Bio

Bio


Dr. Matthew Strehlow is an Associate Professor of Emergency Medicine. He received his doctorate from the University of Washington and completed his emergency medicine residency in the Stanford Kaiser Emergency Medicine Residency Program. Following completion of the Global EM Fellowship at Stanford, he stayed on as faculty with a focus on global health. Currently, Dr. Strehlow serves as Vice Chair of the Department of Emergency Medicine along with his roles as Director of Stanford Emergency Medicine International (SEMI) and as Director SEMI's International EM Fellowship. As a Fellow at the Center for Innovation in Global Health and as an advisor to Stanford's Digital Medic initiative, he works across the campus to help advance the University's mission of improving health and education worldwide. Dr. Strehlow is a recognized educator both nationally and internationally focusing on emergency care in developing countries, cardiology, and critical care. His research focuses on the epidemiology of emergencies in developing countries, emergency referral systems, and the intersection of emergency care systems and gender based violence.

Clinical Focus


  • Emergency Medicine

Academic Appointments


Administrative Appointments


  • Vice Chair, Emergency Medicine (2016 - Present)
  • Director, Stanford Emergency Medicine International Fellowship (2015 - Present)
  • Director,, Stanford Emergency Medicine International (2015 - Present)
  • Fellow, Centers for Innovation in Global Health (2015 - Present)

Honors & Awards


  • Special Contributions to Emergency Medicine, King Saud University (2014)
  • Fellow, American College of Emergency Physicians (2011)
  • Lantern Award for exceptional and innovative performance by ED staff, National Emergency Nurses Association (2011)
  • Team Award International for development of of 1st prehospital EMS service Nepal, California Emergency Medical Services (2011)
  • Fellow, Stanford University Faculty Fellows Program (2010)
  • Malinda S. Mitchell Award for Service Quality, Stanford Hospital (2009)
  • Annual Resident Bedside Teaching Award, Stanford-Kaiser Emergency Medicine Residency (2007)
  • Annual Resident Bedside Teaching Award, Stanford-Kaiser Emergency Medicine Residency (2006)
  • Rising Star: Speaker Award, American College of Emergency Physicians (2006)
  • Outstanding Contributions in International Medical Education, Egyptian Ministry of Health (2005)

Boards, Advisory Committees, Professional Organizations


  • Board Member, Global Emergency Medicine Academy, SAEM (2018 - Present)
  • Member, American College of Emergency Physicians Education Committee (2016 - Present)
  • Fellow, American College of Emergency Physicians (2010 - Present)
  • Fellow, American Academy of Emergency Medicine (2005 - Present)
  • Member, Society of Academic Emergency Medicine (2005 - Present)

Professional Education


  • Fellow, Stanford Emergency Medicine, Global Emergency Medicine (2006)
  • Internship: Stanford University Medical Center (2003) CA
  • Residency: Stanford University Medical Center (2005) CA
  • Board Certification: Emergency Medicine, American Board of Emergency Medicine (2006)
  • Medical Education: University of Washington School of Medicine (2002) WA
  • MD, University of Washington, Medicine (2002)
  • Bachelor of Science, Pacific Lutheran University, Biochemistry (1996)

Community and International Work


  • Online Medical Research, India

    Topic

    EMS Research in India

    Partnering Organization(s)

    GVK Emergency Management and Research Institute

    Populations Served

    India

    Location

    International

    Ongoing Project

    No

    Opportunities for Student Involvement

    Yes

  • Pre-Service Education in Emergency Medicine, Cambodia

    Topic

    Designing curriculum and training faculty in EM

    Partnering Organization(s)

    University Health Sciences

    Populations Served

    Students and Faculty

    Location

    International

    Ongoing Project

    No

    Opportunities for Student Involvement

    Yes

  • Myanmar Emergency Medicine Training Program, Myanmar

    Topic

    Emergency Care

    Partnering Organization(s)

    Golden Zaneka

    Populations Served

    Physicians

    Location

    International

    Ongoing Project

    Yes

    Opportunities for Student Involvement

    No

  • Quality Health Services, Cambodia

    Topic

    Maternal Child Health

    Partnering Organization(s)

    URC USAID

    Populations Served

    Cambodia

    Location

    International

    Ongoing Project

    Yes

    Opportunities for Student Involvement

    No

  • Post-Graduate Program in Emergency Care, India

    Topic

    EMS System Development

    Partnering Organization(s)

    EMRI

    Location

    International

    Ongoing Project

    Yes

    Opportunities for Student Involvement

    Yes

Research & Scholarship

Current Research and Scholarly Interests


My research interests center around the development and delivery of emergency care in Low- and Middle-Income-Countries (LMICs), specifically the epidemiology of emergencies and referral systems in these nations. For example, up to 40% of ambulance runs in India are for obstetric emergencies. By improving our understanding of how medical and traumatic emergencies vary in these unique and diverse settings as compared to High-Income-Countries, nations and development agencies will be better equipped to advocate for emergency care and optimize the allocation of scarce healthcare resources. The foundation of my research efforts has been as part of Stanford Emergency Medicine International’s (SEMI’s) work developing, launching, and researching India’s prehospital care system from the ground up. In 2007, our Indian partner, GVK EMRI, introduced EMS service in a single city. A decade later, this service is now the largest provider of prehospital and interfacility emergency care in the world, serving over 750 million people. Our pivotal role in this expansive venture has been many-fold: 1.) development of their educational programs and operational care manuals, 2.) training of care providers and faculty on best practices, and 3.) cultivation and guidance of their research program. We have built a team of research assistants across seven states in India that conduct prospective epidemiology and quality assurance research on prehospital care in India. Much of this prospective work is just now coming to fruition with studies on cardiovascular, vehicular and non-vehicular trauma, burns, pediatric respiratory illness, seizures, stroke, and maternal care being in various stages of data analysis and manuscript development. We also are parsing through retrospective data from this system, concluding an analysis of over 1 million pediatric prehospital emergency transports.

My experiences strengthening referral systems in a variety of countries across the globe has afforded me the opportunity to work on a Lancet-commissioned paper assessing gaps in maternal care. We found that emergency referral systems are underdeveloped and understudied. In the past two years, our group has launched a number of efforts looking at the referral systems for obstetric and neonatal patients throughout India. Additionally, we are working with the Stanford Geospatial Center to analyze our pediatric data set for referral patterns and to calculate the rates of bypassing, the common practice of selectively moving past a facility with the appropriate care designation to arrive at a facility that lies a further distance away. Similar work in Southeast Asia has resulted in a recently completed analysis of referral system interventions in Cambodia; this work has been preliminarily accepted and is in the revisions stage.

Due to limited resources and infrastructure, investments in emergency care systems are being leveraged in unique ways in LMICs. States in India have launched 911-like systems for women in distress using the currently existing emergency call center platforms. Our prior work published in the Bulletin of the WHO analyzing the impact of these women’s emergency helplines in the State of Gujarat, helped support the expansion of this program nationwide. As part of our ongoing efforts, the past two summers SEMI has sent research teams to two states in India to conduct in-depth interviews with women utilizing the service as a means to better understand the outcomes and risks to callers.

Moving forward I aim to further advance our understanding of formal and informal emergency referral systems in LMICs and to better understand how emergency care resources can be leveraged to combat gender-based violence in South Asia.

Clinical Trials


  • Protocolized Care for Early Septic Shock Not Recruiting

    The ProCESS study is large, 5-year, multicenter study of alternative resuscitation strategies for septic shock. The study hypothesizes that there are "golden hours" in the initial management of septic shock where prompt, rigorous, standardized care can improve clinical outcomes.

    Stanford is currently not accepting patients for this trial. For more information, please contact Valerie Ojha, (650) 498 - 6210.

    View full details

  • Reevaluation Of Systemic Early Neuromuscular Blockade Not Recruiting

    This study evaluates whether giving a neuromuscular blocker (skeletal muscle relaxant) to a patient with acute respiratory distress syndrome will improve survival. Half of the patients will receive a neuromuscular blocker for two days and in the other half the use of neuromuscular blockers will be discouraged.

    Stanford is currently not accepting patients for this trial.

    View full details

Projects


  • GVK EMRI Prehospital Emergency Care

    Location

    India

  • Myanmar Post Graduate Education Program in Emergency Medicine, Stanford University (9/1/2015 - Present)

    Location

    Myanmar

  • USAID Quality Health Services Cambodia, Stanford University (2/17/2014 - Present)

    Location

    cambodia

Publications

All Publications


  • Acute respiratory illness among a prospective cohort of pediatric patients using emergency medical services in India: Demographic and prehospital clinical predictors of mortality. PloS one Bills, C. B., Newberry, J. A., Rao, G. V., Matheson, L. W., Rao, S., Mahadevan, S. V., Strehlow, M. C. 2020; 15 (4): e0230911

    Abstract

    In India, acute respiratory illnesses, including pneumonia, are the leading cause of early childhood death. Emergency medical services are a critical component of India's public health infrastructure; however, literature on the prehospital care of pediatric patients in low- and middle-income countries is minimal. The aim of this study is to describe the demographic and clinical characteristics associated with 30-day mortality among a cohort of pediatric patients transported via ambulance in India with an acute respiratory complaint.Pediatric patients less than 18 years of age using ambulance services in one of seven states in India, with a chief complaint of "shortness of breath", or a "fever" with associated "difficulty breathing" or "cough", were enrolled prospectively. Patients were excluded if evidence of choking, trauma or fire-related injury, patient was absent on ambulance arrival, or refused transport. Primary exposures included demographic, environmental, and clinical indicators, including hypoxemia and respiratory distress. The primary outcome was 7 and 30-day mortality. Multivariable logistic regression, stratified by transport type, was constructed to estimate associations between demographic and clinical predictors of mortality.A total of 1443 patients were enrolled during the study period: 981 (68.5%) were transported from the field, and 452 (31.5%) were interfacility transports. Thirty-day response was 83.4% (N = 1222). The median age of all patients was 2 years (IQR: 0.17-10); 93.9% (N = 1347) of patients lived on family incomes below the poverty level; and 54.1% (N = 706) were male. Cumulative mortality at 2, 7, and 30-days was 5.2%, 7.1%, and 7.7%, respectively; with 94 deaths by 30 days. Thirty-day mortality was greatest among those 0-28 days (N = 38,17%); under-5 mortality was 9.8%. In multivariable modeling prehospital oxygen saturation <95% (OR: 3.18 CI: 1.77-5.71) and respiratory distress (OR: 3.72 CI: 2.17-6.36) were the strongest predictors of mortality at 30 days.This is the first study to detail prehospital predictors of death among pediatric patients with shortness of breath in LMICs. The risk of death is particularly high among neonates and those with documented mild hypoxemia, or respiratory distress. Early recognition of critically ill children, targeted prehospital interventions, and diversion to higher level of care may help to mitigate the mortality burden in this population.

