Bio

Clinical Focus


  • Emergency Medicine

Academic Appointments


Administrative Appointments


  • EM Clerkship Director, Stanford University (2002 - Present)
  • POM Emed Procedures Associate Director, Stanford University (2003 - Present)
  • Paramedic Training Medical Director, National University - WestMed Training Facility (2004 - Present)
  • LifeFlight Medical Director, Stanford LifeFlight (2005 - Present)
  • EMS/Disaster Fellowship Director, Stanford University/Santa Clara County EMS (2006 - Present)
  • EMRI - Assistant Director, Emergency Management and Research Institute, Andhra Pradesh, India (2007 - 2009)
  • Biodesign Faculty - Assistant Director, Stanford University (2008 - Present)
  • EMS Medical Director, San Mateo (2008 - Present)

Honors & Awards


  • STAR Award, Stanford Emergency Department (2007)
  • Quarterly Bedside Teaching Award, Stanford-Kaiser Emergency Medicine Residency (2005)
  • Yearly Bedside Teaching Award, Stanford-Kaiser Emergency Medicine Residency (2004)
  • Preclinical Teaching Award, Henry J. Kaiser (2004)
  • Innovations in Emergency Medicine Exhibit (IEME) Award, Society for Academic Emergency Medicine (SAEM) (2003)
  • Save of the Month, Stanford Emergency Department (2002)
  • Excellence in Clinical Service Award, Stanford Emergency Department (2002)
  • Resident of the Year Award, Emory University/Pfizer (2001)
  • Outstanding Teaching Resident, Emory Medical School (2000)

Professional Education


  • Residency:Emory University Hospital Emergency Medicine Residency (2001) GA
  • Internship:Emory University Hospital Emergency Medicine Residency (1999) GA
  • Medical Education:SUNY Downstate College of Medicine (1998) NY
  • Board Certification: Emergency Medicine, American Board of Emergency Medicine (2002)
  • EM, Emory University, Emergency Medicine (2001)
  • MD, SUNY HSC-Brooklyn, Medicine (1998)
  • BS, SUNY Geneseo, Biochemistry (1994)

Research & Scholarship

Current Research and Scholarly Interests


Interested in education and different modalities to perform education. In addition, interested in different aspects of pre-hospital and disaster medicine. Currently looking into CPR education in the pre-hospital setting.

Teaching

2019-20 Courses


Publications

All Publications


  • A simple decision rule predicts futile resuscitation of out-of-hospital cardiac arrest. Resuscitation Glober, N. K., Tainter, C. R., Abramson, T. M., Staats, K., Gilbert, G., Kim, D. 2019

    Abstract

    Resuscitation of cardiac arrest involves invasive and traumatic interventions and places a large burden on limited EMS resources. Our aim was to identify prehospital cardiac arrests for which resuscitation is extremely unlikely to result in survival to hospital discharge.We performed a retrospective cohort analysis of all cardiac arrests in San Mateo County, California, for which paramedics were dispatched, from January 1, 2015 to December 31, 2018, using the Cardiac Arrest Registry to Enhance Survival (CARES) database. We described characteristics of patients, arrests, and EMS responses, and used recursive partitioning to develop decision rules to identify arrests unlikely to survive to hospital discharge, or to survive with good neurologic function.From 2015-2018, 1750 patients received EMS dispatch for cardiac arrest in San Mateo County. We excluded 44 patients for whom resuscitation was terminated due to DNR directives. Median age was 69 years (IQR 57 - 81), 563 (33.0%) patients were female, 816 (47.8%) had witnessed arrests, 651 (38.2%) received bystander CPR, 421 (24.7%) had an initial shockable rhythm, and 1178 (69.1%) arrested at home. A simple rule (non-shockable initial rhythm, unwitnessed arrest, and age 80 or greater) excludes 223 (13.1%) arrests, of whom none survived to hospital discharge.A simple decision rule (non-shockable rhythm, unwitnessed arrest, age ? 80) identifies arrests for which resuscitation is futile. If validated, this rule could be applied by EMS policymakers to identify cardiac arrests for which the trauma and expense of resuscitation are extremely unlikely to result in survival.

