Browsing by Author "Howard, Ian"

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    Open Access
    A Trigger-Tool-based Description of Adverse Events in Helicopter Emergency Medical Services in Qatar
    (2021) Heuer, Calvin; Stassen, Willem; Howard, Ian
    Introduction Adverse Events (AEs) in Helicopter Emergency Medical Services (HEMS) remains poorly reported, despite the potential for harm to occur. The Trigger Tool (TT) represents a novel approach to AE detection in healthcare. The aim of this study was to retrospectively describe the frequency of AEs and their Proximal Causes (PCs) in Qatar HEMS. Methods Using the Pittsburgh Adverse Event Tool (PittAETool) to identify AEs in HEMS, we retrospectively analyzed 804 records within an existing AE TT database (21-month period). We calculated outcome measures for Triggers, AEs, and Harm per 100 patient encounters, plotted measures on Statistical Process Control (SPC) charts, and conducted a multivariate analysis to report harm associations. Results We identified 883 Triggers in 536 patients, with a rate of 1.1 Triggers per Patient Encounter, where 81.2% had Documentation Errors (n=436). An AE and Harm rate of 27.7% and 3.5% respectively was realized. The leading PC was Actions by HEMS Crew (81.6%; n=182). The majority of harm (57.1%) stemmed from the Intervention and Medication triggers (n=16), where Deviation from Standard of Care was common (37.9%; n=11). Age and diagnosis adjusted odds was significant in the Patient Condition (6.50; 95% CI, 1.71-24.67; P= 0.01) and Interventional (11.85; 95% CI, 1.36-102.92; P= 0.03) trigger groupings, while age and diagnosis had no effect on Harm. Conclusion The TT methodology is a robust, reliable, and valid means of AE detection in the HEMS domain. Whilst an AE rate of 27.7% is high, more research is required to understand prehospital clinical decision-making and reasons for guideline deviance. Furthermore, focused quality improvement initiatives to reduce AEs and Documentation errors should also be addressed in future research.
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    Open Access
    Current practice in the air medical services for the inter-facility transfer of paediatric patients in the Western Cape, South Africa
    (2013) Howard, Ian; Welzel, Tyson
    Includes abstract. Includes bibliographical references.
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    Metoclopramide vs Prochlorperazine for the treatment of Nausea and Vomiting in the Emergency Care Setting: A Scoping Review
    (2019) Areff, Shamiel; Hodkinson, Peter; Howard, Ian
    Introduction: Nausea and vomiting are a common complaint with a wide variety of aetiologies. Patients frequently present to emergency care providers seeking treatment for nausea and vomiting. Metoclopramide and prochlorperazine are well established drugs that have long been used in the treatment of nausea and vomiting. This scoping review aims to map out the available literature on metoclopramide and prochlorperazine in treating nausea and vomiting in the emergency setting, and more specifically for prehospital use. Methods: A broad literature search was conducted using the following search terms “nausea”, “vomiting”, “emergency care setting”, “prehospital”, “motion sickness”, “emergency medical services”, “metoclopramide”, “prochlorperazine”, was done on online databases such as Pubmed, Medline, Embase Cochrane databases, CINAHL, Web of Science, TRIP and EBSCO host. Results: A total of 11 articles were found published between 1989 and 2014. Ten studies were found from emergency centres and just one from the prehospital setting. Six studies originated in America, three in Australia, one in the United Kingdom, and one in New Zealand. The total number of patients in the 11 included studies were 1319 subjects, where 511 received metoclopramide, 448 received a placebo, and 98 patients received prochlorperazine. One study found prochlorperazine to be the better antiemetic at treating nausea and vomiting, one study found metoclopramide to be better, and three studies found that the prophylactic use of metoclopramide cannot be justified. Conclusion: There is no consensus on the superiority of metoclopramide or prochlorperazine to treat uncomplicated nausea and vomiting in the emergency care setting. There is a paucity of research available and further studies needs to be done, particularly in the prehospital arena.
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    Rescue activity of a civilian helicopter emergency medical service in the western cape, South Africa: a five-year retrospective review
    (2021) Park-Ross, Jocelyn Frances; Hodkinson, Peter; Howard, Ian
    Introduction - Helicopter search and rescue in Africa is conducted primarily by military organizations. Since 2002 the Western Cape of South Africa has had a dedicated contracted civilian helicopter emergency medical service (HEMS) conducting air ambulance, terrestrial and aquatic rescue. This is the first description of the operations of an African helicopter rescue service. Objective - To describe the terrestrial and aquatic helicopter rescue activity of a civilian operated HEMS in the Western Cape, South Africa from 1 January 2012 – 31 December 2016. Methods - A five-year retrospective review was conducted using data from the organization's operational database, aviation documents, rescue reports and patient care records. Patient demographics and activity at time of rescue, temporal and geographical distribution, crewing compositions, patient injury, triage, clinical interventions and rescue techniques were analysed. Results – A total of 581 search and rescue missions were conducted, of which 451 were terrestrial and 130 aquatic rescues. The highest volume of rescues was conducted within the urban Cape Peninsula. Hoisting using a rescue harness was the most common rescue technique used. 644 patients were rescued. Uninjured or minorly injured persons represented 79% of the sample. Trauma (33%, 196/644) was the most common medical reason for rescue, with lower limb trauma predominant (15%, 90/644). The most common clinical interventions performed were intravenous access (108, 24%), spinal immobilization (92, 21%), splinting (76, 17%) and analgesia administration (58, 13%). Conclusions - The patient demographics and rescue activity described are similar to those described in high-income settings.