Kevin Munjal - Academia.edu (original) (raw)

Papers by Kevin Munjal

BMJ Open, 2022

IntroductionNearly one-quarter of patients discharged from the hospital with heart failure (HF) a... more IntroductionNearly one-quarter of patients discharged from the hospital with heart failure (HF) are readmitted within 30 days, placing a significant burden on patients, families and health systems. The objective of the ‘Using Mobile Integrated Health and Telehealth to support transitions of care among patients with Heart failure’ (MIGHTy-Heart) study is to compare the effectiveness of two postdischarge interventions on healthcare utilisation, patient-reported outcomes and healthcare quality among patients with HF.Methods and analysisThe MIGHTy-Heart study is a pragmatic comparative effectiveness trial comparing two interventions demonstrated to improve the hospital to home transition for patients with HF: mobile integrated health (MIH) and transitions of care coordinators (TOCC). The MIH intervention bundles home visits from a community paramedic (CP) with telehealth video visits by emergency medicine physicians to support the management of acute symptoms and postdischarge care coor...

JMIR Human Factors, 2022

Background Smart glasses have been gaining momentum as a novel technology because of their advant... more Background Smart glasses have been gaining momentum as a novel technology because of their advantages in enabling hands-free operation and see-what-I-see remote consultation. Researchers have primarily evaluated this technology in hospital settings; however, limited research has investigated its application in prehospital operations. Objective The aim of this study is to understand the potential of smart glasses to support the work practices of prehospital providers, such as emergency medical services (EMS) personnel. Methods We conducted semistructured interviews with 13 EMS providers recruited from 4 hospital-based EMS agencies in an urban area in the east coast region of the United States. The interview questions covered EMS workflow, challenges encountered, technology needs, and users’ perceptions of smart glasses in supporting daily EMS work. During the interviews, we demonstrated a system prototype to elicit more accurate and comprehensive insights regarding smart glasses. Int...

Abstract: Although distraction osteogenesis has proven successful in children, concerns remain re... more Abstract: Although distraction osteogenesis has proven successful in children, concerns remain regarding potential growth inhibition of the lengthened limb. Twenty-one 8-week-old New Zealand White rabbits underwent a unilateral 40 % tibial lengthening with the contralateral tibia as control. The animals were divided into Achilles tendon release and non-release groups. Radiographs and histomor-phometric analysis of the proximal tibial growth plate was performed 5 and 10 weeks after distraction. The corrected length of tibias without tenotomy was significantly shorter than the contralateral controls, whereas those with tenotomy were statistically equivalent to the contralateral control tibias. Histologically, the operated limbs without tenotomy showed a significant decrease in thickness and loss of cellular architecture of the proximal tibial growth plate compared with the tenotomy groups, which were of near-normal appearance. A concomitant tendo Achilles lengthening performed with 40...

EMS world, 2016

Because of the expanded role EMS providers may paly in the community, medical direction in EMS 3.... more Because of the expanded role EMS providers may paly in the community, medical direction in EMS 3.o should appropriately be a collaborative effort led by EMS subspecialty-certified physicians specially trained in emergency medicine, but also physicians who specialize in disciplines such as internal/family medicine, critical care, cardiology, nephrology, endocrinology and pulmonary medicine. The EMS 3.0 medical director should be able to build patient-centered coalitions of physicians to help meet the care coordination goals of the patient, their physicians and the EMS system.

Emergency Medical Services, 2021

The Journal of Emergency Medicine, 2020

reach statistical significance. Conclusion: The study findings suggest that transport home via am... more reach statistical significance. Conclusion: The study findings suggest that transport home via ambulance after hospital discharge could be predictive of a high risk of recidivism independent of established readmission risk factors. Programs that expand the role of EMS to include post-transport interventions may warrant further exploration.

Internal Medicine Journal, 2018

Worp HB et al. Surgical decompression for space-occupying cerebral infarction (the hemicraniectom... more Worp HB et al. Surgical decompression for space-occupying cerebral infarction (the hemicraniectomy after middle cerebral artery infarction with lifethreatening edema trial (HAMLET)): a multicentre, open, randomised trial.

