Browsing by Author "Allgaier, Rachel"

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    Open Access
    A descriptive study of patients presenting with a chief complaint of seizures to the prehospital emergency care practitioner of the Western Cape
    (2019) Bester, Beatrix Hendrina; Saunders, Collen; Allgaier, Rachel
    Background Seizures are considered one of the most common time-sensitive and potentially life-threatening medical emergencies presenting to emergency centres and attended to by prehospital emergency care practitioners. These require a rapid response, prompt identification and appropriate management. There is a paucity of information describing the demographics and prehospital management of patients presenting with seizures in South Africa. Objectives The aim of this study was to describe the demographics and prehospital management of patients presenting with a chief complaint of seizures and/or convulsions to prehospital emergency care practitioners within the Western Cape Government Emergency Medical Services. Methods This retrospective study included all Western Cape Government Emergency Medical Services calls indicating a chief complaint of seizures and/or convulsions between August 2017 and July 2018. Descriptive statistics were performed to describe basic demographics in this population. A sample of emergency calls originating within the City of Cape Town was selected for a clinical chart review to describe on-scene clinical presentation and vitals, response times, and prehospital treatment provided. Results A total of 24 746 seizure and/or convulsion cases were recorded during the study period. The highest frequency of patients was in the 21 - 40 year age group (31%), and 57% of patients were male. The subsample (n=3 075) yielded 1 571 cases with completed electronic patient care records. The mean dispatch and response times were 20 (±36) and 14 (±10) minutes respectively with a mean on-scene time of 25 (±13) minutes. No on-scene vital signs were recorded in 11.3% of patients. Recorded on-scene vitals indicated that 36% of patients presented with a tachycardia, 14% had an oxygen saturation of < 95%. Airway manoeuvres were performed in 30% of cases, and 50% of patients presenting with a SpO2 < 95% received supplemental oxygen. The benzodiazepine Diazepam was the most common medication administered, and 83% of medications were administer through the intravenous route. Conclusions Seizures are a recognised time-sensitive emergency, however in this sample of patients we observed a longer than expected dispatch time. Although the importance of recording baseline vital signs is recognised, there was a large proportion of undocumented vital signs 35 within the sample. Despite consensus recommendations that intramuscular midazolam are the preferred medication and route, IV diazepam was the most frequently administered. Seizures are an under-recognised burden on Emergency Medical Services within the Western Cape. This study provides an initial description of the epidemiology within this population, allowing for optimization of recognition and management in these patients.
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    An assessment of theoretical knowledge and psychomotor skills of Basic Life Support Cardio-Pulmonary Resuscitation provision by Emergency Medical Services in a province in South Africa
    (2015) Veronese, Jean-Paul Tyrone; Wallis, Lee; Allgaier, Rachel; Botha, Ryan
    Introduction: When high quality cardiopulmonary resuscitation (CPR) is performed, survival rates can approach 50% following witnessed out-of-hospital cardiac arrest. However, survival rates are more commonly much worse in both the in-hospital and out-of-hospital context and range from 0% to 18%. There is a paucity of evidence surrounding the competency at which basic life support (BLS) CPR is provided among Emergency Medical Services (EMS) personnel in South Africa, and quality assurance mechanisms are generally scarce or do not exist. Methods: A descriptive analytical study design was used to assess theoretical knowledge and psychomotor skills of BLS CPR provision by EMS personnel in a province in South Africa. An assessment questionnaire from a 'BLS for healthcare providers' course was used to determine theoretical knowledge. Cardiac arrest simulations were video recorded to assess psychomotor skills. BLS instructors independently scored the latter. Results: Overall competency of BLS CPR among the participants (n=115) was poor. The median knowledge assessment was 50% and the median skills 22%. Only 25% of the items tested showed that the participants applied the relevant knowledge to the equivalent skill and the nature and strength of theory influencing skills was small. However, certain demographic and circumstantial variables such as sector of employment, guidelines they were trained according to, age, and location where trained had a significant effect (p<0.05) on knowledge and skills. Discussion: This study suggests that theoretical knowledge has a small but notable role to play in psychomotor skills performance of BLS CPR. Demographic and circumstantial variables that were shown to affect knowledge and skill may be used to improve training and therefore competency. The results of this study highlight the need for continuous, and perhaps tailored BLS CPR instruction to bring the diverse set of EMS personnel currently practicing in South Africa up to international competency standards.
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    Patient presentations during the 2010 FIFA World Cup: Cape Town, South Africa's public emergency centres
    (2012) Galal, Meenal; Smith, Wayne; Allgaier, Rachel
    In light of the inconclusive findings highlighted within the literature currently, suggestions have been made that further studies are required in order to gain deeper insight into the dynamics and variables which may influence patient presentation to emergency centres during major sporting events, as well as their significance, if any. The primary aim of the study is to determine what impact the 2010 FIFA World Cup South AfricaTM had on emergency centre presentations. The objective of the study is to conduct a retrospective, observational, cross-sectional study utilizing previously collected audit data from emergency centre records during the period of a major sporting event, the 2010 FIFA World Cup South AfricaTM, ie. 11th June 2010 to 11th July 2010. The data of the WC2010 audit will be analysed to assess the presence of any statistically significant differences between analyzed variables within the period in question as compared with the control period (11th June to 11th July 2009), in which there was an absence of such an event. A comparison of the data described, to control periods with an absence of major sporting events may allow insight into whether such events require consideration of staffing requirements, capacity/throughput assessment and contingency planning, or not.