Terence D Valenzuela
- Professor, Emergency Medicine
My education, specialization in emergency medicine, experience in the medical direction of emergency medical services, and track record in research on out-of -hospital cardiac arrest spans 30 years. My work in out-of-hospital cardiac arrest (OOHCA) contributed to several milestones such as the importance of rigorous case definition of OOHCA and the relationship between collapse to CPR and collapse to defibrillation intervals as major determinants of outcome. My demonstration that first responders with minimal medical training (basic CPR and orientation to automated external defibrillators [AEDs]) can dramatically increase survival to hospital discharge led to subsequent attempts to enlist lay responders in the use of AEDs. Subsequently, I also investigated the characteristics of manual chest compressions in the field and their effect on survival after OOHCA. Most important is my experience as Medical Director of a municipal fire department, 90% of whose calls are medical in nature and not related to fires. My responsibilities consist of recommending prudent medical practice to fire department paramedics and EMTs and quality assurance in areas including the specifics of resuscitating OOHCA in the field. My education includes a Master of Public Health degree with emphasis on epidemiology that informs my work in the consideration of OOHCA as a public health problem and disparities in access to emergency prehospital care experienced, in particular, by Hispanics. Recently, I started investigating prehospital cooling after cardiac arrest and other prehospital interventions
- MPH Public health
- University of Arizona, Tucson, Arizona, United States
- M.D. Medicine
- University of California San Francisco, San Francisco, California, United States
- Other Biochemistry
- Oxford University, Oxford, oxfordshire, United Kingdom
- B.A. Biology
- Harvard University, Cambridge, Massachusetts, United States
- University of Arizona, Tucson, Arizona (1997 - Ongoing)
- University of Arizona, Tucson, Arizona (1991 - 1997)
- College of Medicine University of Arizona (1985 - 2020)
- University of Arizona, Tucson, Arizona (1985 - 1991)
- University Of Washington (1983 - 1985)
- Health Services Research Institute AAMC, Spring 1993
- American College of Physicians, Spring 1990
- American College of Emergency Physicians, Spring 1989
- American Board of Emergency Medicine, Spring 1989
- American Board of Internal Medicine, Spring 1983
- Regent's Scholar
- University of California San Francisco, Spring 1980
- Rhodes Scholar
- Oxford University, Spring 1976
- Magna Cum Laude
- Harvard College, Spring 1973
- Recognition as 1st medical director for Tucson Fire Department. Length of Service 34 years
- City of Tucson Fire Department, Spring 2019
- Ultrasound of the Month Golden Probe
- Ultrasound sectionDepartment of Emergency MedicineCollege of MedicineUniversity of Arizona, Winter 2018
- Visiting Professor, University of Washington
- Medic One Foundation, Spring 2012
- Harborview Medical Center, Spring 2006
- Michael K Copass Excellence in EMS Award
- Spring 2011
- Journal of Emergency Medical Services, Spring 2006
Licensure & Certification
- Medical License, Arizona Board of Medicine (1985)
- Fellow, American College of Internal Medicine (1987)
- Diplomate, American Board of Emergency Medicine (1987)
- Fellow, American College of Emergency Medicine (1989)
- Diplomate, American Board of Internal Medicine (1985)
Emergency MedicineEmergency Medical System Design and DirectionCognitive processes of decision making in emergency medicineHistory of Out-of-hospital emergency medical care
Prehospital CareEmergency Medical ServicesOut-of-Hospital Cardiac ArrestResuscitation MedicalRegulatory and Political Environment of EMS
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- Bartlett, E., Valenzuela, T., Idris, A., Deye, N., Glover, G., Gillies, M., Taccone, F. S., Sunde, K., Flint, A., Thiele, H., Arrich, J., Hemphill, C., Holzer, M., Skrifvars, M. B., Pittl, U., Polderman, K., Ong, M. E., Kim, K. H., Oh, S. H., , Shin, S., et al. (2019). Systematic Review and Meta-Analysis of INTRAvascular Temperature Management versus Surface Cooling in COMATose Patients Resuscitated from Cardiac Arrest. Resuscitation.More infoTo systematically review the effectiveness and safety of intravascular temperature management (IVTM) versus surface cooling methods (SCM) for induced hypothermia (IH).