AEM education and training, 2018

Paramedics and emergency medical technicians (EMTs) perform triage at disaster sites. There is a ... more Paramedics and emergency medical technicians (EMTs) perform triage at disaster sites. There is a need for disaster triage training. Live simulation training is costly and difficult to deliver. Screen-based simulations may overcome these training barriers. We hypothesized that a screen-based simulation, 60 Seconds to Survival (60S), would be associated with in-game improvements in triage accuracy. This was a prospective cohort study of a screen-based simulation intervention, 60S. Participants included emergency medical services (EMS) personnel from 21 EMS agencies across 12 states. Participants performed assessments (e.g., check for pulse) and actions (e.g., reposition the airway) for 12 patients in each scenario and assigned color-coded triage levels (red, yellow, green, or black) to each patient. Participants received on-screen feedback about triage performance immediately after each scenario. A scoring system was designed to encourage accurate and timely triage decisions. Particip...

American journal of disaster medicine, 2017

Disaster triage training for emergency medical service (EMS) providers is not standardized. Simul... more Disaster triage training for emergency medical service (EMS) providers is not standardized. Simulation training is costly and time-consuming. In contrast, educational video games enable low-cost and more time-efficient standardized training. We hypothesized that players of the video game "60 Seconds to Survival" (60S) would have greater improvements in disaster triage accuracy compared to control subjects who did not play 60S. Participants recorded their demographics and highest EMS training level and were randomized to play 60S (intervention) or serve as controls. At baseline, all participants completed a live school-shooting simulation in which manikins and standardized patients depicted 10 adult and pediatric victims. The intervention group then played 60S at least three times over the course of 13 weeks (time 2). Players triaged 12 patients in three scenarios (school shooting, house fire, tornado), and received in-game performance feedback. At time 2, the same live sim...

Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors, Jan 27, 2016

Studies have shown that a large number of ambulance transports to emergency departments (ED) coul... more Studies have shown that a large number of ambulance transports to emergency departments (ED) could have been safely treated in an alternative environment, prompting interest in the development of more patient-centered models for prehospital care. We examined patient attitudes, perspectives, and agreement/comfort with alternate destinations and other proposed innovations in Emergency Medical Services (EMS) care delivery and determined whether demographic, socioeconomic, acuity, and EMS utilization history factors impact levels of agreement. We conducted a cross-sectional study on a convenience sample of patients and caregivers presenting to an urban academic ED between July 2012 and May 2013. Respondents were surveyed on levels of agreement with 13 statements corresponding to various aspects of a proposed patient-centered emergency response system including increased EMS access to healthcare records, shared decision making with the patient and/or primary care physician, transport to ...

Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors, Jan 15, 2016

Patient handoff occurs when responsibility for patient diagnosis, treatment, or ongoing care is t... more Patient handoff occurs when responsibility for patient diagnosis, treatment, or ongoing care is transferred from one healthcare professional to another. Patient handoff is an integral component of quality patient care and is increasingly identified as a potential source of medical error. However, evaluation of handoff from field providers to ED personnel is limited. We here present a quantitative analysis of the information transferred from EMS providers to ED physicians during handoff of critically ill and injured patients. This study was conducted at an urban academic medical center with an emergency department census of greater than 100,000 visits annually. All patients arriving to our institution by EMS and meeting predefined triage criteria are brought immediately to the ED resuscitation area upon EMS arrival. Handoff from EMS to ED providers occurring in the resuscitation area was observed and audio recorded by trained research assistants and subsequently coded for content. Th...

