Browsing by Author "Cunningham, Charmaine"

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    Open Access
    A 12-month retrospective, descriptive study of Hout Bay Volunteer Emergency Medical Service, Cape Town, South Africa
    (2019) Kahle, Jurgen Werner; Cunningham, Charmaine; Fleming, Julian; Hodkinson, Peter
    Background There is a growing need for Emergency Medical Services (EMS) globally and in Africa, as health services develop. The establishment and continued operation of volunteer ambulance services might assist with this need. This study provides a comprehensive overview of the operational activities of a volunteer ambulance service and forms a first step for further studies of this and other volunteer ambulance services. Objectives This study describes and quantifies the operational activities of Hout Bay Volunteer Emergency Medical Service (Hout Bay EMS) a volunteer ambulance service in Cape Town, South Africa for a one year period from 1 January to 31 December 2016. Methods This retrospective study describes call-outs, shifts and service demographics of Hout Bay EMS for 2016, using Provincial EMS dispatch data and shift records from Hout Bay EMS. Performance comparisons are drawn between Hout Bay EMS and Provincial EMS. Outcomes In the study period, there were 682 call-outs involving Hout Bay EMS, a total mission time of 951 hours worked over 119 shifts by 31 active members in 2016. Assault was the leading call-out type (18.40%); 58.24% of call-outs were Priority 2 (less urgent), and 39.30% of call-outs ended in no patient transport. Response times to Priority 1 call-outs were generally shorter for Hout Bay EMS than those of Provincial EMS within the Hout Bay area. Members largely preferred night shift to day shift by a factor of 4:1; the majority of shifts were worked by Basic Life Support (28.57%) and Intermediate Life Support (57.98%) qualified members compared to the relatively few shifts (13.44%) worked by Advanced Life Support members. This study shows that a small volunteer ambulance service mostly active on weekends can successfully complement the efforts of the larger, full-time provincial ambulance service it is dispatched by. This model could be replicated elsewhere to meet the growing need for emergency medical services.
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    A cross-sectional study of patients presenting to an urban emergency department in Mwanza, Tanzania
    (2024) Kotecha, Shahzmah Suleman; Hodkinson, Peter; Cunningham, Charmaine; Sawe, Hendry Robert
    Introduction: Tanzania suffers from limited healthcare resources, accentuated by the burden of trauma and infectious diseases. There is limited data on the profile of patients attending Emergency Departments (ED). This study describes patients attending the Bugando Medical Centre, Mwanza, Tanzania ED. Methods: A cross-sectional descriptive study was conducted including all patients presenting from 01 – 31 January 2023. Information collected included demographics, referral status, main complaint, ED disposition, hospital length of stay for admitted patients, and hospital outcomes for admitted patients. Results: A total of 3390 patients presented, and 3224 (98%) were included, of which 49.1 % were male, and the median age was 30 years (interquartile range 12-51). Most (72.9%) were self-referrals. The nature of the complaint for the majority of the patients (61.6%) was medical, and the overall median hospital length of stay was 5 days (IQR of 3-12 days) for admitted patients. Higher proportions (17.3% and 18.9%) of patients presented on Mondays and Tuesdays respectively. Among patients aged 14 years and above, hypertensive heart disease with failure, malignant neoplasm of the oesophagus and intracranial injury were the top medical, surgical and trauma diagnoses respectively. In the paediatric population (<14 years), sickle cell anaemia in crisis, hydrocephalus and diffuse traumatic brain injury were the top medical, surgical and trauma diagnoses respectively. The most common complaints among the patients presenting to the ED were gastrointestinal complaints (8.9%), respiratory complaints (3.1%) and congenital abnormalities (3.2%) in the >14 years, 1-14 years and <1 year age groups respectively. Most (63.6%) patients were discharged directly from the ED, and ED and in-hospital mortality were 0.2% and 15.5% respectively. Conclusion: In this study, we observed a high burden of medical complaints, a high rate of ED discharge and high in-hospital mortality. This study can inform future studies in resource mobilization and allocation for the ED, and the health system.
