February 2003
Volume 27
No. 2


Hi-tech ID wristbands boost safety, efficiency

New policy details procedure for missing patients

New Cellular Therapeutics Lab boosts SHC's bone marrow transplant capacity

Emergency Medicine faculty promotes specialty halfway around the globe

Revised policies mean cell phones, laptops can be used in some areas

Physicians can take simple steps to improve patient safety



-On a recent trip to India and Nepal to promote emergency medicine, S.V. MAHADEVAN shows physicians at a Nepali hospital how to bind a patient's pelvis to reduce bleeding from a fracture.

 

Emergency medicine faculty promotes specialty halfway around the globe

Teaching, traveling and emergency medicine are three of S.V. Mahadevan's greatest passions. So when Mahadevan, assistant professor of surgery (emergency medicine), recently had the opportunity to teach emergency medicine in India and Nepal, he jumped at the chance.

On a monthlong trip in October and November, Mahadevan served as an emergency medicine ambassador of sorts, promoting the specialty in a region where it isn't recognized, where an organized emergency medical transport system doesn't exist, and where trauma victims are brought to "casualty wards" often staffed by eager yet inexperienced physicians.

While Mahadevan went to India primarily to present at the country's first-ever emergency medicine conference, he also lectured at several Indian hospitals, observed medical practices at Indian and Nepali hospitals, and recruited candidates for Stanford's International Emergency Medicine Visiting Scholars Program, which he developed and directs. Also on the trip was Alan Gianotti, an emergency medicine staff physician at Stanford who previously volunteered at the Himalayan Reserve Association Clinic in Nepal.

The two men returned from the trip encouraged that real progress is being made. "There's a groundswell of support [for emergency medicine] in India. It's exciting to be involved in that," said Mahadevan, whose parents emigrated from India to Berkeley in the 1960s.

The three-day "International Emergency Medicine and Disaster Preparedness Conference" in Hyderabad, India, featured presentations on everything from toxicology to regional anesthesia to bioterrorism, and drew 600 attendees including public-health officials and government ministers along with physicians from throughout India.

Following Mahadevan's presentation on cervical spine injuries, he was approached by an Indian surgeon - the president of the Society for Emergency Medicine in India, it turned out - who found himself absorbed by the presentation's content. "He came up to me and said, 'I want all the doctors at my hospital to hear this,'" Mahadevan recalled. Two weeks later, Mahadevan presented the material to the medical staff at K.G. Hospital in Coimbatore.

One of Mahadevan's missions while overseas was recruiting candidates for Stanford's Emergency Medicine Visiting Scholars Program. Begun in 2000, the program brings physicians from around the world to spend three months at Stanford, where they receive didactic and hands-on training and observe how the specialty is practiced in the United States. Five physicians have completed the program - including doctors from Indonesia and Uzbekistan - and the sixth will arrive in March from Australia. Mahadevan interviewed several candidates in India and another in Nepal.

"One of our primary missions at Stanford is to educate. Through this program, we can extend our classroom to the whole world," Mahadevan said.

After interviewing the Nepali candidate at a small teaching hospital in Kathmandu, Mahadevan and Gianotti spent the rest of the day observing its emergency department operations. One of the patients they encountered was an elderly man who had been hit by a car. His treating physicians were unaware that he was suffering from a serious pelvic fracture. After assisting with the patient's resuscitation, Mahadevan bound the man's pelvis with a bedsheet to prevent further bleeding - a technique that was new to the Nepali physicians.

As the capstone of their trip, Mahadevan and Giano-tti stretched their physical capabilities to the limit: They climbed to the base of Mount Everest, ascending to 18,200 feet in just five days - an impressive feat for someone like Mahadevan, who had never climbed above 9,000 feet before and hikes only occasionally. (Gianotti is an accomplished mountaineer who has ascended several Himalayan peaks).

"I didn't feel at all sick, though it was exhausting," said Mahadevan, who saw several climbers along the way suffering from high-altitude sickness. Because he and Gianotti are longtime colleagues and friends, "the chance to see Mount Everest with Alan was an opportunity I couldn't pass up," Mahadevan said. "I've been all over the world, and this was among the most beautiful places I've been."

Soon after returning from the trip, Mahadevan received some good news: The government of Andhra Pradesh state announced plans for a Hyderabad-based pilot program called the Emergency Care Project, which would develop and coordinate emergency services among several hospitals. The program, hailed as a model for India, grew out of the emergency medicine conference. "It's gratifying to see that things are really happening and that we played a role in it," Mahadevan said.