Annals of Emergency Medicine, 2016

In 2006, the Institute of Medicine emphasized substantial potential to expand organ donation oppo... more In 2006, the Institute of Medicine emphasized substantial potential to expand organ donation opportunities through uncontrolled donation after circulatory determination of death (uDCDD). We pilot an out-of-hospital uDCDD kidney program for New York City in partnership with communities that it was intended to benefit. We evaluate protocol process and outcomes while identifying barriers to success and means for improvement. We conducted a prospective, participatory action research study in Manhattan from December 2010 to May 2011. Daily from 4 to 12 pm, our organ preservation unit monitored emergency medical services (EMS) frequencies for cardiac arrests occurring in private locations. After EMS providers independently ordered termination of resuscitation, organ preservation unit staff determined clinical eligibility and donor status. Authorized parties, persons authorized to make organ donation decisions, were approached about in vivo preservation. The study population included organ preservation unit staff, authorized parties, passersby, and other New York City agency personnel. Organ preservation unit staff independently documented shift activities with daily operations notes and teleconference summaries that we analyzed with mixed qualitative and quantitative methods. The organ preservation unit entered 9 private locations; all the deceased lacked previous registration, although 4 met clinical screening eligibility. No kidneys were recovered. We collected 837 notes from 35 organ preservation unit staff. Despite frequently recounting protocol breaches, most responses from passersby including New York City agencies were favorable. No authorized parties were offended by preservation requests, yielding a Bayesian posterior median 98% (95% credible interval 76% to 100%). In summary, the New York City out-of-hospital uDCDD program was not feasible. There were frequent protocol breaches and confusion in determining clinical eligibility. In the small sample of authorized persons we encountered during the immediate grieving period, negative reactions were infrequent.

Prehospital Emergency Care, 2011

Emergency medical services (EMS) systems are used by the public for a range of medically related ... more Emergency medical services (EMS) systems are used by the public for a range of medically related problems. To understand and analyze the patterns of EMS utilization and trends over time in a large urban EMS system so that we may better direct efforts toward improving those services. The 63 call type designations from all New York City (NYC) 9-1-1 EMS calls between 1999 and 2007 were obtained and grouped into 10 broad and 30 specific medical categories. Aggregated numbers of total EMS calls and individual categories were divided by NYC resident population estimates to determine utilization rates. Temporal trends were evaluated for statistical significance with Spearman's rho (ρ). There were 9,916,904 EMS calls between 1999 and 2007, with an average of 1,101,878 calls/year. Utilization rates increased from 129.5 to 141.9 calls/1,000 residents/year over the study period (average annual rise of 1.16%). Among all medical/surgical call types (excluding trauma), there was an average annual increase of 1.8%/year. The most substantial increases were among "psychiatric/drug related" (+5.6%/year), "generalized illness" (+3.2%/year), and…

Academic Emergency Medicine, 2014

Blackwell Futura Media Services designates this journal-based CME activity for a maximum of 1 AMA... more Blackwell Futura Media Services designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditÔ. Physicians should only claim credit commensurate with the extent of their participation in the activity. Blackwell Futura Media Services is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. Educational Objectives After completing this exercise the participant will be better able to describe the differences and similarities of two opioid analgesics.

Journal of Clinical Oncology, 2021

97 Background: The COVID-19 pandemic caused sudden changes in healthcare delivery, and new polici... more 97 Background: The COVID-19 pandemic caused sudden changes in healthcare delivery, and new policies were rapidly implemented to ensure safety for patients and staff. However, COVID-19 testing requirements presented a barrier for many patients. Outdoor testing in New York City became less feasible during colder months, and oncology patients have additional concerns, such as limited mobility and immunosuppression. To address these barriers, we created an in-home COVID-19 testing program through a partnership between Community Paramedicine and Oncology: SWABBER (SWABS by Emergency Responders). We evaluated patient use of and satisfaction with SWABBER. Methods: SWABBER began in September 2020 as an interdisciplinary initiative to offer in-home, asymptomatic COVID-19 PCR testing for patients on active treatment in an effort to provide more coordinated care and improve patient experience. Tests were performed prior to the first day of each treatment cycle at no cost to patients. Randomly ...

