Bradley Dreifuss

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Scholarly Contributions

Chapters

• Dreifuss, B. (2012).

  Acute Radiation Emergencies: Chapter 135 of Emergency Medicine

  . In Emergency Medicine: Clinical Essentials, 2nd Edition. Elsevier Health Sciences. doi:10.1016/b978-1-4377-3548-2.00135-x
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  Chapter 135, Acute Radiation Emergencies, from Emergency Medicine, 2nd Edition delivers all the relevant clinical core concepts you need for practice and certification, all in a comprehensive, easy-to-absorb, and highly visual format. This well-regarded emergency medicine reference offers fast-access diagnosis and treatment guidelines that quickly provide the pearls and secrets of your field, helping you optimize safety, efficiency, and quality in the ED as well as study for the boards.

Journals/Publications

• Kajjimu, J., Dreifuss, H., Tagg, A., Dreifuss, B., & Bongomin, F. (2023). Undergraduate Learning in the COVID-19 Pandemic: Lessons Learned and Ways Forward. Advances in medical education and practice, 14, 355-361.
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  The SARS-CoV-2 coronavirus (COVID-19) pandemic is in constant evolution, much like the virus, and we must learn to adapt our undergraduate education and learning strategies to enable students to complete their studies. This narrative review focuses on what is currently known about the face-to-face and e-learning strategies of undergraduate medical students in resource-limited settings during the COVID-19 pandemic. The majority of studies, involving health professional students, took place in 2020. Few involved educators. Students have faced challenges with the transition to remote learning, for which a couple of interventions have been devised. Bridging the gap in access and utilisation of remote learning might have required more time, however, the COVID-19 pandemic has accelerated the learning curve and the transition from in-person to online learning.
• Chandler, A. B., Chandler, A. B., Wank, A., Wank, A., Vanuk, J. R., Vanuk, J. R., O'Connor, M., O'Connor, M., Dreifuss, B. A., Dreifuss, B. A., Dreifuss, H. M., Dreifuss, H. M., Ellingson, K., Ellingson, K., Khan, S. M., Khan, S. M., Friedman, S. E., Friedman, S. E., Athey, A., & Athey, A. (2021). Adapting Psychological First Aid for Healthcare Workers During the COVID-19 Pandemic: A Feasibility Study of the HCW HOSTED ICARE Telehealth Model.. Journal of Community Health.
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  AbstractMaintaining the resilience of healthcare workers (HCWs) during the protracted COVID-19 pandemic is critical as chronic stress is associated with burnout, inability to provide high-quality care, and decreased attentiveness to infection prevention protocols that protect patients and HCWs. Between May 2020 and July 2020, we adapted and implemented ICARE, a psychological first aid (PFA) model, in a novel online (i.e., telehealth) format to address the psychological support needs of HCWs during the COVID-19 pandemic. In doing so, we had the following aims: (1) assess the mental health and psychological functioning of HCWs, (2) determine the feasibility and acceptability of an online PFA program for HCWs, and (3) identify the psychological support needs of HCWs. During the aforementioned period, the HCWs in this program reported low to moderate levels of stress, fair to good quality sleep, and minimal to mild depression and anxiety. We found implementation of the program to be feasible via use of a program website, an online survey system, and a videoconferencing platform. The HCWs in our program repeatedly expressed appreciation for the support we provided. Lastly, we found that HCWs needed psychological support related to obtaining clear information about pandemic policies and guidelines, navigating new rules and responsibilities, and processing overwhelming and conflicting emotions. Future directions include establishing asynchronous online discussion forums, increasing opportunities for individual support, and training HCWs to provide peer support using PFA. This program has far-reaching potential benefit to HCWs and to society at large in the context of a pandemic.Keywords: COVID-19, healthcare workers (HCWs), ICARE, psychological first aid(PFA), telehealth
• Chandler, A. B., Wank, A. A., Vanuk, J. R., O'Connor, M. F., Dreifuss, B. A., Dreifuss, H. M., Ellingson, K. D., Khan, S. M., Friedman, S. E., & Athey, A. (2022). Implementing Psychological First Aid for Healthcare Workers During the COVID-19 Pandemic: A Feasibility Study of the ICARE Model. Journal of clinical psychology in medical settings, 1-8. doi:https://doi.org/10.1007/s10880-022-09900-w
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  Maintaining the resilience of healthcare workers (HCWs) during the protracted COVID-19 pandemic is critical as chronic stress is associated with burnout, inability to provide high-quality care, and decreased attentiveness to infection prevention protocols. Between May and July 2020, we implemented the ICARE model of psychological first aid (PFA) in a novel online (i.e., telehealth) format to address the psychological support needs of HCWs during the COVID-19 pandemic. We found that HCWs needed psychological support related to obtaining clear information about pandemic policies and guidelines, navigating new rules and responsibilities, and processing overwhelming and conflicting emotions. The HCWs in our program repeatedly expressed appreciation for the support we provided. Future directions include establishing online discussion forums, increasing opportunities for individual support, and training HCWs to provide peer support using PFA. This program has far-reaching potential benefit to HCWs and to society at large in the context of a pandemic.
• Chandler, A. B., Wank, A., Vanuk, J., O'Connor, M., Dreifuss, B., Dreifuss, H., Ellingson, K., Khan, S., Friedman, S., & Athey, A. (2020). Online Psychological First Aid for Healthcare Workers: The HCW HOSTED ICARE Model in Response to COVID-19. Psychological Services.
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  HCW HOSTED, a grassroots organization serving the housing, social, and emotionalsupport needs of healthcare workers in Tucson, Arizona, implemented the ICAREmodel of psychological first aid (PFA) online (i.e., via telehealth) for healthcare workersin response to the COVID-19 pandemic. This review outlines existing frameworks forPFA, noting the novel and important contribution to research and practice of this firsttelehealth version of PFA. Additionally, the implementation context and specificelements of the HCW HOSTED ICARE model are described. Service delivery themesand lessons learned from the implementation of the online ICARE service forhealthcare workers are reviewed. Lastly, recommendations and considerations forfuture adoptions/adaptations of the online ICARE service for healthcare workers areoffered.
• Cola, S., Rice, B., Kamugisha, J. B., Kamara, N., Bisanzo, M., Dreifuss, B., Hammerstedt, H., & Chamberlain, S. (2021). Emergency Care of Sepsis in Sub-Saharan Africa: Incidence, Mortality and Non-Physician Clinician Management of Sepsis in rural Uganda from 2010 to 2019. African Journal of Emergency Medicine. doi:https://doi.org/10.21203/rs.3.rs-444837/v1
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  AbstractIntroduction: Little data exists from sub-Saharan Africa describing incidence and outcomes of sepsis in emergency units and uncertainty exists surrounding optimal management of sepsis in low-income settings. There exists limited data regarding quality care metrics for non-physician clinicians trained in emergency care. Methods: Data were obtained for patients seen from 2010-2019 in a rural Ugandan emergency unit staffed by nonphysician clinicians. Sepsis was dened as suspected infection with a qSOFA score ≥ 2. Descriptive analysis was performed and a multi-variable logistic regression mortality model was created. Analysis included Wilcoxon rank-sum test, t-test, one-way ANOVA, and Fisher’s exact test. Results: Overall, 48,653 patient visits from 2010-2019 yielded 17,490 encounters for patients age≥18 who had suspected infection, including 3,323 with sepsis. Overall sepsis incidence from 2010 to 2019 decreased from 16.4% to 4.7%, and malarial sepsis incidence decreased from 4.3% to 0.1%. From 2012 to 2019, the proportion of septic patients receiving quality care (both uids and anti-infectives) increased from 36.2% to 44.7% but observed mortality rates for non-malarial sepsis increased from 6.3% to 14.9% and predicted mortality rates increased from 8.8% to 12.0%. Higher qSOFA scores were signicantly associated with higher rates of both interventions and mortality. All interventions for non-malarial sepsis were independently associated with increased relative risks for death: “uids alone” RR=1.22 [95%CI 0.57 1.87]; “antibiotics alone” RR=1.25 [95%CI 0.60 – 1.91]; “both uids and antibiotics”: RR=1.85 [95%CI 1.02– 2.69]. Conclusion: The largest study of sepsis management and outcomes ever published in both Uganda and sub-Saharan Africa showed decreasing incidence, increasing quality of non-physician clinician care and increasing predicted and observed mortality from 2010 to 2019. With causal associations between antibiotics and mortality deemed implausible, associations between sepsis mortality and interventions likely represent confounding by indication. Dening optimal sepsis care regionally will likely require randomized controlled trials.
• Douglass, K., Jacquet, G. A., Hayward, A. S., Dreifuss, B. B., & Tupesis, J. P. (2016). Development of Global Health Milestones Tool for Emergency Medicine Trainees: A Pilot Project. Academic Emergency Medicine.
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  Abstract:Objectives: In medical education and training, increasing numbers of both institutions and learners are participating in global health projects. Within the context of outcomes-based, competency-linked education and assessment methodologies, a standardized assessment tool may prove valuable to all of the aforementioned stakeholders. Milestones are now used as the standard for trainee assessment across many specialties in Graduate Medical Education, including Emergency Medicine. Thus, the development of a similar tool for Global Health was undertaken with learners in Emergency Medicine in mind.Methods: The Global Emergency Medicine Think Tank Education Working Group convened at the 2016 Society for Academic Medicine Annual Meeting in New Orleans, Louisiana. Using the Interprofessional Global Health Competencies published by the Consortium of Universities for Global Health’s Competency Subcommittee as a foundation, the working group developed individual milestones based on the 11 stated domains. An iterative review process was implemented amongst the teams to develop a final product.Results: Milestones were developed in each of the 11 domains, with five competency levels for each domain. Specific learning resources were identified for each competency level and evaluation methodologies were aligned with the milestones framework. The Global Health EM Milestones Tool is designed for continuous usage by learners and mentors across a career in global emergency care. Conclusions: This Global Health EM Milestones tool may prove valuable to numerous stakeholders in global emergency care and educational health systems development. Next steps include a formalized pilot program for efficacy across programs and stakeholders and evaluation of the same.
• Dressler, C., Periyanayagam, U., Luyimbaazi, J., Dreifuss, B., Wangoda, R., & Bisanzo, M. (2016). Management and Outcomes of Acute Surgical Patients at a District Hospital in Uganda with Non-Physician Emergency Clinicians. World Journal of Surgery.
