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Hexom BJ, Quao NSA, Bandolin NS, Bonney J, Collier A, Dyal J, Lee JA, Nicholson BD, Rybarczyk MM, Rees CA, Roy CM, Bhaskar N, Kivlehan SM. Global Emergency Medicine: A Scoping Review of the Literature from 2022. Acad Emerg Med 2024; 31:71-85. [PMID: 37813813 DOI: 10.1111/acem.14816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 10/01/2023] [Accepted: 10/02/2023] [Indexed: 10/11/2023]
Abstract
OBJECTIVE The objective was to identify the highest quality global emergency medicine (GEM) research published in 2022. The top articles are compiled in a comprehensive list of all the year's GEM articles and narrative summaries are performed on those included. METHODS A systematic PubMed search was conducted to identify all GEM articles published in 2022 and included a manual supplemental screen of 11 organizational websites for gray literature (GRAY). A team of trained reviewers and editors screened all identified titles and abstracts, based on three case definition categories: disaster and humanitarian response (DHR), emergency care in resource-limited settings (ECRLS), and emergency medicine development (EMD). Articles meeting these definitions were independently scored by two reviewers using rubrics for original research (OR), review (RE) articles, and GRAY. Articles that scored in the top 5% from each category as well as the overall top 5% of articles were included for narrative summary. RESULTS The 2022 search identified 58,510 articles in the main review, of which 524 articles screened in for scoring, respectively, 30% and 18% increases from last year. After duplicates were removed, 36 articles were included for narrative summary. The GRAY search identified 7755 articles, of which 33 were scored and one was included for narrative summary. ECRLS remained the largest category (27; 73%), followed by DHR (7; 19%) and EMD (3; 8%). OR articles remained more common than RE articles (64% vs. 36%). CONCLUSIONS The waning of the COVID-19 pandemic has not affected the continued growth in GEM literature. Articles related to prehospital care, mental health and resilience among patients and health care workers, streamlining pediatric infectious disease care, and disaster preparedness were featured in this year's review. The continued lack of EMD studies despite the global growth of GEM highlights a need for more scholarly dissemination of best practices.
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Affiliation(s)
- Braden J Hexom
- Department of Emergency Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Nana Serwaa A Quao
- Department of Emergency Medicine, Accident and Emergency Centre, Korle Bu Teaching Hospital, Accra, Ghana
| | - N Shakira Bandolin
- Department of Emergency Medicine, University of California, Davis, California, USA
| | - Joseph Bonney
- Department of Emergency Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana
- Global Health and Infectious Disease Research Group, Kumasi Center for Collaborative Research in Tropical Medicine, Kumasi, Ghana
| | - Amanda Collier
- Department of Emergency Medicine, Queen's University, Kingston, Ontario, Canada
- Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Jonathan Dyal
- Department of Emergency Medicine, University of Texas, Houston, Texas, USA
| | - J Austin Lee
- Department of Emergency Medicine, Brown University, Providence, Rhode Island, USA
| | - Benjamin D Nicholson
- Department of Emergency Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Megan M Rybarczyk
- Department of Emergency Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Chris A Rees
- Division of Pediatric Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Charlotte M Roy
- Department of Emergency Medicine, Loma Linda University, Loma Linda, California, USA
| | | | - Sean M Kivlehan
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Humanitarian Initiative, Cambridge, Massachusetts, USA
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Klig JE, Stenson BA, Kivlehan SM, Jackson A, Berwick JR, Kosowsky JM. Twelve tips for practical clinical skills coaching. Med Teach 2023; 45:1357-1363. [PMID: 37318542 DOI: 10.1080/0142159x.2023.2220895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Coaching is rapidly evolving in clinical medicine, including for clinical skills (CS) learning. Yet a schema is needed for how to coach students in the many CS that are pivotal to the practice of medicine. These twelve tips aim to provide practical strategies for teachers and educators to coach students for CS learning. The tips cover many important aspects of CS coaching, including establishing a safe space, ways to prepare to coach, setting goals, guiding a coaching relationship, fostering coaching conversations, and in-person or virtual approaches. Together, the tips align as seven key steps of an overall coaching process. The twelve tips apply equally to coaching struggling students and all students seeking to improve CS and offer a guide for coaching at an individual or program level.
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Affiliation(s)
- Jean E Klig
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA
- Office of Medical Education, Harvard Medical School, Boston, MA, USA
| | - Bryan A Stenson
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Sean M Kivlehan
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Agnieszka Jackson
- Office of Medical Education, Harvard Medical School, Boston, MA, USA
| | - Jessica R Berwick
- Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Joshua M Kosowsky
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA
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Owoo C, Adhikari NKJ, Akinola O, Aryal D, Azevedo LC, Bacha T, Baelani JI, Baker T, Bartlett E, Bonney J, Convocar P, Dippenaar E, Dunser MW, Estenssoro E, Fowler R, Gore S, Guddu DK, Hashmi M, Hollong BG, Kabongo D, Kivlehan SM, King LL, Losonczy L, Lundeg G, McCurdy MT, Mer M, Misango D, Moll V, Murthy S, Pattnaik R, Petros S, Riviello E, Schell CO, Shrestha GS, Sultan M, Tefera M, Yim A, Tadesse AZ. The World Health Assembly resolution on integrated emergency, critical, and operative care for universal health coverage and protection from health emergencies: a golden opportunity to attenuate the global burden of acute and critical illness. Intensive Care Med 2023; 49:1223-1225. [PMID: 37578521 PMCID: PMC10556161 DOI: 10.1007/s00134-023-07176-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 07/22/2023] [Indexed: 08/15/2023]
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Erickson TB, Harvin D, Schmid A, Loevinsohn G, Poriechna A, Martyshyn O, Kliukach K, Sydlowski M, Strong J, Kivlehan SM. Evaluation of Chemical, Biological, Radiological, Nuclear, Explosives (CBRNE) Knowledge Change and Skills Confidence Among Frontline-Line Providers During the Russia-Ukraine War. Disaster Med Public Health Prep 2023; 17:e387. [PMID: 37157855 PMCID: PMC10171778 DOI: 10.1017/dmp.2023.52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the change in knowledge and skill confidence after implementation of a chemical, biological, radiological, nuclear, and explosive (CBRNE) training course during the Russia-Ukraine War. METHODS Pre/post-test study in the Ukrainian cities of Kyiv, Dnipro, Zaporizhzhia, and Odesa. Fifteen CBRNE courses were conducted over a 3-mo period, August to October 2022. Change in knowledge and skills confidence were evaluated with pre/post-course written exams and practical skill assessments that were observed during the training exercises. Changes were analyzed based on nonparametric Wilcoxon matched-pairs signed-rank testing. Pre/post self-efficacy surveys were analyzed with McNemar's test for paired data. Course evaluations were conducted with standardized questions which assessed instruction quality, teaching relevance, knowledge gained, and post-course skills confidence. RESULTS A total of 523 participants registered and completed 1 of the 15 courses. Overall mean pre-course test score: 57.8% (SD 20.7%); mean post-course test score: 81.4% (SD 11.3%); participants with increasing test scores: 90.7%; mean difference in score (95% confidence interval) 23.6% (21.2%-25.9%), P < 0.0001. Pre/post self-efficacy surveys (4-point Likert scale) noted participants recognized signs and symptoms of a CBRNE incident, and necessary skills to manage CBRNE exposures, P < 0.0001. CONCLUSIONS The implementation of this CBRNE course for front-line providers in Ukraine was successful. To our knowledge, it was the first implementation of a field course during the current Russian-Ukraine war. Future research should evaluate knowledge retention and impact of our innovative Train-the-Trainer model. Further iterations should emphasize expanding the quantity of training equipment and practical skill sessions.
