Browsing by Author "Saunders, Colleen"

Now showing 1 - 11 of 11
  • Thumbnail Image
    Item
    Open Access
    A retrospective analysis of the circumstantial factors contributing to drowning incidents reported in the South African media
    (2022) de Beer, Willem; Saunders, Colleen
    The first consensus guidelines for the uniform reporting of drowning were published in 2003, and specifically call for the precipitating factor to be described. The aim of this study was to describe the precipitating factors contributing to fatal drowning incidents reported in the South African media between January 2017 and March 2021 through a retrospective analysis of the Lifesaving South Africa media report database. There were 767 fatal drowning incidents reported during this period. Two thirds (66%) of reported incidents occurred during spring and summer, and the majority occurred in coastal provinces. Weekends and public holidays accounted for the highest frequency of reported incidents. Forty percent of reported fatal drowning victims were children under the age of 16 years. Approximately half (48%) of fatal drowning victims were swimming at the time of the incident, 17% drowned following accidental entry into the water and 11% were boating or sailing at the time of the incident. Understanding the activity immediately preceding the drowning event allows for more efficient and context appropriate design of prevention interventions.
  • Thumbnail Image
    Item
    Open Access
    A retrospective study of the prehospital burden of trauma managed by the Western Cape Government emergency medical service
    (2019) Abdullah, Mohammed Naseef; Saunders, Colleen; McCaul, Michael; Nyasulu, Peter
    Introduction: Trauma is one of the leading causes of premature death and disability in South Africa. There is a paucity of data describing the prehospital trauma burden in sub-Saharan Africa. The aim of this study was to describe the epidemiology and common trauma emergencies managed by the Western Cape Government emergency medical service (WCG EMS) in South Africa. Methods: The WCG EMS call centre registry was retrospectively analysed for all trauma patients managed between 01 July 2017 to 30 June 2018. A descriptive analysis of the data was performed using standard procedures for all variables. To date, this was the first analysis of this dataset or any prehospital trauma burden managed in the Western Cape of South Africa. Results: The WCG EMS managed 492 303 cases during the study period. Of these cases, 168 980 (34.3%) or 25.9 per 1000 population were trauma related. However, only 91 196 met the inclusion criteria for the study. The majority of patients (66.4%) were males and between the socio-economically active ages of 21-40 years old (54.0%). Assaults were the most common cause of trauma emergencies, accounting for 50.2% of the EMS case load managed. The patient acuity was categorised as being urgent for 47.5% of the cases, and 74.9% of the prehospital trauma burden was transported to a secondary level health care facility for definitive care. Conclusion: This is the first report of the prehospital trauma burden managed in the Western Cape of South Africa. The Western Cape suffers a unique trauma burden that differs from what is described by the WHO or any other LMIC. It also provides the foundation for further research towards understanding the emergency care needs in South Africa and to support Afrocentric health care solutions to decrease this public health crisis.
  • No Thumbnail Available
    Item
    Open Access
    An evaluation of emergency field side care following implementation of the BokSmart program for rugby in South Africa
    (2023) Green, Lidia; Saunders, Colleen; Dippenaar Enrico
    Introduction Despite the varied health and social benefits of participating in sports, catastrophic injuries associated with rugby such as those of the spinal cord, brain, and cardiovascular system are rare but can be permanently debilitating or even fatal. To improve injury prevention and surveillance of catastrophic injuries the Chris Burger Petro Jackson Player Fund and South African Rugby Union implemented the BokSmart programme in 2011. The aim of this study is to assess and compare how emergency field side care was affected. Methods This observational and descriptive study collected data from the entire Chris Burger Petro Jackson Player Fund catastrophic injury database (n=147) between 2008 and 2019. The study was divided into three parts to describe and analyse: i) the epidemiology of catastrophic injuries in rugby over time, ii) immediate post-injury management and association with player outcomes, and iii) emergency care personnel levels and association with immediate postinjury management. Comparisons were made throughout between pre- and postimplementation of the BokSmart programme. Results There was a significant decrease in the distribution of catastrophic injuries between pre- and post-implementation of the BokSmart programme. Similarly, there was a significant decrease in the mean number of acute spinal cord injuries per year in the post-implementation period. The incidence of injuries occurring during high-impact scrums also substantially decreased. Post-implementation there was an increase in the proportion of incidents where first on-field medical support were registered medical care professionals. Injured players were also more likely to receive care that adhered to the BokSmart guidelines post-implementation; however, this ultimately made no difference in the outcome of acute spinal cord injuries and saw a decrease in the use of external resources like Spineline.
