OpenUCT :: Browsing by Author "Stassen, Willem"

Browsing by Author "Stassen, Willem"

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Open Access
A 12-month retrospective descriptive analysis of a single helicopter emergency medical service operator in four South-African provinces
(2023) Vlok, Neville; Stassen, Willem; Wylie Craig
Introduction: Helicopter Emergency Medical Services (HEMS) forms an important role in integrated modern emergency medical services and have a suggested mortality benefit in certain patient populations, such as those affected by severe trauma or with time-sensitive pathologies in rural areas. Despite this, HEMS is an expensive resource used in South Africa and appropriate use and feasibility in low-to-middle income countries (LMIC) is highly debated. To maximise benefit, it is essential that the right patients be selected for HEMS. In order to evaluate this, the current practices first need to be described. The aim of this study was to describe a population of patients being transported by HEMS in South Africa, in terms of flight data, patient demographics, provisional diagnosis and clinical characteristics and interventions. Methods: A retrospective flight- and patient-chart review were conducted, extracting clinical and mission data of a private, single aeromedical operator in South Africa, over a 12-month period (July 2017 – June 2018) in Gauteng, Free State, Mpumalanga and North-West. Results: A total of 916 cases were included (203 primary cases, 713 interfacility transport (IFT)). The majority of the patients were male (n=548, 59.8%), suffered blunt trauma (n=379, 41.4%) followed by medical pathology (n=247, 27%) and neonatal transfers (n=184, 20.1%). Most flights occurred in daylight hours (n=729, 79.6%). Median mission times were 1-hour 53minutes for primary missions, and 3 hours 10 minutes for IFT cases. Median on-scene times were 26 minutes for primary cases and 55 minutes for IFT cases. Although many patients were transported with an endotracheal tube (n=428, 46.7%), more than a third did not have an advanced airway and received supplemental oxygen via other means (n=348, 37.9%). Almost half of patients received no respiratory support (n=414, 45.2%). No patients received fibrinolysis, defibrillation, cardioversion or cardiac pacing. Almost all patients received intravenous fluid therapy (n=867, 94.7%). The administration of sedation (n=430, 46.9%) and analgesia (n=329, 35.9%) were also common interventions. Conclusion: By describing current HEMS transport practices in one of the largest cohorts in Africa to date, a better understanding is gained of how HEMS is utilised daily. Apart from the lack of universal call out criteria and response to the high burden of trauma, HEMS seem to fulfil an important critical care transport role. Due to the lack of coordinated coronary care networks, it seems that cardiac pathologies are under-represented in this study and might have an important implication for crew training requirements.
Open Access
A comparison of critical care transportation modules taught in bachelor's degrees in emergency medical care in South Africa
(2020) Conradie, Nathan John; Stassen, Willem; Vincent-Lambert, Craig
The aim of this literature review was to collect and appraise literature related to curricula in critical care transportation and retrieval, pre-hospital care, and aeromedical transportation. The search strategy was twofold. Firstly peer-reviewed published literature was sourced from established platforms. Secondly, grey literature was sourced from internet sources. An assessment of reliability and validity was performed on peer-reviewed literature in the appraisal process. The results of the literature review show that there is a paucity of literature describing critical care modules of pre-hospital educational programmes in South Africa. This lack of literature has led the authors of this review to conclude that there is a potential for insufficient benchmarking and standardisation of the critical care module between universities. The results of this study could allow stakeholders to begin the process of academic standardisation. To provide a comprehensive background on the field of critical care transportation and retrieval and specifically education and training, this literature review starts by describing the field locally. It then attempts to outline the risks associated with critical care retrieval and thereby demonstrating the importance of quality education and regulation that can guide practitioners who perform retrievals. It then seeks to understand the importance of standardsetting within education broadly and the role of curricula in standard-setting. Finally, it provides an overview of methods for comparing curricula. After the background sections, the gathered literature was grouped into themes according to the types of curricula included in the literature. All these types of curricula form part of the critical care transportation and retrieval field, as graduates from these programmes are usually involved in the transportation of critically ill patients between facilities.
