Browsing by Department "Division of Emergency Medicine"

Now showing 1 - 20 of 170
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    A 12-month retrospective, descriptive study of Hout Bay Volunteer Emergency Medical Service, Cape Town, South Africa
    (2019) Kahle, Jurgen Werner; Cunningham, Charmaine; Fleming, Julian; Hodkinson, Peter
    Background There is a growing need for Emergency Medical Services (EMS) globally and in Africa, as health services develop. The establishment and continued operation of volunteer ambulance services might assist with this need. This study provides a comprehensive overview of the operational activities of a volunteer ambulance service and forms a first step for further studies of this and other volunteer ambulance services. Objectives This study describes and quantifies the operational activities of Hout Bay Volunteer Emergency Medical Service (Hout Bay EMS) a volunteer ambulance service in Cape Town, South Africa for a one year period from 1 January to 31 December 2016. Methods This retrospective study describes call-outs, shifts and service demographics of Hout Bay EMS for 2016, using Provincial EMS dispatch data and shift records from Hout Bay EMS. Performance comparisons are drawn between Hout Bay EMS and Provincial EMS. Outcomes In the study period, there were 682 call-outs involving Hout Bay EMS, a total mission time of 951 hours worked over 119 shifts by 31 active members in 2016. Assault was the leading call-out type (18.40%); 58.24% of call-outs were Priority 2 (less urgent), and 39.30% of call-outs ended in no patient transport. Response times to Priority 1 call-outs were generally shorter for Hout Bay EMS than those of Provincial EMS within the Hout Bay area. Members largely preferred night shift to day shift by a factor of 4:1; the majority of shifts were worked by Basic Life Support (28.57%) and Intermediate Life Support (57.98%) qualified members compared to the relatively few shifts (13.44%) worked by Advanced Life Support members. This study shows that a small volunteer ambulance service mostly active on weekends can successfully complement the efforts of the larger, full-time provincial ambulance service it is dispatched by. This model could be replicated elsewhere to meet the growing need for emergency medical services.
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    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.
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    A critical realist study into the emergence and absence of academic success among Bachelor of Emergency Medical Care students
    (2018) Sobuwa, Simpiwe; Bruijns, Stevan R; Lord, Bill
    This critical realist thesis explores academic success in the four-year Bachelor of Emergency Medical Care degree in South Africa. The Bachelor of Emergency Medical Care degree is a relatively new degree that is offered at four universities in South Africa. In view of the existing shortage of paramedics both in South Africa and on the African continent, an understanding of the factors that play a role in academic success may lead to an increase in the number of emergency care providers. Accordingly, this study was conceptualised to explore the reasons why academic success is either evident or absent among Bachelor of Emergency Medical Care students. The study utilised a sequential, explanatory, mixed methods research design. The quantitative phase consisted of an online survey that was disseminated to Bachelor of Emergency Medical Care students in South Africa with the aim of gaining an insight into their socio-cultural history. Continuous and categorical variables were described using basic descriptive statistics. The Pearson’s chi-square and Fisher’s exact test were used to test associations between the various survey variables and repeating a year. A p-value of less than 0.05 was considered to be statistically significant. During the qualitative phase focus groups were held with students while semi-structured interviews were conducted with lecturing staff members. The aim of the qualitative approach was to explore the causal powers and generative mechanisms that give rise to or enable the emergence or absence of academic success among Bachelor of Emergency Medical Care students. Thematic analysis was used to analyse results from the focus groups and semistructured interviews. A critical realist concept of the laminated system was also used to explore the themes that emerged. A total of 176 participants from an available sample of 408 students responded to the survey. Not repeating a year was significantly associated with two important variables, namely, the possession of a pre-existing emergency care qualification and not being a white student. The results revealed that the following interactive generative mechanisms played a role in the lack of academic success, namely, biological, socioeconomic, socio-cultural, normative, psychosocial and psychological factors while the following interactive generative mechanisms facilitated the emergence of academic success – psychological, psycho-social, normative and socioeconomic factors.
