Clinical Focus

  • Emergency Medicine

Academic Appointments

Administrative Appointments

  • President, EMS Medical Directors of California (1994 - 1994)
  • Director, Stanford/Kaiser Emergency Medicine Residency Program (2001 - 2015)

Honors & Awards

  • The Henry J. Kaiser Family Foundation Award for Excellence in Preclinical Teaching, Stanford University School of Medicine (2001)
  • Henry J. Kaiser Award for Excellence in Teaching, Stanford University School of Medicine (1994)

Boards, Advisory Committees, Professional Organizations

  • Reviewer, Western Journal of Emergency Medicine (2015 - Present)
  • Reviewer, Academic Emergency Medicine (2010 - Present)
  • Member, Council of Emergency Medicine Residency Directors (1995 - Present)
  • Member, Society for Academic Emergency Medicine (1995 - Present)
  • President, EMS Medical Directors Association of California (1994 - 1994)
  • Executive Committee, EMS Medical Directors Association of California (1992 - 1995)
  • Member, EMS Medical Directors of California (1990 - 1996)
  • Member, National Association of EMS Physicians (1990 - 1995)
  • Member, American College of Emergency Physicians (1982 - Present)

Professional Education

  • Board Certification: Emergency Medicine, American Board of Emergency Medicine (1987)
  • Residency:Christ Hospital and Medical Center (1985) IL
  • Internship:Christ Hospital and Medical Center (1983) IL
  • Medical Education:Chicago Medical School (1982) IL
  • A.B., Univ. of California, Berkeley, Biochemistry (1976)

Community and International Work

  • SEMPER, Nepal


    Disaster Relief

    Partnering Organization(s)

    International Medical Corps

    Populations Served

    Disaster victims



    Ongoing Project


    Opportunities for Student Involvement


  • Pacific Swimming Board of Directors

    Partnering Organization(s)

    USA Swimming

    Populations Served

    Youth, College, Senior Swimmers



    Ongoing Project


    Opportunities for Student Involvement


  • Bay Area Sports Organizing Committee


    Medical Support

    Partnering Organization(s)

    Senior Games

    Populations Served

    Athletes over 50



    Ongoing Project


    Opportunities for Student Involvement


Research & Scholarship

Current Research and Scholarly Interests

Medical Education, particularly the role of simulation (part-task trainers, human patient simulators and virtual reality) in the education of medical students and residents. Also, the use of the internet for distance learning in health care professions.


2015-16 Courses


All Publications

  • Training healthcare personnel for mass-casualty incidents in a virtual emergency department: VED II. Prehospital and disaster medicine Heinrichs, W. L., Youngblood, P., Harter, P., Kusumoto, L., Dev, P. 2010; 25 (5): 424-432


    Training emergency personnel on the clinical management of a mass-casualty incident (MCI) with prior chemical, biological, radioactive, nuclear, or explosives (CBRNE) -exposed patients is a component of hospital preparedness procedures.The objective of this research was to determine whether a Virtual Emergency Department (VED), designed after the Stanford University Medical Center's Emergency Department (ED) and populated with 10 virtual patient victims who suffered from a dirty bomb blast (radiological) and 10 who suffered from exposure to a nerve toxin (chemical), is an effective clinical environment for training ED physicians and nurses for such MCIs.Ten physicians with an average of four years of post-training experience, and 12 nurses with an average of 9.5 years of post-graduate experience at Stanford University Medical Center and San Mateo County Medical Center participated in this IRB-approved study. All individuals were provided electronic information about the clinical features of patients exposed to a nerve toxin or radioactive blast before the study date and an orientation to the "game" interface, including an opportunity to practice using it immediately prior to the study. An exit questionnaire was conducted using a Likert Scale test instrument.Among these 22 trainees, two-thirds of whom had prior Code Triage (multiple casualty incident) training, and one-half had prior CBRNE training, about two-thirds felt immersed in the virtual world much or all of the time. Prior to the training, only four trainees (18%) were confident about managing CBRNE MCIs. After the training, 19 (86%) felt either "confident" or "very confident", with 13 (59%) attributing this change to practicing in the virtual ED. Twenty-one (95%) of the trainees reported that the scenarios were useful for improving healthcare team skills training, the primary objective for creating them. Eighteen trainees (82%) believed that the cases also were instructive in learning about clinical skills management of such incidents.These data suggest that training healthcare teams in online, virtual environments with dynamic virtual patients is an effective method of training for management of MCIs, particularly for uncommonly occurring incidents.