Open Access
A Four-Year Descriptive Analysis of Stroke in a Private Hospital in the Western Cape
(2022) Govender, Sarojini; Stassen, Willem
Background: Stroke is the second leading cause of death and disability globally, with an estimated 26% increase in stroke deaths between 1990 and 2010. The World Stroke Society estimated that one in six people will suffer a stroke in their lifetime. In 2010, stroke accounted for 5.9 million deaths, 71% of which was in low- to middle-income countries (LMICs) and is a major public health concern for Africa and other LMICs together with other non-communicable diseases. Communicable diseases such as HIV/AIDS, malaria, tuberculosis etc. are prioritised in Sub-Saharan Africa (SSA) and the healthcare expenditure has been mostly allocated to treat these. The cost of stroke care in hospital and out of hospital is quite alarming and the burden of stroke places an added burden on an already stretched healthcare budget. Objectives: To identify the different stroke types, risk factors, burden of stroke in a private hospital in terms of gender, age, and length of stay and to identify any associations of risk factors, age, types of strokes, mortality and treatment given. Methods: This descriptive study involved retrospective data from an electronic database which captured all stroke patients seen in the emergency unit during the study period. Data was verified, diagnosis made by CT, MRI scans or both. Results: The total number of 576 cases was included, 278 (48%) for ischaemic stroke, 72(12.5% for haemorrhagic stroke and 226 (39%) for TIA. No difference between gender and type of stroke was observed. Mortality was low, with 21 cases with a mortality rate of 3.6%. Given this low mortality rate, meaningful analyses on mortality could not be done. The most prevalent risk factors were hypertension (59.7%), diabetes (21.7%), hyperlipidaemia (29%), atrial fibrillation (11.1%) and ischaemic heart disease (10.8%). Following logistic regression, atrial fibrillation was found to be associated with ischaemic stroke (p = 0.01), and TIA (p = 0.08). No other risk factors had a statistically significant association with type of stroke in this sample. Conclusion: Ischaemic stroke is more prevalent compared to haemorrhagic stroke. As the population grows and life expectancy increases, the burden of stroke and its complications will also increase. Managing the modifiable risk factors may be key to managing the burden of stroke in Sub-Saharan Africa.
Open Access
A manikin-based simulation study of a dispatch operator directed CPR algorithm within the Western Cape setting and the self- reported comfort around its execution
(2021) De Caires, Leonel Paulo; Stassen, Willem; Evans, Katya
Background: There is little data in Africa regarding dispatch guided telephonic CPR. This study looks at the quality of CPR performed when compared to AHA guidelines, by untrained laypersons when given telephonic CPR instructions using the Western Cape EMS Guidecards algorithm for telephone assisted CPR. Methods: In this prospective observational, simulation study, participants were given telephonic hands-only CPR instructions using the Western Cape EMS Guidecards. CPR quality (hand placement, rate, depth and chest recoil) was analysed and then followed by a questionnaire looking at the self-reported comfort regarding the execution of said instructions. Results: Overall quality of CPR by participants (n=50) was suboptimal with no participant complying with current CPR guidelines. Demographic factors influenced quality where males pushed on average deeper (40.8mm vs 28.5mm, p=0.004) when compared to females. Correct hand placement and chest exposure were directly related to the caregivers' home language with English making it more likely to correctly perform these instructions (p=0.01 and p=0.002, respectively). Self-reported comfort had no effect on executed CPR quality. Conclusion: The quality of CPR performed by laypersons, when directed by a call-taker using the Western Cape Provincial EMS Guidecards Algorithm, can be suboptimal in terms of compression rate, depth, full chest recoil and baring of the chest. There is an urgent need to find more effective ways, in the Western Cape EMS, to improve executed CPR quality when guided by a trained telephone operator.
