OpenUCT :: Browsing by Author "Wallis, Lee"

Browsing by Author "Wallis, Lee"

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Open Access
A descriptive analysis of emergency care provided in Northern Somalia
(2019) Muange, Dennis; Wallis, Lee; Wachira, Benjamin
Emergency care is an integral part of an effective healthcare system. However, emergency care systems remain largely underdeveloped in low- and middle-income countries, particularly in Sub-Saharan Africa. Somalia is in the horn of Africa. Decades of civil war, political instability, and terrorism insurgency have greatly hampered healthcare in the country, and the country does not have a formal emergency care system. The aim of the study was to assess the current provision of emergency care in healthcare facilities in northern Somalia, namely Somaliland and Puntland. This was a cross-sectional descriptive study carried out in all emergency units in Hargeisa and Garowe, the capital cities of Somaliland and Puntland respectively. A standardised WHO emergency care assessment tool was used to assess the performance of emergency care procedures in the emergency units. Simple descriptive statistics were used to analyse the data. Six facilities - two in Puntland, and four in Somaliland - participated in the study. Two of these were regional referral public facilities, while the rest were private. The performance of sixty emergency care procedures was assessed. Absent equipment was the main reason (47%, n=60 for the non-performance of these emergency care procedures. Lack of training (29%), stock out of supplies (13%), and lack of skilled personnel (10%) were the other reasons for the non-performance of these emergency care procedures. The findings of this study underscore the need for more resource allocation with a focus on equipping emergency units and having adequate supplies. The study also highlights the need for training of healthcare providers who routinely provide care in emergency units.
Open Access
A descriptive study of demographics, triage allocations and patient outcomes for a private emergency centre in Pretoria for 2018
(2020) Hedding, Kirsty; Dippenaar, Enrico; Wallis, Lee
Background Triage aims to detect critically ill patients and to prioritise those with time-sensitive needs. It also contributes to the overall efficiency of an emergency centre (EC). International systems have been relatively well researched; however, no data exists on the use of the SATS score in private healthcare settings in SA. Objectives This study aimed to describe the demographics, triage allocations, time spent in EC and disposition of all patients presenting to a private hospital EC in Pretoria, South Africa in 2018. Methods A retrospective descriptive study was undertaken. Data relating to demographics, triage, and hospital disposition were collected on all patients presenting to the EC during the 2018 calendar year. Descriptive data analyses were conducted in Microsoft Excel. Results A total of 29 055 patients were included in this study. More than half (57.6%) were adults aged 18 to 60 years and approximately one-fourth (27.5%) were paediatrics (<18 years). The majority of patients were triaged yellow (73.5%); 17.4% were triaged as red and orange. It took, on average, 28 minutes to be seen by a provider and patients spent an average of 2 hours and 20 minutes in the EC. Delays to be seen exceeded standards for red and orange patients at 8 and 18 minutes respectively, and the mean time these patients spent in the EC was higher (2h 51 minutes and 2h 47 minutes respectively). Most patients (76.1%) were discharged; 5.6% were admitted to ICU/high care, 14.4% to the general ward, and 3.9% either absconded or refused hospital treatment. Of patients triaged red and orange, 11.1% and 49.3% were discharged respectively, and these patients used the most resources . Conclusion This study found that most of the patients were triaged into low acuity categories (yellow and green) and discharged home. High acuity patients were usually admitted to ICU or high care; however, these patients experienced delays in being treated and admitted. Causes of these issues, and implications on patient outcomes remain unknown. Large numbers of high acuity patients were ultimately discharged home. Further studies are needed to understand the influence of triage accuracy on these patients' outcomes.