Prehospital and disaster medicine, 2015

In the past 50 years, cardiopulmonary resuscitation (CPR) has gained widespread recognition as a ... more In the past 50 years, cardiopulmonary resuscitation (CPR) has gained widespread recognition as a life-saving skill that can be taught successfully to the general public. Cardiopulmonary resuscitation can be considered a cost-effective intervention that requires minimal classroom training and low-cost equipment and supplies; it is commonly taught throughout much of the developed world. But, the simplicity of CPR training and its access for the general public may be misleading, as outcomes for patients in cardiopulmonary arrest are poor and survival is dependent upon a comprehensive "chain-of-survival," which is something not achieved easily in resource-limited health care settings. In addition to the significant financial and physical resources needed to both train and develop basic CPR capabilities within a community, there is a range of ethical questions that should also be considered. This report describes some of the financial and ethical challenges that might result fr...

Annals of emergency medicine, 2014

In the United States, more than 115,000 patients are wait-listed for organ transplants despite th... more In the United States, more than 115,000 patients are wait-listed for organ transplants despite that there are 12,000 patients each year who die or become too ill for transplantation. One reason for the organ shortage is that candidates for donation must die in the hospital, not the emergency department (ED), either from neurologic or circulatory-respiratory death under controlled circumstances. Evidence from Spain and France suggests that a substantial number of deaths from cardiac arrest may qualify for organ donation using uncontrolled donation after circulatory determination of death (uDCDD) protocols that rapidly initiate organ preservation in out-of-hospital and ED settings. Despite its potential, uDCDD has been criticized by panels of experts that included neurologists, intensivists, attorneys, and ethicists who suggest that organ preservation strategies that reestablish oxygenated circulation to the brain retroactively negate previous death determination based on circulatory-...

Hastings Center Report, 2012

In the United States, when people die unexpectedly, they are usually not considered as organ dono... more In the United States, when people die unexpectedly, they are usually not considered as organ donors because of the difficulty of keeping organs viable when death occurs outside the hospital, in "uncontrolled" circumstances. New protocols to permit donation in these cases have renewed the debate about how we decide whether a person has died- and whether the moral imperative to help those in need of transplant should affect the determination of death.

BMJ Open, 2022

IntroductionNearly one-quarter of patients discharged from the hospital with heart failure (HF) a... more IntroductionNearly one-quarter of patients discharged from the hospital with heart failure (HF) are readmitted within 30 days, placing a significant burden on patients, families and health systems. The objective of the ‘Using Mobile Integrated Health and Telehealth to support transitions of care among patients with Heart failure’ (MIGHTy-Heart) study is to compare the effectiveness of two postdischarge interventions on healthcare utilisation, patient-reported outcomes and healthcare quality among patients with HF.Methods and analysisThe MIGHTy-Heart study is a pragmatic comparative effectiveness trial comparing two interventions demonstrated to improve the hospital to home transition for patients with HF: mobile integrated health (MIH) and transitions of care coordinators (TOCC). The MIH intervention bundles home visits from a community paramedic (CP) with telehealth video visits by emergency medicine physicians to support the management of acute symptoms and postdischarge care coor...

JMIR Human Factors, 2022

Background Smart glasses have been gaining momentum as a novel technology because of their advant... more Background Smart glasses have been gaining momentum as a novel technology because of their advantages in enabling hands-free operation and see-what-I-see remote consultation. Researchers have primarily evaluated this technology in hospital settings; however, limited research has investigated its application in prehospital operations. Objective The aim of this study is to understand the potential of smart glasses to support the work practices of prehospital providers, such as emergency medical services (EMS) personnel. Methods We conducted semistructured interviews with 13 EMS providers recruited from 4 hospital-based EMS agencies in an urban area in the east coast region of the United States. The interview questions covered EMS workflow, challenges encountered, technology needs, and users’ perceptions of smart glasses in supporting daily EMS work. During the interviews, we demonstrated a system prototype to elicit more accurate and comprehensive insights regarding smart glasses. Int...

