A5058109157- Cardiac Arrest and Resuscitation
- Trauma and Emergency Care Studies
- Emergency and Acute Care Studies
- Acute Ischemic Stroke Management
- Stroke Rehabilitation and Recovery
- Venous Thromboembolism Diagnosis and Management
- Injury Epidemiology and Prevention
- Disaster Response and Management
- SARS-CoV-2 detection and testing
- Trauma Management and Diagnosis
- Acute Myocardial Infarction Research
- Mechanical Circulatory Support Devices
- Cardiac electrophysiology and arrhythmias
- Thermal Regulation in Medicine
- Biosensors and Analytical Detection
- Healthcare Systems and Practices
- Traumatic Brain Injury and Neurovascular Disturbances
- Patient Satisfaction in Healthcare
- Opioid Use Disorder Treatment
- Abdominal Trauma and Injuries
- Air Quality and Health Impacts
- Cardiac Imaging and Diagnostics
- Dental Research and COVID-19
- Disaster Management and Resilience
- SARS-CoV-2 and COVID-19 Research
Baylor College of Medicine
2014-2024
Houston Health and Human Services Department
2016-2024
The University of Texas Health Science Center at Houston
2001-2024
New York City Fire Department
2013-2024
Houston Medical Center
2003-2024
Memorial Hermann
2001-2024
Harvard University
2024
Rice University
2013-2024
Texas Children's Hospital
2024
Health Foundation
2024
Mobile stroke units (MSUs) are ambulances with staff and a computed tomographic scanner that may enable faster treatment tissue plasminogen activator (t-PA) than standard management by emergency medical services (EMS). Whether how much MSUs alter outcomes has not been extensively studied.In an observational, prospective, multicenter, alternating-week trial, we assessed from MSU or EMS within 4.5 hours after onset of acute symptoms. The primary outcome was the score on utility-weighted...
Background and Purpose— Establishment of stroke centers, combined with accurate paramedic diagnosis rapid transport, is essential to deliver acute therapy. We wanted measure improve hospital performance through implementation the Brain Attack Coalition American Stroke Association guidelines. Methods— Pre-intervention active-intervention phases parallel data measurement points were used. The study involved six hospitals comprising majority acute-stroke admissions in Houston, Tex. Hospital,...
Although studies have ascertained that ten percent of soldiers killed in battle bleed to death from extremity wounds, little data exists on exsanguination and mortality injuries civilian trauma. This study examined the treatment course outcomes patients who appear exsanguinated isolated penetrating injuries.Five 1/2 years' (Aug 1994 Dec 1999) were reviewed two Level I trauma centers receive 95% metropolitan Houston, TX. Records (hospital registries, emergency medical system (EMS) examiner...
Background. Emergency medical services (EMS) agencies transport a significant majority of patients with low acuity and non-emergent conditions to local emergency departments (ED), affecting the entire care system's capacity performance. Opportunities exist for alternative models that integrate technology, telehealth, more appropriately aligned patient navigation. While limited number programs have evolved recently, no empirical evidence exists their efficacy. This research describes...
Background— Evidence of an association between the exposure to air pollution and overall cardiovascular morbidity mortality is increasingly found in literature. However, results from studies acute risk out-of-hospital cardiac arrest (OHCA) are inconsistent for fine particulate matter, and, although pathophysiological evidence indicates a plausible link OHCA ozone, none has been reported. Approximately 300 000 persons United States experience each year, which >90% die. Understanding...
Faster treatment with intravenous tissue-type plasminogen activator (tPA) is likely to improve outcomes. Optimizing prehospital triage by mobile stroke units (MSUs) may speed times. The Benefits of Stroke Treatment Delivered Using a Mobile Unit (BEST-MSU) study was launched in May 2014 using the first MSU United States compare management an versus standard (SM). Herein, we describe results prespecified, nonrandomized run-in phase designed obtain preliminary data on logistics.The consisted 8...
