Current Research and Scholarly Interests
Emergency Care Epidemiology
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. 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. Additionally, I have researched the causes and presentations of emergencies in Cambodia, Nepal, Pakistan, and Uganda.
Maternal Child Newborn and Adolescent Health
In HICs only a few mothers and newborns access care through EMS however, in a number of LMICs fledging EMS systems are becoming critical access mechanisms for pregnant women and infants. In India for example, nearly 40% of the millions of calls to EMS annually are for pregnant women and newborns. Further, we have very little understanding of how the different levels of the public hospital system integrate to form a continuous network of care and the role the private healthcare system plays. We received 7 years of USAID funding focused on maternal child health to strengthen the emergency care and referral system in Cambodia. Our program helped launch national EMS guidelines, standardized triage and EMS protocols, an integrated hospital referral network for pregnant women across one half the country, and stabilization and referral training for healthcare workers at over 650 health centers and hospitals. We continue to study how the maternal and newborn referral network impacts outcomes.
Intimate Partner Violence and Gender Equity
Working at the intersection of emergency care and maternal child health in LMICs has led me to explore how EMS can serve as critical access points for victims of intimate partner violence (IPV). As we researched the epidemiology of medical emergencies across South and Southeast Asia, we identified that a substantial percentage of individuals seeking emergency care were victims of IPV. These victims were presenting with a variety of life-threatening conditions such as poisonings, severe burns, and traumatic injuries. Our work prompted the State Government of Gujarat in India to launch a novel women’s helpline operated by our EMS partner and supported by the police, Home Department, and local NGOs. Our team has analyzed the reach and impact of this helpline working to refine its operations. In conjunction with my partners, I aim to advance our understanding of helpseeking behavior for victims of IPV with a focus on marginalized and minority communities.
Inservice Training of Healthcare Workers
Strengthening healthcare delivery requires a better understanding of how to train healthcare workers. While billions of dollars are spent annually on training healthcare workers across the globe little evidence exists on how to effectively reach and train healthcare workers in lower resource settings. We have utilized a number of different approaches depending on learner, resources, and local environment. With each of these we have advanced our understanding of how learners with different training backgrounds, cultures, and resources learn. Currently, to combat the COVID-19 pandemic we worked in partnership with Digital Medic to develop a massive open online course for bedside healthcare workers.