Open Access
A retrospective descriptive analysis of critical care transfers in the private sector of South Africa
(2022) Venter, Monique; Stassen, Willem
Background: Critical Care Transfers (CCTs) are necessitated by the growing prevalence of high acuity patients who require upgrade of care to multidisciplinary teams from less equipped referring facilities. Due to the high acuity of the critical care transfer patient, specialised teams with advanced training and equipment are called upon to undertake these transfers. The specialised and dedicated teams are utilized to mitigate and treat adverse events during transfers, which is found in the especially vulnerable, high acuity patients. Internationally, the insufficient data relating to CCTs has been repeatedly reported as a concern due to the increased number of critical care transfers being undertaken and the high acuity of the patients, along with the reported high number of adverse events that occur during such transfers. The inherent understanding of the potential effects, and therefore needs of the critical care transfer patient, are affected due to the paucity of international, but more specifically, local data relating to CCTs. Methods: This observational cohort study with a retrospective descriptive design samples all non-neonatal, critical care transfers completed for a one-year period (1 January 2017 – 31 December 2017) from the dedicated CCT of the two largest national emergency medical services in South Africa. Data were extracted from patient report forms by trained data extractors and subjected to descriptive analysis. Results: A total of 1839 patients were transferred between the two services (excluding the neonatal cohort). A total of 3143 diagnoses were recorded, yielding an average of ~2 diagnoses per patient. The most prevalent primary diagnosis was Cardiovascular Disease (n=457, 25%), followed by infection (n=180, 10%) and Head Injury (n=133, 7%). Patients had an average of ~3 attachments, with the most prevalent being patient monitoring (n=2856, 155%). The second most prevalent attachment was Peripheral Intravenous Lines (n=794, 43%) of patients, followed by mechanical ventilation (n=496, 27%). A total of 2152 medications were required during transport, yielding an average of ~1 medication or infusion per patient transported. The most common medications recorded were CNS Depresants (n=588; 32%), followed by Analgesics (n=482, 26%), and a further 17% of patients required Inotropic / Vasoactive agents (n=320, 17%). Conclusion: This study provides insight into the demographics, most prevalent diagnoses and interfacility transfer monitoring needs of patients being transported in South Africa by two private dedicated critical care transport services. The results of this study should be used to inform future specialised critical care transport courses and qualifications, as well as the scopes of practice of providers undertaking critical care transfers.
Open Access
A retrospective descriptive analysis of prehospital advanced airway management in a South African private emergency medical service
(2021) Araie, Farzana; Joubert, Ivan; Stassen, Willem
Introduction: Emergency medical systems have evolved from mostly providing patient transport to healthcare facilities to the provision of emergency care interventions on scene or en route to a healthcare facility. Endotracheal intubation is one of these interventions but despite being performed in the prehospital setting for nearly two decades, the practice of prehospital ETI has not yet been examined on a national level. Methods: This is a retrospective chart review of prehospital ETI performed by non-physician prehospital providers of a ground-based emergency medical service that operates on a national level over a 12 month period. Results: Of the 806 cases recorded in the study period, 683 met the criteria for analysis. Male patients accounted for 67% of the cases. The majority of patients (56%) intubated were trauma patients while the remaining 44% were intubated for medical reasons. The first pass success rate was 74% and the overall success rate was 98%. Rapid sequence intubation was the method used to intubate 34% of patients. Approximately 29% received drug facilitated intubation and 27% of patients were intubated whilst being treated for cardiac arrest. Approximately 65% of patients had documented risk factors for difficult intubation. Clinical adverse events were recorded in 14% of cases. Discussion: The first pass success and overall success rates compare favourably with those reported in similar contexts. Adverse events were thought to be under-reported.
Open Access
A retrospective review of post-intubation sedation and analgesia practices in a South African private ambulance service
(2021) de Kock, Joalda Marthiné; Stassen, Willem; Buma, Chloe Ashton
Introduction: Adequate post-intubation sedation and analgesia (PISA) practices are important in the pre-hospital setting where vibration and noise of the transport vehicle may contribute to anxiety and pain in the patient. Inadequate post-intubation practices may lead to long-term detrimental effects in patients. Despite this, these practices are poorly described in the prehospital setting. This study aims to describe the current pre-hospital PISA practices in a private South African emergency medical service. Methodology: Patient report forms (PRF) of intubated patients between 1 Jan 2017 and 31 Dec 2017 from a single private ambulance service were reviewed. Data was analysed descriptively. Correlations were calculated with Spearman's Rank correlations and group differences were calculated with Independent T tests and Mann-Whitney U tests. Significant correlations were entered into a binomial regression model to determine predictive value of receiving PISA. Results: The number of PRFs included for analysis was 437. Of these, 69% of patients received some type of PISA. The estimated time from intubation to 1st PISA ranged from 9 to 12 minutes. There were statistically significantly more PISA interventions in patients who had received Rocuronium (p< 0.01). There was weak but significant correlation between the number of interventions and the mean arterial pressure, (rs = 0.17, p< 0.01) and Glasgow Coma Scale (rs = -0.15, p< 0.01) prior to intubation, along with the transport time to hospital (rs = 0.23, p< 0.01). Conclusion: The PISA practices in the South African pre-hospital setting is comparable to international pre-hospital settings. The time to 1st PISA appears to be shorter in the SA setting. There is an increased number of interventions in the patients who received Rocuronium, which may indicate practitioners being mindful of wakeful paralysis. Practitioners also take the level of consciousness and blood pressure prior to intubation into account when administering PISA. Longer transport times attribute to patients receiving more PISA interventions.