    View details for DOI 10.1016/j.resuscitation.2019.06.011

    View details for PubMedID 31228547

  • Altered Mental Status: Current Evidence-based Recommendations for Prehospital Care WESTERN JOURNAL OF EMERGENCY MEDICINE Sanello, A., Gausche-Hill, M., Mulkerin, W., Sporer, K. A., Brown, J. F., Koenig, K. L., Rudnick, E. M., Salvucci, A. A., Gilbert, G. H. 2018; 19 (3): 527?41

    Abstract

    In the United States emergency medical services (EMS) protocols vary widely across jurisdictions. We sought to develop evidence-based recommendations for the prehospital evaluation and treatment of a patient with an acute change in mental status and to compare these recommendations against the current protocols used by the 33 EMS agencies in the State of California.We performed a literature review of the current evidence in the prehospital treatment of a patient with altered mental status (AMS) and augmented this review with guidelines from various national and international societies to create our evidence-based recommendations. We then compared the AMS protocols of each of the 33 EMS agencies for consistency with these recommendations. The specific protocol components that we analyzed were patient assessment, point-of-care tests, supplemental oxygen, use of standardized scoring, evaluating for causes of AMS, blood glucose evaluation, toxicological treatment, and pediatric evaluation and management.Protocols across 33 EMS agencies in California varied widely. All protocols call for a blood glucose check, 21 (64%) suggest treating adults at <60mg/dL, and half allow for the use of dextrose 10%. All the protocols recommend naloxone for signs of opioid overdose, but only 13 (39%) give specific parameters. Half the agencies (52%) recommend considering other toxicological causes of AMS, often by using the mnemonic AEIOU TIPS. Eight (24%) recommend a 12-lead electrocardiogram; others simply suggest cardiac monitoring. Fourteen (42%) advise supplemental oxygen as needed; only seven (21%) give specific parameters. In terms of considering various etiologies of AMS, 25 (76%) give instructions to consider trauma, 20 (61%) to consider stroke, and 18 (55%) to consider seizure. Twenty-three (70%) of the agencies have separate pediatric AMS protocols; others include pediatric considerations within the adult protocol.Protocols for patients with AMS vary widely across the State of California. The evidence-based recommendations that we present for the prehospital diagnosis and treatment of this condition may be useful for EMS medical directors tasked with creating and revising these protocols.

    View details for PubMedID 29760852

  • Prehospital Care for the Adult and Pediatric Seizure Patient: Current Evidence-based Recommendations. The western journal of emergency medicine Silverman, E. C., Sporer, K. A., Lemieux, J. M., Brown, J. F., Koenig, K. L., Gausche-Hill, M., Rudnick, E. M., Salvucci, A. A., Gilbert, G. H. 2017; 18 (3): 419-436

    Abstract

    We sought to develop evidence-based recommendations for the prehospital evaluation and treatment of adult and pediatric patients with a seizure and to compare these recommendations against the current protocol used by the 33 emergency medical services (EMS) agencies in California.We performed a review of the evidence in the prehospital treatment of patients with a seizure, and then compared the seizure protocols of each of the 33 EMS agencies for consistency with these recommendations. We analyzed the type and route of medication administered, number of additional rescue doses permitted, and requirements for glucose testing prior to medication. The treatment for eclampsia and seizures in pediatric patients were analyzed separately.Protocols across EMS Agencies in California varied widely. We identified multiple drugs, dosages, routes of administration, re-dosing instructions, and requirement for blood glucose testing prior to medication delivery. Blood glucose testing prior to benzodiazepine administration is required by 61% (20/33) of agencies for adult patients and 76% (25/33) for pediatric patients. All agencies have protocols for giving intramuscular benzodiazepines and 76% (25/33) have protocols for intranasal benzodiazepines. Intramuscular midazolam dosages ranged from 2 to 10 mg per single adult dose, 2 to 8 mg per single pediatric dose, and 0.1 to 0.2 mg/kg as a weight-based dose. Intranasal midazolam dosages ranged from 2 to 10 mg per single adult or pediatric dose, and 0.1 to 0.2 mg/kg as a weight-based dose. Intravenous/intrasosseous midazolam dosages ranged from 1 to 6 mg per single adult dose, 1 to 5 mg per single pediatric dose, and 0.05 to 0.1 mg/kg as a weight-based dose. Eclampsia is specifically addressed by 85% (28/33) of agencies. Forty-two percent (14/33) have a protocol for administering magnesium sulfate, with intravenous dosages ranging from 2 to 6 mg, and 58% (19/33) allow benzodiazepines to be administered.Protocols for a patient with a seizure, including eclampsia and febrile seizures, vary widely across California. These recommendations for the prehospital diagnosis and treatment of seizures may be useful for EMS medical directors tasked with creating and revising these protocols.