- Valenzuela, T. D. (2019). Symptomatic Review and Meta-Analysis Intravascular Temperature Management Vs. Surface Cooling In Comatose Patients Resuscitated from Cardiac Arrest. Resuscitation, 146(1), 82-95. doi:10.1016/j
- Elrod, J. B., Merchant, R., Daya, M., Youngquist, S., Salcido, D., Valenzuela, T. D., & Nichol, G. (2017). Public healPublic health surveillance of automated external defibrillators in the USA: protocol for the dynamic automated external defibrillator registry study. BMJ Open., e014902. doi:10.1136/bmjopen-2016-014902.
- Elrod, J. B., Merchant, R., Daya, M., Youngquist, S., Salcido, D., Valenzuela, T., & Nichol, G. (2017). Public health surveillance of automated external defibrillators in the USA: protocol for the dynamic automated external defibrillator registry study. BMJ open, 7(3), e014902.More infoLay use of automated external defibrillators (AEDs) before the arrival of emergency medical services (EMS) providers on scene increases survival after out-of-hospital cardiac arrest (OHCA). AEDs have been placed in public locations may be not ready for use when needed. We describe a protocol for AED surveillance that tracks these devices through time and space to improve public health, and survival as well as facilitate research.
- Valenzuela, T. D., Harrell, A. J., & Nichol, G. (2017). Improving Outcomes After Out-of-Hospital Cardiac Arrest.. JAMA Cardiol, 2(11), 1183-1184. doi:doi: 10.1001/jamacardio.2017.3472
- Valenzuela, T., Harrell, A. J., & Nichol, G. (2017). Improving Outcomes After Out-of-Hospital Cardiac Arrest. JAMA cardiology, 2(11), 1183-1184.
- Brice, J. H., Valenzuela, T., Ornato, J. P., Swor, R. A., Overton, J., Pirrallo, R. G., Dunford, J., Domeier, R. M., & , T. C. (2016). Optimal prehospital cardiovascular care. Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors, 5(1), 65-72.More infoOptimal prehospital cardiovascular care may improve the morbidity and mortality associated with acute myocardial infarctions (AMIs) that begin in the community. Reducing the time delays from AMI symptom onset to intervention begins with maximizing effective patient education to reduce patient delay in recognizing symptoms and seeking assistance. Transportation delays can be minimized by appropriate use of 911 systems and improving technological 911 support. Patient triage to heart centers from the prehospital setting requires strict and comprehensive definition of the criteria for these centers by competent, unbiased clinical societies or governmental agencies. Prehospital 12-lead electrocardiograms and initiation of thrombolytic therapy can provide acute diagnosis and early treatment, thus facilitating faster processing and more directed in-hospital intervention. They also minimize over- and undertriage of patients to cardiac centers. Although evidence from investigational trials suggests that many of these procedures are effective, more research is required to ensure correct implementation and quality assurance at all emergency service levels.
- Mechem, C. C., Goodloe, J. M., Richmond, N. J., Kaufman, B. J., Pepe, P. E., & , U. M. (2016). Resuscitation center designation: recommendations for emergency medical services practices. Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors, 14(1), 51-61.More infoRegionalization of medical resources by designating specialty receiving centers, such as trauma and stroke centers, within emergency medical services (EMS) systems is intended to ensure the highest-quality patient care in the most efficient and fiscally responsible fashion. Significant advances in the past decade such as induction of therapeutic hypothermia following resuscitation from cardiac arrest and a time-driven, algorithmic approach to management of septic patients have created compelling arguments for similar designation for specialized resuscitative interventions. Resuscitation of critically ill patients is both labor- and resource-intensive. It can significantly interrupt emergency department (ED) patient throughput. In addition, clinical progress in developing resuscitation techniques is often dependent on the presence of a strong research infrastructure to generate and validate new therapies. It is not feasible for many hospitals to make the commitment to care for large numbers of critically ill patients and the accompanying investigational activities, whether in the prehospital, ED, or inpatient arena. Because of this, the question of whether EMS systems should designate specific hospitals as "resuscitation centers" has now come center stage. Just as EMS systems currently delineate criteria and monitor compliance for trauma, ST-elevation myocardial infarction (STEMI), and stroke centers, strong logic now exists to develop similar standards for resuscitation facilities. Accordingly, this discussion reviews the current applicable trends in resuscitation science and presents a rationale for resuscitation center designation within EMS systems. Potential barriers to the establishment of such centers are discussed and strategies to overcome them are proposed.
