S. V. Mahadevan

All Publications

• Evaluation of a massive open online course for just-in-time training of healthcare workers. Frontiers in public health Strehlow, M. C., Johnston, J. S., Aluri, K. Z., Prober, C. G., Acker, P. C., Patil, A. S., Mahadevan, A., Mahadevan, S. V. 2024; 12: 1395931

  Abstract

  COVID-19 created a global need for healthcare worker (HCW) training. Initially, mass trainings focused on public health workers and physicians working in intensive care units. However, in resource-constrained settings, nurses and general practitioners provide most patient care, typically lacking the training and equipment to manage critically ill patients. We developed a massive open online course (MOOC) for HCWs in resource-constrained settings aimed at training bedside providers caring for COVID-19 patients. We describe the development, implementation and analysis of this MOOC.From May through June 2020, the course was developed by a multi-disciplinary team and launched on two online platforms in July. The 4-hour course comprises 6 video-based modules. Student knowledge was assessed using pre- and post-module quizzes and final exam, while demographics and user experience were evaluated by pre- and post-course surveys and learning platform data.From July 17th to September 24th, 30,859 students enrolled, 18,818 started, and 7,101 completed the course. Most participants worked in healthcare (78%) and resided in lower middle- (38%) or upper middle- (20%) income countries. Learners from upper middle-income and lower middle-income countries had higher completion rates. Knowledge gains were observed from pre-module to post-module quizzes and a final exam. Afterward, participants reported increased self-efficacy regarding course objectives, a 0.63 mean increase on a 4-point scale (95% CI [0.60,0.66]). Most participants (93%) would recommend the course to others.This article demonstrates the potential of MOOCs to rapidly provide access to emerging medical knowledge during a public health crisis, particularly for HCWs in high- and middle-income countries.

  View details for DOI 10.3389/fpubh.2024.1395931

  View details for PubMedID 39411488

  View details for PubMedCentralID PMC11478164

• 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

• Is AVPU comparable to GCS in critical prehospital decisions? - A cross-sectional study. The American journal of emergency medicine Janagama, S. R., Newberry, J. A., Kohn, M. A., Rao, G. V., Strehlow, M. C., Mahadevan, S. V. 2022; 59: 106-110

  Abstract

  BACKGROUND: Advanced Trauma Life Support field triage utilizes the Glasgow Coma Scale (GCS) to assess the level of consciousness. However, prehospital care providers in low- and middle-income countries (LMICs) often use the Alert, Verbal, Pain, and Unresponsive (AVPU) scale to assess the level of consciousness. This study aimed to determine whether prehospital AVPU categorization correlates with mortality rates in trauma victims, similarly to GCS.METHODS: In this cross-sectional study conducted between November 2015 and January 2016, we enrolled a convenience sample of prehospital trauma-related field activations. The primary outcome measure was the probability of death within 48 h for each category of AVPU.RESULTS: In a convenience sample of 4514 activations, 1606 (35.6%) met exclusion criteria, four did not have AVPU, and four did not have GCS, leaving 2900 (64.2%) trauma activations with both AVPU and GCS available for analysis. Forty-eight-hour follow-up data were available for 2184 (75.3%) activations out of these 2900. The 48-h mortality rates for each category of AVPU were 1.1% (Alert), 4.3% (Verbal), 17.9% (Pain), 53.2% (Unresponsive); and, for each GCS-based injury severity category, they were 0.9% (Mild, GCS 13-15), 8.1% (Moderate, GCS 9-12), 43.5% (Severe, GCS ≤ 8). Overall, there was a statistically significant difference in GCS for each category of AVPU (p < 0.001) except between patients responding to verbal commands and those responding to pain (p = 0.18). The discriminative ability of AVPU (AUC 79.7% (95% CI 73.4-86.1)) and GCS (AUC 81.5% (95% CI 74.8-88.2)) for death within 48-h following hospital drop-off were comparable.CONCLUSION: EMT assessments of AVPU and GCS relate to each other, and AVPU predicts mortality at 48 h. Future studies using AVPU to assess the level of consciousness in prehospital trauma protocols may simplify their global application without impacting the overall quality of care.

  View details for DOI 10.1016/j.ajem.2022.06.042

  View details for PubMedID 35820277

• Development and implementation of a novel Web-based gaming application to enhance emergency medical technician knowledge in low- and middle-income countries. AEM education and training Lindquist, B., Gaiha, S. M., Vasudevan, A., Dooher, S., Leggio, W., Mulkerin, W., Zozula, A., Strehlow, M., Sebok-Syer, S. S., Mahadevan, S. V. 2021; 5 (3): e10602

  Abstract

  Background: Increasing access to high-quality emergency and prehospital care is an important priority in low- and middle-income countries (LMICs). However, ensuring that emergency medical technicians (EMTs) maintain their clinical knowledge and proficiency with procedural skills is challenging, as continuing education requirements are still being introduced, and clinical instructional efforts need strengthening. We describe the development and implementation of an innovative asynchronous learning tool for EMTs in the form of a Web-based trivia game.Methods: Over 500 case-based multiple-choice questions (covering 10 essential prehospital content areas) were created by experts in prehospital education, piloted with EMT educators from LMICs, and delivered to EMTs through a Web-based quiz game platform over a 12-week period. We enrolled 252 participants from nine countries.Results: Thirty-two participants (12.7%) completed the entire 12-week game. Participants who completed the game were administered a survey with a 100% response rate. Ninety-three percent of participants used their mobile phone to access the game. Overall, participants reported that the interface was easy to use (93.8% agreed or strongly agreed), the game improved their knowledge (100% agreed or strongly agreed), and they felt better prepared for their jobs (100% agreed or strongly agreed). The primary motivators for participation were improving patient care (37.5%) and being recognized on the game's leaderboard (31.3%). All participants reported that they would engage in the game again (43.8% agreed and 56.3% strongly agreed) and would recommend the game to their colleagues (34.4% agreed and 65.6% strongly agreed).Conclusions: In conclusion, a quiz game targeting EMT learners from LMICs was viewed as accessible and effective by participants. Future efforts should focus on increasing retention and trialing languages in addition to English.

  View details for DOI 10.1002/aet2.10602

  View details for PubMedID 34124530

• Correction to: Epidemiology of patients presenting to a pediatric emergency department in Karachi, Pakistan. BMC emergency medicine Ijaz, N., Strehlow, M., Wang, N. E., Pirrotta, E., Tariq, A., Mahmood, N., Mahadevan, S. 2020; 20 (1): 66

  Abstract

  An amendment to this paper has been published and can be accessed via the original article.

  View details for DOI 10.1186/s12873-020-00364-5

  View details for PubMedID 32859173

• 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

• Acute respiratory illness among a prospective cohort of pediatric patients using emergency medical services in India: Demographic and prehospital clinical predictors of mortality. PloS one Bills, C. B., Newberry, J. A., Rao, G. V., Matheson, L. W., Rao, S. n., Mahadevan, S. V., Strehlow, M. C. 2020; 15 (4): e0230911

  Abstract

  In India, acute respiratory illnesses, including pneumonia, are the leading cause of early childhood death. Emergency medical services are a critical component of India's public health infrastructure; however, literature on the prehospital care of pediatric patients in low- and middle-income countries is minimal. The aim of this study is to describe the demographic and clinical characteristics associated with 30-day mortality among a cohort of pediatric patients transported via ambulance in India with an acute respiratory complaint.Pediatric patients less than 18 years of age using ambulance services in one of seven states in India, with a chief complaint of "shortness of breath", or a "fever" with associated "difficulty breathing" or "cough", were enrolled prospectively. Patients were excluded if evidence of choking, trauma or fire-related injury, patient was absent on ambulance arrival, or refused transport. Primary exposures included demographic, environmental, and clinical indicators, including hypoxemia and respiratory distress. The primary outcome was 7 and 30-day mortality. Multivariable logistic regression, stratified by transport type, was constructed to estimate associations between demographic and clinical predictors of mortality.A total of 1443 patients were enrolled during the study period: 981 (68.5%) were transported from the field, and 452 (31.5%) were interfacility transports. Thirty-day response was 83.4% (N = 1222). The median age of all patients was 2 years (IQR: 0.17-10); 93.9% (N = 1347) of patients lived on family incomes below the poverty level; and 54.1% (N = 706) were male. Cumulative mortality at 2, 7, and 30-days was 5.2%, 7.1%, and 7.7%, respectively; with 94 deaths by 30 days. Thirty-day mortality was greatest among those 0-28 days (N = 38,17%); under-5 mortality was 9.8%. In multivariable modeling prehospital oxygen saturation <95% (OR: 3.18 CI: 1.77-5.71) and respiratory distress (OR: 3.72 CI: 2.17-6.36) were the strongest predictors of mortality at 30 days.This is the first study to detail prehospital predictors of death among pediatric patients with shortness of breath in LMICs. The risk of death is particularly high among neonates and those with documented mild hypoxemia, or respiratory distress. Early recognition of critically ill children, targeted prehospital interventions, and diversion to higher level of care may help to mitigate the mortality burden in this population.