  • No Thumbnail Available
    Item
    Open Access
    An evaluation of emergency field side care following implementation of the BokSmart program for rugby in South Africa
    (2023) Green, Lidia; Saunders, Colleen; Dippenaar Enrico
    Introduction Despite the varied health and social benefits of participating in sports, catastrophic injuries associated with rugby such as those of the spinal cord, brain, and cardiovascular system are rare but can be permanently debilitating or even fatal. To improve injury prevention and surveillance of catastrophic injuries the Chris Burger Petro Jackson Player Fund and South African Rugby Union implemented the BokSmart programme in 2011. The aim of this study is to assess and compare how emergency field side care was affected. Methods This observational and descriptive study collected data from the entire Chris Burger Petro Jackson Player Fund catastrophic injury database (n=147) between 2008 and 2019. The study was divided into three parts to describe and analyse: i) the epidemiology of catastrophic injuries in rugby over time, ii) immediate post-injury management and association with player outcomes, and iii) emergency care personnel levels and association with immediate post- injury management. Comparisons were made throughout between pre- and post- implementation of the BokSmart programme. Results There was a significant decrease in the distribution of catastrophic injuries between pre- and post-implementation of the BokSmart programme. Similarly, there was a significant decrease in the mean number of acute spinal cord injuries per year in the post-implementation period. The incidence of injuries occurring during high-impact scrums also substantially decreased. Post-implementation there was an increase in the proportion of incidents where first on-field medical support were registered medical care professionals. Injured players were also more likely to receive care that adhered to the BokSmart guidelines post-implementation; however, this ultimately made no difference in the outcome of acute spinal cord injuries and saw a decrease in the use of external resources like Spineline. Conclusion There has been a marked decrease in the mean number of catastrophic injuries per year following the implementation of the BokSmart programme, especially the proportion of acute spinal cord injuries following scrum law changes. This indicates that the BokSmart programme had a positive effect on emergency field-side care through decreasing catastrophic injuries from scrums, increasing the proportion of registered medical care professionals providing field-side care, and improved adherence to the BokSmart serious injury protocols. However, despite improved adherence, outcomes from acute spinal cord injuries have not improved. As there is little to no impact on the outcomes of spinal cord injuries due to the nature of the injury, a shift in focus towards prevention of catastrophic injuries and corresponding law changes should occur. The implementation of the BokSmart programme has shown to be effective through its educational programmes, injury surveillance, management, and reporting guidelines, to not only improve and optimise emergency field-side care, but also to reduce the incidence of catastrophic injuries across all levels of play in rugby.
  • Thumbnail Image
    Item
    Open Access
    Describing the use of social media as a point-of-care tool in facility-based emergency care in Africa
    (2023) Abdelrahman, Abdelmonim; Saunders, Colleen; Wallis, Lee A
    Background Despite privacy and legal concerns, social media is used to provide real-time clinical support to emergency care providers. It can be particularly beneficial for those in Africa, who might lack adequate training or access to information. This PhD aimed to describe the use of social media as a point-of-care telemedicine tool in facility-based emergency care in Africa, to further inform its use. Methods A scoping review was conducted to map available literature on use, benefits, and risks associated with social media as a point-of-care platform. A mixed methods approach was then taken using a cross-sectional survey and semi-structured interviews to obtain a comprehensive description of use of social media as a point-of-care tool in facility-based emergency care in Africa. Results The scoping review identified 13 publications describing use of social media as a point-of-care tool in emergency medical settings. No studies were located in low-income countries. All studies evaluated WhatsApp use for real-time consultations, and those that assessed reliability found it to be highly reliable for consultations. A total of 70 emergency care providers in African facilities responded to the survey; nearly all worked in low- or lower-middle-income countries. Responses showed that clinicians use social media multiple times each day, primarily to share and receive advice. The majority felt social media positively impacts patient and provider experiences and improves speed and safety. Finally, eight African emergency care providers were interviewed to gain an in-depth understanding of how social media use impacts emergency care. All participants noted routine use for a range of professional purposes, including consultations, administrative tasks, and education. Concerns were mentioned by all participants, including legality, privacy, and lack of employer regulations. Conclusions This dissertation provides insight into social media use of African emergency care physicians, showing that social media use in this group is ubiquitous. Most clinicians use social media multiple times each day for a range of point-of-care purposes, and many feel social media is positively impacting both the patient and provider experiences. Post-doctoral work will focus on developing a framework to guide use of social media in facility-based emergency care in the African setting.