- Meislin, H. W., Spaite, D. W., Conroy, C., Detwiler, M., & Valenzuela, T. D. (2016). Development of an electronic emergency medical services patient care record. Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors, 3(1), 54-9.More infoThe need for valid and reliable emergency medical services (EMS) data has long been recognized. EMS data are useful for monitoring resources and operations, documenting patient care and outcome, and evaluating injury prevention strategies. The goal of this project was to develop a computerized data set with the capability to generate a patient care record (PCR) to overcome some of the current EMS data limitations.
- Myers, J. B., Slovis, C. M., Eckstein, M., Goodloe, J. M., Isaacs, S. M., Loflin, J. R., Mechem, C. C., Richmond, N. J., Pepe, P. E., & , U. M. (2016). Evidence-based performance measures for emergency medical services systems: a model for expanded EMS benchmarking. Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors, 12(2), 141-51.More infoThere are few evidence-based measures of emergency medical services (EMS) system performance. In many jurisdictions, response-time intervals for advanced life support units and resuscitation rates for victims of cardiac arrest are the primary measures of EMS system performance. The association of the former with patient outcomes is not supported explicitly by the medical literature, while the latter focuses on a very small proportion of the EMS patient population and thus does not represent a sufficiently broad selection of patients. While these metrics have their place in performance measurement, a more robust method to measure and benchmark EMS performance is needed. The 2007 U.S. Metropolitan Municipalities' EMS Medical Directors' Consortium has developed the following model that encompasses a broader range of clinical situations, including myocardial infarction, pulmonary edema, bronchospasm, status epilepticus, and trauma. Where possible, the benefit conferred by EMS interventions is presented in the number needed to treat format. It is hoped that utilization of this model will serve to improve EMS system design and deployment strategies while enhancing the benchmarking and sharing of best practices among EMS systems.
- Nichol, G., Brown, S. P., Perkins, G. D., Kim, F., Sterz, F., Elrod, J. A., Mentzelopoulos, S., Lyon, R., Arabi, Y., Castren, M., Larsen, P., Valenzuela, T., Grasner, J., Youngquist, S., Khunkhlai, N., Wang, H., Ondrej, F., Sastrias, J. M., Barasa, A., & Sayre, M. (2016). What change in outcomes after cardiac arrest is necessary to change practice? Results of an international survey. Resuscitation.More infoEfficient trials of interventions for patients with out-of-hospital cardiac arrest (OHCA) should have adequate but not excess power to detect a difference in outcomes. The minimum clinically important difference (MCID) is the threshold value in outcomes observed in a trial at which providers should choose to adopt a treatment. There has been limited assessment of MCID for outcomes after OHCA. Therefore, we conducted an international survey of individuals interested in cardiac resuscitation to define the MCID for a range of outcomes after OHCA.
- Spaite, D. W., Conroy, C., Tibbitts, M., Karriker, K. J., Seng, M., Battaglia, N., Criss, E. A., Valenzuela, T. D., & Meislin, H. W. (2016). Use of emergency medical services by children with special health care needs. Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors, 4(1), 19-23.More infoThis study describes emergency medical services (EMS) responses for children with special health care needs (CSHCN) in an urban area over a one-year period.
- Walter, F. G., Bates, G., Criss, E. A., Bey, T., Spaite, D. W., & Valenzuela, T. (2016). Hazardous materials responses in a mid-sized metropolitan area. Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors, 7(2), 214-8.More infoTo determine the chemicals involved in fire department hazardous materials (hazmat) responses and analyze the concomitant emergency medical services' patient care needs.
- Mosier, J. M., Joshi, R., Hypes, C., Pacheco, G., Valenzuela, T., & Sakles, J. C. (2015). The Physiologically Difficult Airway. The western journal of emergency medicine, 16(7), 1109-17.More infoAirway management in critically ill patients involves the identification and management of the potentially difficult airway in order to avoid untoward complications. This focus on difficult airway management has traditionally referred to identifying anatomic characteristics of the patient that make either visualizing the glottic opening or placement of the tracheal tube through the vocal cords difficult. This paper will describe the physiologically difficult airway, in which physiologic derangements of the patient increase the risk of cardiovascular collapse from airway management. The four physiologically difficult airways described include hypoxemia, hypotension, severe metabolic acidosis, and right ventricular failure. The emergency physician should account for these physiologic derangements with airway management in critically ill patients regardless of the predicted anatomic difficulty of the intubation.