Open Access
A descriptive study of the standard operating procedures for disaster response in the Saudi Arabian military health services
(2019) Alshaabani, Tariq Lafi; Wallis, Lee; Alshahrani, Mohammad
Background Saudi Arabia has suffered from disasters commonly in the last decade. The Saudi military medical services play a major role in confronting these events, but there are anecdotal challenges with their planning and response systems. Currently, disaster planning in Saudi Arabia appears to be undertaken in some detail, but the medical response to disasters is fragmented. This study aimed to review and assess the standard operating procedures for disaster response in the Saudi Arabian military health services. Methods We undertook a prospective, survey-based assessment of disaster response. We sought all disaster plans and Standard Operating Procedures from management and emergency department leadership at each of the 13 Military hospitals. We used a standardised survey tool to evaluate facility disaster planning. This tool gathers quantitative data using close-ended questions and open-ended commentary surrounding a hospital’s disaster response operating procedures. Results There was wide variability in the hospitals across the 20 themes in the survey. While most hospitals have a disaster plan, an up to date version was not always available. Key issues were identified in: management of contaminated patients; coordination of visitors, volunteers and extra staff; media management, and collaboration with other agencies. Conclusion The study highlighted a number of strengths in facility disaster preparedness, and a number of aspects where concerted efforts are required to improve the situation. In general, most hospitals had reasonable disaster plans in place, although none covered all the recommended areas in sufficient detail.
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.
Open Access
Assessment of routine laboratory screening of adult psychiatric patients presenting to an emergency centre in Cape Town
(2011) Crede, Andrea; Geduld, Heike; Wallis, Lee
Our study suggests that routine laboratory screening provides no additional information to that obtained from a thorough history and clinical examination in patients at high risk of having an underlying medical cause of presenting psychotic symptoms.
Open Access
An assessment of theoretical knowledge and psychomotor skills of Basic Life Support Cardio-Pulmonary Resuscitation provision by Emergency Medical Services in a province in South Africa
(2015) Veronese, Jean-Paul Tyrone; Wallis, Lee; Allgaier, Rachel; Botha, Ryan
Introduction: When high quality cardiopulmonary resuscitation (CPR) is performed, survival rates can approach 50% following witnessed out-of-hospital cardiac arrest. However, survival rates are more commonly much worse in both the in-hospital and out-of-hospital context and range from 0% to 18%. There is a paucity of evidence surrounding the competency at which basic life support (BLS) CPR is provided among Emergency Medical Services (EMS) personnel in South Africa, and quality assurance mechanisms are generally scarce or do not exist. Methods: A descriptive analytical study design was used to assess theoretical knowledge and psychomotor skills of BLS CPR provision by EMS personnel in a province in South Africa. An assessment questionnaire from a 'BLS for healthcare providers' course was used to determine theoretical knowledge. Cardiac arrest simulations were video recorded to assess psychomotor skills. BLS instructors independently scored the latter. Results: Overall competency of BLS CPR among the participants (n=115) was poor. The median knowledge assessment was 50% and the median skills 22%. Only 25% of the items tested showed that the participants applied the relevant knowledge to the equivalent skill and the nature and strength of theory influencing skills was small. However, certain demographic and circumstantial variables such as sector of employment, guidelines they were trained according to, age, and location where trained had a significant effect (p<0.05) on knowledge and skills. Discussion: This study suggests that theoretical knowledge has a small but notable role to play in psychomotor skills performance of BLS CPR. Demographic and circumstantial variables that were shown to affect knowledge and skill may be used to improve training and therefore competency. The results of this study highlight the need for continuous, and perhaps tailored BLS CPR instruction to bring the diverse set of EMS personnel currently practicing in South Africa up to international competency standards.