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Affiliation(s)
- Timothy B. Erickson
- Division of Medical Toxicology, Department of Emergency Medicine, Mass General Brigham, Harvard Medical School, Boston, Massachusetts
- Harvard Humanitarian Initiative, Harvard University, Cambridge, Massachusetts, USA
| | - Donell Harvin
- Rand Corporation, Homeland Security Operational Analysis Center and Georgetown University, Applied Intelligence and Emergency and Disaster Management Program, Washington, D.C
| | - Alexis Schmid
- Boston Children’s Hospital, Department of Pediatrics, Division of Emergency Medicine, Global Health Program, Boston, MA
| | - Gideon Loevinsohn
- Division of Global Emergency Care and Humanitarian Studies, Department of Emergency Medicine, Mass General Brigham, Harvard Medical School, Boston, Massachusetts
| | | | | | | | | | - Jonathan Strong
- Division of Global Emergency Care and Humanitarian Studies, Department of Emergency Medicine, Mass General Brigham, Harvard Medical School, Boston, Massachusetts
- Harvard Humanitarian Initiative, Harvard University, Cambridge, Massachusetts, USA
| | - Sean M. Kivlehan
- Division of Global Emergency Care and Humanitarian Studies, Department of Emergency Medicine, Mass General Brigham, Harvard Medical School, Boston, Massachusetts
- Harvard Humanitarian Initiative, Harvard University, Cambridge, Massachusetts, USA
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Baugh CW, Sodickson AD, Kivlehan SM, Chen PC, Perencevich ML, Jesudian AB. A Novel Multidisciplinary Team Activation for Patients with Severe Gastrointestinal Bleeding: Creation of the Code GI Bleed Protocol. Clin Exp Gastroenterol 2023; 16:55-58. [PMID: 37131985 PMCID: PMC10149094 DOI: 10.2147/ceg.s404247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 03/18/2023] [Indexed: 05/04/2023] Open
Abstract
Patients with gastrointestinal (GI) bleeding present to the emergency department (ED) with a wide spectrum of illness severity. Among the most critically ill patients, comorbidities and other risk factors, such as liver disease and anticoagulation, can complicate their management. These patients are resource-intensive to stabilize and resuscitate, often requiring the continuous attention of multiple ED staff members along with rapid mobilization of specialty care. At a tertiary care hospital with the ability to provide definitive care for the most critically ill patients with GI bleeding, we introduced a multi-disciplinary team activation pathway to bring together specialists to immediately respond to the ED. We designed a Code GI Bleed pathway to expedite hemodynamic stabilization, diagnostics, source control, and timely disposition out of the ED to the intensive care unit or relevant procedural area of the hospital.
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Affiliation(s)
- Christopher W Baugh
- Department of Emergency Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
- Correspondence: Christopher W Baugh, Brigham and Women’s Hospital, Department of Emergency Medicine, 75 Francis Street, Neville House 2 Floor, Boston, MA, 02115, USA, Tel +1 617-732-8192, Fax +1 617-264-6848, Email
| | - Aaron D Sodickson
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Sean M Kivlehan
- Department of Emergency Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Paul C Chen
- Department of Emergency Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Molly L Perencevich
- Division of Gastroenterology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Arun B Jesudian
- Division of Gastroenterology and Hepatology, Weill Cornell Medicine, New York, NY, USA
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Garbern SC, Relan P, O’Reilly GM, Bills CB, Schultz M, Trehan I, Kivlehan SM, Becker TK. A systematic review of acute and emergency care interventions for adolescents and adults with severe acute respiratory infections including COVID-19 in low- and middle-income countries. J Glob Health 2022; 12:05039. [DOI: 10.7189/jogh.12.05039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Stephanie Chow Garbern
- Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Pryanka Relan
- Department of Emergency Medicine, Emory Healthcare Network, Atlanta, Georgia, USA
| | - Gerard M O’Reilly
- Emergency and Trauma Centre, The Alfred, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Corey B Bills
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Megan Schultz
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Indi Trehan
- Departments of Pediatrics, Global Health, and Epidemiology, University of Washington, Seattle, Washington, USA
| | - Sean M Kivlehan
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts
- Harvard Humanitarian Initiative, Cambridge, Massachusetts, USA
| | - Torben K Becker
- Department of Emergency Medicine, University of Florida, Gainesville, Florida, USA
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Kivlehan SM, Hexom BJ, Bonney J, Collier A, Nicholson BD, Quao NSA, Rybarczyk MM, Selvam A, Rees CA, Roy CM, Bhaskar N, Becker TK. Global emergency medicine: A scoping review of the literature from 2021. Acad Emerg Med 2022; 29:1264-1274. [PMID: 35913419 DOI: 10.1111/acem.14575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/17/2022] [Accepted: 07/26/2022] [Indexed: 01/25/2023]
Abstract
OBJECTIVE The objective was to identify the most important and impactful peer-reviewed global emergency medicine (GEM) articles published in 2021. The top articles are summarized in brief narratives and accompanied by a comprehensive list of all identified articles that address the topic during the year to serve as a reference for clinicians, researchers, and policy makers. METHODS A systematic PubMed search was carried out to identify all GEM articles published in 2021. Title and abstract screening was performed by trained reviewers and editors to identify articles in one of three categories based on predefined criteria: disaster and humanitarian response (DHR), emergency care in resource-limited settings (ECRLS), and emergency medicine development (EMD). Included articles were each scored by two reviewers using established rubrics for original (OR) and review (RE) articles. The top 5% of articles overall and the top 5% of articles from each category (DHR, ECRLS, EMD, OR, and RE) were included for narrative summary. RESULTS The 2021 search identified 44,839 articles, of which 444 articles screened in for scoring, 25% and 22% increases from 2020, respectively. After removal of duplicates, 23 articles were included for narrative summary. ECRLS constituted the largest category (n = 16, 70%), followed by EMD (n = 4, 17%) and DHR (n = 3, 13%). The majority of top articles were OR (n = 14, 61%) compared to RE (n = 9, 39%). CONCLUSIONS The GEM peer-reviewed literature continued to grow at a fast rate in 2021, reflecting the continued expansion and maturation of this subspecialty of emergency medicine. Few high-quality articles focused on DHR and EMD, suggesting a need for further efforts in those fields. Future efforts should focus on improving the diversity of GEM research and equitable representation.
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Affiliation(s)
- Sean M Kivlehan
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Humanitarian Initiative, Cambridge, Massachusetts, USA
| | - Braden J Hexom
- Department of Emergency Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Joseph Bonney
- Department of Emergency Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana.,Global Health and Infectious Disease Research Group, Kumasi Center for Collaborative Research in Tropical Medicine, Kumasi, Ghana
| | - Amanda Collier
- Department of Emergency Medicine, Queen's University, Kingston, Ontario, Canada
| | - Benjamin D Nicholson
- Department of Emergency Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Nana Serwaa A Quao
- Department of Emergency Medicine, Accident and Emergency Centre, Korle Bu Teaching Hospital, Accra, Ghana
| | - Megan M Rybarczyk
- Department of Emergency Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Anand Selvam
- Department of Emergency Medicine, Yale University, New Haven, Connecticut, USA
| | - Chris A Rees
- Division of Pediatric Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Charlotte M Roy
- Department of Emergency Medicine, Loma Linda University, Loma Linda, California, USA
| | | | - Torben K Becker
- Department of Emergency Medicine, University of Florida, Gainesville, Florida, USA
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Kivlehan SM, Allen A, Viun O, Makarov DA, Schnorr D, Patel S, Ryzhenko SA, Pham P, Erickson TB. Evaluation of change in emergency care knowledge and skills among front-line healthcare providers in Ukraine with the Basic Emergency Care course: a pretest/post-test study. BMJ Open 2022; 12:e050871. [PMID: 35701058 PMCID: PMC9198692 DOI: 10.1136/bmjopen-2021-050871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Evaluate the change in participant emergency care knowledge and skill confidence after implementation of the WHO-International Committee of the Red Cross (ICRC) Basic Emergency Care (BEC) course. DESIGN Pretest/post-test quasi-experimental study. SETTING Mechnikov Hospital in Dnipro, Ukraine. PARTICIPANTS Seventy-nine participants engaged in the course, of whom 50 (63.3%) completed all assessment tools. The course was open to healthcare providers of any level who assess and treat emergency conditions as part of their practice. The most common participant profession was resident physician (24%), followed by health educator (18%) and prehospital provider (14%). INTERVENTIONS The 5-day WHO-ICRC BEC course. PRIMARY AND SECONDARY OUTCOME MEASURES Change in pre-course and post-course knowledge and skill confidence assessments. Open-ended written feedback was collected upon course completion and analysed for common themes. RESULTS Participant knowledge assessment scores improved from 19 (IQR 15-20) to 22 (IQR 19-23) on a 25-point scale (p<0.001). Participant skill confidence self-assessment scores improved from 2.5 (IQR 2.1-2.8) to 2.9 (IQR 2.5-3.3) on a 4-point scale (p<0.001). The most common positive feedback themes were high-quality teaching and useful skill sessions. The most common constructive feedback themes were translation challenges and request for additional skill session time. CONCLUSIONS This first implementation of the WHO-ICRC BEC course for front-line healthcare providers in Ukraine was successful and well received by participants. This is also the first report of a BEC implementation outside of Africa and suggests that the course is also effective in the European context, particularly in humanitarian crisis and conflict settings. Future research should evaluate long-term knowledge retention and the impact on patient outcomes. Further iterations should emphasise local language translation and consider expanding clinical skills sessions.