Abstract: Although distraction osteogenesis has proven successful in children, concerns remain re... more Abstract: Although distraction osteogenesis has proven successful in children, concerns remain regarding potential growth inhibition of the lengthened limb. Twenty-one 8-week-old New Zealand White rabbits underwent a unilateral 40 % tibial lengthening with the contralateral tibia as control. The animals were divided into Achilles tendon release and non-release groups. Radiographs and histomor-phometric analysis of the proximal tibial growth plate was performed 5 and 10 weeks after distraction. The corrected length of tibias without tenotomy was significantly shorter than the contralateral controls, whereas those with tenotomy were statistically equivalent to the contralateral control tibias. Histologically, the operated limbs without tenotomy showed a significant decrease in thickness and loss of cellular architecture of the proximal tibial growth plate compared with the tenotomy groups, which were of near-normal appearance. A concomitant tendo Achilles lengthening performed with 40...

EMS world, 2016

Because of the expanded role EMS providers may paly in the community, medical direction in EMS 3.... more Because of the expanded role EMS providers may paly in the community, medical direction in EMS 3.o should appropriately be a collaborative effort led by EMS subspecialty-certified physicians specially trained in emergency medicine, but also physicians who specialize in disciplines such as internal/family medicine, critical care, cardiology, nephrology, endocrinology and pulmonary medicine. The EMS 3.0 medical director should be able to build patient-centered coalitions of physicians to help meet the care coordination goals of the patient, their physicians and the EMS system.

Emergency Medical Services, 2021

The Journal of Emergency Medicine, 2020

reach statistical significance. Conclusion: The study findings suggest that transport home via am... more reach statistical significance. Conclusion: The study findings suggest that transport home via ambulance after hospital discharge could be predictive of a high risk of recidivism independent of established readmission risk factors. Programs that expand the role of EMS to include post-transport interventions may warrant further exploration.

Internal Medicine Journal, 2018

Worp HB et al. Surgical decompression for space-occupying cerebral infarction (the hemicraniectom... more Worp HB et al. Surgical decompression for space-occupying cerebral infarction (the hemicraniectomy after middle cerebral artery infarction with lifethreatening edema trial (HAMLET)): a multicentre, open, randomised trial.

AEM education and training, 2018

Paramedics and emergency medical technicians (EMTs) perform triage at disaster sites. There is a ... more Paramedics and emergency medical technicians (EMTs) perform triage at disaster sites. There is a need for disaster triage training. Live simulation training is costly and difficult to deliver. Screen-based simulations may overcome these training barriers. We hypothesized that a screen-based simulation, 60 Seconds to Survival (60S), would be associated with in-game improvements in triage accuracy. This was a prospective cohort study of a screen-based simulation intervention, 60S. Participants included emergency medical services (EMS) personnel from 21 EMS agencies across 12 states. Participants performed assessments (e.g., check for pulse) and actions (e.g., reposition the airway) for 12 patients in each scenario and assigned color-coded triage levels (red, yellow, green, or black) to each patient. Participants received on-screen feedback about triage performance immediately after each scenario. A scoring system was designed to encourage accurate and timely triage decisions. Particip...

American journal of disaster medicine, 2017

Disaster triage training for emergency medical service (EMS) providers is not standardized. Simul... more Disaster triage training for emergency medical service (EMS) providers is not standardized. Simulation training is costly and time-consuming. In contrast, educational video games enable low-cost and more time-efficient standardized training. We hypothesized that players of the video game "60 Seconds to Survival" (60S) would have greater improvements in disaster triage accuracy compared to control subjects who did not play 60S. Participants recorded their demographics and highest EMS training level and were randomized to play 60S (intervention) or serve as controls. At baseline, all participants completed a live school-shooting simulation in which manikins and standardized patients depicted 10 adult and pediatric victims. The intervention group then played 60S at least three times over the course of 13 weeks (time 2). Players triaged 12 patients in three scenarios (school shooting, house fire, tornado), and received in-game performance feedback. At time 2, the same live sim...

Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors, Jan 27, 2016

Studies have shown that a large number of ambulance transports to emergency departments (ED) coul... more Studies have shown that a large number of ambulance transports to emergency departments (ED) could have been safely treated in an alternative environment, prompting interest in the development of more patient-centered models for prehospital care. We examined patient attitudes, perspectives, and agreement/comfort with alternate destinations and other proposed innovations in Emergency Medical Services (EMS) care delivery and determined whether demographic, socioeconomic, acuity, and EMS utilization history factors impact levels of agreement. We conducted a cross-sectional study on a convenience sample of patients and caregivers presenting to an urban academic ED between July 2012 and May 2013. Respondents were surveyed on levels of agreement with 13 statements corresponding to various aspects of a proposed patient-centered emergency response system including increased EMS access to healthcare records, shared decision making with the patient and/or primary care physician, transport to ...

Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors, Jan 15, 2016

Patient handoff occurs when responsibility for patient diagnosis, treatment, or ongoing care is t... more Patient handoff occurs when responsibility for patient diagnosis, treatment, or ongoing care is transferred from one healthcare professional to another. Patient handoff is an integral component of quality patient care and is increasingly identified as a potential source of medical error. However, evaluation of handoff from field providers to ED personnel is limited. We here present a quantitative analysis of the information transferred from EMS providers to ED physicians during handoff of critically ill and injured patients. This study was conducted at an urban academic medical center with an emergency department census of greater than 100,000 visits annually. All patients arriving to our institution by EMS and meeting predefined triage criteria are brought immediately to the ED resuscitation area upon EMS arrival. Handoff from EMS to ED providers occurring in the resuscitation area was observed and audio recorded by trained research assistants and subsequently coded for content. Th...

Annals of Emergency Medicine, 2016

In 2006, the Institute of Medicine emphasized substantial potential to expand organ donation oppo... more In 2006, the Institute of Medicine emphasized substantial potential to expand organ donation opportunities through uncontrolled donation after circulatory determination of death (uDCDD). We pilot an out-of-hospital uDCDD kidney program for New York City in partnership with communities that it was intended to benefit. We evaluate protocol process and outcomes while identifying barriers to success and means for improvement. We conducted a prospective, participatory action research study in Manhattan from December 2010 to May 2011. Daily from 4 to 12 pm, our organ preservation unit monitored emergency medical services (EMS) frequencies for cardiac arrests occurring in private locations. After EMS providers independently ordered termination of resuscitation, organ preservation unit staff determined clinical eligibility and donor status. Authorized parties, persons authorized to make organ donation decisions, were approached about in vivo preservation. The study population included organ preservation unit staff, authorized parties, passersby, and other New York City agency personnel. Organ preservation unit staff independently documented shift activities with daily operations notes and teleconference summaries that we analyzed with mixed qualitative and quantitative methods. The organ preservation unit entered 9 private locations; all the deceased lacked previous registration, although 4 met clinical screening eligibility. No kidneys were recovered. We collected 837 notes from 35 organ preservation unit staff. Despite frequently recounting protocol breaches, most responses from passersby including New York City agencies were favorable. No authorized parties were offended by preservation requests, yielding a Bayesian posterior median 98% (95% credible interval 76% to 100%). In summary, the New York City out-of-hospital uDCDD program was not feasible. There were frequent protocol breaches and confusion in determining clinical eligibility. In the small sample of authorized persons we encountered during the immediate grieving period, negative reactions were infrequent.

Prehospital Emergency Care, 2011

Emergency medical services (EMS) systems are used by the public for a range of medically related ... more Emergency medical services (EMS) systems are used by the public for a range of medically related problems. To understand and analyze the patterns of EMS utilization and trends over time in a large urban EMS system so that we may better direct efforts toward improving those services. The 63 call type designations from all New York City (NYC) 9-1-1 EMS calls between 1999 and 2007 were obtained and grouped into 10 broad and 30 specific medical categories. Aggregated numbers of total EMS calls and individual categories were divided by NYC resident population estimates to determine utilization rates. Temporal trends were evaluated for statistical significance with Spearman's rho (ρ). There were 9,916,904 EMS calls between 1999 and 2007, with an average of 1,101,878 calls/year. Utilization rates increased from 129.5 to 141.9 calls/1,000 residents/year over the study period (average annual rise of 1.16%). Among all medical/surgical call types (excluding trauma), there was an average annual increase of 1.8%/year. The most substantial increases were among "psychiatric/drug related" (+5.6%/year), "generalized illness" (+3.2%/year), and…

