Jan 1999 - Present
Jun 1988 - Sep 1991
Emergency Medicine Residency Program
Jun 1986 - Jun 1991
Internal Medicine Residency Program
Special Focus in Critical Care / ICU.
Jun 1982 - May 1986
Medical Doctor (MD)
Honors in Cardiology, Pulmonary, Anesthesiology, Emergency and Community Medicine
Sep 1976 - Jun 1981
PACE Intiatated the First Public Access Defibrilator Program in Latin America. There are now 6 in San Miguel de Allende. We ALSO taught 1,800 CPR. Although they have been used a couple of times, the real impact has been the sensitization in the community . There was more focus on general response times and protocols. This may have had as much of an impact as anything. There have been other similar efforts in other communities and there are new Federal Laws defining the use of Defibrillators. There is an anniversary celebration of the AED, every year in August.
PACE has long pioneered the FAST training in Latin America. In 2011 , at the First International Federation of Emergency Medicine Symposium of Resuscitation in San Miguel de Allende Mexico. We rolled out a flagship EM Ultrasound course . Portable, even hand held ultrasound machines ( the size of Smart Phones) are rapidly becoming the Stethescopes of the 21st Century. It is a technology designed for use by clinicians at the bed side , not so much by radiologists. They can detect foreign bodies, measure intracranial pressures through the orbit, and much much more. PACE has been at the forefront
ICEM2018 PACE and SMME has sucessfully bid on the ICEM 2018 for Mexico CIty. It is the first International EM conference of its type in Latin America and will happen at the Centro Banamex in Mexico City
The First IFEM Symposium on Resuscitation IFEM Symposium In June of 2011 in San Miguel de Allende , we sponsored the First International Federation of Emergency Medicine Symposium on Resuscitation. It was a milestone event: the first EM conference with 100% Bi lingual translation. We are helping to organize the IFEM Symposium on Public Health and Emergency Medicine in Havana Cuba , 2015.
In 2002, the PACE-MedSpanish Program was founded in Guanajuato, Mexico. Some medical residents and students wanted to come help us with the programs in Mexico and learn Spanish at the same time. The Program has trained about 450 US health care personnel in Medical Spanish at our sites in Guanajuato. We provide CME Credit as well as clinical electives for residents, medical students and others. About half of the participants are emergency medicine oriented. We are developing an on line MedSpanish program and are beginning to teach with Medspanish instructors in Chiapas, Oaxaca and other locations. The program offers GME and Medical School , professional school electives as well as a successful summer pre professional program in San Miguel de Allende. The program has helped us fund our training center , paying for rent and manikins to train Mexican health care providers and helps us get an Ashoka Award. We are merging the MedSpanish and PACE programs to create Global Health experiences and initiatives.
In 2009, the PACE programmed a high level Sexual Assault Forensic Examiner technical conference that brought thought leaders from Mexico and the US together to share information on a possible provider training program in Mexico. We found that the major barrier to having a Sexual Assault Forensic Examiner program in MExico was that Health Care workers could not collect evidence according to the Napoleonic legal system in Mexico. It is not clear if and when this might change, but it was important to shed light on this area for consideration in the future. There is a lot of work still to be done in this area when the opportunity presents itself.
The NAEMT courses are a "Gold Standard" for Pre-Hospital care. The PACE Program is working with various institutions to make this training available to all first line paramedics , and to bring new levels of Medical Direction and Control, in collaboration with organized emergency medicine specialists. The courses are Pre-Hospital Trauma Life Support, Advanced Medical Life Support and Trauma First Responder. Pre Hospital care in Latin America has been almost exclusively trauma oriented. With the AMLS course, we an to improve non trauma care in Pre Hospital and in Emergency departments as well.
"A"- PACE ECHO is the first formal ECHO Project in Latin America. Project ECHO ( Extension for Community Health Outcomes) is a capacity building program that builds "learning communities". We are adapting the program to emergency care , beginning with a "train the trainer" strategy, ultimately providing faculty "Tele-presence" within our PACE network and for our partners. The strategy is key in areas like Mexico where only 15% of physicians ever complete a residency program. Knowledge and Skills are not enough.... with these techniques, " Virtual Grand Rounds" provide experience and wisdom needed to apply knowledge and skills appropriately.
Centro-PACE is our community based training center headquartered in San Miguel de Allende , Mexico. Guanajuato. We were initially funded by the MedSpanish Program and by Ashoka. We are centers for American Heart, Obstetrics, and Emergency Technicians among others, providing over 15,000 trainings and certifications. We also train in emergency ultrasound and advanced airway courses that have been taught in Mexico, and Latin America. The PACE Program is now developing a strategy based on Knowledge ( by internet), Skills ( Life Support Courses) , and Abilities Project ECHO Tele-faculty... ( KSA) providing "Chain of Survival" and Critical Path training to the last kilometer. We have contracts with Challenger Corporation for the most comprehensive on-line compendium of medical materials in the world today and are working with an innovative ECHO Program out the the University of New Mexico, in alignment with Mexican Health Services organizations ( The Red Cross and the Health Ministry).
"S"- PACE Skills courses are based on competency based certificate courses over a range of emergency conditions as well as special skills such as Advanced Airway Management and Ultrasound. The Cardinal areas are Basic, Cardiac, Medical, Pediatric, Trauma, Obstetric and Disaster at the lay Pre-hospital, nursing, general physician and specialist levels.The courses are used for external validation on other basic training , as well as to extend capacity by various providers. These courses are not just used to train " providers" . By having everybody on the same page, we are training systems and developing interoperability.,
"K"- PACE has signed a agreement with he Challenger Corporation with allows up to translate and develop use their materials in Spanish. It consists of over 30,000 question and 20,000 medical images as well as board preparation for all of the core specialties , as well as a series of specialized courses such as EKG, Radiology, Ultrasound. We will be adding the material to the ALSO Program first , converting from a 2 days course to a comprehensive training program of hundreds of hours on line. These programs will provide a high degree of re enforcement for all of our community based programs. Challenger is the "K" ( Knowledge) part of our KSA.