Open Access
Community-based perceptions of emergency care in communities lacking formalised emergency medicine systems
(2015) Broccoli, Morgan Carol; Wallis, Lee
Kenya and Zambia face an increasing burden of emergent disease, with a high incidence of communicable diseases, increasing prevalence of non-communicable diseases and traumatic injuries. However, neither country has an integrated emergency care system that provides community access to high-quality emergency services. There has been recent interest in strengthening the emergency care systems in these countries, but before any interventions are implemented, an assessment of the current need for emergency care must be conducted, as the burden of acute disease and barriers to accessing emergency care in Zambia and Kenya remain largely undocumented. Aims and Objectives: The aim of this project was to ascertain community-based perceptions of the critical interventions necessary to improve access to emergency care in Zambia and Kenya, with the following objectives: 1. Determine the current pattern of out-of-hospital emergency care delivery at the community level. 2. Identify the communitiesâ€™ experiences with emergency conditions and the barriers they face when trying to access care. 3. Discover community-generated solutions to the paucity of emergency care in urban and rural settings. Methods: Semi-structured focus groups were piloted in Zambia with 200 participants. Results were analysed with subsequent tool refinement for Kenya. Data were collected via focus groups with 600 urban and rural community members in cities and rural villages in the 8 Kenyan provinces. Thematic analysis of community member focus groups identified frequency of emergencies, perceptions of emergency care, perceived barriers to emergency care, and ideas for potential interventions. Results: Analysis of the focus group data identified several common themes. Community members in Zambia and Kenya experience a wide range of medical emergencies, and they rely on family members, neighbours, and Good Samaritans for assistance. These community members frequently provide assistance with transportation to medical facilities, and also attempt some basic first aid. These communities are already assisting one another during emergencies, and are willing to help in the future. Participants in this study also identified several barriers to emergency care : a lack of community education, absent or non-functional communication systems, insufficient transportation, no triage system, a lack of healthcare providers trained in emergency care, and inadequate equipment and supplies. Conclusions: Community members in Zambia and Kenya experience a wide range of medical emergencies. There is substantial reliance on family members and neighbours for assistance, commonly with transportation. Creating community education initiatives, identifying novel transportation solutions, implementing triage in healthcare facilities, and improving receiving facility care were community-identified solutions to barriers to emergency care.
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
Complications of tube thoracostomy for chest trauma
(2009) Maritz, David; Wallis, Lee; Hardcastle, Timothy
Objective. To determine the insertional and positional complications encountered by the placement of intercostal chest drains (ICDs) for trauma and whether further training is warranted in operators inserting intercostal chest drains outside level 1 trauma unit settings. Methods. Over a period of 3 months, all patients with or without an ICD in situ in the front room trauma bay of Tygerberg Hospital were included in the study. Patients admitted directly via the trauma resuscitation unit were excluded. No long-term infective complications were included. A self-reporting system recorded complications, and additional data were obtained by searching the department’s records and monthly statistics. Results. A total of 3 989 patients with trauma injuries were seen in the front room trauma bay during the study period; 273 (6.8%) patients with an ICD in situ or requiring an ICD were assessed in the trauma unit and admitted to the chest drain ward; 24 patients were identified with 26 complications relating to the insertion and positioning of the ICD; 22 (92%) of these had been referred with an ICD in situ. An overall complication rate of 9.5% was seen. Insertional complications numbered 7 (27%), with 19 (73%) positional complications. The most common errors were insertion at the incorrect anatomical site, and extrathoracic and too shallow placement (side portal of the drain lying outside the chest cavity). Conclusion. Operators at the referral hospitals have received insufficient training in the technique for insertion of ICDs for chest trauma and would benefit from more structured instruction and closer supervision of ICD insertion.
Open Access
Death and dying what are the psychological consequences for Emergency Medial Care personnel in the Cape Town Metropole ?
(2012) Minnie, Llizane; Wallis, Lee; Goodman, Suki
Includes abstract. Includes bibliographical references.
Open Access
A descriptive analysis of patient mortality in the emergency centre of a regional hospital in the Western Cape
(2010) Mehl, Nadia; Wallis, Lee
Includes abstract. Includes bibliographical references (leaves 51-58).