  View details for DOI 10.1371/journal.pone.0230911

  View details for PubMedID 32240227

• Critical Communication: A Cross-sectional Study of Signout at the Prehospital and Hospital Interface. Cureus Janagama, S. R., Strehlow, M. n., Gimkala, A. n., Rao, G. V., Matheson, L. n., Mahadevan, S. n., Newberry, J. A. 2020; 12 (2): e7114

  Abstract

  Introduction Miscommunication during patient handoff contributes to an estimated 80% of serious medical errors and, consequently, plays a key role in the estimated five million excess deaths annually from poor quality of care in low- and middle-income countries (LMICs). Objective The objective of this study was to assess signout communication during patient handoffs between prehospital personnel and hospital staff. Methods This is a cross-sectional study, with a convenience sample of 931 interfacility transfers for pregnant women across four states from November 7 to December 13, 2016. A complete signout, as defined for this study, contains all necessary signout elements for patient care exchanged verbally or in written form between an emergency medical technician (EMT) and a physician or nurse. Results Enrollment of 786 cases from 931 interfacility transfers resulted in 1572 opportunities for signout. EMTs and a physician or nurse signed out in 1549 cases (98.5%). Signout contained all elements in 135 cases (8.6%). The mean percentage of signout elements included was 45.2% (95% CI, 43.9-46.6). Physician involvement was correlated with a higher mean percent (63.4% [95% CI, 62-64.8]) compared to nurse involvement (23.6% [95% CI, 22.5-24.8]). With respect to the frequency of signout communication, 63.1% of EMTs reported often or always giving signout, and 60.5% reported often or always giving signout; they reported feeling moderately to very comfortable with signout (73.7%) and 34.1% requested further training. Conclusions Physicians, nurses, and the EMTs conducted signout 99% of the time but often fell short of including all elements required for optimal patient care. Interventions aimed at improving the quality of patient care must include strengthening signout communication.

  View details for DOI 10.7759/cureus.7114

  View details for PubMedID 32140371

  View details for PubMedCentralID PMC7047340

• "So Why Should I Call Them?": Survivor Support Service Characteristics as Drivers of Help-Seeking in India. Journal of interpersonal violence Newberry, J. A., Kaur, J. n., Gurrapu, S. n., Behl, R. n., Darmstadt, G. L., Halpern-Felsher, B. n., Rao, G. V., Mahadevan, S. V., Strehlow, M. C. 2020: 886260520970306

  Abstract

  Women in South Asia face the highest lifetime prevalence of intimate partner violence in the world, which is just one form of violence against women (VAW). In India, few women seek help after experiencing violence, particularly from formal resources, such as physicians or the police. While many studies have investigated the impact of survivor characteristics and patterns of violence on help-seeking behaviors, there is scant research on support service characteristics and their impact on help-seeking. The introduction of a novel crisis helpline in Gujarat, India provided an opportunity to better understand how successful help-seeking can be driven by the perceived and experienced characteristics of the helpline. We conducted in-depth interviews with helpline users to identify factors and pathways that promoted or discouraged help-seeking in general, help-seeking from a formal source, and help-seeking from this particular helpline. We analyzed 32 interviews of women who used the helpline. Participants were from eight districts across the state, representing a diverse range of sociodemographic backgrounds. After conducting a thematic analysis, we found that action-oriented service, timeliness, and women-focused staff influenced (positively and negatively) participants' feelings of safety, empowerment, and trust in the helpline, which ultimately impacted their decision to seek help from the helpline or even to seek help at all. This study illuminates how service characteristics, in and of themselves, can influence the likelihood that survivors will seek help, emphasizing the need for survivors to have a voice in the growth and refinement of VAW support services. Consequently, these areas must be a focus of future research and initiatives to improve help-seeking by VAW survivors.

  View details for DOI 10.1177/0886260520970306

  View details for PubMedID 33150827

• A profile of traumatic injury in the prehospital setting in India: A prospective observational study across seven states. Injury Newberry, J. A., Bills, C. B., Matheson, L., Zhang, X., Gimkala, A., Ramana Rao, G. V., Janagama, S. R., Mahadevan, S. V., Strehlow, M. C. 2019

  Abstract

  BACKGROUND: Traumatic injury continues to be a leading cause of mortality and morbidity in low-income and middle-income countries (LMIC). The World Health Organization has called for a strengthening of prehospital care in order to improve outcomes from trauma. In this study we sought to profile traumatic injury seen in the prehospital setting in India and identify predictors of mortality in this patient population.METHODS: We conducted a prospective observational study of a convenience sample of patients using a single emergency medical services (EMS) system for traumatic injuries across seven states in India from November 2015 through January 2016. Any patient with a chief complaints indicative of a traumatic injury was eligible for enrollment. Our primary outcome was 30-day mortality.RESULTS: We enrolled 2905 patients. Follow-up rates were 76% at 2 days, 70% at 7 days, and 70% at 30 days. The median age was 36 years (IQR: 25-50) and were predominately male (72%, N=2088), of lower economic status (97%, N=2805 used a government issued ration card) and were from rural or tribal areas (74%, N=2162). Cumulative mortality at 2, 7, and 30 days, was 3%, 4%, and 4% respectively. Predictors of 30-day mortality were prehospital abnormal mental status (OR 7.5 (95% CI: 4-14)), presence of hypoxia or hypotension (OR 4.0 (95% CI: 2.2-7)), on-scene mobility (OR 2.8 (95% CI: 1.3-6)), and multisystem injury inclusive of head injury (OR 2.3 (95% CI: 1.1-5)).CONCLUSIONS: EMS in an LMIC can transport trauma patients from poor and rural areas that traditionally struggle to access timely trauma care to facilities in a timeframe consistent with current international recommendations. Information readily obtained by EMTs predicts 30-day mortality within this population and could be utilized for triaging patients with the potential to reduce morbidity and mortality.

  View details for DOI 10.1016/j.injury.2019.11.020

  View details for PubMedID 31761424

• Timely access to care for patients with critical burns in India: a prehospital prospective observational study EMERGENCY MEDICINE JOURNAL Newberry, J. A., Bills, C. B., Pirrotta, E. A., Barry, M., Rao, G., Mahadevan, S., Strehlow, M. C. 2019; 36 (3): 176–82

  View details for DOI 10.1136/emermed-2018-207900

  View details for Web of Science ID 000510036300001

• Timely access to care for patients with critical burns in India: a prehospital prospective observational study. Emergency medicine journal : EMJ Newberry, J. A., Bills, C. B., Pirrotta, E. A., Barry, M., Ramana Rao, G. V., Mahadevan, S. V., Strehlow, M. C. 2019

  Abstract

  BACKGROUND: Low/middle-income countries carry a disproportionate burden of the morbidity and mortality from thermal burns. Nearly 70% of burn deaths worldwide are from thermal burns in India. Delays to medical care are commonplace and an important predictor of outcomes. We sought to understand the role of emergency medical services (EMS) as part of the healthcare infrastructure for thermal burns in India.METHODS: We conducted a prospective observational study of patients using EMS for thermal burns across five Indian states from May to August 2015. Our primary outcome was mortality at 2, 7 and 30 days. We compared observed mortality with expected mortality using the revised Baux score. We used Chi2 analysis for categorical variables and Wilcoxon two-sample test for continuous variables. ORs and 95% CIs are reported for all modelled predictor variables.RESULTS: We enrolled 439 patients. The 30-day follow-up rate was 85.9% (n=377). The median age was 30 years; 56.7% (n=249) lived in poverty; and 65.6% (n=288) were women. EMS transported 94.3% of patients (n=399) to the hospital within 2hours of their call. Median total body surface area (TBSA) burned was 60% overall, and 80% in non-accidental burns. Sixty-eight per cent of patients had revised Baux scores greater than 80. Overall 30-day mortality was 64.5%, and highest (90.2%) in women with non-accidental burns. Predictors of mortality by multivariate regression were TBSA (OR 7.9), inhalation injury (OR 5.5), intentionality (OR 4.7) and gender (OR 2.2).DISCUSSION: Although EMS rapidly connects critically burned patients to care in India, mortality remains high, with women disproportionally suffering self-inflicted burns. To combat the burn epidemic in India, efforts must focus on rapid medical care and critical care services, and on a burn prevention strategy that includes mental health and gender-based violence support services.