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    A cross-sectional study of ECG patterns and outcomes of patients thrombolysed for ST-elevation myocardial infarction at a district, public Cape Town hospital
    (2018) Kibamba, Crispin Ngoy; Malan, Jacques; Bruijns, Stevan
    Introduction There is insufficient data to describe ST-elevation myocardial infarction (STEMI) in sub-Saharan African settings using common diagnostic criteria. This study describes the outcomes at discharge (survival, death or transferred) of patients thrombolysed for STEMI at a public hospital without primary percutaneous coronary intervention capability as well as associated ECG changes. Materials and methods A retrospective, cross- sectional study was conducted at an urban, public emergency centre in Cape Town, South Africa that did not have direct access to percutaneous coronary intervention for STEMI. Descriptive statistics for age, length of stay and the various timings surrounding thrombolysis were presented using proportions, mean and standard deviation. Assumptions were tested using the X2 - test or Fishers Exact test. A p-value less than 0.05 was considered significant. Results The study enrolled 104 patients of which 25 were excluded for insufficient data and two for thrombolysis of an incorrect STEMI diagnosis. Of the remaining patients, 56 (64%) survived to discharge, 26 (30%) required transfer and five (6%) died. There was no difference between regions affected and patient outcome (p=0.31). Resolution of ST-segments was seen in 48 (86%) survivors. It was not seen in 21 (81%) who were transferred and in none that died. The difference between resolution of ST-segments between survivors versus those transferred or dead was highly significant (p< 0.001). Conclusion This study described a higher than expected thrombolysis failure rate as well as a higher than expected association of poor outcome with inferior STEMI. It highlights the need for improved health care records to improve health research in low-resourced settings. The creation of a STEMI registry could contribute to research but will need funding. The use of clinical messaging apps to gain senior ECG interpretation may provide an additional layer toward quality care.
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    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.
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    A descriptive study of call centre complaints and their management in a Western Cape EMS
    (2020) Spicer, Richard Michael Frank; Hodkinson, Peter; Bester, Beatrix
    Introduction Emergency medical services (EMS) play a vital role in addressing the high burden of disease posed by emergency conditions in low-to-medium income countries and it is vital to ensure that EMS care is of a high quality. Complaints and their management are an important mechanism in addressing individual patient concerns and ensuring accountability to the public. Expanding the role of complaints to effectively affect system-wide quality improvement requires knowledge of trends based on aggregated complaint data. This study aims to describe the volume and nature of complaints received by an urban EMS organisation in the Western Cape. Methodology A retrospective analysis was performed of all non-clinical complaints received for the 2018 calendar year by the call centre of a public EMS in Cape Town, South Africa. All complaint documents were collected and collated with the original case dispatch information. Complaints were categorised according to a standardised complaint coding taxonomy published previously. Complaint investigation outcomes and recommendations were analysed by themes identified during the study. Results A total of 156 complaints were received which referred to 172 patients. Complaints originated primarily from healthcare providers (72%) and patients or public (22%). Inter-facility transfers (73%) generated the most complaints. Encoding of complaint narratives revealed 302 individual service issues, which were classified into taxonomy derived domains (Clinical – 36%; Management – 44%; Relationship – 20%). The “Management” domain highlighted delay issues, accounting for 38% (116/302). Conclusion In this urban EMS, the majority of complaints are related to delays. Complaints were primarily lodged by other healthcare providers. Complaint rates lodged by patients and public are low, and would suggest that a unified and well publicised complaint mechanism is necessary, in order to increase public involvement in service quality improvement. Further research is recommended to validate a taxonomy for EMS complaints specifically.
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    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.
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    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.
