Browsing by Author "Smith, Wayne"

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    Open Access
    An analysis of health facility preparedness for major incidents in Kampala
    (2016) Kalanzi, Joseph; Smith, Wayne; Wallis, Lee
    Background & Objectives: Major incidents occur commonly in Uganda, but little is known about either local hazards which risk causing major incidents, or health system preparedness for such events. Understanding risk and current preparedness is the first step in improving response. Methods: We undertook a cross - sectional study across four teaching hospitals in Kampala (Mulago National Referral Hospital, Nsambya Hospital, Mengo Hospital and Lubaga Hospital). A local geographic area Hazard Vulnerability Analysis (HVA) f or each site was combined with a key informant questionnaire and standardized facility checklist within the hospitals. Data collected included status of major incident committees, operational major incident plans and facility major incident operation centres, bed capacity, equipment and supplies and staffing. The HVA assessed the human impact, impact on property and on business of the hazards as well as measures for mitigation (preparedness, internal response and external response) in place at the hospitals. Results: Only one of the four hospitals was found to have had an operational major incident plan. The designated coordinator for major incidents across all facilities was mostly a general surgeon; no funds were specifically allocated for planning .All hospitals have procedures for triage, resuscitation, stabilization and treatment. None of the facilities had officially designated a major incident committee. All the facilities had sufficient supplies for daily use but none had specifically stock piled any reserves for major incidents. All hospitals were staffed by at least a medical officer, clinical officers, nurses and a specialist with procedures for mobilizing extra staff s for major incidents. Some staffs had received some emergency care training in courses namely basic life support, advanced trauma life support, primary trauma care and emergency triage and treatment but no team had received training in major incident response. Only one hospital carried out annual simulation exercises. Incidents involving human hazards specifically bomb threats, road crash mass casualty incidents, civil disorder and epidemics posed the highest risk to all four hospitals and yet preparation and response measures were inadequate. Conclusion: Hospitals in Kampala face a wide range of hazards and frequent major incidents but despite this they remain under - prepared to respond. Large gaps were identified in as far as staffing, equipment and infrastructure.
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    A description of practices of analgesia administration by advanced life support paramedics in the City of Cape Town
    (2016) Matthews, Ryan; Smith, Wayne
    Introduction: Emergency Medical Services (EMS) are ideally placed to provide relief of acute pain and discomfort. EMS frequently follow locally prescribed guidelines and have a variety of qualifications each with differing capabilities and scopes of practice. The objectives of this study are to describe prehospital pain management practices by EMS in the Western Cape, South Africa. Methods: A retrospective descriptive survey was undertaken of analgesic drug administration by advanced life support (ALS) paramedics. Patient care records (PCRs) generated in t he City of Cape Town during an 11 month period containing administrations of Morphine, Ketamine, Nitrates and 50% Nitrous Oxide/Oxygen were randomly sampled. Variables studied were drug dose, dose frequency, and route of administration, patient age, gender, disorder and call type as well as qualification and experience level of the provider. Results: A total of 530 PCRs were included (N=530). Morphine was administered in 70% (95% CI 66 - 74, n=371) of cases, Nitrates in 37 %(95% CI 33 - 41, n=197) and Ketamine in 1.7% (95% CI 1 - 3, n=9) of cases. A total of 5mg or less of Morphine was administered in 75% (95% CI 70 - 79, n=278), with the mean dose being 4mg (IQR 3 - 6). Single doses were administered in 72.2% (95% CI, 67 - 77, n=268) of Morphine administrations, 56% (95% CI, 21 - 86, n=5) of Ketamine administrations and 82% (95% CI, 76 - 87, n=161) of Nitrate administrations. Chest pain was the reason for pain management in 43% (n=226) of cases. ALS providers have a median experience level of 2 years (IQR2 - 4). Conclusion: ALS providers in the Western Cape appear to use low doses of Morphine, with most analgesia administered as a single dose. Chest pain is an important reason for drug administration in acute prehospital pain. Paramedics do not appear to be using a weight based nor a titration based strategy.
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    Open Access
    Major Incident Communication Cascade Evaluation
    (2009) Carstens, Charl; Smith, Wayne
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    Modified Delphi study to determine the components of a Medical Cache required for local or international medical deployment after a major incident or disaster
    (2014) Seymour, Nadine; Smith, Wayne
    Background: Disasters occur without warning; they have the potential to cause chaos and destruction in unsuspecting communities and on the environment. The personnel of the Western Cape Emergency Medical and Rescue Services are suitably trained to respond to major incidents or disasters, but lack the support of a standardised medical cache. This in turn compromises the preparedness of such a team to deploy to major incidents and or disasters inside and outside the provincial boundaries. Aim: This study was to obtain consensus regarding what such a medical cache should be comprised of, specifically regarding medical equipment and pharmacological agents. Methodology: A three iteration modified Delphi study was conducted over ten months. During this time selected experts who are currently working in the field of disaster response and emergency medicine, were asked to voluntarily and anonymously complete three iterations of questionnaires. After each iteration the primary researcher collected and analysed the responses for consensus. Consensus was set at 85% so as to formulate the questionnaires for the subsequent iterations. Results: Consensus was achieved with items like the laryngoscope; rugged electrocardiogram with extra-long leads; scoop stretcher; stokes basket and a KEO. Other items such as the Arterial Blood Gas (ABG) machine and the Ultrasound machine did not achieve consensus. Disposable equipment like endotracheal tubes; bandages; intravenous administration sets and dial-a-flow devices were amongst the items to be included in the medical cache, these were based on existing research regarding disposable equipment. The majority of pharmacological agents, such as broad spectrum Antibiotics, Suxamethonium and Fentanyl achieved consensus early on; while other pharmacological agents like Ondansetron and Thrombolytic agents did unsurprisingly not achieve consensus across any of the iterations. Conclusion: This study assisted in identifying the necessary medical equipment and pharmacological agents to be included in a medical cache, which would enable medical rescue teams to be prepared prior and during deployment, whether in or outside the borders of the Western Cape, South Africa or internationally.
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    Patient presentations during the 2010 FIFA World Cup: Cape Town, South Africa's public emergency centres
    (2012) Galal, Meenal; Smith, Wayne; Allgaier, Rachel
    In light of the inconclusive findings highlighted within the literature currently, suggestions have been made that further studies are required in order to gain deeper insight into the dynamics and variables which may influence patient presentation to emergency centres during major sporting events, as well as their significance, if any. The primary aim of the study is to determine what impact the 2010 FIFA World Cup South AfricaTM had on emergency centre presentations. The objective of the study is to conduct a retrospective, observational, cross-sectional study utilizing previously collected audit data from emergency centre records during the period of a major sporting event, the 2010 FIFA World Cup South AfricaTM, ie. 11th June 2010 to 11th July 2010. The data of the WC2010 audit will be analysed to assess the presence of any statistically significant differences between analyzed variables within the period in question as compared with the control period (11th June to 11th July 2009), in which there was an absence of such an event. A comparison of the data described, to control periods with an absence of major sporting events may allow insight into whether such events require consideration of staffing requirements, capacity/throughput assessment and contingency planning, or not.