Physician House Calls - Research and Publications
Urgent Care by Emergency Physician House Calls™  - "The Doctor Comes to You!™ with The PORTABLE ER®
RESEARCH AND PUBLICATIONS
 
Current Sponsored Research Studies:
 
WHITE PAPER
Test and Evaluation of
Two-Way UHF Business Radios during
Emergency Physician House Calls™ Transporting the PORTABLE ER®
in a Hilly, Rural Environment


© April 18, 2018
John A. Sterba, M.D., Ph.D., FACEP
Saved by Grace Ministry, Inc., East Aurora, NY
 
Authors:
John A. Sterba, M.D., Ph.D., FACEP
President & CEO; Medical & Scientific Director;
New York State, Department of Health Clinical Laboratory Director,
Saved by Grace Ministry, Inc.
 and
Mrs. Janice E. Sterba
Vice President; Secretary/Treasurer; Medical Transcriptionist/Editor
Saved by Grace Ministry, Inc.

We are happy to Email you a color .pdf file or U.S. Mail you a printed and bound color copy of this WHITE PAPER each for a suggested tax-deductible donation of $40.00 to "Saved by Grace Ministry, Inc.", which we will gratefully receipt.  Please note that 100% of all donations are used to "care for those in greater need".

For  ON-LINE PURCHASING the "WHITE PAPER. Test and Evaluation of Two-Way UHF Business Radios during Emergency Physician House Calls™ Transporting the PORTABLE ER® in a Hilly, Rural Environment", please make your tax-deductible donation to "Saved by Grace Ministry, Inc." with PayPal or Credit Card, here: 

Our Email is PhysicianHouseCalls@roadrunner.com and our Office Phone Number is (716) 655-6854.

RESEARCH STUDY EXECUTIVE SUMMARY
Background:  Relying on a cell phone to receive patient requests for Emergency Physician House Calls was discovered to be unreliable.  Missed cell phone calls, messages and texts were due to three reasons:  1. Very weak or even no cell phone service in hilly, rural areas of Western New York (WNY), 2.  In-coming cell phone calls, recorded messages and texts were blocked when inside certain insulated homes later found to have metal-foil insulation or with heavy brick-masonry construction, and 3. In-coming cell phone calls, messages and texts were occasionally blocked inside Saved by Grace Ministry’s Emergency Medicine emergency vehicle due to heavy-gauge ballistic steel in this armored (B6) Tactical Chevrolet Suburban.
 
Therefore, we hypothesized these occasional cell-phone reception problems could be avoided using powerful two-way business radios, thus allowing Dr. Sterba to remain in reliable communication with the office, whether in or out of the armored emergency vehicle, or inside certain insulated homes. 
 
Purpose: While conducting Emergency Physician House Calls transporting the PORTABLE ER® in the remote, hilly, rural environment of WNY, field Test & Evaluation (T&E) of two-way radio reception was done during a 30-day T&E Trial (February 2 – March 2, 2018) using two-way UHF (403-512 mHz) radios at the office base-station, inside the armored Suburban and inside or outside homes using a portable (hand-held) radio.
 
Methods:  Market survey identified ideal UHF business radios: MOTOTRBO™ XPR™5550e and XPR™7550e (Motorola Solutions, Inc., Chicago, IL), which met Saved by Grace Ministry’s four operational radio requirements. 1. Reliable, extra-tough, newest, State-of-the Art digital (not analogue) programmable UHF business radios used in today’s outdoor business industries, 2. Most powerful, FCC-approved mobile radio for use in an armored Suburban testing three common vehicle antennae along with using a powerful FCC-approved base-station radio with a roof-mounted, long-range, high-gain antenna, 3.  Portable (hand-held) radio that is water-proof, not water-resistant, certified for Military Specifications (MILSPEC), and 4. Mobile radio, base-station radio and portable radio that will operate directly radio-to-radio, without using radio repeater towers, to simulate the disaster scenario of a sustained, regional power failure. 
 
