meets any goals incoming fellows may have.

    The increasing supervisory insight mandated by more public and governmental regulatory agencies, led to Leslie Hayes, a former fellow who was recruited to the faculty, assuming the lead role in hospital quality improvement and patient safety initiatives as the first medical safety office for Children’s of Alabama. Dr. Hayes later became integral in the establishment of formal academic training programs in quality improvement and patient safety for UAB Health System and is currently the associate quality education officer for UAB Medicine.

    Research remains an essential component of academic medicine and Michele Kong, recruited by Dr. Winkler after completion of her fellowship at UAB, has been pivotal in cementing research into the divisional foundation. Dr. Kong’s work in protease dysregulation in acute lung injury and the role of RSV induced respiratory failure in children has been recognized both internally and nationally and has led to multiple grant awards as a result. Dr. Kong, has also been responsible for establishment of KultureCity, a private foundation which provides financial, educational, and emotional support for families with children diagnosed with Autism Spectrum disorder.

    William Sasser organizes the educational activities of the division as it relates to the School of Medicine and is highly involved with the organization of family centered services within the PICU.

    Chrystal Rutledge has assumed the role of director of pediatric critical care transport, which in conjunction with her efforts in pediatric simulation has led to the fusion of these interests into programs providing outreach to community hospitals to improve early care for children presenting with critical illness. She along with Kristen Waddell, CRNP and Stacy Gaither, RN, has developed COACHES (Children’s of Alabama Community Healthcare Education Simulation Program) which uses simulated pediatric emergencies to train staff in emergency departments and inpatient areas in hospitals throughout the state.

  • Growth of the Department

    This rapid expansion of the division culminated with the completion of the Benjamin Russell Hospital for Children in 2012 and the opening of a new state of the art Pediatric Critical Care Unit consisting of 24 expansive private rooms. These new rooms offer comfortable and private surroundings for the families of critically ill children.  In 2017, Dr. Winkler stepped down as division director and was followed by Dr. Nancy Tofil.  Dr. Tofil has continued growing of the role of the division within the department, as well as integrating the operation of critical care services more seamlessly into the overall operation of the hospital. She has continued to add to the roster of the division with ongoing recruitment of faculty, such as:

    Robert Richter, a former fellow, leads the development of integrated ECMO services with the Pediatric Cardiac Critical Care Unit and surgical services. He also engages in translational research evaluating the vascular endothelium in sepsis. In his first year, he obtained funding from the Kaul Pediatric Research Institute for his research.

    Madhura Hallman, who completed her pediatric residency at UAB and her subsequent pediatric critical care fellowship at LeBonheur Children’s Hospital at the University of Tennessee in Memphis. Dr. Hallman is leading a multidisciplinary effort to develop a decision support process regarding tracheostomy and long-term ventilation in children. She is also part of a team interested in developing a medical legal partnership aimed at addressing barriers to care for the most vulnerable children in Alabama.

    The Division of Pediatric Critical Care continues to evolve and ongoing recruitment is underway to meet the increasing needs for children with serious acute and chronic medical care. 

  • Division Leadership

    Division Leadership

    Division Directors

    Sam Tilden- 1987-1999

    Margaret Winkler- 1999-2017

    Nancy Tofil- 2017 to present