To establish a trauma preventable/potentially preventable death rate (PPPDR) within heavily populated county in Texas.The National Academies of Sciences estimated the United States to be 20%, issued call for zero deaths, while acknowledging that an accurate was lacking. In this absence, effective strategies improve quality care across systems will remain difficult.A retrospective review death-related records occurred during 2014 Harris County, TX, diverse population 4.4 million. Patient...
Recently, the Mobile Stroke Unit (MSU) concept was introduced in Germany demonstrating prehospital treatment of more patients within first hour symptom onset. However, details and complexities establishing such a program United States are unknown. We describe steps involved setting up MSU States.Implementation included leadership, fund-raising, purchase build-out, knitting collaborative consortium community stakeholders, writing protocols to ensure accountability, radiation safety,...
Hemorrhage is the most common cause of potentially preventable trauma deaths, but no studies have focused on all civilian traumatic deaths from hemorrhage, so we describe a year these large county to identify opportunities for preventing hemorrhagic deaths.All trauma-related in Harris County, Texas, 2014 underwent examination by medical examiner; patients were excluded if hemorrhage was not their primary reason death. Deaths then categorized as preventable/potentially (PPH) or nonpreventable...
Objective There has been very little use of telehealth in pre-hospital emergency medical services (EMS), yet the potential exists for this technology to transform current delivery model. In study, we explore costs and benefits one large EMS initiative. Methods Using a case-control study design both micro- gross-costing data from Houston Fire Department electronic patient care record system, conducted cost-benefit analysis (CBA) comparing with savings associated patients treated through...
Background No proven neuroprotective treatment exists for ischemic brain injury after cardiac arrest. Mild-to-moderate induced hypothermia (MIH) is effective in animal models. Methods and Results A safety feasibility trial was designed to evaluate mild-to-moderate by use of external cooling blankets Inclusion criteria were return spontaneous circulation within 60 minutes advanced life support, initiated 90 minutes, persistent coma, lack acute myocardial infarction or unstable dysrhythmia....
Background and Purpose— Prehospital evaluation using telemedicine may accelerate acute stroke treatment with tissue-type plasminogen activator. We explored the feasibility reliability of in field ambulance to help evaluate patients. Methods— Ten unique, scripted scenarios, each conducted 4 times, were portrayed by trained actors retrieved transported Houston Fire Department emergency medical technicians our center. The vascular neurologists performed remote assessments real time, obtaining...
Rationale Mobile stroke units speed treatment for acute ischemic stroke, thereby possibly improving outcomes. Aim To compare mobile unit and standard management clinical outcomes, healthcare utilization, cost-effectiveness in tissue plasminogen activator-eligible patients calling 911. Sample size 693. Eighty percent power with 0.05 type I error rate to detect a difference of 0.09 mean utility-weighted modified Rankin scale between groups. Design Phase III, multicenter, prospective...
Abstract Wastewater monitoring for SARS-CoV-2 has been suggested as an epidemiological indicator of community infection dynamics and disease prevalence. We report wastewater viral RNA levels in a major metropolis serving over 3.6 million people geographically spread 39 distinct sampling sites. Viral were followed weekly 22 weeks, both before, during, after surge cases, simultaneously by two independent laboratories. found strong predictive trends the nasal positivity rate two-weeks advance....
Since the start of COVID-19 pandemic, wastewater surveillance has emerged as a powerful tool used by public health authorities to track SARS-CoV-2 infections in communities. In May 2020, Houston Health Department began working with coalition municipal and academic partners develop monitoring reporting system for city Houston, Texas. Data collected from are integrated other data communicated through different channels local general public. This information is shape policies inform actions...
Introduction: Telehealth has been used nominally for trauma, neurological, and cardiovascular incidents in prehospital emergency medical services (EMS). Yet, much less is known about the use of telehealth low-acuity primary care. We examine development one program its impact on unnecessary ambulance transports. Objective: The objective this study to describe a large-scale Methods: patient characteristics results from cohort patients Houston, Texas who received consultation an medicine...