Peter Acker

All Publications

• Paediatric use of emergency medical services in India: A retrospective cohort study of one million children. Journal of global health Newberry, J. A., Rao, S. J., Matheson, L., Anurudran, A. S., Acker, P., Darmstadt, G. L., Mahadevan, S. V., Rao, G. V., Strehlow, M. 2022; 12: 04080

  Abstract

  Millions of children in low- and middle-income countries (LMICs) experience illness or trauma amenable to emergency medical interventions, but local resources are not sufficient to treat them. Emergency medical services (EMS), including ambulance transport, bridge the gap between local services and higher-level hospital care, and data collected by EMS could be used to elucidate patterns of paediatric health care need and use. Here we conducted a retrospective observational study of patterns of paediatric use of EMS services by children who used EMS in India, a leader in maternal and child EMS development, to inform public health needs and system interventions to improve EMS effectiveness.We analysed three years (2013-2015) of data from patients <18 years of age from a large prehospital EMS system in India, including 1 101 970 prehospital care records across 11 states and a union territory.Overall, 38.3% of calls were for girls (n = 422 370), 40.5% were for adolescents (n = 445 753), 65.9% were from rural areas (n = 726 154), and most families were from a socially disadvantaged caste or lower economic status (n = 834 973, 75.8%). The most common chief complaints were fever (n = 247 594, 22.5%), trauma (n = 231 533, 21.0%), and respiratory difficulty (n = 161 120, 14.6%). However, transport patterns, including patient sex and age and type of destination hospital, varied by state, as did data collection.EMS in India widely transports children with symptoms of the leading causes of child mortality and provides access to higher levels of care for geographically and socioeconomically vulnerable populations, including care for critically ill neonates, mental health and burn care for girls, and trauma care for adolescents. EMS in India is an important mechanism for overcoming transport and cost as barriers to access, and for reducing the urban-rural gap found across causes of child mortality. Further standardisation of data collection will provide the foundation for assessing disparities and identifying targets for quality improvement of paediatric care.

  View details for DOI 10.7189/jogh.12.04080

  View details for PubMedID 36243953

• A qualitative study of an undergraduate online emergency medicine education program at a teaching Hospital in Kampala, Uganda. BMC medical education Ayoola, A. S., Acker, P. C., Kalanzi, J., Strehlow, M. C., Becker, J. U., Newberry, J. A. 2022; 22 (1): 84

  Abstract

  BACKGROUND: Globally, half of all years of life lost is due to emergency medical conditions, with low- and middle-income countries (LMICs) facing a disproportionate burden of these conditions. There is an urgent need to train the future physicians in LMICs in the identification and stabilization of patients with emergency medical conditions. Little research focuses on the development of effective emergency medicine (EM) medical education resources in LMICs and the perspectives of the students themselves. One emerging tool is the use of electronic learning (e-learning) and blended learning courses. We aimed to understand Uganda medical trainees' use of learning materials, perception of current e-learning resources, and perceived needs regarding EM skills acquisition during participation in an app-based EM course.METHODS: We conducted semi-structured interviews and focus groups of medical students and EM residents. Participants were recruited using convenience sampling. All sessions were audio recorded and transcribed verbatim. The final codebook was approved by three separate investigators, transcripts were coded after reaching consensus by all members of the coding team, and coded data were thematically analyzed.RESULTS: Twenty-six medical trainees were included in the study. Analysis of the transcripts revealed three major themes: [1] medical trainees want education in EM and actively seek EM training opportunities; [2] although the e-learning course supplements knowledge acquisition, medical students are most interested in hands-on EM-related training experiences; and [3] medical students want increased time with local physician educators that blended courses provide.CONCLUSIONS: Our findings show that while students lack access to structured EM education, they actively seek EM knowledge and practice experiences through self-identified, unstructured learning opportunities. Students value high quality, easily accessible EM education resources and employ e-learning resources to bridge gaps in their learning opportunities. However, students desire that these resources be complemented by in-person educational sessions and executed in collaboration with local EM experts who are able to contextualize materials, offer mentorship, and help students develop their interest in EM to continue the growth of the EM specialty.

  View details for DOI 10.1186/s12909-022-03157-5

  View details for PubMedID 35135519

• When Stirrups Aren’t Available: Product Evaluation of a Novel Low- Cost Pelvic Lift Cushion Human Factors in Healthcare Toney-Noland, C., Acker, P. C., Padua, K., Crowe, S., Sie, L., Lee, H., et al 2022; 2

  View details for DOI 10.1016/j.hfh.2022.100020

• 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. n., Zachariah, S. n., 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

• 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

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

  View details for DOI 10.1002/aet2.10100

  View details for Web of Science ID 000770023600008

• Anaphylaxis Progressive Cases in Emergency Medicine Acker, P. C., Lindberg, P., Pillow, T., Ahn, J. McGraw-Hill Education. 2018; 1
• 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 DOI 10.1002/aet2.10066

  View details for PubMedID 30051058

  View details for PubMedCentralID PMC6001592

• 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 Cureus Acker, P. C. 2016; 8 (6)

  View details for DOI 10.7759/cureus.656

• 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