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Affiliation(s)
- Sean M Kivlehan
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Humanitarian Initiative, Cambridge, Massachusetts, USA
| | - Amy Allen
- Emergency Medicine, Denver Health Medical Center, Denver, Colorado, USA
| | - Olha Viun
- Oles Honchar Dnipro National University, Dnipro, Ukraine
| | - Dmitry A Makarov
- Department of Anesthesiology and Intensive Care for Patients with Polytrauma, City Hospital No 17, Kiev, Ukraine
| | - Daniel Schnorr
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Humanitarian Initiative, Cambridge, Massachusetts, USA
| | - Sonny Patel
- Harvard Humanitarian Initiative, Cambridge, Massachusetts, USA
- Transcultural Conflict and Violence Initiative, Georgia State University, Atlanta, GA, USA
| | | | - Phuong Pham
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Humanitarian Initiative, Cambridge, Massachusetts, USA
| | - Timothy B Erickson
- Harvard Humanitarian Initiative, Cambridge, Massachusetts, USA
- Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts, USA
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Schnapp BH, Cassara M, Fisher J, Guttman J, Kayden S, Kivlehan SM, Kuzel AR, Reznek MA, Schertzer K, Sun WW, Rathlev N. From intern to "accepted": A guide to preparing for fellowship in emergency medicine. AEM Educ Train 2022; 6:S23-S31. [PMID: 35783084 PMCID: PMC9222866 DOI: 10.1002/aet2.10751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 11/26/2021] [Accepted: 11/28/2021] [Indexed: 06/15/2023]
Abstract
INTRODUCTION The number of fellowship options for emergency medicine (EM) physicians continues to expand. While guides exist to help residents explore individual fellowship pathways, we aimed to create a comprehensive guide for all residents considering fellowship. METHODS At the direction of the Society for Academic Emergency Medicine (SAEM) Board, 9 members of the Fellowship Guide Workgroup, including members of the Fellowship Approval Committee, and 2 members of SAEM Residents and Medical Students (RAMS) group collaboratively developed the guide using available evidence and expert opinion when high-quality evidence was unavailable. The guide was reviewed and approved by all members. RESULTS The guide offers advice to EM residents on how to conceptualize key aspects of their training with respect to preparation for fellowship, including scholarship, teaching, leadership, and electives. Additionally, it offers perspective on selecting a fellowship that matches the resident's interests and goals and successfully applying. CONCLUSION This fellowship guide for EM residents considering fellowship summarizes the best currently available advice for residents considering fellowship training after residency.
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Affiliation(s)
- Benjamin H. Schnapp
- Department of Emergency MedicineUniversity of Wisconsin School of Medicine and Public HealthMadisonWisconsinUSA
| | - Michael Cassara
- Departments of Emergency Medicine and Science EducationNorthwell HealthDonald and Barbara Zucker School of MedicineLake SuccessNew YorkUSA
| | | | - Joshua Guttman
- Department of Emergency MedicineEmory UniversityAtlantaGeorgiaUSA
| | - Stephanie Kayden
- Department of Emergency MedicineBrigham and Women’s HospitalBostonMassachusettsUSA
| | - Sean M. Kivlehan
- Department of Emergency MedicineBrigham and Women’s HospitalBostonMassachusettsUSA
| | - Aaron R. Kuzel
- Department of Emergency MedicineUniversity of Louisville School of MedicineSt. LouisvilleKentuckyUSA
| | - Martin A Reznek
- Department of Emergency MedicineUniversity of Massachusetts Medical SchoolWorcesterMassachusettsUSA
| | - Kimberly Schertzer
- Department of Emergency MedicineStanford UniversityPalo AltoCaliforniaUSA
| | - Wendy W. Sun
- Department of Emergency MedicineYale–New Haven HealthNew HavenConnecticutUSA
| | - Niels Rathlev
- Department of Emergency MedicineUniversity of Massachusetts Medical School‐BaystateSpringfieldMassachusettsUSA
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Trehan I, Kivlehan SM, Balhara KS, Bonney J, Hexom BJ, Pousson AY, Quao NSA, Rybarczyk MM, Selvam A, Nicholson BD, Bhaskar N, Becker TK, Balhara KS, Bandolin NS, Bannon‐Murphy H, Becker TK, Bhaskar N, Bonney J, Boone A, Broccoli MC, Charlton ADI, Cho DK, Ciano JD, Collier A, Dawson‐Amoah NA, Dyal JW, Flaherty KE, Hartford EA, Hayward AS, Hexom BJ, Hunter C, Jacobson AA, Joiner AP, Jones JE, Kampalath VN, Kivlehan SM, Laurence CE, Leanza J, Ledger E, Lee JA, Levine AC, Lowsby R, McCuskee S, Moretti KR, Nicholson BD, Pigoga JL, Pousson AY, Quao NSA, Rees CA, Roy CM, Rybarczyk MM, Selvam A, Skarpiak BJ, Strong JM, Trehan I, Vogel LD, Wang AH, Wegman KM, Winders WT. Global emergency medicine: A scoping review of the literature from 2020. Acad Emerg Med 2021; 28:1328-1340. [PMID: 34310782 DOI: 10.1111/acem.14356] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 07/07/2021] [Accepted: 07/12/2021] [Indexed: 01/08/2023]
Abstract
OBJECTIVE The objective was to identify, screen, highlight, review, and summarize some of the most rigorously conducted and impactful original research (OR) and review articles (RE) in global emergency medicine (EM) published in 2020 in the peer-reviewed and gray literature. METHODS A broad systematic search of peer-reviewed publications related to global EM indexed on PubMed and in the gray literature was conducted. The titles and abstracts of the articles on this list were screened by members of the Global Emergency Medicine Literature Review (GEMLR) Group to identify those that met our criteria of OR or RE in the domains of disaster and humanitarian response (DHR), emergency care in resource-limited settings (ECRLS), and EM development. Those articles that met these screening criteria were then scored using one of three scoring templates appropriate to the article type. Those articles that scored in the top 5% then underwent in-depth narrative summarization. RESULTS The 2020 GEMLR search initially identified 35,970 articles, more than 50% more than last year's search. From these, 364 were scored based on their full text. Nearly three-fourths of the scored articles constituted OR, of which nearly three-fourths employed quantitative research methods. Nearly 10% of the articles identified this year were directly related to COVID-19. Research involving ECRLS again constituted most of the articles in this year's review, accounting for more than 60% of the literature scored. A total of 20 articles underwent in-depth narrative critiques. CONCLUSIONS The number of studies relevant to global EM identified by our search was very similar to that of last year. Revisions to our methodology to identify a broader range of research were successful in identifying more qualitative research and studies related to DHR. The number of COVID-19-related articles is likely to continue to increase in subsequent years.