  View details for PubMedID 30635272

• Acute Respiratory Illness among a Prospective Cohort of Pediatric Patients Using Emergency Medical Services in India: Demographic, Environmental, and Out-of-Hospital Clinical Predictors of Mortality in a High-Risk Population Bills, C., Newberry, J. A., Matheson, L., Rao, R., Mahadevan, S., Strehlow, M. C. MOSBY-ELSEVIER. 2018: S124–S125

  View details for DOI 10.1016/j.annemergmed.2018.08.322

  View details for Web of Science ID 000445690900312

• Connecting Children to Emergency Care: Pediatric Utilization of the World's Largest Emergency Medical Service from 2013 to 2015 Newberry, J. A., Mahadevan, S., Matheson, L., Bills, C. B., Rao, S., Rao, R. G., Strehlow, M. C. MOSBY-ELSEVIER. 2018: S125–S126

  View details for DOI 10.1016/j.annemergmed.2018.08.324

  View details for Web of Science ID 000445690900314

• Epidemiology of patients presenting to a pediatric emergency department in Karachi, Pakistan. BMC emergency medicine Ijaz, N., Strehlow, M., Ewen Wang, N., Pirrotta, E., Tariq, A., Mahmood, N., Mahadevan, S. 2018; 18 (1): 22

  Abstract

  BACKGROUND: There is little data describing pediatric emergencies in resource-poor countries, such as Pakistan. We studied the demographics, management, and outcomes of patients presenting to the highest-volume, public, pediatric emergency department (ED) in Karachi, Pakistan.METHODS: In this prospective, observational study, we approached all patients presenting to the 50-bed ED during 28 12-h study periods over four consecutive weeks (July 2013). Participants' chief complaints and medical care were documented. Patients were followed-up at 48-h and 14-days via telephone.RESULTS: Of 3115 participants, 1846 were triaged to the outpatient department and 1269 to the ED. Patients triaged to the ED had a median age of 2.0years (IQR 0.5-4.0); 30% were neonates (<28days). Top chief complaints were fever (45.5%), diarrhea/vomiting (32.3%), respiratory (23.1%), abdominal (7.5%), and otolaryngological problems (5.8%). Temperature, pulse and respiratory rate, and blood glucose were documented for 66, 42, and 1.5% of patients, respectively. Interventions included medications (92%), IV fluids (83%), oxygen (35%), and advanced airway management (5%). Forty-five percent of patients were admitted; 11 % left against medical advice. Outcome data was available at time of ED disposition, 48-h, and 14days for 83, 62, and 54% of patients, respectively. Of participants followed-up, 4.3% died in the ED, 11.5% within 48h, and 19.6% within 14days.CONCLUSIONS: This first epidemiological study at Pakistan's largest pediatric ED reveals dramatically high mortality, particularly among neonates. Future research in developing countries should focus on characterizing reasons for high mortality through pre-ED arrival tracking, ED care quality assessment, and post-ED follow-up.

  View details for PubMedID 30075749

• Epidemiology of patients presenting to a pediatric emergency department in Karachi, Pakistan BMC EMERGENCY MEDICINE Ijaz, N., Strehlow, M., Wang, N., Pirrotta, E., Tariq, A., Mahmood, N., Mahadevan, S. 2018; 18

  View details for DOI 10.1186/s12873-018-0175-4

  View details for Web of Science ID 000441236100001

• 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

• Reducing early infant mortality in India: results of a prospective cohort of pregnant women using emergency medical services BMJ OPEN Bills, C. B., Newberry, J. A., Darmstadt, G., Pirrotta, E. A., Rao, G., Mahadevan, S. V., Strehlow, M. C. 2018; 8 (4): e019937

  Abstract

  To describe the demographic characteristics and clinical outcomes of neonates born within 7 days of public ambulance transport to hospitals across five states in India.Prospective observational study.Five Indian states using a centralised emergency medical services (EMS) agency that transported 3.1 million pregnant women in 2014.Over 6 weeks in 2014, this study followed a convenience sample of 1431 neonates born to women using a public-private ambulance service for a 'pregnancy-related' problem. Initial calls were deemed 'pregnancy related' if categorised by EMS dispatchers as 'pregnancy', 'childbirth', 'miscarriage' or 'labour pains'. Interfacility transfers, patients absent on ambulance arrival, refusal of care and neonates born to women beyond 7 days of using the service were excluded.death at 2, 7 and 42 days after delivery.Among 1684 women, 1411 gave birth to 1431 newborns within 7 days of initial ambulance transport. Median maternal age at delivery was 23 years (IQR 21-25). Most mothers were from rural/tribal areas (92.5%) and lower social (79.9%) and economic status (69.9%). Follow-up rates at 2, 7 and 42 days were 99.8%, 99.3% and 94.1%, respectively. Cumulative mortality rates at 2, 7 and 42 days follow-up were 43, 53 and 62 per 1000 births, respectively. The perinatal mortality rate (PMR) was 53 per 1000. Preterm birth (OR 2.89, 95% CI 1.67 to 5.00), twin deliveries (OR 2.80, 95% CI 1.10 to 7.15) and caesarean section (OR 2.21, 95% CI 1.15 to 4.23) were the strongest predictors of mortality.The perinatal mortality rate associated with this cohort of patients with high-acuity conditions of pregnancy was nearly two times the most recent rate for India as a whole (28 per 1000 births). EMS data have the potential to provide more robust estimates of PMR, reduce inequities in timely access to healthcare and increase facility-based care through service of marginalised populations.

  View details for PubMedID 29654018

• Characteristics and outcomes of pediatric patients presenting at Cambodian referral hospitals without appointments: an observational study INTERNATIONAL JOURNAL OF EMERGENCY MEDICINE Yore, M. A., Strehlow, M. C., Yan, L. D., Pirrotta, E. A., Woods, J. L., Somontha, K., Sovannra, Y., Auerbach, L., Backer, R., Grundmann, C., Mahadevan, S. V. 2018; 11: 17

  Abstract

  Emergency medicine is a young specialty in many low- and middle-income countries (LMICs). Although many patients seeking emergency or acute care are children, little information is available about the needs and current treatment of this group in LMICs. In this observational study, we sought to describe characteristics, chief complaints, management, and outcomes of children presenting for unscheduled visits to two Cambodian public hospitals.Children enrolled in the study presented without appointment for treatment at one of two Cambodian public referral hospitals during a 4-week period in 2012. Researchers used standardized questionnaires and hospital records to collect demographic and clinical data. Patients were followed up at 48 h and 14 days after initial presentation. Multivariate logistic regression identified factors associated with hospital admission.This study included 867 unscheduled visits. Mean patient age was 5.7 years (standard deviation 4.8 years). Of the 35 different presenting complaints, fever (63%), respiratory problems (25%), and skin complaints (24%) were most common. The majority of patients were admitted (51%), while 1% were transferred to another facility. Seven patients (1%) died within 14 days. Follow-up rates were 83% at 48 h and 75% at 14 days. Predictors of admission included transfer or referral from another health provider, seeking prior care for the presenting problem, low socioeconomic status, onset of symptoms within 24 h of seeking care, abnormal vital signs or temperature, and chief complaint of abdominal pain or fever.While the admission rate in this study was high, mortality was low. More effective identification and management of children who can be treated and released may free up scarce inpatient resources for children who warrant admission.

