Browsing by Author "Evans, Katya"

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    A manikin-based simulation study of a dispatch operator directed CPR algorithm within the Western Cape setting and the self- reported comfort around its execution
    (2021) De Caires, Leonel Paulo; Stassen, Willem; Evans, Katya
    Background: There is little data in Africa regarding dispatch guided telephonic CPR. This study looks at the quality of CPR performed when compared to AHA guidelines, by untrained laypersons when given telephonic CPR instructions using the Western Cape EMS Guidecards algorithm for telephone assisted CPR. Methods: In this prospective observational, simulation study, participants were given telephonic hands-only CPR instructions using the Western Cape EMS Guidecards. CPR quality (hand placement, rate, depth and chest recoil) was analysed and then followed by a questionnaire looking at the self-reported comfort regarding the execution of said instructions. Results: Overall quality of CPR by participants (n=50) was suboptimal with no participant complying with current CPR guidelines. Demographic factors influenced quality where males pushed on average deeper (40.8mm vs 28.5mm, p=0.004) when compared to females. Correct hand placement and chest exposure were directly related to the caregivers' home language with English making it more likely to correctly perform these instructions (p=0.01 and p=0.002, respectively). Self-reported comfort had no effect on executed CPR quality. Conclusion: The quality of CPR performed by laypersons, when directed by a call-taker using the Western Cape Provincial EMS Guidecards Algorithm, can be suboptimal in terms of compression rate, depth, full chest recoil and baring of the chest. There is an urgent need to find more effective ways, in the Western Cape EMS, to improve executed CPR quality when guided by a trained telephone operator.
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    Prehospital care providers' decision to transport the patient with a suicide attempt refusing care in the Cape Town Metropole, Western Cape: A survey based on the Mental Healthcare Act of 2002
    (2015) Evans, Katya; Geduld, Heike; Stassen, Willem
    Anecdotally incidents of inappropriate refusal of treatment or transportation by patients referred to hospital under the Mental Healthcare Act of 2002 have been noted. There is little documented about the knowledge and understanding of prehospital providers of the mental healthcare act, their responsibilities and the issues around patient competence and refusal of care. The transportation of patients presenting with a suicide attempt who have not yet been formally assessed for involuntary admission poses a particular problem. Aim: To determine the knowledge of prehospital providers with respect to the transport of patients presenting with suicide attempts and the mental health act and to describe their management of cases where these patients may refuse treatment. Methods: A cross-sectional survey and including open ended questions of 100 prehospital providers in the Western Cape both public and private. The questionnaire will include knowledge testing, vignettes describing patient management and open-ended questions regarding their opinions on suicidal patients. Simple descriptive statistics will be used for the knowledge test. Qualitative data will be coded using a grounded theory approach. Discussion: The findings of the study will be used to determine provider knowledge and attitudes regarding the prehospital management of patients presenting with suicide attempts. Recommendations will be made for provincial EMS guidelines and the results will be disseminated in an article for publication.
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    Preparedness for Paediatric CPR amongst Doctors in Cape Town
    (2022) Amien, Nabeela; Bresick, Graham; Evans, Katya
    Background: CPR is the principal medical intervention used to reduce the high mortality associated with cardiorespiratory arrest. There is a paucity of literature on the preparedness for paediatric CPR (pCPR) amongst doctors in Cape Town. The study aimed to assess the preparedness for pCPR of doctors working in Western Cape Provincial Government primary healthcare facilities (PHCFs) in Cape Town with regard to knowledge, confidence and doctors' knowledge of equipment availability. Methods: A cross-sectional descriptive-analytic study using a self-developed questionnaire to collect quantitative data from a sample of 206 doctors working in Cape Town PHCFs. Results: 173 doctors (84% response rate) completed the questionnaire. The majority (81.8%) had not done a pCPR course (Paediatric Advanced Life Support or Advanced Paediatric Life Support). 88.3% had done Basic Life Support; 28% >2 years ago. The average pCPR knowledge score was 61% (SD=20.3, range 8.3-100%). Doctors doing their community service and internship had significantly higher knowledge scores compared to Grade 3 medical officers (p = .001 and .010 respectively). 11% had performed pCPR >10 times in the past year; 20% had never performed pCPR, and 35% did not feel confident performing pCPR. More than 35% of doctors were uncertain about the availability of equipment in their facility. Conclusion: Doctors working in Cape Town PHCFs are poorly prepared to perform pCPR. Doctors' knowledge of pCPR and availability of equipment is inadequate and confidence in their ability to perform pCPR is low. Formal pCPR training and education on equipment location and availability is recommended.
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    The burden of firearm injuries at two district level emergency centres in Cape Town, South Africa: a descriptive analysis
    (2022) Bush, Luke Anthony; Evans, Katya; Hendrikse, Clint; Van Koningsbruggen, Candice
    Introduction Firearm injuries account for an increasingly significant portion of violence related trauma experienced in South Africa. The related burden on district level emergency care, surgical and inpatient services is poorly described. This research aims to provide epidemiological and health service data on patients sustaining firearm injuries presenting at Mitchells Plain Hospital and Heideveld Emergency Centre. The research also assesses the association of the Triage Early Warning Score with anatomical location of injury, the need for surgical intervention and mortality. A geographical analysis of incident location with respect to home address has also been undertaken. Methods All patients who presented to these emergency centres with a firearm injury over a 12-month period (1 Jan 2019 – 31 Dec 2019) were eligible for inclusion in a retrospective chart review. Results Seven-hundred-and-seventy-six firearm injuries were analysed with those injured having a mean age of 27 years and 91% of those injured being male. Sixty-seven percent of patients self-presented and there were 18 deaths in the emergency centre and a further 23 as an inpatient. The Triage Early Warning Score and Shock Index both showed statistical significance when comparing those not surviving to hospital discharge against those that did survive (p<0.01). Discussion Firearm injuries represented 5.7% of all trauma seen at these two facilities and likely form a higher proportion of the injury profile than at other district services in the City of Cape Town. Although a significant number of those injured are transferred out to tertiary centres that are better capacitated to manage these injuries, many remain at district level for their care. Conclusion Firearm injuries, the immediate surgical needs of those injured and the long-term consequence of those injuries pose a significant burden on limited healthcare resources. Multi-sectoral action, supported by evidence-based primary and secondary preventative strategies, is required to reduce this intentional injury burden, and mitigate the effects.