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.
Open Access
An analysis of the Afrikaans telephonic descriptors of cardiac arrest in a Western Cape Emergency Control centre
(2020) van Rensburg, Louis Chris; Stassen, Willem; Claassen, Joel
Introduction: Out of Hospital Cardiac Arrest (OHCA) is a time-sensitive emergency which requires prompt identification and emergency care in order to reduce morbidity and mortality. The first step in recognising OHCA is rapid identification by the emergency dispatch centre. Identification of such patients remains challenging in South Africa due to multiple languages and widely differing levels of education. This study aimed to identify the key descriptors (words and phrases) of OHCA used by callers speaking Afrikaans when contacting the emergency dispatch centre of the Western Cape Provincial Emergency Medical Services (WC-EMS). Methodology: Computer-aided dispatch (CAD) data with a corresponding “patient unresponsive” incident type were drawn for a 12 month period (January – December 2018). Corresponding patient care records were extracted to verify OHCA. The original voice recordings between the caller and emergency call taker at the time of the emergency were extracted and transcribed verbatim. Transcriptions were subjected to inductive, qualitative content analysis to the manifest level. Descriptors of OHCA in Afrikaans calls were coded, categorised and quantified. Results: A total of 729 confirmed OHCA cases were identified, of which 36 (5%) were in Afrikaans and eligible for analysis. Following content analysis, 83 distinct codes in six categories were identified. The most prevalent categories were descriptors related to Respiratory Effort (apnoea and difficulty in breathing; 30.1%) (30.1%), Clinical Features (related to the eyes, mouth and body temperature; 20.4%) and Cardiac Activity (pulselessness; 16.8%). Conclusion Afrikaans Callers within the Western Cape province of South Africa use consistent descriptors when requesting and ambulance for OHCA. Future studies should focus on describing descriptors for other languages commonly spoken in the province, and to develop and validate telephonic OHCA recognition algorithms.
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.
Open Access
A comparison of the demographics, injury patterns and outcome data for patients injured in motor vehicle collisions who are trapped compared to those patients who are not trapped
(2021-01-14) Nutbeam, Tim; Fenwick, Rob; Smith, Jason; Bouamra, Omar; Wallis, Lee; Stassen, Willem
Background Motor vehicle collisions (MVCs) are a common cause of major trauma and death. Following an MVC, up to 40% of patients will be trapped in their vehicle. Extrication methods are focused on the prevention of secondary spinal injury through movement minimisation and mitigation. This approach is time consuming and patients may have time-critical injuries. The purpose of this study is to describe the outcomes and injuries of those trapped following an MVC: this will help guide meaningful patient-focused interventions and future extrication strategies. Methods We undertook a retrospective database study using the Trauma Audit and Research Network database. Patients were included if they were admitted to an English hospital following an MVC from 2012 to 2018. Patients were excluded when their outcomes were not known or if they were secondary transfers. Results This analysis identified 426,135 cases of which 63,625 patients were included: 6983 trapped and 56,642 not trapped. Trapped patients had a higher mortality (8.9% vs 5.0%, p < 0.001). Spinal cord injuries were rare (0.71% of all extrications) but frequently (50.1%) associated with other severe injuries. Spinal cord injuries were more common in patients who were trapped (p < 0.001). Injury Severity Score (ISS) was higher in the trapped group 18 (IQR 10–29) vs 13 (IQR 9–22). Trapped patients had more deranged physiology with lower blood pressures, lower oxygen saturations and lower Glasgow Coma Scale, GCS (all p < 0.001). Trapped patients had more significant injuries of the head chest, abdomen and spine (all p < 0.001) and an increased rate of pelvic injures with significant blood loss, blood loss from other areas or tension pneumothorax (all p < 0.001). Conclusion Trapped patients are more likely to die than those who are not trapped. The frequency of spinal cord injuries is low, accounting for < 0.7% of all patients extricated. Patients who are trapped are more likely to have time-critical injuries requiring intervention. Extrication takes time and when considering the frequency, type and severity of injuries reported here, the benefit of movement minimisation may be outweighed by the additional time taken. Improved extrication strategies should be developed which are evidence-based and allow for the expedient management of other life-threatening injuries.
