Bio

Clinical Focus


  • Emergency Medicine
  • International Emergency Medicine
  • Medical Education
  • Emergency Medical Services
  • Trauma

Academic Appointments


Administrative Appointments


  • Director, International Visiting Scholar's Program, Stanford Emergency Medicine International (SEMI) (2000 - 2008)
  • Course Director, Surgery 220, Introduction to Emergency Medicine, Stanford University School of Medicine (2000 - 2008)
  • Course Director, Surgery 313A, Medical Student Clerkship in Emergency Medicine, Stanford University School of Medicine (1999 - 2006)
  • Director, Fellowship in International Emergency Medicine, Stanford University School of Medicine (2005 - 2015)
  • Founding Director, Stanford Emergency Medicine International, Stanford University School of Medicine (2000 - 2015)
  • Medical Director, Stanford University Emergency Department (2000 - 2012)
  • Associate Chief, Stanford Division of Emergency Medicine (2000 - 2012)
  • Interim (Founding) Chairman, Department of Emergency Medicine, Stanford University School of Medicine (2015 - Present)

Honors & Awards


  • Spring Emergency Medicine Bedside Teaching Award, Stanford- Kaiser Emergency Medicine Residency Program (2001)
  • 2002-2003 Emergency Medicine Bedside Teaching Award, Stanford-Kaiser Emergency Medicine Residency (2002-2003)
  • Fall Emergency Medicine Bedside Teaching Award, Stanford- Kaiser Emergency Medicine Residency Program (2003)
  • Innovations in Emergency Medicine Exhibit (IEME) Award, Society for Academic Emergency Medicine (SAEM) (2003)
  • Council of Residency Directors (CORD) Faculty Teaching Award, Council of Emergency Medicine Residency Directors (CORD) (2003)
  • ACEP 2004-2005 Scientific Assembly Rookie Speaker of the Year Award, American College of Emergency Physicians (ACEP) (2004-2005)
  • 50 Outstanding UC Riverside Students, 50th Anniversary of the UC Riverside Alumni Association (2006)
  • AMWA 2006 Book Award Winner: Physician's Category: An Introduction to Clinical Emergency Medicine, American Medical Writers Association (AMWA) (2006)
  • Winter Emergency Medicine Bedside Teaching Award, Stanford- Kaiser Emergency Medicine Residency Program (2007)
  • ACEP 2006-2007 Honorable Mention Outstanding Speaker of the Year Award, American College of Emergency Physicians (ACEP) (2006-2007)
  • Award for Outstanding Community Service/Dedicated Leadership/ Contributions to Improving India's EMS, Osmania Gandhi Kakatiya Medical Alumni Assoc. (OGKMA) (2007)
  • Stanford Biodesign Faculty Teaching Award, Stanford Biodesign (2008)
  • CAL ACEP Education Award, California American College of Emergency Physicians (ACEP) (2011)
  • 2011 California EMS Authority: Team Award (International), California EMS Authority (2011)
  • Denise M. O"Leary Award for Excellence, Board of Directors, Stanford Hospital and Clinics (2012)
  • Arthur L. Bloomfield Award for Excellence in the Teaching of Clinical Medicine, Stanford University School of Medicine (2012)
  • ACEP National Faculty Teaching Award, American College of Emergency Physicians (2012)
  • SEMI Excellence Award, Emergency Medical Services, Society of Emergency Medicine in India (SEMI) (2012)
  • Save of the Month (July), Stanford University Emergency Department (2013)
  • 4th Lifeline-AAEMI Award for EMS (India), Lifeline, American Academy for Emergency Medicine in India (2013)
  • SEMI Lifetime Achievement Award 2014, Society of Emergency Medicine in India (SEMI) (2014)
  • Save of the Month (January), Stanford University Emergency Department (2015)
  • 25 Emergency Medicine & EMS Professors You Should Know, Medical School Technologies (2015)

Professional Education


  • Board Certification: Emergency Medicine, American Board of Emergency Medicine (1998)
  • Residency:Olive View - UCLA Medical Center (1996) CA
  • Internship:Harbor-UCLA Medical Center (1993) CA
  • Medical Education:UCLA School of Medicine (1992) CA
  • BS, UC Riverside, Biomedical Sciences (1988)
  • MD, UCLA School of Medicine, Medicine (1992)

Community and International Work


  • 2015-2017 Myanmar Emergency Medicine Training

    Location

    International

    Ongoing Project

    Yes

    Opportunities for Student Involvement

    No

  • 2014-2019 USAID Quality Health ServIces project in Cambodia, Cambodia

    Topic

    Improve reproductive, maternal, newborn and child health and nutrition (RMNCHN) services

    Partnering Organization(s)

    USAID/ URC-CHS / Cambodia MOH

    Location

    International

    Ongoing Project

    Yes

    Opportunities for Student Involvement

    No

  • 2014 VPOL Course: Managing Emergencies: What Every Doctor Needs to Know, Uganda

    Partnering Organization(s)

    Makerere University

    Location

    International

    Ongoing Project

    Yes

    Opportunities for Student Involvement

    Yes

  • 2013-2016 Stanford Essential Prehospital Care Course, India

    Partnering Organization(s)

    EMRI

    Location

    International

    Ongoing Project

    Yes

    Opportunities for Student Involvement

    Yes

  • 2012-2013 Stanford-EMRI Pediatric District Hospital Course, India

    Topic

    Pediatric Emergency Medicine

    Partnering Organization(s)

    EMRI

    Location

    International

    Ongoing Project

    Yes

    Opportunities for Student Involvement

    No

  • 2011-2013 Stanford-URC Cambodia, Cambodia

    Topic

    Emergency medicine strengthening

    Partnering Organization(s)