Founding Executive Director of the American Academy of Family Practice Advanced Life Support for Obstetrics Program / Basic Life Support for Obstetrics Programs in Mexico. Certification for specialists, general physicians, nurses, midwives and EMTs, which is becoming a standard in Mexico. We have been integrated into the Federal Strategy to decrease maternal mortality in Mexico. The program was credited with helping to reduce the Maternal Mortality rate 31% in Chiapas and Oaxaca, the states with the highest mortality rates. The Basic Life Support for Obstetrics Program is directed at midwives and EMS systems and was first piloted globally by the PACE Program. The program has become a ALSO Center of Excellence and is the clearing house for all Spanish language Materials for the ALSO Program internationally. We will be starting the Community Life Support for Obstetrics program in 2014, so that we can train community health workers and traditional midwives
We formed an International Training Center for the American Heart Association in (one of thirty in Mexico); the center teaches BLS, ACLS, PALS and HeartSaver CPR courses led by emergency physicians. The program initiated the first public Access Defibrillator program in Latin America in June of 2011 in San Miguel de Allende, Mexico in the ¨ Safe San Miguel Program ¨. There are plans for 26 defibrillators to be placed and PACE has trained over 1,800 in CPR in San Miguel including all Police and Transit, and Fire fighters in defibrillator use. PACE has worked with the Health Ministry to develop a Chest Pain Center in the General Hospital. The program offers university credit for its courses and as well as certification by the Department of Labor.
Our Program was chosen for Impact Acceleration by the Agora Partnerships for 2014. The Agora mission is to scale the growth of early-stage companies throughout Latin America that are helping to solve critical problems. Agora entrepreneurs directly confront the most intractable social problems facing the region by harnessing market forces and channeling them to create long-term value for shareholders and for society. We are combining our SKILLS (Competency Based Certification), Knowledge ( Challenger on line education) and Abilities (ECHO Tele-faculty Program), Telemedicine, as well a Global Health Crowd Funding into a viable , self-sustaining /regenerating innovation engine, which will bring quality primary care and emergency medicine training to the "Last Kilometer" throughout Latin America. .
Telemedicine Emergency Physician Services
Sep 2013 - Present
Oct 2008 - Sep 2013
Sep 2011 - Oct 2011
Medical Officer - USPHS
Was the Medical Officer for a Federally Designated Disaster Team at the World Trade Center" Ground Zero".
Was also deployed to the Sierro Grande Fire in Los Alamos , New Mexico , May 2000.
Nov 1994 - Oct 2009
11/2004 – 10 -2009
05/1994 – 07/1994
09/1997 – 12/1997
06/1998 – 08/2000
May 1994 - Oct 2009
11/2004 – 10 -2009
05/1994 – 07/1994
09/1997 – 12/1997
06/1998 – 08/2000
Sep 2002 - Jun 2009
2101 Pease Street, Harington, Texas 78550
Aug 2008 - Feb 2009
Oct 1999 - Dec 2004
504 Elm Street NE
Albuquerque, NM 87102
Apr 2004 - Oct 2004
5501 S. Expressway 77
Harlingen, Texas 78550 Ph: 956-365-1000
Fax: 956 - 365-1875
Jan 2004 - May 2004
301 W.Expressway 83
McAllen, Texas 78503
Fax: 956 - 632-4833
Jun 1999 - Oct 1999
Finishing IM Residency Requirements
Jan 1997 - Dec 1997
Emergency Physician PRN
1501 S. Coulter
Amarillo, Texas 79106
Ph: 806 -354-1000
Apr 1996 - Dec 1997
Aug 1996 - Aug 1997
New Mexico Regional Federal Medical Center (Veterans Administration and Kirkland Air Force Base facility)
1501 San Pedro Dr. SE, Albuquerque, NM 87108
Apr 1994 - Apr 1996
601 East 15th Street Austin, TX 78701
Sep 1992 - Jul 1994
2101 Pease Street, Haringen, Texas 78550
Feb 1992 - Dec 1993
ED Physician PRN
Memorial Medical Center 2450 S Telshor Blvd
Las Cruces, NM 88011
Sep 1992 - Sep 1993
AKA Clovis High Plains Hospital
2100 N Dr Martin Luther King Jr Blvd
Clovis, NM 88101
Sep 1991 - Sep 1992
601 Dr. Martin Luther King Jr. Ave NE Albuquerque, NM 87102 505.727.8000
Oct 1987 - Sep 1991
Moonlighting During Residency
Medicus / Spectrum
Grants, Gallup, Los Lunas, Roswell, Espanola, Holoman Air Force Base.
Program Offers Spanish Lessons, Clinical Insights
ACEP News July 2007
By Martha Collins ACEP News Contributing Writer
Latinos are now the largest and fastest-growing ethnic minority in the United States. As the population of Latino patients continues to expand, more U.S. health care providers are finding that they need to learn to communicate in Spanish with patients for whom Spanish is the sole or primary language.
PACE-MedSpanish is a clinically based immersion program focusing on medical Spanish and Latino culture. The program is offered at sites throughout Latin America, including Mexico, Panama, Argentina, Ecuador, Guatemala, and the Dominican Republic.
It began 10 years ago with PACEMD (Pan American Collaborative Emergency Medicine Development Program), which focuses on community-based strategies to improve emergency care in Latin America. Five years ago, PACEMD spawned the MedSpanish immersion program, which has trained more than 450 U.S. and Canadian participants in medical Spanish, Latino culture, and international health. Half of the participants so far have been emergency physicians.
"What better way to learn a language than to be immersed in another culture?" asked Dr. Haywood Hall, PACE-MedSpanish Program Director and ACEP Ambassador to Mexico. "We focus on getting you started. And when you go back, you have something that you can build on with your Spanish-speaking patients."
PACE-MedSpanish integrates general and medical Spanish training from basic to advanced levels with hands-on clinical experience. MedSpanish online instruction can be provided preceding and following the immersion course.
MedSpanish provides a clinically based elective for MS-1 to MS-4 medical students, residents, and nurses, as well as CME credit for physicians. A maximum of 50 CME credits is available for those who typically stay at least 2 weeks, and as many as 35 credits for those who stay 1 week.
"The program starts on a Monday. Residents and senior medical students typically stay for 4 weeks. The CME physicians typically come for 1-2 weeks, sometimes longer," Dr. Hall said. "The schedule is 2 hours a day of intensive, one-on-one Spanish instruction, and then 5 hours of clinical work, mostly in an emergency department."
Dr. Beverly Bauman directs pediatric emergency services at Renown Regional Medical Center in Reno, Nev. Dr. Bauman went to La Paz, Baja California, Mexico, for 3 and a half weeks of MedSpanish at a training hospital for family practice residents.
"The area of Reno in which I practice has a large Hispanic population. Before I went to La Paz, I was able to conduct simple medical interviews using limited Spanish vocabulary. As a result of the MedSpanish program, the sophistication of my conversations increased significantly," she said.
