Browsing by Author "Stassen, W"
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- ItemOpen AccessDeveloping call out criteria for South African helicopter services: A delphi study(2018) Laatz, Diane Inge; Welzel,Tyson; Stassen, WBackground Helicopter Emergency Medical Services (HEMS) are an expensive resource that should be utilised efficiently to optimise the cost-benefit ratio. This is especially true in resource-limited settings, such as South Africa. This may be achieved by implementing call-out criteria that are most appropriate to the healthcare system in which HEMS operate. Currently, there are no published evidence-based HEMS callout criteria developed for South Africa. By identifying patients that are most likely to benefit from HEMS, their utilisation can be enhanced and adjusted to ensure optimal patient outcome. Aim To systematically utilise expert opinions to reach consensus on HEMS call-out criteria that are contextual to the South African setting. Methods A modified Delphi technique was used to develop call-out criteria, using current literature as the basis of the study. Purposive, snowball sampling was employed to identify a sample of 118 participants locally and internationally, of which 42 participated for all three rounds. Using an online survey platform, binary agreement/disagreement with each criterion was sought. Acceptable consensus was set at 75%. Statements were sent out in the third round ascertaining whether participants agreed with the analysis of the first two rounds. Results After two rounds, consensus was obtained for 63% (36/57) of criteria, while 64% of generated statements received consensus in the third round. Results emphasised the opinion that HEMS dispatch criteria relating to patient condition and incident locations were preferential to a comprehensive list. We present these criteria in a collated format, favouring further inquiry on a case-by-case basis. Participants suggested the use of a screening tool, which can guide dispatch decision-making. Conclusion The combination of existing literature and participant opinions, established that callout criteria are most efficient when based on clinical parameters and geographic considerations, as opposed to a specified list of criteria. This could improve resource allocation, specifically in a low to middle income country such as South Africa.
- ItemOpen AccessRisks to responders safety and mitigation strategies during rescue work in natural disasters: a scoping review(2022) Alzahrani, Yahya; Stassen, W; Rambharose, SIntroduction: Emergency medical services (EMS) who attend to natural disasters are at a high risk of experiencing numerous psychological and physical conditions that adversely affect their health and safety as well as their ability to serve their purpose. This study aimed to identify factors that affect EMS responders' health and safety in natural disasters and provide information to mitigate harm in future natural disasters. Methods: A scoping review was conducted to identify literature published between 2000 and 2020 relating to EMS responder safety in natural disasters according to a predetermined search strategy. Titles and abstracts were first screened, whereafter full texts were reviewed and extracted. Results: In total, 49 articles were identified and 22 articles were ultimately included. The findings from the research identified numerous factors and outcomes that affect the health and safety of responders attending to disasters. These could be categorised into mental and psychological issues (PTSD, suicidal ideation, depression) and physical issues (environmental, infectious, and traumatic conditions). Conclusion: Numerous health and safety hazards befall responders attending to natural disasters and the variability of their incidence commands case-specific prevention and mitigation strategies. There is poor monitoring of factors affecting the health and safety of responders as well as their consequences, making current mitigation and prevention strategies ineffective. Enhanced surveillance and reporting systems should be developed and implemented to inform and improve mitigation strategies.
- ItemOpen AccessThe prevalence of hypotension and hypoxaemia in blunt traumatic brain injury in the prehospital setting of Johannesburg, South Africa: A retrospective chart review(2014) Stassen, W; Welzel, TBACKGROUND: Each year, ~89 000 (180/100 000) new cases of head injury are reported in South Africa (SA), with the majority of patients being in the economically active population. Hypotension and hypoxaemia significantly increase the morbidity and mortality in patients who have suffered a traumatic brain injury (TBI). Cerebral tissue is particularly vulnerable to these secondary insults in the period immediately following a TBI, emphasising the importance of prehospital care in TBI. OBJECTIVE: To establish the prevalence of prehospital hypotension and hypoxaemia in moderate to severe blunt TBI in greater Johannesburg, Gauteng, SA. METHODS: The records of adult patients who sustained a moderate to severe TBI between 1 January and 31 December 2011 were retrospectively reviewed for hypotension (systolic blood pressure <90 mmHg) and hypoxaemia (oxygen saturation <90%) during their prehospital phase of care. These results were subject to descriptive analysis. RESULTS: A total of 299 records were identified, 66 of which met the inclusion criteria. The prevalence of prehospital hypotension and hypoxaemia were 33.3% (n=22) and 37.9% (n=25), respectively, while 21.2% (n=14) of patients suffered double insults of hypotension and hypoxaemia. Hypotension and hypoxaemia were associated with haemorrhage (p=0.011) and chest injuries (p=0.001), respectively. CONCLUSION: The prevalence of hypotension in this study was similar to that observed in international studies, but the prevalence of hypoxaemia was much higher. There is a need for local guidelines to be developed to inform the quality of TBI care in the context of the developing world.