Peter Acker

All Publications

• Developing Emergency Triage Systems in Cambodia. Cureus Khan, A., Rice, B., Acker, P. 2020; 12 (10): e11233

  Abstract

  As Cambodia works to rebuild its public health system, an area of focus has been improving the quality of emergency services. After a needs assessment in 2011, project partners identified the implementation of a patient triage system as the first target for development efforts. A context-specific triage system was created using the input of a spectrum of local stakeholders. It was tailored to fit the needs and resources available within the Cambodian health system. The system was implemented through a series of educational interventions at 35 public hospitals throughout nine Cambodian provinces. Follow-up quality improvement visits occurred on a quarterly basis between February 2016 and September 2018, during which feedback on the system was gathered using both quantitative and qualitative methods, and additional system updates were implemented. In this technical report we aim to describe the triage system design, implementation and quality improvement processes utilized with the hope of informing and supporting colleagues working to address similar challenges in other areas of the world. Through this assessment process a number of key observations were made: 1) Establishment of context-specific emergency triage systems is feasible in low resource settings; 2) Development of new triage processes requires an iterative approach; 3) Successful uptake of new practice systems requires flexibility from both the implementers and end-users in the development relationship; 4) Process improvement requires consistent retraining and reinforcement.

  View details for DOI 10.7759/cureus.11233

  View details for PubMedID 33269161

  View details for PubMedCentralID PMC7706145

• Strengthening the Emergency Referral System in Cambodia for Women and Children Under Five: A Description of Interventions and Impact Analysis. Journal of Global Health Reports Acker, P. C. 2020

  View details for DOI 10.29392/joghr.3.e2019079

• Continuing Education for Prehospital Healthcare Providers in India - A Novel Course and Concept. Open access emergency medicine : OAEM Lindquist, B. D., Koval, K. W., Acker, P. C., Bills, C. B., Khan, A., Zachariah, S., Newberry, J. A., Rao, G. V., Mahadevan, S. V., Strehlow, M. C. 2020; 12: 201–10

  Abstract

  Emergency medical services (EMS) in India face enormous challenges in providing care to a geographically expansive and diverse patient population. Over the last decade, the public-private-partnership GVK EMRI (Emergency Management and Research Institute) has trained over 100,000 emergency medical technicians (EMTs), with greater than 21,000 currently practicing, to address this critical gap in the healthcare workforce. With the rapid development and expansion of EMS, certain aspects of specialty development have lagged behind, including continuing education requirements. To date, there have been no substantial continuing education EMT skills and training efforts. We report lessons learned during development and implementation of a continuing education course (CEC) for EMTs in India.From 2014 to 2017, we employed an iterative process to design and launch a novel CEC focused on five core emergency competency areas (medicine and cardiology, obstetrics, trauma, pediatrics, and leadership and communication). Indian EMT instructors and providers partnered in design and content, and instructors were trained to independently deliver the CEC. Many challenges had to be overcome: scale (>21,000 EMTs), standardization (highly variable skill levels among providers and instructors), culture (educational emphasis on rote memorization rather than practical application), and translation (22 major languages and a few hundred local dialects spoken nationwide).During the assessment and development phases, we identified five key strategies for success: (1) use icon-based video instruction to ensure consistent quality and allow voice-over for easy translation; (2) incorporate workbooks during didactic videos and (3) employ low-cost simulation and case discussions to emphasize active learning; (4) focus on non-technical skills; (5) integrate a formal training-of-trainers prior to delivery of materials.These key strategies can be combined with innovation and flexibility to address unique challenges of language, system resources, and cultural differences when developing impactful continuing educational initiatives in bourgeoning prehospital care systems in low- and middle-income countries.

  View details for DOI 10.2147/OAEM.S249447

  View details for PubMedID 32982494

  View details for PubMedCentralID PMC7505709

• Developing Emergency Triage Systems in Cambodia Cureus Khan, A., Rice, B., Acker, P. C. 2020

  View details for DOI 10.7759/cureus.11233

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

  View details for PubMedID 30051096

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

  View details for DOI 10.1002/aet2.10066

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

  Abstract

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

  View details for PubMedID 30051058

• Anaphylaxis Progressive Cases in Emergency Medicine Acker, P. C., Lindberg, P., Pillow, T., Ahn, J. McGraw-Hill Education. 2018; 1
• Procedural Sedation in Resource Limited Settings Critical Decisions in Emergency Medicine Acker, P. C., Koval, K., Leeper, S. 2017; 31 (4): 3-13
• Implementing an Innovative Prehospital Care Provider Training Course in Nine Cambodian Provinces. Cure¯us Acker, P., Newberry, J. A., Hattaway, L. B., Socheat, P., Raingsey, P. P., Strehlow, M. C. 2016; 8 (6)

  Abstract

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

  View details for DOI 10.7759/cureus.656

  View details for PubMedID 27489749

  View details for PubMedCentralID PMC4963230

• Efficacy of a novel two-day EMT refresher training program focused on essential EMS knowledge and skills International Summit on Emergency Medicine and Trauma Acker, P. C. 2014

  View details for DOI 10.1186/1865-1380-7-S1-P5