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    A retrospective analysis of the circumstantial factors contributing to drowning incidents reported in the South African media
    (2022) de Beer, Willem; Saunders, Colleen
    The first consensus guidelines for the uniform reporting of drowning were published in 2003, and specifically call for the precipitating factor to be described. The aim of this study was to describe the precipitating factors contributing to fatal drowning incidents reported in the South African media between January 2017 and March 2021 through a retrospective analysis of the Lifesaving South Africa media report database. There were 767 fatal drowning incidents reported during this period. Two thirds (66%) of reported incidents occurred during spring and summer, and the majority occurred in coastal provinces. Weekends and public holidays accounted for the highest frequency of reported incidents. Forty percent of reported fatal drowning victims were children under the age of 16 years. Approximately half (48%) of fatal drowning victims were swimming at the time of the incident, 17% drowned following accidental entry into the water and 11% were boating or sailing at the time of the incident. Understanding the activity immediately preceding the drowning event allows for more efficient and context appropriate design of prevention interventions.
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    A retrospective evaluation of the impact of a dedicated Obstetric and Neonatal transport service on transport times within an Urban setting
    (2009) de Vries, Shaheem
    Objective: To determine whether the establishment of a dedicated obstetric and neonatal flying squad resulted in improved performance within the setting of a major metropolitan area. Design and Setting: The Cape Town metropolitan service of the Emergency Medical Services was selected for a retrospective review of the transit times for the newly implemented Flying Squad programme. Data were imported from the Computer Aided Dispatch programme. Dispatch, Response, Mean Transit and Total Pre-hospital times, relating to the obstetric and neonatal incidents was analysed for 2005 and 2008. Results: There was a significant improvement between 2005 and 2008 in all incidents evaluated. Flying Squad dispatch performance improved from 11.7% to 46.6% of all incidents dispatched within 4 minutes (p< 0.0001). Response time performance at the 15- minute threshold did not demonstrate a statistically significant improvement (p=0.4 .. ) although the improvement in the 30-minute performance category was statistically significant in both maternity and neonatal incidents. Maternity incidents displayed the greatest improvement with the 30-minute performance increasing from 30.3 % to 72,9%. The analysis of the mean transit times demonstrated that neonatal transfers displayed the longest status time in all but one of the categories. Even so, the introduction of the Flying Squad programme resulted in a reduction in a total pre-hospital time from 298 minutes to 184 minutes. Conclusion: The introduction of the Flying Squad programme has resulted in significant improvement in the transit times of both neonatal and obstetric incidents. In spite of the severe resource constraints facing developing nations, the model employed offers significant gains.
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    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.
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    Adrenaline and amiodarone dosages in resuscitation: Rectifying misinformation
    (2013) Botha, Martin; Wells, Mike; Dickerson, Roger; Wallis, Lee; Stander, Melanie
    Despite the recognition of specialists in emergency medicine and the professionalisation of prehospital emergency care, international guidelines and consensus are often ignored, and the lag between guideline publication and translation into clinical practice is protracted. South African literature should reflect the latest evidence to guide resuscitation and safe patient care. This article addresses erroneous details regarding life-saving interventions in the South African Medicines Formulary , 10th edition.
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    Adverse event registry analysis of an EMS system in a low resource setting: a descriptive study
    (2018) Geraty, Sian; Bruijns, Stevan; Lamprecht, Hein
    Introduction Out of hospital emergency medical service patients present unique challenges and ample opportunities for medical error to occur. Identifying medical error is important for mitigating future risk and improving patient safety. Hypothesis/problem Our study describes the adverse event registry of an emergency medical service system in a low resource setting over a six-year period. Methods The Western Cape Emergency Medical Services Adverse Event Registry were reviewed for the period 1 January 2010 to 31 December 2015. From these, all cases classified as an adverse event or near miss were extracted for in depth review. Demographics, type of error, and types of recommendations implemented are reported. Results Altogether 106 (69%) adverse events and 47 (31%) near misses were reported over the six-year period. The mean age of patients was 31 years (standard deviation ±24.8). Of these 65 (42%) cases were adult medical patients, 31 (20%) adult trauma patients, 15 (10%) obstetric patients and 42 (27%) paediatric patients. The caseload was observed to increase over the six-year period, whilst system medical errors decreased and individual medical errors increased over the same period. Conclusion In this low resource emergency medical service system, individual medical errors increased and system medical errors decreased as more recommendations derived from adverse events caused by the system errors were implemented. This created a greater need for individual and group training of EMS clinical providers. We recommend further research in order to adequate describe the reason for the increase individual medical error, as well as to find more effective means of detecting adverse events and near misses in this population.