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  ABSTRACTIntroductionAcute surgical care services in rural Sub-Saharan Africa suffer from human resource and systemic constraints. Developing emergency care systems and task sharing aspects of acute surgical care addresses many of these issues. This paper investigates the degree to which specialized non-physicians practicing in a dedicated emergency department contribute to the effective and efficient management of acute surgical patients.MethodsThis is a retrospective review of an electronic quality assurance database of patients presenting to an Emergency Department in rural Uganda staffed by non-physician clinicians trained in emergency care. Relevant de-identified clinical data on patients admitted directly to the operating theater from 2011 to 2014 was analyzed in Microsoft Excel. ResultsOverall, 112 Emergency Department patients were included in the analysis and 96% received some form of lab testing, imaging, medication, or procedure in the ED, prior to surgery. 72 % of surgical patients referred by ED received pre-operative antibiotics, and pre-operative fluid resuscitation was initiated in 65%. Disposition to operating theater was accomplished within 3 hours of presentation for 73% of patients. 79% were successfully followed up to assess outcomes at 72hrs. 92% of those with successful follow-up reported improvement in their clinical condition. The confirmed mortality rate was 5%.ConclusionSpecialized non-physician clinicians practicing in a dedicated emergency department can perform resuscitation, bedside imaging, and laboratory studies to aid in diagnosis of acute surgical patients, and arrange transfer to an operating theater in an efficient fashion. This model has the potential to sustainably address structural and human resources problems inherent to sub-Saharan Africa’s current acute surgical care model, and will benefit from further study and expansion.
• Hayward, A. S., Lee, S. S., Douglass, K., Jacquet, G. A., Hudspeth, J., Walrath, J., Dreifuss, B. A., Baird, J., & Tupesis, J. P. (2022). The Impact of Global Health Experiences on the Emergency Medicine Residency Milestones. Journal of medical education and curricular development, 9, 23821205221083755.
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  Identify the impact of experiences in global health (GH) on the Accreditation Council for Graduate Medical Education (ACGME) competencies in emergency medicine (EM) residents and describe the individual characteristics of EM residents with global health experience compared to those without.
• Hayward, A., Walrath, J., Jacquet, G., Dreifuss, B., & Tupesis, J. (2015). Impact of Global Health Electives on Residency Milestone Achievements. TBA.
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  IRB approved at Yale, University of Wisconsin and Boston University, and being prepared for submission at UA. The educational setting is Emergency Medicine residency training. Approximately 22% of Emergency Medicine physicians-in-training participate in a global health elective during their residency (King et al, 2013). In 2013, Emergency Medicine residency leadership began evaluating residents on a semiannual basis using educational milestones as a framework for determining resident performance within the six ACGME core competencies. We will study the impact the global health elective has on milestone achievements by comparing 1) the pre- and post-global health elective milestone achievement scores of individual residents and 2) the milestone achievement scores of residents who participated in a global health elective to those who did not.
• Nelson, S., Stolz, U., Periyanayagam, U., Nichols, K., Dreifuss, B., Chamberlain, S., Maling, S., Kasyaba, R., Hammerstedt, H., & Bisanzo, M. (2016). Training Emergency Care Practitioners and Creating Access to Acute Care Services in Uganda: The Pilot Phase. Emergency Medicine Journal.
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  Acutely ill or injured patients require urgent treatment to avoid morbidity and mortality. Given current physician density in Sub-Saharan Africa (SSA), very few patients are seen by a physician promptly on presentation to a health unit. A novel task-shifting program training non-physician clinicians was initiated in rural Uganda to create access to high-quality emergency care. The EmergencyCare Practitioner (ECP) program is a 2-year program incorporating semi-weekly didactics using a symptom-based approach, simulation/procedure labs, and graded clinical responsibility (40 hours of clinical time per week). The initial data on patients cared for by the student ECPs at Karoli Lwanga Hospital are described here.
• Pickering, A. E., Dreifuss, H. M., Ndyamwijuka, C., Nichter, M., & Dreifuss, B. A. (2022). Getting to the Emergency Department in time: Interviews with patients and their caregivers on the challenges to emergency care utilization in rural Uganda. PloS one, 17(8), e0272334.
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  AbstractObjectivesKaroli Lwanga Hospital and Global Emergency Care, a 501(c)(3) nongovernmental organization, operate an Emergency Department (ED) in Uganda’s rural Rukungiri District. Despite available emergency care (EC), preventable death and disability persist due to delayed patient presentations. This study seeks to understand the emergency care seeking behavior of community members utilizing the established ED.MethodsWe purposefully sampled and interviewed patients and caregivers presenting to the ED more than 12 hours after onset of chief complaint in January-March 2017 to include various ages, genders, and complaints. Semistructured interviews addressing actions taken before seeking EC and delays to presentation once the need for EC was recognized were conducted until a diverse sample and theoretical saturation were obtained. An interdisciplinary and multicultural research team conducted thematic analysis based on descriptive phenomenology.ResultsThe 50 ED patients for whom care was sought (mean age 33) had approximately even distribution of gender, as well as occupation (none, subsistence farmers and small business owner). Interviews were conducted with 13 ED patients and 37 caregivers, on the behalf of patients when unavailable. The median duration of patients’ chief complaint on ED presentation was 5.5 days. On average, participants identified severe symptoms necessitating EC 1 day before presentation. Four themes of treatment delay before and after severity were recognized were identified: 1) Cultural factors and limited knowledge of emergency signs and initial actions to take; 2) Use of local health facilities despite perception of inadequate services; 3) Lack of resources to cover the anticipated cost of obtaining EC; 4) Inadequate transportation options.ConclusionsInterventions are warranted to address each of the four major reasons for treatment delay. The next stage of formative research will generate intervention strategies and assess the opportunities and challenges to implementation with community and health system stakeholders.
• Mowafi, H., Rice, B., Nambaziira, R., Nirere, G., Wongoda, R., James, M., Group, G. W., Bisanzo, M., & Post, L. (2021). Household economic impact of road traffic injury versus routine emergencies in a low-income country. Injury, 52(9), 2657-2664. doi:https://doi.org/10.1016/j.injury.2021.06.007
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  I am included in the Global Emergency Care Collaborative Investigators Group (in addition to Heather Hammerstedt, Stacey Chamberlain, Tom Neill and Mark Bisanzo). AbstractIntroductionRoad traffic injuries (RTIs) are increasing and have disproportionate impact on residents of low- and middle-income countries (LMICs) where 90% of deaths occur. RTIs are a leading cause of death for those aged 15 – 29 years with costs estimated to be up to 3% of GDP. Despite this fact, little primary research has been done on the household economic impact of these events.MethodsFrom July to October 2016, 860 consecutive emergency department patients were enrolled and followed up at 6-8 weeks to assess the household financial impacts of these emergency presentations. At follow-up, patients were queried regarding health status, lost wages or schooling, household costs incurred due to their injury or illness, and assets sold.Results860 patients were enrolled and 675 patients (78%) completed follow-up surveys. Of those, 660 had a confirmed reason for visit - 303 (45%) road traffic injuries, 357 (53%) other emergency presentations (non-RTI) - encompassing medical presentations and other types of injury, and reason for visit was missing for 15 patients (2%). More than 90% of RTI patients were working or in school prior to their injury. In the economically productive ages (15-44 years) RTI predominated (70%) vs non-RTI (39%). RTI patients were more likely to report residual disability (78.2% RTI vs 68.1% non-RTI, p=0.004). All emergency patients reported difficulty paying for basic needs (food, housing and medical expenses). More than ⅓ of emergency patients reported having to sell assets in order to meet basic needs after their illness or injury. Despite similar hospital costs and fewer lost days of work for both patients and caregivers, the mean financial impact on households of RTI patients was 37% more than for non-RTI patients. These costs equalled between 6-16 weeks of income for patients based on their occupation type and median reported pre-hospitalization income.DiscussionUgandan emergency care patients suffered significant personal and household economic hardship. In addition to the need for policy and infrastructural changes to improve road safety, these findings highlight the need for basic emergency care systems to secure economic gains in vulnerable households and prevent medical impoverishment of marginal communities.
• Pickering, A. E., Dreifuss, H. M., Ndyamwijuka, C., Nichter, M., Dreifuss, B. A., & Global, E. (2021). Getting to the Emergency Department in Time: Interviews With Patients and Their Caregivers on the Challenges to Emergency Care Utilization in Rural Uganda - a Grounded Theory Approach. medRxiv.
• Dreifuss, B. (2020). I’m a Health Care Worker. You Need to Know How Close We Are to Breaking. - Now it’s hospital staff in Arizona who are being challenged by the coronavirus, and that didn’t have to be.. The New York Times - Opinion/Editorial.
• Dreifuss, B., Duncan, D., Nichter, M., & Ellingson, K. (2020). A way to help Tucson healthcare workers keep their loved ones safe. Arizona Daily Star.
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  Op-Ed in Arizona Daily Star
• Rice, B., Leanza, J., Mowafi, H., Thadeus Kamara, N., Mugema Mulogo, E., Bisanzo, M., Nikam, K., Kizza, H., Newberry, J. A., Strehlow, M., , G. E., & Kohn, M. (2020). Defining High-risk Emergency Chief Complaints: Data-driven Triage for Low- and Middle-income Countries. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine, 27(12), 1291-1301.
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  Emergency medicine in low- and middle-income countries (LMICs) is hindered by lack of research into patient outcomes. Chief complaints (CCs) are fundamental to emergency care but have only recently been uniquely codified for an LMIC setting in Uganda. It is not known whether CCs independently predict emergency unit patient outcomes.
• Bitter, C. C., Rice, B., Periyanayagam, U., Dreifuss, B., Hammerstedt, H., Nelson, S. W., Bisanzo, M., Maling, S., & Chamberlain, S. (2018). What resources are used in emergency departments in rural sub-Saharan Africa? A retrospective analysis of patient care in a district-level hospital in Uganda. BMJ open, 8(2), e019024.
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  To determine the most commonly used resources (provider procedural skills, medications, laboratory studies and imaging) needed to care for patients.
• Rice, B. T., Bisanzo, M., Maling, S., Joseph, R., Mowafi, H., & , G. E. (2018). Derivation and validation of a chief complaint shortlist for unscheduled acute and emergency care in Uganda. BMJ open, 8(6), e020188.
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  Derive and validate a shortlist of chief complaints to describe unscheduled acute and emergency care in Uganda.
• Douglass, K. A., Jacquet, G. A., Hayward, A. S., Dreifuss, B. A., Tupesis, J. P., Acerra, J., Bloem, C., Brenner, J., DeVos, E., Douglass, K., Dreifuss, B., Hayward, A. S., Hilbert, S. L., Jacquet, G. A., Lin, J., Muck, A., Nasser, S., Oteng, R., Powell, N. N., , Rybarczyk, M. M., et al. (2017). Development of a Global Health Milestones Tool for Learners in Emergency Medicine: A Pilot Project. AEM education and training, 1(4), 269-279.
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  In medical education and training, increasing numbers of institutions and learners are participating in global health experiences. Within the context of competency-based education and assessment methodologies, a standardized assessment tool may prove valuable to all of the aforementioned stakeholders. Milestones are now used as the standard for trainee assessment in graduate medical education. Thus, the development of a similar, milestone-based tool was undertaken, with learners in emergency medicine (EM) and global health in mind.
• Dreifuss, B. A., Douglass, K. A., Jacquet, G. A., Hayward, A. S., & Tupesis, J. P. (2017). Development of a Global Health Milestones Tool for Learners in Emergency Medicine: A Pilot Project. AEM Education and Training, 1(4), 269-279. doi:10.1002/aet2.10046