    View details for DOI 10.1371/journal.pone.0230911

    View details for PubMedID 32240227

  • First look at emergency medical technician wellness in India: Application of the Maslach Burnout Inventory in an unstudied population. PloS one Koval, K. W., Lindquist, B., Gennosa, C., Mahadevan, A., Niknam, K., Patil, S., Rao, G. V., Strehlow, M. C., Newberry, J. A. 2020; 15 (3): e0229954

    Abstract

    Professional wellness is critical to developing and maintaining a health care workforce. Previous work has identified burnout as a significant challenge to professional wellness facing emergency medical technicians (EMTs) in many countries worldwide. Our study fills a critical gap by assessing the prevalence of burnout among emergency medical technicians (EMTs) in India.This was a cross-sectional survey of EMTs within the largest prehospital care organization in India. We used the Maslach Burnout Inventory (MBI) to measure wellness. All EMTs presenting for continuing medical education between July-November 2017 from the states of Gujarat, Karnataka, and Telangana were eligible. Trained, independent staff administered anonymous MBI-Medical Personnel Surveys in local languages.Of the 327 EMTs eligible, 314 (96%) consented to participate, and 296 (94%) surveys were scorable. The prevalence of burnout was 28.7%. Compared to EMTs in other countries, Indian EMTs had higher levels of personal accomplishment but also higher levels of emotional exhaustion and moderate levels of depersonalization. In multivariate regression, determinants of burnout included younger age, perceived lack of respect from colleagues and administrators, and a sense of physical risk. EMTs who experienced burnout were four times as likely to plan to quit their jobs within one year.This is the first assessment of burnout in EMTs in India and adds to the limited body of literature among low- and middle-income country (LMIC) prehospital providers worldwide. Burnout was strongly associated with an EMT's intention to quit within a year, with potential implications for employee turnover and healthcare workforce shortages. Burnout should be a key focus of further study and possible intervention to achieve internationally recognized targets, including Sustainable Development Goal 3C and WHO's 2030 Milestone for Human Resources.

    View details for DOI 10.1371/journal.pone.0229954

    View details for PubMedID 32155192

  • Defining high-risk emergency chief complaints: data-driven triage for low- and middle-income countries. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine Rice, B., Leanza, J., Mowafi, H., Thadeus Kamara, N., Mulogo, E. M., Bisanzo, M., Nikam, K., Kizza, H., Newberry, J. A., Strehlow, M., Kohn, M. 2020

    Abstract

    Emergency medicine in low- and middle-income countries (LMICs) is hindered by lack of research into patient outcomes. Chief complaints are fundamental to emergency care but have only recently been uniquely codified for an LMIC setting in Uganda. It is not known whether chief complaints independently predict emergency unit patient outcomes.Patient data collected in a Ugandan emergency unit between 2009-2018 were randomized into validation and derivation datasets. A recursive partitioning algorithm stratified chief complaints by three-day mortality risk in each group. The process was repeated in 10,000 bootstrap samples to create an averaged risk ranking. Based on this ranking, chief complaints were categorized as "high-risk" (>2x baseline mortality), "medium-risk" (between 2 and 0.5x baseline mortality) and "low-risk" (<0.5x baseline mortality). Risk categories were then included in a logistic regression model to determine if chief complaints independently predicted three-day mortality.Overall, the derivation dataset included 21,953 individuals with 7,313 in the validation dataset. In total, 43 complaints were categorized, and 12 chief complaints were identified as high-risk. When controlled for triage data including age, sex, HIV status, vital signs, level of consciousness, and number of complaints, high-risk chief complaints significantly increased three-day mortality odds (OR 2.39, 95% CI 1.95 - 2.93, p<0.001) while low-risk chief complaints significantly decreased three-day mortality odds (OR 0.16, 95% CI 0.09 - 0.29, p<0.001).High-risk chief complaints were identified and found to predict increased three-day mortality independent of vital signs and other data available at triage. This list can be used to expand local triage systems and inform emergency training programs. The methodology can be reproduced in other LMIC settings to reflect their local disease patterns.

    View details for DOI 10.1111/acem.14013

    View details for PubMedID 32416022

  • Workplace violence among prehospital care providers in India: a cross-sectional study. BMJ open Lindquist, B., Koval, K., Mahadevan, A., Gennosa, C., Leggio, W., Niknam, K., Rao, G. V., Newberry, J. A., Strehlow, M. 2019; 9 (11): e033404

    Abstract

    OBJECTIVES: The purpose of this study was twofold: (1) establish the prevalence of safety threats and workplace violence (WPV) experienced by emergency medical technicians (EMTs) in a low/middle-income country with a new prehospital care system, India and (2) understand which EMTs are at particularly high risk for these experiences.SETTING: EMTs from four Indian states (Gujarat, Karnataka, Tamil Nadu and Telangana) were eligible to participate during the study period from July through November 2017.METHODS: Cross-sectional survey study.PARTICIPANTS: 386 practicing EMTs from four Indian states.RESULTS: The overall prevalence of any WPV was 67.9% (95%CI 63.0% to 72.5%). The prevalence of physical assault was 58% (95% CI 52.5% to 63.4%) and verbal assault was 59.8% (95% CI 54.5% to 65%). Of physical assault victims, 21.7% were injured and 30.2% sought medical attention after the incident. Further, 57.3% (n=216) of respondents reported they were 'somewhat worried' and 28.4% (n=107) reported they were 'very worried' about their safety at work.CONCLUSION: WPV and safety fears were found to be common among EMTs in India. Focused initiatives to counter WPV in countries developing prehospital care systems are necessary to build a healthy and sustainable prehospital healthcare workforce.

    View details for DOI 10.1136/bmjopen-2019-033404

    View details for PubMedID 31772106

  • A profile of traumatic injury in the prehospital setting in India: A prospective observational study across seven states. Injury Newberry, J. A., Bills, C. B., Matheson, L., Zhang, X., Gimkala, A., Ramana Rao, G. V., Janagama, S. R., Mahadevan, S. V., Strehlow, M. C. 2019

    Abstract

    BACKGROUND: Traumatic injury continues to be a leading cause of mortality and morbidity in low-income and middle-income countries (LMIC). The World Health Organization has called for a strengthening of prehospital care in order to improve outcomes from trauma. In this study we sought to profile traumatic injury seen in the prehospital setting in India and identify predictors of mortality in this patient population.METHODS: We conducted a prospective observational study of a convenience sample of patients using a single emergency medical services (EMS) system for traumatic injuries across seven states in India from November 2015 through January 2016. Any patient with a chief complaints indicative of a traumatic injury was eligible for enrollment. Our primary outcome was 30-day mortality.RESULTS: We enrolled 2905 patients. Follow-up rates were 76% at 2 days, 70% at 7 days, and 70% at 30 days. The median age was 36 years (IQR: 25-50) and were predominately male (72%, N=2088), of lower economic status (97%, N=2805 used a government issued ration card) and were from rural or tribal areas (74%, N=2162). Cumulative mortality at 2, 7, and 30 days, was 3%, 4%, and 4% respectively. Predictors of 30-day mortality were prehospital abnormal mental status (OR 7.5 (95% CI: 4-14)), presence of hypoxia or hypotension (OR 4.0 (95% CI: 2.2-7)), on-scene mobility (OR 2.8 (95% CI: 1.3-6)), and multisystem injury inclusive of head injury (OR 2.3 (95% CI: 1.1-5)).CONCLUSIONS: EMS in an LMIC can transport trauma patients from poor and rural areas that traditionally struggle to access timely trauma care to facilities in a timeframe consistent with current international recommendations. Information readily obtained by EMTs predicts 30-day mortality within this population and could be utilized for triaging patients with the potential to reduce morbidity and mortality.

    View details for DOI 10.1016/j.injury.2019.11.020

    View details for PubMedID 31761424

  • Timely access to care for patients with critical burns in India: a prehospital prospective observational study EMERGENCY MEDICINE JOURNAL Newberry, J. A., Bills, C. B., Pirrotta, E. A., Barry, M., Rao, G., Mahadevan, S., Strehlow, M. C. 2019; 36 (3): 176–82
  • Timely access to care for patients with critical burns in India: a prehospital prospective observational study. Emergency medicine journal : EMJ Newberry, J. A., Bills, C. B., Pirrotta, E. A., Barry, M., Ramana Rao, G. V., Mahadevan, S. V., Strehlow, M. C. 2019

    Abstract

    BACKGROUND: Low/middle-income countries carry a disproportionate burden of the morbidity and mortality from thermal burns. Nearly 70% of burn deaths worldwide are from thermal burns in India. Delays to medical care are commonplace and an important predictor of outcomes. We sought to understand the role of emergency medical services (EMS) as part of the healthcare infrastructure for thermal burns in India.METHODS: We conducted a prospective observational study of patients using EMS for thermal burns across five Indian states from May to August 2015. Our primary outcome was mortality at 2, 7 and 30 days. We compared observed mortality with expected mortality using the revised Baux score. We used Chi2 analysis for categorical variables and Wilcoxon two-sample test for continuous variables. ORs and 95% CIs are reported for all modelled predictor variables.RESULTS: We enrolled 439 patients. The 30-day follow-up rate was 85.9% (n=377). The median age was 30 years; 56.7% (n=249) lived in poverty; and 65.6% (n=288) were women. EMS transported 94.3% of patients (n=399) to the hospital within 2hours of their call. Median total body surface area (TBSA) burned was 60% overall, and 80% in non-accidental burns. Sixty-eight per cent of patients had revised Baux scores greater than 80. Overall 30-day mortality was 64.5%, and highest (90.2%) in women with non-accidental burns. Predictors of mortality by multivariate regression were TBSA (OR 7.9), inhalation injury (OR 5.5), intentionality (OR 4.7) and gender (OR 2.2).DISCUSSION: Although EMS rapidly connects critically burned patients to care in India, mortality remains high, with women disproportionally suffering self-inflicted burns. To combat the burn epidemic in India, efforts must focus on rapid medical care and critical care services, and on a burn prevention strategy that includes mental health and gender-based violence support services.