In La Paz, Dr. Bauman worked with residents in the ED. "Their English was very good. They would listen to me say what I wanted to say in Spanish, and then help me say it better. We talked about cases and reviewed EKGs and x-rays," she said. "I participated in their presentations, and they had me give a presentation, which was challenging because I gave it in Spanish."
Dr. Bauman learned that in some cases, the drugs and equipment available in Mexico are different. "They taught me about what they use, and they were interested to know what we use in the United States," she said.
"As emergency physicians, our ability to communicate with our patients is critical to providing excellent medical care. The Spanish-speaking population in the United States is continuing to grow, and if we want to provide the best medical care for our patients, we need to work on our language skills," Dr. Bauman said.
MedSpanish programs can be tailored to accommodate the tight schedules of practicing physicians.
Dr. George Molzen, a past president of ACEP, works at Presbyterian Healthcare Systems in Albuquerque, N.M. He and his wife, Dr. Judy Hardage, a family physician, took a 5-day MedSpanish course prior to attending an emergency medicine conference in Mexico.
"For us, getting away is difficult, so 5 days was all we had," Dr. Molzen said. "The Spanish I knew before was just what I'd picked up interacting with patients. We each worked one-on-one with our own tutor. After 5 days, we could do a rudimentary exchange with a patient but not a full history. But certainly we came away with enough background that if we keep studying, we'll be able to do a full history and physical in Spanish."
They stayed in the historic city of San Miguel de Allende.
"When you walk through the square in the evening, you see people everywhere, just enjoying the evening and talking to each other. It's a very social community. Going to local places gave us more opportunities to practice our Spanish. So one highlight was interacting with people in a traditional Mexican culture," Dr. Molzen said.
Another highlight was being able to interact with patients and learn about medicine in Mexico. They worked with an emergency physician in the city of Dolores Hidalgo, in an emergency department that is a training site for residents.
"We did not get involved in patient care, but we could talk to them and practice our Spanish. We could see how patients interact with the Mexican physicians, and we got an idea of what Mexican physicians can and can't do. For example, they send patients out of the hospital for x-rays, and the patients come back carrying their x-rays," Dr. Molzen said.
"It was a great opportunity to learn by actually being immersed in the culture. MedSpanish focuses more on clinical medicine than other language programs would. And the patient interaction is invaluable," he said.
"I do see myself putting what I learned into practice, and I think patients will appreciate it," Dr. Molzen added.
To find out more about the PACE-MedSpanish program, visit www.PACE-MedSpanish.org.
Living the American Dream by Helping Others in Mexico
•Public Health•Jan 24, 2008
When Haywood Hall, MD, became an emergency physician many years ago, he seemed symbolic of the American dream. Here was a Mexican-raised, pulled-up-by-his-bootstraps high-school dropout who, thanks to personal grit, beat tough odds to become a doctor. And that is one of the reasons he ended up returning to Mexico, founding a Mexican program that teaches Spanish to emergency physicians, and finding professional renewal, as he describes it.
Called the Pan American Collaborative Emergency Medicine Development program (PACEMD), it has, in the past decade, welcomed hundreds of physicians, residents, and other health professionals, who visit and live in a setting that immerses them in Spanish, steeps them in cultural literacy, and allows them to practice emergency medicine in a picturesque Mexican village, San Miguel de Allende.
As one of its many physician participants, Judith Tintinalli, MD, said the experience was just phenomenal, and for several reasons. Participants live in the geographic heart of Mexico while learning the language, take Spanish classes in a charming historic inn turned academic center, and use newfound language skills professionally while providing treatment at the town’s emergency care facility.
But the PACEMD program, while impressive, is not the subject of Dr. Tintinalli’s highest praise; that she reserves for Dr. Hall.
He built this out of nothing. It is absolutely amazing. He did it without [outside] funding. His ability to negotiate and network just blows me away, said Dr. Tintinalli, a professor and the chairwoman emeritus of emergency medicine at the University of North Carolina, Chapel Hill.
From Meter Reader to EP PACEMD actually is the result of a combination of events. On an outing in the Sonora Desert of Mexico, he witnessed a brutal car crash. He intervened to save the life of a man by fashioning a chest tube out of an endotracheal tube and a glove. Mulling over the incident, he decided to find a way to spend more time professionally where he grew up.
Dr. Hall expanded the scope of his emergency medicine practice, as well as his professional influence, south of the border. Raised in Mexico during early childhood, Dr. Hall was just another happy Mexican kid, he said. He was different, however, in terms of his heritage: an African American father and a Caucasian mother, both American expatriates.
The sense of serenity he remembers from those years changed abruptly around his eighth birthday when he relocated to the United States with his mother following his parents’ separation. It was only then that he began to encounter discrimination, he said. I wasn’t black enough. I wasn’t white enough. I wasn’t Hispanic enough, he said.
Living in Ann Arbor while his mother earned her doctorate at the University of Michigan, Dr. Hall mastered English and enjoyed learning about science, but that wasn’t enough to ignite an interest in academics. The fact is, I was truant and could not sit still for junior high school, he recalled. I dropped out as soon as I could.
He loved music, however, and devoted every spare moment to it. By the time his mother had clinched a position at Rutgers University in New Jersey, he was tuning pianos to generate income. Eventually he got a steady job across the river in New York, reading meters for Con Edison. I was going nowhere, Dr. Hall recalled.
Then, in a stroke of fortuity, a bank of the meters he was assigned to read stood right outside the emergency department of a hospital. The vitality of the place intrigued him, and soon he became acquainted with physicians and nurses working just yards from that periodic stop. It wasn’t long before I started volunteering [there], he said.
The Path to Mexico His experience in that ER convinced him he wanted a career in medicine, but he still hadn’t earned a high school diploma. So he reviewed materials for a general equivalency exam, passed it, and then went to Brooklyn College.
He left his meter-reading days behind, becoming a cab driver to have the money and flexibility to attend college full-time. Soon, he was also tutoring others in the very subjects that once had held no interest for him. It was during medical school that he began to see that his multi-cultural background was no longer a disadvantage but a real benefit, allowing him to connect almost immediately with minority patients. What seemed a weakness to me when I was younger was now a strength, he said.
And that strength also became a source of pride. As a result, he was determined to go to the Southwest, the part of America near the Mexican home of his youth. That is how, for many years, he wound up in New Mexico.