• Dresser, C., Periyanayagam, U., Dreifuss, B., Wangoda, R., Luyimbaazi, J., & Bisanzo, M. (2017). Management and Outcomes of Acute Surgical Patients at a District Hospital in Uganda with Non-physician Emergency Clinicians. WORLD JOURNAL OF SURGERY, 41(9), 2193-2199.
• Dresser, C., Periyanayagam, U., Dreifuss, B., Wangoda, R., Luyimbaazi, J., Bisanzo, M., & , G. E. (2017). Management and Outcomes of Acute Surgical Patients at a District Hospital in Uganda with Non-physician Emergency Clinicians. World journal of surgery, 41(9), 2193-2199.
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  Acute surgical care services in rural Sub-Saharan Africa suffer from human resource and systemic constraints. Developing emergency care systems and task sharing aspects of acute surgical care addresses many of these issues. This paper investigates the degree to which specialized non-physicians practicing in a dedicated Emergency Department contribute to the effective and efficient management of acute surgical patients.
• Chanler-Berat, J., Birungi, A., Dreifuss, B., & Mbiine, R. (2016). Typhoid intestinal perforation: Point-of-care ultrasound as a diagnostic tool in a rural Ugandan Hospital. African journal of emergency medicine : Revue africaine de la medecine d'urgence, 6(1), 44-46.
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  Point-of-care ultrasound (POCUS) in resource-limited areas has demonstrated utility in the hands of physicians and may be useful for non-physician providers to learn as well.
• Pickering, A., Hammerstedt, H., & Dreifuss, B. (2016). Community Barriers to Emergency Care Utilization in Rural Uganda: Review of Current Literature and Proposed Research April 2016. http://dx.doi.org/10.1016/j.aogh.2016.04.487. Annals of Global Health, 82(3), 552-553. doi:http://dx.doi.org/10.1016/j.aogh.2016.04.487
• Rice, B., Periyanayagam, U., Chamberlain, S., Dreifuss, B., Hammerstedt, H., Nelson, S., Maling, S., & Bisanzo, M. (2016). Mortality in Children Under Five Receiving Nonphysician Clinician Emergency Care in Uganda. Pediatrics, 137(3), 1-8. doi:10.1542/peds.2015-3201
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  A nonphysician clinician (NPC) training program was started in Uganda in 2009. NPC care was initially supervised by a physician and subsequent care was independent. The mortality of children under 5 (U5) was analyzed to evaluate the impact of transitioning NPC care from physician-supervised to independent care.
• Rice, B., Periyanayagam, U., Nelson, S. W., Maling, S., Hammerstedt, H., Dreifuss, B., Chamberlain, S., & Bisanzo, M. (2016). Mortality in Children Under Five Receiving Nonphysician Clinician Emergency Care in Uganda.. Pediatrics, 137(3), e20153201. doi:10.1542/peds.2015-3201
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  A nonphysician clinician (NPC) training program was started in Uganda in 2009. NPC care was initially supervised by a physician and subsequent care was independent. The mortality of children under 5 (U5) was analyzed to evaluate the impact of transitioning NPC care from physician-supervised to independent care..A retrospective review was performed of a quality assurance database including 3-day follow-up for all patients presenting to the emergency department (ED). Mortality rates were calculated and χ(2) tests used for significance of proportions. Multiple logistic regression was used to assess independent predictors of mortality..Overall, 68.8% of 4985 U5 patients were admitted and 28.6% were "severely ill." The overall mortality was significantly lower in physician-supervised versus independent NPC care (2.90% vs 5.04%, P = .05). No significant mortality difference was seen between supervised and unsupervised care (2.17% vs 3.01%, P = .43) for the majority of patients that were not severely ill. Severely ill patients analyzed separately showed a significant mortality difference (4.07% vs 10.3%, P = .01). Logistic regression revealed physician supervision significantly reduced mortality for patients overall (odds ratio = 0.52, P = .03), but not for nonseverely ill patients analyzed separately (odds ratio = 0.73, P = .47)..Though physician supervision reduced mortality for the severely ill subset of patients, physicians are not available full-time in most EDs in Sub-Saharan Africa. Training NPCs in emergency care produced noninferior mortality outcomes for unsupervised NPC care compared with physician-supervised NPC care for the majority of U5 patients.
• Stoneking, L. R., Dreifuss, B., & Cappa, A. (2016). Better preparing emergency medicine physician trainees for global and rural practice settings: a longitudinal component of university of Arizona's south campus emergency medicine graduate medical education curriculum. Annals of global health, 82(3), 351. doi:10.1016/j.aogh.2016.04.058
• Stoneking, L. R., Waterbrook, A. L., Garst Orozco, J., Johnston, D., Bellafiore, A., Davies, C., Nuno, T., Fatas, J. M., Beita, O., Ng, V., Grall, K., & Adamas-Rappaport, W. (2016). Does Spanish instruction for emergency medicine resident physicians improve patient satisfaction in the emergency department and adherence to medical recommendations?. Advances in Medical Education and Practice, 7, 467-473.
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  Approximately 1 hours spent on project for 2015Approximately 6 hours spent on project for 2016
• Chamberlain, S., Stolz, U., Dreifuss, B., Nelson, S. W., Hammerstedt, H., Andinda, J., Maling, S., & Bisanzo, M. (2015). Mortality related to acute illness and injury in rural Uganda: task shifting to improve outcomes. PloS one, 10(4), 11. doi:doi:10.1371/journal. pone.0122559
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  Due to the dual critical shortages of acute care and healthcare workers in resource-limited settings, many people suffer or die from conditions that could be easily treated if existing resources were used in a more timely and effective manner. In order to address this preventable morbidity and mortality, a novel emergency midlevel provider training program was developed in rural Uganda. This is the first study that assesses this unique application of a task-shifting model to acute care by evaluating the outcomes of 10,105 patients.
• Cherniak, W., Dreifuss, B., Evert, J., Dasco, M., Lin, H., & Loh, L. (2015). A Framework for Categorizing Short-Term Medical Experiences Abroad by Local Partnership Engagement Model - (Published Abstract). Annals of Global Health, 81(1), 19. doi:doi:10.1016/j.aogh.2015.02.556
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  Published Conference Abstract from:Consortium of Universities for Global Health: Poster Abstracts from the 6th Annual CUGH Conference "Mobilizing Research for Global Health"Interest in short-term medical experiences (STME) abroad continues to increase. Countless organizations are developing stylistic approaches to entice volunteers, and public perception has explored the entire spectrum of reasons behind participation, ranging from education to service. Unprecedented levels of participation is increasingly raising questions around ethics and responsibility, with some discussions focusing particularly on local partner engagement. By presenting a framework around different models of local partner engagement, this work aims to allow STME conducting groups to evaluate their programs and strategies to better consider potential ethical ramifications.
• Dreifuss, B., Periyanayagam, U., Chamberlain, S., Nelson, S., Hammerstedt, H., Kamugisha, J. B., & Bisanzo, M. (2015). 72hr patient follow-up as a metric for measuring outcomes and quality of emergency care provided in resource-limited settings: An outcomes study from a rural Ugandan district hospital's emergency department (published abstract). Annals of Global Health, 81(1), 146-147. doi:http://dx.doi.org/10.1016%2Fj.aogh.2015.02.837
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  Published Conference Abstract from:Consortium of Universities for Global Health: Poster Abstracts from the 6th Annual CUGH Conference "Mobilizing Research for Global Health"In 2007, the World Health Assembly passed Resolution 60.22, highlighting the role for strengthening Emergency Care (EC) systems in reducing the burden of acute illness, injury, and acute decomposition of chronic disease. In 2014 Emergency Care (EC) training remains largely un-funded in low and middle-income countries (LMICs), where there is little consensus on reasonable quality metrics for EC. Creating contextually appropriate and cost effective programs for data collection enables development of quality metrics to demonstrate EC training program and Emergency Department (ED) efficacy. This study's aim is to assess the success of utilizing a 72 hour post-ED disposition follow-up (f/u) interview as a tool to calculate ED visit mortality and efficacy of care via a self-reported patient assessment of health status
• Hudspeth, J. C., Rabin, T. L., Dreifuss, B. A., Schaaf, M., Lipnick, M. S., Russ, C. M., Autry, A. M., Pitt, M. B., & Rowthorn, V. (2019). Reconfiguring a One-Way Street: A Position Paper on Why and How to Improve Equity in Global Physician Training. Academic medicine : journal of the Association of American Medical Colleges, 94(4), 482-489. doi:10.1097/ACM.0000000000002511
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  Large numbers of U.S. physicians and medical trainees engage in hands-on clinical global health experiences abroad, where they gain skills working across cultures with limited resources. Increasingly, these experiences are becoming bidirectional, with providers from low- and middle-income countries traveling to experience health care in the United States, yet the same hands-on experiences afforded stateside physicians are rarely available for foreign medical graduates or postgraduate trainees when they arrive. These physicians are typically limited to observership experiences where they cannot interact with patients in most U.S. institutions. In this article, the authors discuss this inequity in global medical education, highlighting the shortcomings of the observership training model and the legal and regulatory barriers prohibiting foreign physicians from engaging in short-term clinical training experiences. They provide concrete recommendations on regulatory modifications that would allow meaningful short-term clinical training experiences for foreign medical graduates, including the creation of a new visa category, the designation of a specific temporary licensure category by state medical boards, and guidance for U.S. host institutions supporting such experiences. By proposing this framework, the authors hope to improve equity in global health partnerships via improved access to meaningful and productive educational experiences, particularly for foreign medical graduates with commitment to using their new knowledge and training upon return to their home countries.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
• Loh, L. C., Cherniak, W., Dreifuss, B. A., Dacso, M. M., Lin, H. C., & Evert, J. (2015). Short term global health experiences and local partnership models: a framework. Globalization and health, 11, 50. doi:10.1186/s12992-015-0135-7
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  Contemporary interest in in short-term experiences in global health (STEGH) has led to important questions of ethics, responsibility, and potential harms to receiving communities. In addressing these issues, the role of local engagement through partnerships between external STEGH facilitating organization(s) and internal community organization(s) has been identified as crucial to mitigating potential pitfalls. This perspective piece offers a framework to categorize different models of local engagement in STEGH based on professional experiences and a review of the existing literature. This framework will encourage STEGH stakeholders to consider partnership models in the development and evaluation of new or existing programs.The proposed framework examines the community context in which STEGH may occur, and considers three broad categories: number of visiting external groups conducting STEGH (single/multiple), number of host entities that interact with the STEGH (none/single/multiple), and frequency of STEGH (continuous/intermittent). These factors culminate in a specific model that provides a description of opportunities and challenges presented by each model. Considering different models, single visiting partners, working without a local partner on an intermittent (or even one-time) basis provided the greatest flexibility to the STEGH participants, but represented the least integration locally and subsequently the greatest potential harm for the receiving community. Other models, such as multiple visiting teams continuously working with a single local partner, provided an opportunity for centralization of efforts and local input, but required investment in consensus-building and streamlining of processes across different groups. We conclude that involving host partners in the design, implementation, and evaluation of STEGH requires more effort on the part of visiting STEGH groups and facilitators, but has the greatest potential benefit for meaningful, locally-relevant improvements from STEGH for the receiving community. There are four key themes that underpin the application of the framework: 1. Meaningful impact to host communities requires some form of local engagement and measurement. 2. Single STEGH without local partner engagement is rarely ethically justified. 3. Models should be tailored to the health and resource context in which the STEGH occurs. 4. Sending institutions should employ a model that ultimately benefits local receiving communities first and STEGH participants second. Accounting for these themes in program planning for STEGH will lead to more equitable outcomes for both receiving communities and their sending partners.