  View details for PubMedID 29536212

• 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 DOI 10.1002/aet2.10066

  View details for PubMedID 30051058

  View details for PubMedCentralID PMC6001592

• Innovative, Scalable Educational Model to Improve Out-of-Hospital Care in India Koval, K., Khan, A., Lindquist, B., Surla, R., Rao, R., Strehlow, M., Mahadevan, S. MOSBY-ELSEVIER. 2017: S66

  View details for DOI 10.1016/j.annemergmed.2017.07.191

  View details for Web of Science ID 000445699100165

• Preparing for International Travel and Global Medical Care EMERGENCY MEDICINE CLINICS OF NORTH AMERICA Mahadevan, S. V., Strehlow, M. C. 2017; 35 (2): 465-?

  Abstract

  Thorough pretravel preparation and medical consultation can mitigate avoidable health and safety risks. A comprehensive pretravel medical consultation should include an individualized risk assessment, immunization review, and discussion of arthropod protective measures, malaria prophylaxis, traveler's diarrhea, and injury prevention. Travel with children and jet lag reduction require additional planning and prevention strategies; travel and evacuation insurance may prove essential when traveling to less resourced countries. Consideration should also be given to other high-risk travel scenarios, including the provision of health care overseas, adventure and extreme sports, water environments and diving, high altitude, and terrorism/unstable political situations.

  View details for DOI 10.1016/j.emc.2017.01.006

  View details for PubMedID 28411937

• Adaptive leadership curriculum for Indian paramedic trainees. International journal of emergency medicine Mantha, A., Coggins, N. L., Mahadevan, A., Strehlow, R. N., Strehlow, M. C., Mahadevan, S. V. 2016; 9 (1): 9-?

  Abstract

  Paramedic trainees in developing countries face complex and chaotic clinical environments that demand effective leadership, communication, and teamwork. Providers must rely on non-technical skills (NTS) to manage bystanders and attendees, collaborate with other emergency professionals, and safely and appropriately treat patients. The authors designed a NTS curriculum for paramedic trainees focused on adaptive leadership, teamwork, and communication skills critical to the Indian prehospital environment.Forty paramedic trainees in the first academic year of the 2-year Advanced Post-Graduate Degree in Emergency Care (EMT-paramedic equivalent) program at the GVK-Emergency Management and Research Institute campus in Hyderabad, India, participated in the 6-day leadership course. Trainees completed self-assessments and delivered two brief video-recorded presentations before and after completion of the curriculum.Independent blinded observers scored the pre- and post-intervention presentations delivered by 10 randomly selected paramedic trainees. The third-party judges reported significant improvement in both confidence (25 %, p < 0.01) and body language of paramedic trainees (13 %, p < 0.04). Self-reported competency surveys indicated significant increases in leadership (2.6 vs. 4.6, p < 0.001, d = 1.8), public speaking (2.9 vs. 4.6, p < 0.001, d = 1.4), self-reflection (2.7 vs. 4.6, p < 0.001, d = 1.6), and self-confidence (3.0 vs. 4.8, p < 0.001, d = 1.5).Participants in a 1-week leadership curriculum for prehospital providers demonstrated significant improvement in self-reported NTS commonly required of paramedics in the field. The authors recommend integrating focused NTS development curriculum into Indian paramedic education and further evaluation of the long term impacts of this adaptive leadership training.

  View details for DOI 10.1186/s12245-016-0103-x

  View details for PubMedID 26897379

  View details for PubMedCentralID PMC4761349

• One-two-triage: validation and reliability of a novel triage system for low-resource settings. Emergency medicine journal Khan, A., Mahadevan, S. V., Dreyfuss, A., Quinn, J., Woods, J., Somontha, K., Strehlow, M. 2016; 33 (10): 709-715

  Abstract

  To validate and assess reliability of a novel triage system, one-two-triage (OTT), that can be applied by inexperienced providers in low-resource settings.This study was a two-phase prospective, comparative study conducted at three hospitals. Phase I assessed criterion validity of OTT on all patients arriving at an American university hospital by comparing agreement among three methods of triage: OTT, Emergency Severity Index (ESI) and physician-defined acuity (the gold standard). Agreement was reported in normalised and raw-weighted Cohen κ using two different scales for weighting, Expert-weighted and triage-weighted κ. Phase II tested reliability, reported in Fleiss κ, of OTT using standardised cases among three groups of providers at an urban and rural Cambodian hospital and the American university hospital.Normalised for prevalence of patients in each category, OTT and ESI performed similarly well for expert-weighted κ (OTT κ=0.58, 95% CI 0.52 to 0.65; ESI κ=0.47, 95% CI 0.40 to 0.53) and triage-weighted κ (κ=0.54, 95% CI 0.48 to 0.61; ESI κ=0.57, 95% CI 0.51 to 0.64). Without normalising, agreement with gold standard was less for both systems but performance of OTT and ESI remained similar, expert-weighted (OTT κ=0.57, 95% CI 0.52 to 0.62; ESI κ=0.6, 95% CI 0.58 to 0.66) and triage-weighted (OTT κ=0.31, 95% CI 0.25 to 0.38; ESI κ=0.41, 95% CI 0.35 to 0.4). In the reliability phase, all triagers showed fair inter-rater agreement, Fleiss κ (κ=0.308).OTT can be reliably applied and performs as well as ESI compared with gold standard, but requires fewer resources and less experience.

  View details for DOI 10.1136/emermed-2015-205430

  View details for PubMedID 27466347

• Ambulance Service Associated With Reduced Probabilities Of Neonatal And Infant Mortality In Two Indian States. Health affairs Babiarz, K. S., Mahadevan, S. V., Divi, N., Miller, G. 2016; 35 (10): 1774-1782

  Abstract

  India had no large-scale, centralized emergency medical system or ambulance service until 2005. Since then, the GVK Emergency Management and Research Institute (GVK EMRI) has emerged as India's largest ambulance service provider, covering more than 630 million people. This study provides the first quantitative evidence of GVK EMRI's early impact on population-level infant and maternal health outcomes in Andhra Pradesh and Gujarat, two Indian states with a combined population of about 145 million people. We found that GVK EMRI coverage is associated with reductions in the probability of neonatal and infant mortality as well as delivery complications (statewide in Andhra Pradesh and in high-mortality districts in Gujarat). However, we found little change in the probability of institutional delivery or skilled birth attendance. Taken together, our findings suggest that population-level health gains were achieved through improvements in the quality (rather than quantity) of maternal and neonatal health services-an interpretation consistent with qualitative reports. More research on this topic is needed.

  View details for PubMedID 27702948

• Characteristics and outcomes of women using emergency medical services for third-trimester pregnancy-related problems in India: a prospective observational study. BMJ open Strehlow, M. C., Newberry, J. A., Bills, C. B., Min, H. E., Evensen, A. E., Leeman, L., Pirrotta, E. A., Rao, G. V., Mahadevan, S. V. 2016; 6 (7): e011459

  Abstract

  Characterise the demographics, management and outcomes of obstetric patients transported by emergency medical services (EMS).Prospective observational study.Five Indian states using a centralised EMS agency that transported 3.1 million pregnant women in 2014.This study enrolled a convenience sample of 1684 women in third trimester of pregnancy calling with a 'pregnancy-related' problem for free-of-charge ambulance transport. Calls were deemed 'pregnancy related' if categorised by EMS dispatchers as 'pregnancy', 'childbirth', 'miscarriage' or 'labour pains'. Interfacility transfers, patients absent on ambulance arrival and patients refusing care were excluded.Emergency medical technician (EMT) interventions, method of delivery and death.The median age enrolled was 23 years (IQR 21-25). Women were primarily from rural or tribal areas (1550/1684 (92.0%)) and lower economic strata (1177/1684 (69.9%)). Time from initial call to hospital arrival was longer for rural/tribal compared with urban patients (66 min (IQR 51-84) vs 56 min (IQR 42-73), respectively, p<0.0001). EMTs assisted delivery in 44 women, delivering the placenta in 33/44 (75%), performing transabdominal uterine massage in 29/33 (87.9%) and administering oxytocin in none (0%). There were 1411 recorded deliveries. Most women delivered at a hospital (1212/1411 (85.9%)), however 126/1411 (8.9%) delivered at home following hospital discharge. Follow-up rates at 48 hours, 7 days and 42 days were 95.0%, 94.4% and 94.1%, respectively. Four women died, all within 48 hours. The caesarean section rate was 8.2% (116/1411). On multivariate regression analysis, women transported to private hospitals versus government primary health centres were less likely to deliver by caesarean section (OR 0.14 (0.05-0.43)) CONCLUSIONS: Pregnant women from vulnerable Indian populations use free-of-charge EMS for impending delivery, making it integral to the healthcare system. Future research and health system planning should focus on strengthening and expanding EMS as a component of emergency obstetric and newborn care (EmONC).