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Affiliation(s)
- Indi Trehan
- Departments of Pediatrics, Global Health, and Epidemiology University of Washington Seattle Washington USA
| | - Sean M. Kivlehan
- Department of Emergency Medicine Brigham and Women’s Hospital Boston Massachusetts USA
- Harvard Humanitarian Initiative Cambridge Massachusetts USA
| | - Kamna S. Balhara
- Department of Emergency Medicine Johns Hopkins University Baltimore Maryland USA
| | - Joseph Bonney
- Department of Emergency Medicine Komfo Anokye Teaching Hospital Kumasi Ghana
- Global Health and Infectious Disease Research Group Kumasi Center for Collaborative Research in Tropical Medicine Kumasi Ghana
| | - Braden J. Hexom
- Department of Emergency Medicine Rush University Medical Center Chicago Illinois USA
| | - Amelia Y. Pousson
- Department of Emergency Medicine Johns Hopkins University Baltimore Maryland USA
| | - Nana S. A. Quao
- Department of Emergency Medicine, Accident and Emergency Centre Korle Bu Teaching Hospital Accra Ghana
| | - Megan M. Rybarczyk
- Department of Emergency Medicine University of Pennsylvania Philadelphia Pennsylvania USA
| | - Anand Selvam
- Department of Emergency Medicine Yale University New Haven Connecticut USA
| | - Benjamin D. Nicholson
- Department of Emergency Medicine Virginia Commonwealth University Richmond Virginia USA
| | | | - Torben K. Becker
- Department of Emergency Medicine University of Florida Gainesville Florida USA
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Kivlehan SM, Dixon J, Kalanzi J, Sawe HR, Chien E, Robert J, Wallis L, Reynolds TA. Strengthening emergency care knowledge and skills in Uganda and Tanzania with the WHO-ICRC Basic Emergency Care Course. Emerg Med J 2021; 38:636-642. [PMID: 33853936 PMCID: PMC8311081 DOI: 10.1136/emermed-2020-209718] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 03/21/2021] [Accepted: 03/25/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND There is a pressing need for emergency care (EC) training in low-resource settings. We assessed the feasibility and acceptability of training frontline healthcare providers in emergency care with the World Health Organization (WHO)-International Committee of the Red Cross (ICRC) Basic Emergency Care (BEC) Course using a training-of-trainers (ToT) model with local providers. METHODS Quasiexperimental pretest and post-test study of an educational intervention at four first-level district hospitals in Tanzania and Uganda conducted in March and April of 2017. A 2-day ToT course was held in both Tanzania and Uganda. These were immediately followed by a 5-day BEC Course, taught by the newly trained trainers, at two hospitals in each country. Both prior to and immediately following each training, participants took assessments on EC knowledge and rated their confidence level in using a variety of EC skills to treat patients. Qualitative feedback from participants was collected and summarised. RESULTS Fifty-nine participants completed the four BEC Courses. All participants were current healthcare workers at the selected hospitals. An additional 10 participants completed a ToT course. EC knowledge scores were significantly higher for participants immediately following the training compared with their scores just prior to the training when assessed across all study sites (Z=6.23, p<0.001). Across all study sites, mean EC confidence ratings increased by 0.74 points on a 4-point Likert scale (95% CI 0.63 to 0.84, p<0.001). Main qualitative feedback included: positive reception of the sessions, especially hands-on skills; request for additional BEC trainings; request for obstetric topics; and need for more allotted training time. CONCLUSIONS Implementation of the WHO-ICRC BEC Course by locally trained providers was feasible, acceptable and well received at four sites in East Africa. Participation in the training course was associated with a significant increase in EC knowledge and confidence at all four study sites. The BEC is a low-cost intervention that can improve EC knowledge and skill confidence across provider cadres.
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Affiliation(s)
- Sean M Kivlehan
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Julia Dixon
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Joseph Kalanzi
- Department of Emergency Medicine, Makerere University, Kampala, Uganda
| | - Hendry R Sawe
- Department of Emergency Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Emily Chien
- Department of Emergency Medicine, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
| | - Jordan Robert
- Department of Emergency Medicine, University of Cape Town, Rondebosch, Western Cape, South Africa
| | - Lee Wallis
- Department of Emergency Medicine, University of Cape Town, Rondebosch, Western Cape, South Africa
| | - Teri A Reynolds
- Integrated Health Services, World Health Organization, Geneve, Switzerland
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Olufadeji A, Usoro A, Akubueze CE, Aiwonodagbon BO, Strong J, Kivlehan SM, Akodu B. Results from the implementation of the World Health Organization Basic Emergency Care Course in Lagos, Nigeria. Afr J Emerg Med 2021; 11:231-236. [PMID: 33747757 PMCID: PMC7966968 DOI: 10.1016/j.afjem.2021.02.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 02/01/2021] [Accepted: 02/10/2021] [Indexed: 11/18/2022] Open
Abstract
Background The emergency care of time-sensitive injuries and illnesses is increasingly recognized as an essential component of effective health care systems. However, many low- and middle-income countries (LMICs) lack healthcare providers formally trained in the care of emergency conditions. The Disease Control Priorities 3 project estimates that effective emergency care systems could avert up to half of all premature deaths in LMICs. Nigeria, a lower-middle income country of nearly 200 million people in Sub-Saharan Africa, could save approximately 100,000 lives per year with an effective emergency care system. The World Health Organization developed the Basic Emergency Care (BEC) course to train frontline healthcare workers in the management of emergency conditions in low resource settings. In this study we describe our work implementing the BEC course Nigeria. Methods This study was designed as a mixed methods research analysis comparing pre- and post- course examination results and surveys to evaluate participant knowledge acquisition and levels of confidence with management of various emergency conditions. Thirty-two participants were involved in the course which took place over four days at the Lagos University Teaching hospital. Quantitative data was analyzed using Stata 14.2 (College Station, TX). Paired data sets were analyzed using McNemar's chi-squared. Unpaired data sets were analyzed using a Wilcoxon signed-rank test. Results Post-course test scores showed significant improvement (p-value <0.001) as compared to pre-course. The average pre-course test score was 73% and average post-course score was 86.5%. Pre- and post-course questionnaires demonstrated significantly increased confidence in managing emergency conditions and agreement with course objectives. Conclusions The WHO Basic Emergency Care (BEC) course successfully increased the knowledge and confidence of frontline emergency care providers in Nigeria. The course was well received by participants. Future study should focus on BEC course scalability and long-term knowledge retention.
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Affiliation(s)
- Ayobami Olufadeji
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States of America
- Corresponding author.
| | - Agnes Usoro
- Department of Emergency Medicine, Johns Hopkins Howard Country General Medical Center, Columbia, MD, United States of America
| | | | - Benjamin O. Aiwonodagbon
- Department of Communicable and Non-Communicable Diseases Cluster of the Country Office, World Health Organization, Abuja, Nigeria
| | - Jonathan Strong
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, United States of America
| | - Sean M. Kivlehan
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, United States of America
| | - Babatunde Akodu
- College of Medicine, University of Lagos, Lagos, Nigeria
- Department of Family Medicine, Lagos University Teaching hospital, Lagos, Nigeria
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13
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Winders WT, Garbern SC, Bills CB, Relan P, Schultz ML, Trehan I, Kivlehan SM, Becker TK, McQuillan R. The effects of mobile health on emergency care in low- and middle-income countries: A systematic review and narrative synthesis. J Glob Health 2021; 11:04023. [PMID: 33828846 PMCID: PMC8021077 DOI: 10.7189/jogh.11.04023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND In resource-constrained settings, mobile health (mHealth) has varied applications. While there is strong evidence for its use in chronic disease management, the applications of mHealth for management of acute illness in low- and middle-income countries (LMICs) are not as well described. This review systematically explores current available evidence on the effectiveness of mHealth interventions at improving health outcomes in emergency care settings in LMICs. METHODS A systematic search of the literature was performed in accordance with PRISMA guidelines, utilizing seven electronic databases and manual searches to identify peer-reviewed literature containing each of three search elements: mHealth, emergency care (EC), and LMICs. Articles quality was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria. RESULTS After removing duplicates, 6498 studies met initial search criteria; 108 were eligible for full text review and 46 met criteria for inclusion. Thirty-six pertained to routine emergency care, and 10 involved complex humanitarian emergencies. Based on the GRADE criteria, 15 studies were rated as "Very Low" quality, 24 as "Low" quality, 6 as "Moderate" quality, and 1 as "High" quality. Eight studied data collection, 9 studied decision support, 15 studied direct patient care, and 14 studied health training. All 46 studies reported positive impacts of mHealth on EC in LMICs. CONCLUSIONS Mobile health interventions can be effective in improving provider-focused and patient-centered outcomes in both routine and complex EC settings. Future investigations focusing on patient-centered outcomes are needed to further validate these findings.