• Stolz, L. A., Muruganandan, K. M., Bisanzo, M. C., Sebikali, M. J., Dreifuss, B. A., Hammerstedt, H. S., Nelson, S. W., Nayabale, I., Adhikari, S., & Shah, S. P. (2015). Point-of-care ultrasound education for non-physician clinicians in a resource-limited emergency department. Tropical medicine & international health : TM & IH, 20(8), 1067-72. doi:doi:10.1111/tmi.12511
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  To describe the outcomes and curriculum components of an educational programme to train non-physician clinicians working in a rural, Ugandan emergency department in the use of POC ultrasound.
• Hammerstedt, H., Maling, S., Kasyaba, R., Dreifuss, B., Chamberlain, S., Nelson, S., Bisanzo, M., & Ezati, I. (2014). Addressing World Health Assembly Resolution 60.22: A Pilot Project to Create Access to Acute Care Services in Uganda. Annals of emergency medicine, 64(5), 461-8. doi:http://dx.doi.org/10.1016/j.annemergmed.2014.01.035
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  The World Health Assembly 2007 Resolution 60.22 tasked the global health community to address the lack of emergency care in low- and middle-income countries. Little progress has yet been made in integrating emergency care into most low- and middle-income-country health systems. At a rural Ugandan district hospital, however, a collaborative between a nongovernmental organization and local and national stakeholders has implemented an innovative emergency care training program. To our knowledge, this is the first description of using task shifting in general hospital-based emergency care through creation of a new nonphysician clinician cadre, the emergency care practitioner. The program provides an example of how emergency care can be practically implemented in low-resource settings in which physician numbers are limited. The Ministry of Health is directing its integration into the national health care system as a component of a larger ongoing effort to develop a tiered emergency care system (out-of-hospital, clinic- and hospital-based provider and physician trainings) in Uganda. This tiered emergency care system is an example of a horizontal health system advancement that offers a potentially attractive solution to meet the mandate of World Health Assembly 60.22 by providing inexpensive educational interventions that can make emergency care truly accessible to the rural and urban communities of low- and middle-income countries.
• Nayebare, I., Nambaziira, R., Frank, D. S., Dunleavy, K., Dreifuss, B., & Bisanzo, M. (2014). Upper extremity injury management by non- physician emergency practitioners in rural Uganda: A pilot study. African Journal of Emergency Medicine, 4(1), 25-30. doi:10.1016/j.afjem.2013.12.001
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  Introduction Improper management of and resultant poor outcomes from upper extremity injuries can be economically devastating to patients who rely on manual labour for survival. This is a pilot study using the Quick DASH Survey (disabilities of arm, shoulder and hand), a validated outcome measurement tool. Our objective was to assess functional outcomes of patients with acute upper extremity injuries who were cared for by non-physician clinicians as part of a task-shifting programme. Methods This pilot study was performed at the Karoli Lwanga Hospital Emergency Centre (EC) in Uganda. Patients were identified retrospectively by querying the EC quality assurance database. An initial list of all patients who sustained traumatic injury (road traffic accident, assault) between March 2012 and February 2013 was narrowed to patients with upper extremity trauma, those 18 years and older, and those with cellular phone access. This subset of patients was called and administered the Quick DASH. The results were subsequently analysed using the standardised DASH metrics. These outcome measures were further analysed based upon injury type (simple laceration, complex laceration, fracture and subluxation). Results There were a total of 25 initial candidates, of which only 17 were able to complete the survey. Using the Quick DASH Outcome Measure, our 17 patients had a mean score of 28.86 (range 5.0–56.8). Conclusions When compared to the standardised Quick DASH outcomes (no work limitation at 27.5 vs. work limited by injury at 52.6) the non-physician clinicians appear to be performing upper extremity repairs with good outcomes. The key variable to successful repair was the initial injury type. Although accommodations needed to be made to the standard Quick DASH protocol, the tool appears to be usable in non-traditional settings.
• Stoneking, L. R., Grall, K. H., Min, A., Dreifuss, B., & Spear Ellinwood, K. C. (2014). Role of an audience response system in didactic attendance and assessment. Journal of graduate medical education, 6(2), 335-7. doi:http://dx.doi.org/10.4300/JGME-D-13-00285.1
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  The Residency Review Committee for Emergency Medicine mandates conference participation, but tracking attendance is difficult and fraught with errors. Feedback on didactic sessions, if not collected in real time, is challenging to obtain.We assessed whether an audience response system (ARS) would (1) encourage residents to arrive on time for lectures, and (2) increase anonymous real-time audience feedback.
• Nayebare, I., Nambaziira, R., Frank, D. S., Dunleavy, K., Dreifuss, B., & Bisanzo, M. (2013). Emergency medicine task shifting: Quick dash outcome scores of upper extremity injury management. African Journal of Emergency Medicine, 3(4), S14-S15. doi:10.1016/j.afjem.2013.08.037
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  Study Objectives This is a pilot study using the Quick DASH Survey (disabilities of arm, shoulder and hand), a validated outcome measurement tool. Our primary objective was to assess functional outcomes of patients with acute upper extremity injuries who were cared for by non-physician clinicians as part of a task-shifting program. Secondarily, we determined if the Quick DASH can be successfully utilized in a non-traditional low-resourced setting. Methods This pilot was administered by the Global Emergency Care Collaborative (GECC) at the Karoli Lwanga Hospital Emergency Department (ED) in Uganda. Patients were identified retrospectively by querying the ED quality assurance database. An initial list of all patients who sustained traumatic injury (RTA, Assault or Accident) between March 2012 and February 2013 was narrowed to patients with upper extremity trauma, those 18 yrs and older, and those with cellular phone access. This subset of patients was called and administered the Quick DASH. The results were subsequently analyzed using the standardized DASH metrics. These outcome measures were further analysed based upon injury type (simple laceration, complex laceration, fracture, subluxation), laceration location (finger, palm, wrist), age at presentation (18–69), and time from initial presentation to follow up (1–11 months). Results and conclusions There were a total of 25 initial candidates, of which only 17 were able to complete the survey. Using the Quick DASH Outcome Measure, our 17 patients had a mean score of 29.5 (range 5.0– 56.8). When compared to the standardized Quick DASH outcomes (no work limitation at 27.5 vs. work limited by injury at 52.6) the non-physician clinicians appear to be performing upper extremity repairs with good outcomes. The key variable to successful repair was the initial injury type. Although accommodations needed to be made to the standard Quick DASH protocol, the tool appears to be usable in non-traditional settings.
• Tiemeier, K., Bisanzo, M., Dreifuss, B., Ward, K. C., & Dreifuss, D. (2013). The Effect of Geography and Demography on Outcomes of Emergency Department Patients in Rural Uganda. Annals of Emergency Medicine, 62(4), S99. doi:10.1016/j.annemergmed.2013.07.096
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  controls to have ever consumed alcohol (aOR, 1.64; 95% CI, 1.29e2.07). Both past drinking (aOR, 1.70; 95% CI, 1.24e2.35) or current drinking (aOR, 1.51; 95% CI, 1.10e2.07) were associated with breast cancer risk. A doseeresponse relationship was observed for years of drinking (P trend < 0.001), with each additional year contributing to a 2% increase in risk. Among women with family history of breast cancer (aOR, 2.81; 95% CI, 1.09e7.24), the relationship between alcohol drinking and breast cancer was stronger than that among women without the history (aOR, 1.55; 95% CI, 1.21e1.99). Summary/Conclusion: We found a positive relationship between alcohol consumption and breast cancer risk among African women, although it was heterogeneous across three countries. Alcohol drinking may be becoming increasingly common among African women, and this modifiable risk factor should be addressed in breast cancer prevention programs in Africa.
• Bisanzo, M., Nichols, K., Hammerstedt, H., Dreifuss, B., Nelson, S. W., Chamberlain, S., Kyomugisha, F., Noble, A., Arthur, A., & Thomas, S. (2012). Nurse-administered ketamine sedation in an emergency department in rural Uganda. Annals of emergency medicine, 59(4), 268-75.
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  We determine whether, after a brief training program in procedural sedation, nurses can safely independently administer ketamine sedation in a resource-limited environment.
• Waters, T., Tiemeier, K., Terry, B. M., Nelson, S. W., Mcnamara, M., Hammerstedt, H., Dreifuss, B., Chamberlain, S., & Bisanzo, M. (2012). Task shifting: Meeting the human resources needs for acute and emergency care in Africa. African Journal of Emergency Medicine, 2(4), 182-187. doi:10.1016/j.afjem.2012.06.005
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  Abstract The enormous shortage of health workers in sub-Saharan Africa (SSA) is a major contributor to the unacceptably high rates of morbidity and mortality in the region. This is especially true for patients whose illnesses and injuries require time-sensitive interventions. To address the crisis, a number of countries have utilized "task-shifting" in various health disciplines where they call upon other cadres, often nurses, to assume new roles and responsibilities that are not traditionally within their scope of practice. This practice has been shown to increase access, to be cost-effective and of high-quality. A literature review was undertaken to better understand the implications of task-shifting on emergency medical care in Africa. This review demonstrates that, while task-shifting has been used effectively for specific emergency procedures in specialty fields such as obstetrics and surgery, to date there are no studies on the use of task-shifting to treat the acute, undifferentiated patient in SSA. Task shifting is a potential solution to help address the very limited access to emergency care across SSA, but requires further study to ensure effective implementation.
• Michaels, A. J., Wanek, S. M., Dreifuss, B. A., Gish, D. M., Otero, D., Payne, R., Jensen, D. H., Webber, C. C., & Long, W. B. (2002). A protocolized approach to pulmonary failure and the role of intermittent prone positioning. The Journal of trauma, 52(6), 1037-47; discussion 1047.
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  We present a series of adult patients treated under a protocol for severe lung failure (acute respiratory distress syndrome [ARDS]) that uses positive end-expiratory pressure (PEEP) optimization and intermittent prone positioning (IPP) to reduce shunt, improve oxygen (O(2)) delivery, and reduce FiO(2).