After he completed a residency in emergency and internal medicine at the University of New Mexico, he decided to stay there. Dr. Hall worked in rural emergency development in New Mexico, becoming the founding director for the emergency department at Heart Hospital of New Mexico. He also served as the Region III EMS Director for the State of New Mexico Health Department.
He left those posts when he moved his family to Mexico and started the PACEMD program. To support the program, he made monthly day-long bus ride to an emergency department near Brownsville, TX. Eight shifts a month is all it took to keep his life financially afloat back in Mexico.
He says it was more than worth it. He continued with his vocation, and ended up in this stunning colonial town, Dr. Hall said.
About PACEMD For more information about the Pan American Collaborative Emergency Medicine Development program, visit www. pacemd.org or send an email firstname.lastname@example.org.
Source: Emergency Medicine News:Volume 29(11)November 2007pp 14,19-20
October 16, 2008 email@example.com
Taos Emergency Physician Haywood Hall, MD, Recognized by the American College of Emergency Physicians as a “Hero of Emergency Medicine”
Washington, D.C. — The American College of Emergency Physicians (ACEP) today announced it has recognized Haywood Hall, MD, ACEP ambassador to Mexico, as a “Hero of Emergency Medicine.” The campaign, which is part of ACEP’s 40th anniversary, recognizes emergency physicians who have made significant contributions to emergency medicine, their communities and their patients.
“Emergency physicians are on the front lines of America’s health care system, providing the essential community service of emergency care,” says ACEP President Linda L. Lawrence, MD. “The dedication, passion and commitment Dr. Hall has shown embodies the vision of ACEP’s founders and the ideals of our specialty.”
Dr. Hall is also founding director of the Pan American Collaborative Emergency Medicine Development (PACEMD) and MedSpanish Programs, an Ashoka Fellow, initiator and co-founder of the University of New Mexico Master’s in Public Health Program, and an emergency clinician at Taos Holy Cross Hospital and Valley Baptist Medical Center (Harlingen, Texas). He is a recognized medical-social entrepreneur who has dedicated himself to developing the specialty and improving emergency health care in Mexico, the US-Mexico border and Latin America. He has worked tirelessly to give more than 450 medical students, residents and CME physicians outstanding medical Spanish training though the MedSpanish immersion program in San Miguel de Allende, Mexico (www.PACE-MedSpanish.org).
Dr. Hall’s community-based training center teaches BLS/ACLS, PALS, and FAST, as well as the Advanced and Basic Life Support for Obstetrics Programs throughout Mexico. He is actively working to increase the Latin American membership in the International Federation of Emergency Medicine and considers emergency medicine as the clinical arm of public health.
“The American College of Emergency Physicians is celebrating 40 years of advancing emergency care, and the nation’s emergency physicians are dedicated to saving even more lives and to improving emergency care for the next 40 years,” said Dr. Lawrence. “Tens of thousands of lives are saved each year by emergency physicians and 115 million patients are treated in the nation’s emergency departments. Emergency physicians are medical specialists who are experts in their field.”
ACEP is a national medical specialty society representing emergency medicine with more than 26,000 members. ACEP is committed to advancing emergency care through continuing education, research and public education. Headquartered in Dallas, Texas, ACEP has 53 chapters representing each state, as well as Puerto Rico and the District of Columbia. A Government Services Chapter represents emergency physicians employed by military branches and other government agencies.
Write up by Michelle HellumColorado Business School Senior
It all began in 1996 as vacationing Dr. Hall happened upon a multiple vehicle accident in the dead of night on a stretch of highway somewhere between Juarez and Chihuahua.
Dr. Hall, a U.S. emergency physician, took in the scene with particular focus on the unconscious man with a head injury experiencing acute agonal respiration. A hundred thoughts ricocheted in his mind: time of the essence; no sign of help; absence of equipment; legal liability without a recognized license; but, above all, his Hippocratic oath. A life was on the line. Minutes were precious. The fuse was lit.
Thirty minutes passed before an ambulance arrived with its sub-par equipment, outdated drugs, and woefully under-trained crew. Hall sought and received from the police permission to intervene. He did his best with what he had. He stabilized the patient and addressed his otherwise-fatal tension pnuemathorax by decompressing his chest with an improvised chest tube fashioned from an old endotracheal tube and glove and intubating him with expired Valium and another ET tube. This story had a satisfactory ending as the patient survived after the ambulance run to Chihuahua.
Dr. Hall later reflected on the experience. He recalled the sorry display of the response team that night and the likely outcome without his chance intervention.How many other people in Latin America were dying due to grossly inadequate emergency response resulting from the lack of basic medical knowledge, skills and equipment?
It so happened that this reflection intersected with Dr. Hall's own reevaluation of his professional life. He was in his fifth year of practicing emergency medicine in the U.S. and was looking for new directions. After arriving in beautiful San Miguel de Allende, Dr. Hall's reflection blossomed into an epiphany. His life goal would be breathtaking in scope: apply his extensive training to develop a comprehensive emergency medical program for the entire Spanish-speaking population in the Western Hemisphere.
Dr. Hall identified two basic deficiencies in the current environment. First was the simple lack in Mexico and Latin America of emergency personnel, including doctors, nurses and EMTs, adequately trained in emergency care. This gave rise to the so-called Pan American Emergency Medicine Development Program (PACE*). Second was the degree to which the language barrier often interfered with the adequate treatment of Spanish-speaking patients in the United States. This issue would be addressed through Dr. Hall’s second program, MedSpanish.
Both the PACE and MedSpanish programs operate with a shared mission to fill the gaps in medical care for the Spanish-speaking community. PACE is designed to improve the quality of healthcare in Mexico and Latin America by providing advanced competency based training and certifications to emergency care providers. Its sister program, MedSpanish, aims to minimize the communication barrier between U.S. medical providers and their Spanish-speaking patients. Tuition from the MedSpanish program provides funds for the PACE program to operate and grow. Each program seeks to improve the quality of emergency medicine and primary Latino Health Care by addressing different needs that span the western hemisphere.
PACE:ADDRESSING THE EMERGENCY SKILL DEFICIENCIES
Dr. Hall first took stock of the basic emergency response capability of physicians south of the border. He started with Mexico. He was alarmed by what he discovered.