Open Access
Developing a patient-centred care pathway for paediatric critical care in the Western Cape
(2015) Hodkinson, Peter William; Wallis, Lee; Argent, Andrew
Background: Emergency care of critically ill or injured children requires prompt identification, high quality treatment and rapid referral. This study examines the critical care pathways in a health system to identify preventable care failures by evaluating the entire pathway to care, the quality of care at each step along the referral pathway, and the impact on patient outcomes. Methods: A year-long cohort study of critically ill and injured children was performed in Cape Town, South Africa, from first presentation until paediatric intensive care unit admission or emergency centre death, using a modified confidential enquiry process of expert panel review and caregiver interview. Outcomes were expert panel assessment of quality of care, avoidability of death or PICU admission and severity at PICU admission, identification of modifiable factors, adherence to consensus standards of care, as well as time delays and objective measures of severity and outcome. Results: The study enrolled 282 children: 85% medical and 15% trauma cases (252 emergency admissions, and 30 children who died at referring health facilities). Global quality of care was graded poor in 57(20%) of all cases and 141(50%) had at least one major impact modifiable factor. Key modifiable factors related to access and identification of the critically ill, assessment of severity, inadequate resuscitation, delays in decision making and referral, and access to paediatric intensive care. Standards compliance increased with increasing level of healthcare facility, as did caregiver satisfaction. Children presented primarily to primary health care (54%), largely after hours (65%), and were transferred with median time from first presentation to PICU admission of 12.3 hours. There was potentially avoidable severity of illness in 74% of children, indicating room for improvement. Conclusions and Relevance: The study presents a novel methodology, examining the quality of paediatric critical care across a health system in a middle income country. The findings highlight the complexity of the care pathway and focus attention on specific issues, many amenable to suggested interventions that could reduce mortality and morbidity, and optimize scarce critical care resources; as well as demonstrating the importance of continuity and quality of care throughout the referral pathway.
Open Access
The development and testing of a training intervention designed to improve the acquisition and retention of CPR knowledge and skills in ambulance paramedics
(2016) Govender, Pregalathan; Sliwa-Hahnle, Karen; Wallis, Lee
Despite several therapeutic advances in cardio-pulmonary resuscitation (CPR), there has been little overall improvement in the out-of-hospital, cardiac arrest (OHCA) survival rates. Reports indicate that, although the incidence and outcome of OHCA vary across the globe, the median reported rates of survival at hospital discharge have remained below 10% for the 30 years preceding this study. One of the factors associated with this low survival rate is the deficient quality of the CPR provided during an OHCA by paramedics. Despite revised training standards, structured CPR training programmes and industry-regulated CPR refresher training schedules, paramedic-delivered CPR (pdCPR) during OHCAs is reported to be both inadequate and rarely in line with established resuscitation guidelines. International resuscitation bodies such as the International Liaison Committee on Resuscitation (ILCOR) postulate the need for tailored CPR training interventions in order to improve CPR performance. The aim of this study was to investigate the impact of a tailored pdCPR training intervention on pdCPR performance. The study was conducted in four phases and, using a mixed-method, multiphase design the study developed, implemented and evaluated the impact of a pdCPR training intervention which had been designed and tailored to improve the acquisition and retention of knowledge and skills by ambulance paramedics (AP). The primary outcome measure used in the study was the achievement of a competent rating which reflected the ability of the AP in question to perform high-quality, effective CPR as determined and evaluated by a 26 measure CPR Rapid Evaluation Tool predicated on variables derived from the globally accepted Cardiff list. Each of the 26 measures represented a treatment element within a pdCPR care bundle and which had been shown to contribute to successful resuscitation.
Open Access
Does emergency medicine training improve ECG interpretation skills in South Africa?
(2009) De Jager, J L C; Wallis, Lee
The aim of this study is to assess whether ECG interpretation improves with advancing years of Emergency Medicine training in South Africa, and to compare the results with similar international studies. A prospective cross-sectional study of Emergency Medicine registrars and recently qualified emergency physicians was conducted between August 2008 and February 2009 during training sessions at various universities through South Africa. Subjects completed a survey about level of training and experience, previous ECG training and their impression of the current training program and how it could be improved. They were then asked to interpret 10 clinically important ECGs. The trainees in their first and second years of emergency medicine training were compared to their more senior counterparts (third to fifth years).
Open Access
Effective use of defibrillators in the Emergency Centre
(2009) Louw, Pauline; Wallis, Lee
Includes bibliographical references (leaves 68-73).