  • Thumbnail Image
    Item
    Open Access
    Designing a course model for distance-based online bioinformatics training in Africa: The H3ABioNet experience
    (2017) Maslamoney, Suresh; Domelevo Entfellner, Jean-Baka; Guerfali, Fatma Z; Saunders, Colleen; Mansour Alzohairy, Ahmed; Cloete, Ruben; Mulder, Nicola
    Africa is not unique in its need for basic bioinformatics training for individuals from a diverse range of academic backgrounds. However, particular logistical challenges in Africa, most notably access to bioinformatics expertise and internet stability, must be addressed in order to meet this need on the continent. H3ABioNet (www.h3abionet.org), the Pan African Bioinformatics Network for H3Africa, has therefore developed an innovative, free-of-charge “Introduction to Bioinformatics” course, taking these challenges into account as part of its educational efforts to provide on-site training and develop local expertise inside its network. A multiple-delivery–mode learning model was selected for this 3-month course in order to increase access to (mostly) African, expert bioinformatics trainers. The content of the course was developed to include a range of fundamental bioinformatics topics at the introductory level. For the first iteration of the course (2016), classrooms with a total of 364 enrolled participants were hosted at 20 institutions across 10 African countries. To ensure that classroom success did not depend on stable internet, trainers pre-recorded their lectures, and classrooms downloaded and watched these locally during biweekly contact sessions. The trainers were available via video conferencing to take questions during contact sessions, as well as via online “question and discussion” forums outside of contact session time. This learning model, developed for a resource-limited setting, could easily be adapted to other settings.
  • Thumbnail Image
    Item
    Open Access
    Factors which affect the application and implementation of a spinal motion restriction protocol by prehospital providers in low resource settings: a scoping review
    (2021) Geduld, Charlene; Saunders, Colleen; Muller, Henra
    The South African Professional Board for Emergency Care prehospital Clinical Practice Guideline (CPG) recommends that emergency medical services (EMS) make use of the National Emergency X Radiography Utilization Study (NEXUS) rule and Canadian C-spine Rule (CCSR) when managing traumatic spinal injury. However, the safety and effectiveness of prehospital clinical spinal clearance or spinal motion restriction (SMR) decision support tools within poorly resourced settings are unclear. We conducted a scoping review on clinical spinal clearance and selective SMR decision support tools which aimed at identifying possible barriers to their implementation, safety, and effectiveness when used by EMS personnel. Studies were included if they described the use of clinical spinal clearance or SMR decision tools in first line management of blunt trauma patients by medical practitioners in the Emergency Department (ED) or by EMS personnel working in a prehospital setting. After screening, 42 documents fulfilled the inclusion criteria. Several selective SMR decision support tools have been implemented in the prehospital setting, the most common of which were those based on the NEXUS and the CCSR tools. Only one study evaluated the safety and efficacy of the NEXUS rule when used by EMS personnel. The limited prehospital literature available investigating either the NEXUS rule or CCSR therefore makes it difficult to determine its appropriateness for adoption and implementation by EMS personnel in other prehospital settings such as that of South Africa. Furthermore, commonly found prehospital NEXUS-based decision tools presented with unique challenges related to the subjective nature of some of the individual components of the decision tool. This leaves the decision tool open to interpretation by examiners and is especially relevant in settings, such as South Africa, where there are many different levels in scope of practices. This increases the risk of the patient being either under-triaged or over-triaged. More studies are therefore needed to definitively assess for the safety, efficacy and effectiveness of clinical spine clearance within the prehospital setting. It is believed that a selective SMR decision tool which has more specific instructions for the prehospital practitioner may be able to accommodate such challenges and is an area which needs further investigation.