  View details for DOI 10.1136/bmjopen-2016-011459

  View details for PubMedID 27449891

  View details for PubMedCentralID PMC4964166

• Using an emergency response infrastructure to help women who experience gender-based violence in Gujarat India BULLETIN OF THE WORLD HEALTH ORGANIZATION Newberry, J. A., Mahadevan, S., Gohil, N., Jamshed, R., Prajapati, J., Rao, G. V., Strehlow, M. 2016; 94 (5): 388-392

  Abstract

  Many women who experience gender-based violence may never seek any formal help because they do not feel safe or confident that they will receive help if they try.A public-private-academic partnership in Gujarat, India, established a toll-free telephone helpline - called 181 Abhayam - for women experiencing gender-based violence. The partnership used existing emergency response service infrastructure to link women to phone counselling, nongovernmental organizations (NGOs) and government programmes.In India, the lifetime prevalence of gender-based violence is 37.2%, but less than 1% of women will ever seek help beyond their family or friends. Before implementation of the helpline, there were no toll-free helplines or centralized coordinating systems for government programmes, NGOs and emergency response services.In February 2014, the helpline was launched across Gujarat. In the first 10 months, the helpline assisted 9767 individuals, of which 8654 identified themselves as women. Of all calls, 79% (7694) required an intervention by phone or in person on the day they called and 43% (4190) of calls were by or for women experiencing violence.Despite previous data that showed women experiencing gender-based violence rarely sought help from formal sources, women in Gujarat did use the helpline for concerns across the spectrum of gender-based violence. However, for evaluating the impact of the helpline, the operational definitions of concern categories need to be further clarified. The initial triage system for incoming calls was advantageous for handling high call volumes, but may have contributed to dropped calls.

  View details for DOI 10.2471/BLT.15.163741

  View details for PubMedID 27147769

• Epidemiology of Shortness of Breath in Prehospital Patients in Andhra Pradesh, India. journal of emergency medicine Mercer, M. P., Mahadevan, S. V., Pirrotta, E., Ramana Rao, G. V., Sistla, S., Nampelly, B., Danthala, R., Strehlow, A. N., Strehlow, M. C. 2015; 49 (4): 448-454

  Abstract

  Shortness of breath is a frequent reason for patients to request prehospital emergency medical services and is a symptom of many life-threatening conditions. To date, there is limited information on the epidemiology of, and outcomes of patients seeking emergency medical services for, shortness of breath in India.This study describes the characteristics and outcomes of patients with a chief complaint of shortness of breath transported by a public ambulance service in the state of Andhra Pradesh, India.This prospective, observational study enrolled patients with a chief complaint of shortness of breath during twenty-eight, 12-h periods. Demographic and clinical data were collected from emergency medical technicians using a standardized questionnaire. Follow-up information was collected at 48-72 h and 30 days.Six hundred and fifty patients were enrolled during the study period. The majority of patients were male (63%), from rural communities (66%), and of lower socioeconomic status (78%). Prehospital interventions utilized included oxygen (76%), physician consultation (40%), i.v. placement (15%), nebulized medications (13%), cardiopulmonary resuscitation (5%), and bag-mask ventilation (4%). Mortality ratios before hospital arrival, at 48-72 h, and 30 days were 12%, 27%, and 35%, respectively. Forty-six percent of patients were confirmed to have survived to 30 days. Predictors of death before hospital arrival were symptoms of chest pain (16% vs. 12%; p < 0.05) recent symptoms of upper respiratory infection (7.5% vs. 4%; p < 0.05), history of heart disease (14% vs. 7%; p < 0.05), and prehospital hypotension, defined as systolic blood pressure <90 mm Hg (6.3% vs. 3.7%; p < 0.05).Among individuals seeking prehospital emergency medical services in India, the chief complaint of shortness of breath is associated with a substantial early and late mortality, which may be in part due to the underutilization of prehospital interventions.

  View details for DOI 10.1016/j.jemermed.2015.02.041

  View details for PubMedID 26014761

• An observational study of adults seeking emergency care in Cambodia BULLETIN OF THE WORLD HEALTH ORGANIZATION Yan, L. D., Mahadevan, S. V., Yore, M., Pirrotta, E. A., Woods, J., Somontha, K., Sovannra, Y., Raman, M., Cornell, E., Grundmann, C., Strehlow, M. C. 2015; 93 (2): 84-92

  Abstract

  To describe the characteristics and chief complaints of adults seeking emergency care at two Cambodian provincial referral hospitals.Adults aged 18 years or older who presented without an appointment at two public referral hospitals were enrolled in an observational study. Clinical and demographic data were collected and factors associated with hospital admission were identified. Patients were followed up 48 hours and 14 days after presentation.In total, 1295 hospital presentations were documented. We were able to follow up 85% (1098) of patients at 48 hours and 77% (993) at 14 days. The patients' mean age was 42 years and 64% (823) were females. Most arrived by motorbike (722) or taxi or tuk-tuk (312). Most common chief complaints were abdominal pain (36%; 468), respiratory problems (15%; 196) and headache (13%; 174). Of the 1050 patients with recorded vital signs, 280 had abnormal values, excluding temperature, on arrival. Performed diagnostic tests were recorded for 539 patients: 1.2% (15) of patients had electrocardiography and 14% (175) had diagnostic imaging. Subsequently, 783 (60%) patients were admitted and 166 of these underwent surgery. Significant predictors of admission included symptom onset within 3 days before presentation, abnormal vital signs and fever. By 14-day follow-up, 3.9% (39/993) of patients had died and 19% (192/993) remained functionally impaired.In emergency admissions in two public hospitals in Cambodia, there is high admission-to-death ratio and limited application of diagnostic techniques. We identified ways to improve procedures, including better documentation of vital signs and increased use of diagnostic techniques.

  View details for DOI 10.2471/BLT.14.143917

  View details for PubMedID 25883401

• Implementing an emergency medical services system in kathmandu, Nepal: a model for "white coat diplomacy". Wilderness & environmental medicine Walker, R., Auerbach, P. S., Kelley, B. V., Gongal, R., Amsalem, D., Mahadevan, S. 2014; 25 (3): 311-318

  Abstract

  Wilderness medicine providers often visit foreign lands, where they come in contact with medical situations that are representative of the prevailing healthcare issues in the host countries. The standards of care for matters of acute and chronic care, public health, and crisis intervention are often below those we consider to be modern and essential. Emergency medical services (EMS) is an essential public medical service that is often found to be underdeveloped. We describe our efforts to support development of an EMS system in the Kathmandu Valley of Nepal, including training the first-ever class of emergency medical technicians in that country. The purpose of this description is to assist others who might attempt similar efforts in other countries and to support the notion that an effective approach to improving foreign relations is assistance such as this, which may be considered a form of "white coat diplomacy."

  View details for DOI 10.1016/j.wem.2014.04.006

  View details for PubMedID 24954196

• Setting the agenda in emergency medicine in the southern African region: Conference assumptions and recommendations, Emergency Medicine Conference 2014: Gaborone, Botswana AFRICAN JOURNAL OF EMERGENCY MEDICINE Christopher, L. D., Naidoo, N., de Waal, B., Mampane, T. S., Kgosibodiba, K., Chepete, K., Mahadevan, S. V. 2014; 4 (3): 154–57

  View details for DOI 10.1016/j.afjem.2014.07.003

  View details for Web of Science ID 000218900900013

• Proceedings of the international summit on emergency medicine and trauma 2014. International journal of emergency medicine Alagappan, K., Brown, A., Ganti, L., Biros, M., Mahadevan, S. 2014; 7 (Suppl 1): I1-O7

  View details for DOI 10.1186/1865-1380-7-S1-I1

  View details for PubMedID 25748859

  View details for PubMedCentralID PMC4127461

• PHYSICIAN IDENTIFICATION AND PATIENT SATISFACTION IN THE EMERGENCY DEPARTMENT: ARE THEY RELATED? JOURNAL OF EMERGENCY MEDICINE Mercer, M. P., Hernandez-Boussard, T., Mahadevan, S. V., Strehlow, M. C. 2014; 46 (5): 711-718