    View details for DOI 10.5811/westjem.2016.12.32066

    View details for PubMedID 28435493

  • Acute Stroke: Current Evidence-based Recommendations for Prehospital Care WESTERN JOURNAL OF EMERGENCY MEDICINE Glober, N. K., Sporer, K. A., Guluma, K. Z., Serra, J. P., Barger, J. A., Brown, J. F., Gilbert, G. H., Koenig, K. L., Rudnick, E. M., Salvucci, A. A. 2016; 17 (4): 104?28

    Abstract

    In the United States, emergency medical services (EMS) protocols vary widely across jurisdictions. We sought to develop evidence-based recommendations for the prehospital evaluation and treatment of a patient with a suspected stroke and to compare these recommendations against the current protocols used by the 33 EMS agencies in the state of California.We performed a literature review of the current evidence in the prehospital treatment of a patient with a suspected stroke and augmented this review with guidelines from various national and international societies to create our evidence-based recommendations. We then compared the stroke protocols of each of the 33 EMS agencies for consistency with these recommendations. The specific protocol components that we analyzed were the use of a stroke scale, blood glucose evaluation, use of supplemental oxygen, patient positioning, 12-lead electrocardiogram (ECG) and cardiac monitoring, fluid assessment and intravenous access, and stroke regionalization.Protocols across EMS agencies in California varied widely. Most used some sort of stroke scale with the majority using the Cincinnati Prehospital Stroke Scale (CPSS). All recommended the evaluation of blood glucose with the level for action ranging from 60 to 80 mg/dL. Cardiac monitoring was recommended in 58% and 33% recommended an ECG. More than half required the direct transport to a primary stroke center and 88% recommended hospital notification.Protocols for a patient with a suspected stroke vary widely across the state of California. The evidence-based recommendations that we present for the prehospital diagnosis and treatment of this condition may be useful for EMS medical directors tasked with creating and revising these protocols.

    View details for PubMedID 26973735

  • Chest Pain of Suspected Cardiac Origin: Current Evidence-based Recommendations for Prehospital Care. The western journal of emergency medicine Savino, P. B., Sporer, K. A., Barger, J. A., Brown, J. F., Gilbert, G. H., Koenig, K. L., Rudnick, E. M., Salvucci, A. A. 2015; 16 (7): 983?95

    Abstract

    In the United States, emergency medical services (EMS) protocols vary widely across jurisdictions. We sought to develop evidence-based recommendations for the prehospital evaluation and treatment of chest pain of suspected cardiac origin and to compare these recommendations against the current protocols used by the 33 EMS agencies in the state of California.We performed a literature review of the current evidence in the prehospital treatment of chest pain and augmented this review with guidelines from various national and international societies to create our evidence-based recommendations. We then compared the chest pain protocols of each of the 33 EMS agencies for consistency with these recommendations. The specific protocol components that we analyzed were use of supplemental oxygen, aspirin, nitrates, opiates, 12-lead electrocardiogram (ECG), ST segment elevation myocardial infarction (STEMI) regionalization systems, prehospital fibrinolysis and ?-blockers.The protocols varied widely in terms of medication and dosing choices, as well as listed contraindications to treatments. Every agency uses oxygen with 54% recommending titrated dosing. All agencies use aspirin (64% recommending 325 mg, 24% recommending 162 mg and 15% recommending either), as well as nitroglycerin and opiates (58% choosing morphine). Prehospital 12-Lead ECGs are used in 97% of agencies, and all but one agency has some form of regionalized care for their STEMI patients. No agency is currently employing prehospital fibrinolysis or ?-blocker use.Protocols for chest pain of suspected cardiac origin vary widely across California. The evidence-based recommendations that we present for the prehospital diagnosis and treatment of this condition may be useful for EMS medical directors tasked with creating and revising these protocols.

    View details for DOI 10.5811/westjem.2015.8.27971

    View details for PubMedID 26759642

    View details for PubMedCentralID PMC4703143

  • Drive-Through Medicine: A Novel Proposal for Rapid Evaluation of Patients During an Influenza Pandemic ANNALS OF EMERGENCY MEDICINE Weiss, E. A., Ngo, J., Gilbert, G. H., Quinn, J. V. 2010; 55 (3): 268-273

    Abstract

    During a pandemic, emergency departments (EDs) may be overwhelmed by an increase in patient visits and will foster an environment in which cross-infection can occur. We developed and tested a novel drive-through model to rapidly evaluate patients while they remain in or adjacent to their vehicles. The patient's automobile would provide a social distancing strategy to mitigate the person-to-person spread of infectious diseases.We conducted a full-scale exercise to test the feasibility of a drive-through influenza clinic and measure throughput times of simulated patients and carbon monoxide levels of staff. We also assessed the disposition decisions of the physicians who participated in the exercise. Charts of 38 patients with influenza-like illness who were treated in the Stanford Hospital ED during the initial H1N1 outbreak in April 2009 were used to create 38 patient scenarios for the drive-through influenza clinic.The total median length of stay was 26 minutes. During the exercise, physicians were able to identify those patients who were admitted and discharged during the real ED visit with 100% accuracy (95% confidence interval 91% to 100%). There were no significant increases of carboxyhemoglobin in participants tested.The drive-through model is a feasible alternative to a traditional walk-in ED or clinic and is associated with rapid throughput times. It provides a social distancing strategy, using the patient's vehicle as an isolation compartment to mitigate person-to-person spread of infectious diseases.

