Bio

Bio


Dr. Jennifer A. Newberry is a Clinical Assistant Professor at Stanford University. She earned her law degree and medical degree from the University of Chicago. After graduating from residency at Stanford, she completed a fellowship in Social Emergency Medicine and Population Health. Dr. Newberry?s interest in social justice and popluation health led to her current work in global health and emergency medicine. She is currently the Research Director for Stanford Emergency Medicine International (SEMI). Dr. Newberry runs the Online Medical Research program, a collaboration between SEMI and the largest ambulance service in the world (GVK EMRI), collecting data across nine states on the epidemiology of emergency medical complaints in the prehospital setting. Dr. Newberry?s current research seeks to understand how to strengthen crisis support systems in developing countries for women experiencing gender-based violence and/or other medical emergencies.

Clinical Focus


  • Emergency Medicine
  • Gender-based violence
  • Gender disparities in emergency care and outcomes

Academic Appointments


Administrative Appointments


  • Co-Medical Director, Peninsula Family Advocacy Program, A Medical Legal Partnership (2014 - 2017)

Honors & Awards


  • Fellow, American College of Emergency Physicians (ACEP) (10/2016-present)
  • Stanford Health Care Innovation Challenge Program Grant, Spectrum (1/2015-1/2016)
  • KL2 Mentored Career Development Award, Spectrum (7/1/2016)

Boards, Advisory Committees, Professional Organizations


  • Member, Expert Panel on Population Health in Medical Education, Association of American Medical Colleges (2015 - 2016)
  • Fellow, Center for Innovation in Global Health (2015 - Present)
  • Advisory Board Member, Peninsula Family Advocacy Program (2013 - 2016)
  • Member, Medical-Legal Partnership Bay Area Coalition (2013 - 2017)
  • Member, Bay Area Regional Help Desk Consortium (2013 - 2015)
  • Member, American Academy of Emergency Medicine (2010 - Present)
  • Member, Society for Academic Emergency Medicine (2010 - Present)
  • Member, American College of Emergency Physicians (2009 - Present)

Professional Education


  • MSc, Stanford University, Epidemiology and Clinical Research (2018)
  • Board Certification: Emergency Medicine, American Board of Emergency Medicine (2014)
  • Fellow, Division of Emergency Medicine, Department of Surgery, Stanford School of Medicine, Social Emergency Medicine and Population Health (2014)
  • Residency: Stanford University Medical Center (2013) CA
  • Medical Education: Pritzker School of Medicine University of Chicago Registrar (2010) IL
  • JD, University of Chicago Law School, Law (2008)

Research & Scholarship

Current Research and Scholarly Interests


Interests include global emergency medicine research, emergency obstetric and neonatal care in low- and middle-income countries, gender-based violence, and the intersection of emergency medicine, social justice, and development goals.

Projects


  • Online Medical Research Program

    Analysis of prospectively collected real-time data from EMS runs to identify epidemiology of emergency medical conditions and care in the prehospital setting.

    Location

    India

  • Utilization of a Novel Emergency Response Service for Gender-Based Violence in Gujarat, India

    1) Retrospective analysis of a women's helpline using traditional qualitative methods and AI; 2) In-depth interviews with helpline users to understand help seeking choices, service expectations, and needs

    Location

    India

  • Pediatric Utilization of EMS in India

    Analysis of a transport of pediatric patients across several states in India from 2013-2015

    Location

    India

Teaching

2019-20 Courses


Stanford Advisees


Publications

All Publications


  • 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

  • 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

  • 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

  • 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

  • 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

  • Emergency care research ethics in low-income and middle-income countries. BMJ global health Millum, J., Beecroft, B., Hardcastle, T. C., Hirshon, J. M., Hyder, A. A., Newberry, J. A., Saenz, C. 2019; 4 (Suppl 6): e001260