  Abstract

  Patient satisfaction has become a quality indicator tracked closely by hospitals and emergency departments (EDs). Unfortunately, the primary factors driving patient satisfaction remain poorly studied. It has been suggested that correct physician identification impacts patient satisfaction in hospitalized patients, however, the limited studies that exist have demonstrated mixed results.In this study, we sought to identify factors associated with improved satisfaction among ED patients, and specifically, to test whether improving physician identification by patients would lead to increased satisfaction.We performed a pre- and postintervention, survey-based study of patients at the end of their ED visits. We compared patient satisfaction scores as well as patients' abilities to correctly identify their physicians over two separate 1-week periods: prior to and after introducing a multimedia presentation of the attending physicians into the waiting room.A total of 486 patients (25% of all ED visits) were enrolled in the study. In the combined study population, overall patient satisfaction was higher among patients who correctly identified their physicians than among those who could not identify their physicians (combined mean satisfaction score of 8.1 vs. 7.2; odds ratio [OR] 1.07). Overall satisfaction was also higher among parents or guardians of pediatric patients than among adult patients (satisfaction score of 8.4 vs. 7.4; OR 1.07), and among patients who experienced a shorter door-to-doctor time (satisfaction score of 8.2 for shorter waiting time vs. 5.6 for longer waiting time; OR 1.15). Ambulance patients showed decreased satisfaction over some satisfaction parameters, including physician courtesy and knowledge. No direct relationship was demonstrated between the study intervention (multimedia presentation) and improved patient satisfaction or physician identification.Improved patient satisfaction was found to be positively correlated with correct physician identification, shorter waiting times, and among the pediatric patient population. Further studies are needed to determine interventions that improve patients' abilities to identify their physicians and lower waiting times.

  View details for DOI 10.1016/j.jemermed.2013.08.036

  View details for PubMedID 24462030

• Setting the Agenda in Emergency Medicine in the Southern African Region: Conference Assumptions and Recommendations, Emergency Medicine Conference 2014: Gaborone, Botswana. African Journal of Emergency Medicine Christopher, L., Naidoo, N., de Waal, B., Mampane, T., Kgosibodiba, K., Chepete, K., Mahadevan, S. 2014; 4 (3)
• Importance of research for the specialty of Emergency Medicine in India INTERNATIONAL JOURNAL OF EMERGENCY MEDICINE Alagappan, K., Brown, A., Ganti, L., Biros, M., Mahadevan, S. 2014; 7

  View details for DOI 10.1186/1865-1380-7-S1-I1

  View details for Web of Science ID 000215048900001

• Opt-In versus Opt-out HIV Screening in Emergency Departments: A Randomized Trial Montoy, J. C., Chan, G. K., Mahadevan, S. MOSBY-ELSEVIER. 2012: S103

  View details for DOI 10.1016/j.annemergmed.2012.06.268

  View details for Web of Science ID 000309636100287

• INDIAN AND UNITED STATES PARAMEDIC STUDENTS: COMPARISON OF EXAMINATION PERFORMANCE FOR THE AMERICAN HEART ASSOCIATION ADVANCED CARDIOVASCULAR LIFE SUPPORT (ACLS) TRAINING JOURNAL OF EMERGENCY MEDICINE Goodwin, T., Delasobera, B. E., Strehlow, M., Camacho, J., Koskovich, M., D'Souza, P., Gilbert, G., Mahadevan, S. V. 2012; 43 (2): 298-302

  Abstract

  The American Heart Association (AHA) Advanced Cardiovascular Life Support (ACLS) course is taught worldwide. The ACLS course is designed for consistency, regardless of location; to our knowledge, no previous study has compared the cognitive performance of international ACLS students to those in the United States (US).As international health educational initiatives continue to expand, an assessment of their efficacy is essential. This study assesses the AHA ACLS curriculum in an international setting by comparing performance of a cohort of US and Indian paramedic students.First-year paramedic students at the Emergency Management and Research Institute, Hyderabad, India, and a cohort of first-year paramedic students from the United States comprised the study population. All study participants had successfully completed the standard 2-day ACLS course, taught in English. Each student was given a 40-question standardized AHA multiple-choice examination. Examination performance was calculated and compared for statistical significance.There were 117 Indian paramedic students and 43 US paramedic students enrolled in the study. The average score was 86% (± 11%) for the Indian students and 87% (± 6%) for the US students. The difference between the average examination scores was not statistically significant in an independent means t-test (p=0.508) and a Wilcoxon test (p=0.242).Indian paramedic students demonstrated excellent ACLS cognitive comprehension and performed at a level equivalent to their US counterparts on an AHA ACLS written examination. Based on the study results, the AHA ACLS course proved effective in an international setting despite being taught in a non-native language.

  View details for DOI 10.1016/j.jemermed.2011.05.096

  View details for PubMedID 22244286

• PENETRATING CARDIAC INJURY FROM A WOODEN KNITTING NEEDLE JOURNAL OF EMERGENCY MEDICINE Hsia, R. Y., Mahadevan, S. V., Brundage, S. I. 2012; 43 (1): 116-119

  View details for DOI 10.1016/j.jemermed.2010.06.027

  View details for Web of Science ID 000306729100023

  View details for PubMedID 20832964

• Airway Management In Mahadevan S (Editor) & Garmel G (Co-editor): An Introduction to Clinical Emergency Medicine (2nd edition) Mahadevan S, Sovndal S 2012
• Ear pain In Mahadevan S (Editor) & Garmel G (Co-editor): An Introduction to Clinical Emergency Medicine (2nd edition) Gilbert G, Mahadevan S 2012
• An Introduction to Clinical Emergency Medicine (2nd Edition) Mahadevan SV, Garmel GM 2012
• Abdominal Pain In Mahadevan S (Editor) & Garmel G (Co-editor): An Introduction to Clinical Emergency Medicine (2nd edition) Mahadevan S 2012
• Low Back Pain In Mahadevan S (Editor) & Garmel G (Co-editor): An Introduction to Clinical Emergency Medicine (2nd edition) Herbert M, Lanctot-Herbert M, Mahadevan S 2012
• Pediatric Cervical Spine Tutorial In Wang NE (Editor): Handbook of Pediatric Emergencies Mahadevan S 2011
• Pediatric Cervical Spine Injuries In Wang NE (Editor): Handbook of Pediatric Emergencies Mewaldt K, Mahadevan S 2011
• Emergency Airway Management In Auerbach PS (Editor): Wilderness Medicine (6th Edition) Mahadevan S 2011
• Evaluating the efficacy of simulators and multimedia for refreshing ACLS skills in India RESUSCITATION Delasobera, B. E., Goodwin, T. L., Strehlow, M., Gilbert, G., D'Souza, P., Alok, A., Raje, P., Mahadevan, S. V. 2010; 81 (2): 217-223

  Abstract

  Data on the efficacy of the simulation and multimedia teaching modalities is limited, particularly in developing nations. This study evaluates the effectiveness of simulator and multimedia educational tools in India.Advanced Cardiac Life Support (ACLS) certified paramedic students in India were randomized to either Simulation, Multimedia, or Reading for a 3-h ACLS refresher course. Simulation students received a lecture and 10 simulator cases. The Multimedia group viewed the American Heart Association (AHA) ACLS video and played a computer game. The Reading group independently read with an instructor present. Students were tested prior to (pre-test), immediately after (post-test), and 3 weeks after (short-term retention test), their intervention. During each testing stage subjects completed a cognitive, multiple-choice test and two cardiac arrest scenarios. Changes in exam performance were analyzed for significance. A survey was conducted asking students' perceptions of their assigned modality.One hundred and seventeen students were randomized to Simulation (n=39), Multimedia (n=38), and Reading (n=40). Simulation demonstrated greater improvement managing cardiac arrest scenarios compared to both Multimedia and Reading on the post-test (9% versus 5% and 2%, respectively, p<0.05) and Reading on the short-term retention test (6% versus -1%, p<0.05). Multimedia showed significant improvement on cognitive, short-term retention testing compared to Simulation and Reading (5% versus 0% and 0%, respectively, p<0.05). On the survey, 95% of Simulation and 84% of Multimedia indicated they enjoyed their modality.Simulation and multimedia educational tools were effective and may provide significant additive benefit compared to reading alone. Indian students enjoyed learning via these modalities.