- Mosier, J. M., Mosier, J. M., Mosier, J. M., Joshi, R., Joshi, R., Joshi, R., Hypes, C., Hypes, C., Hypes, C., Pacheco, G. S., Pacheco, G. S., Pacheco, G. S., Valenzuela, T. D., Valenzuela, T. D., Valenzuela, T. D., Sakles, J. C., Sakles, J. C., & Sakles, J. C. (2015). The Physiologically Difficult Airway. Western Journal of Emergency Medicine, 16(7), 1109-1117.
- Stocchetti, N., Taccone, F. S., Citerio, G., Pepe, P. E., Le Roux, P. D., Oddo, M., Polderman, K. H., Stevens, R. D., Barsan, W., Maas, A. I., Meyfroidt, G., Bell, M. J., Silbergleit, R., Vespa, P. M., Faden, A. I., Helbok, R., Tisherman, S., Zanier, E. R., Valenzuela, T., , Wendon, J., et al. (2015). Neuroprotection in acute brain injury: an up-to-date review. Critical care (London, England), 19, 186.More infoNeuroprotective strategies that limit secondary tissue loss and/or improve functional outcomes have been identified in multiple animal models of ischemic, hemorrhagic, traumatic and nontraumatic cerebral lesions. However, use of these potential interventions in human randomized controlled studies has generally given disappointing results. In this paper, we summarize the current status in terms of neuroprotective strategies, both in the immediate and later stages of acute brain injury in adults. We also review potential new strategies and highlight areas for future research.
- Valenzuela, T. (2014). A cuff & a clock. JEMS : a journal of emergency medical services, 39(6), 44-9.More infoIschemic conditioning is a unique physiologic process that has shown potential for reducing the size of MI in animal studies for more than twenty years. Early human trials have been inconclusive. However, one clinical trial is in progress that is well designed and will enroll enough subjects to potentially demonstrate significant reductions in mortality and hospitalization for congestive heart failure in STEMI patients who receive RIC in the field. Certainly, the simplicity, low cost and safety of ischemic conditioning merit continued clinical study in humans.
- Valenzuela, T., Mosier, J., & Sakles, J. (2013). Tunnel vision. JEMS : a journal of emergency medical services, 38(1), 32-4, 36-7.More infoSince 2000, many studies of advanced emergency airway management have appeared in the medical literature. Although most described patients in the operating room, intensive care unit or emergency department, studies of video laryngoscopy in the field are in progress and beginning to appear in the literature. Video laryngoscopy provides better views of the glottis, and it permits more successful intubations with fewer attempts. Price reductions as more devices, some specifically intended for EMS, enter the market will lower the entry costs for adoption. It is my prediction that in five years, video laryngoscopy will be the method of choice for endotracheal intubation in the field.
- Sakles, J. C., Mosier, J., Hadeed, G., Hudson, M., Valenzuela, T., & Latifi, R. (2011). Telemedicine and telepresence for prehospital and remote hospital tracheal intubation using a GlideScope™ videolaryngoscope: a model for tele-intubation. Telemedicine journal and e-health : the official journal of the American Telemedicine Association, 17(3), 185-8.More infoThe inability to secure a patient's airway in the prehospital setting is a major cause of potentially preventable death in the field of trauma and emergency medicine.
- Latifi, R., Weinstein, R. S., Porter, J. M., Ziemba, M., Judkins, D., Ridings, D., Nassi, R., Valenzuela, T., Holcomb, M., & Leyva, F. (2007). Telemedicine and telepresence for trauma and emergency care management. Scandinavian journal of surgery : SJS : official organ for the Finnish Surgical Society and the Scandinavian Surgical Society, 96(4), 281-9.More infoThe use of telemedicine is long-standing, but only in recent years has it been applied to the specialities of trauma, emergency care, and surgery. Despite being relatively new, the concept of teletrauma, telepresence, and telesurgery is evolving and is being integrated into modern care of trauma and surgical patients. This paper will address the current applications of telemedicine and telepresence to trauma and emergency care as the new frontiers of telemedicine application. The University Medical Center and the Arizona Telemedicine Program (ATP) in Tucson, Arizona have two functional teletrauma and emergency telemedicine programs and one ad-hoc program, the mobile telemedicine program. The Southern Arizona Telemedicine and Telepresence (SATT) program is an inter-hospital telemedicine program, while the Tucson ER-link is a link between prehospital and emergency room system, and both are built upon a successful existing award winning ATP and the technical infrastructure of the city of Tucson. These two programs represent examples of integrated and collaborative community approaches to solving the lack of trauma and emergency care issue in the region. These networks will not only be used by trauma, but also by all other medical disciplines, and as such have become an example of innovation and dedication to trauma care. The first case of trauma managed over the telemedicine trauma program or "teletrauma" was that of an 18-month-old girl who was the only survival of a car crash with three fatalities. The success of this case and the pilot project of SATT that ensued led to the development of a regional teletrauma program serving close to 1.5 million people. The telepresence of the trauma surgeon, through teletrauma, has infused confidence among local doctors and communities and is being used to identify knowledge gaps of rural health care providers and the needs for instituting new outreach educational programs.