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    Aetiology and outcome of patients burned from 2003 to 2008 at the Tygerberg Hospital burns unit, Western Cape, SA
    (2013) Maritz, David
    Rural to urban migration to major cities in South Africa continues to lead to the proliferation of informal settlements. There is little recent published data on the epidemiology of adult burns in the Western Cape, South Africa. The prediction of outcome in severe burns is important to aid in clinical decision making, improve scarce resource allocation and allow comparisons between different burn units. Age, burn size and the presence of inhalational injury have been determined to be the most important factors in predicting mortality. There is little published data on the outcome of severe burns in the Southern African region. A retrospective review of patients on the Burn Unit database was undertaken, looking at patients admitted to the Burn Unit between January 2003 and December 2008. This study discusses the characteristics and outcome of patients who were treated at the Tygerberg Burn unit. A total of 1908 patients were admitted to the burn unit during the 6 year period under review. Most fatal injuries occurred in the 20 to 40 year age group. Injuries due to shack fires and fuel stoves comprised 21% (399) of all admissions. Mortality due to these injuries comprised 28% (137) of total mortality. Gas stoves accounted for 24% with kerosene stoves accounting for 71% of injuries. The burn death rate in this study (25%) was found to have increased dramatically from the last audit done from 1986 to 1995 in which a burn death rate of 7.5% was observed. Reasons for this are explored. A stepwise logistic regression analysis was done on the derivation cohort where age, gender, TBSA% and presence of inhalational injury were identified as significant for predicting death. A mortality prediction model is presented which was internally validated on the validation cohort. An easy to use EXCEL calculator was created to estimate the probability of death. Shack fires and injuries due to fuel stoves are a common reason for admission to the burn unit and mostly involve young male individuals. Other research from the Southern African region does not mention shack fires as a separate entity making it difficult to obtain an accurate idea of the scale of the problem. Their injuries are severe with a high mortality. The use of kerosene stoves are a major contributing factor. Recommendations include enforceable legislation to promote safer stove design, research into safer bio fuels and materials for building shacks as well promoting fire safety among schoolchildren in the community. Further research is needed to determine the impact of HIV/AIDS on the outcome of acute burn injuries within the Southern African region. Further interventions are needed to tackle this serious public health issue. A mortality prediction model is proposed for use in the burn unit, but needs external validation before being adopted into clinical practice. Further research is needed to improve data capturing in the burn unit.
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    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.