  View details for DOI 10.1016/j.resuscitation.2009.10.013

  View details for Web of Science ID 000274982500014

  View details for PubMedID 19926385

• Maxillofacial and Neck Injury In Savitsky ES (editor): Combat Casualty Care: Lessons Learned in OEF & OIF Hale RG, Hayes DK, Orloff G, Peterson J, Powers D, Mahadevan S 2010
• Development of a Self-Sustaining Paramedic Educational Program in India: The Stanford-GVK EMRI Partnership EMS India Mahadevan S, Strehlow M 2010
• Epidemiology of Out-of-Hospital Emergencies in Andhra Pradesh, India, 2007 Mahadevan, S., Strehlow, M. C. MOSBY-ELSEVIER. 2009: S80

  View details for DOI 10.1016/j.annemergmed.2009.06.284

  View details for Web of Science ID 000269346100254

• Cervical Spine Fractures In Wolfson AB (Editor): Harwood Nuss? Clinical Practice of Emergency Medicine (5th edition) Mower W, Hoffman JR, Mahadevan S 2009
• Eye Medications In Wolfson AB (Editor): Harwood Nuss? Clinical Practice of Emergency Medicine (5th edition) Schertzer K, Mahadevan S 2009
• Discordance rates between preliminary and final radiology reports on cross-sectional imaging studies at a level 1 trauma center ACADEMIC RADIOLOGY Stevens, K. J., Griffiths, K. L., Rosenberg, J., Mahadevan, S., Zatz, L. M., Leung, A. N. 2008; 15 (10): 1217-1226

  Abstract

  The goal was to determine discordance rates between preliminary radiology reports provided by on-call radiology house staff and final reports from attending radiologists on cross-sectional imaging studies requested by emergency department staff after hours.A triplicate carbon copy reporting form was developed to provide permanent records of preliminary radiology reports and to facilitate communication of discrepant results to the emergency department. Data were collected over 21 weeks to determine the number of discordant readings. Patients' medical records were reviewed to show whether discrepancies were significant or insignificant and to assess their impact on subsequent management and patient outcome.The emergency department requested 2830 cross-sectional imaging studies after hours and 2311 (82%) had a copy of the triplicate form stored in radiology archives. Discrepancies between the preliminary and final report were recorded in 47 (2.0%), with 37 (1.6%) considered significant: 14 patients needed no change, 13 needed a minor change, and 10 needed a major change in subsequent management. Ten (0.43%) of the discordant scans were considered insignificant. A random sample of 104 (20%) of the 519 scans without a paper triplicate form was examined. Seventy-one (68%) did have a scanned copy of the triplicate form in the electronic record, with a discrepancy recorded in 3 (4.2%), which was not statistically different from the main cohort (P = .18).Our study suggests a high level of concordance between preliminary reports from on-call radiology house staff and final reports by attending subspecialty radiologists on cross-sectional imaging studies requested by the emergency department.

  View details for DOI 10.1016/j.acra.2008.03.017

  View details for PubMedID 18790392

• Issues and Solutions in Introducing Western Systems to the Pre-hospital Care System in Japan WESTERN JOURNAL OF EMERGENCY MEDICINE Suzuki, T., Nishida, M., Suzuki, Y., Kobayashi, K., Mahadevan, S. V. 2008; 9 (3): 166–70

  Abstract

  This report aims to illustrate the history and current status of Japanese emergency medical services (EMS), including development of the specialty and characteristics adapted from the U.S. and European models. In addition, recommendations are made for improvement of the current systems.Government reports and academic papers were reviewed, along with the collective experiences of the authors. Literature searches were performed in PubMed (English) and Ichushi (Japanese), using keywords such as emergency medicine and pre-hospital care. More recent and peer-reviewed articles were given priority in the selection process.The pre-hospital care system in Japan has developed as a mixture of U.S. and European systems. Other countries undergoing economic and industrial development similar to Japan may benefit from emulating the Japanese EMS model.Currently, the Japanese system is in transition, searching for the most suitable and efficient way of providing quality pre-hospital care.Japan has the potential to enhance its current pre-hospital care system, but this will require greater collaboration between physicians and paramedics, increased paramedic scope of medical practice, and greater Japanese societal recognition and support of paramedics.

  View details for Web of Science ID 000422580400010

  View details for PubMedID 19561736

  View details for PubMedCentralID PMC2672269

• Internationalizing the Broselow tape: How reliable is weight estimation in Indian children Conference of the Western-Society-for-Academic-Emergency-Medicine Ramarajan, N., Krishnamoorthi, R., Strehlow, M., Quinn, J., Mahadevan, S. V. WILEY-BLACKWELL PUBLISHING, INC. 2008: 431–36

  Abstract

  The Broselow pediatric emergency weight estimation tape is an accurate method of estimating children's weights based on height-weight correlations and determining standardized medication dosages and equipment sizes using color-coded zones. The study objective was to determine the accuracy of the Broselow tape in the Indian pediatric population.The authors conducted a 6-week prospective cross-sectional study of 548 children at a government pediatric hospital in Chennai, India, in three weight-based groups: < 10 kg (n = 175), 10-18 kg (n = 197), and > 18 kg (n = 176). Measured weight was compared to Broselow-predicted weight, and the percentage difference was calculated. Accuracy was defined as agreement on Broselow color-coded zones, as well as agreement within 10% between the measured and Broselow-predicted weights. A cross-validated correction factor was also derived.The mean percentage differences were -2.4, -11.3, and -12.9% for each weight-based group. The Broselow color-coded zone agreement was 70.8% in children weighing less than 10 kg, but only 56.3% in the 10- to 18-kg group and 37.5% in the > 18-kg group. Agreement within 10% was 52.6% for the < 10-kg group, but only 44.7% for the 10- to 18-kg group and 33.5% for the > 18-kg group. Application of a 10% weight-correction factor improved the percentages to 77.1% for the 10- to 18-kg group and 63.0% for the >18-kg group.The Broselow tape overestimates weight by more than 10% in Indian children > 10 kg. Weight overestimation increases the risk of medical errors due to incorrect dosing or equipment selection. Applying a 10% weight-correction factor may be advisable.

  View details for DOI 10.1111/j.1553-2712.2008.00081.x

  View details for PubMedID 18439198

• Internationalizing the broselow tape: How reliable is weight estimation in Indian children? 12th International Conference on Emergency Medicine Ramaralan, N., Krishnamoorthi, R., Strehlow, M., Quinn, J., Mahadevan, S. MOSBY-ELSEVIER. 2008: 512–13

  View details for Web of Science ID 000254648000160

• Expedition Orthopedics In Bledsoe GH (Editor): Expedition Medicine Gianotti A, Mahadevan S 2008
• Issues and Solutions in Introducing Western Systems to Prehospital Care Systems in Japan. WestJEM Suzuki T, Nishida M, Suzuki Y, Kobayashi K, Mahadevan S. 2008; 9: 166-170
• Spine Trauma and Spinal Cord Injury In Adams J (Editor): Emergency Medicine: Expert Consult: Online and Print Lin M, Mahadevan S 2008
• Effects of implementing a rapid admission policy in the ED AMERICAN JOURNAL OF EMERGENCY MEDICINE Quinn, J. V., Mahadevan, S. V., Eggers, G., Ouyang, H., Norris, R. 2007; 25 (5): 559-563

  Abstract

  The purpose of this study is to determine the impact of a new rapid admission policy (RAP) on emergency department (ED) length of stay (EDLOS) and time spent on ambulance diversion (AD).The RAP, instituted in January 2005, allows attending emergency physicians to send stable patients, requiring admission to the general medicine service, directly to available inpatient beds. The RAP thereby eliminates 2 conventional preadmission practices: having admitting physicians evaluate the patient in the ED and requiring all diagnostic testing to be complete before admission. We compared patient characteristics, percentage of patients leaving without being seen, EDLOS for admitted patients, time on AD, and total adjusted facility charge for a 3-month period after the RAP implementation to the same period of the prior year.There was a 1.1% increase in census with no difference in patient demographics, acuity, or disposition categories for the 2 periods. The EDLOS decreased on average by 10.1 minutes (95% confidence interval [CI], 3.3-17.0 minutes), resulting in an average of 4.2 hours of extra bed availability per day. Weekly minutes of AD decreased 169 minutes (95% CI, 29-310 minutes). There was also a 3.2% increase (95% CI, 3.1%-3.3%) in adjusted facility charge between these periods in 2005 compared with 2004.The RAP resulted in a small decrease in the EDLOS, which likely decreased AD time. The resulting small increase in ED volume and higher acuity ambulance patients significantly improved ED revenue. Wider implementation of the policy and more uniform use among emergency physicians may further improve these measures.