  • Thumbnail Image
    Item
    Open Access
    Paediatric procedural sedation and analgesia in the emergency centre: a description of the fasting status
    (2023) Dunn, Cornelle; Cloete, Philip; Saunders, Colleen; Evans, K
    Background Procedural sedation and analgesia (PSA) is considered a core competency in emergency medicine as patients present to the Emergency Centre (EC) on an unscheduled basis, often complex complaints that necessitate emergent management (1). Previous evidence has consistently shown that procedural sedation and analgesia(PSA) in the EC in the paediatric population, even the very young, is safe if appropriate monitoring is performed and appropriate medications are used (2–5). The aim of the study was to describe the indications for PSA in the paediatric EC population, the fasting status of paediatric patients undergoing PSA, and the complications observed during PSA in a single Western Cape emergency centre. Methods A retrospective, descriptive study was conducted at Mitchells Plain Hospital, a district-level hospital situated in Mitchells Plain, Cape Town. All paediatric patients younger than 13 years of age who presented to the EC and received PSA during the study period (December 2020 – April 2021) were included in the study. Data was extracted from a standardised PSA form and simple descriptive statistics were used. Results A total of 116 patients (70,7% male) were included: 13 infants (<1 year of age) 48 young children (1-5 years of age) and 55 older children (5-13 years of age). There were only 2 (1,7%) complications documented, both of which were vomiting and did not require admission. The most of patients received ketamine (93,1%). The standardised PSA form was completed in 49,1% of cases. Indications for PSA included burns debridement (11,2%), suturing (17,2%), fracture reduction (23,3%), lumbar punctures (31,9%) and others (27,6%). The indications for PSA varied between the different age groups. Conclusion The study findings are in accordance with previous international literature. Emergency Centre PSA in the paediatric populations did not show an increase in interventions or complications, despite the fasting status (6). Safe, timely PSA with minimal pain and unnecessary suffering can become the norm in Emergency Medicine practice in South Africa.
  • Thumbnail Image
    Item
    Open Access
    The validation of the mid-upper arm circumference measurement in adults as a weight estimation tool in a high HIV prevalence setting
    (2022) Chen, Emily; Saunders, Colleen; van Hoving, Daniël J
    Background Accurate weight estimation in emergency centres is important to ensure accurate treatment and limit adverse outcomes. The mid-upper arm circumference (MUAC) as a weight estimation tool has recently expanded to adults. The MUAC's ease of use and cost effectiveness could be beneficial to estimate the weight of sick, adult patients presenting to emergency centres. The objectives were to assess correlation between MUAC and both weight and body mass index (BMI) in adults, externally validate an existing MUAC-based weight estimation formula in a high HIV prevalent emergency centre, and if inaccurate, to derive a MUAC-based weight estimation formula more suitable to the adult study population. Methods A cross-sectional diagnostic study was done in the emergency centre of Khayelitsha hospital, South Africa. Anthropometric data (MUAC, weight and height) and HIV status were obtained from consecutive adult (≥18 year) participants. Correlation of MUAC with weight and BMI were determined using Spearman's correlation coefficient with 95% confidence intervals in all participants and in HIV positive participants. Predicted weights were calculated from previously developed formulae (regression formula: kg=(3.8484×MUAC)−46.8585; simplified formula: kg=(4×MUAC)−50). The agreement between the predicted and observed weights were graphically assessed with a calibration plot. Linear regression was used to derive a MUAC-based formula in the study population. Results A total of 244 participants (median age = 37 years; 111 male) were included, of whom 121 (49.6%) were HIV positive. The correlation between MUAC and weight was 0.93 (HIV positive 0.92), and between MUAC and BMI 0.93 (HIV positive 0.94). The regression formula predicted weight within 10%, 20% and 30% of actual weight in 43.9%, 77.5% and 90.2% of all participants and 33.1%, 69.5% and 85.1% in HIV positive participants. The simplified formula predicted weights within 10%, 20% and 30% of actual weight in 46.7%, 77.5% and 89.8% of all participants and in 35.5%, 70.2% and 85.1% in HIV positive participants. The locally derived formula (kg=(3x MUAC) -16) better estimated weight in the local population.