    View details for PubMedID 21053190

  • Design, Development, and Evaluation of an Online Virtual Emergency Department for Training Trauma Teams SIMULATION IN HEALTHCARE Youngblood, P., Harter, P. M., Srivastava, S., Moffett, S., Heinrichs, W. L., Dev, P. 2008; 3 (3): 146-153


    Training interdisciplinary trauma teams to work effectively together using simulation technology has led to a reduction in medical errors in emergency department, operating room, and delivery room contexts. High-fidelity patient simulators (PSs)-the predominant method for training healthcare teams-are expensive to develop and implement and require that trainees be present in the same place at the same time. In contrast, online computer-based simulators are more cost effective and allow simultaneous participation by students in different locations and time zones. In this pilot study, the researchers created an online virtual emergency department (Virtual ED) for team training in crisis management, and compared the effectiveness of the Virtual ED with the PS. We hypothesized that there would be no difference in learning outcomes for graduating medical students trained with each method.In this pilot study, we used a pretest-posttest control group, experimental design in which 30 subjects were randomly assigned to either the Virtual ED or the PS system. In the Virtual ED each subject logged into the online environment and took the role of a team member. Four-person teams worked together in the Virtual ED, communicating in real time with live voice over Internet protocol, to manage computer-controlled patients who exhibited signs and symptoms of physical trauma. Each subject had the opportunity to be the team leader. The subjects' leadership behavior as demonstrated in both a pretest case and a posttest case was assessed by 3 raters, using a behaviorally anchored scale. In the PS environment, 4-person teams followed the same research protocol, using the same clinical scenarios in a Simulation Center. Guided by the Emergency Medicine Crisis Resource Management curriculum, both the Virtual ED and the PS groups applied the basic principles of team leadership and trauma management (Advanced Trauma Life Support) to manage 6 trauma cases-a pretest case, 4 training cases, and a posttest case. The subjects in each group were assessed individually with the same simulation method that they used for the training cases.Subjects who used either the Virtual ED or the PS showed significant improvement in performance between pretest and posttest cases (P < 0.05). In addition, there was no significant difference in subjects' performance between the 2 types of simulation, suggesting that the online Virtual ED may be as effective for learning team skills as the PS, the method widely used in Simulation Centers. Data on usability and attitudes toward both simulation methods as learning tools were equally positive.This study shows the potential value of using virtual learning environments for developing medical students' and resident physicians' team leadership and crisis management skills.

    View details for DOI 10.1097/SIH.0b013e31817bedf7

    View details for Web of Science ID 000207536200004

    View details for PubMedID 19088658

  • Simulation for team training and assessment: Case studies of online training with virtual worlds WORLD JOURNAL OF SURGERY Heinrichs, W. L., Youngblood, P., Harter, P. M., Dev, P. 2008; 32 (2): 161-170


    Individuals in clinical training programs concerned with critical medical care must learn to manage clinical cases effectively as a member of a team. However, practice on live patients is often unpredictable and frequently repetitive. The widely substituted alternative for real patients-high-fidelity, manikin-based simulators (human patient simulator)-are expensive and require trainees to be in the same place at the same time, whereas online computer-based simulations, or virtual worlds, allow simultaneous participation from different locations. Here we present three virtual world studies for team training and assessment in acute-care medicine: (1) training emergency department (ED) teams to manage individual trauma cases; (2) prehospital and in-hospital disaster preparedness training; (3) training ED and hospital staff to manage mass casualties after chemical, biological, radiological, nuclear, or explosive incidents. The research team created realistic virtual victims of trauma (6 cases), nerve toxin exposure (10 cases), and blast trauma (10 cases); the latter two groups were supported by rules-based, pathophysiologic models of asphyxia and hypovolemia. Evaluation of these virtual world simulation exercises shows that trainees find them to be adequately realistic to "suspend disbelief," and they quickly learn to use Internet voice communication and user interface to navigate their online character/avatar to work effectively in a critical care team. Our findings demonstrate that these virtual ED environments fulfill their promise of providing repeated practice opportunities in dispersed locations with uncommon, life-threatening trauma cases in a safe, reproducible, flexible setting.