- Ewy, G. A., Kern, K. B., Sanders, A. B., Newburn, D., Valenzuela, T. D., Clark, L., Hilwig, R. W., Otto, C. W., Hayes, M. M., Martinez, P., & Berg, R. A. (2006). Cardiocerebral resuscitation for cardiac arrest. The American journal of medicine, 119(1), 6-9.More infoSurvival rates from out-of-hospital cardiac arrest continue to be low despite periodic updates in the Guidelines for Emergency Medical Services and periodic improvements such as the addition of automatic external defibrillators (AEDs). The low incidence of bystander cardiopulmonary resuscitation (CPR), substantial time without chest compressions throughout the resuscitation effort, and a lack of response to initial defibrillation after prolonged ventricular fibrillation contribute to these unacceptably poor results. Resuscitation guidelines are only revised every 5 to 7 years and can be difficult to change because of the lack of randomized controlled trials in humans. Such trials are rare because of a number of logistical difficulties, including the problem of obtaining informed consent. An alternative approach to advancing resuscitation science is for evidence-based demonstration projects in areas that have adequate records, so that one may determine whether the new approach improves survival. This is reasonable because the current guidelines make provisions for deviations under certain local circumstances or as directed by the emergency medical services medical director. A wealth of experimental evidence indicates that interruption of chest compressions for any reason in patients with cardiac arrest is deleterious. Accordingly, a new approach to out-of-hospital cardiac arrest called cardiocerebral resuscitation (CCR) was developed that places more emphasis on chest compressions for witnessed cardiac arrest in adults and de-emphasizes ventilation. There is also emphasis on chest compressions before defibrillation in circulatory phase of cardiac arrest. CCR was initiated in Tucson, Arizona, in November 2003, and in two rural Wisconsin counties in early 2004.
- Berg, M. D., Clark, L. L., Valenzuela, T. D., Kern, K. B., & Berg, R. A. (2005). Post-shock chest compression delays with automated external defibrillator use. Resuscitation, 64(3), 287-91.More infoIn a swine model of out-of-hospital ventricular fibrillation (VF) cardiac arrest, we established that automated external defibrillator (AED) defibrillation could worsen outcome from prolonged VF compared with manual defibrillation. Worse outcomes were due to substantial interruptions and delays in chest compressions for AED rhythm analyses and shock advice. In particular, the mean interval from first AED shock to first post-shock compressions was 46+/-6s. We hypothesized that the delay from shock to provision of chest compressions is similar in the out-of-hospital setting.
- Berg, M. D., Samson, R. A., Meyer, R. J., Clark, L. L., Valenzuela, T. D., & Berg, R. A. (2005). Pediatric defibrillation doses often fail to terminate prolonged out-of-hospital ventricular fibrillation in children. Resuscitation, 67(1), 63-7.More infoThe recommended dose for pediatric defibrillation is 2 J/kg, based on animal studies of brief duration ventricular fibrillation (VF) and a single pediatric study of short duration in-hospital VF. In a piglet model of out-of-hospital (prolonged) cardiac arrest, this recommended dose was usually ineffective at terminating VF. We, therefore, hypothesized that pediatric dose defibrillation may be less effective for prolonged out-of-hospital pediatric VF.
- Kern, K. B., Valenzuela, T. D., Clark, L. L., Berg, R. A., Hilwig, R. W., Berg, M. D., Otto, C. W., Newburn, D., & Ewy, G. A. (2005). An alternative approach to advancing resuscitation science. Resuscitation, 64(3), 261-8.More infoStagnant survival rates in out-of-hospital cardiac arrest remain a great impetus for advancing resuscitation science. International resuscitation guidelines, with all their advantages for standardizing resuscitation therapeutic protocols, can be difficult to change. A formalized evidence-based process has been adopted by the International Liason Committee on Resuscitation (ILCOR) in formulating such guidelines. Currently, randomized clinical trials are considered optimal evidence, and very few major changes in the Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care are made without such. An alternative approach is to allow externally controlled clinical trials more weight in Guideline formulation and resuscitation protocol adoption. In Tucson, Arizona (USA), the Fire Department cardiac arrest database has revealed a number of resuscitation issues. These include a poor bystander CPR rate, a lack of response to initial defibrillation after prolonged ventricular fibrillation, and substantial time without chest compressions during the resuscitation effort. A local change in our previous resuscitation protocols had been instituted based upon this historical database information.