  • Thumbnail Image
    Item
    Open Access
    Whole exome sequencing: a customised approach to exploring the genetic basis of musculoskeletal soft tissue injuries
    (2018) Gibbon, Andrea; September, Alison V; Collins, Malcolm; Saunders, Colleen
    Background: Several variants have been associated with the risk of musculoskeletal soft tissue injuries, suggesting a role for genetics in the aetiology of chronic Achilles tendinopathy (AT) and anterior cruciate ligament (ACL) ruptures. Genetic risk modifiers have primarily been identified using a hypothesis driven candidate gene approach. However, the ability to identify all risk-conferring variants using this approach alone is limited. Therefore, the primary aim of this thesis was to further define the molecular signatures of musculoskeletal soft tissue injuries mapping to specific genes. The genes encoding the tenascin-C glycoprotein (TNC, chromosome 9), the α1 chain of type XXVII collagen (COL27A1, chromosome 9), matrix metalloproteinase 3 (MMP3, chromosome 11) and the α1 chain of type I collagen (COL1A1, chromosome 17) were previously associated with the risk of injury and were therefore prioritised for further interrogation. Variants within these regions, which had either been previously associated with injury risk or prioritised from the list of new candidates identified by whole exome sequencing (WES) through the application of a customised tiered filtering strategy, were genotyped in several self-identified white AT and ACL rupture cohorts. The second aim of this study was to determine whether the observed risk-associated variants in the self-identified white cohorts were similar to those underpinning injury in the ancestrally admixed South African Coloured cohort, using ACL ruptures as the phenotypic model. The specific objectives of this thesis were: • To select well-phenotyped participants to be sequenced using an extended whole exome sequencing platform • The development and application of a reusable bioinformatics analyses pipeline involving a customised, tiered filtering strategy to select candidates for interrogation from the list of variants identified by WES. The TNC, COL27A1, MMP3 and COL1A1 genes were prioritised for further interrogation using this approach. • To test the association between the selected candidate variants and the risk of chronic AT and ACL ruptures using a case-control genetic association study design. The candidates selected from the list of variants identified by WES included: TNC rs1061494 (T>C), rs2104772 (T>A) and rs1061495 (T>C) and COL27A1 rs2567706 (A>G), rs2241671 (G>A) and rs2567705 (A>T). In addition, several variants previously associated with the risk of injury including TNC rs1138545 (C>T), MMP3 rs3025058 (5A>6A), rs679620 (G>A), rs591058 (C>T) and rs650108 (G>A) and COL1A1 rs1107946 (G>T) and rs1800012 (G>T), were also prioritised for investigation in additional injury cohorts. • To functionally annotate the prioritised variants using a host of in silico bioinformatic analyses tools. Methods Whole exome sequencing and data processing: Ten asymptomatic controls and ten chronic AT cases were selected for sequencing. Controls were older than 47 years of age, were physically active and had not reported any previous tendon or ligament injuries. Cases were younger than 35 years of age, had suffered chronic, bilateral Achilles tendinopathy and/or reported several Achilles tendon injuries. Paired-end WES was performed on the Illumina HiSeq 2000/2500 platform at 30X coverage. A customised, tiered filtering strategy was developed to screen for candidate variants. All candidate variants were confirmed using Sanger Sequencing and genotyped, together with the other prioritised variants in the larger injury cohorts. Case-control genetic association studies Achilles tendon injury cohorts: Three cohorts were independently recruited from South Africa (SA), Australia (AUS) and the United Kingdom (UK). The South African White (SAW)- Achilles tendon injury cohort consisted of 165 controls (SAW-CONAT), 123 cases with chronic Achilles tendinopathy (SAW-TEN) and 47 cases with acute Achilles tendon ruptures (SAWRUP). The UK-Achilles tendon injury cohort consisted of 130 controls (UK-CON), 87 cases with chronic Achilles tendinopathy (UK-TEN) and 35 cases with acute Achilles tendon rupture (UKRUP). The AUS-Achilles tendon injury cohort included 210 controls (AUS-CON) and 85 cases with chronic Achilles tendinopathy (AUS-TEN). Anterior cruciate ligament rupture cohorts: The first ACL rupture cohort consisted of 232 control participants (SAW-CONACL) and 234 cases with surgically diagnosed ACL ruptures (SAW-ACL), of which 135 were reportedly non-contact in mechanism (SAW-NON). All participants in this group were self-identified to be of South African White ancestry. The participants in the second South African ACL rupture cohort were of mixed ancestry and self-identified as being South African Coloured (SAC). This group consisted of 100 controls (SAC-CON) and 97 participants with surgically diagnosed ACL ruptures (SAC-ACL), of which 50 were reportedly non-contact in mechanism (SAC-NON). The TNC and COL27A1 genomic intervals were explored through the TNC rs1061494, rs1138545, rs2104772 and rs1061495 variants and the COL27A1 rs2567706, rs2241671 and rs2567705 variants in the SAW- and UK-Achilles tendon injury cohorts, in addition to the SAWand SAC-ACL rupture cohorts. The MMP3 locus was explored using the previous riskassociated rs3025058, rs679620, rs591058 and rs650108 variants in the AUS-Achilles tendon injury and SAW-ACL rupture cohorts. Chapter 5 explored the COL1A1 locus using the previous risk-associated COL1A1 rs1107946 and rs1800012 variants in the SAW- and UK-Achilles tendon