Open Access
Emergency care assessment tool for health facilities
(2016) Bae, Crystal; Wallis, Lee; Calvello, Emilie
To date, health facilities in Africa have not had an objective measurement tool for evaluating essential emergency service provision. One major obstacle is the lack of consensus on a standardized evaluation framework, applicable across a variety of resource settings. The African Federation for Emergency Medicine has developed an assessment tool, specifically for low- and middle-income countries, via consensus process that assesses provision of key medical interventions. These interventions are referred to as essential emergency signal functions. A signal function represents the culmination of knowledge of interventions, supplies, and infrastructure capable for the management of an emergent condition. These are evaluated for the six specific clinical syndromes, regardless of aetiology, that occur prior to death: respiratory failure, shock, altered mental status, severe pain, trauma, and maternal health. These clinical syndromes are referred to as sentinel conditions. This study used the items deemed "essential", developed by consensus of 130 experts at the African Federation for Emergency Medicine Consensus Conference 2013, to develop a tool, the Emergency Care Assessment Tool (ECAT), incorporating these using signal functions for the specific emergency sentinel conditions. The tool was administered in a variety of settings to allow for the necessary refinement and context modifications before and after administering in each country. Four countries were chosen: Cameroon, Uganda, Egypt, and Botswana, to represent West/Central, East, North, and Southern Africa respectively. To enhance effectiveness, ECAT was used in varying facility levels with different health care providers in each country. This pilot precedes validation studies and future expansive roll out throughout the region.
Open Access
Emergency care practitioner students’ satisfaction with simulation across two universities in South Africa
(2019) Strachan, Helen; Wallis, Lee
Background Simulation learning is an educational strategy that has been used in South African Emergency Care Practitioner training for at least a decade. No authors had previously measured the satisfaction of South African ECP students with simulation learning. Objective The objectives of this study were to explore the simulation satisfaction of students from two universities in South Africa, and to describe the simulation satisfaction using descriptive statistics. Methods This cross-sectional, descriptive, quantitative study used an English, electronic version of the SSES with one item from the tool deleted. Results A total of 81 students participated in the study - 32 from Nelson Mandela University (NMU) (39.5%) and 49 (60.5%) from the University of Johannesburg (UJ). Statistically significant differences were noted between the two groups in all three factors between the students from NMU and UJ: debriefing and reflection (median = 3.5 vs median = 4.2; p = 0.000; r = 0.5), clinical reasoning (median = 3.6 vs median = 4.0; p=0.002; r = 0.3.) and clinical learning (median = 3.7 vs median = 4.0; p=0.005; r = 0.3). Conclusions Students from both universities have had an overall positive experience of simulation learning, the students from UJ reported higher levels of satisfaction with simulation. These data provide important information for ECP student educators and highlight areas of satisfaction as well as dissatisfaction with simulation learning. This study also indicates that further research is required into the ECP student experiences of simulation learning in South Africa.
Open Access
Emergency medical service response system performance in an urban South African setting: a computer simulation model
(2014) Stein, Christopher Owen Alexander; Wallis, Lee; Adetunji, Olufemi
This study investigated the effects of different response strategies, vehicle location strategies and vehicle numbers on response times in a simulated Emergency Medical Services system. The simulation was a computer model using discrete-event simulation and the model was based on Western Cape Emergency Medical Services operations in Cape Town. The study objectives were to (i) create the simulation model, (ii) determine the best-performing combination of explanatory factors and (iii) determine the effect of increasing vehicle numbers on response time performance. The simulation model took into account incident arrival rates, incident and hospital spatial distributions, vehicle numbers and dispatch practices in the modelled system. Verification and validation of the simulation model utilised a combination of quantitative and qualitative methods. The validated simulation model was changed in two ways: (i) the response strategy was changed to either single or two-tier (the response model factor) and (ii) the vehicle location strategy was changed to either dynamic or static (the vehicle location factor). This yielded four individual models each representing one combination of these factors. Each simulation model was run for a simulated period of seven days. Output data were analysed using multivariate analysis of variance in order to identify differences in response time between the factor combinations. A single-tier model using dynamic vehicle locations produced the best response performance. This model was run repeatedly, increasing vehicle numbers incrementally with each run to assess the effect of increased vehicle numbers on response time performance. A doubling of vehicle numbers resulted in an 14% increase in the number of responses meeting the national performance target for high acuity incidents, while a seven-fold increase in vehicle numbers increased this to 15%. No further performance increases were seen beyond this with increased vehicle numbers. A 2% performance increase for lower acuity incidents was seen with the same increase in vehicle numbers. In the system modelled, increasing vehicle numbers should not be expected to realise anything more than small improvements in response time performance, at a high operational cost. Fine-grained dynamic deployment of vehicles in anticipation of system demand appears to be a more important determinant of response performance than vehicle numbers alone.