    View details for PubMedID 30635272

  • Comparing Teaching Methods in Resource-Limited Countries. AEM education and training Mahadevan, S. V., Walker, R., Kalanzi, J., Stone, L. T., Bills, C., Acker, P., Apfeld, J. C., Newberry, J., Becker, J., Mantha, A., Tecklenburg Strehlow, A. N., Strehlow, M. C. 2018; 2 (3): 238

    View details for PubMedID 30051096

  • Reducing early infant mortality in India: results of a prospective cohort of pregnant women using emergency medical services BMJ OPEN Bills, C. B., Newberry, J. A., Darmstadt, G., Pirrotta, E. A., Rao, G., Mahadevan, S. V., Strehlow, M. C. 2018; 8 (4): e019937

    Abstract

    To describe the demographic characteristics and clinical outcomes of neonates born within 7 days of public ambulance transport to hospitals across five states in India.Prospective observational study.Five Indian states using a centralised emergency medical services (EMS) agency that transported 3.1 million pregnant women in 2014.Over 6 weeks in 2014, this study followed a convenience sample of 1431 neonates born to women using a public-private ambulance service for a 'pregnancy-related' problem. Initial calls were deemed 'pregnancy related' if categorised by EMS dispatchers as 'pregnancy', 'childbirth', 'miscarriage' or 'labour pains'. Interfacility transfers, patients absent on ambulance arrival, refusal of care and neonates born to women beyond 7 days of using the service were excluded.death at 2, 7 and 42 days after delivery.Among 1684 women, 1411 gave birth to 1431 newborns within 7 days of initial ambulance transport. Median maternal age at delivery was 23 years (IQR 21-25). Most mothers were from rural/tribal areas (92.5%) and lower social (79.9%) and economic status (69.9%). Follow-up rates at 2, 7 and 42 days were 99.8%, 99.3% and 94.1%, respectively. Cumulative mortality rates at 2, 7 and 42 days follow-up were 43, 53 and 62 per 1000 births, respectively. The perinatal mortality rate (PMR) was 53 per 1000. Preterm birth (OR 2.89, 95% CI 1.67 to 5.00), twin deliveries (OR 2.80, 95% CI 1.10 to 7.15) and caesarean section (OR 2.21, 95% CI 1.15 to 4.23) were the strongest predictors of mortality.The perinatal mortality rate associated with this cohort of patients with high-acuity conditions of pregnancy was nearly two times the most recent rate for India as a whole (28 per 1000 births). EMS data have the potential to provide more robust estimates of PMR, reduce inequities in timely access to healthcare and increase facility-based care through service of marginalised populations.

    View details for PubMedID 29654018

  • The scale, scope, coverage, and capability of childbirth care LANCET Campbell, O. M., Calvert, C., Testa, A., Strehlow, M., Benova, L., Keyes, E., Donnay, F., Macleod, D., Gabrysch, S., Rong, L., Ronsmans, C., Sadruddin, S., Koblinsky, M., Bailey, P. 2016; 388 (10056): 2193-2208

    Abstract

    All women should have access to high quality maternity services-but what do we know about the health care available to and used by women? With a focus on low-income and middle-income countries, we present data that policy makers and planners can use to evaluate whether maternal health services are functioning to meet needs of women nationally, and potentially subnationally. We describe configurations of intrapartum care systems, and focus in particular on where, and with whom, deliveries take place. The necessity of ascertaining actual facility capability and providers' skills is highlighted, as is the paucity of information on maternity waiting homes and transport as mechanisms to link women to care. Furthermore, we stress the importance of assessment of routine provision of care (not just emergency care), and contextualise this importance within geographic circumstances (eg, in sparsely-populated regions vs dense urban areas). Although no single model-of-care fits all contexts, we discuss implications of the models we observe, and consider changes that might improve services and accelerate response to future challenges. Areas that need attention include minimisation of overintervention while responding to the changing disease burden. Conceptualisation, systematic measurement, and effective tackling of coverage and configuration challenges to implement high quality, respectful maternal health-care services are key to ensure that every woman can give birth without risk to her life, or that of her baby.

    View details for DOI 10.1016/S0140-6736(16)31528-8

    View details for Web of Science ID 000386332400039

    View details for PubMedID 27642023

  • Using an emergency response infrastructure to help women who experience gender-based violence in Gujarat India BULLETIN OF THE WORLD HEALTH ORGANIZATION Newberry, J. A., Mahadevan, S., Gohil, N., Jamshed, R., Prajapati, J., Rao, G. V., Strehlow, M. 2016; 94 (5): 388-392

    Abstract

    Many women who experience gender-based violence may never seek any formal help because they do not feel safe or confident that they will receive help if they try.A public-private-academic partnership in Gujarat, India, established a toll-free telephone helpline - called 181 Abhayam - for women experiencing gender-based violence. The partnership used existing emergency response service infrastructure to link women to phone counselling, nongovernmental organizations (NGOs) and government programmes.In India, the lifetime prevalence of gender-based violence is 37.2%, but less than 1% of women will ever seek help beyond their family or friends. Before implementation of the helpline, there were no toll-free helplines or centralized coordinating systems for government programmes, NGOs and emergency response services.In February 2014, the helpline was launched across Gujarat. In the first 10 months, the helpline assisted 9767 individuals, of which 8654 identified themselves as women. Of all calls, 79% (7694) required an intervention by phone or in person on the day they called and 43% (4190) of calls were by or for women experiencing violence.Despite previous data that showed women experiencing gender-based violence rarely sought help from formal sources, women in Gujarat did use the helpline for concerns across the spectrum of gender-based violence. However, for evaluating the impact of the helpline, the operational definitions of concern categories need to be further clarified. The initial triage system for incoming calls was advantageous for handling high call volumes, but may have contributed to dropped calls.

    View details for DOI 10.2471/BLT.15.163741

    View details for PubMedID 27147769

  • Characteristics and outcomes of women using emergency medical services for third-trimester pregnancy-related problems in India: a prospective observational study. BMJ open Strehlow, M. C., Newberry, J. A., Bills, C. B., Min, H. E., Evensen, A. E., Leeman, L., Pirrotta, E. A., Rao, G. V., Mahadevan, S. V. 2016; 6 (7)

    Abstract

    Characterise the demographics, management and outcomes of obstetric patients transported by emergency medical services (EMS).Prospective observational study.Five Indian states using a centralised EMS agency that transported 3.1 million pregnant women in 2014.This study enrolled a convenience sample of 1684 women in third trimester of pregnancy calling with a 'pregnancy-related' problem for free-of-charge ambulance transport. Calls were deemed 'pregnancy related' if categorised by EMS dispatchers as 'pregnancy', 'childbirth', 'miscarriage' or 'labour pains'. Interfacility transfers, patients absent on ambulance arrival and patients refusing care were excluded.Emergency medical technician (EMT) interventions, method of delivery and death.The median age enrolled was 23 years (IQR 21-25). Women were primarily from rural or tribal areas (1550/1684 (92.0%)) and lower economic strata (1177/1684 (69.9%)). Time from initial call to hospital arrival was longer for rural/tribal compared with urban patients (66 min (IQR 51-84) vs 56 min (IQR 42-73), respectively, p<0.0001). EMTs assisted delivery in 44 women, delivering the placenta in 33/44 (75%), performing transabdominal uterine massage in 29/33 (87.9%) and administering oxytocin in none (0%). There were 1411 recorded deliveries. Most women delivered at a hospital (1212/1411 (85.9%)), however 126/1411 (8.9%) delivered at home following hospital discharge. Follow-up rates at 48 hours, 7 days and 42 days were 95.0%, 94.4% and 94.1%, respectively. Four women died, all within 48 hours. The caesarean section rate was 8.2% (116/1411). On multivariate regression analysis, women transported to private hospitals versus government primary health centres were less likely to deliver by caesarean section (OR 0.14 (0.05-0.43)) CONCLUSIONS: Pregnant women from vulnerable Indian populations use free-of-charge EMS for impending delivery, making it integral to the healthcare system. Future research and health system planning should focus on strengthening and expanding EMS as a component of emergency obstetric and newborn care (EmONC).

    View details for DOI 10.1136/bmjopen-2016-011459

    View details for PubMedID 27449891

    View details for PubMedCentralID PMC4964166

  • Experiences of Workplace Violence Among Healthcare Providers in Myanmar: A Cross-sectional Survey Study CUREUS Lindquist, B., Feltes, M., Niknam, K., Koval, K. W., Ohn, H., Newberry, J., Strehlow, M., Walker, R. 2020; 12 (4)
  • Fostering a Diverse Pool of Global Health Academic Leaders Through Mentorship and Career Path Planning. AEM education and training Newberry, J. A., Patel, S., Kayden, S., O'Laughlin, K. N., Cioe-Pena, E., Strehlow, M. C. 2020; 4 (Suppl 1): S98–S105

    Abstract

    Established in 2011, the Global Emergency Medicine Academy (GEMA) aims "to improve the global delivery of emergency care through research, education, and mentorship." Global health remains early in its development as an academic track in emergency medicine, and there are only a small number of global emergency medicine academic faculty in most institutions. Consequently, GEMA focused its efforts at the Society for Academic Emergency Medicine (SAEM) Annual Meeting in 2019 on developing a diverse pool of global health academics and leaders in emergency medicine. Current and previous members of the GEMA Executive Committee convened to appraise and describe how current GEMA efforts situate within existing knowledge in the arenas of professional development and mentorship. The 2019 SAEM Annual Meeting unveiled the Global Emergency Medicine Roadmap, a joint venture between GEMA and the residents and medical students (RAMS) group. The roadmap guides medical students, residents, and fellows in the exploration of global emergency medicine and career development. GEMA's mentorship roundtable complemented this effort by providing a version of speed mentoring across several critical areas: work-life balance, identifying near-peer and long-distance mentoring opportunities, negotiating with your Chair, finding funding, networking, and teaching abroad. Finally, the GEMA-sponsored panel "Empowering Women through Emergency Care Development in LMICs" underscored the potential for empowering women through global emergency medicine development, including policy advocacy, inclusive research approaches, and mentorship and sponsorship. In summary, GEMA is committed to developing a diverse group of future global health leaders to guide the expansion of emergency medicine worldwide. Our work indicates critical future directions in global emergency medicine education and training including building innovative mentoring networks across institutions and countries. Further, we will continue to focus on growing faculty diversity, empowering underrepresented populations through emergency care development, and supporting rising global emergency medicine faculty in their pursuit of advancement and promotion.