Presentations

• Dreifuss, B. (2021, Spring). COVID-19 Vaccines: Truths, Myths, and Q&A. A health Talk Tuesday Presentation for Agave Health. Virtual Lecture (zoom): Agave Health.
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  This was a solicited lecture for a community health organization seeking to reduce vaccine hesitancy and COVID19 mis/dis-information.
• Dreifuss, B., & Dreifuss, H. (2021, Fall). COVID-Delta and What We Can Do to STOP IT. Academy for Math and Sciences' - Prince - Parent and Advisory Council. Virtual (Zoom): Academy for Math and Sciences - Prince.
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  Right 2 Safe Schools AZ - Presentation to AMS Prince PAC Meeting
• Dreifuss, B. (2019, August). Compassion in Healthcare: Making for better patient outcomes, happier and more productive clinicians, and a more robust bottom line.". Emergency Care Society of Uganda's Inaugural Conference on Emergency Medicine: "Beginnings and Beyond". Jinja Uganda: Emergency Care Society of Uganda, Global Emergency Care, Seed Global Health, Uganda Ministry of Health.
• Dreifuss, B., Ahaisibwe, B., Wanaiye, J. B., Neill, T., Geduld, H., Luggya, T. S., Harborne, D., Wachira, B., Obuku, E., Kanaahe, B., & Nkalubo, M. (2019, August). Panel Discussion on Global Health and Emergency Care. Emergency Care Society of Uganda's Inaugural Conference on Emergency Medicine: "Beginnings and Beyond". Jinja, Uganda: Emergency Care Society of Uganda, Global Emergency Care, Seed Global Health, Malterser International, Uganda Ministry of Health.
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  Panel discussion of experts working across academia, non-governmental organizations, Ministry of Health, and hospital administration regarding the fundamental importance of developing emergency care systems in coordinated ways.
• Dreifuss, B., Merchant, N. C., Bukenya, E., Williams, C., Tremblay, E., & Jordan, C. (2019, October). "Digital Health Innovations". 2019 TENWEST Festival's Sustainability and Social Impact Summit. Tucson Convention Center: TENWEST Impact Festival, McGuire Center for Entrepreneurship at Eller College of Management; Startup Tucson; Microsoft.
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  Digital health, the intersection of technology and healthcare systems, is aimed at making healthcare more effective, efficient, and personalized. This panel features local startups working in this space and a discussion of the the role of digital health in increasing equity to health services. Moderated by Nirav Merchant.
• Dreifuss, B., Rabin, T., & Mayanja-Kizza, H. (2019, August). Workshop - "Equity in Short-Term Global Physician Training: Updates from a US-based Advocacy Effort". 2019 AFREhealth Symposium. Lagos, Nigeria: AFREhealth; Ibadan University.
• Gaskin, G., Gaskin, G., Saleh, A. A., Saleh, A. A., Dreifuss, B., & Dreifuss, B. (2018, November 7-9th). Health Information Technology (HIT) Supporting Emergency Care in Sub-Saharan Africa- A Scoping Review. 2018 African Conference on Emergency Medicine: Breaking Barriers in Emergency Medicine Education. Kigali, Rwanda: African Federation of Emergency Medicine.
• Pickering, A., Dreifuss, B., Dunleavy, J., Howe, C. L., Dreifuss, H., Dreifuss, H., Dunleavy, J., Howe, C. L., Pickering, A., & Dreifuss, B. (2018, November 7-9th). Building It So They Will Come: Factors Contributing to Delays in Seeking Available Emergency Medical Care in Rural Uganda - A systematic Review. 2018 African Conference on Emergency Medicine: Breaking Barriers in Emergency Medicine Education. Kigali, Rwanda: African Federation of Emergency Medicine.
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  Objectives:Karoli Lwanga Hospital and Global Emergency Care (501c3 NGO) operate an Emergency Department (ED) in Uganda’s Rukungiri District. Despite available Emergency Care (EC), preventable death and disability persist due to delayed patient presentations. Implementation of effective EC requires assessment of socioeconomic, cultural, and structural factors leading to treatment delay. We undertook a systematic literature review to assess current knowledge and research regarding access to EC. Methods: A systematic literature review was performed using controlled vocabulary terms and key words to search the following databases for studies on factors impacting access to EC facilities in rural Uganda or the immediately adjacent countries: Ovid/MEDLINE, Elsevier/Embase, Elsevier/Scopus, Wiley/Cochrane Library, Thomson-Reuters/Web of Science, EBSCO/CINAHL, and K4Health/Popline. Results:4091 articles were initially identified; 4004 were excluded due to irrelevance to the topic. Strict inclusion/exclusion criteria were applied to the full text of 87 articles and 27 met criteria and quality assessment comprising the basis of this review.Knowledge of barriers to utilization of available EC is limited, with most literature specific to rural Uganda and adjacent countries focusing on obstetric and paediatric emergencies, which makes generalizations imperfect. However, this review suggests that cost and transportation are not the sole determinants of EC access and utilization. Challenges may be more complex, relating to identification of emergency conditions, healthcare decision-making, perceptions of healthcare quality and traditional culture and beliefs. Conclusion:Currently, the research needed for optimal implementation of EC in rural locations in Uganda and adjacent countries remains limited. A better understanding of community members’ challenges in accessing and utilizing EC is necessary for EC system development, as low utilization and/or delayed presentation limits the impact of EC in reducing preventable morbidity and mortality. Qualitative research in the ED and community-based settings may better elucidate factors affecting EC seeking behaviours and access to these vital services.
• Pickering, A., Ndyamwijuka, C., Dreifuss, H., Kusasira, A., Hammerstedt, H., Mbabazi, N., Niwagaba, B., Nichter, M., & Dreifuss, B. (2018, March, 16-18). Building It So They Will Come: Factors Contributing to Delays in Seeking Available Emergency Medical Care in Rural Uganda. 9th Annual Consortium of Universities for Global Health Conference. New York, New York: Consortium of Universities for Global Health.
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  Background: Karoli Lwanga Hospital and Global Emergency Care operate an ED in Uganda’s Rukungiri District. Still, preventable death and disability persist.Implementation of an effective EM system requires assessment of factors leading to treatment delay.Methods: Two methodologies, conducted January-April, 2017, enabled data triangulation. 50 case studies (EDCS) were collected; within a convenience sample of ED patients presenting >12 hours after onset of chief complaint(s), purposeful sampling ensured diverse ages, genders and chief complaints. Semi-structured interviews probed actions taken before, and delays while, seeking ED care. 20 community-based focus groups (CFG, N=157) were conducted in 11 locations with varied geography, healthcare resources and socioeconomics. CFGs addressed hypothetical emergency scenarios and participants’ experiences. Both were recorded, translated and transcribed; the interdisciplinary, multicultural, research team conducted thematic analysis via the Multi-Investigator Consensus Method.Results: The majority of participants (mean age 40) were: female, and/or subsistence farmers, and/or primary school educated. EDCSs and CFGs yielded complementary data; the former provided more insight into predisposing and service related factors, and the latter suggested enabling factors leading to delay.Participants expressed limited knowledge of signs indicating medical emergencies, sought advice from multiple sources, and were treated at local clinic(s) with limited EM capacity. Upfront cost, especially for transport, was a major barrier; hospital cost was less frequently cited. Cultural factors leading to delay included: male-controlled finances, and concepts of traditional and biomedical illness. Service related factors focused on lack of trust in healthcare.Conclusion: Interventions to increase timely ED utilization include: community education on complaints requiring ED care, training community first responders, subsidized or credit-based emergency transport, and a referral system from local clinics to the ED. Formative research is needed to identify intervention implementation strategies compatible with ongoing health system strengthening. This research methodology was effective and could be valuable when implementing EM systems in similar settings.
• Pickering, A., Ndyamwijuka, C., Dreifuss, H., Kusasira, A., Hammerstedt, H., Mbabazi, N., Niwagaba, B., Nichter, M., & Dreifuss, B. (2018, May 15-18). Building It So They Will Come: Factors Contributing to Delays in Seeking Available Emergency Medical Care in Rural Uganda. 2018 Society of Academic Emergency Medicine Annual Meeting. Indianapolis, Indiana: Society of Emergency Medicine.
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  Background: Karoli Lwanga Hospital and Global Emergency Care operate an ED in Uganda’s Rukungiri District. Still, preventable death and disability persist.Implementation of an effective EM system requires assessment of factors leading to treatment delay.Methods: Two methodologies, conducted January-April, 2017, enabled data triangulation. 50 case studies (EDCS) were collected; within a convenience sample of ED patients presenting >12 hours after onset of chief complaint(s), purposeful sampling ensured diverse ages, genders and chief complaints. Semi-structured interviews probed actions taken before, and delays while, seeking ED care. 20 community-based focus groups (CFG, N=157) were conducted in 11 locations with varied geography, healthcare resources and socioeconomics. CFGs addressed hypothetical emergency scenarios and participants’ experiences. Both were recorded, translated and transcribed; the interdisciplinary, multicultural, research team conducted thematic analysis via the Multi-Investigator Consensus Method.Results: The majority of participants (mean age 40) were: female, and/or subsistence farmers, and/or primary school educated. EDCSs and CFGs yielded complementary data; the former provided more insight into predisposing and service related factors, and the latter suggested enabling factors leading to delay.Participants expressed limited knowledge of signs indicating medical emergencies, sought advice from multiple sources, and were treated at local clinic(s) with limited EM capacity. Upfront cost, especially for transport, was a major barrier; hospital cost was less frequently cited. Cultural factors leading to delay included: male-controlled finances, and concepts of traditional and biomedical illness. Service related factors focused on lack of trust in healthcare.Conclusion: Interventions to increase timely ED utilization include: community education on complaints requiring ED care, training community first responders, subsidized or credit-based emergency transport, and a referral system from local clinics to the ED. Formative research is needed to identify intervention implementation strategies compatible with ongoing health system strengthening. This research methodology was effective and could be valuable when implementing EM systems in similar settings.
• Pickering, A., Ndyamwijuka, C., Kusasira, A., Dreifuss, H., Hammerstedt, H., Mbabazi, N., Nichter, M., & Dreifuss, B. (2018, November 7-9th). Building It so They Will Come: Factors Contributing to Delays in Seeking Available Emergency Medical Care in Rural Uganda – ED Patient Case Studies. 2018 African Conference on Emergency Medicine: Breaking Barriers in Emergency Medicine Education. Kigali, Rwanda: African Federation of Emergency Medicine.
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  Objectives:Karoli Lwanga Hospital and Global Emergency Care (501c3 NGO) operate an Emergency Department (ED) in Uganda’s Rukungiri District. Despite available Emergency Care (EC), preventable death and disability persist due to delayed patient presentations. Implementation of effective EC requires assessment of socioeconomic, cultural, and structural factors leading to treatment delay. Methods:Case studies of ED patients (EDCS) was conducted via convenience sampling of patients presenting (January-March, 2017) ≥12 hours after onset of chief complaint(s) (CC). Purposeful sampling ensured diversity of ages, genders, and CCs. Semi-structured interviews with patients/attendants addressed actions taken before seeking EC and delays to presentation once the need for EC was recognized. EDCSs were conducted until data saturation was reached. The EDCSs were audio recorded and translated/transcribed, enabling the interdisciplinary/multicultural research team to conduct thematic analysis via the Multi-Investigator Consensus Method.Results:50 EDCS included 37 ED patients’ caregivers and 13 ED patient interviews. The majority of participants (mean age 38) were: female, subsistence farmers, and/or primary school educated. Median duration of patients’ CCs was 5.5 days prior to ED presentation. “Severe” illness was identified by participants an average of 1 day prior to presentation. Four overarching themes of delay were identified: 1) Limited knowledge by interviewees of signs of acute illness or basic prehospital interventions; 2) Use of local health facilities lacking EC training, capacity for medical stabilization, or referral protocols; 3) Lack of financial resources to cover direct, indirect and opportunity cost of anticipated EC; 4) Inadequate transport options, especially night-time & in inclement weather.Conclusion:Community interventions to increase timely EC utilization are necessary. However, the EDCS clarify that community members may not identify the need for EC and/or may be unable to access EC. Additional community-based qualitative research is needed to design and implement targeted interventions increasing EC utilization.
• Pickering, A., Ndyamwijuka, C., Kusasira, A., Dreifuss, H., Hammerstedt, H., Niwagaba, B., Nichter, M., & Dreifuss, B. (2018, November 7-9th). Building It so They Will Come: Factors Contributing to Delays in Seeking Available Emergency Medical Care in Rural Uganda – Community Focus Groups. 2018 African Conference on Emergency Medicine: Breaking Barriers in Emergency Medicine Education. Kigali, Rwanda: African Federation of Emergency Medicine.
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  Objectives:Karoli Lwanga Hospital and Global Emergency Care (501c3 NGO) operate an ED in Uganda’s Rukungiri District. Despite available Emergency Care (EC), preventable death and disability persist due to delayed patient presentations. Implementation of effective EC requires assessment of socioeconomic, cultural, and structural factors leading to treatment delay. Prior case studies of ED patients (EDCS) with delayed presentation clarified the need to understand community members’ EC-seeking behaviours and perceived challenges to EC utilization.Methods:Twenty community-based focus groups (CFGs) (n=157) were conducted, March-April, 2017, in eleven Rukungiri District locations with varied geography, healthcare resources, and socioeconomics. CFGs addressed hypothetical case-based scenarios (modelled on EDCS) and participants’ EC experiences. CFGs were audio recorded and translated/transcribed, enabling the interdisciplinary, multicultural, research team to conduct thematic analysis via the Multi-Investigator Consensus Method.Results:The majority of participants (mean age 41) were: female, subsistence farmers, and/or primary school educated. EDCSs and CFGs yielded complementary insights into delays, the former providing more insights into sociocultural and quality of healthcare related factors and the latter economic and structural factors. However, the CFGs supported the four overarching themes of delay identified in the EDCSs: 1. Limited knowledge of signs indicating medical emergencies and initial actions to be taken; 2 Use of local health facilities lacking EC training, capacity for medical stabilization, or referral protocols; 3. Lack of resources to cover direct, indirect, and opportunity cost of emergency care; 4. Inadequate transport options especially at night and with inclement weather.Conclusion:Data supported interventions to increase timely EC utilization include: community education to recognize signs requiring EC, training community first responders, creating a subsidized or credit-based emergency transport system, and a referral system from local clinics to EC. Formative research is needed to identify implementation and integration strategies for interventions within Uganda’s health system strengthening efforts.
• Dreifuss, B. (2017, October). Non-fellowship International Emergency Medicine Training Options. Emergency Medicine Resident's Association Workshop. Washington, DC: American College of Emergency PhysiciansThi.
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  This session consisted of a panel of presenters discussing options for training and practice of International Emergency Medicine, which then was followed by networking discussions..
• Dreifuss, B. A. (2017, January). Capacity Development & Evaluation of Emergency Care in LMIC’s. University of Utah’s Global Health Extreme Affordability Conference. Salt Lake City, Utah: University of Utah.
• Dreifuss, B. (2015, May). A Model to Maximize ROI for Emergency Care Training and Service Delivery;. Global Summit on Health-Technology-Education: Finding Affordable Solutions for Urgent Social and Human Problems. Atlanta, Georgia: Global Summit on Health-Technology-Education.
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  This talk describes demand for acute/emergency care services as well as the current gap in the market of acute/emergency care providers in Uganda/sub-Saharan Africa. The talk/pitch presents a training/care provision model that has been piloted and found to successfully serve the needs of disease/injury surveillance, acute care training/service provision, outcomes evaluation, as well as effectively lowering case fatality rates and reducing preventable morbidity and mortality. Finally, projections for cost savings within health systems and communities are presented in an effort to articulate the potential return on investment for scaling up this rural hospital based Emergency Care Practitioner model.
• Dreifuss, B. (2015, September). Management of Acute Surgical Patients by Non-Physician Emergency Care Practitioners in Rural Uganda. Global Partners in Anesthesia and Surgery (GPAS) 2015 Global Surgery Conference. Entebbe, Uganda: Global Partners in Anesthesia and Surgery.
• Dreifuss, B., & Cappa, A. (2015, August). Preparing Emergency Physicians for a Rural (resource-limited) Practice Environment: BUMC-South Campus Emergency Medicine’s Curriculum for Rural, Border, and Global Health. 42nd Annual Arizona Rural Health Conference. Sedona, Arizona: Arizona Center for Rural Health.
• Dreifuss, B., Cappa, A., Fatas, J., & Stoneking, L. (2015, August). A Model for Integrating Medical Spanish into Healthcare Provider Training: BUMC-South Campus Emergency Medicine’s Curriculum for Medical Spanish. 42nd Annual Arizona Rural Health Conference. Sedona, Arizona: Arizona Center for Rural Health.
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  A Model for Integrating Medical Spanish into Healthcare Provider Training: BUMC-South Campus Emergency Medicine’s Curriculum for Medical Spanish; Poster and Oral Presentation for the 42nd Annual Arizona Rural Health Conference, August 4th, 2015.
• Dreifuss, B., Periyanayagama, U., Chamberlain, S., Nelson, S., Hammerstedt, H., Kamugisha, J. B., & Bisanzo, M. (2015, April). 72hr Patient Follow-Up as a Metric for Measuring Outcomes and Quality of Emergency Care Provided in Resource-Limited Settings: an outcomes study from a rural Ugandan district hospital’s Emergency Department. Oral presentation for the 19th World Congress on Disaster and Emergency Medicine. Cape town, South Africa: Word Association for Disaster and Emergency Medicine.
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  Oral presentation for the 19th World Congress on Disaster and Emergency Medicine; Cape Town, South Africa; April 2015