Results: Radio reception was first predicted by a computer-generated model (Saia Communications, Inc., Buffalo, NY).  Next, radio reception, using the common 5-to-0 scale, was simultaneously measured in the field and at the office base-station at 40 check-points including at actual Emergency Physician House Calls over a 30-day T&E Trial in the 313-square mile Emergency Medicine service area of WNY.  Mobile radio reception using the 5-to-0 scale in the armored Suburban with the tallest 5dB High-Gain antenna was 3.14 (± 1.48 SD), which was significantly greater vs. mid-sized 3dB Mid-Gain antenna (2.88 ± 2.10; *p =0 .0002) and was significantly greater vs. the smallest Quarter-Gain Unity antenna (2.93 dB ± 1.89; *p = 0.00006).  There was no significant difference (NS) in mobile radio reception between the 3dB Mid-Gain vs. Quarter-Gain Unity antennae (NS, p = 0.79).  Office base-station radio reception comparing all three mobile radio antennae was NS.  Confounding factors were discovered that affected portable radio transmission and reception to the base-station when inside or immediately outside the armored Suburban.  When the portable radio was used inside the armored Suburban with its mobile radio turned on, portable radio transmission was either amplified due to passive conductance of the overhead more powerful mobile radio antenna, or portable radio transmission and reception was blocked with rapidly repeating noise due to desensitizing (“de-sense”) the receiver of the car’s mobile radio.  Therefore, were no statically significant differences for base-station reception or portable radio reception when the portable radio was either used inside vs. immediately outside the armored Suburban.  Similar to cell phone/text reception problems, portable radio reception and transmission inside patients’ homes that had metal-foil insulation or heavy construction was likewise blocked unless the portable radio was used by a window facing towards the office base-station. 
 
Conclusions and Recommendations:  There were seven conclusions with recommendations from this 30-day T&E Trial using two-way radios for actual patient-care on Emergency Physician House Calls using the PORTABLE ER® and while traveling throughout the hilly, rural medical service area. 
 
One.  Reliable, FCC-licensed, two-way, digital UHF radio communications between Saved by Grace Ministry’s office base-station and inside the armored Suburban, or outside the vehicle (e.g. in patients’ homes and elsewhere) was secure and confidential.  Communication in either Dispatch mode (using radio repeater towers) or Direct Channel mode (radio-to-radio) was digitally encrypted meaning patient-care communications were kept protected and confidential (private) not able to be monitored by the public using a police-type scanner. 
 
Two.  The UHF base-station, mobile and portable radios used in this hilly, rural area in Direct Channel mode were successful for day-to-day patient-care operations.  In the absence of a good cell phone signal in someone’s home, placing the portable radio on the window sill facing the base-station often allowed adequate radio reception solving this poor cell phone reception problem.  These positive results predict successful use of these radios during disaster operations including a sustained regional power failure with loss of the use repeater radio towers that had no electricity.
 
Three.  The computer-modeled radio reception maps that were generated by Saia Communications, Inc. (Buffalo, NY) were confirmed to be reliable and accurate based on our independently-determined transmission and reception data from 40 Check-Points. 
 
Four.  There was one-day installation, radio training and same-day successful use of two-way UHF radios for the office base-station, mobile and portable radios in either Dispatch mode or Direct Channel mode.  Overall, radio installation and use was easy and fast with no equipment failures noted during this 30-day T&E Trial. 
 
Five.  These positive reception results will encourage physicians, nurse practitioners, physician’s assistants and medical students to start using two-way digitally-encrypted radio communications for Physician House Calls caring for more patients, at-home
 
Six.  Motorola Solutions, Inc. MOTOTRBO™ digital two-way UHF radios, XPR™7550e (portable) and XPR™5550e (base-station and mobile) are programmable (1,000 channels). Therefore, with an FCC business radio license, and with written prior authorizations, critical UHF frequencies can be programmed for direct, FCC-allowed radio communications from an emergency physician directly to Law Enforcement Agencies, Fire/Rescue, EMS, Emergency Services, hospitals and others operating on UHF frequencies (403 – 512 MHz) during emergencies, declared disasters or war.
 