    View details for DOI 10.1002/aet2.10403

    View details for PubMedID 32072113

  • Experiences of Workplace Violence Among Healthcare Providers in Myanmar: A Cross-sectional Survey Study. Cureus Lindquist, B., Feltes, M., Niknam, K., Koval, K. W., Ohn, H., Newberry, J., Strehlow, M., Walker, R. 2020; 12 (4): e7549

    Abstract

    Background Healthcare providers face enormous threats to personal safety from workplace violence (WPV). Prior investigations estimate a highly varied prevalence of WPV in the United States and around the world, including both verbal and physical assault. Little is known about WPV in Myanmar. Only a single prior study has evaluated WPV experiences among physicians in Myanmar, reporting an unusually low prevalence of verbal (8.7%) and physical (1.0%) assault. Given this much lower prevalence compared with similar studies in other low- and middle-income countries (LMICs), we embarked on a study to identify the prevalence of WPV in a separate cohort of healthcare providers in Myanmar. Methods This was a cross-sectional analysis of WPV prevalence among healthcare providers who attended a national emergency medicine conference in Myanmar in November 2018. The survey instrument was adapted from a validated survey from the Joint Program on Workplace Violence in the Healthcare Sector (International Labour Office, International Council of Nurses, World Health Organization, and Public Services International), which had been used in other global settings. Results Sixty-three participants completed the survey questionnaire, including 35 women (55.6%) and 26 men (41.3%). Among them, 25 (39.7%) were primary care providers. Overall, the combined prevalence of WPV in the previous 12 months was found to be 47.6% (n = 30; 95% CI: 34.9-60.6%). The prevalence of verbal assault was 47.6% (n = 30; 95% CI: 34.9-60.6%), and that of physical assault was 4.8% (n = 3; 95% CI: 1.0-13.3%). Twenty-four participants (42.4%) reported that they were encouraged to report violence in the workplace, and five (8.1%) reported they had received training on how to manage WPV. Respondents who were 30-34 years in age and those working in private facilities were significantly less likely to report WPV on univariate analysis. Conclusion Although our cohort comprised a limited sample of a select group of providers, we found a dramatically higher prevalence of WPV experiences among healthcare providers attending an emergency medicine conference in Myanmar when compared with a prior investigation. Very few participants had received training on WPV, and less than half reported a work culture where WPV reporting is encouraged. To combat healthcare provider shortages, more investigation is required into WPV to understand its impact and identify amelioration strategies.

    View details for DOI 10.7759/cureus.7549

    View details for PubMedID 32382453

    View details for PubMedCentralID PMC7202584

  • Critical Communication: A Cross-sectional Study of Signout at the Prehospital and Hospital Interface. Cureus Janagama, S. R., Strehlow, M., Gimkala, A., Rao, G. V., Matheson, L., Mahadevan, S., Newberry, J. A. 2020; 12 (2): e7114

    Abstract

    Introduction Miscommunication during patient handoff contributes to an estimated 80% of serious medical errors and, consequently, plays a key role in the estimated five million excess deaths annually from poor quality of care in low- and middle-income countries (LMICs). Objective The objective of this study was to assess signout communication during patient handoffs between prehospital personnel and hospital staff. Methods This is a cross-sectional study, with a convenience sample of 931 interfacility transfers for pregnant women across four states from November 7 to December 13, 2016. A complete signout, as defined for this study, contains all necessary signout elements for patient care exchanged verbally or in written form between an emergency medical technician (EMT) and a physician or nurse. Results Enrollment of 786 cases from 931 interfacility transfers resulted in 1572 opportunities for signout. EMTs and a physician or nurse signed out in 1549 cases (98.5%). Signout contained all elements in 135 cases (8.6%). The mean percentage of signout elements included was 45.2% (95% CI, 43.9-46.6). Physician involvement was correlated with a higher mean percent (63.4% [95% CI, 62-64.8]) compared to nurse involvement (23.6% [95% CI, 22.5-24.8]). With respect to the frequency of signout communication, 63.1% of EMTs reported often or always giving signout, and 60.5% reported often or always giving signout; they reported feeling moderately to very comfortable with signout (73.7%) and 34.1% requested further training. Conclusions Physicians, nurses, and the EMTs conducted signout 99% of the time but often fell short of including all elements required for optimal patient care. Interventions aimed at improving the quality of patient care must include strengthening signout communication.

    View details for DOI 10.7759/cureus.7114

    View details for PubMedID 32140371

    View details for PubMedCentralID PMC7047340

  • Epidemiology of patients presenting to a pediatric emergency department in Karachi, Pakistan. BMC emergency medicine Ijaz, N., Strehlow, M., Ewen Wang, N., Pirrotta, E., Tariq, A., Mahmood, N., Mahadevan, S. 2018; 18 (1): 22

    Abstract

    BACKGROUND: There is little data describing pediatric emergencies in resource-poor countries, such as Pakistan. We studied the demographics, management, and outcomes of patients presenting to the highest-volume, public, pediatric emergency department (ED) in Karachi, Pakistan.METHODS: In this prospective, observational study, we approached all patients presenting to the 50-bed ED during 28 12-h study periods over four consecutive weeks (July 2013). Participants' chief complaints and medical care were documented. Patients were followed-up at 48-h and 14-days via telephone.RESULTS: Of 3115 participants, 1846 were triaged to the outpatient department and 1269 to the ED. Patients triaged to the ED had a median age of 2.0years (IQR 0.5-4.0); 30% were neonates (<28days). Top chief complaints were fever (45.5%), diarrhea/vomiting (32.3%), respiratory (23.1%), abdominal (7.5%), and otolaryngological problems (5.8%). Temperature, pulse and respiratory rate, and blood glucose were documented for 66, 42, and 1.5% of patients, respectively. Interventions included medications (92%), IV fluids (83%), oxygen (35%), and advanced airway management (5%). Forty-five percent of patients were admitted; 11 % left against medical advice. Outcome data was available at time of ED disposition, 48-h, and 14days for 83, 62, and 54% of patients, respectively. Of participants followed-up, 4.3% died in the ED, 11.5% within 48h, and 19.6% within 14days.CONCLUSIONS: This first epidemiological study at Pakistan's largest pediatric ED reveals dramatically high mortality, particularly among neonates. Future research in developing countries should focus on characterizing reasons for high mortality through pre-ED arrival tracking, ED care quality assessment, and post-ED follow-up.

    View details for PubMedID 30075749

  • Characteristics and outcomes of pediatric patients presenting at Cambodian referral hospitals without appointments: an observational study INTERNATIONAL JOURNAL OF EMERGENCY MEDICINE Yore, M. A., Strehlow, M. C., Yan, L. D., Pirrotta, E. A., Woods, J. L., Somontha, K., Sovannra, Y., Auerbach, L., Backer, R., Grundmann, C., Mahadevan, S. V. 2018; 11: 17

    Abstract

    Emergency medicine is a young specialty in many low- and middle-income countries (LMICs). Although many patients seeking emergency or acute care are children, little information is available about the needs and current treatment of this group in LMICs. In this observational study, we sought to describe characteristics, chief complaints, management, and outcomes of children presenting for unscheduled visits to two Cambodian public hospitals.Children enrolled in the study presented without appointment for treatment at one of two Cambodian public referral hospitals during a 4-week period in 2012. Researchers used standardized questionnaires and hospital records to collect demographic and clinical data. Patients were followed up at 48 h and 14 days after initial presentation. Multivariate logistic regression identified factors associated with hospital admission.This study included 867 unscheduled visits. Mean patient age was 5.7 years (standard deviation 4.8 years). Of the 35 different presenting complaints, fever (63%), respiratory problems (25%), and skin complaints (24%) were most common. The majority of patients were admitted (51%), while 1% were transferred to another facility. Seven patients (1%) died within 14 days. Follow-up rates were 83% at 48 h and 75% at 14 days. Predictors of admission included transfer or referral from another health provider, seeking prior care for the presenting problem, low socioeconomic status, onset of symptoms within 24 h of seeking care, abnormal vital signs or temperature, and chief complaint of abdominal pain or fever.While the admission rate in this study was high, mortality was low. More effective identification and management of children who can be treated and released may free up scarce inpatient resources for children who warrant admission.