Poster Presentations

• Chandler, A. B., Wank, A., Vanuk, J., O'Connor, M., Dreifuss, B., Dreifuss, H., Ellingson, K., Khan, S., Friedman, S., & Athey, A. (2020, Fall). Online Psychological First Aid for Healthcare Workers: The HCW HOSTED ICARE Model in Response to COVID-19. Psychological Services. Virtual Meeting: American Psychosomatic Society.
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  HCW HOSTED, a grassroots organization serving the housing, social, and emotionalsupport needs of healthcare workers in Tucson, Arizona, implemented the ICAREmodel of psychological first aid (PFA) online (i.e., via telehealth) for healthcare workersin response to the COVID-19 pandemic. This review outlines existing frameworks forPFA, noting the novel and important contribution to research and practice of this firsttelehealth version of PFA. Additionally, the implementation context and specificelements of the HCW HOSTED ICARE model are described. Service delivery themesand lessons learned from the implementation of the online ICARE service forhealthcare workers are reviewed. Lastly, recommendations and considerations forfuture adoptions/adaptations of the online ICARE service for healthcare workers areoffered.
• Murphy, J., Wells, K., Dreifuss, B., & Rice, B. (2018, May 15-18). Gender Disparity in Injury Outcomes: Increased Mortality in Female Children Under Five in Uganda. 2018 Society of Academic Emergency Medicine Annual Conference. Indianapolis, Indiana: Society of Emergency Medicine.
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  Background: Under five (U5) mortality has seen a drastic two-thirds reduction worldwide between 1990- 2015 as a result of becoming a global health priority as part of Millenium Development Goal (MDG) 4 and now as a component of Sustainable Development Goal (SDGs) 3. Unintentional injury remains animportant cause of morbidity and mortality for U5 patients and its epidemiological burden is poorly described.Methods: A single researcher abstracted retrospective injury surveillance data from a quality assurance database at two dedicated emergency departments in Uganda. Data was collected from 2010 - 2017 at a rural hospital and from 2014 - 2017 at a regional referral hospital. Injury surveillance data collection protocol was modeled on data collection forms developed by Injury Control Center of Uganda. Demographics, injury details, and three-day mortality outcomes were recorded for all patients during these time periods. v 2 tests were used for significance of proportions and multiple logistic regression assessed independent predictors of mortality.Results: There were 15,463 U5 children treated at the two clinical sites in Uganda. Of those, 9.8% (n= 1740) were found to have traumatic injuries and 41.0% (n=713) were female. The gross mortality rate for U5 females was significantly higher than males (3.4% vs. 1.9%, p=0.045) No differences were seen for type of injury between genders (p=0.4), with road traffic accidents (F=29.7%, M=28.4%), burns (F=19.5%, M=20.8%), and poisonings (F=16.9%, M=16.5%) predominating. For fatal injuries, burns were the most common for females (F=33.3%, M=16.7%) and blunt force was most common for males (F=28.6%, M=38.9%). Logistic regression for admitted U5 patients controlling for abnormal vitals, clinical site and injury cause showed a trend towards increased mortality for females with an odds ratio of 1.82 (95%CI 0.94 - 3.54, p=0.08).Conclusion: Though great strides have been made to reduce U5 mortality in sub-Saharan Africa, gender disparity in injury-related mortality persists across two clinical sites in Uganda. As SDG 3 and SDG 5 - focusing on Gender Equity - shape international priorities, improved injury surveillance may assist withidentifying injury patterns to inform injury prevention programs and interventions.
• Bitter, C. C., Rice, B., Periyanayagam, U., Dreifuss, B., Nelson, S. W., Hammerstedt, H., Maling, S., Bisanzo, M., & Chamberlain, S. (2016, April). Resources Used to Care for Patients at an Emergency Department in Rural Uganda. International Conference on Emergency Medicine. Cape Town, South Africa: International Federation of Emergency Medicine.
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  Abstract:INTRODUCTION: In June 2008, Global Emergency Care Collaborative (GECC) partnered with Karoli Lwanga Hospital to open the first Emergency Department in rural Uganda. Non-physician clinicians locally called Emergency Care Practitioners (ECPs) were trained in the practice of emergency care and began treating patients independently. This paper describes the resources utilized in caring for the first 27,000 patients seen by the ECPs. METHODS: Data on procedures performed, medications prescribed, laboratory tests requested, and radiography imaging were prospectively collected in a quality assurance database. Descriptive analysis of the data is presented here. RESULTS: Procedures were performed for 84% of patients, predominantly IV cannulation, wound care and soft tissue procedures, bladder catheterization, lumbar puncture and orthopedic procedures. Medications were administered to 88% of patients, most often pain medications, antibiotics, IV fluids, antimalarials, nutritional supplements and vaccinations. Laboratory testing was utilized for 84% of patients, predominantly malaria smears, rapid glucose testing, HIV assays, blood count, urinalysis, blood typing and Widal screens. CONCLUSION: This study describes the resources needed to care for a large prospective cohort of patients seen in an Emergency Department in rural Uganda. It demonstrates that the vast majority of patients were treated with a small formulary of critical medications and limited access to labs and imaging, but that providers require a broad set of procedural skills.
• Pickering, A., Hammerstedt, H., Dreifuss, H. M., & Dreifuss, B. A. (2016, April). Assessment of Perceived Barriers to Emergency Care Utilization in Rural Uganda.. 7th Annual Consortium of Universities for Global Health Conference - Bridging to a Sustainable Future in Global HealthConsortium of Universities for Global Health.
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  Program/Project PurposeIn Africa, capacity development has resulted in significant improvements in health indicators. Timely emergency care (EC) has potential to further these gains. Estimates project that EC can prevent 41% of deaths and 39% of disability in sub-Saharan Africa. Impact however, is contingent on widespread access and utilization.Karoli Lwanga Hospital, in rural southwest Uganda, operates an Emergency Department in collaboration with an NGO, Global Emergency Care Collaborative. Despite high-quality care, unacceptable levels of preventable morbidity and mortality occur since patients often delay care seeking. Understanding of sociocultural barriers to EC is needed to foster appropriate utilization of services, particularly as availability increases.Structure/Method/DesignA narrative literature review was performed. PubMed, Scopus and Goggle Scholar were searched with keywords of: Barriers, Emergency Care and Uganda. Studies related to accessing healthcare in rural Uganda and bordering countries were included if ED care was specifically addressed. Citations used in the resulting studies were also reviewed.Outcome & EvaluationKnowledge of barriers to EC is limited, and most literature specific to rural Uganda focuses on obstetric and pediatric emergencies, making generalizations imperfect. However, this review suggests that cost and transportation are not the sole barriers. Barriers may be more complex, relating to: healthcare decision-making, perceptions of quality and traditional culture and beliefs. It is noted that many patients die before reaching care at the facility level.Going ForwardMultiple methods will provide perspectives from the community on barriers to optimal EC access.•Case studies: Cases that present to the ED late in the course of illness will be utilized to understand aspects such as recognition of symptoms and severity, first aid administered and deliberations of the patient or caregivers.•Focus Groups: Emergency scenarios will be utilized to explore the course of action that would be taken by community members.•Community Survey: Hypothesis will be drawn from the qualitative data and tested with a quantitative survey implemented in locations frequented by a wide cross-section of the community.This program has potential to increase understanding of rural Ugandan sociocultural factors in EC seeking, impact EC implementation and increase mutual understanding between providers and similar underserved populations.FundingThis research is not funded.
• Pickering, A., Hammerstedt, H., Dreifuss, H. M., & Dreifuss, B. A. (2016, April). Community Barriers to Emergency Care Utilization in Rural Uganda: Review of Current Literature and Proposed Research. 7th Annual Consortium of Universities for Global Health Conference - Bridging to a Sustainable Future in Global Health. San Francisco: Consortium of Universities for Global Health.
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  Program/Project PurposeIn Africa, capacity development has resulted in significant improvements in health indicators. Timely emergency care (EC) has potential to further these gains. Estimates project that EC can prevent 41% of deaths and 39% of disability in sub-Saharan Africa. Impact however, is contingent on widespread access and utilization.Karoli Lwanga Hospital, in rural southwest Uganda, operates an Emergency Department in collaboration with an NGO, Global Emergency Care Collaborative. Despite high-quality care, unacceptable levels of preventable morbidity and mortality occur since patients often delay care seeking. Understanding of sociocultural barriers to EC is needed to foster appropriate utilization of services, particularly as availability increases.Structure/Method/DesignA narrative literature review was performed. PubMed, Scopus and Goggle Scholar were searched with keywords of: Barriers, Emergency Care and Uganda. Studies related to accessing healthcare in rural Uganda and bordering countries were included if ED care was specifically addressed. Citations used in the resulting studies were also reviewed.Outcome & EvaluationKnowledge of barriers to EC is limited, and most literature specific to rural Uganda focuses on obstetric and pediatric emergencies, making generalizations imperfect. However, this review suggests that cost and transportation are not the sole barriers. Barriers may be more complex, relating to: healthcare decision-making, perceptions of quality and traditional culture and beliefs. It is noted that many patients die before reaching care at the facility level.Going ForwardMultiple methods will provide perspectives from the community on barriers to optimal EC access.•Case studies: Cases that present to the ED late in the course of illness will be utilized to understand aspects such as recognition of symptoms and severity, first aid administered and deliberations of the patient or caregivers.•Focus Groups: Emergency scenarios will be utilized to explore the course of action that would be taken by community members.•Community Survey: Hypothesis will be drawn from the qualitative data and tested with a quantitative survey implemented in locations frequented by a wide cross-section of the community.This program has potential to increase understanding of rural Ugandan sociocultural factors in EC seeking, impact EC implementation and increase mutual understanding between providers and similar underserved populations.FundingThis research is not funded.
