Browsing by Author "Saunders, Collen"

Now showing 1 - 2 of 2
  • Thumbnail Image
    Item
    Open Access
    A descriptive study of patients presenting with a chief complaint of seizures to the prehospital emergency care practitioner of the Western Cape
    (2019) Bester, Beatrix Hendrina; Saunders, Collen; Allgaier, Rachel
    Background Seizures are considered one of the most common time-sensitive and potentially life-threatening medical emergencies presenting to emergency centres and attended to by prehospital emergency care practitioners. These require a rapid response, prompt identification and appropriate management. There is a paucity of information describing the demographics and prehospital management of patients presenting with seizures in South Africa. Objectives The aim of this study was to describe the demographics and prehospital management of patients presenting with a chief complaint of seizures and/or convulsions to prehospital emergency care practitioners within the Western Cape Government Emergency Medical Services. Methods This retrospective study included all Western Cape Government Emergency Medical Services calls indicating a chief complaint of seizures and/or convulsions between August 2017 and July 2018. Descriptive statistics were performed to describe basic demographics in this population. A sample of emergency calls originating within the City of Cape Town was selected for a clinical chart review to describe on-scene clinical presentation and vitals, response times, and prehospital treatment provided. Results A total of 24 746 seizure and/or convulsion cases were recorded during the study period. The highest frequency of patients was in the 21 - 40 year age group (31%), and 57% of patients were male. The subsample (n=3 075) yielded 1 571 cases with completed electronic patient care records. The mean dispatch and response times were 20 (±36) and 14 (±10) minutes respectively with a mean on-scene time of 25 (±13) minutes. No on-scene vital signs were recorded in 11.3% of patients. Recorded on-scene vitals indicated that 36% of patients presented with a tachycardia, 14% had an oxygen saturation of < 95%. Airway manoeuvres were performed in 30% of cases, and 50% of patients presenting with a SpO2 < 95% received supplemental oxygen. The benzodiazepine Diazepam was the most common medication administered, and 83% of medications were administer through the intravenous route. Conclusions Seizures are a recognised time-sensitive emergency, however in this sample of patients we observed a longer than expected dispatch time. Although the importance of recording baseline vital signs is recognised, there was a large proportion of undocumented vital signs 35 within the sample. Despite consensus recommendations that intramuscular midazolam are the preferred medication and route, IV diazepam was the most frequently administered. Seizures are an under-recognised burden on Emergency Medical Services within the Western Cape. This study provides an initial description of the epidemiology within this population, allowing for optimization of recognition and management in these patients.
  • 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.