Seven.  For Emergency Physician House Calls,the small vehicle mobile antenna (Quarter-Gain Unity antenna) allowed full use of all regional UHF radio repeater towers with excellent mobile radio transmission and reception from the base-station using an Emergency Medicine armored Suburban.  However, the largest 5dB mobile antenna should be stored at all times in the vehicle.  Should there be a sudden loss of regional radio repeater towers (e.g. sustained loss of electricity or tower malfunction), the small Unity antenna can be quickly un-screwed and the largest 5dB mobile antenna screwed-on the roof-mount in less than one minute. This simulated disaster scenario was successfully practiced in this study.  Therefore, a sudden regional loss of electricity in an emergency, disaster or war scenario should automatically prompt manual switching of all radios from Dispatch to Direct Channel mode to maintain two-way radio communication.  Portable radio use inside the armored Suburban or nearby required the armored Suburban’s mobile radio to be turned off to avoid affecting portable radio transmission and reception from being blocked by rapidly repeating noise due to desensitizing (“de-sense”) the receiver of the car’s mobile radio. 
 
Summary.  Two-way radio communications equipped an emergency physician to reliably and securely communicate while conducting Emergency Physician House Calls transporting the PORTABLE ER® caring for those in greater need in a hilly, rural environment.
____________________________________________________________________

WHITE PAPER
Emergency Physician House Calls:
Time, Outcome Benefits and Cost of
Point of Care (POC) Laboratories Used
with Community-based  PORTABLE ER®
© December 11, 2017
John A. Sterba, M.D., Ph.D., FACEP
Saved by Grace Ministry, Inc., East Aurora, NY

Author
John A. Sterba, M.D., Ph.D., FACEP
President & CEO; Medical & Scientific Director;
New York State, Department of Health Clinical Laboratory Director,
Saved by Grace Ministry, Inc.

We are happy to Email a color .pdf file or U.S. Mail you a printed and bound color copy of this WHITE PAPER each for a suggested tax-deductible donation of $40.00 to "Saved by Grace Ministry, Inc.", which we will gratefully receipt.  Please note that 100% of all donations are used to "care for those in greater need".

For ON-LINE PURCHASING the "WHITE PAPER.  Emergency Physician House CallsTime, Outcome Benefits and Cost of Point of Care (POC) Laboratories Used with Community-based  PORTABLE ER®", please make your tax-deductible donation to "Saved by Grace Ministry, Inc." with PayPal or Credit Card, here: 

Our Email is PhysicianHouseCalls@roadrunner.com and our Office Phone Number is (716) 655-6854.

RESEARCH STUDY ABSTRACT
Objective.  This novel prospective, observational study of private practice Emergency Medicine (EM) by one Emergency Physician (EP) on EP House Calls (EPHCs™) using America’s first PORTABLE ER®, measured possible time savings, outcome benefits and cost savings from 100 consecutive patients needing Point-of-Care (POC) blood chemistry labs (Abbott-iSTAT, Abaxis-Piccolo-xpress™). 
 
Methods.  Measured-Times (minutes) for the EP-response, triage and emergency care and EP to conduct, receive and explain POC labs were compared (ANOVA, *p<0.05) to corresponding reported times (questionnaires) from primary care physicians (PCP), urgent care facilities (UCF) & hospital-based emergency departments (ED).  Total EPHC™ Time, patient percentages staying at home vs. admitted to hospital, and patient-care insurance-charges (cost) for 100 EPHCs™ were calculated.
 
Results. Mean-age: 75.0 yr ± 18.4 SD, range 20-108; males, 32%/females, 68%.  EP Response-Time, 6.3 min ± 6.4 SD.  EP Drive-Time to Patient, 10.1 ± 5.9, not-significantly different (NS) vs. Patient Drive-Time to their PCP, 13.0 ± 8.7 (NS), nearest UCF, 16.5 ± 6.0 (NS), but faster vs. to regional hospital-based ED, 21.8 ± 5.6*.  EP Triage-Time, 3.9 ± 2.4, faster vs. PCP, 7.9 ± 3.6*; UCF, 12.5 ± 3.5*; and ED, 11.8 ± 4.8*.  EP Time-to-See-Patient, 4.2 ± 2.6, faster vs. PCP, 12.5 ± 6.5*; UCF, 11.3 ± 1.8*; and ED, 29.4 ± 12.6*. Total EP Lab-Time (conduct, receive and explain results) 13.6 min ± 3.5, much-faster vs. PCP, 3.6-days ± 0.8*, UCF, 2.5-days ± 1.2*, and ED, 108.7 min ± 61.1*.  POC-lab Times comparing i-STAT® vs. Piccolo xpress™ were NS.  Total EPHC-Time, 164.8 min (2-hr:45-min) ± 52.5; 89% patients remained safely-at-home; 11% admitted  to hospital.  Mean EPHC™ patient-care insurance-charge (cost) was $375.53 (USD) ± 187.70.  Strong public and medical-support was widespread and documented.
 