    View details for PubMedID 29536212

  • Comparison of online and classroom-based formats for teaching emergency medicine to medical students in Uganda AEM Education and Training Mahadevan, S., Walker, R., Kalanzi, J., Luggya, T., Bills, C., Acker, P., et al 2018; 2 (1)

    View details for DOI 10.1002/aet2.10066

  • Comparison of Online and Classroom-based Formats for Teaching Emergency Medicine to Medical Students in Uganda. AEM education and training Mahadevan, S. V., Walker, R., Kalanzi, J., Stone, L. T., Bills, C., Acker, P., Apfeld, J. C., Newberry, J., Becker, J., Mantha, A., Tecklenburg Strehlow, A. N., Strehlow, M. C. 2018; 2 (1): 5–9

    Abstract

    Severe global shortages in the health care workforce sector have made improving access to essential emergency care challenging. The paucity of trained specialists in low- and middle-income countries translates to large swathes of the population receiving inadequate care. Efforts to expand emergency medicine (EM) education are similarly impeded by a lack of available and appropriate teaching faculty. The development of comprehensive, online medical education courses offers a potentially economical, scalable, and lasting solution for universities experiencing professional shortages.An EM course addressing core concepts and patient management was developed for medical students enrolled at Makerere University College of Health Sciences in Kampala, Uganda. Material was presented to students in two comparable formats: online video modules and traditional classroom-based lectures. Following completion of the course, students were assessed for knowledge gains.Forty-two and 48 students enrolled and completed all testing in the online and classroom courses, respectively. Student knowledge gains were equivalent (classroom 25 ± 8.7% vs. online 23 ± 6.5%, p = 0.18), regardless of the method of course delivery.A summative evaluation of Ugandan medical students demonstrated that online teaching modules are effectively equivalent and offer a viable alternative to traditional classroom-based lectures delivered by on-site, visiting faculty in their efficacy to teach expertise in EM. Web-based curriculum can help alleviate the burden on universities in developing nations struggling with a critical shortage of health care educators while simultaneously satisfying the growing community demand for access to emergency medical care. Future studies assessing the long-term retention of course material could gauge its incorporation into clinical practice.

    View details for PubMedID 30051058

  • Comparison of Live Versus Online Instruction of a Novel Soft Skills Course in Mongolia CUREUS Mahadevan, A., Strehlow, M. C., Dorjsuren, K., Newberry, J. A. 2017; 9 (11): e1900

    Abstract

    Background Soft skills are essential for employee success in the global marketplace; however, many developing countries lack content experts to provide the requisite instruction to an emerging workforce. One possible solution is to use an online, open-access curriculum. To date, no studies on soft skills curricula using an online learning platform have been undertaken in Mongolia. Objective To evaluate the efficacy of an online versus classroom platform to deliver a novel soft skills course in Mongolia. Methods A series of eight lectures along with corresponding surveys and multiple choice question tests were developed and translated into the Mongolian language. Two different delivery modalities, online and traditional classroom lectures, were then compared for knowledge gain, comfort level, and satisfaction. Knowledge gain and comfort level were assessed pre- and post-course, while satisfaction was assessed only post-course. Results Enrollment in the online and classroom courses was 89 students and 291 students, respectively. Sixty-two online students (68% female) and 114 classroom students (77% female) completed the entire course and took the post-test. The online cohort had higher pre-test scores than the classroom cohort (46.4% and 37.3%, respectively, p < 0.01). The online cohort's overall knowledge gain was not significant (0.4%, p=0.87), but the classroom cohort's knowledge gain was significant (13.9%, p < 0.01). Both the online and classroom cohorts demonstrated significant improvement in overall comfort level for all soft skills topics (p < 0.01). Both cohorts were also highly satisfied with the course, as assessed on a Likert scale (4.59 for online, 4.40 for classroom). Conclusion The study compared two cohorts of Mongolian college students who took either an online or classroom-based soft skills course, and it was found that knowledge gain was significantly higher for the classroom group, while comfort and satisfaction with individual course topics was comparable.

    View details for PubMedID 29399428

  • Preparing for International Travel and Global Medical Care EMERGENCY MEDICINE CLINICS OF NORTH AMERICA Mahadevan, S. V., Strehlow, M. C. 2017; 35 (2): 465-?

    Abstract

    Thorough pretravel preparation and medical consultation can mitigate avoidable health and safety risks. A comprehensive pretravel medical consultation should include an individualized risk assessment, immunization review, and discussion of arthropod protective measures, malaria prophylaxis, traveler's diarrhea, and injury prevention. Travel with children and jet lag reduction require additional planning and prevention strategies; travel and evacuation insurance may prove essential when traveling to less resourced countries. Consideration should also be given to other high-risk travel scenarios, including the provision of health care overseas, adventure and extreme sports, water environments and diving, high altitude, and terrorism/unstable political situations.

    View details for DOI 10.1016/j.emc.2017.01.006

    View details for PubMedID 28411937

  • Adaptive leadership curriculum for Indian paramedic trainees. International journal of emergency medicine Mantha, A., Coggins, N. L., Mahadevan, A., Strehlow, R. N., Strehlow, M. C., Mahadevan, S. V. 2016; 9 (1): 9-?

    Abstract

    Paramedic trainees in developing countries face complex and chaotic clinical environments that demand effective leadership, communication, and teamwork. Providers must rely on non-technical skills (NTS) to manage bystanders and attendees, collaborate with other emergency professionals, and safely and appropriately treat patients. The authors designed a NTS curriculum for paramedic trainees focused on adaptive leadership, teamwork, and communication skills critical to the Indian prehospital environment.Forty paramedic trainees in the first academic year of the 2-year Advanced Post-Graduate Degree in Emergency Care (EMT-paramedic equivalent) program at the GVK-Emergency Management and Research Institute campus in Hyderabad, India, participated in the 6-day leadership course. Trainees completed self-assessments and delivered two brief video-recorded presentations before and after completion of the curriculum.Independent blinded observers scored the pre- and post-intervention presentations delivered by 10 randomly selected paramedic trainees. The third-party judges reported significant improvement in both confidence (25 %, p < 0.01) and body language of paramedic trainees (13 %, p < 0.04). Self-reported competency surveys indicated significant increases in leadership (2.6 vs. 4.6, p < 0.001, d = 1.8), public speaking (2.9 vs. 4.6, p < 0.001, d = 1.4), self-reflection (2.7 vs. 4.6, p < 0.001, d = 1.6), and self-confidence (3.0 vs. 4.8, p < 0.001, d = 1.5).Participants in a 1-week leadership curriculum for prehospital providers demonstrated significant improvement in self-reported NTS commonly required of paramedics in the field. The authors recommend integrating focused NTS development curriculum into Indian paramedic education and further evaluation of the long term impacts of this adaptive leadership training.

    View details for DOI 10.1186/s12245-016-0103-x

    View details for PubMedID 26897379

    View details for PubMedCentralID PMC4761349

  • One-two-triage: validation and reliability of a novel triage system for low-resource settings. Emergency medicine journal Khan, A., Mahadevan, S. V., Dreyfuss, A., Quinn, J., Woods, J., Somontha, K., Strehlow, M. 2016; 33 (10): 709-715

    Abstract

    To validate and assess reliability of a novel triage system, one-two-triage (OTT), that can be applied by inexperienced providers in low-resource settings.This study was a two-phase prospective, comparative study conducted at three hospitals. Phase I assessed criterion validity of OTT on all patients arriving at an American university hospital by comparing agreement among three methods of triage: OTT, Emergency Severity Index (ESI) and physician-defined acuity (the gold standard). Agreement was reported in normalised and raw-weighted Cohen κ using two different scales for weighting, Expert-weighted and triage-weighted κ. Phase II tested reliability, reported in Fleiss κ, of OTT using standardised cases among three groups of providers at an urban and rural Cambodian hospital and the American university hospital.Normalised for prevalence of patients in each category, OTT and ESI performed similarly well for expert-weighted κ (OTT κ=0.58, 95% CI 0.52 to 0.65; ESI κ=0.47, 95% CI 0.40 to 0.53) and triage-weighted κ (κ=0.54, 95% CI 0.48 to 0.61; ESI κ=0.57, 95% CI 0.51 to 0.64). Without normalising, agreement with gold standard was less for both systems but performance of OTT and ESI remained similar, expert-weighted (OTT κ=0.57, 95% CI 0.52 to 0.62; ESI κ=0.6, 95% CI 0.58 to 0.66) and triage-weighted (OTT κ=0.31, 95% CI 0.25 to 0.38; ESI κ=0.41, 95% CI 0.35 to 0.4). In the reliability phase, all triagers showed fair inter-rater agreement, Fleiss κ (κ=0.308).OTT can be reliably applied and performs as well as ESI compared with gold standard, but requires fewer resources and less experience.

    View details for DOI 10.1136/emermed-2015-205430

    View details for PubMedID 27466347

  • Barriers to Real-Time Medical Direction via Cellular Communication for Prehospital Emergency Care Providers in Gujarat, India. Cure¯us Lindquist, B., Strehlow, M. C., Rao, G. V., Newberry, J. A. 2016; 8 (7)

    Abstract

    Many low- and middle-income countries depend on emergency medical technicians (EMTs), nurses, midwives, and layperson community health workers with limited training to provide a majority of emergency medical, trauma, and obstetric care in the prehospital setting. To improve timely patient care and expand provider scope of practice, nations leverage cellular phones and call centers for real-time online medical direction. However, there exist several barriers to adequate communication that impact the provision of emergency care. We sought to identify obstacles in the cellular communication process among GVK Emergency Management and Research Institute (GVK EMRI) EMTs in Gujarat, India.A convenience sample of practicing EMTs in Gujarat, India were surveyed regarding the barriers to call initiation and completion.108 EMTs completed the survey. Overall, ninety-seven (89.8%) EMTs responded that the most common reason they did not initiate a call with the call center physician was insufficient time. Forty-six (42%) EMTs reported that they were unable to call the physician one or more times during a typical workweek (approximately 5-6 twelve-hour shifts/week) due to their hands being occupied performing direct patient care. Fifty-eight (54%) EMTs reported that they were unable to reach the call center physician, despite attempts, at least once a week.This study identified multiple barriers to communication, including insufficient time to call for advice and inability to reach call center physicians. Identification of simple interventions and best practices may improve communication and ensure timely and appropriate prehospital care.