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Affiliation(s)
- W Tyler Winders
- School of Public Health, University of Edinburgh, Edinburgh, UK
| | - Stephanie C Garbern
- Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Corey B Bills
- Department of Emergency Medicine, University of Colorado School of Medicine, Denver, Colorado, USA
| | - Pryanka Relan
- Department of Emergency Medicine, Emory Healthcare Network, Atlanta, Georgia, USA
| | - Megan L Schultz
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Indi Trehan
- Departments of Pediatrics and Global Health, University of Washington, Seattle, Washington, USA
| | - Sean M Kivlehan
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, and Harvard Humanitarian Initiative, Cambridge, Massachusetts, USA
| | - Torben K Becker
- Department of Emergency Medicine, University of Florida, Gainesville, Florida, USA
| | - Ruth McQuillan
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
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14
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Karim N, Rybarczyk MM, Jacquet GA, Pousson A, Aluisio AR, Bilal S, Moretti K, Douglass KA, Henwood PC, Kharel R, Lee JA, MenkinSmith L, Moresky RT, Gonzalez Marques C, Myers JG, O’Laughlin KN, Schmidt J, Kivlehan SM. COVID-19 Pandemic Prompts a Paradigm Shift in Global Emergency Medicine: Multidirectional Education and Remote Collaboration. AEM Educ Train 2021; 5:79-90. [PMID: 33521495 PMCID: PMC7821062 DOI: 10.1002/aet2.10551] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 10/13/2020] [Accepted: 10/18/2020] [Indexed: 05/10/2023]
Abstract
To date, the practice of global emergency medicine (GEM) has involved being "on the ground" supporting in-country training of local learners, conducting research, and providing clinical care. This face-to-face interaction has been understood as critically important for developing partnerships and building trust. The COVID-19 pandemic has brought significant uncertainty worldwide, including international travel restrictions of indeterminate permanence. Following the 2020 Society for Academic Emergency Medicine meeting, the Global Emergency Medicine Academy (GEMA) sought to enhance collective understanding of best practices in GEM training with a focus on multidirectional education and remote collaboration in the setting of COVID-19. GEMA members led an initiative to outline thematic areas deemed most pertinent to the continued implementation of impactful GEM programming within the physical and technologic confines of a pandemic. Eighteen GEM practitioners were divided into four workgroups to focus on the following themes: advances in technology, valuation, climate impacts, skill translation, research/scholastic projects, and future challenges. Several opportunities were identified: broadened availability of technology such as video conferencing, Internet, and smartphones; online learning; reduced costs of cloud storage and printing; reduced carbon footprint; and strengthened local leadership. Skills and knowledge bases of GEM practitioners, including practicing in resource-poor settings and allocation of scarce resources, are translatable domestically. The COVID-19 pandemic has accelerated a paradigm shift in the practice of GEM, identifying a previously underrecognized potential to both strengthen partnerships and increase accessibility. This time of change has provided an opportunity to enhance multidirectional education and remote collaboration to improve global health equity.
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Affiliation(s)
- Naz Karim
- From theDepartment of Emergency MedicineBrown University Alpert Medical SchoolProvidenceRIUSA
| | - Megan M. Rybarczyk
- theDepartment of Emergency MedicinePerelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPAUSA
| | - Gabrielle A. Jacquet
- theDepartment of Emergency MedicineBoston University School of MedicineBoston Medical CenterBostonMAUSA
| | - Amelia Pousson
- theDepartment of Emergency MedicineJohns Hopkins UniversityBaltimoreMDUSA
| | - Adam R. Aluisio
- From theDepartment of Emergency MedicineBrown University Alpert Medical SchoolProvidenceRIUSA
| | - Saadiyah Bilal
- theDepartment of Emergency MedicineIcahn School of Medicine at Mount SinaiNew York CityNYUSA
| | - Katelyn Moretti
- From theDepartment of Emergency MedicineBrown University Alpert Medical SchoolProvidenceRIUSA
| | | | - Patricia C. Henwood
- theDepartment of Emergency MedicineThomas Jefferson UniversityPhiladelphiaPAUSA
| | - Ramu Kharel
- theDepartment of Emergency MedicineEmory University School of MedicineAtlantaGAUSA
| | - J. Austin Lee
- From theDepartment of Emergency MedicineBrown University Alpert Medical SchoolProvidenceRIUSA
| | - Lacey MenkinSmith
- theDepartment of Emergency MedicineMedical University of South CarolinaCharlestonSCUSA
| | - Rachel T. Moresky
- theEmergency Medicine DepartmentColumbia University College of Physicians and Surgeons and Columbia University Mailman School of Public Health, Heilbrunn Population and Family HealthNew YorkNYUSA
| | | | - Justin G. Myers
- theDepartment of Emergency MedicineUniversity of North Carolina at Chapel HillChapel HillNCUSA
| | - Kelli N. O’Laughlin
- theDepartments of Emergency Medicine and Global HealthUniversity of WashingtonSeattleWAUSA
| | - Jessica Schmidt
- theDepartment of Emergency MedicineUniversity of WisconsinMadisonWIUSA
| | - Sean M. Kivlehan
- and theDepartment of Emergency MedicineBrigham and Women’s HospitalHarvard Medical SchoolBostonMAUSA
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15
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Trehan I, Kivlehan SM, Balhara KS, Hexom BJ, Pousson AY, Quao NSA, Rybarczyk MM, Selvam A, Bonney J, Bhaskar N, Becker TK. Global Emergency Medicine: A Review of the Literature From 2019. Acad Emerg Med 2021; 28:117-128. [PMID: 32772445 DOI: 10.1111/acem.14107] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 08/02/2020] [Accepted: 08/05/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The annual systematic search of the peer-reviewed and gray literature relevant to global emergency medicine (EM) was conducted by the Global Emergency Medicine Literature Review (GEMLR) to screen, evaluate, and review the most rigorously conducted and relevant research in global EM published in 2019. METHODS After a broad search of PubMed and websites of organizations publishing relevant gray literature, all articles that were deemed relevant to the fields of disaster and humanitarian response, emergency care in resource-limited settings, and EM development by at least one reviewer, an editor, and the managing editors were then scored by two different reviewers using a 20-point scoring template relevant to either original research (OR) or review (RE) articles. This scoring system rates articles on their clarity, research design, ethics, importance to global EM, and breadth of impact. Articles that then scored in the top 5% were then critiqued in depth. RESULTS A total of 23,321 article titles and abstracts were screened by 22 reviewers with a wide swath of clinical and research experience in global EM. From these, a total of 356 articles underwent full-text review and scoring on the 20-point scale; 26% were categorized as disaster and humanitarian response, 58% as emergency care in resource-limited settings, and 15% as EM development. Of these 356 articles, 276 (77.5%) were OR articles and 80 (22.5%) were RE articles. The 16 articles that scored in the top 5% (>17.5 of 20 points) received full in-depth narrative summaries. CONCLUSIONS In 2019, the overall number of studies relevant to global EM that were identified by our search decreased from the prior year, but more high-scoring articles related to the development of EM clinical practice and as a specialty in resource-constrained settings were identified.
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Affiliation(s)
- Indi Trehan
- From the Departments of Pediatrics and Global Health University of Washington Seattle WAUSA
| | - Sean M. Kivlehan
- the Department of Emergency Medicine Brigham and Women’s Hospital Boston MAUSA
- the Harvard Humanitarian Initiative Cambridge MAUSA
| | - Kamna S. Balhara
- the Department of Emergency Medicine Johns Hopkins University Baltimore MDUSA
| | - Braden J. Hexom
- the Department of Emergency Medicine Rush University Medical Center Chicago ILUSA
| | - Amelia Y. Pousson
- the Department of Emergency Medicine Johns Hopkins University Baltimore MDUSA
| | | | - Megan M. Rybarczyk
- the Department of Emergency Medicine Brigham and Women’s Hospital Boston MAUSA
| | - Anand Selvam
- the Department of Emergency Medicine Yale University New Haven CTUSA
| | - Joseph Bonney
- the Department of Emergency Medicine Komfo Anokye Teaching Hospital Kumasi Ghana
| | | | - Torben K. Becker
- and the Department of Emergency Medicine University of Florida Gainesville FLUSA
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16
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Patiño AM, Cantillo-Campos S, Kearney AS, Kivlehan SM, Maldonado A. Emergency Medicine Challenges in Ecuador. West J Emerg Med 2020; 21:284-290. [PMID: 33207178 PMCID: PMC7673876 DOI: 10.5811/westjem.2020.8.47694] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 08/21/2020] [Indexed: 11/24/2022] Open
Abstract
Introduction Emergency medicine (EM) was recognized as a specialty in Ecuador in 1993. Currently, there are two four-year EM residency programs and an estimated 300 residency-trained emergency physicians countrywide. This study describes the current challenges in EM in Ecuador. Methods We conducted 25 semi-structured, in-person interviews with residency-trained emergency physicians, general practitioners, public health specialists, prehospital personnel, and physicians from other specialties. The interviewer asked about challenges in the areas of emergency care, working conditions of emergency physicians, EM residency education, EM leadership, and prehospital care. We analyzed data for challenges and registered the number of interviewees who mentioned each challenge. Results Interviewees worked in the three largest cities in the country: Quito (60%); Guayaquil (20%); and Cuenca (20%). Interviewees included 16 (64%) residency-trained emergency physicians; six (24%) residency-trained physicians from other specialties working in or closely associated with the emergency department (ED); one (4%) general practitioner working in the ED; one (4%) specialist in disasters; and one (4%) paramedic. Shortage of medical supplies, need for better medico-legal protection, lack of EM residencies outside of Quito, and desire for more bedside teaching were the challenges mentioned with the highest frequency (each 44%). The next most frequently mentioned challenges (each 38%) were the need for better access to ultrasound equipment and the low presence of EM outside the capital city. Other challenges mentioned included the low demand for emergency physicians in private institutions, the lack of differential pay for night and weekends, need for more training in administration and leadership, need for a more effective EM national society, and lack of resources and experience in EM research. Conclusion Emergency medicine has a three-decade history in Ecuador, reaching important milestones such as the establishment of two EM residencies and a national EM society. Challenges remain in medical care, working conditions, residency education, leadership, and prehospital care. Stronger collaboration and advocacy among emergency physicians can help strengthen the specialty and improve emergency care.