    View details for DOI 10.1016/j.annemergmed.2009.11.025

    View details for PubMedID 20079956

  • 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

  • Characteristics of Pediatric Trauma Transfers to a Level I Trauma Center: Implications for Developing a Regionalized Pediatric Trauma System in California ACADEMIC EMERGENCY MEDICINE Acosta, C. D., Delgado, M. K., Gisondi, M. A., Raghunathan, A., D'Souza, P. A., Gilbert, G., Spain, D. A., Christensen, P., Wang, N. E. 2010; 17 (12): 1364-1373

    Abstract

    since California lacks a statewide trauma system, there are no uniform interfacility pediatric trauma transfer guidelines across local emergency medical services (EMS) agencies in California. This may result in delays in obtaining optimal care for injured children.this study sought to understand patterns of pediatric trauma patient transfers to the study trauma center as a first step in assessing the quality and efficiency of pediatric transfer within the current trauma system model. Outcome measures included clinical and demographic characteristics, distances traveled, and centers bypassed. The hypothesis was that transferred patients would be more severely injured than directly admitted patients, primary catchment transfers would be few, and out-of-catchment transfers would come from hospitals in close geographic proximity to the study center.this was a retrospective observational analysis of trauma patients ? 18 years of age in the institutional trauma database (2000-2007). All patients with a trauma International Classification of Diseases, 9th revision (ICD-9) code and trauma mechanism who were identified as a trauma patient by EMS or emergency physicians were recorded in the trauma database, including those patients who were discharged home. Trauma patients brought directly to the emergency department (ED) and patients transferred from other facilities to the center were compared. A geographic information system (GIS) was used to calculate the straight-line distances from the referring hospitals to the study center and to all closer centers potentially capable of accepting interfacility pediatric trauma transfers.of 2,798 total subjects, 16.2% were transferred from other facilities within California; 69.8% of transfers were from the catchment area, with 23.0% transferred from facilities ? 10 miles from the center. This transfer pattern was positively associated with private insurance (risk ratio [RR] = 2.05; p < 0.001) and negatively associated with age 15-18 years (RR = 0.23; p = 0.01) and Injury Severity Score (ISS)?> 18 (RR = 0.26; p < 0.01). The out-of-catchment transfers accounted for 30.2% of the patients, and 75.9% of these noncatchment transfers were in closer proximity to another facility potentially capable of accepting pediatric interfacility transfers. The overall median straight-line distance from noncatchment referring hospitals to the study center was 61.2 miles (IQR = 19.0-136.4), compared to 33.6 miles (IQR = 13.9-61.5) to the closest center. Transfer patients were more severely injured than directly admitted patients (p < 0.001). Out-of-catchment transfers were older than catchment patients (p < 0.001); ISS > 18 (RR = 2.06; p < 0.001) and age 15-18 (RR = 1.28; p < 0.001) were predictive of out-of-catchment patients bypassing other pediatric-capable centers. Finally, 23.7% of pediatric trauma transfer requests to the study institution were denied due to lack of bed capacity.from the perspective an adult Level I trauma center with a certified pediatric intensive care unit (PICU), delays in definitive pediatric trauma care appear to be present secondary to initial transport to nontrauma community hospitals within close proximity of a trauma hospital, long transfer distances to accepting facilities, and lack of capacity at the study center. Given the absence of uniform trauma triage and transfer guidelines across state EMS systems, there appears to be a role for quality monitoring and improvement of the current interfacility pediatric trauma transfer system, including defined triage, transfer, and data collection protocols.

    View details for DOI 10.1111/j.1553-2712.2010.00926.x

    View details for PubMedID 21122022

  • 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

  • Digital necrosis necessitating amputation after tube gauze dressing application in the ED AMERICAN JOURNAL OF EMERGENCY MEDICINE Norris, R. L., Gilbert, G. H. 2006; 24 (5): 618-621

    View details for DOI 10.1016/j.ajem.2005.12.009

    View details for PubMedID 16938605

  • Emergency department orientation utilizing web-based streaming video ACADEMIC EMERGENCY MEDICINE Mahadevan, S. V., Gisondi, M. A., Sovndal, S. S., Gilbert, G. H. 2004; 11 (8): 848-852

    Abstract

    To assure a smooth transition to their new work environment, rotating students and housestaff require detailed orientations to the physical layout and operations of the emergency department. Although such orientations are useful for new staff members, they represent a significant time commitment for the faculty members charged with this task. To address this issue, the authors developed a series of short instructional videos that provide a comprehensive and consistent method of emergency department orientation. The videos are viewed through Web-based streaming technology that allows learners to complete the orientation process from any computer with Internet access before their first shift. This report describes the stepwise process used to produce these videos and discusses the potential benefits of converting to an Internet-based orientation system.

    View details for DOI 10.1197/j.aem.2003.10.032

    View details for PubMedID 15289191

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