    View details for DOI 10.7759/cureus.676

    View details for PubMedID 27551654

    View details for PubMedCentralID PMC4977222

  • Characteristics and outcomes of women using emergency medical services for third-trimester pregnancy-related problems in India: a prospective observational study. BMJ open Strehlow, M. C., Newberry, J. A., Bills, C. B., Min, H. E., Evensen, A. E., Leeman, L., Pirrotta, E. A., Rao, G. V., Mahadevan, S. V. 2016; 6 (7): e011459

    Abstract

    Characterise the demographics, management and outcomes of obstetric patients transported by emergency medical services (EMS).Prospective observational study.Five Indian states using a centralised EMS agency that transported 3.1 million pregnant women in 2014.This study enrolled a convenience sample of 1684 women in third trimester of pregnancy calling with a 'pregnancy-related' problem for free-of-charge ambulance transport. Calls were deemed 'pregnancy related' if categorised by EMS dispatchers as 'pregnancy', 'childbirth', 'miscarriage' or 'labour pains'. Interfacility transfers, patients absent on ambulance arrival and patients refusing care were excluded.Emergency medical technician (EMT) interventions, method of delivery and death.The median age enrolled was 23 years (IQR 21-25). Women were primarily from rural or tribal areas (1550/1684 (92.0%)) and lower economic strata (1177/1684 (69.9%)). Time from initial call to hospital arrival was longer for rural/tribal compared with urban patients (66 min (IQR 51-84) vs 56 min (IQR 42-73), respectively, p<0.0001). EMTs assisted delivery in 44 women, delivering the placenta in 33/44 (75%), performing transabdominal uterine massage in 29/33 (87.9%) and administering oxytocin in none (0%). There were 1411 recorded deliveries. Most women delivered at a hospital (1212/1411 (85.9%)), however 126/1411 (8.9%) delivered at home following hospital discharge. Follow-up rates at 48 hours, 7 days and 42 days were 95.0%, 94.4% and 94.1%, respectively. Four women died, all within 48 hours. The caesarean section rate was 8.2% (116/1411). On multivariate regression analysis, women transported to private hospitals versus government primary health centres were less likely to deliver by caesarean section (OR 0.14 (0.05-0.43)) CONCLUSIONS: Pregnant women from vulnerable Indian populations use free-of-charge EMS for impending delivery, making it integral to the healthcare system. Future research and health system planning should focus on strengthening and expanding EMS as a component of emergency obstetric and newborn care (EmONC).

    View details for PubMedID 27449891

  • Implementing an Innovative Prehospital Care Provider Training Course in Nine Cambodian Provinces Cureus Acker, P. C. 2016; 8 (6)

    View details for DOI 10.7759/cureus.656

  • Implementing an Innovative Prehospital Care Provider Training Course in Nine Cambodian Provinces. Cure¯us Acker, P., Newberry, J. A., Hattaway, L. B., Socheat, P., Raingsey, P. P., Strehlow, M. C. 2016; 8 (6)

    Abstract

    Despite significant improvements in health outcomes nationally, many Cambodians continue to experience morbidity and mortality due to inadequate access to quality emergency medical services. Over recent decades, the Cambodian healthcare system and civil infrastructure have advanced markedly and now possess many of the components required to establish a well functioning emergency medical system. These components include enhanced access to emergency transportation through large scale road development efforts, widspread availability of emergency communication channels via the spread of cellphone and internet technology, and increased access to health services for poor patients through the implementation of health financing schemes. However, the system still lacks a number of key elements, one of which is trained prehospital care providers. Working in partnership with local providers, our team created an innovative, Cambodia-specific prehospital care provider training course to help fill this gap. Participants received training on prehospital care skills and knowledge most applicable to the Cambodian healthcare system, which was divided into four modules: Basic Prehospital Care Skills and Adult Medical Emergencies, Traumatic Emergencies, Obstetric Emergencies, and Neonatal/Pediatric Emergencies. The course was implemented in nine of Cambodia's most populous provinces, concurrent with a number of overarching emergency medical service system improvement efforts. Overall, the course was administered to 1,083 Cambodian providers during a 27-month period, with 947 attending the entire course and passing the course completion exam.

    View details for DOI 10.7759/cureus.656

    View details for PubMedID 27489749

    View details for PubMedCentralID PMC4963230

  • Barriers to Real-Time Medical Direction via Cellular Communication for Prehospital Emergency Care Providers in Gujarat, India Cureus Lindquist, B., Strehlow, M., Rao, G., Newberry, J. 2016

    View details for DOI 10.7759/cureus.676

  • EPIDEMIOLOGY OF SHORTNESS OF BREATH IN PREHOSPITAL PATIENTS IN ANDHRA PRADESH, INDIA JOURNAL OF EMERGENCY MEDICINE Mercer, M. P., Mahadevan, S. V., Pirrotta, E., Rao, G. V., Sistla, S., Nampelly, B., Danthala, R., Strehlow, A. N., Strehlow, M. C. 2015; 49 (4): 448-454

    Abstract

    Shortness of breath is a frequent reason for patients to request prehospital emergency medical services and is a symptom of many life-threatening conditions. To date, there is limited information on the epidemiology of, and outcomes of patients seeking emergency medical services for, shortness of breath in India.This study describes the characteristics and outcomes of patients with a chief complaint of shortness of breath transported by a public ambulance service in the state of Andhra Pradesh, India.This prospective, observational study enrolled patients with a chief complaint of shortness of breath during twenty-eight, 12-h periods. Demographic and clinical data were collected from emergency medical technicians using a standardized questionnaire. Follow-up information was collected at 48-72 h and 30 days.Six hundred and fifty patients were enrolled during the study period. The majority of patients were male (63%), from rural communities (66%), and of lower socioeconomic status (78%). Prehospital interventions utilized included oxygen (76%), physician consultation (40%), i.v. placement (15%), nebulized medications (13%), cardiopulmonary resuscitation (5%), and bag-mask ventilation (4%). Mortality ratios before hospital arrival, at 48-72 h, and 30 days were 12%, 27%, and 35%, respectively. Forty-six percent of patients were confirmed to have survived to 30 days. Predictors of death before hospital arrival were symptoms of chest pain (16% vs. 12%; p < 0.05) recent symptoms of upper respiratory infection (7.5% vs. 4%; p < 0.05), history of heart disease (14% vs. 7%; p < 0.05), and prehospital hypotension, defined as systolic blood pressure <90 mm Hg (6.3% vs. 3.7%; p < 0.05).Among individuals seeking prehospital emergency medical services in India, the chief complaint of shortness of breath is associated with a substantial early and late mortality, which may be in part due to the underutilization of prehospital interventions.

    View details for DOI 10.1016/j.jemermed.2015.02.041

    View details for Web of Science ID 000363207200021

  • Epidemiology of Shortness of Breath in Prehospital Patients in Andhra Pradesh, India. journal of emergency medicine Mercer, M. P., Mahadevan, S. V., Pirrotta, E., Ramana Rao, G. V., Sistla, S., Nampelly, B., Danthala, R., Strehlow, A. N., Strehlow, M. C. 2015; 49 (4): 448-454

    Abstract

    Shortness of breath is a frequent reason for patients to request prehospital emergency medical services and is a symptom of many life-threatening conditions. To date, there is limited information on the epidemiology of, and outcomes of patients seeking emergency medical services for, shortness of breath in India.This study describes the characteristics and outcomes of patients with a chief complaint of shortness of breath transported by a public ambulance service in the state of Andhra Pradesh, India.This prospective, observational study enrolled patients with a chief complaint of shortness of breath during twenty-eight, 12-h periods. Demographic and clinical data were collected from emergency medical technicians using a standardized questionnaire. Follow-up information was collected at 48-72 h and 30 days.Six hundred and fifty patients were enrolled during the study period. The majority of patients were male (63%), from rural communities (66%), and of lower socioeconomic status (78%). Prehospital interventions utilized included oxygen (76%), physician consultation (40%), i.v. placement (15%), nebulized medications (13%), cardiopulmonary resuscitation (5%), and bag-mask ventilation (4%). Mortality ratios before hospital arrival, at 48-72 h, and 30 days were 12%, 27%, and 35%, respectively. Forty-six percent of patients were confirmed to have survived to 30 days. Predictors of death before hospital arrival were symptoms of chest pain (16% vs. 12%; p < 0.05) recent symptoms of upper respiratory infection (7.5% vs. 4%; p < 0.05), history of heart disease (14% vs. 7%; p < 0.05), and prehospital hypotension, defined as systolic blood pressure <90 mm Hg (6.3% vs. 3.7%; p < 0.05).Among individuals seeking prehospital emergency medical services in India, the chief complaint of shortness of breath is associated with a substantial early and late mortality, which may be in part due to the underutilization of prehospital interventions.

    View details for DOI 10.1016/j.jemermed.2015.02.041

    View details for PubMedID 26014761

  • Cerebrospinal fluid and plasma oxytocin concentrations are positively correlated and negatively predict anxiety in children MOLECULAR PSYCHIATRY Carson, D. S., Berquist, S. W., Trujillo, T. H., Garner, J. P., Hannah, S. L., Hyde, S. A., Sumiyoshi, R. D., Jackson, L. P., MOSS, J. K., Strehlow, M. C., Cheshier, S. H., Partap, S., Hardan, A. Y., Parker, K. J. 2015; 20 (9): 1085-1090

    Abstract

    The neuropeptide oxytocin (OXT) exerts anxiolytic and prosocial effects in the central nervous system of rodents. A number of recent studies have attempted to translate these findings by investigating the relationships between peripheral (e.g., blood, urinary and salivary) OXT concentrations and behavioral functioning in humans. Although peripheral samples are easy to obtain in humans, whether peripheral OXT measures are functionally related to central OXT activity remains unclear. To investigate a possible relationship, we quantified OXT concentrations in concomitantly collected cerebrospinal fluid (CSF) and blood samples from child and adult patients undergoing clinically indicated lumbar punctures or other CSF-related procedures. Anxiety scores were obtained in a subset of child participants whose parents completed psychometric assessments. Findings from this study indicate that plasma OXT concentrations significantly and positively predict CSF OXT concentrations (r=0.56, P=0.0064, N=27). Moreover, both plasma (r=-0.92, P=0.0262, N=10) and CSF (r=-0.91, P=0.0335, N=10) OXT concentrations significantly and negatively predicted trait anxiety scores, consistent with the preclinical literature. Importantly, plasma OXT concentrations significantly and positively (r=0.96, P=0.0115, N=10) predicted CSF OXT concentrations in the subset of child participants who provided behavioral data. This study provides the first empirical support for the use of blood measures of OXT as a surrogate for central OXT activity, validated in the context of behavioral functioning. These preliminary findings also suggest that impaired OXT signaling may be a biomarker of anxiety in humans, and a potential target for therapeutic development in individuals with anxiety disorders.Molecular Psychiatry advance online publication, 4 November 2014; doi:10.1038/mp.2014.132.