Open Access
Determining the variables associated with EMS non-conveyance of patients with respiratory complaints in Western Cape, South Africa: A retrospective chart review
(2023) Alsufayan, Mohammed; Stassen, Willem
Introduction: The South African (SA) demand for emergency care is increasing, placing more strain on the emergency medical services (EMS) and the larger healthcare system. However, not all patients who call EMS require conveyance to hospital. It is intuitive that the increase in ambulance responses has also increased the probability for non-conveyance. By determining the variables associated with non-conveyance, EMS resource utilisation can be adjusted accordingly. Local data on the phenomenon is lacking, however, international data suggests that respiratory complaints are common causes for responses resulting in non-conveyance. The aim of this study is to determine the variables that are associated with the nonconveyance of patients with respiratory complaints serviced by the Provincial Government Western Cape (PGWC) EMS, SA. Methods: A retrospective chart review was conducted using data from the PGWC EMS computer aided dispatch (CAD) and electronic patient care reports (ePCR). Data were collected over a one-year period (1 October 2018 - 30 September 2019). All records where the emergency was a respiratory complaint, and the ambulance response ended in nonconveyance were included. The rate of non-conveyance was determined using descriptive analysis. Logistic regression was performed to evaluate factors that affect the likelihood of non-conveyance of respiratory complaints. Results: Out of 33 295 total respiratory complaints, the median patient age was 46 years. Males represented 50.2%(n = 16702) of the sample. There were no significant differences between the age and gender of those who were and were not conveyed. Of the total, 4.48%(n = 1493) were not conveyed to the hospital. Of the non-conveyed calls, 73.34%(n = 1081) were assigned a priority level 1 at dispatch and the remainder were priority 2. The majority, 45.16% (n = 504), of cases had a final triage code of yellow, followed by 31% (n = 356) coded green. Following multivariate regression, the following variables increased the odds of nonconveyance: Green triage (OR 2.04; 95% CI 1.77-2.36; p<0.01), weekends (OR 1.27; 95% CI 1.12-1.44; p<0.01), and nebulisation on scene (OR 1.47; 95% CI 1.23-1.74; p<0.01). Conversely, dispatch priority 2 (less urgent; OR 0.66; 95% CI 0.57-0.76; p<0.01), orange triage (OR 0.68; 95% CI 0.58-0.80; p<0.01), red triage (OR 0.22; 95% CI 0.13-0.37; p<0.01), and oxygen administration (OR 0.52, 95% CI 0.41-0.67; p<0.01) were all associated with decreased odds of non-conveyance. Conclusion: Several variables are associated with the non-conveyance of respiratory complaint patients seen to by PGWC EMS. Future research focusing on the predictors for ambulance non-conveyance could lead to raised efficiency and minimisation in operational expenses, and provider fatigue amongst others.