In Mexico, roughly 200 emergency medicine specialists graduate from residency training programsannually, and currently, a total of 2,500 specialists serve the population of over 106 million.This is astonishing in comparison to the United States 30,000 practicing emergency specialists that serve over 308 million people. And Mexico is light years ahead of other Latin American countries!With so few specialists in the field, it is inevitable that response to emergencies is unreliable.Calls go unanswered 48% of the time when Mexico’s “060” emergency telephone number, equivalent to the United States’ “911,” is dialed. When calls do get through to the emergency line, excessive wait times for an ambulance drastically increase the risk of disability and death.When taken to a local emergency department, it is rare to have people there certified to manage even the most basic life saving emergencies or to have critical life saving equipment or drugs available.
Maternal mortality is exceptionally high in Mexico, especially in more remote areas. There were 63.4 deaths per 100,000 births in Mexico in 2005.The indigent state of Guerrero has a rate twice that of the nation at 128 deaths per 100,000 births.The application of basic emergency medical knowledge and skills can make a big difference, from the OB specialists, all the way to the level of the traditional midwife and could prevent many of these deaths appalling death rates.These facts underscore the need for a program like PACE that teaches Basic and Advanced Life Support for Obstetrics.( When we say we bring Advanced Medical care, people imaging all this expensive high tech equipment and personnel…what is actually lacking is BASIC knowledge and skills. That is what we teach.The technologywe can offer midwives is limited, but we CAN teach them how to save lives by recognizing emergencies and teaching them how to manage with the most basic tools and network….get it?)
Emergency medical training is found almost exclusively in the big cities and the presence of emergency care specialists in the outskirts few. The PACE program focuses on this problem through the establishment of community based training centers in less populated areas, as well as in big cities.
Founded in San Miguel de Allende, Mexico, PACE specifically addresses the profound need for supplemental emergency care on the part of Mexican physicians and health care providers. These emergency care programs include targeted courses in such areas as emergency ultrasound, obstetrics, pediatrics, trauma, and cardiac care. The program works in close collaboration with the Mexican government, academic institutions, and voluntary organizations in Mexico and Latin America to promote the development of emergency medicine and emergency care.
One distinguishing feature of PACE is its use of a “community based learning” approach rather than the mass-scale training typically found in Mexico. The philosophy behind this more localized training is that the long-term needs of the community are best served by the establishment of a solid local instructor base and the encouragement of localized continued provider training. PACE identifies natural leaders in the local area who have strong interests in the progression of emergency care.These empowered leaders are trained to be instructors and receive a modest honoraria from PACE. These training centers are then meant to become self-sustaining within a few months under the direction of the instructors with quality control enforced by the PACE Center in San Miguel.Currently, there are about 150 instructors of the various disciplines around the country.
In Oaxaca, for example, the Mexican Health Ministry contracted with PACE to develop a local instructor base. Previously, doctors of the area would have to go to Mexico City to receive emergency care training. Thus, there were a limited number of providers proficient in emergency response. Dr. Hall recalls: “We started a training center in Oaxaca for advanced life support for obstetrics. They were almost in tears that we showed up with the idea that we could help them develop their own training center. They were so used to having crumbs fall of the table from Mexico City.” Now, the ALSO Team in Oaxaca occasionally travels to Mexico City to train them! Not only has PACE improved the quality of health care in Oaxaca, the program has also empowered the community. The Federal Health Ministry has askedALSO- Mexicoto train 300 traditional midwives from the jungles of Guerrero and to help develop a specialized EMS radio network. There are training programs developing in Tabasco, Chiapas, Veracruz,Michoacan and other high risk maternal mortality areas.The ALSO program has become part of the official strategy of federal and state governments in Mexico to reduce maternal mortality rates.
PACE also works extensively to improve disaster medicine along the U.S.-Mexican border.The Geographic Emergency Medical Services of Texas’ Rio Grande Valley recruits doctors to provide emergency medical service on the US side of the Mexican border, while facilitating training on both sides of the border. Dr. Hall was recently hired by the University of Texas Southwestern medical school as a part-time faculty member to establish the Border and International Medicine Fellowship program.Fellows are recruited for this two-year program to develop emergency care in Mexico and Latin America, returning to Dallas to work an average of five shifts per month in the Parkland Health and Hospital System.In this program, doctors optionally obtain a Master’s degree in public health, learn extensive Spanish, and can complete a six-week course about tropical medicine in Peru.
While the initial PACE program is based in Mexico, the need is quite similar throughout Latin America where Dr. Hall’s program could be replicated. Dr Hall has worked with the International Federation of Emergency Medicine to bring Peru, Panama, Venezuela, and the Dominican Republic into the IFEM, based on the official recognition of the specialty and uses PACE to provide models of community based training in other Latin American countries.
MedSpanish: ADDRESSING THE LANGUAGE BARRIER
Proper medical treatment for Spanish-speaking patients located in the United States presents its own unique challenges. The very nature of emergency care often requires instant and comprehensive communication between the patient and the attending physician. The physician’s proper diagnosis of a patient in acute distress may be dependent upon symptoms best described by the patient. This often requires the physician to be in a position to give and receive information in the patient’s native language. Clear communication and understanding cultural context can mean literally the difference between life and death. The “therapeutic relationship” often cannot exist through the dry filter of an interpreter. Even a basic knowledge of Spanish Language and culture by the provider fixes this problem, even if an interpreter is needed.
The target patient community is immense. By way of example, the U.S. has the fifth largest Spanish-speaking population in the world at 45.5 million in 2007 (out of 17 countries with Spanish speakers in them). The Mexican-U.S. Border has become increasingly porous with 350 million people crossing back and forth over the border each year. Los Angeles is second only to Mexico City in terms of the most-populated Spanish-speaking city in the world. Over 60% of the population in San Antonio Texas is primarily Spanish speaking. The need for attending emergency physicians and other health care providers with knowledge of Spanish in a medical context is thus quite clear.
MedSpanish was established to address the need for intensive Spanish training and cultural literacy to U.S. health care providers and to fund the PACE center in San Miguel. MedSpanish is based on a “five-pronged approach” consisting of: 1) intensive language training 2) cultural literacy and awareness 3) full immersion 4) clinical practice and 5) remote instruction.
One distinguishing feature of the MedSpanish program is the small group instruction tailored to the student’s individual needs and the degree of the required Spanish proficiency. For at least two hours per day, the student is exposed to and learns general Spanish in the health care setting ( This is different from Medical Terminology….people have a hard time wrapping their minds around that) The MedSpanish instructors work with students of all Spanish levels, and no prior knowledge of the language is required.As Dr. Hall has said, “everybody has to start somewhere and the need is great”.The program can typically take someone with no Spanish language ability and have them take a basic medical history in 3 weeks.
