Browsing by Author "Vlok, Neville"

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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.
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    Open Access
    The development of consensus-based pre-hospital core competencies and outcomes as a component of specialist emergency physician training - a South African-based study
    (2025) Vlok, Neville; Khan, Waseela; Stassen, Willem
    BACKGROUND: South African Emergency Medicine registrars undertake between one and three-month pre-hospital work placements as a component of the specialist training programme. Anecdotally, the experiences of trainees nationally vary substantially which may be attributed to the lack of a curriculum to guide expected graduate outcomes, teaching, learning or assessment in Pre-Hospital Emergency Medicine (PHEM). Although efforts are underway to renew the EM curriculum in SA by the College of Emergency Medicine (CEM), this is the first body of research dedicated towards a pre-hospital curriculum for South African EM specialist training. AIM: To seek consensus on expected graduate level pre-hospital core competencies and generate broad learning outcomes for the SA EM specialist training curriculum. METHODS: A modified nominal group technique (NGT) was used to derive PHEM competencies and outcomes for specialist trainees. A scoping review of the literature informed the NGT by extrapolating global pre-hospital competencies and outcomes for registrars. Fourteen experts in either pre-hospital education and/or practice and specialist EM physicians were purposively recruited. A summary of core competencies and outcomes were presented to the panel over two virtual sessions. PHEM core competencies and broad-level outcomes were generated through consensus and context-specific gaps in the international literature were addressed and suggestions also presented for consensus. RESULTS The panel concluded that the WHO Emergency Care Systems Framework (ECSF) was appropriate to organise competencies and outcomes. The consensus process yielded 6 core competencies and 36 broad-level outcomes; eleven outcomes for scene response, 21 for transport and 4 for facility. CONCLUSION: The consensus process allowed researchers to design a curriculum framework for a PHEM module which can inform the specialist training curriculum for the CEM SA. Aviation for Health Care Provider and Hospital Major Incident Medical Management and Support courses potentially address specific outcomes. Self-directed and experiential learning have been highlighted as crucial teaching-learning methodologies, and opportunities identified for transprofessional collaboration. The results reported here could be used in the next steps of curriculum development.