    View details for DOI 10.1007/s00268-007-9354-2

    View details for Web of Science ID 000252477100005

    View details for PubMedID 18188640

  • Assessment of resident professionalism using high-fidelity simulation of ethical dilemmas ACADEMIC EMERGENCY MEDICINE Gisondi, M. A., Smith-Coggins, R., Harter, P. M., Soltysik, R. C., Yarnold, P. R. 2004; 11 (9): 931-937


    To examine the responses of emergency medicine residents (EMRs) to ethical dilemmas in high-fidelity patient simulations as a means of assessing resident professionalism.This cross-sectional observational study included all EMRs at a three-year training program. Subjects were excluded if they were unable or unwilling to participate. Each resident subject participated in a simulated critical patient encounter during an Emergency Medicine Crisis Resource Management course. An ethical dilemma was introduced before the end of each simulated encounter. Resident responses to that dilemma were compared with a professional performance checklist evaluation. Multi-response permutation procedure analysis was used to compare performance measures between resident classes, with the a priori hypothesis that mean performance should increase as experience increases.Of the 30 potential subjects, 90% (27) participated. The remaining three residents were unavailable due to scheduling conflicts. It was observed that senior residents (second and third year) performed more checklist items than did first-year residents (p < 0.028 for each senior class). Omnibus comparison of mean critical actions completed across all three years was not statistically significant (p < 0.13). Residents performed a critical action with 100% uniformity across training years in only one ethical scenario ("Practicing Procedures on the Recently Dead"). Residents performed the fewest critical actions and overall checklist items for the "Patient Confidentiality" case.Senior residents had better overall performance than incoming interns, suggesting that professional behaviors are learned through some facet of residency training. Although limited by small sample size, the application of this performance-assessment tool showed the ability to discriminate between experienced and inexperienced EMRs with respect to a variety of aspects of professional competency. These findings suggest a need for improved resident education in areas of professionalism and ethics.

    View details for DOI 10.1197/j.aem.2004.04.005

    View details for Web of Science ID 000223732700005

    View details for PubMedID 15347542

  • Emergency medicine crisis resource management (EMCRM): Pilot study of a simulation-based crisis management course for emergency medicine ACADEMIC EMERGENCY MEDICINE Reznek, M., Smith-Coggins, R., Howard, S., Kiran, K., Harter, P., Sowb, Y., Gaba, D., Krummel, T. 2003; 10 (4): 386-389


    To determine participant perceptions of Emergency Medicine Crisis Resource Management (EMCRM), a simulation-based crisis management course for emergency medicine.EMCRM was created using Anesthesia Crisis Resource Management (ACRM) as a template. Thirteen residents participated in one of three pilot courses of EMCRM; following a didactic session on principles of human error and crisis management, the residents participated in simulated emergency department crisis scenarios and instructor-facilitated debriefing. The crisis simulations involved a computer-enhanced mannequin simulator and standardized patients. After finishing the course, study subjects completed a horizontal numerical scale survey (1 = worst rating to 5 = best rating) of their perceptions of EMCRM. Descriptive statistics were calculated to evaluate the data.The study subjects found EMCRM to be enjoyable (4.9 +/- 0.3) (mean +/- SD) and reported that the knowledge gained from the course would be helpful in their practices (4.5 +/- 0.6). The subjects believed that the simulation environment prompted realistic responses (4.6 +/- 0.8) and that the scenarios were highly believable (4.8 +/- 0.4). The participants reported that EMCRM was best suited for residents (4.9 +/- 0.3) but could also benefit students and attending physicians. The subjects believed that the course should be repeated every 8.2 +/- 3.3 months.The EMCRM participants rated the course very favorably and believed that the knowledge gained would be beneficial in their practices. The extremely positive response to EMCRM found in this pilot study suggests that this training modality may be valuable in training emergency medicine residents.

    View details for Web of Science ID 000181995500016

    View details for PubMedID 12670855

  • Teaching procedural skills to medical students: one institution's experience with an emergency procedures course. Annals of emergency medicine van der Vlugt, T. M., Harter, P. M. 2002; 40 (1): 41-49


    We examine the effect of a preclinical emergency procedures course on students' clinical procedural skills and medical knowledge.This is a retrospective review of evaluation forms for a cohort of 86 students graduating from medical school at an academic center. A cross section of students (n=57) taking a clinical emergency medicine rotation over a 4-year period was also studied. Numeric scores (1 to 9 on a Likert scale) in procedural skills and medical knowledge categories were extracted from evaluations for internal medicine, surgery, obstetrics and gynecology, and emergency medicine rotations. Scores of students who had taken an elective course, Essential Procedures in Emergency Medicine (EPEM), were compared with scores of students who did not take this course. US Medical Licensing Examination Step I scores for both groups were also compared.Students who took EPEM scored significantly higher in the procedural skills category during the emergency medicine rotation (P =.04) and during both months of the internal medicine rotation (P =.02; P =.02). Students scored on average higher in the surgery and obstetrics and gynecology rotations, but these differences were not statistically significant. Students who took EPEM scored significantly higher in the medical knowledge category for emergency medicine (P =.01; P =.002), both months of internal medicine (P =.03; P =.006), and 1 of 2 months of surgery (P =.01) rotations. Students in obstetrics and gynecology rotations scored higher, although not significantly. US Medical Licensing Examination Step I scores were not different between students taking or not taking EPEM.Students taking EPEM achieved higher procedural skill and medical knowledge scores in clinical rotations. Emergency medicine is a specialty well suited to study procedures teaching and performance.