The cultural literacy component is essential. Christin Kuo, a pediatric resident of Oakland, California, completed the MedSpanish program and comments on her newfound cultural awareness. (Cite: The Med Spanish website) She learned that women in Mexico often refrain from breastfeeding their children during highly emotional states, fearing that the breast milk will be toxic to the infants. It is cultural barriers such as these that the MedSpanish program seeks to diminish. The health care provider needs to understand the cultural context and assumptions of their patients, or compliance will be an issue, say Dr. Hall.
The full immersion component of the program is one way students can recognize and learn about cultural characteristics of the country.The MedSpanish program offers U.S. healthcare professionals a chance to travel to the current centers in San Miguel, Oaxaca and Chiapas to acquire international skills needed to practice at home. They act as observers and consultants in local clinics and hospitals, working closely with the PACE program. After participating in MedSpanish, the professionals are able to better serve the significant Spanish-speaking populations in US emergency departments and other health care settings. If a student is not able to travel to Mexico or would like to prepare for the immersion experience, MedSpanish even offers live language instruction via the Internet. Many students continue their training after being in the program through Skype.
MedSpanish (Pre-Professional Summer Program):
MedSpanish also appeals to an entirely new audience by offering the Pre-Professional Summer Program for International Medicine: the tens of thousands of undergraduate students interested in applying to medical, physician’s assistant, nursing, and other professional schools.These students can spend six to eight weeks during the summer in San Miguel de Allende, taking classes in general and medical Spanish.Additionally, the students can be certified as First Responders through the University of Texas Brownsville EMS and for Basic life Support through the PACE Center. They obtain clinical experience at local hospitals and in Red Cross ambulances and could potentially receive university transfer credit.The Pre-Professional Summer Program will indisputably bolster the student applications to competitive graduate schools for the health professions.
The MedSpanish program is a remarkable opportunity for students to learn the Spanish language and culture in a medical context, while gaining Continuing Medical Education (CME) credit upon completion.Hillary Bassett, a fourth year medical student at Tufts University, remarks on the importance of MedSpanish in a 2006 interview. “Medicine is almost 90 percent based on history so if you can’t communicate with someone you’re really lost. To not speak their language, you cannot get a good feeling of what is going on and you don’t know how to treat a sick person in these circumstances.”*Learning the language and culture in a total-immersion setting is an experience almost impossible to obtain within the borders of the United States.
VISION AND CHALLENGES: PACE AND MedSpanish
The story of PACE and MedSpanish is one of vision, opportunity and challenges.
Dr. Hall’s overarching vision is to establish, maintain, and grow that which is necessary to efficiently serve the emergency and general medical needs of the Spanish-speaking community. Recognizing that such needs are, by their very nature, localized and time-sensitive, his focus is first the establishment of a framework to allow multiple centers to flourish.
PACE centers would grow organically around some combination of local facilities, personnel, along with supporting physical or virtual networks.This would allow for extensive outside participation, whether professional or financial, at the program level or at the local center level.
To accommodate financial support at the program level, for example, Dr. Hall expects to establish a 501(3) organization, tentatively called PACE-USA. Dr. Hall’s vision of PACE-USA would also provide the opportunity for a funding source to “adopt” a particular training center to which the targeted funding would be applied. Such adopted centers could additionally be supported through the participation of such professionals as businessmen, lawyers, financial analysts, marketing and money managers as needed. Whether the support is at the program level or at the centers, private donations from the U.S. would be solicited in order to equip facilities with supplies needed to train doctors in trauma, cardiac, prenatal, pediatric, and obstetrical care.
While the specific look and feel of any given PACE site would be a function of the applicable community needs and the available resources, all centers would benefit from the program’s shared resources, common training techniques, a standardized certification program, and a consistent operating philosophy. The participating centers would share the best medical advice through state-of-the-art web networking.
The MedSpanish program also relies upon all tools necessary to overcome the language barrier that may interfere with servicing the medical needs of the Spanish-speaking community. MedSpanish tackles this daunting task through a combination of in-class training and use of all available on-line resources, as described earlier.
Not surprisingly, the establishment of the PACE and MedSpanish programs has been no easy task for Haywood Hall and his colleagues. They encounter various political, financial, marketing, and administrative challenges.
Since the PACE program is largely funded by charging tuition to Mexican government workers who are , (sometimes) re embursed, constant changes in governmental positions can be frustrating. As Dr. Hall explains, after he spends months or years cultivating relationships with officials, changes in the government cause a real setback.Connections are terminated and contracts become questionable (Cite Interview).Close interaction with the Mexican government also poses financial constraints. The government finances 80 percent of the business by sending its doctors to be trained and certified through PACE and is often slow to pay. The accounts receivable from the government are high due to the drawn-out lag time (up t 6 months) between the times that the service is provided and the payment is made. As the program is growing exponentially, this has created a critical shortage of operational resources needed to improve the infrastructure.Dr Hall is trying to find a mechanism to obtain “bridge loans” from foundations or banks for the government contracts that are guaranteed to pay out….eventually.
For MedSpanish, Dr. Hall has traditionally relied on word-of-mouth to brand his operations, but is discovering innovative ways to market his programs. Dr. Hall is in the initial stages of creating of a “virtual community,” whereby online viewers in the U.S. can access the information about the programs in a timelier manner. It would increase brand awareness, promote new sales, and allow people interested in international health to discuss current issues...and to get involved.
Looking to the Future:
One way to summarize the essence of PACE and MedSpanish is to visualize the re-enactment of the accident described in the background at some future point after the full flowering of the PACE/MedSpanish programs.
The year is 2012. Dr. Hall happens upon the same multi vehicle accident but, this time, the responding ambulance and Proteccion Civil arrives to the scene just outside the city of San Miguel promptly, securing the scene and insuring a safe response.Within minutes of receiving the emergency call, a paramedic who was certified just over a year ago with PACE leads the team of responders. The paramedics stabilize the patient and insert a chest tube.Air was drained from the chest, and breathing proceeds normally. The patient’s life was saved due to the emergency responders’ extensive knowledge and certified skill and the stabilized patient is transported to the local PACE certified Emergency Department. Upon arrival the medical team expertly uses the available equipment, some donated by the US community and US MedSpanish students, some of them professors in emergency medicine in the United States provide support and re enforcement and continuously review the system for quality control and improvement.Every day, similar scenarios play out for pediatric, cardiac and obstetrical emergencies in San Miguel.On weekends, the extended network travel throughout Mexico teaching and certifying providers throughout the country and establishing reproducible training sites which aid each other in training their respective populations. PACE instructors are now found on oil platforms in the Gulf of Mexico, in the jungles of Chiapas and Guerrero teaching tradition Midwives, in emergency departments and in conferences throughout Mexico.The buzz is real….everybody involved in emergency care wants to be a part of the PACE emergency care revolution !