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    An evaluation of emergency field side care following implementation of the BokSmart program for rugby in South Africa
    (2023) Green, Lidia; Saunders, Colleen; Dippenaar Enrico
    Introduction Despite the varied health and social benefits of participating in sports, catastrophic injuries associated with rugby such as those of the spinal cord, brain, and cardiovascular system are rare but can be permanently debilitating or even fatal. To improve injury prevention and surveillance of catastrophic injuries the Chris Burger Petro Jackson Player Fund and South African Rugby Union implemented the BokSmart programme in 2011. The aim of this study is to assess and compare how emergency field side care was affected. Methods This observational and descriptive study collected data from the entire Chris Burger Petro Jackson Player Fund catastrophic injury database (n=147) between 2008 and 2019. The study was divided into three parts to describe and analyse: i) the epidemiology of catastrophic injuries in rugby over time, ii) immediate post-injury management and association with player outcomes, and iii) emergency care personnel levels and association with immediate post- injury management. Comparisons were made throughout between pre- and post- implementation of the BokSmart programme. Results There was a significant decrease in the distribution of catastrophic injuries between pre- and post-implementation of the BokSmart programme. Similarly, there was a significant decrease in the mean number of acute spinal cord injuries per year in the post-implementation period. The incidence of injuries occurring during high-impact scrums also substantially decreased. Post-implementation there was an increase in the proportion of incidents where first on-field medical support were registered medical care professionals. Injured players were also more likely to receive care that adhered to the BokSmart guidelines post-implementation; however, this ultimately made no difference in the outcome of acute spinal cord injuries and saw a decrease in the use of external resources like Spineline. Conclusion There has been a marked decrease in the mean number of catastrophic injuries per year following the implementation of the BokSmart programme, especially the proportion of acute spinal cord injuries following scrum law changes. This indicates that the BokSmart programme had a positive effect on emergency field-side care through decreasing catastrophic injuries from scrums, increasing the proportion of registered medical care professionals providing field-side care, and improved adherence to the BokSmart serious injury protocols. However, despite improved adherence, outcomes from acute spinal cord injuries have not improved. As there is little to no impact on the outcomes of spinal cord injuries due to the nature of the injury, a shift in focus towards prevention of catastrophic injuries and corresponding law changes should occur. The implementation of the BokSmart programme has shown to be effective through its educational programmes, injury surveillance, management, and reporting guidelines, to not only improve and optimise emergency field-side care, but also to reduce the incidence of catastrophic injuries across all levels of play in rugby.
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    An exploratory survey: experiences and perceptions of community members who have accessed pre-hospital Emergency Medical Service in Langa, Cape Town
    (2019) Bam, Zina; Hodkinson, Peter
    Background: Calling an ambulance is the first line for citizens in dealing with many healthcare emergencies. It is crucial for the caller to convey correct information regarding the patient’s emergency and on-scene location to the emergency services, resulting in prompt dispatch of correct emergency resources to the exact location. Although there is a good deal of focus on emergency medicine time parameters and outcomes, little is known about the experiences, perceptions and satisfaction level from those who have accessed pre-hospital Emergency Medical Services. Methods: A telephonic survey was conducted on individuals who had recently called for an ambulance, from the urban township of Langa, Cape Town. Surveys were conducted in the caller’s home language, using a standardized tool for collecting quantitative data around the call process, caller satisfaction, outcomes of the call, and issues experienced. Results: During June 2018, 50 callers completed the survey (69% response rate). Most callers (88%) used a personal mobile phone, and 83% called predominantly for medical problems in the daytime. Callers accessed the service by dialling a variety of emergency phone numbers. Callers were largely satisfied with the call (66%), and there were fewer language mismatches than expected. A need for better communication regarding ambulance status and over the phone medical advice was identified. A substantial number of inconsistencies were reported between callers’ outcomes and those from emergency communication centre which require further analysis. These inconsistencies, pointed into gaps within the emergency communication centre’s collecting and database system Conclusion: The study provided the first insight into pre-hospital emergency caller experiences and perceptions, highlighting important aspects perhaps not revealed through other metrics. Measurement of caller satisfaction can be a useful quality improvement tool, and would seem feasible without substantial resources. Further investigation into data capturing system and identification of call outcomes are recommended.