    View details for DOI 10.1038/mp.2014.132

    View details for Web of Science ID 000360175500009

  • Septris: a novel, mobile, online, simulation game that improves sepsis recognition and management. Academic medicine Evans, K. H., Daines, W., Tsui, J., Strehlow, M., Maggio, P., Shieh, L. 2015; 90 (2): 180-184

    Abstract

    Annually affecting over 18 million people worldwide, sepsis is common, deadly, and costly. Despite significant effort by the Surviving Sepsis Campaign and other initiatives, sepsis remains underrecognized and undertreated.Research indicates that educating providers may improve sepsis diagnosis and treatment; thus, the Stanford School of Medicine has developed a mobile-accessible, case-based, online game entitled Septris (http://med.stanford.edu/septris/). Septris, launched online worldwide in December 2011, takes an innovative approach to teaching early sepsis identification and evidence-based management. The free gaming platform leverages the massive expansion over the past decade of smartphones and the popularity of noneducational gaming.The authors sought to assess the game's dissemination and its impact on learners' sepsis-related knowledge, skills, and attitudes. In 2012, the authors trained Stanford pregraduate (clerkship) and postgraduate (resident) medical learners (n = 156) in sepsis diagnosis and evidence-based practices via 20 minutes of self-directed game play with Septris. The authors administered pre- and posttests.By October 2014, Septris garnered over 61,000 visits worldwide. After playing Septris, both pre- and postgraduate groups improved their knowledge on written testing in recognizing and managing sepsis (P < .001). Retrospective self-reporting on their ability to identify and manage sepsis also improved (P < .001). Over 85% of learners reported that they would or would maybe recommend Septris.Future evaluation of Septris should assess its effectiveness among different providers, resource settings, and cultures; generate information about how different learners make clinical decisions; and evaluate the correlation of game scores with sepsis knowledge.This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License, where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially.

    View details for DOI 10.1097/ACM.0000000000000611

    View details for PubMedID 25517703

  • An observational study of adults seeking emergency care in Cambodia BULLETIN OF THE WORLD HEALTH ORGANIZATION Yan, L. D., Mahadevan, S. V., Yore, M., Pirrotta, E. A., Woods, J., Somontha, K., Sovannra, Y., Raman, M., Cornell, E., Grundmann, C., Strehlow, M. C. 2015; 93 (2): 84-92

    Abstract

    To describe the characteristics and chief complaints of adults seeking emergency care at two Cambodian provincial referral hospitals.Adults aged 18 years or older who presented without an appointment at two public referral hospitals were enrolled in an observational study. Clinical and demographic data were collected and factors associated with hospital admission were identified. Patients were followed up 48 hours and 14 days after presentation.In total, 1295 hospital presentations were documented. We were able to follow up 85% (1098) of patients at 48 hours and 77% (993) at 14 days. The patients' mean age was 42 years and 64% (823) were females. Most arrived by motorbike (722) or taxi or tuk-tuk (312). Most common chief complaints were abdominal pain (36%; 468), respiratory problems (15%; 196) and headache (13%; 174). Of the 1050 patients with recorded vital signs, 280 had abnormal values, excluding temperature, on arrival. Performed diagnostic tests were recorded for 539 patients: 1.2% (15) of patients had electrocardiography and 14% (175) had diagnostic imaging. Subsequently, 783 (60%) patients were admitted and 166 of these underwent surgery. Significant predictors of admission included symptom onset within 3 days before presentation, abnormal vital signs and fever. By 14-day follow-up, 3.9% (39/993) of patients had died and 19% (192/993) remained functionally impaired.In emergency admissions in two public hospitals in Cambodia, there is high admission-to-death ratio and limited application of diagnostic techniques. We identified ways to improve procedures, including better documentation of vital signs and increased use of diagnostic techniques.

    View details for DOI 10.2471/BLT.14.143917

    View details for PubMedID 25883401

  • Septris: A Novel, Mobile, Online, Simulation Game That Improves Sepsis Recognition and Management Academic Medicine Evans, K. H., Daines, W. P., Tsui, J., Strehlow, M., Maggio, P., Shieh, L. 2015; Vol. 90, No. 2 (February 2015)

    Abstract

    Annually affecting over 18 million people worldwide, sepsis is common, deadly, and costly. Despite significant effort by the Surviving Sepsis Campaign and other initiatives, sepsis remains underrecognized and undertreated.Research indicates that educating providers may improve sepsis diagnosis and treatment; thus, the Stanford School of Medicine has developed a mobile-accessible, case-based, online game entitled Septris (http://med.stanford.edu/septris/). Septris, launched online worldwide in December 2011, takes an innovative approach to teaching early sepsis identification and evidence-based management. The free gaming platform leverages the massive expansion over the past decade of smartphones and the popularity of noneducational gaming.The authors sought to assess the game's dissemination and its impact on learners' sepsis-related knowledge, skills, and attitudes. In 2012, the authors trained Stanford pregraduate (clerkship) and postgraduate (resident) medical learners (n = 156) in sepsis diagnosis and evidence-based practices via 20 minutes of self-directed game play with Septris. The authors administered pre- and posttests.By October 2014, Septris garnered over 61,000 visits worldwide. After playing Septris, both pre- and postgraduate groups improved their knowledge on written testing in recognizing and managing sepsis (P < .001). Retrospective self-reporting on their ability to identify and manage sepsis also improved (P < .001). Over 85% of learners reported that they would or would maybe recommend Septris.Future evaluation of Septris should assess its effectiveness among different providers, resource settings, and cultures; generate information about how different learners make clinical decisions; and evaluate the correlation of game scores with sepsis knowledge.This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License, where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially.

    View details for DOI 10.1097/ACM.0000000000000611

  • PHYSICIAN IDENTIFICATION AND PATIENT SATISFACTION IN THE EMERGENCY DEPARTMENT: ARE THEY RELATED? JOURNAL OF EMERGENCY MEDICINE Mercer, M. P., Hernandez-Boussard, T., Mahadevan, S. V., Strehlow, M. C. 2014; 46 (5): 711-718

    Abstract

    Patient satisfaction has become a quality indicator tracked closely by hospitals and emergency departments (EDs). Unfortunately, the primary factors driving patient satisfaction remain poorly studied. It has been suggested that correct physician identification impacts patient satisfaction in hospitalized patients, however, the limited studies that exist have demonstrated mixed results.In this study, we sought to identify factors associated with improved satisfaction among ED patients, and specifically, to test whether improving physician identification by patients would lead to increased satisfaction.We performed a pre- and postintervention, survey-based study of patients at the end of their ED visits. We compared patient satisfaction scores as well as patients' abilities to correctly identify their physicians over two separate 1-week periods: prior to and after introducing a multimedia presentation of the attending physicians into the waiting room.A total of 486 patients (25% of all ED visits) were enrolled in the study. In the combined study population, overall patient satisfaction was higher among patients who correctly identified their physicians than among those who could not identify their physicians (combined mean satisfaction score of 8.1 vs. 7.2; odds ratio [OR] 1.07). Overall satisfaction was also higher among parents or guardians of pediatric patients than among adult patients (satisfaction score of 8.4 vs. 7.4; OR 1.07), and among patients who experienced a shorter door-to-doctor time (satisfaction score of 8.2 for shorter waiting time vs. 5.6 for longer waiting time; OR 1.15). Ambulance patients showed decreased satisfaction over some satisfaction parameters, including physician courtesy and knowledge. No direct relationship was demonstrated between the study intervention (multimedia presentation) and improved patient satisfaction or physician identification.Improved patient satisfaction was found to be positively correlated with correct physician identification, shorter waiting times, and among the pediatric patient population. Further studies are needed to determine interventions that improve patients' abilities to identify their physicians and lower waiting times.

    View details for DOI 10.1016/j.jemermed.2013.08.036

    View details for PubMedID 24462030

  • INDIAN AND UNITED STATES PARAMEDIC STUDENTS: COMPARISON OF EXAMINATION PERFORMANCE FOR THE AMERICAN HEART ASSOCIATION ADVANCED CARDIOVASCULAR LIFE SUPPORT (ACLS) TRAINING JOURNAL OF EMERGENCY MEDICINE Goodwin, T., Delasobera, B. E., Strehlow, M., Camacho, J., Koskovich, M., D'Souza, P., Gilbert, G., Mahadevan, S. V. 2012; 43 (2): 298-302

    Abstract

    The American Heart Association (AHA) Advanced Cardiovascular Life Support (ACLS) course is taught worldwide. The ACLS course is designed for consistency, regardless of location; to our knowledge, no previous study has compared the cognitive performance of international ACLS students to those in the United States (US).As international health educational initiatives continue to expand, an assessment of their efficacy is essential. This study assesses the AHA ACLS curriculum in an international setting by comparing performance of a cohort of US and Indian paramedic students.First-year paramedic students at the Emergency Management and Research Institute, Hyderabad, India, and a cohort of first-year paramedic students from the United States comprised the study population. All study participants had successfully completed the standard 2-day ACLS course, taught in English. Each student was given a 40-question standardized AHA multiple-choice examination. Examination performance was calculated and compared for statistical significance.There were 117 Indian paramedic students and 43 US paramedic students enrolled in the study. The average score was 86% (± 11%) for the Indian students and 87% (± 6%) for the US students. The difference between the average examination scores was not statistically significant in an independent means t-test (p=0.508) and a Wilcoxon test (p=0.242).Indian paramedic students demonstrated excellent ACLS cognitive comprehension and performed at a level equivalent to their US counterparts on an AHA ACLS written examination. Based on the study results, the AHA ACLS course proved effective in an international setting despite being taught in a non-native language.