Open Access
Initiating the development of a South African curriculum for education in Neonatal Critical Care Transfers
(2022) Williams, West; Stassen, Willem; Theron, Elzarie; Khan, Waseela
Background Owing to limited neonatal care resources, the transfer of neonates to district and tertiary facilities is inevitable in a Low- and Middle-Income Country (LMIC) such as South Africa. The lack of neonatal transport is one of the top ten avoidable causes of under-5 mortality. In South Africa, these transfers are mostly conducted by Advanced Life Support (ALS) Providers with limited neonatal specific education. The transfer of neonates by teams with limited neonatal knowledge can lead to high adverse event rates. Dedicated Critical Care Retrieval Services (CCRS) teams have providers with additional education in neonatal critical care transfers and have shown a lower risk of adverse events in developed settings. Given the limited neonatal education of ALS providers that conduct transfers and the lack of dedicated CCRS teams in South Africa, it is the aim of this study to initiate the development of a neonatal critical care transfer curriculum. Methods A general and targeted needs assessment was conducted through semi-structured interviews with experts in the field and a focus group discussion with a learner group. The voice recordings were transcribed verbatim and data were analysed inductively, using content analysis to the manifest level. Results Six experts in neonatal critical care transfers participated in semi-structured interviews with a mean duration of 59 minutes (51-68min). Following transcription and analysis, 372 codes were extracted. Seven learners that involved in neonatal transfers in South Africa participated in a semi-structured focus group discussion with a duration of 91 minutes. The audio recording was transcribed and analysed with 97 codes extracted. The main categories were: Current status of neonatal CCR in South Africa; Learning and education in neonatal CCR; and proposed curriculum structure. The proposed curriculum structure described 13 broad course outcomes to be delivered as a blended postgraduate programme. Participants noted that funding, employer buy-in and internet resources would be required. The targeted student group should be all ALS providers with a change in their scope of practice on completion. Conclusion This study described the specific needs of prehospital learners as it pertains to the teaching, learning and assessment (TLA) of a curriculum in neonatal critical care transfers. It also described some of the limitations in the current and past education systems in neonatal critical care transfers. This study provides broad course outcomes and the results can be used to inform the next steps in curriculum development for education in neonatal critical care transfers.
Open Access
Prehospital care providers' decision to transport the patient with a suicide attempt refusing care in the Cape Town Metropole, Western Cape: A survey based on the Mental Healthcare Act of 2002
(2015) Evans, Katya; Geduld, Heike; Stassen, Willem
Anecdotally incidents of inappropriate refusal of treatment or transportation by patients referred to hospital under the Mental Healthcare Act of 2002 have been noted. There is little documented about the knowledge and understanding of prehospital providers of the mental healthcare act, their responsibilities and the issues around patient competence and refusal of care. The transportation of patients presenting with a suicide attempt who have not yet been formally assessed for involuntary admission poses a particular problem. Aim: To determine the knowledge of prehospital providers with respect to the transport of patients presenting with suicide attempts and the mental health act and to describe their management of cases where these patients may refuse treatment. Methods: A cross-sectional survey and including open ended questions of 100 prehospital providers in the Western Cape both public and private. The questionnaire will include knowledge testing, vignettes describing patient management and open-ended questions regarding their opinions on suicidal patients. Simple descriptive statistics will be used for the knowledge test. Qualitative data will be coded using a grounded theory approach. Discussion: The findings of the study will be used to determine provider knowledge and attitudes regarding the prehospital management of patients presenting with suicide attempts. Recommendations will be made for provincial EMS guidelines and the results will be disseminated in an article for publication.
Open Access
The prevalence of hypotension and hypoxaemia in the prehospital setting of traumatic brain injury in Johannesburg, Gauteng
(2013) Stassen, Willem; Welzel, Tyson
Includes abstract. Includes bibliographical references.
Open Access
Rapid sequence intubation: a survey of current practice in the South African pre-hospital setting
(2020) Botha, Johanna Catharina; Stassen, Willem; Lourens, Andrit
Background: Rapid sequence intubation (RSI) is an advanced airway skill commonly performed in the pre-hospital setting globally. In South Africa, pre-hospital RSI was first approved for non-physician providers by the Health Professions Council of South Africa in 2009 and introduced as part of the scope of practice of degree qualified Emergency Care Practitioners (ECPs) only. The aim of the research study was to investigate and describe, based on the components of the minimum standards of pre-hospital RSI in South Africa, specific areas of interest related to current pre-hospital RSI practice. Methods: A descriptive cross-sectional study design in the form of an online survey were conducted amongst operational ECPs in the pre-hospital setting of South Africa, using convenience and snowball sampling strategies. Results: A total of 87 participants agreed to participate. Eleven (12.6%) incomplete survey responses were excluded while 76 (87.4%) were included in the data analysis. The survey response rate could not be calculated. Most participants were operational in Gauteng (n=27, 35.5%) and the Western Cape (n=25, 32.9%). Overall participants reported that their education and training were perceived as being of good quality. An overwhelming number of participants (n=69, 90.8%) did not participate in an internship programme before commencing duties as an independent practitioner. Most RSI and post-intubation equipment were reported to be available, however, our results found that introducer stylets and/or bougies and EtCO2 devices are not available to some participants. Only 50 (65.8%) participants reported the existence of a clinical governance system within their organisation. Furthermore, our results indicate a lack of clinical feedback, deficiency of an RSI database, infrequent clinical review meetings and a shortage of formal consultation frameworks. Conclusion: The practice of safe and effective pre-hospital RSI, performed by non-physician providers or ECPs, rely on comprehensive implementation and adherence to all the 51 components of the minimum standards. Although there is largely an apparent alignment with the minimum standards, recurrent revision of practice needs to occur to ensure alignment with recommendations. Additionally, there are areas that may benefit from further research to improve current practice.