 An extremely successful and well-accomplished physician, Dr. Hall is the founder of the PACE/MedSpanish programs. He has been widely recognized for his work in the field of medicine.He was named the American College of Emergency Medicine Ambassador to Mexico and Cuba and was recently named a Fellow of the International Federation of Emergency Medicine.In 2007, he was nominated for the Jonathan Mann Award, which is an award given to only one practitioner annual who has substantially impacted health and human rights.Dr. Hall’s most impressive award to date is his recognition as a Social Entrepreneur by the Ashoka organization, a world-renowned association of leaders who inspire social change. Haywood Hall is part of an elite group of Ashoka Fellows who innovatively address social problems. This prestigious award gives the entrepreneurs access to funding, professional help, and Ashoka’s extensive global network. Ashoka played a significant role in the initial funding for Dr. Hall’s programs.
* El Programa de Actualización Continua en Emergencias
Fellow of the Order of the Federation of International Emergency Medicine and Hero of the American College of Emergency Medicine
Terrence Mulligan DO,MPH January 26, 2013,
Assistant Professor, University of Maryland School of Medicine, Dept of Emergency Medicine
Dr Haywood Hall is one of the most dynamic, hard-working, diversified emergency physicians working in the international emergency medicine arena. His foresight, enthusiasm, selflessness and dedication have earned him well-earned respect from his far-reaching international colleagues, and his involvement on multiple levels of local, national and international emergency medicine and acute care systems development are well-known, emulated and sought-after. I offer my highest recommendation of Haywood Hall, one of the international EM gurus in the field.
Dr Mulligan is a Board Member of the International Federation of emergency Medicine , representing the United States and Canada and has worked extensively with Dr. Hall.
VP, Quality and Health IT at American Heart Association
January 22, 2013,
Dr. Haywood Hall is one of the foremost social entrepenuers in Global Health. He leverages his years of expertise to improve the health and well-being of populations through partnerships to provide excellent emergency and acute care from birth onwards...
Dr Robert Suter is Past President of both the American College of Emergency Physicians and the the International Federation of Emergency Medicine
Centro-PACE / PACEMD International
Research Director at BMC Injury Prevention Center
March 19, 2013,
Dr Hall makes dreams come true and miracles to happen for people in need of education and medical care throughout the Americas. He is an innovator and out of the box thinker in both public health, emergency medicine and internationalism and humanitarian pursuits. We are fortunate to have his leadership in ACEP and other organizations.
Dr. Edward Bernstein was the founding program Director of Emergency Medicine Residency Program at the University of New Mexico where Dr Hall trained.
Dr Angel Brana MD, MPH, . CAPT (ret) USPHS
Independent Consultant - Primary Health Care Systems
January 27, 2013,
Dr Haywood is a great leader that thinks about and plans the future with imagination and wisdom. He is a person that inspires trust and confidence whose work is framed within values of justice and responsibility. A great friend!
Dr. Angel Rafael was the UN Public Health Service, US / Mexico representative and worked directly with Dr. Haywood at Centro-PACE / PACEMD International on a variety of projects.
Global Center of Excellence for ALSO Training
Advanced Life Support for Obstetrics Program
Diana Winslow January 23, 2013,
Mgr, Advanced Life Support in Obstetrics (ALSO) Program at
American Academy of Family Physicians
Haywood Hall MD is results driven. He concentrates on goals/priorities that will have the greatest impact on decreasing maternal and neonatal mortality throughout Mexico. He is innovative and approaches situations with open-mindedness and a willingness to change perspectives. He collaborates and maintains productive working relationships with individuals at all levels. Haywood puts the long term success of the ALSO Program ahead of personal gain or ambition. Diana Winslow
Diana Winslow has been the managing director of the Advanced Life Support for Obstetrics program at the American Academy of Family Physicians and has overseen the training of 160,000 physician worldwide in this innovative program.
Lee Dresang February 17, 2013,
I am writing is strong support of Dr. Haywood Hall. I have worked with him closely during my 7 years on the Advanced Life Support in Obstetrics (ALSO) Advisory Board and my current position on the ALSO Editorial Board. During that time, Dr. Hall brought the ALSO course to Mexico and has organized courses which have trained hundreds of maternity care providers in Mexico. Certainly this has saved the lives of many women and children. ALSO Mexico has become a regional and world leader in ALSO. Dr. Hall has organized teams which have introduced ALSO to countries including Panama, Costa Rica, Chile, Colombia and Argentina. Dr. Hall is a visionary who is changing the world for the better. Dr. Hall has not only promoted ALSO, but also Basic Life Support in Obsteterics (BLSO) to bring emergency obstetrical skills to the prehospital setting. Dr. Hall is head of PACE MD which runs not only ALSO but many emergency medical courses from San Miguel de Allende Mexico. First responders are more prepared for whatever emergency they may encounter. Dr. Hall has skill writing grants. He has negotiated the translation of ALSO into Spanish. This translation is the official Spanish translation used throughout the world.
In summary, I give Dr. Hall my highest recommendation. Sincerely, Lee T Dresang, MD
Dr Dresang worked directly with Dr. Haywood as the Director of ALSO International.
Sheila Bloomquist October 20, 2011,
Dr Haywood Hall, MD has been fundamental in setting up the infrastructure for ALSO Mexico. In the past year no less than 30 programs were run last year 2010. He has also extended various other life support programs in areas or rural need. He is extremely organized and focused on implementing better life support measures for the rural and deprived areas where need is greatest and mortalities rate occur it is always a joy to be able to work with Haywood and learn from him
Dr Bloomquist worked directly with Dr. Haywood at Centro-PACE / PACEMD International as ALSO member of ALSO International.
Consulting Editor Emergency Physician International
Emergency Physician International Advisory Board
Logan Plaster January 25, 2013,
Editor/Creative Director at Emergency Physicians Monthly
I've had the privilege of working with Dr. Haywood Hall since he began serving on the EPI editorial board in 2010. Dr. Hall is a tireless advocate for emergency medicine, but even more for his patients. His passion for improving medical care for his community is truly inspiring and he makes his mark wherever he goes. EPI is proud to have Dr. Hall contributing as a writer and editor – but even more as a standard bearer.