Open Access
Epidemiology and outcomes from severe hypoglycemia in Kuwait: a prospective cohort study
(2021-05-29) Al Hasan, Dalal; Yaseen, Ameen; Al Roudan, Mohammad; Wallis, Lee
Abstract Background The objective of this study was to describe the epidemiology of severe hypoglycaemia in Kuwait, aiming to provide a preliminary background to update the current guidelines and improve patient management. Method This was a prospective analysis of severe hypoglycaemia cases retrieved from emergency medical services (EMS) archived data between 1 January and 30 June 2020. The severe hypoglycaemia cases were then sub-grouped based on EMS personal initial management and compared in terms of scene time, transportation rate, complications and outcomes. The primary outcomes were GCS within 10–30 min and normal random blood glucose (RBS) within 10–30 min. Results A total of 167 cases met the inclusion criteria. The incidence of severe hypoglycaemia in the national EMS was 11 per 100,000. Intramuscular glucagon was used on scene in 89% of the hypoglycaemic events. Most of the severe hypoglycaemia patients regained normal GCS on scene (76.5%). When we compared the two scene management strategies for severe hypoglycaemia cases, parenteral glucose administration prolonged the on-scene time (P = .002) but was associated with more favourable scene outcomes than intramuscular glucagon, with normal GCS within 10–30 min (P = .05) and normal RBS within 10–30 min (P = .006). Conclusion: Severe hypoglycaemia is not uncommon during EMS calls. Appropriate management by EMS personals is fruitful, resulting in favourable scene outcomes and reducing the hospital transportation rate. More research should be invested in improving and structuring the prehospital management of severe hypoglycaemia. One goal is to clarify the superiority of parenteral glucose over intramuscular glucagon in the prehospital setting.
Open Access
Evaluation of the World Health Organization’s basic emergency care course and online cases in Uganda
(2019) Friedman, Alexandra; Wallis, Lee; Tenner, Andrea
Background Uganda lacks formal emergency care training programs to address its high burden of acute illness and injury. The Ugandan Ministry of Health (MoH) rolled out the World Health Organization’s (WHO) Basic Emergency Care (BEC) course, the first openaccess short course to provide comprehensive basic emergency training for health workers in low-resource settings. The BEC and its new online cases both require further evaluation. Aim and Objectives The study aimed to assess the BEC course and online cases’ impact with the following objectives: 1. Determine participants’ knowledge acquisition and self-efficacy in emergency care. 2. Evaluate BEC participants’ perceptions of the course and online cases. 3. Assess the online cases’ impact on participants’ knowledge and self-efficacy in emergency care. Methods Mixed methods design explored the BEC’s impact. MCQs and Likert scales assessed knowledge and self-efficacy, respectively, among 137 participants pre-BEC, post-BEC and six-months post-BEC using mixed model analysis of variance (ANOVA). FGDs assessed perceptions of the course and online cases post-BEC and six-months postBEC among 74 participants using thematic content analysis. Results Participants gained and maintained significant increases in MCQ averages and Likert scores. The pre-course cases group scored significantly higher on the pre-test MCQ than controls (p=0.004) and found cases most useful pre-BEC. Nurses experienced more significant initial gains and long-term decays in MCQ and self-rated knowledge than doctors (p=0.009, p< 0.05). Providers valued the ABCDE approach and reported improved emergency care management post-BEC. Resource constraints, untrained colleagues and knowledge decay limited the course’s utility. Conclusions Basic emergency care courses for low-resource settings can increase frontline providers’ long-term knowledge and self-efficacy in emergency care. Nurses experience greater initial gains and long-term losses in knowledge than doctors. Online adjuncts can enhance health professional education in LMICs. Future efforts should focus on increasing trainings and determining the need for re-training.