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    Investigating public sector emergency medical service staff perception of the performance management and development system at the eThekwini District
    (2023) Sangweni, Sbusiso; Cunningham, Charmaine
    Background Performance management and development systems are designed to align processes and to manage the performance of employees on a continuous basis. The implementation of these systems in the public sector domain remains a challenge and necessitates the exploration of staff perceptions of the system, its implementation, and fairness. This study seeks to provide meaningful evidence regarding the perception of the Emergency Medical Services staff about the effectiveness and fairness of the Performance Management and Development System application in the eThekwini District in KwaZulu-Natal. Objectives The research objectives are to describe the perceptions of Emergency Medical Service employees of the Performance Management and Development System, to describe employees' participation and perception of management commitment to the system and to compare the differences in perceptions by using descriptive variables such as age, gender, professional category, and tenure. Methods This study used a descriptive design and used a validated tool. 200 surveys were handed out and 175 questionnaires were collected for analysis. After data cleaning and validation, 164 questionnaires were used in the analysis. Subsequently, inferential statistics in the form of independent !-test and data analysis of variance (ANOVA) was used. Data was analysed using demographic information and employee perceptions about fairness, involvement, and participation in performance management. Results The results showed that 62.2% of Emergency Medical Service staff in the eThekwini District perceived that a Performance Management and Development System is not effective and fair. The results showed no statistical significance based on gender, age and years employed in the public sector EMS. However, there were statistically significant differences between qualifications, current EMS sector, and current position at work. This demonstrates several shortcomings in the implementation of a Performance Management and Development System in the eThekwini district EMS sector
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    The adaptive capability of the operational team to respond to challenges in the Emergency Centre. A SenseMaker® study in Emergency Centres within Cape Town
    (2020) Cunningham, Charmaine; Wallis, Lee A; Vosloo, Marietjie
    Background Emergency centres (ECs) serve as a main entry point for patients into hospitals, and patients that present here are undifferentiated with varying levels of acuity. Uncertainty, interruptions, multiple – often conflicting – priorities, and gaps in information flow are inherent to EC work practices, making it a high-risk environment for operational failure. The EC team, the core of which is formed by doctors and nurses, needs the ability to collaboratively and reliably sense and respond to the constant change and flux of information. This depends on the interactions and sense-making of the EC team. Objectives People give meaning to situations through the process of sense-making; they then subjectively construct their reality and share it via plausible stories regarding their situation and environment. The main objective of this study was to explore the collective team-based sense-making of the operational challenges and decisions within the EC. This interprofessionalstudy focused on the dynamics and negotiations within the EC as a complex adaptive system. Methods This exploratory study used narrative-based inquiry with abductive reasoning to meet the objectives. It was divided into two sections. The first was a thick description of the EC context, daily operations and processes. Then, using the SenseMaker® tool, we captured stories about a situation that stood out to participants, and thus mattered to them. Using this novel method, once they told their story, the storytellers self-analysed their stories within a specially designed framework. The results were then explored to find patterns based on the perspectives of sense-making. Results There is no proof of interprofessional sense-making in the EC, and if it occurs it is due to the informal networks between doctors and nurses, and despite formal structure. There is an operational disconnect between doctors, nurses and management, which is caused by information asymmetry, poor feedback loops and disparate communication channels. Because there is no collective sense-making, the EC team is vulnerable to operational failure and crises. Currently, they respond to operational challenges via quick fixes that result in constant firefighting, the impact of which could be seen by the extensive use of war-related metaphors in their stories.
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    The impact of the COVID-19 pandemic on EMS practitioners in the Western Cape: strategies to enhance wellness
    (2025) Cermak, Radomir; Cunningham, Charmaine
    This research study aimed to explore the psycho-social impact of stress endured by frontline emergency medical services providers during COVID-19 pandemic and to develop a framework for enhancing their wellness during healthcare crises of the same or similar nature. Prior to the pandemic, emergency medical services providers faced high occupational stress within their work environment, which was characterised by exposure to traumatic scenes and high-stress conditions. The COVID-19 crisis added unique pressures, including increased mortality rates, higher exposure to the virus, and lack of resources emphasising the need for improved wellness strategies. Conducted as a qualitative design, using instrumental case study at the Western Cape Government Emergency Medical Services, Khayelitsha base, Cape Town, this research delved into the experiences of emergency medical care providers during the pandemic, the psycho-social effects the pandemic had on these providers, the coping strategies employed during the crisis and the wellness-enhancing aspects within the context of a health crisis, such as the COVID-19 pandemic. The study data was obtained using one-on-one interviews with a sample of thirty emergency medical care providers and focus group interviews with nine managers from the Western Cape Government Emergency Medical Services, Khayelitsha base, Cape Town, who were operational during the pandemic. The samples included both staff who became infected with COVID-19 but recovered and those that did not contract COVID-19. The qualitative data was analysed using thematic analysis to identify key themes and patterns in the participants' responses. The findings propose a structural framework for bolstering the wellness of emergency medical services providers, within four wellness contexts of spirituality, family, work, and community, with suggested interventions in each context The findings highlight the importance of recognising and addressing the mental and social toll that emergency medical care work during the COVID-19 pandemic had on providers, as well as the need for ongoing preparation, support and resilience building in high-stress situations, such as the COVID-19 pandemic. The proposed framework may provide basis for further implementation of specific psycho-social interventions within emergency medical services work environment and inform policy development in this regard.