• Cherniak, W., Dreifuss, B., Evert, J., Dasco, M., Lin, H., & Loh, L. (2015, March). A Framework for Categorizing Short-Term Medical Experiences Abroad by Local Partnership Engagement Model. 6th Annual Consortium of Universities for Global Health Conference: Making the university a transforming force in global health through research, education, and service. Boston, MA: Consortium of Universities for Global Health.
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  Contemporary interest in in short-term experiences in global health (STEGH) has led to important questions of ethics, responsibility, and potential harms to receiving communities. In addressing these issues, the role of local engagement through partnerships between external STEGH facilitating organization(s) and internal community organization(s) has been identified as crucial to mitigating potential pitfalls. This perspective piece offers a framework to categorize different models of local engagement in STEGH based on professional experiences and a review of the existing literature. This framework will encourage STEGH stakeholders to consider partnership models in the development and evaluation of new or existing programs.The proposed framework examines the community context in which STEGH may occur, and considers three broad categories: number of visiting external groups conducting STEGH (single/multiple), number of host entities that interact with the STEGH (none/single/multiple), and frequency of STEGH (continuous/intermittent). These factors culminate in a specific model that provides a description of opportunities and challenges presented by each model. Considering different models, single visiting partners, working without a local partner on an intermittent (or even one-time) basis provided the greatest flexibility to the STEGH participants, but represented the least integration locally and subsequently the greatest potential harm for the receiving community. Other models, such as multiple visiting teams continuously working with a single local partner, provided an opportunity for centralization of efforts and local input, but required investment in consensus-building and streamlining of processes across different groups. We conclude that involving host partners in the design, implementation, and evaluation of STEGH requires more efforton the part of visiting STEGH groups and facilitators, but has the greatest potential benefit for meaningful, locally relevant improvements from STEGH for the receiving community. There are four key themes that underpin the application of the framework:1. Meaningful impact to host communities requires some form of local engagement and measurement2. Single STEGH without local partner engagement is rarely ethically justified3. Models should be tailored to the health and resource context in which the STEGH occurs4. Sending institutions should employ a model that ultimately benefits local receiving communities first and STEGH participants second.Accounting for these themes in program planning for STEGH will lead to more equitable outcomes for both receiving communities and their sending partners.
• Dreifuss, B. (2015, March). 72hr Patient Follow-Up as a Metric for Measuring Outcomes and Quality of Emergency Care Provided in Resource-Limited Settings: an outcomes study from a rural Ugandan district hospital’s Emergency Department. 6th Annual Consortium of Universities for Global Health Conference: Making the university a transforming force in global health through research, education, and service. Boston, Massachusetts: Consortium of Universities for Global Health.
• Dreifuss, B., Cappa, A., & Stoneking, L. (2015, August). Preparing Emergency Physicians for a Rural (resource-limited) Practice Environment: BUMC-South Campus Emergency Medicine’s Curriculum for Rural, Border, and Global Health;. 42nd Annual Arizona Rural Health Conference. Sedona, Arizona: Arizona Center for Global Health.
• Dreifuss, B., Cappa, A., Fatas, J., & Stoneking, L. (2015, August). A Model for Integrating Medical Spanish into Healthcare Provider Training: BUMC-South Campus Emergency Medicine’s Curriculum for Medical Spanish. 42nd Annual Arizona Rural Health Conference. Sedona, Arizona: Arizona Center for Rural Health.
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  A Model for Integrating Medical Spanish into Healthcare Provider Training: BUMC-South Campus Emergency Medicine’s Curriculum for Medical Spanish; Poster and Oral Presentation for the 42nd Annual Arizona Rural Health Conference, August 4th, 2015.
• Dressler, C., Dreifuss, B., Periyanayagam, U., Luyimbaazi, J., Wangoda, R., & Bisanzo, M. (2015, September). Management of Acute Surgical Patients by Non-Physician Emergency Care Practitioners in Rural Uganda. Global Partners in Anesthesia and Surgery (GPAS) 2015 Global Surgery Conference. Entebbe, Uganda: Global Partners in Anesthesia and Surgery.
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  Sub-Saharan Africa faces a large, unmet burden of acute surgical illness and injury. Low numbers of surgeons, concentration of surgeons in urban areas, and inefficient utilization of personnel contribute to this treatment gap. The existing acute surgical care model does not make the best possible use of scarce surgical providers and therefore does not maximize the capability for rapid diagnosis and treatment of acute surgical patients. While the majority of acute surgical illnesses can be treated with minor procedures, critically ill patients require prompt identification, resuscitation, and skilled operative care. Provision of non-operative emergency care by emergency care trained clinicians is a practical mechanism for improving delivery of acute surgical care. Given low numbers of physicians in most sub-Saharan African countries, a system utilizing both physician and non-physician emergency care providers to definitively treat patients with minor surgical illnesses and rapidly identify and resuscitate patients who require an operation in theatre will increase access to care and maximize the effectiveness of surgeons by allowing them to focus on operative care. Such a system may provide secondary benefits to quality of life and retention of surgeons, especially in rural areas.

Reviews

• Dreifuss, B., Ohlson, E., & Saleh, A. (2016. Emergency Medicine: A Health System Strengthening & Public Health Intervention.
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  This is a review of the literature from the perspective of Emergency Medicine fitting well into an established model for articulating the functions of Public Health. Reframing EM onto an accepted model will make it easier to articulate EM development as truly health system strengthening.
• Dreifuss, B., Pickering, A., Dunleavy, J., Howe, C., Nichter, M., & Hammerstedt, H. (2016. Barriers to Emergency Care in Uganda and Bordering Countries, A systematic Review.
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  Program/Project PurposeIn Africa, capacity development resulted in significant improvements in health indicators. Timely emergency care (EC) has potential to further these gains. Estimates project that EC can prevent 41% of deaths and 39% of disability in sub-Saharan Africa1. Impact however, is contingent on widespread access and utilization. Karoli Lwanga Hospital, in rural southwest Uganda, operates an Emergency Department in collaboration with an NGO, Global Emergency Care Collaborative. Despite high-quality care patients often delay presenting to EC, potentially missing the opportunity for reduction of preventable morbidity and mortality. Understanding of sociocultural barriers to EC is needed to foster appropriate utilization as services increase.Structure/Method/DesignA narrative literature review was performed. PubMed, Scopus and Goggle Scholar were searched with keywords of: Barriers, Emergency Care and Uganda. Studies related to accessing healthcare in rural Uganda and bordering countries were included if ED care was specifically addressed. The citations used in the resulting studies were also reviewed.Outcome & EvaluationKnowledge of barriers to EC is limited, as literature specific to rural Uganda focuses on obstetric and pediatric emergencies, making generalizations imperfect. However, this review suggests that cost and transportation are not the sole barriers. Barriers may be more complex, relating to: healthcare decision-making, perceptions of quality and traditional culture and beliefs. It is noted that many patients die before reaching care at the facility level. Going Forward Multiple methods will be utilized to gain perspectives from the community on barriers to optimal emergency care access. • Case studies: Cases that present to the ED late in the course of illness will be utilized to understand aspect such as recognition of symptoms and severity, first aid administered and deliberations of the patient or caregivers.• Focus Groups: Emergency scenarios will be utilized to explore the course of action that would be taken by community members. • Community Survey: Hypothesis will be drawn from the qualitative data and tested with a quantitative survey implemented in locations frequented by a wide cross-section of the community.This program has potential to increase understanding of sociocultural factors impacting EC seeking, inform EC systems implementation and foster understanding of similar underserved populations.

Creative Productions

• Dreifuss, B., Sandweiss, S., & Hung, C. (2015. Global Emergency Care: Who we are and what we do. Documentary/video production. Uganda, South Africa: Global Emergency Care and Love a Community with Sam Sandweiss/Craig Hung. https://youtu.be/_OpT5_i31HM
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  I serve in the role of an Executive Producer, coordinating the storyline, interviewees and logistics for production of a collaborative video project that will result in a promotional video for GEC and stakeholder organizations.This is a promotional video that highlights GEC's work to expand capacity for Emergency Care education and service delivery in Uganda, in collaboration with and at direction of our Ugandan stakeholders in the Ministry of Health and institutions of higher learning. This production developed as a result of a conversation about collaboration between Global Emergency Care and Love a Community, that will ideally lead to expansion of GEC's programming to a hospital that Love a Community works with in Eastern Uganda.

