Browsing by Author "Buma, Chloe Ashton"

Now showing 1 - 2 of 2
  • Thumbnail Image
    Item
    Open Access
    A retrospective review of post-intubation sedation and analgesia practices in a South African private ambulance service
    (2021) de Kock, Joalda Marthiné; Stassen, Willem; Buma, Chloe Ashton
    Introduction: Adequate post-intubation sedation and analgesia (PISA) practices are important in the pre-hospital setting where vibration and noise of the transport vehicle may contribute to anxiety and pain in the patient. Inadequate post-intubation practices may lead to long-term detrimental effects in patients. Despite this, these practices are poorly described in the prehospital setting. This study aims to describe the current pre-hospital PISA practices in a private South African emergency medical service. Methodology: Patient report forms (PRF) of intubated patients between 1 Jan 2017 and 31 Dec 2017 from a single private ambulance service were reviewed. Data was analysed descriptively. Correlations were calculated with Spearman's Rank correlations and group differences were calculated with Independent T tests and Mann-Whitney U tests. Significant correlations were entered into a binomial regression model to determine predictive value of receiving PISA. Results: The number of PRFs included for analysis was 437. Of these, 69% of patients received some type of PISA. The estimated time from intubation to 1st PISA ranged from 9 to 12 minutes. There were statistically significantly more PISA interventions in patients who had received Rocuronium (p< 0.01). There was weak but significant correlation between the number of interventions and the mean arterial pressure, (rs = 0.17, p< 0.01) and Glasgow Coma Scale (rs = -0.15, p< 0.01) prior to intubation, along with the transport time to hospital (rs = 0.23, p< 0.01). Conclusion: The PISA practices in the South African pre-hospital setting is comparable to international pre-hospital settings. The time to 1st PISA appears to be shorter in the SA setting. There is an increased number of interventions in the patients who received Rocuronium, which may indicate practitioners being mindful of wakeful paralysis. Practitioners also take the level of consciousness and blood pressure prior to intubation into account when administering PISA. Longer transport times attribute to patients receiving more PISA interventions.
  • Thumbnail Image
    Item
    Open Access
    An analysis of the descriptors of acute myocardial infarction used by South Africans when calling for an ambulance from a National Emergency Call Centre
    (2019) Buma, Chloe Ashton; Saunders, Collen; Stassen, Willem
    Introduction Acute Myocardial Infarction (AMI) is a time sensitive emergency. In resource limited settings such as South Africa, prompt identification and management of these patients in the pre-hospital setting may minimise the negative consequences of an overburdened emergency medical and hospital service. Expedited care thus, in part, relies on the dispatch of appropriate pre-hospital medical providers by emergency medical dispatchers. Identification of these patients in the call centre is challenging due to a highly diverse South African society, with multiple languages, cultures, and levels of education. The aim of this study was therefore, to describe the terms used by members of the South African public when calling for an ambulance for patients suffering an AMI. Methodology In this qualitative study, we performed content analysis to identify keywords and phrases that callers used to describe patients who were experiencing an AMI. Using the patient report form number of randomly selected paramedic- diagnosed AMI cases, original voice recordings between the caller and call centre operators at the time of the emergency were extracted and transcribed verbatim. Descriptors of AMI were identified, coded and categorised using content analysis, and quantified. Results Of the 50 randomly selected calls analysed, 5 were not conducted in English. The descriptors (meaning units) used by callers were and found to fall into three categories; Pain: Thorax, No pain: Thorax and Ill- health. The code that occurred most often was no pain, heart related (n=16; 23.2%), followed by the code describing pain in the chest (n=15; 21.7%). Conclusion South African callers use a consistent set of descriptors when requesting an ambulance for a patient experiencing an AMI. The most common of these are non- pain descriptors related to the heart (“heart attack”). These descriptors may ultimately be used in developing validated algorithms to assist dispatch decisions. In this way, we hope to expedite the correct level of care to these time- critical patients and prevent the dispatching of resource limited advanced life support paramedics to inappropriate cases.