Open Access
South African paramedic perspectives on prehospital palliative care
(2020-10-08) Gage, Caleb H; Geduld, Heike; Stassen, Willem
Abstract Background Palliative care is typically performed in-hospital. However, Emergency Medical Service (EMS) providers are uniquely positioned to deliver early palliative care as they are often the first point of medical contact. The aim of this study was to gather the perspectives of advanced life support (ALS) providers within the South African private EMS sector regarding pre-hospital palliative care in terms of its importance, feasibility and barriers to its practice. Methods A qualitative study design employing semi-structured one-on-one interviews was used. Six interviews with experienced, higher education qualified, South African ALS providers were conducted. Content analysis, with an inductive-dominant approach, was performed to identify categories within verbatim transcripts of the interview audio-recordings. Results Four categories arose from analysis of six interviews: 1) need for pre-hospital palliative care, 2) function of pre-hospital healthcare providers concerning palliative care, 3) challenges to pre-hospital palliative care and 4) ideas for implementing pre-hospital palliative care. According to the interviewees of this study, pre-hospital palliative care in South Africa is needed and EMS providers can play a valuable role, however, many challenges such as a lack of education and EMS system and mindset barriers exist. Conclusion Challenges to pre-hospital palliative care may be overcome by development of guidelines, training, and a multi-disciplinary approach to pre-hospital palliative care.
Open Access
The development of evidence-based guidelines to inform the extrication of casualties trapped in motor vehicles following a collision
(2022) Nutbeam, Tim; Stassen, Willem; Smith, Jason; Wallis Lee
Background Motor vehicle collisions (MVCs) are a common cause of injury and death throughout the world. Following an MVC some patients will remain in their vehicles due to injury, the potential for injury or physical obstruction. Extrication is the process of removing injured or potentially injured patients from vehicles following a motor-vehicle collision. Current extrication practices are based on the principles of 'movement minimisation' with the purpose of minimising the incidence of avoidable secondary spinal injury. Movement minimisation adds time to the process of extrication and may result in an excess morbidity and mortality for patients with time dependent injuries. The current extrication approach has evolved without the application of evidence-based medicine (EBM) principles. The principles of EBM; consideration of the relevant scientific evidence, patient values and preferences and expert clinical judgement are used as a framework for this thesis. Aims and Objectives To develop evidence-based guidance for the extrication of patients trapped in motor vehicles by applying EBM principles to this area of practice. This will be achieved through: - Describing the injury patterns, morbidity and mortality of patients involved in MVCs (trapped and not trapped). - To analyse the movement associated with and the time taken to deliver across a variety of extrication methods. - Determining the perceptions of patients who have undergone vehicle extrication and describe their experiences of extrication. - Developing consensus-based guidelines for extrication.