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    An analysis of health facility preparedness for major incidents in Kampala
    (2016) Kalanzi, Joseph; Smith, Wayne; Wallis, Lee
    Background & Objectives: Major incidents occur commonly in Uganda, but little is known about either local hazards which risk causing major incidents, or health system preparedness for such events. Understanding risk and current preparedness is the first step in improving response. Methods: We undertook a cross - sectional study across four teaching hospitals in Kampala (Mulago National Referral Hospital, Nsambya Hospital, Mengo Hospital and Lubaga Hospital). A local geographic area Hazard Vulnerability Analysis (HVA) f or each site was combined with a key informant questionnaire and standardized facility checklist within the hospitals. Data collected included status of major incident committees, operational major incident plans and facility major incident operation centres, bed capacity, equipment and supplies and staffing. The HVA assessed the human impact, impact on property and on business of the hazards as well as measures for mitigation (preparedness, internal response and external response) in place at the hospitals. Results: Only one of the four hospitals was found to have had an operational major incident plan. The designated coordinator for major incidents across all facilities was mostly a general surgeon; no funds were specifically allocated for planning .All hospitals have procedures for triage, resuscitation, stabilization and treatment. None of the facilities had officially designated a major incident committee. All the facilities had sufficient supplies for daily use but none had specifically stock piled any reserves for major incidents. All hospitals were staffed by at least a medical officer, clinical officers, nurses and a specialist with procedures for mobilizing extra staff s for major incidents. Some staffs had received some emergency care training in courses namely basic life support, advanced trauma life support, primary trauma care and emergency triage and treatment but no team had received training in major incident response. Only one hospital carried out annual simulation exercises. Incidents involving human hazards specifically bomb threats, road crash mass casualty incidents, civil disorder and epidemics posed the highest risk to all four hospitals and yet preparation and response measures were inadequate. Conclusion: Hospitals in Kampala face a wide range of hazards and frequent major incidents but despite this they remain under - prepared to respond. Large gaps were identified in as far as staffing, equipment and infrastructure.
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    An analysis of the clinical practice of emergency medicine in emergency centres in the Western Cape
    (2010) Cohen, Kirsten Lesley
    To determine whether the current South African Emergency Medicine Curriculum is appropriate for the burden of disease seen by registrars in Cape Town Emergency Centres, a cross- sectional retrospective audit of 1283 clinical presentations from three secondary level ECs in Cape Town was done. The type of clinical presentations, investigations done and procedures per- formed were analysed. Basic descriptives are presented. The curriculum did not cover all the clinical conditions, procedures and investigations encountered by EM registrars in Cape Town. There were also multiple categories in the curriculum that were not encountered in EM practice at all. The investigations section correlated particularly poorly with the skills needed for the burden of disease seen in ECs in Cape Town. The curriculum should be redrafted guided by a practice analysis of EM.
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    Assessing spinal movement during four extrication methods: a biomechanical study using healthy volunteers
    (2022-01-15) Nutbeam, Tim; Fenwick, Rob; May, Barbara; Stassen, Willem; Smith, Jason E; Bowdler, Jono; Wallis, Lee; Shippen, James
    Background Motor vehicle collisions are a common cause of death and serious injury. Many casualties will remain in their vehicle following a collision. Trapped patients have more injuries and are more likely to die than their untrapped counterparts. Current extrication methods are time consuming and have a focus on movement minimisation and mitigation. The optimal extrication strategy and the effect this extrication method has on spinal movement is unknown. The aim of this study was to evaluate the movement at the cervical and lumbar spine for four commonly utilised extrication techniques. Methods Biomechanical data was collected using inertial Measurement Units on 6 healthy volunteers. The extrication types examined were: roof removal, b-post rip, rapid removal and self-extrication. Measurements were recorded at the cervical and lumbar spine, and in the anteroposterior (AP) and lateral (LAT) planes. Total movement (travel), maximal movement, mean, standard deviation and confidence intervals are reported for each extrication type. Results Data from a total of 230 extrications were collected for analysis. The smallest maximal and total movement (travel) were seen when the volunteer self-extricated (AP max = 2.6 mm, travel 4.9 mm). The largest maximal movement and travel were seen in rapid extrication extricated (AP max = 6.21 mm, travel 20.51 mm). The differences between self-extrication and all other methods were significant (p < 0.001), small non-significant differences existed between roof removal, b-post rip and rapid removal. Self-extrication was significantly quicker than the other extrication methods (mean 6.4 s). Conclusions In healthy volunteers, self-extrication is associated with the smallest spinal movement and the fastest time to complete extrication. Rapid, B-post rip and roof off extrication types are all associated with similar movements and time to extrication in prepared vehicles.