Browsing by Author "Fleming, Julian"

Now showing 1 - 3 of 3
  • Thumbnail Image
    Item
    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.
  • Thumbnail Image
    Item
    Open Access
    An evaluation of blood cultures in the emergency centre
    (2011) Fleming, Julian
    The aim of this study is to determine whether routine blood cultures performed in a secondary level hospital Emergency Centre affect the choice of antibiotic used in treating patients with bacterial infections. A secondary aim is to determine if staff in the EC are aware of correct procedures for drawing blood cultures, and whether their practice reflects this. This will be a retrospective analysis of all blood cultures done in GF Jooste hospital over a 12 month period (1 April 2008 - 31 March 2009). The EC sees approximately 45 000 patients per year, and approximately 300 blood cultures are performed every month. Inclusion criteria: Age 18 or greater; Blood culture performed by EC staff in EC; Recorded blood culture result by laboratory; Patient in hospital when results received. The data will be analysed and presented as simple descriptive statistics.
  • Thumbnail Image
    Item
    Open Access
    ‘The rates of pre-hospital over-triage and the reasons behind them in a Cape Town setting'
    (2021) McAlpine, David; Hodkinson, Peter; Fleming, Julian
    Introduction: Inappropriate dispatch of urgent ambulances by call centre personnel causes an unnecessary drain on existing resources. How often these urgent dispatches are inappropriate has not been evaluated in any lower middle income countries, nor have factors been assessed that contribute to these decisions. Problem: The study aims to establish rates of pre-hospital over-triage in Cape Town, South Africa and to assess the call centre factors around these decision-making processes. Methods: This was a retrospective study examining a single calendar month of all urgent ("lights and sirens") ambulance dispatches made from a large public sector ambulance call centre in Cape Town. On-scene, the ambulance field crew assessed these patients using the South African Triage Score (SATS) and these assessments were correlated with the prioritization of these dispatches by the call centre to determine which patients were 'over-triaged' by the call-taker. Contributory factors were also analysed and included time of day, nature of presenting complaint; and call-taker training and experience - all of which may have affected rates of over-triage. Results: In the course of one month in 2017, 4169 urgent calls were assessed: of these 2701 were over-triaged (58.48%). Over-triage was similar between day (58.02%) and night (59.11%). The most regularly over-triaged complaint was obstetric & gynaecological (84.87%) followed by motor vehicle accidents (65.70%); the lowest rate was for cardiac call-outs (47.12%). We reviewed the 38 highest workload call-takers, and found subtle, but non-statistically significant, trends towards higher over-triage rates with higher levels of training (ILS 62.16%, no medical training 59.42%; p=0.67), more years as a call-taker (< 2 years 59.32%, > 5 years 60.23%; p=0.93) and more years working in the field (0 years 59.36%, > 5 years 63.66%; p=0.31). Conclusion: Rates of pre-hospital over-triage in Cape Town are marginally lower than those described internationally. The nature of the complaint had a strong impact on these rates, notably trauma and gynaecological issues. More experienced call-takers may tend to over-triage more frequently, however the small sample size made these findings uncertain. These findings do however suggest the potential for improvement for better efficiency without compromising patient safety.