Other Teaching Materials

• Jones, D., Roy, A., Tillis, C., Welty, C., Dreifuss, H., & Dreifuss, B. (2021. HCW HOSTED - An Advocacy Guide- Promoting Mental Health Among Healthcare Workers During the COVID-19 Pandemic. HCW HOSTED and Mel and Enid Zuckerman College of Public Health.
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  This is an advocacy guide created with graduate students from the College of Public Health. It was created to be utilized by HCW HOSTED and partner organizations working on advocacy at the local community, hospital system, and governmental levels. Prepared by: Desiree Jones, Alexa Roy, Caitlin Tillis, and Cody Welty, University of Arizona, Mel and Enid Zuckerman College of Public HealthEffort mentored by:Heather Dreifuss, DrPH, MPH, MATBradley Dreifuss, MD FACEP, AAEM Executive Summary:Healthcare workers are an at-risk population for mental health crises, such as depression, anxiety, PTSD, and suicide. Current hospital emergency operation plans (EOPs) do not adequately address mental health needs of healthcare workers. Using Kingdon’s policy streams, we outlined an open policy window where this issue can be addressed. Our public health goal is to improve healthcare workers access to mental health services during disaster response. Our overall advocacy goal is to ask Arizona Hospitals to update their Emergency Operation Plan to add a component to address mental health for healthcare workers during disasters, such as the COVID-19 pandemic. Framing for this issue will be crucial to secure support and buy in from hospital administrators, HCWs, and HCW advocacy organizations across the state. This group anticipates that our strongest allies will be healthcare worker advocacy organizations, healthcare workers, and the general public. We anticipate the strongest opponents to be the hospital administration because if they choose to adopt our recommendations, they will have to allocate this plan into their budget, and this may not be seen as a high priority for hospitals. Our Advocacy Plan includes strategies, tactics, and tools that aim to support in advocacy efforts on our policy recommendation.

Others

• Dreifuss, B. A., & Pickering, A. (2020, September). Assessment! of Perceived Barriers to Emergency Care Utilization in Rural Uganda. Research currently in progress.
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  This project is currently IRB approved at University of Arizona and Uganda's The Aids Support Organization (TASO) with UNCST's provisional approval. See the project description below. 1) BackgroundPrimary medical care has resulted in immense health gains in Africa. While preventing emergencies through effective healthcare systems remains the goal, the reality is clear. Timely, cost-effective, emergency medical care can prevent needless death and disability. It has been estimated that introducing emergency medical care has the potential to prevent up to 41% of deaths and 39% of disability in sub-Saharan Africa. However, this impact is contingent on high utilization, which poses a challenge, especially as new emergency medical care facilities are implemented in low resource settings, such as rural Uganda. Uganda is in desperate need of timely, effective emergency medical care (EMC) to alleviate needless death and disability. Despite limited resources Uganda’s government, its hospitals and physicians are working toward building capacity to meet this need, but realize that once made available EMC will be under-utilized if perceived cultural and/or socioeconomic barriers are seen as insurmountable. Emergency departments (ED) are becoming increasingly available and more healthcare providers are receiving training in EMC. The availability of EDs and qualified providers however, does not ensure their use; a comprehensive EMC system spans care in the community, emergency transport, and emergency medical care upon arrival at the facility. For a EMC system to be effective communities must be educated in how and when to access emergency services, emergency transport is needed, triage must be facilitated and individuals must have confidence in the quality of care at all points in the system. Barriers at any point in this continuum can lead to preventable mortality, suffering, and disability. Scholarly knowledge of the barriers facing rural Ugandans seeking emergency care is currently inadequate, as the limited literature available focuses only narrowly on obstetric and pediatric emergencies, making generalizations to the broad spectrum of clinical emergencies impossible. However, the existing literature suggests that cost and transportation are not the sole barriers to ED utilization. It’s suggested that perceived barriers may be more nuanced, relating to: healthcare decision-making, perceptions of care quality available as well as traditional culture and beliefs. The literature reveals that recognition of conditions amenable to ED care and delays attributed to gathering borrowed or personal assets, to fund care may impact healthcare decision-making. Additionally, husbands and mothers-in-law are found to be the primary healthcare decisions makers, as well as in control of finances. The literature also references perceptions of the quality of care such as lack of staffing, supplies and medications, long waits and crowding, and marginalized healthcare environments, as having significant impact in EMC utilization. Lastly, traditional cultural and beliefs, including traditional birth practices emphasizing independence and intergenerational conflict regarding the use of biomedical care verses traditional healers, impact EMC utilization. Currently, the existing literature does not provide the breath or depth, of information required to implement sustainable interventions to increase EMC utilization. 2) PurposeTo discern community perceptions, beliefs or other factors that might decrease likelihood of utilization of available emergency care services by the population living in rural Rukungiri District, Uganda. Understanding these perceptions will allow for development of targeted interventions to increase accessibility and utilization of these services. 3) Lay Summary (approximately 400 words)Karoli Lwanga Hospital provides much of the healthcare in the Rukungiri district, which is 250 miles southwest of Kampala, in rural Uganda. In 2008 Global Emergency Care Collaborative (GECC), a 501c3 non-profit organization, partnered with Karoli Hospital to open an Emergency Department (ED) and Mid-Level Emergency Care Practitioner (ECP) training program, to provide sustainable staffing for the ED. There was not an ED in, or assessable to, the Rukungiri district prior. “Nyakibale” Hospital ED provides effective EMC, utilizing qualified ECPs to overcome delays related to shortage of physicians and keeping patients with emergent needs from being placed directly on overburdened nursing wards. GECC was founded to meet the pressing need for timely emergency care services in Uganda, thorough workforce training and development. However, despite the ED providing high quality and timely lifesaving interventions, these services remain underutilized. Therefore, high rates of preventable morbidity and mortality persist. Review of cases arriving at the ED indicates that patients typically arrive late in the course of illness. Furthermore, community members anecdotally report that many victims in emergency situations never utilize the ED. Both scenarios suggest barriers to ED utilization in the Rukungiri community. In 2014/15 GECC preformed a large sample size quantitative survey of ED patients on the barriers to seeking care at in emergency situations. While GECC is in the process of publishing these results, it is clear that a continuation of the project is needed in order to collect narratives from ED patients and to understand barriers to care seeking as articulated by community members who don’t make their way to the ED. Utilization of qualitative methods, including case studies, key informant interviews and community focus groups, will allow for a more in-depth understanding of the complex decision making process and experiences of patients prior to arrival at the ED. Community focus groups will also allow the barriers of those who are unable to utilize the ED in the case of emergency to be elicited. The information that will be obtained is necessary to empower use of locally developed sustainable interventions to reduced perceived barriers to seeking EMC, thereby decreasing preventable death and disability from conditions amenable to EMC treatment through available ED services. Although the results will not be generalizable to all populations, due to dependence on local rural context, they will be recorded and documented in an effort to foster further efforts to understand and reduce barriers utilization of available ED services. 4) Setting of the Human ResearchPart A: Emergency Department Case StudiesThe Karoli Lwanga Hospital, Rukungiri District, Uganda, will be the site of all ED case study interviews with patients and caregivers. Part B: Community Focus Groups and Key Informant InterviewsFocus groups and interviews will take place throughout the Rukungiri District of Uganda and will be held in sociocultural neutral, public places such as, but not limited to, churches, schools and village meeting places.
• Pattavina, C. F., McNamara, R. M., & Dreifuss, B. A. (2022, September). ACEP 2022 Council Resolution 12: Council Approval of Board Actions on Referred Resolutions. American College of Emergency Medicine Council.
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  Purpose: Seeks to amend the Bylaws to: 1) require a report on each resolution referred to the Board will become a matter of business at the subsequent Council meeting; 2) the report will include a summary of the Board’s discussion and their recommendations regarding the referred resolution; and 3) the Board’s recommendations on referred resolutions will be subject to approval by the Council.Council Action: Not Adopted
• Pattavina, C. F., McNamara, R. M., & Dreifuss, B. A. (2022, September). ACEP 2022 Council Resolution 18: Disclosure of Clinical Emergency Data Registry Revenue Sources. American College of Emergency Medicine Council.
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  Purpose: 1) Requests ACEP to provide information on the sources and amount of revenue for CEDR in the Treasurer’s Report to the Council.Council Action: Not Adopted
• Pattavina, C. F., McNamara, R. M., & Dreifuss, B. A. (2022, September). ACEP 2022 Council Resolution 19: Due Process and Interaction with ACEP . American College of Emergency Medicine Council.
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  Purpose: 1) adopt a new policy requiring any entity that wants to advertise, exhibit, or provide other sponsorship of any ACEP activity to remove all restrictions on or waivers of due process for emergency physicians; 2) create a method for members to report incidents of denial of due process, review member-submitted contractual clauses or other methods of denying such that are of concern, and to investigate the matter allowing the entity an opportunity to respond or modify its policy prior to exclusion for violation of this policy.Council Action: Amended and Adopted (1st "resolved" deleted , 2nd "resolved" amended and adopted)Board Action: Adopted
• Pattavina, C. F., McNamara, R. M., & Dreifuss, B. A. (2022, September). ACEP 2022 Council Resolution 21: Financial Support of Litigation Involving the Corporate Practice of Medicine in California. American College of Emergency Medicine Council.
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  Purpose: 1) Requests ACEP to donate $1 million from members’ equity to the American Academy of Emergency Medicine Foundation to support the American Academy of Emergency Medicine – Physician Group litigation versus Envision.Council Action: Not Adopted
• Pattavina, C. F., McNamara, R. M., & Dreifuss, B. A. (2022, September). ACEP 2022 Council Resolution 28: Billing and Collections Transparency and Interaction with ACEP. American College of Emergency Medicine Council.
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  Purpose: 1) Petition state or federal legislative and regulatory to require revenue cycle management entities to provide every emergency physician it bills or collects for with a detailed itemized statement of billing and remittances for medical services they provide on at least a monthly basis. 2) Adopt a new policy statement prohibiting any entity that fails to meet this standard from advertising, exhibiting, sponsoring, or otherwise being associated with ACEPCouncil Action: Not Reviewed
• Pattavina, C. F., McNamara, R. M., & Dreifuss, B. A. (2022, September). ACEP 2022 Council Resolution 56: Policy Statement on the Corporate Practice of Medicine. American College of Emergency Medicine Council.
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  Purpose: 1) Adopt a policy statement on the corporate practice of medicine based on the California Medical Board’s guidance.Council Action: Amended and AdoptedBoard Action: Adopted
• Girma, T. (2015, March). "Weak Healthcare Systems Cause Epidemics". Corporate Africa, Issue 61, Volume 2(888) "Partnerships for Prevention and Care".
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  I was interviewed for an article about the role of Emergency Care at the 2014 African Federation of Emergency Medicine Conference in Addis Ababa, Ethiopia and the development of Emergency Care in sub-Saharan Africa.Excerpt below:‘The Ebola outbreak has taken a severe toll on fragile healthcare systems and courageous healthcare workers, many of whom were exposed o very high risk of infection and death. More than 240 have succumbed to the virus. They are what Dr. Bradley Dreifuss, Assistant Professor of Emergency Medicine and the University of Arizona, calls “the second burden of disease”.Hysteria surrounding Ebola, has lead to absences of healthcare works causing patients with other urgent care needs to go untreated, creating a second burden of disease. “Under-five-year-old mortality from malaria is going through the roof right now because there is no one willing to treat them because of fears over Ebola,” said Dr. Dreifuss.The current Ebola outbreak seems to have two effects on the healthcare situation. On one hand, the outbreak has diverted attention from other acute care needs with high mortality rates such as malaria and respiratory conditions. On the other hand, it has highlighted the need to put robust healthcare systems in regions likely to experience future outbreaks into place at an early stage through effective surveillance systems. It has to put emergency care on the agenda, offering a real opportunity to do things well, to invest well, train people well, and acquire good infrastructure and appropriate systems.’