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Affiliation(s)
- Andrés M Patiño
- Emory University School of Medicine, Department of Emergency Medicine, Atlanta, Georgia
| | | | - Alexis S Kearney
- Brown University, Department of Emergency Medicine, Providence, Rhode Island
| | - Sean M Kivlehan
- Brigham and Women's Hospital, Department of Emergency Medicine, Boston, Massachusetts
| | - Augusto Maldonado
- Universidad San Francisco de Quito, Hospital General Docente Calderon, Department of Emergency Medicine, Quito, Ecuador
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Rybarczyk MM, Ludmer N, Broccoli MC, Kivlehan SM, Niescierenko M, Bisanzo M, Checkett KA, Rouhani SA, Tenner AG, Geduld H, Reynolds T. Emergency Medicine Training Programs in Low- and Middle-Income Countries: A Systematic Review. Ann Glob Health 2020; 86:60. [PMID: 32587810 PMCID: PMC7304456 DOI: 10.5334/aogh.2681] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background Despite the growing interest in the development of emergency care systems and emergency medicine (EM) as a specialty globally, there still exists a significant gap between the need for and the provision of emergency care by specialty trained providers. Many efforts to date to expand the practice of EM have focused on programs developed through partnerships between higher- and lower-resource settings. Objective To systematically review the literature to evaluate the composition of EM training programs in low- and middle-income countries (LMICs) developed through partnerships. Methods An electronic search was conducted using four databases for manuscripts on EM training programs - defined as structured education and/or training in the methods, procedures, and techniques of acute or emergency care - developed through partnerships. The search produced 7702 results. Using a priori inclusion and exclusion criteria, 94 manuscripts were included. After scoring these manuscripts, a more in-depth examination of 26 of the high-scoring manuscripts was conducted. Findings Fifteen highlight programs with a focus on specific EM content (i.e. ultrasound) and 11 cover EM programs with broader scopes. All outline programs with diverse curricula and varied educational and evaluative methods spanning from short courses to full residency programs, and they target learners from medical students and nurses to mid-level providers and physicians. Challenges of EM program development through partnerships include local adaptation of international materials; addressing the local culture(s) of learning, assessment, and practice; evaluation of impact; sustainability; and funding. Conclusions Overall, this review describes a diverse group of programs that have been or are currently being implemented through partnerships. Additionally, it highlights several areas for program development, including addressing other topic areas within EM beyond trauma and ultrasound and evaluating outcomes beyond the level of the learner. These steps to develop effective programs will further the advancement of EM as a specialty and enhance the development of effective emergency care systems globally.
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Affiliation(s)
- Megan M. Rybarczyk
- Department of Emergency Medicine, Brigham and Women’s Hospital, Harvard Medical School, US
| | - Nicholas Ludmer
- Section of Emergency Medicine, Department of Medicine, University of Chicago Pritzker School of Medicine, US
| | | | - Sean M. Kivlehan
- Department of Emergency Medicine, Brigham and Women’s Hospital, Harvard Medical School, US
| | - Michelle Niescierenko
- Division of Emergency Medicine, Boston Children’s Hospital, Harvard Medical School, US
| | - Mark Bisanzo
- Division of Emergency Medicine, Department of Surgery, University of Vermont, US
| | - Keegan A. Checkett
- Section of Emergency Medicine, Department of Medicine, University of Chicago Pritzker School of Medicine, US
| | - Shada A. Rouhani
- Department of Emergency Medicine, Brigham and Women’s Hospital, Harvard Medical School, US
| | - Andrea G. Tenner
- Department of Emergency Medicine, University of California, San Francisco, US
| | - Heike Geduld
- University of Cape Town/Stellenbosch University, College of Emergency Medicine of South Africa, ZA
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18
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Trehan I, Osei‐Ampofo M, Balhara KS, Hexom BJ, Kivlehan SM, Modi P, Pousson AY, Selvam A, Quao NSA, Cho DK, Becker TK, Levine AC, Bannon‐Murphy H, Bartels SA, Beyene T, Bonney J, Collier AT, Cook J, Dyal JW, Enriquez KT, Gomes DJ, Hayward AS, Ibrahim WMA, Keefe DM, Lee JA, Lee S, Lowsby R, Mediratta RP, Mickman CT, Nicholson BD, O'Reilly GM, Relan P, Ragins KT, Reid EA, Roy CM, Rybarczyk MM, Schultz ML, Stanford KA, Vogel LD, Wang AH, Zewdie A. Global Emergency Medicine: A Review of the Literature from 2018. Acad Emerg Med 2019; 26:1186-1196. [PMID: 31313411 DOI: 10.1111/acem.13832] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Revised: 07/06/2019] [Accepted: 07/12/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The Global Emergency Medicine Literature Review (GEMLR) conducts a systematic annual search of peer-reviewed and gray literature relevant to global emergency medicine (EM) to identify, review, and disseminate the most rigorously conducted and widely relevant research in global EM. METHODS An electronic search of PubMed, a comprehensive retrieval of articles from specific journals, and search of the gray literature were conducted. Title and abstracts retrieved by these searches were screened by a total of 22 reviewers based on their relevance to the field of global EM, across the domains of disaster and humanitarian response (DHR), emergency care in resource-limited settings (ECRLS), and emergency medicine development (EMD). All articles that were deemed relevant by at least one reviewer, their editor, and the managing editor underwent formal scoring of overall methodologic quality and importance to global EM. Two independent reviewers scored all articles; editors provided a third score in cases of widely discrepant scores. RESULTS A total of 19,102 articles were identified by the searches and, after screening and removal of duplicates, a total of 517 articles underwent full review. Twenty-five percent were categorized as DHR, 61% as ECRLS, and 15% as EMD. Inter-rater reliability testing between the reviewers revealed a Cohen's kappa score of 0.213 when considering the complete score or 0.426 when excluding the more subjective half of the score. A total of 25 articles scored higher than 17.5 of 20; these were selected for a full summary and critique. CONCLUSIONS In 2018, the total number of articles relevant to global EM that were identified by our search continued to increase. Studies and reviews focusing on pediatric infections, several new and traditionally underrepresented topics, and landscape reviews that may help guide clinical care in new settings represented the majority of top-scoring articles. A shortage of articles related to the development of EM as a specialty was identified.