Academic Emergency Medicine, 2014

Blackwell Futura Media Services designates this journal-based CME activity for a maximum of 1 AMA... more Blackwell Futura Media Services designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditÔ. Physicians should only claim credit commensurate with the extent of their participation in the activity. Blackwell Futura Media Services is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. Educational Objectives After completing this exercise the participant will be better able to describe the differences and similarities of two opioid analgesics.

Journal of Clinical Oncology, 2021

97 Background: The COVID-19 pandemic caused sudden changes in healthcare delivery, and new polici... more 97 Background: The COVID-19 pandemic caused sudden changes in healthcare delivery, and new policies were rapidly implemented to ensure safety for patients and staff. However, COVID-19 testing requirements presented a barrier for many patients. Outdoor testing in New York City became less feasible during colder months, and oncology patients have additional concerns, such as limited mobility and immunosuppression. To address these barriers, we created an in-home COVID-19 testing program through a partnership between Community Paramedicine and Oncology: SWABBER (SWABS by Emergency Responders). We evaluated patient use of and satisfaction with SWABBER. Methods: SWABBER began in September 2020 as an interdisciplinary initiative to offer in-home, asymptomatic COVID-19 PCR testing for patients on active treatment in an effort to provide more coordinated care and improve patient experience. Tests were performed prior to the first day of each treatment cycle at no cost to patients. Randomly ...

Prehospital and disaster medicine, 2015

In the past 50 years, cardiopulmonary resuscitation (CPR) has gained widespread recognition as a ... more In the past 50 years, cardiopulmonary resuscitation (CPR) has gained widespread recognition as a life-saving skill that can be taught successfully to the general public. Cardiopulmonary resuscitation can be considered a cost-effective intervention that requires minimal classroom training and low-cost equipment and supplies; it is commonly taught throughout much of the developed world. But, the simplicity of CPR training and its access for the general public may be misleading, as outcomes for patients in cardiopulmonary arrest are poor and survival is dependent upon a comprehensive "chain-of-survival," which is something not achieved easily in resource-limited health care settings. In addition to the significant financial and physical resources needed to both train and develop basic CPR capabilities within a community, there is a range of ethical questions that should also be considered. This report describes some of the financial and ethical challenges that might result fr...

Annals of emergency medicine, 2014

In the United States, more than 115,000 patients are wait-listed for organ transplants despite th... more In the United States, more than 115,000 patients are wait-listed for organ transplants despite that there are 12,000 patients each year who die or become too ill for transplantation. One reason for the organ shortage is that candidates for donation must die in the hospital, not the emergency department (ED), either from neurologic or circulatory-respiratory death under controlled circumstances. Evidence from Spain and France suggests that a substantial number of deaths from cardiac arrest may qualify for organ donation using uncontrolled donation after circulatory determination of death (uDCDD) protocols that rapidly initiate organ preservation in out-of-hospital and ED settings. Despite its potential, uDCDD has been criticized by panels of experts that included neurologists, intensivists, attorneys, and ethicists who suggest that organ preservation strategies that reestablish oxygenated circulation to the brain retroactively negate previous death determination based on circulatory-...

Hastings Center Report, 2012

In the United States, when people die unexpectedly, they are usually not considered as organ dono... more In the United States, when people die unexpectedly, they are usually not considered as organ donors because of the difficulty of keeping organs viable when death occurs outside the hospital, in "uncontrolled" circumstances. New protocols to permit donation in these cases have renewed the debate about how we decide whether a person has died- and whether the moral imperative to help those in need of transplant should affect the determination of death.