Conclusions. Private practice EM by EPHCs using the PORTABLE ER® provided very fast EP Response-Time and faster Triage and Seen-Times vs. PCP, UCF or ED.  Emergency Physician POC-Labs were conducted, received and explained much faster (< 14 min) vs. labs by PCP, UCF, or ED.  After 100-EPHCs, 89% of patients remained safely at-home never needing admission with no problems, complaints or adverse events.  Patient-care insurance-charge (cost) for 100 EPHCs with POC-labs using PORTABLE ER® was ten-fold-less ($375.53, 9.8%) vs. 7.4 million Florida hospital-ED patient-care insurance-charges ($3,808.00) during 2012-2013.

Therefore, these medical Emergency Physician House Calls (EPHCs™) using the PORTABLE ER®, which required POC portable labs, saved Medicare B and all other medical insurances $3,432.47 per patient for those patients that never had to go to the hospital ED. 
___________________________________________________

Peer-Reviewed Medical Journal Publication:
 
J.A. Sterba. "Wound Care On The Go.  
‘Portable ER’ Allows Physician to 
Reinvent House Calls". 
Today’s Wound Clinic. 2012, September: 18-21. 

 
Please contact us.  We are happy to freely Email or U.S. Mail you a complimentary copy of this published article.  

Our Email is PhysicianHouseCalls@roadrunner.com and our Office Phone Number is (716) 655-6854.
 
From our on-going Institutional Review Board (IRB)-approved clinical research study on Emergency Physician House Calls using The PORTABLE ER®, here are some interesting published findings from our article with encouraging conclusions:
 
"Our insurance billing is approximately 25 percent of the cost for similar services billed from the hospital-based ED (emergency department)." (pg. 20)
 
"Of all patients seen during house calls, 91 percent are not clinically indicated to be sent to the ED (emergency department). The remaining nine percent require to be transported to the ED for further lab/radiology studies, but are rarely admitted." (pp. 20-21)
 
"From our ongoing Institutional Review Board-approved clinical study that measures patient convenience of house calls, the time from ordering a blood chemistry test until lab results are explained is 13.8 mins. (+ 5.2 mins., SD, n = 45 patients)." (pg. 20)

"In conclusion, Physician House Calls using the Community-based Portable ER provides faster, better and cheaper care - including advanced wound care - when compared to the hospital-based ED (emergency department) or urgent care facility." (pg. 21). 
________________________________________________

Overall, Emergency Physician House Calls™ using our nation's
first community-based PORTABLE ER® allowed 91% of our emergency patients, their family members, and care givers to received these blessings:
-AVOID the much higher Hospital ER costs, 
-AVOID wasting their valuable time, 
-AVOID aggravation or frustration in the crowded ER, and 
-AVOID exposure to hospital infections coming from the ER
 
This research is now a part of the very encouraging One and Two-Hour Equipping Seminar, "Practicing Medicine by Physician House Calls". Please contact Saved by Grace Ministry, Inc. for Seminar details.

Our Email is PhysicianHouseCalls@roadrunner.com and our Office Phone Number is (716) 655-6854.
___________________________________________________

Reference Textbook:
 
"TEXTBOOK of EQUIPPING FOR DISASTERS. 
SHELTERING AT HOME"
Textbook Equipping for Disasters Sheltering at Home
For a tax-deductible donation of $60.00 to "Saved by Grace Ministry, Inc.", we offer the Newly Updated:
 
"TEXTBOOK of EQUIPPING FOR DISASTERS. SHELTERING AT HOME"
Revised & Expanded, Fourth Edition.  
Copyrighted, 2016
Authors John A. Sterba, M.D., Ph.D., FACEP 
and Mrs. Janice E. Sterba.  
 