Open Access
The perceived barriers to timely therapeutic hypothermia treatment for neonates diagnosed with hypoxic-ischaemic encephalopathy when born outside the cooling facility within the private healthcare setting
(2022) de Wet, Wardie; Stassen, Willem; Dippenaar, R
Background Hypoxic-Ischemic Encephalopathy (HIE) is a debilitating neurological injury at birth due to a hypoxic event. The recommended treatment is therapeutic hypothermia (TH) provided at certain neonatal facilities and should commence within the treatment window of 6 hours (1). The outborn neonates are at a disadvantage because they require timely transport to a TH-capable neonatal ICU. The study aimed to identify the perceived barriers to care of HIE neonates born outside the cooling facility within the private healthcare setting. Methods This study made use of one-on-one structured open-ended interviews that were recorded on two separate digital recording devices. All the interviews were transcribed and stored within a cloud-based secured folder. All the interviews were subjected to qualitative content analysis using dedicated qualitative software. All audio files were destroyed after transcription to ensure participant confidentiality, including participants' names and locations. Results A total of seven participants were interviewed during the data collection phase of this study. The participants were all employed in South Africa within the private healthcare system and comprised of paediatricians, neonatologists, and neonatal nursing staff. The participants represented both the referral and receiving facilities. The descriptive analysis of the data obtained showed overlapping of emerged themes, ranging in repetitive strength. During the data analysis, three main themes were identified, with other supporting themes providing additional insight: HIE recognition and decision-making, navigating the referral process, and communication barriers. Discussion Despite the availability of resources within the private healthcare system and private patient transfer services, there are perceived barriers to timely care for HIE or Birth Asphyxia (BA) neonatal patients needing an urgent interhospital transfer. This study concluded that changes within the referral system are needed to mitigate the perceived barriers to time-sensitive care. Further research is required to motivate changes and must include the roleplayers' input within the referral process to match the patient's best interest.
Open Access
The thoughts and opinions of advanced life support providers in the South African private emergency medical services sector concerning pre-hospital palliative care
(2020) Gage, Caleb Hanson; Geduld, Heike; Stassen, Willem
The World Health Organisation (WHO) defines palliative care as 'an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.' 1 This includes a wide variety of situations such as chronic illness and end-of-life care. 2 Palliative care is usually performed in-hospital. However, emergency medical services (EMS) often encounter patients requiring palliative care as these patients may have acute exacerbations of illness, progress towards end-of-life or require transport to a medical facility. 3-9 Thus, there is a role for palliative care in the pre-hospital setting. EMS providers are uniquely positioned to deliver this care in the pre-hospital setting as they are often the first point of medical contact. 10 This has great potential benefit for patient comfort, early identification and relief of suffering and earlier referral to hospice care. 10, 11 Despite this unique position there is an overall lack of guidance within EMS systems to manage palliative patients. 5, 6, 10 In the United States of America (USA), for example, only 5-6% of EMS systems have protocols for palliative care. 6, 10 In addition, there is no specific pre-hospital emergency care curricula on the subject, resulting in a lack of education and training for EMS providers. 3-5, 12, 13 This may stem from the historical focus of EMS training which primarily involves immediate measures to preserve life or limb until definitive care is reached. 11 This focus has resulted in an EMS ethos of 'saving lives.' 5, 12 Palliative care, on the other hand, is not focussed on 'saving lives', but rather the prevention and relief of suffering. 1 Therefore, palliative care may seem to conflict with emergency care, placing EMS providers in difficult situations when confronted with palliative care patients. 8, 12, 14 South Africa itself faces what has been termed a “quadruple burden of disease” due to communicable diseases such as HIV/AIDS, high maternal and paediatric mortality rates, non-communicable disease as well as injury. 15 The large number of patients suffering from these diseases and the life-limiting complications thereof, results in increased need for palliative care in the country as noted by the South African Minister of Health. 16 Access to health care for patients suffering from these diseases is a further challenge in the Sub-Saharan African setting. 17, 18, 19 In South Africa, EMS are often contacted 3 by those without access to transport to provide this service. 20 Thus, South African EMS providers may frequently encounter not only high acuity emergency patients, but many ill HIV/AIDS, cancer and other chronically ill patients requiring palliative care who are unable to access healthcare via alternative means. 21 European studies have found that approximately 3-5% of all pre-hospital calls involve palliative care situations. 2, 22, 23 With the quadruple burden of disease and limited access in the South African setting, this percentage is likely higher as these factors result in increased frequency of contact between EMS providers and patients requiring palliative care. Although EMS providers in South Africa manage palliative patients in the prehospital setting, to our knowledge, no research has been produced in the (South) African setting regarding prehospital palliative care. Outside of Africa literature has been produced but is limited. This literature review discusses paramedic perceptions of prehospital palliative care, prehospital palliative care patient management and legislation concerning prehospital palliative care. Finally, expert opinion pieces and recommendations are reviewed.

Browsing by Author "Stassen, Willem"

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