    Abstract

    A large proportion of the total global burden of disease is caused by emergency medical conditions. Emergency care research is essential to improving emergency medicine but this research can raise some distinctive ethical challenges, especially with regard to (1) standard of care and risk-benefit assessment; (2) blurring of the roles of clinician and researcher; (3) enrolment of populations with intersecting vulnerabilities; (4) fair participant selection; (5) quality of consent; and (6) community engagement. Despite the importance of research to improve emergency care in low-income and middle-income countries (LMICs) and the widely acknowledged ethical challenges, very little has been written on the ethics of emergency care research in LMICs. This paper examines the ethical and regulatory challenges to conducting emergency care research with human participants in LMICs. We outline key challenges, present potential solutions or frameworks for addressing these challenges, and identify gaps. Despite the ethical and regulatory challenges, conducting high-quality, ethical emergency care research in LMICs is possible and it is essential for global health.

    View details for DOI 10.1136/bmjgh-2018-001260

    View details for PubMedID 31406598

  • 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

  • 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

  • Global Health and Emergency Care: Defining Clinical Research Priorities. Academic emergency medicine Hansoti, B., Aluisio, A. R., Barry, M. A., Davey, K., Lentz, B. A., Modi, P., Newberry, J. A., Patel, M. H., Smith, T. A., Vinograd, A. M., Levine, A. C. 2017

    Abstract

    Despite recent strides in the development of global emergency medicine (EM), the field continues to lag in applying a scientific approach to identifying critical knowledge gaps and advancing evidence-based solutions to clinical and public health problems seen in emergency departments (EDs) worldwide. Here, progress on the global EM research agenda created at the 2013 Academic Emergency Medicine Global Health and Emergency Care Consensus Conference is evaluated and critical areas for future development in emergency care research internationally are identified.A retrospective review of all studies compiled in the Global Emergency Medicine Literature Review (GEMLR) database from 2013 through 2015 was conducted. Articles were categorized and analyzed using descriptive quantitative measures and structured data matrices. The Global Emergency Medicine Think Tank Clinical Research Working Group at the Society for Academic Emergency Medicine 2016 Annual Meeting then further conceptualized and defined global EM research priorities utilizing consensus-based decision making.Research trends in global EM research published between 2013 and 2015 show a predominance of observational studies relative to interventional or descriptive studies, with the majority of research conducted in the inpatient setting in comparison to the ED or prehospital setting. Studies on communicable diseases and injury were the most prevalent, with a relative dearth of research on chronic noncommunicable diseases. The Global Emergency Medicine Think Tank Clinical Research Working Group identified conceptual frameworks to define high-impact research priorities, including the traditional approach of using global burden of disease to define priorities and the impact of EM on individual clinical care and public health opportunities. EM research is also described through a population lens approach, including gender, pediatrics, and migrant and refugee health.Despite recent strides in global EM research and a proliferation of scholarly output in the field, further work is required to advocate for and inform research priorities in global EM. The priorities outlined in this paper aim to guide future research in the field, with the goal of advancing the development of EM worldwide.

    View details for DOI 10.1111/acem.13158

    View details for PubMedID 28103632

  • Addressing Social Determinants of Health from the Emergency Department through Social Emergency Medicine. The western journal of emergency medicine Anderson, E. S., Lippert, S., Newberry, J., Bernstein, E., Alter, H. J., Wang, N. E. 2016; 17 (4): 487-489

    View details for DOI 10.5811/westjem.2016.5.30240

    View details for PubMedID 27429706

  • 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): 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

  • Social determinants of health from the emergency department: The practice of social emergency medicine WestJEM Anderson, E. S., Lippert, S., Newberry, J. A., Bernstien, E., Alter, H. J., Wang, N. E. 2016: 487?89
  • 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

  • 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

  • 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

  • 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

  • Image diagnosis: Perilunate and lunate dislocations. The Permanente journal Newberry, J. A., Garmel, G. M. 2012; 16 (1): 70-71

    View details for PubMedID 22529764

    View details for PubMedCentralID PMC3327118

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