- Valenzuela, T. D., Kern, K. B., Clark, L. L., Berg, R. A., Berg, M. D., Berg, D. D., Hilwig, R. W., Otto, C. W., Newburn, D., & Ewy, G. A. (2005). Interruptions of chest compressions during emergency medical systems resuscitation. Circulation, 112(9), 1259-65.More infoSurvival after nontraumatic out-of-hospital (OOH) cardiac arrest in Tucson, Arizona, has been flat at 6% (121/2177) for the decade 1992 to 2001. We hypothesized that interruptions of chest compressions occur commonly and for substantial periods during treatment of OOH cardiac arrest and could be contributing to the lack of improvement in resuscitation outcome.
- Nichol, G., Valenzuela, T., Roe, D., Clark, L., Huszti, E., & Wells, G. A. (2003). Cost effectiveness of defibrillation by targeted responders in public settings. Circulation, 108(6), 697-703.More infoOut-of-hospital cardiac arrest is frequent and has poor outcomes. Defibrillation by trained targeted nontraditional responders improves survival versus historical controls, but it is unclear whether such defibrillation is a good value for the money. Therefore, this study estimated the incremental cost effectiveness of defibrillation by targeted nontraditional responders in public settings by using decision analysis.
- Valenzuela, T. D. (2003). Priming the pump--can delaying defibrillation improve survival after sudden cardiac death?. JAMA, 289(11), 1434-6.
- Spaite, D. W., Bartholomeaux, F., Guisto, J., Lindberg, E., Hull, B., Eyherabide, A., Lanyon, S., Criss, E. A., Valenzuela, T. D., & Conroy, C. (2002). Rapid process redesign in a university-based emergency department: decreasing waiting time intervals and improving patient satisfaction. Annals of emergency medicine, 39(2), 168-77.More infoAcademic emergency departments are traditionally associated with inefficiency and long waits. The academic medical model presents unique barriers to system changes. Several non-university-based EDs have undertaken process redesign, with significant decreases in patient waiting time intervals. This is the presentation of a rapid process redesign in a university-based ED to reduce waiting time intervals. We present the application of a process-improvement team approach to evaluate and redesign patient flow. As a result of this effort, the median waiting room time interval (triage to patient room) decreased from 31 minutes in January 1998 to 4 minutes in July 1998. ED throughput times also decreased, from 4 hours, 21 minutes in January 1998 to 2 hours, 55 minutes in July 1998. Urgent care waiting room time intervals decreased from 52 minutes to 7 minutes and throughput times from 2 hours, 9 minutes to 1 hour, 10 minutes. Patient satisfaction evaluations by an independent institute demonstrated dramatic improvement and establishment of a new benchmark for academic EDs. Process redesign is possible in a busy, complex, tertiary-care ED, with decreases in waiting time intervals and improvement in patient satisfaction. Major sustained support from top-level hospital administrators and physician leadership are fundamental prerequisites. With these in place, a process improvement team approach for evaluating and redesigning the patient care system can be successful.
- Keim, S. M., Anderson, K., Siegel, E., Spaite, D. W., & Valenzuela, T. D. (2001). Factors associated with CPR certification within an elderly community. Resuscitation, 51(3), 269-74.More infoTo determine the frequency of CPR certification amongst residents living within a predominantly elderly community and examine the perceived barriers to learning basic CPR and factors associated with intent to become certified.
- Valenzuela, T. D., & Copass, M. K. (2001). Clinical research on out-of-hospital emergency care. The New England journal of medicine, 345(9), 689-90.