(From the BACK COVER)
TEXTBOOK of EQUIPPING FOR DISASTERS,
SHELTERING AT HOME
Fourth Edition, Copyrighted 2016
 
“This 249-page Reference Book has been expanded & fully field-tested to teach us how to best care for each other 
as Good Neighbors, during and recovering from all disasters.”
 
  • Prayer and Community Based Home-Care Ministry: The Safe Haven Home; Determining needs in your neighborhood; Medically-trained people as our neighbors; Volunteers; Planning ahead & Using the Emergency Information Sheet
  • Food Pantry for the Home and Community-Based Disaster Shelters: Economical shopping; Balanced-diet; Long-term safe storage of food
  • Home Preparation Guide and Mini-Guide: 25 Home Systems (heating, electrical systems, etc.); Making & storing drinking water; Safety & well being.
  • Emergency Physician-written, Home Care Instructions for 45 Common Illnesses & Injuries: East-to-understand teaching by a doctor.
  • Community-Based, DISASTER SHELTERS: Loss of power; Complete care.
  • Community-Based, PORTABLE ER®: The PORTABLE ER® in 101-pages; Medical & Surgical Kits and Cases (24) with full inventory including ordering I.D. numbers; Portable Dispensary Cabinets-PDCs (16) for all medications from all drug categories; Inventories of economical, essential antibiotics & pain meds.
  • Community-Based, MOBILE ER: Motor homes; Staffing; Disaster care.
 
The Authors
 
John A. Sterba, M.D., Ph.D., FACEP President & CEO, Medical & Scientific Director, NYS DOH Laboratory Director Emergency Physician Saved by Grace Ministry, Inc.Mrs. Janice E. Sterba Vice President, Secretary/Treasurer Saved by Grace Ministry, Inc.
Since 1998,‘Dr. John’ and Mrs. Janice E. Sterba have told people about Jesus Christ, while caring for people’s needs through Saved by Grace Ministry, Inc., East Aurora, NY.  They encourage us to remain obedient to the LORD’s commands, “Love your neighbor as yourself.” (Leviticus 19:18) and “This is my command: Love each other.” (John 15:17).
 
Since 1998, Saved by Grace Ministry, Inc. faithfully provides for those in greater need.  Its Corporation’s Purposes include: “To relieve poverty, hunger, illness, homelessness and other forms of suffering in the world; to assist underprivileged people to improve their living conditions; to offer hope, comfort and aid those in need, particularly widows and orphans; to respond to natural and man-made disasters; to testify to the good news of the Gospel of Jesus Christ;”
 
Dr. John A. Sterba is a missionary doctor and former operational Medical Officer (Navy Commander).  He clinically practices and teaches Emergency Medicine in NY State.  He is Board-certified in Emergency Medicine and Urgent Care Medicine for children and adults.  Dr. Sterba is a Fellow of American College of Emergency Physicians (FACEP).  He has academic appointments from the University of Sierra Leone, West Africa and the Women & Children's Hospital of Buffalo (recently renamed to the John R. Oishei Children's Hospital), University of Buffalo, NY School of Medicine.
 
 
ORDERING YOUR COPY OF "THE TEXTBOOK OF EQUIPPING FOR DISASTERS.  SHELTERING AT HOME"
 
  • To preview the content of our "Textbook of Equipping for Disasters. Sheltering at Home", we are happy to freely Email you the Front/Back Covers, three-page Table of Contents and any Chapter, for free, with no donation requested.  Our Email address is PhysicianHouseCalls@roadrunner.com 
 
  • If you want to purchase a hard-copy, spiral-bound "Textbook of Equipping for Disasters. Sheltering at Home", please send a suggested tax-deductible donation of $60.00 per Textbook (check or money order please) payable to "Saved by Grace Ministry, Inc." and mail your request with return address to:
 
Dr. and Mrs. John and Janice Sterba
Saved by Grace Ministry, Inc.
226 Center Rd.
East Aurora, NY 14052-2233 USA 
 
  • We will promptly mail out your Textbook within 3-5 business days along with your tax-deductible Receipt and Thank You Letter. 
 