    URC-CHS

    Populations Served

    http://www.urc-chs.com/country?countryID=17

    Location

    International

    Ongoing Project

    Yes

    Opportunities for Student Involvement

    Yes

  • 2010-2012 Iraq Regional Health Emergency Response Project (RHERP), Iraq

    Topic

    Emergency Medical Services

    Partnering Organization(s)

    World Bank

    Location

    International

    Ongoing Project

    Yes

    Opportunities for Student Involvement

    No

  • 2010-2011 Stanford-EMRI EMS Protocol Development, India

    Topic

    EMS Protocols

    Partnering Organization(s)

    GVK EMRI

    Location

    International

    Ongoing Project

    No

    Opportunities for Student Involvement

    No

  • 2009-2010 Stanford-EMRI District Hospital Course, India

    Topic

    Emergency Medicine at the District Hospital

    Location

    International

    Ongoing Project

    Yes

    Opportunities for Student Involvement

    No

  • 2009-2011 Stanford-EMRI International Research Insitute, India

    Partnering Organization(s)

    GVK EMRI

    Location

    International

    Ongoing Project

    Yes

    Opportunities for Student Involvement

    Yes

  • 2010 Nepal Ambulance Project, EMT-Education, Nepal

    Topic

    EMS development

    Partnering Organization(s)

    Nepal Ambulance Service

    Populations Served

    http://nepalambulanceservice.org/

    Location

    International

    Ongoing Project

    No

    Opportunities for Student Involvement

    No

  • 2007 Stanford-EMRI Post-Graduate Program in Emergency Care, Hyderabad, India

    Topic

    Emergency Medical Services

    Partnering Organization(s)

    Emergency Management and Research Institute (EMRI)

    Populations Served

    http://www.emri.in/

    Ongoing Project

    No

    Opportunities for Student Involvement

    No

  • 2006 Stanford-Apollo EMT-Intermediate Training Program, Hyderabad and Chennai, India

    Topic

    Emergency Medical Services

    Partnering Organization(s)

    Apollo Hospital India

    Location

    International

    Ongoing Project

    No

    Opportunities for Student Involvement

    No

  • 2005 United Nations handbook Landmine And

    Topic

    First Aid

    Partnering Organization(s)

    UCLA CIM, United Nations

    Location

    International

    Ongoing Project

    No

    Opportunities for Student Involvement

    No

  • 2004-2005 Fundamentals in Trauma Care, China

    Topic

    Trauma care

    Partnering Organization(s)

    UCLA CIM, Project Hope

    Location

    International

    Ongoing Project

    No

    Opportunities for Student Involvement

    No

  • 2003-2005 Fundamentals in Trauma Care, Egypt

    Topic

    Trauma care

    Partnering Organization(s)

    UCLA CIM, Project Hope

    Location

    International

    Ongoing Project

    No

    Opportunities for Student Involvement

    No

  • 2000-present Stanford Emergency Medicine International Visiting Scholar's Program, Stanford

    Topic

    International Emergency Medicine

    Location

    International

    Ongoing Project

    Yes

    Opportunities for Student Involvement

    No

  • On field volunteer emergency physician San Francisco 49ers

    Topic

    Emergency Medicine

    Partnering Organization(s)

    San Francisco 49ers

    Location

    Bay Area

    Ongoing Project

    Yes

    Opportunities for Student Involvement

    No

Research & Scholarship

Projects


  • USAID Quality Health ServIces project in Cambodia

    Location

    Cambodia

  • Managing Emergencies: What Every Doctor Needs to Know (Global EM Course)

    Location

    Mongolia

  • Stanford Essential Prehospital Care Course

    Location

    India

Publications

All Publications


  • 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

  • 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. R., Strehlow, M. 2016; 94 (5): 388-92

    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

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

    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

  • 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

  • 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 Web of Science ID 000350538200011

  • 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 Web of Science ID 000341286100008

    View details for PubMedID 24954196

  • 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 Web of Science ID 000334791000028

    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)
  • 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 Web of Science ID 000307920500016

    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
  • 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
  • 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
  • Airway Management In Mahadevan S (Editor) & Garmel G (Co-editor): An Introduction to Clinical Emergency Medicine (2nd edition) Mahadevan S, Sovndal 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
  • 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 Web of Science ID 000259742400002

    View details for PubMedID 18790392

  • Internationalizing the Broselow tape: How reliable is weight estimation in Indian children ACADEMIC EMERGENCY MEDICINE Ramarajan, N., Krishnamoorthi, R., Strehlow, M., Quinn, J., Mahadevan, S. V. 2008; 15 (5): 431-436

    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 Web of Science ID 000255285200005

    View details for PubMedID 18439198

  • Internationalizing the broselow tape: How reliable is weight estimation in Indian children? Ramaralan, N., Krishnamoorthi, R., Strehlow, M., Quinn, J., Mahadevan, S. MOSBY-ELSEVIER. 2008: 512-513
  • Spine Trauma and Spinal Cord Injury In Adams J (Editor): Emergency Medicine: Expert Consult: Online and Print Lin M, 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
  • Expedition Orthopedics In Bledsoe GH (Editor): Expedition Medicine Gianotti A, 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 Web of Science ID 000247298800012

    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
  • Airway Management In Mahadevan S (Editor) & Garmel G (Co-editor): An Introduction to Clinical Emergency Medicine Mahadevan SV, Sovndal S 2005
  • Ear pain In Mahadevan S (Editor) & Garmel G (Co-editor): An Introduction to Clinical Emergency Medicine Gilbert G, Mahadevan SV 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 Web of Science ID 000223090900006

    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 ANNALS OF EMERGENCY MEDICINE Mahadevan, S., Mower, W. R., Hoffman, J. R., Peeples, N., Goldberg, W., Sonner, R. 1998; 31 (2): 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