- Spaite, D. W., Karriker, K. J., Seng, M., Conroy, C., Battaglia, N., Tibbitts, M., Meislin, H. W., Salik, R. M., & Valenzuela, T. D. (2000). Increasing paramedics' comfort and knowledge about children with special health care needs. The American journal of emergency medicine, 18(7), 747-52.More infoThis study evaluated a continuing education program for paramedics about children with special health care needs (CSHCN). Pretraining, posttraining, and follow-up surveys containing two scales (comfort with CSHCN management skills and comfort with Pediatric Advanced Life Support [PALS] skills) were administered. Objective measures of knowledge were obtained from pre- and posttraining tests. Differences in average scores were assessed using t-tests. Response rates for paramedics completing the program ranged from 94% for the posttraining survey, 81% for the initial comfort survey, 56% for the knowledge pretest, and 56% for the follow-up survey. PALS comfort scores were significantly higher than CSHCN comfort scores both before and after training, both P < .01. Posttraining surveys showed an increase in CSHCN comfort, P < .01. The follow-up surveys showed a significant decline in CSHCN comfort, P = .05. Scores on the tests showed a similar pattern, with a significant increase in knowledge from pre- to posttraining (P = .02) and a significant decrease in knowledge from posttraining to follow-up (P < .01). Comfort was significantly higher for standard pediatric skills than for specialized management skills. Completion of the self-study program was associated with an increase in comfort and knowledge, but there was some decay over time.
- Valenzuela, T. D., Roe, D. J., Nichol, G., Clark, L. L., Spaite, D. W., & Hardman, R. G. (2000). Outcomes of rapid defibrillation by security officers after cardiac arrest in casinos. The New England journal of medicine, 343(17), 1206-9.More infoThe use of automated external defibrillators by persons other than paramedics and emergency medical technicians is advocated by the American Heart Association and other organizations. However, there are few data on the outcomes when the devices are used by nonmedical personnel for out-of-hospital cardiac arrest.
- Cairnes, C. B., Garrison, H. G., Hedges, J. R., Schriger, D. L., & Valenzuela, T. D. (1998). Development of new methods to assess the outcomes of emergency care. Annals of emergency medicine, 31(2), 166-71.More infoThis article provides information supporting the need for new outcome measures in emergency care. It also addresses the use of outcome measures in emergency care, the impact of emergency care, identification of at-risk groups, new approaches to measuring patient satisfaction, quality of life and cost-effectiveness, and the unique related implications for emergency medicine.
- Cairns, C. B., Garrison, H. G., Hedges, J. R., Schriger, D. L., & Valenzuela, T. D. (1998). Development of new methods to assess the outcomes of emergency care. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine, 5(2), 157-61.More infoThis article provides information supporting the need for new outcome measures in emergency care. It also addresses the use of these measures in emergency care, the impact of emergency care, identification of at-risk groups, new approaches to measuring patient satisfaction, quality of life, and cost-effectiveness, and the related unique implications for emergency medicine.
- Cummins, R. O., Hazinski, M. F., Kerber, R. E., Kudenchuk, P., Becker, L., Nichol, G., Malanga, B., Aufderheide, T. P., Stapleton, E. M., Kern, K., Ornato, J. P., Sanders, A., Valenzuela, T., & Eisenberg, M. (1998). Low-energy biphasic waveform defibrillation: evidence-based review applied to emergency cardiovascular care guidelines: a statement for healthcare professionals from the American Heart Association Committee on Emergency Cardiovascular Care and the Subcommittees on Basic Life Support, Advanced Cardiac Life Support, and Pediatric Resuscitation. Circulation, 97(16), 1654-67.
- Nichol, G., Hallstrom, A. P., Ornato, J. P., Riegel, B., Stiell, I. G., Valenzuela, T., Wells, G. A., White, R. D., & Weisfeldt, M. L. (1998). Potential cost-effectiveness of public access defibrillation in the United States. Circulation, 97(13), 1315-20.More infoApproximately 360,000 Americans experience sudden cardiac arrest each year; current treatments are expensive and not very effective. Public access defibrillation (PAD) is a novel treatment for out-of-hospital sudden cardiac arrest that refers to use of automated external defibrillators by the lay public or by nonmedical personnel such as police. A clinical trial has been proposed to evaluate the effectiveness of public access defibrillation, but it is unclear whether such early defibrillation will offer sufficient value for money. Our objective was to estimate the potential cost-effectiveness of public access defibrillation by use of decision analysis.
- Spaite, D. W., Criss, E. A., Valenzuela, T. D., & Meislin, H. W. (1998). Prehospital advanced life support for major trauma: critical need for clinical trials. Annals of emergency medicine, 32(4), 480-9.More infoA widely diverse body of information exists on the use of Advanced Life Support procedures by prehospital personnel. We compared and contrasted the literature that currently exists on this topic. We examined methodologies, results, and conclusions for each article. We also stress the need for critical clinical evaluations in this arena.