injury cohorts, in addition to the SAW-ACL rupture and SAC-ACL rupture cohorts. Statistical analyses were performed using the R programming environment, with statistical significance set at PC) variant is predicted to overlap the sequence motifs of the muscle initiator nuclear protein, members of the myogenic family of transcription factors and RNA polymerase II subunit A. Furthermore, the rs1061494 variant demonstrated marked differences in its predicted pre-mRNA structure. The other TNC variant associated with injury risk, rs2104772 (T>A), was predicted to be deleterious by two independent annotation tools. The investigated COL27A1 variants were suggested to interact with several predicted enhancers of cellular function. However, this gene is still relatively uncharacterised in musculoskeletal soft tissue injuries, and therefore, these variants will require further interrogation. The 8kb MMP3 genomic interval demonstrated high levels of linkage disequilibrium. Furthermore, MMP3 was predicted to interact with the MMP12 gene mediated by chromatin looping. The COL1A1 rs1800012 (G>T) variant overlaps the recognition sequence of the Sp1 transcription factor in intron 1. This variant is also proposed to interact with the functional promoter variants, rs1107946 (G>T) and rs11327935 (indel/T). This interaction is suggested to be mediated by chromatin looping. Furthermore, the rare rs1800012 T allele is predicted to result in a looser mRNA conformation immediately surrounding the variant within the pre-mRNA sequence compared to the ancestral G allele. Conclusion: These results provide proof of concept for the use of WES and a customised tiered filtering strategy to identify and prioritise variants for further interrogation using traditional molecular techniques. This approach, utilising previous research to guide a targeted analysis of a WES dataset has highlighted the potential risk modifying effects of several new variants in the TNC and COL27A1 genes. Furthermore, haplotype analysis has implicated several signatures encompassing variants previously associated with risk of injury in the four investigated genes. Although no new candidate variants within the MMP3 and COL1A1 genes were independently associated with risk of injury, unique allele combinations were observed to co-segregate with an altered injury risk profile. Therefore, this study has genetically characterised several previously implicated loci and highlighted new sequence signatures, which may potentially contribute to the susceptibility of musculoskeletal soft tissue injuries. The next step would be to explore the functional significance of these sequence signatures in vitro; a process that would help further characterise the biological mechanisms underpinning the observed risk associations.
  • Thumbnail Image
    Item
    Open Access
    Workplace violence against emergency medicine registrars and consultants, and their experience of job safety and satisfaction
    (2021) Midgley, Alexandra; Saunders, Colleen; Jooste, Willem; Geduld, Heike
    Background: Studies have shown that healthcare workers in Emergency Units (EUs) are at a high risk of both physical and non-physical workplace violence. While several international studies have focused on the experience of workplace violence by Emergency Medicine (EM) specialist physicians, there is a paucity of data regarding that of EM physicians in training. Objectives: This study aimed to determine the amount of workplace violence (and the subtypes thereof) perpetrated against Western Cape EM registrars and consultants, and their perceived level of, and identified barriers to and facilitators of, job safety and satisfaction. Methods: This cross-sectional study relied upon responses to a survey, electronically disseminated over a 6-week period, in May/June 2018, amongst Western Cape public sector EM registrars and consultants. The primary outcome was the incidence of workplace violence experienced. The secondary outcomes were the sub-types of workplace violence perpetrated, as well as the perceived level of job safety and satisfaction, and identified barriers thereto and facilitators thereof. Results: In total, 66% of respondents had experienced at least one act of physical violence while working in Western Cape EUs, specifically by patients. Regarding non-physical violence, 90.6% of respondents had experienced at least one act of verbal harassment, 84.9% of verbal threat, and 45.3% of sexual harassment. The rates of both physical and non-physical workplace violence (especially sexual harassment), perpetrated by patients specifically, were found to be higher in female than in male respondents. Apart from acts of verbal harassment, which were perpetrated equally by patients and visitors, all other acts of physical and nonphysical workplace violence were perpetrated at a higher rate by patients than visitors. The rates of both physical and non-physical workplace violence, perpetrated by patients specifically, were found to be higher in EM consultants than in EM registrars. The factors most commonly indicated by respondents as contributory to workplace violence were patient and/or visitor alcohol use, drug use and psychiatric illness. Other factors commonly indicated were long waiting times and unmet expectations, and resultant patient and/or visitor frustration. Conclusion: Workplace violence against EM registrars and consultants is a significant problem in Western Cape EUs. The information gained during this study will be useful in improving safety and security policies at an EU (and hospital) level. It may even be applicable at a provincial (or national) level in changing legislation, in order to reduce, and ultimately prevent, workplace violence in the EU.