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Affiliation(s)
- Indi Trehan
- Lao Friends Hospital for Children Luang Prabang Lao PDR
- Department of Pediatrics Washington University in St. Louis St. Louis MO
| | - Maxwell Osei‐Ampofo
- Emergency Medicine Directorate Komfo Anokye Teaching Hospital, and the Department of Anaesthesia and Intensive Care Kwame Nkrumah University of Science and Technology Kumasi Ghana
| | - Kamna S. Balhara
- Department of Emergency Medicine Johns Hopkins University Baltimore MD
| | - Braden J. Hexom
- Department of Emergency Medicine Rush University Medical Center Chicago IL
| | - Sean M. Kivlehan
- Department of Emergency Medicine Brigham and Women's Hospital Boston MA
- Harvard Humanitarian Initiative Cambridge MA
| | - Payal Modi
- Department of Emergency Medicine University of Massachusetts Worcester MA
| | - Amelia Y. Pousson
- Department of Emergency Medicine Johns Hopkins University Baltimore MD
| | - Anand Selvam
- Department of Emergency Medicine Yale University New Haven CT
| | - Nana Serwaa A. Quao
- Department of Emergency Medicine Korle Bu Teaching Hospital (NSAQ) Accra Ghana
| | | | - Torben K. Becker
- Department of Emergency Medicine University of Florida Gainesville FL
| | - Adam C. Levine
- and the Department of Emergency Medicine Brown University Providence RI
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19
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Becker TK, Trehan I, Hayward AS, Hexom BJ, Kivlehan SM, Lunney KM, Modi P, Osei‐Ampofo M, Pousson A, Cho DK, Levine AC, Anderson Reid E, Balhara KS, Bartels S, Becker TK, Beyene T, Bills CB, Bonney J, Bustamante ND, Chan J, Chang J, Cho DK, Coker A, Collier AT, Cook J, Chow Garbern S, Gutierrez CE, Hansoti B, Hauswald M, Hayward AS, Hexom B, Kearney A, Koval K, Keefe DM, Kivlehan SM, Lee S, Levine AC, Lowsby R, Lunney KM, McVane B, Mediratta RP, Modi P, Nicholson B, Osei‐Ampofo M, Osterhoudt KC, Pousson A, Quao NSA, Ragins K, Rees CA, Rybarczyk M, Schultz M, Selvam A, Silvestri D, Stanford K, Trehan I, Vogel L, Winders WT, Zewdie A. Global Emergency Medicine: A Review of the Literature From 2017. Acad Emerg Med 2018; 25:1287-1298. [PMID: 29791967 DOI: 10.1111/acem.13456] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 05/17/2018] [Accepted: 05/18/2018] [Indexed: 12/24/2022]
Abstract
OBJECTIVES The Global Emergency Medicine Literature Review (GEMLR) conducts an annual search of peer-reviewed and gray literature relevant to global emergency medicine (EM) to identify, review, and disseminate the most important new research in this field to a global audience of academics and clinical practitioners. METHODS This year, 17,722 articles written in three languages were identified by our electronic search. These articles were distributed among 20 reviewers for initial screening based on their relevance to the field of global EM. Another two reviewers searched the gray literature, yielding an additional 11 articles. All articles that were deemed appropriate by at least one reviewer and approved by their editor underwent formal scoring of overall quality and importance. Two independent reviewers scored all articles. RESULTS A total of 848 articles met our inclusion criteria and underwent full review. Sixty-three percent were categorized as emergency care in resource-limited settings, 23% as disaster and humanitarian response, and 14% as EM development. Twenty-one articles received scores of 18.5 or higher out of a maximum score 20 and were selected for formal summary and critique. Inter-rater reliability testing between reviewers revealed a Cohen's kappa of 0.344. CONCLUSIONS In 2017, the total number of articles identified by our search continued to increase. Studies and reviews with a focus on infectious diseases, pediatrics, and trauma represented the majority of top-scoring articles.
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Affiliation(s)
- Torben K. Becker
- Department of Emergency Medicine University of Florida Gainesville FL
| | - Indi Trehan
- Lao Friends Hospital for Children Luang Prabang Lao PDR
- Department of Pediatrics and Institute for Public Health Washington University in St. Louis St. Louis MO
- Department of Paediatrics and Child Health University of Malawi BlantyreMalawi
| | | | - Braden J. Hexom
- Department of Emergency Medicine Rush University Medical Center Chicago IL
| | - Sean M. Kivlehan
- Department of Emergency Medicine Brigham and Women's Hospital Boston MA
- Harvard Humanitarian Initiative Cambridge MA
| | - Kevin M. Lunney
- Navy Trauma Training Center Los Angeles County and University of Southern California Los Angeles CA
| | - Payal Modi
- Department of Emergency Medicine University of Massachusetts Worcester MA
| | - Maxwell Osei‐Ampofo
- Emergency Medicine Directorate Komfo Anokye Teaching Hospital and the Kwame Nkrumah University of Science and Technology KumasiGhana
| | - Amelia Pousson
- Department of Emergency Medicine The Johns Hopkins University School of Medicine Baltimore MD
| | | | - Adam C. Levine
- Department of Emergency Medicine The Warren Alpert Medical School of Brown University Providence RI
- Humanitarian Innovation Initiative (HI²) Watson Institute for International and Public Affairs Providence RI
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Mutschler MS, Kivlehan SM, Landry AI. Young Man With Flank Pain. Ann Emerg Med 2018; 72:e15-e16. [PMID: 30031518 DOI: 10.1016/j.annemergmed.2018.02.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Indexed: 11/16/2022]
Affiliation(s)
| | - Sean M Kivlehan
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA
| | - Adaira I Landry
- Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA
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Balhara KS, Silvestri DM, Tyler Winders W, Selvam A, Kivlehan SM, Becker TK, Levine AC. Impact of nutrition interventions on pediatric mortality and nutrition outcomes in humanitarian emergencies: A systematic review. Trop Med Int Health 2017; 22:1464-1492. [PMID: 28992388 DOI: 10.1111/tmi.12986] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Malnutrition contributes to paediatric morbidity and mortality in disasters and complex emergencies, but summary data describing specific nutritional interventions in these settings are lacking. This systematic review aimed to characterise such interventions and their effects on paediatric mortality, anthropometric measures and serum markers of nutrition. METHODS A systematic search of OVID MEDLINE, Cochrane Library and relevant grey literature was conducted. We included all randomised controlled trials and observational controlled studies evaluating effectiveness of nutritional intervention(s) on defined health outcomes in children and adolescents (0-18 years) within a disaster or complex emergency. We extracted study characteristics, interventions and outcomes data. Study quality was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria. RESULTS A total of 31 studies met inclusion criteria. Most were conducted in Africa (17), during periods of conflict or hunger gaps (14), and evaluated micronutrient supplementation (14) or selective feeding (10). Overall study quality was low, with only two high and four moderate quality studies. High- and medium-quality studies demonstrated positive impact of fortified spreads, ready-to-use therapeutic foods, micronutrient supplementation, and food and cash transfers. CONCLUSION In disasters and complex emergencies, high variability and low quality of controlled studies on paediatric malnutrition limit meaningful data aggregation. If existing research gaps are to be addressed, the inherent unpredictability of humanitarian emergencies and ethical considerations regarding controls may warrant a paradigm shift in what constitutes adequate methods. Periodic hunger gaps may offer a generalisable opportunity for robust trials, but consensus on meaningful nutritional endpoints is needed.
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Affiliation(s)
- Kamna S Balhara
- Department of Emergency Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - David M Silvestri
- Department of Emergency Medicine, Harvard Affiliated Emergency Medicine Residency, Brigham and Women's Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - W Tyler Winders
- Department of Emergency Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Anand Selvam
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Sean M Kivlehan
- Department of Emergency Medicine, Harvard Medical School, Division of International Emergency Medicine and Humanitarian Programs, Brigham and Women's Hospital, Boston, MA, USA
| | - Torben K Becker
- Department of Emergency Medicine, University of Florida, Gainesville, FL, USA
| | - Adam C Levine
- Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, RI, USA
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Ordoobadi A, Kivlehan SM. ExDS is characterized by extreme agitation and aggression in a patient with altered mental status. EMS World 2017; 46:26-32. [PMID: 29989727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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23
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Kivlehan SM. Cardiac Resuscitation RESEARCH REVIEW. Studies address the efficacy of continuous chest conpressions and automated cornmpression devices. EMS World 2016; 45:27-29. [PMID: 26946587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Collopy KT, Kivlehan SM, Snyder SR. Prehospital Stabilization of Pulmonary Embolism. Acute PEs can be life-threatening emergencies – be prepared to recognize and manage them. EMS World 2015; 44:54-62. [PMID: 26523305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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25
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Snyder SR, Kivlehan SM, Collopy KT. Cardiac Causes of Syncope. They may faint and then feel fine, but the reason isn't always benign. EMS World 2015; 44:40-53. [PMID: 26359526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Collopy KT, Kivlehan SM, Snyder SR. Prehospital stabilization of unstable neonates. They're prone to rapid deterioration; here's how to handle them. EMS World 2015; 44:46-52. [PMID: 26284273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Snyder SR, Kivlehan SM, Collopy KT. HELLP Syndrome. How to recognize and treat this life-threatening complication of pregnancy. EMS World 2015; 44:39-45. [PMID: 26146751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Collopy KT, Kivlehan SM, Snyder SR. Beyond Ebola: worldly viruses close to home. In an era of easy travel, exotic illnesses can end up on your doorstep. EMS World 2015; 44:26-34. [PMID: 26052608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Snyder SR, Kivlehan SM, Collopy KT. Diagnosis and treatment of the patient with heart failure. What their history and your clinical exam should tell you about what's happening. EMS World 2015; 44:33-42. [PMID: 25950034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Collopy KT, Kivlehan SM, Snyder SR. Busting top trauma myths. Exploring best practices for prehospital trauma care. EMS World 2015; 44:38-45. [PMID: 25821875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Evidence-based medicine will continually change the paradigm in which emergency medicine is practiced. Fifteen years ago tourniquets were a last resort and often considered a guaranteed way to lose a limb; today they are a gold standard in hemorrhage control. Believing in, and having practiced, medicine we later learn to be false doesn't make someone a bad provider, nor does it make them wrong. It simply means emergency medicine and EMS will continue to develop as a profession, and our body of evidence will continue to grow as we learn more about prehospital care. As we prepare to retire MAST, backboards and lidocaine, and realize the golden hour as a concept rather than a definitive 60 minutes, it's important to keep a critical eye out for the next intervention that truly will help patients during their prehospital care.