    View details for PubMedID 12085072

  • Teaching procedural skills to medical students: One institution's experience with an emergency procedures course van der Vlugt, T. M., Harter, P. M. MOSBY-ELSEVIER. 2002: 43-51
  • Virtual reality and simulation: Training the future emergency physician ACADEMIC EMERGENCY MEDICINE Reznek, M., Harter, P., Krummel, T. 2002; 9 (1): 78-87


    The traditional system of clinical education in emergency medicine relies on practicing diagnostic, therapeutic, and procedural skills on live patients. The ethical, financial, and practical weaknesses of this system are well recognized, but the alternatives that have been explored to date have shown even greater flaws. However, ongoing progress in the area of virtual reality and computer-enhanced simulation is now providing educational applications that show tremendous promise in overcoming most of the deficiencies associated with live-patient training. It will be important for academic emergency physicians to become more involved with this technology to ensure that our educational system benefits optimally.

    View details for Web of Science ID 000173033300013

    View details for PubMedID 11772675

  • Famotidine in the treatment of acute urticaria Watson, N. T., Weiss, E. L., Harter, P. M. BLACKWELL PUBLISHING. 2000: 186-189


    Recent studies suggest that histamine H2-receptor antagonists may be useful in the treatment of urticaria. This study was conducted to determine whether famotidine, a H2 antagonist, is effective in the treatment of acute urticaria and compare its effect with that of the H1 antagonist diphenhydramine. In this prospective, double-blind, controlled trial, 25 patients with urticaria of less than 72 h duration were randomized to receive a single dose of either famotidine 20 mg i.m. or diphenhydramine 50 mg i.m. Prior to treatment and 30 min after treatment, patients rated pruritus and sedation using visual analogue scales, while physicians evaluated intensity of urticaria and percentage of body surface area involved by urticaria. Famotidine was found to reduce pruritus associated with acute urticaria, intensity of urticaria, and body surface area affected by urticaria without causing sedation. Famotidine was comparable to diphenhydramine in efficacy; however, there was a (nonsignificant) trend for diphenhydramine to be more effective than famotidine in the treatment of pruritus, and for famotidine to be more effective in the reduction of surface area of involvement. It is concluded that famotidine merits further investigation as a potential medication for treatment of urticaria.

    View details for Web of Science ID 000087227800004

    View details for PubMedID 10844490



    The purpose of this study was to determine the value of reformatted noncontrast helical CT in patients with suspected renal colic. We hoped to determine whether this technique might create images acceptable to both radiologists and clinicians and replace our current protocol of sonography and abdominal plain film.Thirty-four consecutive patients with signs and symptoms of renal colic were imaged with both noncontrast helical CT and a combination of plain film of the abdomen and renal sonography. Reformatting of the helical CT data was performed on a workstation to create a variety of reformatted displays. The correlative studies were interpreted by separate blinded observers. Clinical data, including the presence of hematuria and the documentation of stone passage or removal, were recorded.Findings on 18 CT examinations were interpreted as positive for the presence of ureteral calculi; 16 of these cases were determined to be true positives on the basis of later-documented passage of a calculus. Thirteen of the 16 cases proved to be positive were interpreted as positive for renal calculi using the combination of abdominal plain film and renal sonography. The most useful CT reformatting technique was curved planar reformatting of the ureters to determine whether a ureteral calculus was present.In this study, noncontrast helical CT was a rapid and accurate method for determining the presence of ureteral calculi causing renal colic. The reformatted views produced images similar in appearance to excretory urograms, aiding greatly in communicating with clinicians. Limitations on the technique include the time and equipment necessary for reformatting and the suboptimal quality of reformatted images when little retroperitoneal fat is present.

    View details for Web of Science ID A1995RQ00600003

    View details for PubMedID 7645461



    The i.v. administration of calcium before or shortly after treatment of supraventricular tachycardia with verapamil has been suggested to counteract a hypotensive response to verapamil. We discuss the case of a patient who presented to the emergency department with an accelerated wide-complex tachycardia and minimal symptoms. Immediately after i.v. administration, of 1 g calcium chloride as pretreatment for verapamil administration, ventricular fibrillation developed. Emergency physicians should be aware of potential dangers after the administration of i.v. calcium preparations when trying to prevent known hypotensive side effects of i.v. verapamil administration.

    View details for Web of Science ID A1995QK32100020

    View details for PubMedID 7864486

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