    View details for DOI 10.1016/j.jemermed.2011.05.096

    View details for PubMedID 22244286

  • National Survey of Preventive Health Services in US Emergency Departments Scientific Assembly of the American-College-of-Emergency-Physicians Delgado, M. K., Acosta, C. D., Ginde, A. A., Wang, N. E., Strehlow, M. C., Khandwala, Y. S., Camargo, C. A. MOSBY-ELSEVIER. 2011: 104–8

    Abstract

    We describe the availability of preventive health services in US emergency departments (EDs), as well as ED directors' preferred service and perceptions of barriers to offering preventive services.Using the 2007 National Emergency Department Inventory (NEDI)-USA, we randomly sampled 350 (7%) of 4,874 EDs. We surveyed directors of these EDs to determine the availability of (1) screening and referral programs for alcohol, tobacco, geriatric falls, intimate partner violence, HIV, diabetes, and hypertension; (2) vaccination programs for influenza and pneumococcus; and (3) linkage programs to primary care and health insurance. ED directors were asked to select the service they would most like to implement and to rate 5 potential barriers to offering preventive services.Two hundred seventy-seven EDs (80%) responded across 46 states. Availability of services ranged from 66% for intimate partner violence screening to 19% for HIV screening. ED directors wanted to implement primary care linkage most (17%) and HIV screening least (2%). ED directors "agreed/strongly agreed" that the following are barriers to ED preventive care: cost (74%), increased patient length of stay (64%), lack of follow-up (60%), resource shifting leading to worse patient outcomes (53%), and philosophical opposition (27%).Most US EDs offer preventive services, but availability and ED director preference for type of service vary greatly. The majority of EDs do not routinely offer Centers for Disease Control and Prevention-recommended HIV screening. Most ED directors are not philosophically opposed to offering preventive services but are concerned with added costs, effects on ED operations, and potential lack of follow-up.

    View details for DOI 10.1016/j.annemergmed.2010.07.015

    View details for Web of Science ID 000287464900007

    View details for PubMedID 20889237

    View details for PubMedCentralID PMC3538034

  • Evaluating the efficacy of simulators and multimedia for refreshing ACLS skills in India RESUSCITATION Delasobera, B. E., Goodwin, T. L., Strehlow, M., Gilbert, G., D'Souza, P., Alok, A., Raje, P., Mahadevan, S. V. 2010; 81 (2): 217-223

    Abstract

    Data on the efficacy of the simulation and multimedia teaching modalities is limited, particularly in developing nations. This study evaluates the effectiveness of simulator and multimedia educational tools in India.Advanced Cardiac Life Support (ACLS) certified paramedic students in India were randomized to either Simulation, Multimedia, or Reading for a 3-h ACLS refresher course. Simulation students received a lecture and 10 simulator cases. The Multimedia group viewed the American Heart Association (AHA) ACLS video and played a computer game. The Reading group independently read with an instructor present. Students were tested prior to (pre-test), immediately after (post-test), and 3 weeks after (short-term retention test), their intervention. During each testing stage subjects completed a cognitive, multiple-choice test and two cardiac arrest scenarios. Changes in exam performance were analyzed for significance. A survey was conducted asking students' perceptions of their assigned modality.One hundred and seventeen students were randomized to Simulation (n=39), Multimedia (n=38), and Reading (n=40). Simulation demonstrated greater improvement managing cardiac arrest scenarios compared to both Multimedia and Reading on the post-test (9% versus 5% and 2%, respectively, p<0.05) and Reading on the short-term retention test (6% versus -1%, p<0.05). Multimedia showed significant improvement on cognitive, short-term retention testing compared to Simulation and Reading (5% versus 0% and 0%, respectively, p<0.05). On the survey, 95% of Simulation and 84% of Multimedia indicated they enjoyed their modality.Simulation and multimedia educational tools were effective and may provide significant additive benefit compared to reading alone. Indian students enjoyed learning via these modalities.

    View details for DOI 10.1016/j.resuscitation.2009.10.013

    View details for Web of Science ID 000274982500014

    View details for PubMedID 19926385

  • Early Identification of Shock in Critically Ill Patients EMERGENCY MEDICINE CLINICS OF NORTH AMERICA Strehlow, M. C. 2010; 28 (1): 57-?

    Abstract

    Emergency providers must be experts in the resuscitation and stabilization of critically ill patients, and the rapid recognition of shock is crucial to allow aggressive targeted intervention and reduce morbidity and mortality. This article reviews the physiologic definition of shock, the importance of early intervention, and the clinical and diagnostic signs that emergency department providers can use to identify patients in shock.

    View details for DOI 10.1016/j.emc.2009.09.006

    View details for Web of Science ID 000278319500005

    View details for PubMedID 19945598

  • A better way to estimate adult patients' weights AMERICAN JOURNAL OF EMERGENCY MEDICINE Lin, B. W., Yoshida, D., Quinn, J., Strehlow, M. 2009; 27 (9): 1060-1064

    Abstract

    In the emergency department (ED), adult patients' weights are often crudely estimated before lifesaving interventions. In this study, we evaluate the reliability and accuracy of a method to rapidly calculate patients' weight using readily obtainable anthropometric measurements. We compare this method to visual estimates, patient self-report, and measured weight.A convenience sample of adult ED patients in an academic medical center were prospectively enrolled. Midarm circumference and knee height were measured. These values were input in to equations to calculate patients' weights. A physician and nurse were then independently asked to estimate the patients' weights. Each patient was asked to report his/her own weight before being weighed. Calculated weights using the above equations, visual estimates, and patient reports were compared with actual weights by determining the percentage accurate within 10%. The intraclass correlation coefficient was used to determine the reliability of the estimates with respect to actual weights.Weight was determined within 10% accuracy of actual weight in 69% (95% confidence interval, 63-75) of calculated estimates, 54% (48-61) of physician estimates, 51% (44-57) of nurse estimates, and 86% (81-90) of patient estimates. The weight estimation tool calculated weights more accurately in males (74%, 65-82) than females (65%, 56-73). An analysis of errors revealed that when estimates were inaccurate, approximately half were overestimates and half were underestimates. The correlation coefficient between the calculated estimates and actual weights was 0.89. The correlation coefficient of actual weights with respect to physician estimates, nurse estimates, and doctor's estimates were 0.85, 0.78, and 0.95, respectively.This technique using readily obtainable measurements estimates weight more accurately than ED providers. The technique correlates well with actual patient weights. When available, patient estimates of their own weight are most accurate.

    View details for DOI 10.1016/j.ajem.2008.08.018

    View details for Web of Science ID 000272403400006

    View details for PubMedID 19931751

  • Internationalizing the Broselow tape: How reliable is weight estimation in Indian children Conference of the Western-Society-for-Academic-Emergency-Medicine Ramarajan, N., Krishnamoorthi, R., Strehlow, M., Quinn, J., Mahadevan, S. V. WILEY-BLACKWELL PUBLISHING, INC. 2008: 431–36

    Abstract

    The Broselow pediatric emergency weight estimation tape is an accurate method of estimating children's weights based on height-weight correlations and determining standardized medication dosages and equipment sizes using color-coded zones. The study objective was to determine the accuracy of the Broselow tape in the Indian pediatric population.The authors conducted a 6-week prospective cross-sectional study of 548 children at a government pediatric hospital in Chennai, India, in three weight-based groups: < 10 kg (n = 175), 10-18 kg (n = 197), and > 18 kg (n = 176). Measured weight was compared to Broselow-predicted weight, and the percentage difference was calculated. Accuracy was defined as agreement on Broselow color-coded zones, as well as agreement within 10% between the measured and Broselow-predicted weights. A cross-validated correction factor was also derived.The mean percentage differences were -2.4, -11.3, and -12.9% for each weight-based group. The Broselow color-coded zone agreement was 70.8% in children weighing less than 10 kg, but only 56.3% in the 10- to 18-kg group and 37.5% in the > 18-kg group. Agreement within 10% was 52.6% for the < 10-kg group, but only 44.7% for the 10- to 18-kg group and 33.5% for the > 18-kg group. Application of a 10% weight-correction factor improved the percentages to 77.1% for the 10- to 18-kg group and 63.0% for the >18-kg group.The Broselow tape overestimates weight by more than 10% in Indian children > 10 kg. Weight overestimation increases the risk of medical errors due to incorrect dosing or equipment selection. Applying a 10% weight-correction factor may be advisable.

    View details for DOI 10.1111/j.1553-2712.2008.00081.x

    View details for PubMedID 18439198

  • Images in emergency medicine - Diagnosis: Serum sickness-like reaction to amoxicillin ANNALS OF EMERGENCY MEDICINE Lin, B., Strehlow, M. 2007; 50 (3): 350-?
  • National study of emergency department visits for sepsis, 1992 to 2001 Scientific Assembly of the American-College-of-Emergency-Physicians Strehlow, M. C., Emond, S. D., Shapiro, N. I., Pelletier, A. J., Camargo, C. A. MOSBY-ELSEVIER. 2006: 326–31

    Abstract

    Epidemiologic data on emergency department (ED) patients with sepsis are limited. Inpatient discharge records from 1979 to 2000 show that hospitalizations for sepsis are increasing. We examine the epidemiology of sepsis in US EDs and the hypothesis that sepsis visits are increasing.The National Hospital Ambulatory Medical Care Survey data (1992 to 2001) provided nationally representative estimates of frequency and disposition in adult ED visits for sepsis. Sepsis visits were identified using International Classification of Diseases, Ninth Revision, Clinical Modification codes; severe sepsis was defined as sepsis in conjunction with organ failure.Of 712 million adult visits during the 10-year period, approximately 2.8 million (0.40%, 95% confidence interval [CI] 0.33% to 0.46%) were related to sepsis. We found no significant increase in overall ED visits for sepsis from 1992 to 2001 (P for trend=.09). ED patients with sepsis were more likely to be elderly, non-Hispanic, and publicly insured and to arrive by ambulance compared with nonsepsis patients (all P<.01). The overall admission rate was 87% (95% CI 82% to 92%), with only 12% (95% CI 8% to 16%) of patients admitted to the ICU. The most frequent codiagnoses were pneumonia (13%), urinary tract infection (13%), and dehydration (11%). Severe sepsis accounted for 8% (95% CI 5% to 11%) of sepsis visits, for an annual incidence of 0.01%; 98% of patients with severe sepsis were admitted.In contrast to data from hospital discharges, ED visits for sepsis demonstrated no increase. Most ED visits for sepsis resulted in admission to non-critical care units.

    View details for DOI 10.1016/j.annemergmed.2006.05.003

    View details for Web of Science ID 000240256400016

    View details for PubMedID 16934654

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