Logan Plaster the leading publisher of Emergency Physicians Monthly ( circulation 30,000) and of Emergency Physicians International .
Founding Director, Emergency Department
Heart Hospital of New Mexico
Kathleen Blake, MD, MPH February 15, 2013,
Vice-President, AMA-Convened Physician Consortium for Performance Improvement at American Medical Association
Dr. Hall demonstrated his commitment to excellence and team work, as well as his superb medical judgement when he founded the Emergency Room at the Heart Hospital of New Mexico, contributing immensely to the hospital's reputation as a Best Place to Work and as a nationally recognized program for heart care.
Dr Kathleen Blake is a leading New Mexico Cardiologist who worked with Dr. Haywood at Heart Hospital of New Mexico
Medical Officer NM-1 , US Public Health Service Reserve
National Disaster Medical System. 911 World Trade Center Deployment
John K Gaffney February 9, 2013,
Diversely experienced emergency management and public safety professional
Dr. Hall is an intelligent, energetic, and personable physician with a broad range of education and experience whom I have enjoyed knowing and working with for many years. We have worked together in many locations and situations - including during extremely difficult responses to Presidentially-declared disasters - and I have absolutely no doubt that Haywood will perform whatever duties are asked of him reliably and capably. In addition to these abilities Haywood is a strategic thinker and can be counted on to provide valuable contributions to the design or planning of an activity. I am happy to provide my highest recommendation, without reservation, on behalf of Dr. Hall.
John Gaffney worked directly as administrator of the New Mexico Disaster Assistance Team / National Disaster Medical System which responded to the World Trade Center Disaster in 2001 where Dr. Hall was a Medical Officer for the team.
Diversity and Change Agent: Community oriented emergency physician and recognized Social Entrepreneur (www.Ashoka.org). Multicultural, Born Brooklyn New York, June 24th 1956, but raised in Mexico until age 8. Bilingual (English-Spanish.) One daughter, born 1987.
Much life experience as a musician/ high school drop out, piano tuner, meter reader and New York City Cab driver, ultimately enduring and prevailing to become a leading international emergency physician dedicated to the development of emergency care in Latin America with broad based development activity in clinical and academic emergency medicine, emergency department and EMS administration, and international project development and management in austere and developing systems.
Expert in community based training and infrastructure development in all aspects of emergency care and
competency certification in medically austere environments. I am the founding Director of PACE (www.pacemd.org). PACEMD has trained well over 8000 in American Heart Basic and Advanced Cardiac Life Support, and over 8,000 in the Advanced Life Support for Obstetrics course within the last 5 years.
Areas of special competence-
Emergency Medicine Development
EM Training and Certification
Multilevel Emergency Obstetrics competency based training and certification. Mexico, Latin America and the Caribbean US Mexico Border HealthCultural Literacy and Medical SpanishInternational and Global Health Leadership Development and MentoringInternational Conference ManagementDisaster Medicine
PACE GLOBAL EMERGENCY MEDICINE TRAINING ACADEMY
COMMUNITY ORIENTED EMERGENCY CARE (COEC) IN LATIN AMERICA
The goal is to develop ¨Chain of Survival¨ capacity in medically austere conditions in all of the cardinal areas of emergency care: Basic , Cardiac, Obstetrical, Trauma, Pediatric, Neonatal, Advanced Medical, Disaster as well as improve in technical areas such as emergency ultrasound , advanced airway and ventilation, and other procedures as appropriate for ALL providers and systems of emergency care.
By providing consultation system review and high mentoring for communities. We aim to make every Emergency Medical Services instructor and EM Clinical Educator a ¨Changemaker¨ for their communities and to develop a pool of strong PACE Faculty for Latin America as well as , eventually , other regions.
The PACE Model is one of developing KNOWLEDGE, SKILLS, and ABILITIES.
KNOWLEDGE: ON LINE training Materials such as Challenger CME ( 30,000 questions and 20,000 images) and other on line sources of knowledge. We have exclusive rights to develop Challenger materials in Spanish
SKILLS: PACE Achieves this by various "gold standard " competency Based certification programs, such as American Heart Association and National Association of EMTs, and Advanced Live Support for Obstetrics Certification courses.
ABILITIES: Knowledge and Experience through Tele-faculty presence, developing learning communities through PACE ECHO. PACE has a partnership with the University of New Mexico ECHO Program ( Extension for Community Health Outcomes)
GLOBAL HEALTH EXPERIENCES , CULTURAL LITERACY AND MED-SPANISH IMMERSION TRAINING FOR US HEALTH CARE PERSONNEL
The goal is to improve the ability of US English speaking health care providers to care for Latino patients , especially in emergencies. We do this through total immersion language training in a medical context, as well as providing meaningful global health experiences at our training sites in Latin America.
The model is to develop Global Health experiences out of language training centers , and to develop community based training programs for local health care providers and to develop has local training capacity starting with Basic Life Support , Basic Trauma, Basic Life Support for Obstetrics , eventually providing advanced Cardiac, Advanced Medical, Trauma and Obstetrical Training as well as other trainings out of the Latin American training sites.
- American College of Emergency Physician's (ACEP) "Hero of Emergency Medicine "
- ABEM Board Certified Emergency Medicine Specialist
- Fellow of the Order of International Federation of Emergency Medicine (IFEM) and Recipient IFEM Humanitarian Award ( 2014), Member IFEM Governance Committee
- Director of the ACEP Ambassador Program (2012 to 2013)
- Recipient , ACEP International Section Individual Achievement Award
- ACEP Ambassador to Mexico, Panama and Cuba
- Charter Member of the American Academy of Emergency Medicine
- Social Entrepreneur / Ashoka Fellow / Agora Partner
- Founding Director PACE-MedSpanish.Org and PACEMD Programs
- Adjunct Professor of Emergency Medicine , Department of Emergency Medicine , UNC Chapel Hill
- Associate Professor of Emergency Medicine , Division of Emergency Medicine, Department of Surgery, University of Texas Southwestern-Parkland, Dallas Texas
- Assistant Clinical Professor - University of New Mexico Health Sciences Center, Department of Emergency Medicine.
- Initiator/Co-Founder, University of New Mexico Master’s in Public Health Program
- Medical Director - Emergency Management Resources
- Tele-medicine Consultant
- International Emergency and Community Health, Cultural Literacy Advocate
- Empiric applied anthropologist