- Farris, C., Spaite, D. W., Criss, E. A., Valenzuela, T. D., & Meislin, H. W. (1997). Observational evaluation of compliance with traffic regulations among helmeted and nonhelmeted bicyclists. Annals of emergency medicine, 29(5), 625-9.More infoTo evaluate whether helmeted bicyclists are more compliant with traffic regulations than nonhelmeted bicyclists.
- Lloyd, F., Reyna, V. F., Liebowitz, R. S., & Valenzuela, T. D. (1997). The AHCPR unstable angina algorithm in practice. JAMA, 277(12), 961; author reply 962.
- Meislin, H., Criss, E. A., Judkins, D., Berger, R., Conroy, C., Parks, B., Spaite, D. W., & Valenzuela, T. D. (1997). Fatal trauma: the modal distribution of time to death is a function of patient demographics and regional resources. The Journal of trauma, 43(3), 433-40.More infoUnlike previous studies in an urban environment, this study examines traumatic death in a geographically diverse county in the southwestern United States.
- Spaite, D. W., Criss, E. A., Valenzuela, T. D., & Meislin, H. W. (1997). Developing a foundation for the evaluation of expanded-scope EMS: a window of opportunity that cannot be ignored. Annals of emergency medicine, 30(6), 791-6.More infoEMS systems are about to undergo a major transformation. Not only will the scope of EMS change, but many experts believe that it will dramatically expand. Some see the "expanded scope" as entailing relatively limited changes, whereas others consider them to be more broad. Although no agreement is evident about the definition for expanded-scope EMS, it is hoped that all EMS professionals can agree that it must be implemented in a manner that can be carefully evaluated to determine its effects on patients and EMS systems. We present a framework for evaluating the effect of expanded-scope EMS in the various types of systems that currently exist. Special consideration must be given to the indirect effects that system changes may have on survival from out-of-hospital cardiac arrest. Numerous issues will affect our ability to properly assess expanded-scope EMS. The basic research models necessary to assess the impact of system change are lacking. Few EMS systems consistently produce significant volumes of good systems research ... that is, there are few "EMS laboratories." Cost-effectiveness and issues surrounding the "societal value" of EMS remain essentially unstudied. Reliable scoring methods, severity scales, and outcome measures are lacking: and, it is ethically and logistically difficult to justify withholding the "standard of care" in an effort to understand the impact of EMS interventions. Despite all of these barriers, it is time to pay the price of doing methodologically sound evaluations that ensure the most optimal societal impact by the EMS systems of the future.
- Valenzuela, T. D., Roe, D. J., Cretin, S., Spaite, D. W., & Larsen, M. P. (1997). Estimating effectiveness of cardiac arrest interventions: a logistic regression survival model. Circulation, 96(10), 3308-13.More infoThe study objective was to develop a simple, generalizable predictive model for survival after out-of-hospital cardiac arrest due to ventricular fibrillation.
- Levine, R., Spaite, D. W., Valenzuela, T. D., Criss, E. A., Wright, A. L., & Meislin, H. W. (1995). Comparison of clinically significant infection rates among prehospital-versus in-hospital-initiated i.v. lines. Annals of emergency medicine, 25(4), 502-6.More infoTo compare the risk of infection for i.v. lines placed in the prehospital versus in the in-hospital setting in a midsized emergency medical service system.
- Spaite, D. W., Criss, E. A., Valenzuela, T. D., & Guisto, J. (1995). Emergency medical service systems research: problems of the past, challenges of the future. Annals of emergency medicine, 26(2), 146-52.More infoOut-of-hospital emergency care was designed around the concept of a system of interrelated events that combine to offer a patient the best care possible outside the hospital. However, in contrast to the actual operations of emergency medical service (EMS) systems, research has not typically used systems-based models as the method for evaluation. In this discussion we outline the weaknesses of component-based research models in EMS evaluation and attempt to provide a "systems-analysis" framework that can be used for future research. Incorporation of this multidiscipline approach into EMS research is essential if there is to be any hope of finding answers to many of the important questions that remain in the arena of out-of-hospital health care.
- Spaite, D. W., Criss, E. A., Weist, D. J., Valenzuela, T. D., Judkins, D., & Meislin, H. W. (1995). A prospective investigation of the impact of alcohol consumption on helmet use, injury severity, medical resource utilization, and health care costs in bicycle-related trauma. The Journal of trauma, 38(2), 287-90.More infoTo examine if a relationship exists between bicycle-related injuries, consumption of alcohol, helmet use, and medical resource utilization.