  View details for DOI 10.1016/j.ajem.2006.11.034

  View details for PubMedID 17543661

• Annotated Bibliography of Blast Injury. Blast Injury Educational Curriculum for Healthcare providers in Egypt. Strehlow M, Mahadevan S, Savitsky E 2007
• Clinical Assessment of Hypovolemia. Emergency Medicine Practice?s The 2007Lifelong Learning and Self-Assessment (LLSA) Study Guide. Strehlow M, Mahadevan S 2007
• Emergency Airway Management In Auerbach PS (Editor): Wilderness Medicine (5th Edition) Mahadevan S 2007
• Adolescent Violence, Sikh Religion and Hate Crimes Case Based Cultural Competency Curriculum in Emergency Medicine. Mahadevan S 2006
• Ultrasound-Guided Procedural Training Using Emerging Technologies Acad Emerg Med Savitsky E, Mahadevan S 2006; 25: 559-63
• Importance, Advances and Impact of an International Emergency Trauma Care Education Program. Indian Emergency Journal. Indian Emergency Journal Mahadevan S 2005; 1 (1)
• Importance, Advances and Impact of an International Emergency Trauma Care Education Program. Indian Emergency Journal Mahadevan SV 2005; 1 (1): 12-15
• Cervical Spine Fractures Harwood Nuss? Clinical Practice of Emergency Medicine (4th edition). Mower W, Hoffman JR, Mahadevan S: 2005
• Ear pain In Mahadevan S (Editor) & Garmel G (Co-editor): An Introduction to Clinical Emergency Medicine Gilbert G, Mahadevan SV 2005
• Airway Management In Mahadevan S (Editor) & Garmel G (Co-editor): An Introduction to Clinical Emergency Medicine Mahadevan SV, Sovndal S 2005
• Abdominal Pain In Mahadevan S (Editor) & Garmel G (Co-editor): An Introduction to Clinical Emergency Medicine Mahadevan SV 2005
• An Introduction to Clinical Emergency Medicine: Guide for Practitioners in the Emergency Department (First Edition) Mahadevan SV, Garmel GM 2005
• Emergency department orientation utilizing web-based streaming video ACADEMIC EMERGENCY MEDICINE Mahadevan, S. V., Gisondi, M. A., Sovndal, S. S., Gilbert, G. H. 2004; 11 (8): 848-852

  Abstract

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

  View details for DOI 10.1197/j.aem.2003.10.032

  View details for PubMedID 15289191

• Evaluation and Clearance of the Cervical Spine in Adult Trauma Patients: Clinical Concepts, Controversies and Advances: Part 2 Trauma Reports Mahadevan SV, Navarro M 2004; 5 (5)
• Evaluation and Clearance of the Cervical Spine in Adult Trauma Patients: Clinical Concepts, Controversies and Advances: Part 1 Trauma Reports Mahadevan SV, Navarro M 2004; 5 (4)
• Cervical Spine Injury in Blunt Trauma Emergency Medicine Practice?s The 2004 Lifelong Learning and Self-Assessment (LLSA) Study Guide. Mahadevan SV 2003
• Knee Injuries. Emergency Medicine Practice?s The 2004 Lifelong Learning and Self-Assessment (LLSA) Study Guide. Garza D, Mahadevan SV 2003
• The outstanding medical student in emergency medicine ACADEMIC EMERGENCY MEDICINE Mahadevan, S., Garmel, G. M. 2001; 8 (4): 402-403

  View details for Web of Science ID 000168133100018

  View details for PubMedID 11282680

• Ocular Trauma Trauma Reports Mahadevan SV, Savitsky E 2001; 2 (4)
• Traumatic Ocular Injuries and Visual Loss Hospital Physician: Emergency Medicine Board Review Manuak Mahadevan SV 1999; 5 (1)
• Interrater reliability of cervical spine injury criteria in patients with blunt trauma Annual Meeting of the Society-for-Academic-Emergency-Medicine Mahadevan, S., Mower, W. R., Hoffman, J. R., Peeples, N., Goldberg, W., Sonner, R. MOSBY-ELSEVIER. 1998: 197–201

  Abstract

  To determine the interrater reliability of previously defined risk criteria for cervical spine injury.Two emergency physicians independently evaluated patients with blunt trauma to determine whether they exhibited any of four risk criteria: (1) altered neurologic function; (2) evidence of intoxication; (3) spinous process or posterior midline cervical tenderness; or (4) distracting painful injury. Each criterion was explicitly described on study data forms. Physician concordance was measured, and the kappa statistic was calculated, for the combined risk criteria (based on the presence of any individual criterion), and for each individual criterion.There were 122 patients evaluated. Physicians agreed on overall classifications for 107 patients (87.7%; kappa, .73; confidence interval [CI], .61 to .86). Agreement for individual criteria were as follows: (1) altered neurologic function--102 patients (83.6%; kappa, .58; CI, .41 to .74); (2) intoxication--118 patients (96.7%; kappa, .86; CI, .72 to .99); (3) posterior midline tenderness--109 patients (89.3%; kappa, .77; CI .65 to .89); (4) distracting injury--112 patients (91.8%; kappa.77; CI, .64 to .91).The combined cervical spine injury criteria have substantial interrater reliability. Individual criteria are slightly less reliable.

  View details for Web of Science ID 000071887900007

  View details for PubMedID 9472180

• Nontraumatic Ocular Emergencies. Hospital Physician: Emergency Medicine Board Review Manuak Mahadevan SV 1998; 4 (3)
• ADENOSINE FOR THE PREHOSPITAL TREATMENT OF PAROXYSMAL SUPRAVENTRICULAR TACHYCARDIA ANNALS OF EMERGENCY MEDICINE Gausche, M., Persse, D. E., SUGARMAN, T., Shea, S. R., PALMER, G. L., Lewis, R. J., BRUESKE, P. J., Mahadevan, S., Melio, F. R., KUWATA, J. H., Niemann, J. T. 1994; 24 (2): 183-189

  Abstract

  To determine the efficacy and feasibility of adenosine for the treatment of paroxysmal supraventricular tachycardia (PSVT) in the prehospital setting.Prospective case series.Large, urban, advanced life support emergency medical services system.One hundred twenty-nine adult patients with PSVT, as identified by paramedic personnel. Pregnant patients and those taking carbamazepine or dipyridamole were excluded.Dose of 12 mg adenosine by rapid i.v. push followed by a 5-mL saline flush and a repeat dose of 12 mg adenosine i.v. push if the patient's rhythm remained unchanged.Six-second lead II rhythm strips and vital signs were documented before and 2 minutes after the administration of adenosine. Demographic information, past medical history, medications, number of adenosine doses given, and complications were recorded by the paramedic on a case-report form. One hundred six of 129 (82%) of the case-report forms included the rhythm strips from before and after adenosine administration. Actual initial rhythms were determined by a consensus panel. The initial rhythms were PSVT in 79% (84 of 106) of patients, atrial fibrillation in 12% (13 of 106), sinus tachycardia in 5% (five of 106), atrial flutter in 2% (two of 106), and ventricular tachycardia in 2% (two of 106). Eighty-five percent (71 of 84) of patients in PSVT were successfully converted to sinus rhythms; four (5.6%) of these patients required a second 12-mg dose. One patient in atrial fibrillation spontaneously converted to normal sinus rhythm and one patient in ventricular tachycardia converted after adenosine. All other patients not initially in PSVT remained in their initial rhythm. Complications occurred in 12 of 129 patients and included chest pain (five), flushing (three), shortness of breath (two), nausea (one), anxiety (one), dizziness (one), headache (one), and seizure (one). All complications were transient and required no treatment. Prior history of PSVT was the only variable associated with a higher rate of conversion (P = .029).Paramedics are able to accurately identify PSVT using a single lead. Adenosine is safe and effective treatment for PSVT in the prehospital setting. This series is the largest prehospital study of adenosine use to date.

  View details for Web of Science ID A1994PA15600001

  View details for PubMedID 8037382