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Snyder SR, Kivlehan SM, Collopy KT. COPD exacerbation. What are the keys to treating it in the prehospital setting? EMS World 2015; 44:54-60. [PMID: 25806397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Collopy KT, Kivlehan SM, Snyder SR. Surgical cricothyrotomies in prehospital care. Surgical airway placement is indicated when you cannot intubate or ventilate. EMS World 2015; 44:42-49. [PMID: 25803984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Managing the airway does not mean intubation, it means managing the airway. Allowing a patient to breathe on their own with appropriate positioning, bag-valve ventilation and blind insertion devices are all airway management options. The surgical cricothyrotomy is a rare and life-saving procedure when managing patients who are in a "can't intubate, can't ventilate" situation. These patients will die without aggressive and rapid intervention. While not all surgical cricothyrotomies provide a definitive airway, the needle cricothyrotomy is an ineffective means for ventilation and its use is discouraged. Understand the techniques used in your program and that are within your scope of practice as an EMS provider. Provide your patient the best opportunity for survival by knowing your program's surgical airway procedure thoroughly, and practice it regularly.
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Snyder SR, Kivlehan SM, Collopy KT. Common STEMI imitators: Part 2. There are other causes of ST-segment elevation besides myocardial infarction. EMS World 2014; 43:90-95. [PMID: 25812298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Snyder SR, Kivlehan SM, Collopy KT. Common STEMI imitators: Part 1. There are other causes of ST-segment elevation besides myocardial infarction. EMS World 2014; 43:61-85. [PMID: 25816557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Collopy KT, Kivlehan SM, Snyder SR. ECG changes in acute coronary syndrome. How to identify and understand the significance of ECG changes occurring throughout acute coronary syndrome. EMS World 2014; 43:44-49. [PMID: 25815399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Collopy KT, Kivlehan SM, Snyder SR. Aortic dissections and aneurysms. Prehospital care of these rare but life-threatening emergencies. EMS World 2014; 43:43-49. [PMID: 25276895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Aortic dissections and aneurysms are seen with low frequency and have high risk for deterioration during prehospital care. It is essential to include both dissections and aneurysms in your differential diagnoses whenever evaluating patients with chest or abdominal complaints. Often a good history is the best indication of one of these grave vascular emergencies. Consider thoracic aortic dissection in your differential diagnosis for any patient who complains of chest pain and aortic aneurysm in patients who have any sort of abdominal discomfort or syncope with an unknown etiology. When either is suspected transport rapidly to a facility with cardiothoracic and vascular surgery capability, and provide care that prepares you to manage the patient quickly should a rupture occur.
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Snyder SR, Kivlehan SM, Collopy KT. Hypertensive urgencies and emergencies. How to tell the difference and what to know about each. EMS World 2014; 43:31-36. [PMID: 25230437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Harvin D, Caplan N, Kivlehan SM. EMS response to pediatric disorders. Is your system ready to treat large numbers of injured children? EMS World 2014; 43:39-64. [PMID: 25181869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Collopy KT, Kivlehan SM, Snyder R. Critical transport decisions. In time-sensitive emergencies, every moment counts--choose wisely. EMS World 2014; 43:42-47. [PMID: 25073295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Time-sensitive emergencies require early recognition and rapid transport to a facility properly equipped to manage the patient's needs. When managing STEMI, cardiac arrest, suspected stroke, trauma or a severe sepsis patient, use your resources smartly. Manage the patient using all of your capabilities on scene and know the destination best prepared to manage the patient upon ED arrival. When it makes sense to extend transport time to take a patient to a proper facility, it is OK to do so. Considering air medical transport for patients as ground transports exceed 30 minutes is reasonable as long as the flight team provides transport more rapidly or brings additional care that will improve patient outcomes.
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Collopy KT, Kivlehan SM, Snyder SR. Preventing back injuries in EMS. What's the best approach to avoiding harm to providers? EMS World 2014; 43:23-31. [PMID: 24937912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Reducing back injuries requires a holistic approach and investment by all interested parties, from front-line staff to leadership and supporting agencies. As a provider, take the time to ensure you are lifting and moving equipment and patients in a manner that protects both the patient and you.
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Snyder SR, Kivlehan SM, Collopy KT. Withdrawal and the chronic alcohol abuser. Years of drinking can cause big changes and make drying out dangerous. EMS World 2014; 43:44-51. [PMID: 24791440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Snyder SR, Kivlehan SM, Collopy KT. Acute alcohol poisoning: what can you do for the patient who's had too much? EMS World 2014; 43:36-42. [PMID: 24734396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Collopy KT, Kivlehan SM, Snyder S. What's the point of point-of-care testing? Understanding the potential of this evolving capability. EMS World 2014; 43:34-42. [PMID: 24649589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Point-of-care testing is a rapidly evolving yet complex field. As your POCT program grows, take the time to understand the regulations, as they are important to ensuring patient safety. The regualtions established CLIA are designed to ensure consistent and reliable laboratory results that can accurately impact patient care. When beginning your look into POCY, first identify what labs can directly impact your patient care, then look for a device that meets your needs.
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Snyder SR, Kivlehan SM, Collopy KT. 10 tips for effective airway management and ventilation: from BLS to ALS, what are the best current practices? EMS World 2014; 43:29-30, 32, 34 passim. [PMID: 24645392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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45
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Collopy KT, Kivlehan SM, Snyder SR. The impaired immune system. How is it suppressed, and what does it mean for EMS? EMS World 2013; 42:115-118. [PMID: 24450091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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46
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Snyder SR, Kivlehan SM, Collopy KT. Prehospital childbirth fetal complications. Part 2: what can go wrong, and how can you tell? EMS World 2013; 42:50-57. [PMID: 24308174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Scott R Snyder
- Public Safety Training Center, Emergency Care Program, Santa Rosa Junior College, CA, USA.
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Snyder SR, Kivlehan SM, Collopy KT. Prehospital childbirth without complications. Part 1: Babies are delivered everyday--just not by EMS providers. EMS World 2013; 42:34-40. [PMID: 24205526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Scott R Snyder
- Public Safety Training Center, Santa Rosa Junior College, CA, USA.
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Collopy KT, Kivlehan SM, Snyder SR. Hyperglycemia and what to do about it. EMS World 2013; 42:68-77. [PMID: 24191388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Diabetes mellitus is on incredibly complex disease and impacts millions of Americans. The pancreas and insulin are both key to normal glucose metabolism and glucose control.Nearly any body stressor that alters a patient's metabolism can impair normal insulin function and trigger hyperglycemia. It is prudent to check blood sugar in all patients with suspected serious illness, whether or not they have diabetic histories. Hyperglycemia can affect any patient and is a predictor of increased mortality if not treated early. Diabetic ketoacidosis has a more rapid onset than a hyperosmolar hyperglycemic state and often presents with a comparatively lower blood sugar and the presence of acidosis. HHS does not present with profound acidosis and has a slower onset, yet more profound dehydration and a higher blood sugar. Do not underestimate the need for early prehospital intervention with hyperglycemia. Early and aggressive IV fluid administration can improve patient outcomes and speed recovery.
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Synder SR, Kivlehan SM, Collopy KT. Case studies in hypoglycemia. When is it safe to leave these patients at home? EMS World 2013; 42:54-61. [PMID: 24073511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Scott R Synder
- Public Safety Training Center, Emergency Care Program at Santa Rosa Junior College, CA, USA.
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Collopy KT, Kivlehan SM, Snyder SR. An EMS guide to chronic pain. EMS World 2013; 42:59-63. [PMID: 23926841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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