  • For ON-LINE PURCHASING the "Textbook of Equipping for Disasters. Sheltering at Home", please make your tax-deductible donation of $60.00 per Textbook to "Saved by Grace Ministry, Inc." with PayPal or Credit Card, here: 





  • IMPORTANT!  After you have made your on-line donation, you must either call us, (716) 655-6854, or Email us, PhysicianHouseCalls@roadrunner.com, to tell us how many "Textbook of Equipping for Disasters. Sheltering at Home" you ordered and give us your mailing address, so we can ship them to you.

  • Rest assured, 100% of all donations to "Saved by Grace Ministry, Inc." have always and will continue to go towards caring for those in greater need.  We do not receive any salary. Thank you.
 
 
Other Publications by Saved by Grace Ministry, Inc.
 
Reference Books, Textbooks, Articles and Abstracts
 
Sterba, JA and JE Sterba. Textbook of Equipping for Disasters, Sheltering at Home. Revised & Expanded, Third Edition. 
www.Amazon.com, Kindle eBook:
 
Sterba, JA and JE Sterba. Textbook of Equipping for Disasters, Sheltering at Home. Revised & Expanded, Fourth Edition. Saved by Grace Ministry, Inc., East Aurora, NY, 2012; 249 pages. November 5, 2016.

Sterba, JA and JE Sterba. Textbook of Equipping for Disasters, Sheltering at Home. Revised & Expanded, Third Edition. Saved by Grace Ministry, Inc., East Aurora, NY, 2012; 249 pages. March 12, 2012.
 
Sterba, JA and JE Sterba. Textbook of Equipping for Disasters, Sheltering at Home. Revised & Expanded, Second Edition. Saved by Grace Ministry, Inc., East Aurora, NY, 2010; 249 pages.
 
Sterba, JA and JE Sterba. Equipping for Disasters, Sheltering at Home. Handbook of Preparation & Encouragement. Saved by Grace Ministry, Inc., East Aurora, NY, 2007; 134 pages.
 
Sterba, JA and JE Sterba. Sports Therapy and Recreational Programs for Children with Disabilities. The Center for Sports Therapy Research, Inc., East Aurora, NY, 2004. (out of print)
 
Sterba, JA and JE Sterba. The Complete Handbook for Parents with Disabled Children. American Christian Writers (ACW Press), Phoenix, Arizona, 2002. (out of print)
 
Published Research Articles, Sports Therapy
 
Disabled Children Horseback Riding Therapy Hippotherapy
Sterba, JA, BT Rogers, AP France, DA Vokes. Horseback riding in children with cerebral palsy: effects on gross motor function. Developmental Medicine & Child Neurology 2002, 44: 301-308.
 
 
Disabled children Adaptive Skiing Therapy
Sterba, JA.  Adaptive downhill skiing therapy in children with cerebral palsy: effect on gross motor function. Pediatric Physical Therapy. 2006 Winter; 18(4):289-96.
 
 
Disabled children Horseback Riding Therapy Hippotherapy
Sterba, JA.  A Review: Does Horseback Riding Therapy or Therapist-Directed Hippotherapy Rehabilitate Children with Cerebral Palsy? Developmental Medicine & Child Neurology 2007, 49: 68-73. 
 
 
Paper Presented with Published Abstract
 
Disabled children Aquatic Therapy
Sterba, JA, D Safar-Riessen, M DeForest. Effect of aquatic therapy on Gross Motor Function Measure in children with cerebral palsy. Developmental Medicine & Child Neurology 2004: No. 99 (suppl), Vol. 46, page 47-48.
 
 
Instructional Missionary Booklet
 
Missionary Medicine
Sterba, JA. Mission Guide: Caribbean and Central America.  Saved by Grace Ministry, Inc., East Aurora, NY, 2009.
 
Please contact us and we will happily Email or U.S. Mail you a copy of this Instructional Missionary Booklet for free, no donations requested.  Our Email is PhysicianHouseCalls@roadrunner.com and our Office Phone Number is (716) 655-6854.
 
May the LORD Jesus bless, protect and provide for you and your family.  Amen!
 
Dr. and Mrs. John and Janice Sterba
Saved by Grace Ministry, Inc.
(Ephesians 2: 8-10)
 
 
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